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Multimedia podcast: Pregnancy 101 - preconception counseling
Melissa Stoffel, D.O. joined Marshfield Clinic Weston Center’s medical staff in 2006. As an obstetrician/gynecologist, Dr. Stoffel provides a full range of medical care for women, including well-women’s examinations, low and high risk prenatal care, ultrasound and colposcopy, management of infertility, loss of bowel and bladder support, menopause and hormone replacement therapy, and evaluation of menstrual irregularities and pelvic pain.
• Dr. Stoffel sees patients at Marshfield Clinic Wausau and Weston Centers
• For appointments, call 715-847-3284 |
In this multimedia presentation Dr. Melissa Stoffel, D.O. provides valuable insight on preconception counseling, the practice of getting a woman as healthy as they can be prior to pregnancy, and describes what women should expect during pregnancy.
Stoffel describes what to expect from preconception counseling, how to prepare for counseling sessions and how she manages special conditions like asthma management, diabetes management, smoking cessation and heart conditions before a pregnancy.
Listen to Dr. Stoffel answer questions about pregnancy and preconception counseling from the audience
The presentation was followed by a vibrant and candid question and answer session that covered a wide range of pregnancy topics including;
How long after miscarriage should I wait before trying to get pregnant again?
2:02
Miscarriages are quite common and I hear this everyday in the office from someone. Usually they start talking about it and the majority of their acquaintances say, “oh yeah I know someone, happened to them”.
Once a miscarriage does occur, usually, I talk to my patients to say you need to heal physically, emotionally, spiritually and mentally. And when you feel like you are ready to try to acheive pregnancy again, that is when you as a couple should decide to do that.
I usually tell them three months, and what’s the magic number? Why is it three months? Has there been a study after study proving that after three months everybody is healed and ready to go? Absolutely not. You need to take some time to heal. There is a grieving process, that’s normal; you may not be ready to achieve pregnancy again for a whole year after that. But once you and your partner feel like you are ready to achieve pregnancy again, that’s what you should do.
Once a miscarriage happens, it might take a while for your menstrual cycle to resume, so you may need to wait for your body to continue having cycles so you can prepare and try for pregnancy as well. Some women never get a cycle and end up pregnant again. So depending on that special magical time; there really is none.
After a miscarriage happens, 90% of pregnancies after that are perfectly fine, go to term, are normal. So one a miscarriage does occur, does your risk increase for miscarriage? No.
If you miscarriage time and time again, when do we consider that more of a problem, or someone we call a habitual aborter? That would be after three miscarriages where more lab studies would be done to look why this is happening. Before that, studies have shown that what we look for is not very beneficial; we don’t come up with anything.
Are there any cosmetics or body lotions that should be avoided if I’m trying to get pregnant?
1:23
As far as any lotions for the body, to avoid, there’s not much. You usually can use any medication that you’ve already had. Where you are talking something more for eczema or psoriasis, some of those medications we would change to something safer. But normal cosmetics, facial soaps, things like that, those don’t need to be avoided.
Tylenol is fine to take with pregnancy. Tylenol and Sudafed are pretty safe to take during pregnancy. Cold preparations are usually safe. Benadryl is safe to take as well. Anytime there would be a question, make sure you call and ask someone before you take it, and we get those questions a lot. “What can I take for this?” “Can I take this for this?”
If you would come through our office we do have what is known as a nurse educator. Her name is Cindy, and she sits down with you before every pregnancy and kind of goes over; what to expect, some testing with pregnancy, how the appointments will go, things to avoid, things that are safe.
But anytime there are questions about medications or lotions or even anything like that, feel free to call. But the majority of times those are perfectly safe to take and use.
When in the menstrual cycle would I most likely get pregnant?
1:23
The normal, and that definition doesn’t exist, the normal cycle is suppose to be twenty-eight days. And ovulation should occur right at day fourteen. Day one would start any day you have bleeding vaginally. Whether it would be one brown spot one huge flood, anything that comes out of the vagina that looks like blood, discharge, thicker discharge, heavy discharge would be day one for you. And everything is based off of day one.
So day one is important, and usually ovulation would occur on day fourteen. If you have a longer cycle, a forty day cycle, you are looking at day twenty. If you have a shorter cycle you are looking at day twelve, day eleven.
