By April Wallace, nwaMotherlode contributor and local mama
Seeing a little pink plus sign on a pregnancy test leads to so many questions that you may not have time to ask them all by the time your baby (or even your second baby) makes his arrival.
Dr. Christopher Hall, an OBGYN at Mercy Clinic of Obstetrics and Gynecology, recently sat down with me to answer all my unanswered questions. He cleared up the conflicting advice, broached topics that are hard for some mamas to bring up, and even walked me through the weird wonderings I originally had while eating something I craved from the bowl I balanced on my big, pregnant belly. Hall completed his residency at the University of Arkansas for Medical Sciences in June 2017.
There are so many ways to approach getting a balanced diet during pregnancy. Some books and apps stress the importance of vegetables and fruits to an extreme, where I wonder if anyone can meet the supposed amount of servings needed. But a nurse told me that protein servings are more important than getting 12 servings of produce. What’s best? Are there any myths about eating while pregnant that you would like to dispel?
One myth is that you’re eating for two people. You’re not. I see so many young women whose mothers or grandmothers urge them to eat more and they ask me, “How can I eat for two while I have morning sickness? I can barely keep anything down.” If there’s anything we’ve learned, it’s important to have appropriate weight gain. For a healthy person that’s 25-35 pounds. If you’re overweight, we might taper that back a bit.
Overall, you just want to keep it well balanced. Say yes to veggies and fruits, but you need fiber and vitamins, too. If you take a prenatal vitamin, that will supplement good nutritional choices. But you do need protein. The main thing is to be conscientious and keep it healthy. We’re learning more about (the impact of a pregnant mother’s dietary choices) each day. Dietary choices during pregnancy set that child’s metabolism up for life. If, for instance, a mother gains an extraordinary amount of weight during pregnancy the baby is at risk for diabetes, obesity, and other medical issues later in life.
Natural birth seems to have made a comeback. It’s a trendy thing, but the c-section rate in our country is pretty high, so clearly not everyone who sets out for natural childbirth gets to follow through. What do you tell a patient who is interested in going the natural route? How do you suggest being prepared for childbirth?
The biggest thing I advocate for patients is that the important thing is to deliver in a safe environment where we can intervene for mom or baby’s benefit if we need to — unlike if they chose a home birth. It’s well studied that if the mother goes into labor naturally, she has the best chances of vaginal delivery without c-section. That doesn’t mean we need to do it in an unsafe environment. Even if a patient is in the hospital, she still has a lot of choices regarding labor and intervention. We’ll monitor baby to make sure he’s OK. We’ll monitor labor to make sure it progresses normally. I also explain that there are some good reasons for c-sections. In some cases, an epidural is especially beneficial because it helps them relax enough so labor can progress.
What other resources are available for expectant mothers?
Mercy.net has hours worth of videos about pregnancy care, delivery, pain control, breastfeeding, baby care and instructions for baby CPR. They’re all free and online, including checklists for your hospital bag and a sample birth plan. Mercy does have birthing and baby classes. They are a four or five-week course, with each class being an hour long in the evening, for about $65-80. They’re taught by our labor and delivery nurses and lactation specialists.
If a patient were going to read only one book during pregnancy, what would you recommend it be?
If you’re going to read just one, I’d go with “Moms On Call: Basic Baby Care for 0-6 Months” by Laura Hunter and Jennifer Walker. It is not medical advice, but it is written by two pediatric nurses. It’s more for after delivery, but it is easy to read and provides basic information about caring for a newborn which is so helpful for first time parents.
This book gave my wife and I some sanity because it helped us get our now nearly two year old on a schedule. The book provides helpful tips for feeding, sleep, and getting baby in a routine so that baby, Mom, and Dad can all get the rest they need.”
Many women are on antidepressants or anti-anxiety medications and others may take medication to relieve chronic pain. We know that many medications are not recommended during pregnancy. What does current research say about the use of medical marijuana and/or CBD? What alternative routes are available for pain relief and managing depression?
We provide a list of widely acceptable medications during pregnancy to our patients at Mercy. For general aches and pains, like a swollen knee or a sprained ankle, we recommend Tylenol because medications like Advil or Aleve can cause some issues for the baby. For persistent or chronic pain symptoms, I usually recommend working with physical therapy or a chiropractor who specializes in women’s health.
