Growing Healthy Podcast

Letter:  Dr. Kang and Dr. Power, my friend was talking about having a doula at her birth.  I have no idea what role a doula would play?  I worry my husband would find it weird having a stranger at the delivery....could you tell me more about Doulas? Alicia Power: Welcome to Growing Healthy, today are lucky enough to have Laura Warren from Vida Doulas on the show to tell us all about what a Doula is and what they can offer to your pregnancy, delivery and postpartum experience.    Just after this little reminder.  Alicia Power: Hello Laura, and thanks for joining us.  Why don't you start off by telling us a little bit about yourself.   Laura: Hi Alicia, thank you for having me on your show. I've been a doula for almost 20 years. I'm also a childbirth educator and breastfeeding counselor, but most importantly, the mother of three amazing young women and grandmother of four incredible boys. Alicia Power: For people who don't know what a Doula is can you give us a quick idea?  Laura:A 'birth' doula is a person trained to provide continuous physical, emotional and educational support to women before, during and immediately after labour; that's what I do. A birth doula meets with the clients once or twice before the birth to discuss options and wishes for their birth. The doula will join the couple at home or hospital when they need her. She will help with comfort measures and reassurance throughout.  She will remain with them throughout their labour and one to two hours after the birth, to assist with breastfeeding. Most doulas will do one to two post natal visits.By having a doula, the partner is able to participate at his comfort level and most, actually feel more confident to participate, knowing that there is someone experienced to offer suggestions. AP: Laura, we are trying to be evidence based in our podcasts.  Have there been many studies looking at the benefits of having a doula at your birth.   LW:  In 2010, Dr. Amy Gilliland did a study about effective labour support where she theorised that doulas are effective because of the attachment that clients form with their doulas. This attachment creates trust and helps in the release of Oxytocin which promotes labour contractions. In 2017, Bohren et al published and updated Cochrane  review on the use of labour support. Here, they found that overall, people who received continous labour support from a doula were more likely to have spontaneous vaginal births and less likely to have any pain medication, epidurals, negative feelings about childbirth,vacuum or forceps-assisted births and cesareans.  In my opinion though, the most important and effective role of the doula is to help a couple achieve the most positive birth experience possible, regardless of how they gave birth; and we do that by making sure that they exercise informed consent every step of the way, that they feel nurtured and that they are treated with utmost respect.  AP: Laura, is there formal training or a liscencing body for Doulas? Laura: Most doulas in Victoria do their training through DONA international which is the largest certifying organization. Clients hire a doula at different times. Most, do sometime during their second trimester, but I've been hired as soon as they find out that they are expecting, and I was once hired at ten days post dates (not that I recommend that ). My recommendation is that a couple start their search early on to make sure they get the doula they want Alicia Power: What is the cost of a doula? Are there any programs that you know of that may be able to help people out who can not afford a doula? Laura: The cost of a doula varies greatly, depending on level of experience. We'd like to think that there is a doula for everyone. Some doulas work on a sliding scale and other's (like my group) who charge the same fee, but are happy to arrange a payment plan if it makes it easier. Roughly, I would say that doula fees range between $400 and $1000 dollars. The local doula trainer, keeps a list of doulas interested in attending births to get experience. In order to access those doulas, the client must have a referral from their care provider and the cost is on a sliding scale. Alicia Power: You work as a Doula with Vida Doulas - can you tell us about why you formed a group as opposed to being doulas on your own?  Laura: We decided to form Vida doulas because we wanted to make sure that we had back ups who had similar levels of experience and commitment to the profession. We wanted to make sure our clients would receive the same level of care if their primary doula couldn't be with them. Vida is : Jay Duncan, Ashley Brilhante, Barb Fraumeni and I.  Besides being 'birth' doulas, Barb is also a post partum doula, I'm a breastfeeding counselor and Ashley has a birth pool rental business.  Alicia Power: What other services do you offer - I know you run a great prenatal course that I often recommend to my patients…  Laura: Yes! We appreciate all the support that Grow Health has shown VIda; thank you.Jay and I are childbirth educators with years of experience. When we started Vida, I created the 60/40 class which is a quaint, small group class that is 60% childbirth preparation and 40% newborn care. Jay teaches a similar version of this class for larger groups. We also offer private classes in the client's home and of course we offer breastfeeding consultations. http://www.doulasofvictoria.ca http://www.vidadoulas.ca/

