The Fourth Trimester NP Show

Why do we avoid therapy?

a health activity

How to choose a therapist?

First, consider the type of therapy that they use…

For perinatal depression & anxiety, the two most effective therapies are:

Second, look for a maverick.

-Look beyond the years of experience and look for someone who is regularly learning.

-Verify their baseline therapy credential (state and board certified)

-Also look for someone who is specifically trained in perinatal mood disorders, e.g.

by Postpartum Support International

Third, look for someone with similar life experience.

-Look for someone of similar race, ethnicity, gender, lifestyle

-Will make it easier to enter a safe space for therapeutic work to occur

Fourth, know that you are in control.

-Meet for 15 minute free consult if possible

-Schedule only if you were able to connect

-If you do not agree with the treatment plan, or you don’t connect or you don’t think that you

are being listened to, keep looking

Fifth, look for social emotional intelligence.

-adaptable

-flexible

-self aware

In Summary,

- You have to feel safe in your interactions with your therapist.

- Feel free to shop around until you have the right fit.

- Self evaluate mood for improvement and keep a journal or mood log.

References

McNamara, J., Townsend, M. L., & Herbert, J. S. (2019). A

systemic review of maternal wellbeing and its relationship with

maternal fetal attachment and early postpartum bonding. PloS

one, 14(7), e0220032.

Smith, K. (2021). How to choose a therapist? Retrieved from

How to choose a therapist | Psyche Guides

Symes, E. (2017). The transition to motherhood. Psychological

factors associated with pregnancy, labour and birth. Retrieved

from The transition to motherhood: Psychological factors

associated with pregnancy, labour and birth | APS

(psychology.org.au)

Resources

Psychology Today - Psychology Today Belgium: Health, Help, Happiness + Find a Therapist

ZenCare - Find The Best Therapists & Psychiatrists Near You — Zencare

Postpartum Support International - https://www.postpartum.net/

Guest

Lydia Moore Allen is the Founder and CEO of Se-ReNew Therapy & Consulting Services LLC.

She has been in the mental health field for almost 20 years. Lydia is a Licensed Clinical Social

Worker, Certified Master's Level Addiction Professional, Certified Parenting Instructor and

Qualified Supervisor. Lydia provides counseling for individuals, couples, families and

supervision for registered MSW Interns. She also offers comprehensive Diagnostic

Evaluations

for Immigration Court for Hardships, Violence against Women (VAWA), U-VISA (for

immigrants who were victims or witnesses to a crime in the U.S) and T-VISA (for victims

involved

in human trafficking. Lydia has dedicated her years working with individuals, couples and

families

facing life changing challenges, including addiction, marital/relationship conflict, mental

health imbalance and parenting hurdles. She has experience working in residential and partial-

hospitalization settings with clients of varying cultural, ethnic, and socioeconomic backgrounds.

Lydia is transparent and compassionate while collaborating with her clients to achieve their

goals. Furthermore, she dedicates time as a Board Member for Phoebe’s Fortress Non-profit

Organization in Miami, Florida. Her commitment to Phoebe’s Fortress is geared towards

supporting and equipping young ladies aging out of the foster care system with skills to

advance into adulthood.

                                                      The Bonding Edition

What is a mother? Some definitions include:

What is bonding?

There are two important bonding types to consider:

Maternal fetal bonding spans three semesters:

Mother-Baby Bonding
-acceptance of baby as a whole and no longer just an idea
-may be some attachment concerns with difficult deliveries (PTSD)
-or if delivery did not go as planned, like planned water birth and ended up with forceps delivery - or epidural during labor or c/s etc
- or if baby ended up in NICU
-or if preterm delivery

Mother-Baby Bonding

- perinatal time is one of identity shift
- from own entity or person to mother of 1
- Identity is fluid, could be shift from mother of 1 to now mother of 2
- Bonding impacted by historical family relationships (mother was idolized or not?)

Why do we care about bonding?

- early attachment relationships between mom and baby improve baby’s psychological, cognitive, and social development
- attachment styles impact how the baby interacts with humanity in the future
- A mother who is bonded with her baby will try to know, protect, interact with, and meet the needs of her baby

What impacts bonding?

Social Support:

Self Esteem:

Mental Health:

Depression decreases bonding (inverse relationship)

Some studies anxiety decreased bonding

Hollywood Bonding Versus Bonding in Reality

Reality:

Pro Tips

Lydia’s Book Recommendations :-

Anxiety scale. Discuss score with healthcare provider.

