Wednesday, January 19, 2011
Thursday, January 13, 2011
Monday, January 10, 2011
I recently read an advice column in the news paper concerning how to tell people you are pregnant. The writer was concerned with how to give the good news to a friend who had been struggling with infertility. I was struck by the thoughtfulness of the writer to be so considerate as to realize the mixed emotions that are processed by those wanting children when they hear that someone near them is expecting. The advisor (I think it was Dear Abby, but I can’t specifically remember) recommended to tell the person in private or consider writing a note to inform them, giving them permission to process the news however they needed to emotionally, before they have to see you. I thought this was really good advice.
I remember during my adoption journey, that it didn’t bother me when close friends got pregnant or adopted, but sometimes when I would hear the ‘good news’ from acquaintances it would sometimes upset me, I’m embarrassed to say. I’m not exactly sure why. I guess if it was someone I knew, then I could identify with their journey, but it was harder to process when I didn’t know the entire story. For some strange reason it would also bother me when TV characters had babies. I remember one specific Blue’s Clues I was watching with Ryan. Mr. Salt and Mrs. Pepper were having another baby. Umm, really! Couldn’t they just be happy with a baby Paprika! But NO, here comes cute little baby Cinnamon. It’s funny now, but it really ruined my day.
On a related note I will often get asked by patients when is it safe to tell people that they are pregnant. Especially those that have previously struggled with infertility, I get the sense sometimes, that they feel that if the doctor tells them it’s OK to spread the word then nothing can happen. Each person’s situation is different. I can give them the statistics for their pregnancy, but deciding how and when to tell the good news is a personal decision. Some patient post their pregnancy test on twitter as soon as it comes back with a double line, others anxiously await the second trimester to feel safe to speak a word.
Some reassuring numbers for those waiting to tell:
In a healthy women less than 32 years old with no history of previous miscarriage the chances of having a miscarriage drop to 3% after a heart beat is seen at 7 weeks. This number drops to less than .5% after entering the second trimester. The risk of miscarriage does increase with age >35, smoking, medical condition and history of previous miscarriages. Even with these risk factors, though, the chance of loss decreases with each advancing week. So if you are looking for a ‘safe point’ to tell, after seeing a heart beat is a reassuring time. If you want an even ‘safer’ point, then second trimester is better. Really, the best time to tell, is when you feel it’s the right time to tell.
I get to hear from my patients some cute stories of ‘how’ they spread the news to their family; like framing their ultrasound picture to be opened at holidays, making a video featuring the news or having the good news written on cake. However you tell have fun with it, but be sensitive to those who may have a difficult time with hearing it.
I’d love to hear some feedback on ways you have told people about your pregnancy and also from our readers who have struggled with infertility on how they think is the best way to ‘break the good news’.
Wednesday, December 29, 2010
After only a few weeks of pregnancy, I was struck by nausea. Constant nausea. There was no "morning sickness" just an all day lingering 'blah'. I didn't vomit very much, though most days I wished I would, so that maybe I might feel a little better. Eating seemed to help the nausea, especially carbs. Shakes (from Swensons were the best) would often soothe my upset stomach, though they most likely contributed to my stretch marks. I don't remember any food aversions I had, though patients often tell me theirs and they are very common at this point in pregnancy.
My two main cravings throughout my pregnancy were apples and Dr. Pepper. I would eat at least two sometimes up to five apples a day. It was during pregnancy that I discovered honeycrisp apples which are perhaps the most delightful of all apples. I would be almost giddy with anticipation as I pulled a fresh honeycrisp out of the fridge and took a huge bite. The sweet crispiness would hit my tongue, while the juices ran down my chin. Then I would be faced with a conundrum: do I take another bite first or do I pause to wipe off the juices? Usually the next bite won the contest, as I attacked the apple much like lions attack antelopes on the Discovery channel.
My rare treat was Dr.Pepper, BUT it had to be in a can and REALLY cold. The best were Dr Peppers that had been in a cooler with the ice half melted so that they were floating in the freezing water. SO cold that it would give a slight chill as it ran down my throat helping, if only for a moment, for me to forget about my heart burn and focus on the sweet, fizzy, cold, wonderfulness that is Dr. Pepper in a can.