Hi, Dr. Alicia Power here, and we are lucky enough to have Natasha and Kelsey from West Coast Sleep Consultants join us on Growing Healthy today. They are going to give us a quick primer on common sleep concerns in the first few years of life.  We will get to that right after this quick reminder.  Welcome Natasha and Kelsey, so excited that you could come and speak with me today. Sleep is so important for both children and their parents, and yet it is such a challenging topic for so many families out there!  Can we start by learning a bit about both of you and how you ended up being Sleep Consultants, and what you feel your role is in helping families sleep?  1. Sleep props  - What is a sleep prop? (good and bad, and why)  - When is it okay to use a sleep prop?   2. Sleep Training  - what is it?  - when is a good time to sleep train?  - benefits of having a consultant?   3. Toddler Sleep  - Bedtimes & normal sleep amounts?  - when to drop the nap? https://www.westcoastsleepconsulting.com [email protected]

Help!! my son has horrible eczema.  he is 5 years old and if flares for no obvious reason.  we use the steroid cream prescribed, which helps...but then it comes back when we stop.  What can we do to treat it?  is there something that might be triggering it?  The poor guy is so itchy when it happens....is there something we can do to help that?   http://aishamd.com/?p=974 AP: Maria, what is eczema and what causes it? MK: well Alicia, Eczema, or dermatitis is a problem with the skin as a barrier to keep moisture in and bacteria and irritatants out.  Lets first talk about what normal skin does.  Healthy skin cells form a barrier to the outside world, they are plumped up by water and have fats and oils surrounding them to create a protective barrier against the outside world.  In eczema the structure of skin is a bit different, you may not have as much fat and oil between those skin cells and as a result your skin cells are not as able to keep as much water inside them.  They get dry and gaps in the skin form which allow more moisture to leak out and irritants and bacteria to get in.  Some people are more prone to having eczema through genetics (ie family members have it or other conditions that are commonly linked such as allergies or asthma) or their profession, or daily activities increase the risk of eczema.  Common things that might increase the risk of eczema are washing hands frequently, or repeated exposure to substances that pull away those healthy oils and fats. As a result your skin barrier breaks down and becomes dry, irritated, cracked and inflamed.  This damaged skin is then even more susceptible to any substances that irritate it and it worsens.  The skin changes also are associated with significant itch, which can then lead to further skin damage when people scratch this itch!  What a vicious circle! Eczema can be quite mild - day a bit of redness and itchiness behind the knees or in the elbow creases, to quite severe with red, itchy, weepy skin with crusts.  It can also come and go, or be present for long periods of time and require ongoing treatment to keep it at bay! Alicia, who gets eczema? AP: Good question Maria!  We know that 1 in 10 people will be affected by eczema.  Most of these will have it before the age of 5.  We also know that it can be associated with seasonal allergies and asthma.  If one parent has one of these then kids are about twice as likely to get eczema, if both parents have these symptoms then it is 3-5 times more likely that the child will get it.  In terms of decreasing risk, we know that early exposure to certain bacteria through day care, farm animals and having a dog at home can be protective, and decrease the risk of getting eczema.  Most cases of eczema in children will get better by the time they get through their teenage years.  Maria we know that in people who have eczema there are certain things that can make it worse or cause a flare...could you chat with us a bit about that? MK: Sure.  So anything that disrupts that skin barrier can bring on a flare or make eczema worse, and this is important to recognize for prevention and the ongoing management of eczema.  Common things that can disrupt that skin barrier are soaps, bubble baths or anything else that strips those precious natural oils from our skin.  Also trauma to the skin itself can increase flares of eczema - this can come from someone scratching their itchy skin, or wearing "scratchy" clothing such as wool next to skin.  