Fortunately, there are some antidepressants we have studied enough to know they are pretty safe. Some medications, like Zoloft, Prozac, Celexa and Wellbutrin, are considered to be safe even in the first trimester and while breastfeeding. By the time patients see me for their first prenatal visit, many have already stopped their depression or anxiety medications due to fear of causing harm to the baby. I encourage counseling first of all; it has been well documented that medication with counseling is better than just medication alone. However, counseling is not always an option due to financial or time constraints.
There’s no medical evidence supporting the use of CBD and medical marijuana in pregnancy, and the available body of evidence shows that marijuana use during pregnancy and breastfeeding may be negatively associated with neurologic development in the womb and during early childhood. If there is any concern of maternal marijuana use during pregnancy, most medical centers have a pediatrics policy to obtain drug screening samples from the baby and report these results to the appropriate authorities, such as DHS.
Speaking of the chiropractor, we’re often told that it never hurts to go while we’re pregnant, BUT does it have any actual benefits for labor and delivery?
In extreme cases, yes, for those people who have some chronic back pain issues or those who have had major back injuries. If that pain is more significant, whether or not you opt for an epidural, the labor and delivery is tougher because pain is manifesting in the back or abdomen already. In those cases, there’s not as much strength in a woman’s core at the time of delivery, so maneuvering and positioning is going to be harder for her. I wouldn’t recommend it for every person, but it may be helpful for some individuals. Physical therapy is also a great option for women dealing with pain in their pelvis, low back, or hips during pregnancy.
How helpful is a patient’s birth plan to you, the doctor?
A birth plan is helpful for me because it starts an in-depth, productive conversation. I can better understand their expectations and what their ideal scenario looks like. It gets us to ask, “What if something happens?” “This may not be safe to do and here’s why.” It takes a little stress of the unknown out of the picture. I usually talk to families about forming a birth plan once you hit third trimester.
Some women are advised to not push during birth when they need to and instead told to wait for a doctor to return, sometimes for periods of time that feel incredibly long while in labor (say a half-hour or longer). Can you explain what the reasoning might be? I’m wondering if this is typically a hospital’s policy or a physician’s individual choice or preference.
Sometimes a mother begins to feel a strong sensation to push before her cervix is completely dilated. If that’s the case, we may encourage her to wait until her cervix is completely dilated in order to prevent tearing the cervix and causing extensive blood loss. My recommendation is to always have an obstetrician present for delivery because that is the safest environment. At Mercy, there is always one of our OB/GYNs at the hospital 24 hours a day.
I understand that a mother undergoing stress affects her unborn baby, but what happens to baby if she’s startled (for instance if she’s nearly in a traffic accident). Does that act as stress on the baby, too?
If it’s a short term stress like that, there’s probably no significant consequence. If you were in a situation where it triggers your fight or flight response, your adrenaline would be released, which can cross the placenta and cause a short-term rise in the baby’s heart rate. But it would not send the baby into fetal distress or something like that.
We wonder about how significant stress from life in general affects baby. Chronic stress, which is constant or long term, can case elevations of corticosteroids and could theoretically predispose the mother to having gestational diabetes.
Is it possible for a baby to have food allergies in the womb since they’re being nourished by what mother eats and tasting the flavors of food through the amniotic fluid?
In order to have an allergy, your body must have IgE antibodies which trigger an anaphylactic response, and a baby’s immune system simply isn’t mature enough in the womb to make these. We recommend mothers get the Tdap and Flu shots to stimulate their immune system to produce IgG antibodies which can cross the placenta and will provide the baby with some immunity for 3-6 months after delivery. For the same reason, we recommend moms breastfeed for at least 6 months to give their babies beneficial antibodies.
Where do our cravings come from or why do our bodies have them, do we know?
No, we are not sure about cravings—where they come from or whether they serve a purpose. From a simplistic thought process, they may be somehow linked to high estrogen and progesterone levels.
How do we know that babies dream in utero?
We’ve done studies to observe a healthy baby’s heart rate in the womb and it fluctuates in the same way ours do while we dream.
Plenty of us have apps that tell us a little about our baby and his development, but it’s usually after the fact when I realize that until that point the baby’s eyes weren’t in the right place or his eyes and hair were entirely white or his skin was still wrinkly or see through. Would we be surprised to see what our babies actually look like at various stages in the womb?
It probably depends on your background, whether you’re in science or not. After getting into the second trimester, the fetus begins to look more like a baby.
When a mother gives birth to a new child while still breastfeeding her older child (tandem breastfeeding), does her body make full breastmilk (as it has for the toddler up until this point) on day one? Or does it reset in a sense and make colostrum, and then breastmilk later that is tailored for the new baby?
