Why do they call it “morning sickness” when it lasts all day?

No one really knows what causes the nausea of pregnancy, but it affects over half of all pregnant women. It is thought to be related to the high hormone levels of pregnancy, like human chorionic gonadotropin (hcg) and estrogen.  The high progesterone level also relaxes a pregnant woman’s esophagus, so that she is more likely to have reflux and gagging.

Symptoms of nausea may be brought on by hunger or swings in blood sugar. Many notice that their nausea is worse when they are tired. Some moms report that smells may make their nausea worse. Sometimes even a vitamin is a trigger, but the vitamins are needed! There are some women who make extra saliva during pregnancy, and this constant swallowing makes them sicker.

The worst week of morning sickness is usually in the middle of the first trimester. By the second trimester, your body will have some relief.   If you need relief sooner, here are some things to try:

1.       Get lots of rest.   Fatigue can cause nausea even when you are not pregnant. What a great excuse to take a nap!

2.      Try frequent small meals that include some protein or fat.   The old advice of eating crackers may help temporarily, but a little cheese and turkey on the crackers will bring longer relief by keeping blood sugars stable. Sipping on flavored beverages all day long not only improve hydration, which makes you feel better, but may also help those with excess saliva production.

3.      Antacids. Tums contain calcium, and are good for pregnancy. In some cases, the heartburn and gagging is helped by pepcid 20 mg every day.

4.      Antihistamines. Doctors often prescribe antihistamines like phenergan to help with nausea, but benedryl (diphenhydramine) 25 mg as needed every 6 hours may also help.

OR   An older remedy for nausea was to recommend ½ of a unasom tablet (doxylamine 12.5 mg) every 6 hours.  Remember that any antihistamine may cause fatigue, and see step 1!

5.      Vitamin B supplementation.   Some people have less nausea with extra vitamin B6, 50 mg every day.

6.      Ginger. Ginger snap cookies, ginger ale, and candied ginger have all been said to improve nausea, though not well studied.

7.      Prescriptions have improved over the last 10 years. Doctors often recommend Zofran, Kytril, Reglan, Compazine or others to help with the nausea. Of course, all have side effects that should be discussed with a physician.

The extreme form of morning sickness is called hyperemesis. It causes relentless vomiting and can result in dehydration, weight loss, and nutritional deficiencies. While vomiting occasionally is common, hyperemesis occurs in less than 2% of pregnancies. Hyperemesis needs to be treated aggressively with medications and fluids, and should not be ignored.

 

Emily Cunningham, MD

Lexington Women’s Health

 Emily Cunningham 2014

 

The Robotic Surgery Revolution

So what’s all the hype about robotic surgery? If you would have told me ten years ago that I would be spending my days in the operating room with a robot assisting me, I would have thought you were crazy! But it’s true. When the difficult decision is made to undergo hysterectomy, we are often concerned about the amount of time required for recovery. We’re all too busy to be down for surgery! We want the least invasive option that will meet our needs safely.

 Robotic surgery has distinct advantages over traditional surgery requiring a large incision on the abdomen. Robotic surgery is done through small incisions less than one centimeter. It follows that there is less pain with robotic surgery. Robotic surgery is much more precise than other operations and as a result, there is less blood loss. Operations for women with multiple prior surgeries or a very large uterus can be done with robotic technique. If you are facing hysterectomy and are told you are not a candidate for minimally invasive surgery, certainly seek a second opinion! Chances are, you could be home the same day as your operation and back to most normal activities in 2 weeks!

 

Jennifer A. Fuson, MD

Jennifer Fuson 2014 Black and White

 

 

Excessive Menstrual Bleeding

Excessive menstrual bleeding affects millions of women every year. Women who are affected suffer decreased quality of life, reduced productivity in the workplace and the constant threat of inconvenience or embarrassment.  Chronic health conditions such as fatigue and anemia can result from heavy bleeding. Until recently, women were expected to suffer with the bleeding, take hormonal medications or have a traditional hysterectomy with a large abdominal incision. Today’s women are offered many newer options. Women suffering from heavy menstrual flow should talk with their healthcare provider about the options that may be appropriate for them. These generally include:

 

NSAID therapy. Medications such as Motrin®, Advil® or Aleve®, taken three to five days prior to menstruation, may reduce bleeding up to 30%. This treatment requires very regular cycles in order to work well.

 

Hormonal therapy. Hormones either in the form of oral contraceptive pills or cyclic progesterone can induce a regular and lighter flow. This treatment is very effective to induce regular menstrual cycles and may have the added benefit of improving acne and PMS.