GAD-7 (General Anxiety Disorder-7) - MDCalc

Depression Scale. Discuss score with healthcare provider.

PHQ-9 (Patient Health Questionnaire-9) - MDCalc

                                                                        Guest Bio

Lydia Moore Allen is the Founder and CEO of Se-ReNew Therapy & Consulting Services LLC.

She has been in the mental health field for almost 20 years. Lydia is a Licensed Clinical Social

Worker, Certified Master's Level Addiction Professional, Certified Parenting Instructor and

Qualified Supervisor. Lydia provides counseling for individuals, couples, families and

supervision for registered MSW Interns. She also offers comprehensive Diagnostic Evaluations

for Immigration Court for Hardships, Violence against Women (VAWA), U-VISA (for

immigrants who were victims or witnesses to a crime in the U.S) and T-VISA (for victims involved in human trafficking. Lydia has dedicated her years working with individuals, couples and families facing life changing challenges, including addiction, marital/relationship conflict, mental health imbalance and parenting hurdles. She has experience working in residential and partial-hospitalization settings with clients of varying cultural, ethnic, and socioeconomic backgrounds.

Lydia is transparent and compassionate while collaborating with her clients to achieve their

goals. Furthermore, she dedicates time as a Board Member for Phoebe’s Fortress Non-profit

Organization in Miami, Florida. Her commitment to Phoebe’s Fortress is geared towards

supporting and equipping young ladies aging out of the foster care system with skills to advance

into adulthood.

References

McNamara, J., Townsend, M. L., & Herbert, J. S. (2019). A systemic review of maternal wellbeing and its relationship with maternal fetal attachment and early postpartum bonding. PloS one, 14(7), e0220032

Smith, K. (2021). How to choose a therapist? Retrieved from How to choose a therapist | Psyche Guides

Symes, E. (2017). The transition to motherhood. Psychological factors associated with pregnancy, labour and birth. Retrieved from The transition to motherhood: Psychological factors associated with pregnancy, labour and birth | APS (psychology.org.au)

Disclaimer

Disclaimer: The primary purpose of this podcast is for private, non-commercial use. It does not constitute medical or professional advice.

https://linktr.ee/fourth.trimester.np?subscribe

What is a mother? Some definitions include:

What is bonding?

There are two important bonding types to consider:

Next week we will start with how to bond with your baby during pregnancy…

                                                                    Guest Bio

Lydia Moore Allen is the Founder and CEO of Se-ReNew Therapy & Consulting Services LLC.

She has been in the mental health field for almost 20 years. Lydia is a Licensed Clinical Social

Worker, Certified Master's Level Addiction Professional, Certified Parenting Instructor and

Qualified Supervisor. Lydia provides counseling for individuals, couples, families and

supervision for registered MSW Interns. She also offers comprehensive Diagnostic Evaluations

for Immigration Court for Hardships, Violence against Women (VAWA), U-VISA (for

immigrants who were victims or witnesses to a crime in the U.S) and T-VISA (for victims involved in human trafficking. Lydia has dedicated her years working with individuals, couples and families facing life changing challenges, including addiction, marital/relationship conflict, mental health imbalance and parenting hurdles. She has experience working in residential and partial-hospitalization settings with clients of varying cultural, ethnic, and socioeconomic backgrounds.

Lydia is transparent and compassionate while collaborating with her clients to achieve their

goals. Furthermore, she dedicates time as a Board Member for Phoebe’s Fortress Non-profit

Organization in Miami, Florida. Her commitment to Phoebe’s Fortress is geared towards

supporting and equipping young ladies aging out of the foster care system with skills to advance

into adulthood.

                                                                            References

McNamara, J., Townsend, M. L., & Herbert, J. S. (2019). A systemic review of maternal wellbeing and its relationship with maternal fetal attachment and early postpartum bonding. PloS one, 14(7), e0220032

Smith, K. (2021). How to choose a therapist? Retrieved from How to choose a therapist | Psyche Guides

Symes, E. (2017). The transition to motherhood. Psychological factors associated with pregnancy, labour and birth. Retrieved from The transition to motherhood: Psychological factors associated with pregnancy, labour and birth | APS (psychology.org.au)

                                                                             Disclaimer

Disclaimer: The primary purpose of this podcast is for private, non-commercial use. It does not constitute medical or professional advice.

https://linktr.ee/fourth.trimester.np?subscribe

This is the conclusion of the conversation with Ivette. Please enjoy, we start abruptly and dive into acne.