What do these crazy cravings mean? Despite being a common symptom of pregnancy there is not a lot of data on pregnancy craving. The first trimester is a pivotal point in pregnancy, where all the tiny organs are forming. This is a key time to avoid chemical/ foods that might cause harm to the baby, leading to malformations. It's thought that this is why God made that first trimester to have the aversions and nausea, to avoid foods and chemical that might be harmful. Its also important to take your prenatal vitamin daily, as the folic acid gives the spine its building blocks to help it form properly, preventing spina bifida. Carbs, which are a common craving, are one of the easiest foods to digest, full of energy, safe for the baby and can help ease the nausea.
The key with first trimester eating, especially if you are fighting nausea, is to eat small meals through out the day. The baby doesn't need a large amount of calories at this point, so you don't need to eat an increased amount of food, but do try to eat small amount of heathly carbs and protein throughout the day: Whole grain bagels, whole grain pasta, applesauce, bananas, rice, toast ect.
If you feel you are eating too much, gaining too much weight or constantly hungry then focus on trying to slow down the speed of your eating: spend 20 minutes eating a bagel.
What if I'm having weird cravings? Some people will crave things that aren't food, such as dirt, laundry soap, baby powder, ice or paint. This can be a sign of anemia or a vitamin deficiency. If you find that you are eating or craving non-food items please tell your doctor immediately.
Will my baby like the things I crave during pregnancy? I often get asked this question, but medically we don't know. In my own experience my son does LOVE apples, one the few foods he likes (that's a whole OTHER post!).
If you have healthy cravings, like fruits and vegetables, then go with it! If you have non-healthy cravings (IE, REALLY cold Dr Pepper in a can) then give in to those once or twice a week, not once or twice a day! If you have non-food craving notify your doctor.
Friday, December 17, 2010
I'm hungry all the time but not much sounds good to me. I am blessed in that I don't suffer from extreme nausea or vomiting during my first trimester. Just a touch of queasiness from time to time. But I have lots of food aversions and honestly, they seem to come and go. One minute chicken sounds good, the next anything related to my feathered friends makes me want to puke. It makes it very challenging to eat healthy during these early stages of pregnancy.
My hope is that after I share my pregnant point of view on this symptom, Dr. Rupe will chime in with another entry that gives the facts and some good, doctorly advice on how to handle this early pregnancy dilemma.
Preparation is perhaps the most important action you can take when trying to eat healthy in your first trimester (and throughout your entire pregnancy for that matter). Since I know that chicken is hit or miss for me right now, I have to be ready with other options. What does sound good? Make a list of foods you have not been averse to and make sure you keep them around. Any kind of meat is tough for most women I talk to in their first trimester. What other forms of protein can you stomach at this stage?
I don't hear much that fruits and vegetables bother women in pregnancy so focusing on those things is a good idea. I've eaten a lot of salads (the tangy vinegar helps the queasiness) along with citrus fruits (sour is great for nausea). When all else fails look to whole grains. Toast and whole wheat pasta are mild and will give you the carbs you need for energy. Try to find some form of protein to add to it though. Cheese is a good idea. Lastly, make sure you drink lots of water to keep you from dehydrating. Water is also just a great cleansing agent. It almost resets my system to drink a tall glass of cold water. Chicken might sound yucky but after downing 8 oz of agua, it might not be so bad.
We'd love to hear your pregnancy menu secrets. What worked for you?
Sunday, December 12, 2010
1.Carson waking up:
When Carson wakes up from his nap, first he starts jabbering. Then, when I walk in the room to 'rescue' him from his crib, he gets so excited that he stands up, holds onto the crib rail and bounces up and down. He giggles with his whole body, reaches up and says mom-ma. A heart melter for sure.