Also anything that increases the pull of moisture out of your skin can be a problem, these are things like low humidity and heat.  Because eczema and seasonal allergies can be associated, there is always a question as to whether certain substances can cause flares of eczema. There is not great evidence that certain foods can trigger or worsen eczema, and it is important to see a doctor who specializes in allergies if you think this might be the case in your child or yourself before you eliminate it from their diet.  The risk of foods triggering eczema in adults is very rare.  There is some evidence that contact with dust mite and cat dander can worsen eczema in the areas that were exposed, but again, not in the majority of cases.  Alicia, Now that we know a bit more about eczema - how can we manage it.  AP: So there are a few things we can do on a daily basis as prevention for eczema in those people who have it.  Some of these things we have already eluded to.  Avoiding harsh soaps, fragrances and other substances that can strip our skins naturally occuring oils is a great first step.  If you are having a bath, do not add bubble bath, and only use soap on your dirty bits in the last few minutes.  Good options for cleansing include Cetaphil, Cera Ve and Aveeno skin cleansers.  Also good if you have to wash your hands often, is to have some of these at all the sinks you use to wash your hands at, and right next to it...some good moisturizer! AP - One of the most important things is to hydrate our skin, and in this case the goopier the hydrating cream the better!  These create a better barrier to keep moisture in our skin.  The commonly recommended products are thick creams such as Cera Ve and Glaxyl Base and ointment type products such as Vaseline,  Aquaphor or Prevex.  We should be applying these 2-3 times daily and after our skin has been wet (after a bath, washing hands etc).  It is really important that we apply to wet skin, do not thouroughly dry it, and apply quickly after bath, shower or hand washing.  Some people find the ointment products very greasy, so perhaps using the cream's during the day and ointment before bed may be more acceptable. Different creams and emollients work differently for people, so there is a bit of trial and error, and this may change based on the time of year as well.  Instead of using a typical soap to wash - emmolient soap substitutes such as the Cera Ve or non scented bath oil is fine.  Also making sure water in our baths or showers are not too hot, as this pulls moisture out of the skin.   MK - I will add in that for babies and toddlers with very dry skin prone to eczema, I often recommend not using any soap at all.  People are often taken aback by this but remember that all soaps will strip the natural moisture barrier.  You still need to add in a good THICK moisturizer. AP - Avoiding scratchy materials, such as wool, synthetics, tags and zippers that irritate the area. Avoiding excessive heat, overdressing.   MK - What about your favorite activity, Alicia?  Laundry? AP - I love laundry.  For eczema and sensitive skin, remove all harsh and perfumed detergents.  And try not to use dryer sheets.  Anything that smells, really. Maria, if doing these things regularly does not keep eczema at bay, what would the next steps be for managing a flare.  MK: So there are a variety of different techniques we can use to manage flares.  First of all....keep up with all the preventative strategies!   In terms of managing the skin symptoms the mainstay is topical steroids.  These are applied to the affected areas of the skin and help to decrease the inflammation and allow the skin to heal.  Some milder options you can buy at a pharmacy are 1% hydrocortisone ointment, which you can apply twice daily to the flared area until it goes away, this may be all some people need.  Remember there is a difference between cream and ointment.  Ointment is thicker and will stay on longer.  But it's greasy and can stain clothes.  Others may have more significant flares and need a prescription based steroid for their skin.  We generally recommend applying for 48 hours after a flare seems to have gone.  Occasionally eczema can get infected, and this often appears like a yellowy orange crust to the eczema, we can often manage this with a topical antibiotic, but if you think the eczema is infected, you should certainly see your health care provider to have it assesed.  For people who are getting infected eczema we also recommend 1-2 bleach baths a week, as long as there are no open areas on the skin, as a preventative measure.  This is 1/4 cup of bleach in a half full (80 litres) of warm water and soak for about 10 minutes. Do not put your head under water and rinse off with warm water after, and then immediately apply your moisturizing cream or emollient to it.  Occasionally we also recommend Wet Wraps for those people with more severe eczema, these are applied over the emollient and/or steroid cream to help cool, improve moisturization and help with the itch.  