If you get acne during pregnancy, take these steps to treat your skin -

Additional ACNE Tips

AVOID!!!!!

During the show facts-

Guest Information

Ivette Guttierez was born in Nicaragua and came to the US at the tender age of 6 months. She is the youngest of 3 children and was raised by a strong single mother.

As a child she showed an interest in teaching and loved everything related to makeup. After high school she enrolled in Beauty School. While in school, her artistry skills flourished and she was found to be naturally talented at eyebrow shaping. Ultimately she became a professional esthetician and makeup artist. 

She then worked with Christian Dior cosmetics and has spent 17 years working with prestigious cosmetic brands, and 12 years as a Senior Executive sales manager for a multi-million dollar company. She was also a state board educator for future licensed estheticians.

In 2018 she obtained her permanent make-up certification.

During the pandemic she was no longer fulfilled in the corporate realm and started her own business dedicated to all things eyebrows. She then further ventured into the paramedical space and works with women and men that are survivors of trauma, cancer, alopecia, areola reconstruction, SMP, scar camouflage etc. 

Her slogan is “beauty should be used to illuminate our inner beauty and not mask it!”

References

ACOG. (2023). Skin Conditions in Pregnancy. Retrieved from https://www.acog.org/womens-health/faqs/skin-conditions-duringpregnancy#:~:text=As%20your%20belly%20grows%20during,Sometimes%20the%20marks%20are%20faint.

Cleveland Clinic. (2020). Melasma. Retrieved from Melasma: Treatment, Causes & Prevention (clevelandclinic.org)

Food and Drug Administration. (2022). Cosmetics & Pregnancy. Retrieved from Cosmetics & Pregnancy | FDA

Medical News Today. (2022). Pregnancy and skin care: What products are safe to use? Retrieved from What is safe to use for pregnancy skin care? (medicalnewstoday.com)

Sharma, Jharaik, Sharma, Chauhan, & Wadhwa. (2019). Clinical study of pregnancy associated cutaneous changes. International Journal of Clinical Obstetrics and Gynaecology, 3(4) 71-75. Retrieved from 3-4-1-996.pdf (gynaecologyjournal.com)

Disclaimer

Disclaimer: The primary purpose of this podcast is for private, non-commercial use. It does not constitute medical or professional advice.

https://linktr.ee/fourth.trimester.np?subscribe

Self-Love while pregnant can be anything that restores you. I think that the basics are essential to consider, nutrition, exercise, keeping your prenatal appointments, paying attention to dental hygiene, following your healthcare provider’s advice and attending childbirth education classes. Other important things are the ones that you choose. If you are not sure what restores you consider journaling and observing what brings you joy during a week.

Things that brought me joy during pregnancy were:
 Lathering my skin with oil
 Getting my toes done
 Wearing makeup
 Immersing myself at the beach
 Watching a funny movie
 Exercise
 Going for walks outside
 Giggling with my husband
 Resting when my body told me to while understanding that it was making a human being
 Staying away from negative people
 Staying in the present moment

Next week - how to choose clean cosmetics

#fourthtrimesternp #selflove #selfaware #selfawareness #healthymom #healthymomhealthybaby #momlife #bumplife #selfcare #loveyourself #positivevibes #happiness #inspiration #happy #goals #podcast #healthpodcast #happymom #baby #selfaware #selfcare #duke #dukealumni 

Skin Changes in Pregnancy

Skin Changes in Pregnancy occur because of -

Hyperpigmentation

Connective Tissue Changes

Vascular Changes

Glandular Changes

Skin, Nails & Hair

So what can we do?

If you get acne during pregnancy, take these steps to treat your skin -

Additional ACNE Tips

AVOID!!!!!

During the show facts-

Guest Information

Ivette Guttierez was born in Nicaragua and came to the US at the tender age of 6 months. She is the youngest of 3 children and was raised by a strong single mother.

As a child she showed an interest in teaching and loved everything related to makeup. After high school she enrolled in Beauty School. While in school, her artistry skills flourished and she was found to be naturally talented at eyebrow shaping. Ultimately she became a professional esthetician and makeup artist. 

She then worked with Christian Dior cosmetics and has spent 17 years working with prestigious cosmetic brands, and 12 years as a Senior Executive sales manager for a multi-million dollar company. She was also a state board educator for future licensed estheticians.

In 2018 she obtained her permanent make-up certification.

During the pandemic she was no longer fulfilled in the corporate realm and started her own business dedicated to all things eyebrows. She then further ventured into the paramedical space and works with women and men that are survivors of trauma, cancer, alopecia, areola reconstruction, SMP, scar camouflage etc. 