2.Russ telling a joke:
So, we're driving along and the Pink song, "Get the Party Started" begins playing on the radio. Russ says in the most deadpan voice, "Oh. its my theme song." It takes knowing Russ for many years to appreciate the irony of this snarky comment, but I laughed so hard my eyes started to water. In that moment I was reminded how much he is and how much I love him. Even after 17 years together, just sitting beside him laughing at silly inside jokes, is often one of my happiest moments of the day.
I find joy in delivering babies, EVEN the 2 a.m. deliveries., but twins are even more special. Twice the fun I guess. There's the challenge of getting the second twin out as safely as the first, combined with all the extra energy in the room and just the fact that its not an every day occurrence I guess. Whatever reason, I love it.
4.Seeing a heart beat:
A patient's first pregnancy visit often has a slight air of tension in the room. Especially when their is a history of loss or infertility, you can tell the patient is only concerned about one thing: seeing that flicker of a heart beat on the ultrasound. This week I was able to show that flicker to two patients who had waited a long time to see it, and then see the sense of relief wash across their faces was a true moment of comfort and joy.
5.Ryan (age 6) quote:
"Mom I'm glad we're mammals and not reptiles, because I like living with you and dad, and reptiles abandon their young." sweetness.
6.Anticipation of Christmas day:
I will get to spend Christmas day with my whole family this year. We will all be together for the first time in a long time and that will be awesome.
7.The knowledge that our book is actually being printed at this moment!
Merry Christmas to you all. May your holiday season be full of joy and all your travels be safe. I hope this will inspire you to take a few minutes to really count your blessing and think on the things that truly give you joy.
I will be the first to admit that I was having trouble getting in the Christmas spirit this year. When I saw Jessica's post about Christmas traditions I was a little intimidated. Every year Christmas looks a little different to us, some years I'm on call, spending the day at the hospital, other years we travel to Tulsa. I sat there wracking my brain... what can I write about? When am I going to have time to write? We don't do anything extra special at our house, just the 'normal Christmas stuff': cut down the tree, decorate it, make cookies, etc. However, slowly over the past few weeks as our family has gone through our Christmas routine my Christmas spirit has started to grow.
We usually cut down our own tree, but with the baby toddling everywhere we elected to put up a fake tree upstairs where he couldn't get into it. I'm partially to blame for this for this initial "Scrooge-ness". I am a hard-core real tree fan, the smell can't be imitated. I also realized that keeping a 1 year old out of the tree was going to be quite challenging, so I caved and went for the fake one this year.
When we set up our tree, Ryan helped me decorate it. This was so much fun. He is six now and our tree is full of decorations that he has made in various art classes over the years. He was so proud of his past ornaments and I began to tell him the stories behind many of our other ornaments. One of our holiday traditions is to pick an ornament each year that embodies something special about that year. As we went through the box of ornaments it was like a trip through time.
There was the baseball ornament with chief wahoo on it (Go Tribe!) from the years we lived in Akron. The skiing Santa from the year we went skiing for Christmas. There's an ornament from Puerto Rico which was our 'Cruising Christmas' (one of my favorites).
At the bottom of the box was my favorite ornament of all: The pregnant snowman (snow woman?). This was the Christmas of 2004, when I was 8 months pregnant with Ryan. My eyes brimmed with tears as I told Ran about this ornament, what an exciting Christmas this was for us as we patiently awaited his birth. He got so tickled as I told him about how we didn't know if he was a boy or girl and how much we loved him even before we saw him or knew him. I recounted the story of his birth, how he decided to come a few days early, even though all his grandparents had already bought their plane tickets. How much he meant to us.
He and I finished with the tree. He sat on my lap and rested his head on my shoulder. "Mom, the tree is so beautiful".
"Yes, honey it is."
I thought about my family, how much they mean to me. I wondered how many more Christmases until he was too big (or thought he was too big) to sit on my lap. I enjoyed every minute of it.
Then I unpacked the stockings. Carson's "faith" stocking was on top. We bought his stocking blank, many years before God brought him to our family. The same joy I felt last year when I hung it for the first time was rekindled in my heart.
Though our traditions are not overly unique, they are ours. Even though our Christmas 'days' often look different each year, we embraced the traditions leading up to it, realizing that family is the most important tradition of all.