There is more information about this in the show notes, but certainly talk to your health care provider about this.  There are stronger topical medications then can also be applied if what we have reviewed is not effective, but most mild to moderate eczema can be managed with diligent prevention and quick treatment of the flares.  The other component to eczema is the itch...and this can be severe! Alicia, what do you generally recommend to your patients for this?  AP: In milder cases, the steroid cream itself and good moisturizing can certainly help with the itch.  But some people need a bit more help, and it is really important to try to help control this itch, as we scratch itches...and this causes more damage to our skin, which will then worsen the eczema!  So antihistamines such as benadryl, reactine etc can be used, and we dose these based on weight in kids, and please ensure if you are using any medication regularly in children that you use a proper measuring device, and not a kitchen spoon!  There are also stronger medications that can be prescribed for the itch, so talk to your health care provider if you are still struggling.  MK: So I think that is the basics for Eczema, and of course there are some people out there struggling with severe eczema, for which they are needing oral medications to help control, but for those of you with mild to moderate eczema, we hope this helps to keep it at bay...and dont forget that eczema is a long term disease of the skin, and so it will flare if you dont use the daily preventative measures that we spoke about.   Keep on Growing Healthy! Cleansers: Cera Ve Cleanser Aveeno Soothing  Cetaphil Gentle Skin Cleanser Creams: Cera Ve Cream Aveeno Eczema Care Cetaphil Moisturizing Cream Creamy Vaseline Ointment: Aquaphor healing ointment Vaseline 

AP:Well Maria....last time we spoke about preparing for pregnancy....now what about when you actually are pregnant!!!  MK:  Well that is what we are talking about today...just after this quick reminder! MK: So....where to start....mmm Iove food...what can we eat...and what should we avoid during pregnancy?  AP: Well in Canada we have pretty good food safety laws but if you want to be really safe we generally recommend fish and meats being properly cooked, avoiding deli meats (cured meats are fine if properly cooked) and making sure cheese is pasteurized.   MK: now i need a bit of pep in my step in the mornings...what about caffeine... AP: a bit of caffeine is fine...1-2 coffee or tea a day is just fine, and also helps to keep those bowels moving...which can get a bit sluggish in pregnancy.  But we should avoid pop or juice...try to stick to water and milk for your beverages.  You want to try to keep weight gain to a reasonable amount.... MK: 15-25 lbs if you start at a healthy weight is what we are shooting for.... AP: now developmentally...as a pediatrician...what is your recommendation for alcohol, smoking and drugs? MK: well we certainly emphasize risk reduction...and unfortunately we can not be 100% sure on all the answers but we certainly do know that..... What about prescription medications in pregnancy??? AP: certainly prescription medications need to be reviewed on an individual basis, and you should certainly review these with your care provider prior to becoming pregnant if possible, or as early as possible during the pregnancy.  If you do not need a medication it is probably best to not take it during pregnancy, but if a medication keeps you or your disease stable, then certainly have a discussion with your care provider sooner rather than later! MK: we both like to exercise, what are the recommendations during pregnancy?  AP: anything you have been doing fine to keep doing.  may need to modify as time goes on.  Aim for at least 3-4 days a week for 30-45 min.  Certain conditions which health care provider may want you to modify your activity.   Maria...when did you first see your prenatal care provider... MK: well I was under the impression that you should reach out to your care provider as soon as you find out you are pregnant...the earlier you see them the better.  It is great if you can touch base with them somewhere between 6-10 weeks pregnant.  Generally they will order some screening bloodwork, get a dating ultrasound, and review options for prenatal screening - which is testing, that a couple can choose to do, to look at the risk of having a baby with a chromosomal abnormality such as down syndrome.  Not every woman decides to do this, but the testing is started around 10 weeks so it is nice to have the discussion before this point should you with to! Breast Tenderness: this is a positive sign of pregnancy, but can be more than annoying!  make sure you have a good supportive bra, and you may want to sleep with a sports bra.  Make sure to tell your partner what you are experiencing...as you may not want them to go near that area for a bit!!   