Signs that show you are ovulating. Some women may have regular periods but they don’t actually ovulate an egg. Signs of ovulation:
- breast tenderness
- bloating
- irritability and moodiness
- temperature increase
- cervical or vaginal mucus gets thicker
- the position of the cervix changes
So if you are really trying to pinpoint when I should have intercourse to achieve pregnancy, some easy ways to do that are on day one start taking your temperature the first time you get out of bed. Before you even get out of bed, preferably after eight hours of sleep you take your temperature. You start marking your temperatures, if you see a rise of 0.5 degrees in your temperature, usually that will signal ovulation.
You may notice your breasts are tender, you may be getting some bloating; you may notice your mucus changes. That would be a good time to time intercourse.
Other things that can help are; there are ovulation predictor kits that you can buy in the store and you would start doing those preferably on day eleven, eleven through seventeen of your cycle. Once you hit positive on your ovulation predictor kit that is when you would want to time intercourse as well.
Regardless of when you ovulate, you still want to continue taking your temperature. If your temperature continues to stay up, that usually signifies pregnancy. As soon as your temperature starts to drop, you are probably looking at having a cycle relatively soon soon. If you have 28, 29 day cycles, if by day 30 you do not have your period you should take a pregnancy test. If you are one that is 40 days, probably wait till day 45 to take a pregnancy test. Within about six days of your missed period you will probably have a positive test.
How long after a person stops taking oral contraception do recommend waiting before trying to get pregnant?
2:11
The misconception is “Oh I’ve been on the pill for ten years and I will probably have a hard time getting pregnant.” I have some patients come straight off of the pill, never have their period and are pregnant. For others, it might take six months, eight months to actually get regular cycles.
My recommendation would be to probably six months before you consider actively try for pregnancy to go off of your birth control pill. Prevent pregnancies some other way and see what your cycles are going to do. Start tracking the days between your cycles and your temperatures, things like that.
Some women are very, very regular when the come off the pill, others its takes a while. Depo Provera is another big one. If you have been on Depo for a while, coming off of Depo, you may wait a year to get regular periods. You may even wait up to a year to get a period. If that is you, and you haven’t had a period in some time and you do want to get pregnant, you need to call and make an appointment to be seen. There are ways we can help start your periods faster.
If you have Polycystic Ovarian Syndrome, get irregular periods, there are ways to help you ovulate. What happens in Polycystic Ovarian Syndrome is women may get a period every 3 months, every 6 months, sometimes every month, but they are not always ovulating. So even if they have a period, they think they are having regular cycles, they are not ovulating an egg so the chances of pregnancy are zero obviously since they aren’t ovulating an egg.
So those women, there are medications called Ovulation Induction Agents that will help make you ovulate, so we know you do ovulate. There’s not one test we have to do for you just take a pill on a certain day of your cycle, take your temperature, do your ovulation predictor kit. A majority of women who have Polycystic Ovarian Syndrome can get pregnant and have babies. So that is another misconception.
Endometriosis. I was told I could never get pregnant. That is a misconception as well. Endometriosis can cause infertility, but women with endometriosis have babies every day.
Do women who have had abnormal pap smears and a colposcopy have problems getting pregnant or delivering a baby?
2:16
Those women don’t necessarily have a harder chance of getting pregnant. They are able to carry pregnancies to term.
What can happen is after a colposcopy, we use pap smears to screen women for cervical cancer and HPV that causes cervical cancer. And when a pap smear comes back abnormal, we look for that virus.
A colposcopy is something that is a fancy name for looking at the cervix with a microscope. And sometimes when disease is present, we physically have to remove part of the cervix, not removing the cervix. You will still have a cervix but we will need to remove part of that cervix. And what happens after that procedure is done, that heals and becomes a scar. And normally the cervix is supposed to be open and when you ovulate, your cervix will open a little bit to help the transport of sperm. So if the cervix is scarred, what can happen is that sperm could have a hard time getting where it needs to go.
Or with pregnancy when part of your cervix is removed, there is a misconception that that cervix is not going to do its job, its not going to hold the pregnancy. Or with labor, that scar is not going to get broken up so the women doesn’t dilate and is going to have to have a c-section.