Her slogan is “beauty should be used to illuminate our inner beauty and not mask it!”

References

ACOG. (2023). Skin Conditions in Pregnancy. Retrieved from https://www.acog.org/womens-health/faqs/skin-conditions-duringpregnancy#:~:text=As%20your%20belly%20grows%20during,Sometimes%20the%20marks%20are%20faint.

Cleveland Clinic. (2020). Melasma. Retrieved from Melasma: Treatment, Causes & Prevention (clevelandclinic.org)

Food and Drug Administration. (2022). Cosmetics & Pregnancy. Retrieved from Cosmetics & Pregnancy | FDA

Medical News Today. (2022). Pregnancy and skin care: What products are safe to use? Retrieved from What is safe to use for pregnancy skin care? (medicalnewstoday.com)

Sharma, Jharaik, Sharma, Chauhan, & Wadhwa. (2019). Clinical study of pregnancy associated cutaneous changes. International Journal of Clinical Obstetrics and Gynaecology, 3(4) 71-75. Retrieved from 3-4-1-996.pdf (gynaecologyjournal.com)

Disclaimer

Disclaimer: The primary purpose of this podcast is for private, non-commercial use. It does not constitute medical or professional advice.

https://linktr.ee/fourth.trimester.np?subscribe

How to choose a supplement with pharmacist Dr. Azelia Brown

First Nutrition is the key
- Eating a variety of foods is the best way to obtain your vitamin and mineral needs
- Supplements are just an aid

How are supplements regulated?
- Food & Drug Administration (FDA) does not do premarketing analysis but they perform post marketing surveillance
- However they must adhere to current good manufacturing practices (CGMP)

So what can we do?
-Look for third party testing
-companies decide to choose an independent third party
-most recommended was USP
-others are NSF, BSCG & Consumer lab

What does regulation mean?
-The supplement contains what is stated on the label
- Products are standardized from batch to batch
- The supplement is free of harmful levels of contaminants or potential drug contaminants
-The product doesn’t contain any undeclared ingredients

Major concerns
- Toxicity with high doses
- Side effects
- Drug interactions
- Supplement may have no effect
- If you are a vegan, make sure that the product is certified vegan
- Allergic reactions (Food Allergen Labeling and Consumer Protection Act means that they must check for 8 major allergens)

Pro Tips
-Eat a Healthy diet
-Make sure supplement is Third Party approved
- Look for Recommended amount of vitamins, minerals and DHA
- Always discuss supplements with your healthcare provider

Upcoming
-Plan to do aspirin use during pregnancy with Dr. Azelia Brown in the future
-Next week we discuss the beauty and the beast of pregnancy
-With esthetician Ivette Gutierrez

Guest Information

DR. AZELIA BROWN IS CLINICAL PHARMACY SPECIALIST WITH OVER 5 YEARS OF EXPERIENCE IN THE HOSPITAL SETTING. SHE COMPLETED HER UNDERGRADUATE STUDIES AT THE UNIVERSITY OF FLORIDA. SHE THEN RECEIVED HER DOCTOR OF PHARMACY DEGREE FROM MERCER UNIVERSITY AND COMPLETED POST-GRADUATE TRAINING AT WELLSTAR ATLANTA MEDICAL CENTER. THOUGH SHE PRIMARILY PRACTICES IN THE CARDIOLOGY AND CRITICAL CARE SETTING, SHE HAS EXPERIENCE TAKING CARE OF A WIDE VARIETY OF PATIENT POPULATIONS.
SHE IS PASSIONATE ABOUT HELPING HER PATIENTS OPTIMIZE THEIR MEDICATION THERAPY AND IMPROVING THEIR HEALTH OUTCOMES.

References
-ACOG. (2022). NUTRITION DURING PREGNANCY. RETRIEVED FROM HTTPS://WWW.ACOG.ORG/WOMENS-HEALTH/FAQS/NUTRITION-DURING-PREGNANCY
-AMERICAN PREGNANCY ASSOCIATION (2023). PRENATAL VITAMINS. RETRIEVED FROM PRENATAL VITAMINS | EVERYTHING YOU NEED TO KNOW (AMERICANPREGNANCY.ORG)
-BIOSSAT, G. (2019). PRENATAL VITAMINS: A SMALL INTRODUCTION TO A BIG PILL. RETRIEVED FROM PRENATAL VITAMINS: A SMALL INTRODUCTION TO A BIG PILL - CHICAGO HEALTH (CHICAGOHEALTHONLINE.COM)
-NHS. (2023). VITAMINS, SUPPLEMENTS AND NUTRITION IN PREGNANCY. RETRIEVED FROM HTTPS://WWW.NHS.UK/PREGNANCY/KEEPING-WELL/VITAMINS-SUPPLEMENTS-AND-NUTRITION/