Nausea: another good sign that you are pregnant...but annoying....some things you can try at home include eating small bits throughout the day...we tend to crave carbohydrates, but proteins are a good choice.  There is an organic Gravol Ginger lozenge that can help, Sea Bandz are also a good option.  Vitamin B6 10 mg three times a day is part of one of the medications (Diclectin) that we often prescribe to help.  Bloating is caused by increased progesterone, which is important in the support of early pregnancy.  This pregnancy also causes loosening of our sphincters leading to more gas!! so watch out!  not much to do about this.... Fatigue: the first trimester can be pretty tiring, your body is going through a lot of changes to help support the growing fetus.  Give yourself a break!  you will get some more energy in the second trimester.  Take some time to rest when you are able, go to bed early and allow your cute little baby to grow!  Dont' be too hard on yourself...these first few weeks can be pretty tough!   Gravol Ginger Lozenge Vitamin B6 50 mg Sea Band Bracelet Prenatal Vitamin (inexpensive) Sleep/Nursing Bra

 

Dr. Kang and Dr. Power take care of both pregnant women and their babies....but we gotta start somewhere!  Are you thinking of getting pregnant....Well this is the podcast for you!! Generally women and their partners have quite a few questions about how to get their pregnancy off to the healthiest start!  This podcast is to introduce us and answer these questions.  Right after this little reminder! Preparing for Pregnancy:  MK: Alicia, what are your recommendations for eating in pregnancy? AP:  there is some evidence that the diet you are eating around the time of conception can influence how your body diverts its energy to your placenta - so make sure you are eating a well balanced diet, of real food.  Start taking a prenatal vitamin as soon as you find out you are pregnant, or better yet when you start thinking about getting pregnant.  Maria...what about exercise??? MK: Exercise: is good! anything you have been doing, keep doing - 30-45 min 3-4 times a week.   AP: When it comes to alcohol during pregnancy, there is no safe amount of alcohol during pregnancy.  Maria, what do you think about alcohol during pregnancy?   MK - You are absolutely right.  Most people have heard of Fetal Alcohol Syndrome or Fetal Alcohol Spectrum Disorders (FASD) and there is a broad range of effects to the baby including general size, brain size, development, learning disorders...these are lifelong problems that can affect the baby.  There is no safe amount or safe time during the pregnancy to drink.   And before you ask about all those women in Europe who drink during pregnancy, there are consensus guidelines out there, which means that even the European countries like France and Italy recommend avoiding alcohol during pregnancy.  I looked into this and Bulgaria and the UK have come out with the guideline of no more than 1-2 units of alcohol once or twice a week.  They still say that if you are pregnant or trying to get pregnant, you should avoid alcohol. This is probably has more to do with harm reduction and public health strategy.  Bottom line, the earliest intervention we can promote is a healthy pregnancy and this starts with avoiding alcohol.   AP: what about drugs, marijuana? MK:  This is a big topic.  Drugs like heroin, cocaine and ecstasy complicate your pregnancy and can compromise blood flow to your baby.  This means your baby may be very small and premature.  Plus the smaller and earlier your baby is born, the more problems it can run into during those critical first few days and weeks of life.  This can really affect brain development down the road.  Another major problem immediately after babies are born is withdrawal.  Babies will actively withdraw in the same way that adults do.  They are sweaty, have high heart rates, have diarrhea, are in pain and can even have seizures.  On top of that, withdrawing babies spend less time with their moms, have difficulty feeding and are hard to manage even for experienced moms and caregivers. The effects of Mary J haven't been teased apart as much as heroin, cocaine and ecstasy but it's known as the "gateway drug".  This means, that it easily paves the way for more illicit drug use.  I think this is why the research is difficult to perform and to analyze, because there are not as many mom's using JUST marijuana.   The bottom line is:  AVOID illicit drug use.  But more importantly, if you are struggling with a drug and/or alcohol problem, please just get help.  There are programs for pregnant moms who are struggling and it's not about taking your baby away.  The more you seek out help and work at it, the better your baby will be in every aspect. Get on board with a maternity care provider that you connect with.  And reach out the the Addictions Outpatient Clinic - 1125 Pembroke Street here in Victoria, BC. MK: what about health conditions?  Alicia what do you normally counsel women on?   