I have seen all of the above. There have been women who have had part of their cervix removed that the scar tissue doesn’t open up during labor and yes they had to have a c-section. Does that mean if you have had that procedure you need to have one? No.
There have also been cases of pregnancy where the cervix starts to open up because the cervix isn’t doing its job. In that case, we put a stitch in the cervix to help hold the pregnancy in. That does not happen all the time though.
Now if you are one that has been trying years, six months or more, you may want to get that checked out because there may be another reason why pregnancy is not occurring. If nothing else has shown up, there are ways to dilate the cervix and increase chances that way if that truly is the case.
How often during the menstrual cycle should I have intercourse?
1:26
Once you have either a positive temperature spike or positive ovulation, usually for the next three day I say have intercourse. Once a day, twice a day, whatever. Prior to that though, I would say save intercourse until that time. Build up the best sperm possible.
I’ve had women too that do not know when they ovulate so every other day of the month they have intercourse. Those are things to try as well. Or you can even say have intercourse every day and see what happens. But usually I say once that positive spike or predictor try every day for the next three days.
Something else to do as far as preparing for pregnancy is once intercourse takes place is do not get up and go urinate. Do not get up and out of bed. I would say lay there for at least a good half hour if you can. Ideally, just go to sleep.
If you urinate after intercourse to discourage bladder infections, there are medications that you can take for that. But getting up and going to the bathroom, all that sperm is pretty much gone. So do not get up out of bed.
Do I have to tilt my pelvis up? No. If you want to, fine, but you don’t have to, there’s nothing magical about that. It has just been an old wives tale. So that’s not necessary either.
Can I use natural family planning to help get pregnant?
0:54
You can definitely use natural family planning to get pregnant. Usually it is a bit more successful if you have a regular cycle; it’s hard to do natural family planning if you don’t because you don’t know exactly when you are ovulating. But the times to then avoid intercourse would be that window in your regular 28-day cycle, days 11-17 you would want to avoid intercourse.
Have intercourse soon after the start of your cycle or much later in your cycle. And people who do use natural family planning are so in tune to their bodies it’s phenomenal. They can tell you exactly when they ovulate. And they do all those temperature, the cervical positioning and the cervical mucus would all be things you would need to use as well.
If you are considering getting pregnant or are already pregnant and you need to choose a doctor what are the reasons to choose an OB versus choosing a family practitioner, what things should a person think about when making that decision?
1:52
A family practitioner may see your whole family. They may see you, see your husband, see your children and you may feel comfortable with someone like that.
If there would be any problems during pregnancy, such as blood pressure issues or sugar issues, growth issues with the baby, or if during labor there are issues where you would need a c-section, a family practitioner normally does not do those types of things.
They would refer you out to an OBGYN. Places that are really small and don’t have OBGYN specialists, they still continue to do those types of deliveries, but the larger places do have those specialists available.
Family practitioners are quite capable, I think they need to know their limitations and be ok to refer if there are any issues. But an OBGYN definitely has more training in some of those situations so you may feel more comfortable and trust that a little bit more than a family practitioner.
As far as residency; Medical school is four years, and depending on what specialty you pick, residency can last anywhere from two to eight years.
A family practitioner will have residency for three years, an OBGYN will have residency for four years. While it does matter to some extent where the residency takes place, most OBGYN’s have over 1000 deliveries worth of experience, including c-sections; whereas a family practitioner may have half that much experience, and they do not necessarily perform c-sections.
If you had a preterm delivery in the past would there be something you would recommend to do differently during the pre-pregnancy planning stag or during the first trimester?
1:00
Good Question. No. As far as preterm delivery, the highest, or one of the factors of predicting that the same woman is going to have preterm delivery is her having a pre-term delivery the first time.
That doesn’t necessarily mean they are going to have a preterm delivery the second time.
But as far as changing what you do prior to pregnancy, I would say there is nothing that you can do except for smoking. Definitely smoking, and if you are a smoker as pregnancy continues decrease smoking.
We would pretty much follow you closely with ultrasounds, maybe modify your activity, things like that. But there really is no way that we have found to prevent preterm delivery. And one thing that can change that is if the father is the same or different. That can matter
Can I go into a hot tub during my pregnancy?