-U.S. Pharmacopeia (USP). (n.d.). Products and Solutions. Retrieved from USP Products and Solutions

Disclaimer: The primary purpose of this podcast is for private, non-commercial use. It does not constitute medical or professional advice.

https://linktr.ee/fourth.trimester.np?subscribe

How to choose a prenatal vitamin (PNV) with pharmacist Dr. Azelia Brown

Fast Facts

-IF YOU ARE OF CHILDBEARING AGE YOU SHOULD BE TAKING A PNV

-MOST WOMEN (97%) TAKE A PNV BUT ONLY AFTER THEY ARE FOUND TO BE PREGNANT

-TO AVOID THE DELAY IF YOU ARE NOT PREGNANT START TAKING A PNV TODAY

Why do we need a prenatal vitamin?

-VITAMINS & MINERALS ARE NEEDED FOR GROWTH AND DEVELOPMENT.

-THERE ARE 13 IMPORTANT VITAMINS: BACKED OR IN OTHER WORDS VITAMINS B (DIFFERENT ONES) A, C, K, E, D.

-APART FROM VITAMIN D, WHICH WE GET FROM SUNLIGHT, MOST VITAMINS COME FROM OUR DIET.

-DEPENDING ON WHERE YOU LIVE IN THE WORLD, OR YOUR ETHNICITY IT IS QUITE COMMON FOR PEOPLE TO BE LOW IN VITAMIN D (1 BILLION IN DEFICIT)

-DEPENDING ON YOUR DIET YOU MAY BE LOW IN FOLIC ACID (VITAMIN B9).

-THESE VITAMINS ARE IMPORTANT IN PREGNANCY.

-YOU CAN BOOST YOUR LEVELS BY TAKING A VITAMIN SUPPLEMENT IRON

-ANOTHER COMPONENT OF MOST PNVS IS IRON -IRON DEFICIENCY ANEMIA IS COMMON IN PREGNANCY

-AS IRON NEEDS INCREASE IN PREGNANCY (40-45% BLOOD VOLUME)

-SUPPORTS DEVELOPMENT OF PLACENTA AND FETUS

-SOURCES – MEAT, FISH, BEANS, LEGUMES, BLACK STRAP MOLASSES

-RECOMMENDED 27 MG DAILY

-IF ANEMIC YOUR PROVIDER WILL RECOMMEND ADDITIONAL SUPPLEMENTATION THAT SHOULD BE PAIRED WITH VITAMIN C TO INCREASE ABSORPTION

                                                                          DHA

-AN OMEGA-3 FATTY ACID

-IMPORTANT FOR FETAL VISUAL AND COGNITIVE DEVELOPMENT

-DEMANDS INCREASED IN LAST TRIMESTER

-RECOMMENDED 300 MG DAILY

-EAT 2 SERVINGS OF SAFE/LOW MERCURY FISH (WILD CAUGHT SALMON, SHRIMP)

                                                      Folic Acid Shout Out

-PREVENTS NEURAL TUBE DEFECTS -SEVERE BIRTH DEFECTS OF THE BRAIN & THE SPINE -SUCH AS SPINA BIFIDA & ANENCEPHALY

-400 MCG OF FOLIC ACID IS RECOMMENDED FOR MOST

-4 MG FOR OTHERS DEPENDING ON MEDICAL HISTORY

-START 1 MONTH PRIOR TO CONCEPTION

-HAVE CONVERSATION WITH HEALTHCARE PROVIDER

                                                        Choline Shout Out

-REDUCES NEURAL TUBE DEFECTS

-INDEPENDENT EFFECT REGARDLESS OF FOLIC ACID SUPPLEMENTATION

-IMPROVES COGNITION, ATTENTION SPAN, MEMORY AND PROBLEM SOLVING (APA, 2023)

-BEST SOURCE ARE EGG YOLKS, BEEF LIVER, BEEF, SALMON

-RECOMMEND 450 MG -Nature Made PNV with Folic Acid + DHA+ Choline - Women's Prenatal Gummy Vitamin | Nature Made®

                                                How to choose???