AP: If you have medical conditions, it is important to be as stable as possible when you are trying to conceive - some examples of diseases that should be stable are diabetes, seizure disorders, crohn's or colitis, hypertension, kidney disease, depression and anxiety.  Please tell your health care provider as soon as you think you may want to get pregnant, as certain medications are safer than others in pregnancy and so they may decide to change a medication to plan for pregnancy. Many people are on antidepressants and often ask the question about whether they should stop their medication prior to conceiving...this is a complicated question with no easy answer...but the most important part of the answer is that a stable mother is the most important thing to work towards.  If your care provider is unsure, they can always ask someone who does this all the time for help. The docs at grow health are always happy to see women to discuss these issues prior to becoming pregnant!  Book an appointment with a care provider, and depending on where you live your options will be a midwife, nurse pratitioner, family doctor or Obstetrician.  In Victoria bc, the options are a midwife or family doctor.  We will be doing a future podcast on this topic.  MK: Now dad's also play a role in this, and probably good for them to be on the same track as future mom's.  Eating healthy, exercising, stopping smoking/drugs and minimizing alcohol is always a good rule of thumb.     AP: now lets get to the nitty gritty of things.... Mk: yes indeed....what do you tell people about how to get pregnant!   AP: Basics on menstrual cycles and when to try to get pregnant.  Most women have a 28 day cycle.  This starts on the first day of your menstrual cycle, and ends the day before your next menstrual cycle.  Most women ovulate around day 14, and the egg generally needs to be fertilized within 24 hours so I usually recommend women have intercourse on day 14, day 12 and day 16.  If you really want to hedge your bets then you could add on day 10 and 18.  We usually recommend 48 hours between intercourse to allow for the man's sperm to reaccumulate to a reasonable number.  The majority of people, with consistent trying will be pregnant within 6 months of starting, if you are under the age of 36 and not pregnant by 6 months, it is probably a good idea to see your health care provider, if you are older than 36 years, i usually recommended seeking health advice after 3 months of unsuccesful trying. AP: What is the latest on Zika virus and pregnancy.... MK:  Current recommendations are that women consider a delay in conceiving a child for 2 months and that a male partner delay conceiving a child for 6 months after returning from travel to a Zika virus affected area. Pregnancy resources: http://www.health.gov.bc.ca/library/publications/year/2015/babys-best-chance-2015.pdf

AP - Skin is the biggest organ in our body, and we need to take care of it!  We do this with eating healthy food, drinking lots of water and by what we put on it.  Today's podcast is going to be about the basics of skin care. We will get to that, right after this quick reminder.  MK - Welcome to Skincare 101...we are going to talk about the basics we are not going to get into all fancy kinds of stuff...but if you can manage this you are in a good place!  Obviously everyone has different skin types and needs and so there may be a bit of trial and error depending on your skin type and if you have any complicating factors such as eczema or acne.  We will give you a few suggestions of products in each area and put links in the show notes if you are interested.  MK - Lets start by talking about a basic skin care regime - want to give big shout out to AishaMD.com where a lot of this information came from. She is an emergency physician in calgary that has a special interest in skin, and a great website!  AP - Your morning regimine should start off with a mild cleanser - such as cera ve, cetaphil or neutrogena.  This is not the time to do your exfoliation, that will come in our evening routine.  Next on goes the moisturizer, probably best to do a light one during the day, then sunscreen and if you choose after this would be your makeup.  Certainly if you are hoping to add some more protection from the sun and environment a mineral powder make up will provide you with more protection.   MK - At the end of the day, you want to use a make up remover if you wear makeup.  You then want to cleanse all the dirt of the day off of your face.  This is the time that you can add in some mechanical exfoliation - use a washcloth (cheap is fine folks) to gently scrub some of those extra skin cells off.  Be extra careful in the under eye are as this is a sensitive spot.  You can also use a skin cleansing brush for this mechanical exfoliation.  Then you want to apply your moisturizer, and this can be a bit thicker and more moisturizing for overnight and gently dab this in the under eye area so as to not damage the skin.   