 

Hormonal intrauterine system. Mirena® is a device that slowly releases progesterone in the uterine cavity. This dramatically reduces or even eliminates bleeding by keeping the lining very thin and healthy. It is an excellent alternative for people who want to avoid oral hormonal therapy. This requires only a simple office procedure, minimal discomfort and no down time.

 

Global endometrial ablation. Done in the office or operating room, this technique uses thermal energy to destroy the lining of the uterus, resulting in significantly decreased uterine bleeding. 85% of people will see reduced or even absent menstrual flow following ablation.

 

  1. This surgery is now often done on an outpatient basis with tiny incisions using traditional laparoscopic techniques or with the newer da Vinci robotic surgical system. These minimally invasive surgical procedures offer definitive treatment, and patients are able to get back to their lives quicker than ever before and with less pain. No longer are large abdominal incisions,extended hospital stays and long recoveries usually necessary.

Women experiencing excessive menstrual bleeding that affects their ability to enjoy a happy and productive life should speak with their provider about the treatment options that might be right for them. It is no longer necessary to plan family, recreational and work activities around episodes of heavy menstrual bleeding. Newer options available today make it easier than ever to be free from the uncertainty of heavy or irregular menstrual flow. Despite the newer nonsurgical options, hysterectomy is sometimes necessary.  When performed in a minimally invasive way, women can get back to doing the things they enjoy faster than ever before.

Jennifer Fuson, MD Lexington Women’s Health

Elective induced labor not without its risks

Induction of labor refers to stimulating labor to cause contractions before spontaneous natural labor begins. The term elective induction of labor is used when a woman undergoes stimulation of labor without a medical reason for doing so. A medical reason would include conditions that put the health or life of the mother or fetus at risk. Labor inductions are appealing for many reasons. First, they are convenient. The prospect of organizing a birth into an already overbooked family or work schedule can be very tempting. Excitement about meeting the infant, stress, discomfort and even pressure from friends and family are other reasons women may schedule an induction of labor. Although these seem like justifiable reasons to have a baby on a predetermined date, it is important to remember that labor induction is a medical procedure that could have life-threatening risks for both the mother and fetus.

Many methods are used to induce labor. Understanding those methods is an important part of understanding the overall risks involved. The more common methods include rupturing the amniotic membranes surrounding the fetus— often referred to as “breaking water”—and the use of intravenous Oxytocin, a synthetic form of a naturally occurring hormone that is responsible for labor and breastfeeding.

Studies have hown that the risk of Caesarean section can be as much as two-fold higher for women undergoing induction of labor. This is especially true for first-time mothers. Other associated risks include fever, infection, rupture of the
uterus, hemorrhage, blood transfusion and even death in rare instances. Fetuses
may experience stress during the process. Fetal distress is an indication for
Caesarean section.

There are also health care costs associated with induction of labor. Women who undergo labor induction require more medical intervention, more equipment, more medications and usually have longer hospital stays. Because of this, some insurance companies are now refusing to pay for elective labor inductions.

Women considering an induction of labor should discuss it with their doctor or
midwife. The discussion should include reasons induction might be appropriate,
risks, benefits and what procedures will be used to stimulate labor. Women should have a clear understanding of the entire process before proceeding. It is
important to remember that swollen feet and discomfort evident at the end of
pregnancy are only temporary conditions and that the most desired outcome for
any pregnancy is a healthy mother and a healthy baby.
Alisha C. Morgan, CNM

 

 

What you really need for the hospital!

The arrival of your baby is a time of excitement! It’s often a hectic time as well, so it can be difficult to remember to pack everything that you need AND want to bring to the hospital….Remember to pack early.  Some babies arrive early and some fashionably late!

The hospital will give you gowns, disposable underwear, and basic toiletries but the first few days postpartum are a notoriously messy time so you may not want to bring your brand-new lingerie. That’s why I’ve composed… Tanya’s list of

What you really need for the hospital

 

 

  • Nightgown(s) and robe- I say robe because it’s easy to throw on if you’ve got to go the the rest room and a visitor stops by.
  • Slippers
  • Bra/ nursing bra
  • Breast pads
  • Socks (fuzzy warm ones) I froze!
  • Underwear (several pair and not expensive ones)
  • Hair clips, bands, etc
  • Toiletries: toothbrush, toothpaste, hair brush, lip balm, lotion, deodorant, bath gel, shampoo and conditioner (unless you enjoy using the same liquid soap for all of these things)and a small make up bag
  • Comfortable and loose fitting clothing to wear home

 

Items for Baby

The hospital supplies most of the items you need for the baby.  They will have diapers, wipes, and toiletries in your room. Don’t forget to take the nasal bulb home with you-it is the best and you can’t buy one like it anywhere! 