0:51
It raises your core body temperature. Now you are going to get different answers but I don’t allow my patients to. I tell them not to use hot tubs. Others say that’s fine but I don’t think it’s worth it.
Hair dye? Can you do hair dye? I would wait until after the first trimester if you want to dye, but to me it’s not worth it as well. There have been no studies correlating risk but some of those chemicals. The amount of dye the fetus would get is minimal, but I don’t necessarily want my patients to take that chance.
Tanning beds? No. Tan spray? Fine. Lotions? Fine. Just don’t do the tanning bed as they increase core body temperatures as well.
How often can I eat fish during pregnancy?
0:10
Once a week; and that’s crab, tuna, shrimp, scallops.
Not just the fish you catch out of a lake.
It is any of the above.
What about using sunscreen when you’re pregnant?
0:40
Please do. I had a patient who went to Florida and got third degree burns when she was pregnant.
Hormone changes cause your skin to be more susceptible to the sun and you will burn. Especially with fair, fair skin you need to be careful. You should be using hats, you should we wearing light, wear things that are long sleeves, stay in the shade.
Another thing is water, water, water, water, water! Heat stroke and things like that can happen as well. Dehydration can cause, you know, uterine activities so you want to make sure you are nice and hydrated.
So sunscreen is a must, sun block, you’ve got to protect yourself.
Is there anything out there to help prevent stretch marks?
0:19
Unfortunately that is a million dollar question. I’ve heard lotion with coco butter works fairly well, but once you have them you have them. They tend to fade but there’s nothing you can really do.
There’s laser surgery that afterwards can maybe help them fade but I haven’t really seen any success stories with that.
I’ve seen some women where a belt during pregnancy, what is that for?
0:46
Right. It’s called a maternity belt or an abdominal binder, and it kind of comes across this way, around and helps take pressure of the pubic bone and helps support the back.
I have found you need to be consistent with using it. You can’t wear it one day and say “oh it doesn’t work,” because it won’t work. But you need to be consistent with using it but I have had women who have used that as well.
I have a lot of women I send to physical therapy. Back pain is pretty common.
Carpel Tunnel is also very common during pregnancy. I had a gal who just today said “Oh yeah I should probably complain to you about my Carpel Tunnel now.” I said that happens with pregnancy, it is probably pregnancy related. I have a lot of women who have Carpel Tunnel that goes away after pregnancy. But there are splints you can wear to kind of help with the pain. But that is something else that can happen with pregnancy too.
What about chiropractic care or messages during pregnancy?
0:52
Chiropractic care is fine with pregnancy and a lot of women do go to the chiropractor. I have some chiropractors who won’t treat pregnant women so you for sure need to find out about that. I have not seen any studies that have shown that causes pre-term labor.
There have been some studies with massaging. You would go and get a pedicure or something where there’s a pressure point in the back of the ankle here that has been shown, can theoretically increase pre-term delivery or put you into labor. I’m not seeing that a lot, however it is out there.
Massages; there are a lot of places out there who have maternity beds where when you lay down on your belly they have a big whole for your stomach, where it would be safe to get a massage. Just really drink and push the fluids afterwards though.
When can I begin to slim down post pregnancy?
1:23
During the postpartum period, and I’ve went through it twice, your time is very precious. So for you to go out and exercise after that is not realistic really. You’re exhausted, and I don’t say that to scare you, but sleep takes a little bit more of a priority.
That is why prior to pregnancy if you can be the healthiest you can and gain the least amount of weight during pregnancy; it tends to be able to get back in shape a bit quicker and faster.
Breastfeeding has been shown to really help decrease weight after pregnancy occurs. That is one way to really decrease some of the weight.
Walking, just any type of exercise you can do, especially if you deliver when it’s warm out, it ok to take your babies out for a walk. Things like that can help.
As far as dietary or restricting your caloric intake, obviously if you are breastfeeding, absolutely not. But modifying what you eat after delivery if you are not breastfeeding is one way to decrease the weight. But breastfeeding is probably the best way to do that. And breastfeeding is not for everyone. Sometimes milk doesn’t come in, sometimes it just doesn’t work. So say you want to breastfeed and it doesn’t work, that’s ok.