Some people choose to do a chemical exfoliation with fruit acids (the new fad is lactic acid) or similar products.  This is also fine, but can be a bit harsher on the skin, so probably 1-2 times a week is plenty.   AP - If you are using retinoid product, then you could apply this 1-2 times a week.  Not in combination with your chemical exfoliation with fruit acids though.   That is your basic skin care regimine...for your face....simple right!!  For the rest of your body, you want to use an emollient based cleanser such as Cera Ve, Cetaphil,  or neutrogena to wash your hands during the day and body in the shower.  After washing your hands or body, you want to make sure to moisturize quickly and frequently to maintain the hydration of your skin.  MK - This advice regarding care of your body skin also applies to babies and kids, use a gentle emollient based cleanser and good thick moisturizers to help maintain the integrity and function of their skin!  I will add in that for kids with very dry skin prone to eczema, I often recommend not using any soap at all.  People are often taken aback by this but remember that all soaps will strip the natural moisture barrier.  You still need to add in a good THICK moisturizer. Now that we spoke generally....lets get into the nitty gritty!   AP - Sunscreen is so important at helping to prevent the damage that is caused by ultra violet light in our skin.  There are two main types of ultraviolet light that we are concerned about, UVA which are longer wavelengths and go deeper in the skin can cause premature ageing.  UVB are shorter wavelengths and tend to cause more of the sunburns (although both can) and this is what we make vitamin D from. It takes about 5 min of sun exposure with shorts and t-shirt in fair skinned people to get the vitamin D we need!.  Both UVA and UVB wavelengths can cause skin cancer.  For these reasons, we should use sunscreen every day....every day....for day to day use SPF 30 is probably fine, but if you know you will be spending more time in the sun, and SPF of 60 is better.  Also wearing wide brimmed hats, long sleeves and pants to protect agains those UV rays.  Choosing a sunscreen - you want one that covers both UVA and UVB rays.   If you have dry skin, choose one that is more of a cream or ointment base, if you have oily skin or acne prone skin, you will want to choose one that has an alcohol based lotion, gel or spray.   MK - You may have heard some news about certain sunscreen products that cause significant irritation to baby skin and sensitive skin.  This is a great reminder that you need to test out any sunscreen on a patch of skin before you go and lather it iall over. AP - Applying sunscreen:  none of us do this properly, we use way less than we should be using, so apply liberally, you should feel a film on your skin where the sunscreen was applied.  Give it time to work, so apply about 30 minutes prior to going out in the sun, and reapply every 2 hours if you are going to be staying out in the sun. Also reapply after swimming, excessive sweating or if the sunscreen gets wiped off another way.  Retinoids are a topical substance, generally applied a couple of times a week to the face or affected area that are used to treat acne and help reduce some of the damage by the sun that shows up as ageing.  It takes about 6 weeks to notice a difference with acne, and is used long term when being used for managing the signs of ageing.  It is generally applied sparingly all over your face, and if you have sensitive skin wiped off after an hour or so.  You can start with 1-2 times per week and as your skin gets used to it, increase the frequency and how long you leave it on.  It can irritate the skin, so best to wait about 30 min after you have washed/exfoliated your skin prior to applying it if you can. As they work by peeling off the top layer of skin, they can cause some redness and irritation to your skin in the first few days to weeks of using them.  If you have a severe reaction to them, they may be too much for your sensitive skin.  Please be sure to use sunscreen on any skin being treated with retinoids.  We do not recommend topical retinoids in pregnancy or breastfeeding.        Sunscreen for Oily Skin:  Cetaphil Oil Control SPF 30 CereVe Moisturizing lotion am SPF 30 (daily) La Roche Posay Anthelios SPF 60 Skinceuticals Physical Matte Defense SPF 50 Rodan & Fields Reverse SPF 55   Sunscreen for Dry Skin:  Neutrogena Healthy Defense SPF 45 Aveeno Positively Radiant SPF 30 (for daily) La Roche Posay Anthelios SPF 60 Skinceuticals Physical Defense SPF 50         Sensitive skin:    La Roche Posay Toleriane ultra cleanser and serum Avene Clinderm Rodan & Fields Sooth   Skin care products to avoid in pregnancy: retinoids (topical and oral)  salicylic acid (glycolic acid is good option for pregnancy)   Skin care lines for acne in pregnancy: La Roche Posay's Effaclar cleanser and Efflaclar Duo Spectro purplish blemish control line Reversa Solution for Acne Prone skin