Small diaper bag stocked with….

  • Outfit for pictures/matching      blanket for background
  • Going home outfit for baby
  • Receiving blankets
    • Baby car seat. (Call the Auto Safety Hotline at 1-888-DASH-2-DOT for more information on the safety rating of a particular model.) A car seat is required by law and MUST be properly installed in your car before you go to the hospital.
  • Warm clothing to wear      home/heavy bunting or blanket (if cold weather)
  • Baby socks/Baby hat      (especially for cold weather climates)
  • Burp cloths

Items for Partner/Labor Coach

  • Cell phone or email list of people to contact
  • Cash in case snack machines do not take credit/debit cards
  • Snacks/drinks if you have time to pack them
  • Sleep t shirt/pants if you plan on staying all night
  • Massage rollers, massage oils to relieve back pain due to labor, pillow or anything else you request to get comfortable
  • The object you’ve chosen to use to focus your attention during labor (the “focal point”)
  • Camera/video camera with charged battery and new or empty video card!

Items for Hospital Staff

  • Hospital admissions papers – Please pre-register! You may go online to www.centralbap.com to save you some time
  • Insurance Card(s)

When I was in labor with my first child, everything was going smoothly, we were pushing and I remember Dr. Fuson asked me if I wanted to take my socks off. I said yes.  She sweetly looked at me and said who did your pedicure, dear?  I naively said, Donnie did I can’t reach my toes anymore…she said, well you might want to leave your socks on.  Everyone in the L & D room cracked up and I thought I’m going to kill him.  He had pretty much painted my entire toes.  A 2 year old could have done a better job. I knew I should have taken the time to go to the salon I just didn’t!

I know this sounds corny but I wanted my husband, my Doctor and my Momma there.  Those 3 things meant I could deal with anything (well, that and the epidural!) And I knew that with those people I would have everything I needed.  Establish a good support team-It really does make a difference.  Even if they do a bad job on your pedicure they always come through when it really counts.

I’ll see you next time in the Chat Womb.

Tanya

A little about myself…

Hi I’m Tanya Bolton. I am 36, married to a good guy and have 2 adorable little girls. I work full time (and then some) at Lexington Women’s Health, have a booth at the local peddlers’ mall, help out in Sunday school, cook dinner every night (sometimes it’s fish sticks) and still find time to take snacks to my daughter’s soccer games. I guess I should start out by telling you about myself…  I am originally from a small town, Barbourville, Kentucky.  When I was 18, I moved to Lexington (the big city) to go to college and it was there that my journey began.  My room-mate who was in PA school, hooked me up with a job at a local obgyn practice answering the switch board.  I loved it.  I loved the people, I loved the doctors, I loved feeling like a grown up in a big office.  I loved it so much, I never left.  I have evolved over the years and so has the practice.  In 2007, we opened the brand new practice “Lexington Women’s Health”.  We are an all female practice that has physicians, midwives, nurse practicioners and physician assistants…Not to mention a fabulous staff. I am now one of the managers and I still love my job!  I joke that if I won the lottery I would just volunteer everyday (or at least 3 days a week)…

Lexington Women’s Health is a great place to work because our motto is that we want everyone to be taken care of like you would want your mother, sister or best friend treated. Over the years, many patients have become our friends. When you have such an intimate relationship over the course of a pregnancy, miscarriage, infertility crisis, divorce, surgery, etc you really get to know each other.  I have gone through many of these things myself at LWH as well and the patients have shared my experiences. It is a very busy and lucrative practice but at the heart of it all (Dr’s Fuson and Cunningham) are the same people I came to love when they first started practicing. They are the 2 partners who founded and continue to manage Lexington Women’s Health.  Daily, I see some of the most miraculous events and also some of the most hilarious. We are truly a family-but working together with over 40 women is not always easy. I have always said, “One of these days I’m going to write a book” but for now, I’ll try a blog.  Through the course of this blog, I hope to have many guest bloggers, aka our providers, to talk about things that most people don’t talk about! Also current health news and issues as well as the craziness that comes along with working together with 40 women! I hope you enjoy reading as much as I enjoy sharing.