As far as I know, the breastmilk changes some, but you don’t start making colostrum again. It does change a little bit in makeup, such as having a higher fat content.
Are there any long-term consequences of an IUGR (intrauterine growth restriction) diagnosis, where a mother’s baby is smaller than the 10th percentile while still in the womb?
About 50 percent of the time, IUGR is constitution, meaning that the baby is just meant to be small. However when severe IUGR is present, this is often associated with delivering prematurely. Sometimes, IUGR and premature birth are linked with secondary issues such as physical and mental developmental delays. Physical, speech, and occupational therapy are often times very beneficial for children with developmental delays.
What are some things you might experience during pregnancy that surprisingly still fall under the category of a “normal pregnancy”?
Increased vaginal discharge is very common and normal, but is often times surprising and concerning for first-time moms. Signs of an abnormality include vaginal itching or a fishy odor.
A lot of first time moms are also surprised by colostrum production before delivery. That can start as early as the second trimester. This is just mom’s body getting ready to support the new baby.
Are there any shooting pains that would be normal during pregnancy, such as when you roll over in bed in the middle of night or when you stand up too quickly?
It is normal for women to experience sharp, shooting pains during pregnancy. They are associated with pinched nerves, and symptoms are usually worse in the later part of the 3rd trimester.
Why is it that we don’t lose our hair at a normal rate during pregnancy? All I’ve heard is that it has to do with our changing hormones, but it can be a little alarming in the postpartum stage seeing all that hair loss months after baby arrives.
Patient-perceived hair loss is worse in the postpartum period because the life-cycle of a woman’s hair follicles tend to align during pregnancy and the postpartum period, so a postpartum mother tends to lose more of her hair at the same time.
Are there any situations in which a father may not be allowed to be present for a c-section?
Typically, we do not have the patient’s husband or significant other present in the operating room when it’s an emergency c-section or if the mother needs to be placed under general anesthesia.
In my first pregnancy experience, I feel like prenatal care was 99.5 percent of what I got from my medical provider and postpartum knowledge and care was less than 0.5 percent of it. I know for sure now that I needed more help postpartum. Is postpartum care changing much to help women recover from their pregnancies and childbirth?
I’ve seen that transition happening during my time in practice. We talk about postpartum care before they leave the hospital: perineal care, c-section precautions, etc. My nurse touches base a few weeks after birth to make sure the mother is recovering well.
We don’t want postpartum moms to come in for a checkup two weeks after birth if they’re doing well because it’s a stressful time with sleep deprivation and arranging childcare for the appointment. But there’s increasing awareness of the importance of it.
Monitoring for postpartum depression is a big part of this process for us. Even today it has some stigma. If you struggle with it, you may feel that you’re failing as a mom or you’re a crazy person or whatever. Social media has done a lot to show that it’s a condition a lot of people struggle with.
How do you treat postpartum depression?
With awareness and screening. If you’ve experienced it once, you’re likely to again. Or if you’ve had anxiety in the past, you’re more likely to have it. Anyone discharged from Mercy gets a PPD screening before they leave the hospital.
The people I worry about are those who get so depressed that they don’t want to ask for help. Ask a family member to make a phone call. It starts with counseling and working out how we can do it (based on insurance), how soon, and are we breastfeeding or not. If not, we go with medical therapy right away. If the mom is breastfeeding, several medications are generally safe with nursing. Depending on how the conversation goes and how mom is doing, I recommend medication and therapy.
How did your wife’s pregnancy change your view of your work, or of the prenatal experience?
My wife experienced mastitis, so now I’m more mindful to prepare my patients for the signs and symptoms, and I encourage them not to wait — call me. In general, being on the other side of things showed me how I can be a better doctor. It showed me just how much this is truly a family experience, not just for the mom and baby. If there’s a situation where there might be an emergency, my focus is obviously on the mom and baby. But, I also make sure to help the family get through things.
Were you given any special privileges in the delivery room given your specialty?
I got to be just a dad that day. I was able to be there for my wife. I did the cord cutting and that was it. In fact I was so nervous, I almost did it in the wrong spot! 🙂
Our thanks to Dr. Chris Hall, OBGYN, of Mercy Clinic of Obstetrics and Gynecology for his time and expertise! To schedule an appointment with Dr. Hall, call the Mercy Clinic at (479) 321-3851. Click here for directions on how to get to the clinic, located at 3333 Pinnacle Hills Parkway, Suite 600, in Rogers, Ark.