-A healthy, well-balanced diet in combination with prenatal vitamins is the best way to ensure that you get all your necessary daily vitamins, minerals and omega-3 fatty acids.

-As with any over-the-counter dietary supplement or medication, choosing a prenatal vitamin is a discussion to be had with your healthcare provider.

                                                          Pro Tips

-Let provider know the type of PNV that you are taking

-Bring a bottle in for them to review during a visit

-Take PNV with food

-Take daily when of childbearing age

                                                      Beef, Iron & Wine

-contains pre-digested beef -believed to be a medicinal tonic

- sold under different brands

-some contained alcohol up to 22%

-some overproof

-Not for pregnant moms!

                                                     Guest Information

DR. AZELIA BROWN IS CLINICAL PHARMACY SPECIALIST WITH OVER 5 YEARS OF EXPERIENCE IN THE HOSPITAL SETTING. SHE COMPLETED HER UNDERGRADUATE STUDIES AT THE UNIVERSITY OF FLORIDA. SHE THEN RECEIVED HER DOCTOR OF PHARMACY DEGREE FROM MERCER UNIVERSITY AND COMPLETED POST-GRADUATE TRAINING AT WELLSTAR ATLANTA MEDICAL CENTER. THOUGH SHE PRIMARILY PRACTICES IN THE CARDIOLOGY AND CRITICAL CARE SETTING, SHE HAS EXPERIENCE TAKING CARE OF A WIDE VARIETY OF PATIENT POPULATIONS. SHE IS PASSIONATE ABOUT HELPING HER PATIENTS OPTIMIZE THEIR MEDICATION THERAPY AND IMPROVING THEIR HEALTH OUTCOMES.

                                                            References

-ACOG. (2022). NUTRITION DURING PREGNANCY. RETRIEVED FROM HTTPS://WWW.ACOG.ORG/WOMENS-HEALTH/FAQS/NUTRITION-DURING-PREGNANCY

-AMERICAN PREGNANCY ASSOCIATION (2023). PRENATAL VITAMINS. RETRIEVED FROM PRENATAL VITAMINS | EVERYTHING YOU NEED TO KNOW (AMERICANPREGNANCY.ORG)

-BIOSSAT, G. (2019). PRENATAL VITAMINS: A SMALL INTRODUCTION TO A BIG PILL. RETRIEVED FROM PRENATAL VITAMINS: A SMALL INTRODUCTION TO A BIG PILL - CHICAGO HEALTH (CHICAGOHEALTHONLINE.COM)

-NHS. (2023). VITAMINS, SUPPLEMENTS AND NUTRITION IN PREGNANCY. RETRIEVED FROM HTTPS://WWW.NHS.UK/PREGNANCY/KEEPING-WELL/VITAMINS-SUPPLEMENTS-AND-NUTRITION/

Disclaimer: The primary purpose of this podcast is for private, non-commercial use. It does not constitute medical or professional advice. https://linktr.ee/fourth.trimester.np?subscribe

                                                         Preconception Care

Preconception Care helps to decrease poor outcomes for mom and baby. It has been found that health decisions that are made prior to conception can decrease the likelihood of gestational diabetes, pre-eclampsia and other possible detrimental events. Ng et al. (2020) put it beautifully when they said “it is not the seed but the soil that makes the plant healthy”.

What should you expect from your healthcare provider?

Screening for Infectious Diseases, Treat, Immunize, Counsel

• HIV

• Syphilis

• Gonorrhea/Chlamydia

• Hepatitis C in those with tattoos and/or body piercings

• Immunizations:

• Rubella, varicella, hepatitis B

• Influenza vaccine if woman will be pregnant during influenza season

• Toxoplasmosis – avoid raw meat, cat litter, garden soil

• Cytomegalovirus, parvovirus B19 (fifth disease): - encourage frequent hand washing

Environmental Toxins

• Smoking cessation including Marijuana 7% (CDC, 2016-2017), Vaping etc.

• Screening for alcohol use or abuse

• use of illegal drugs

• Occupational exposures – Material Safety Data Sheets from employer

• Household chemicals – avoid paint thinners/strippers, other solvents, pesticides

• Radiation exposure in early pregnancy Medical Assessment

• Evaluate overall health and opportunities for improving health

• Labwork which will help determine if woman suffers from any undiagnosed or uncontrolled medical problems (e.g. diabetes, thyroid disease, dental caries or gum disease, heart disease, asthma)

• If history of Diabetes – optimize control HbA1C < 6.5

• If history of Hypertension – avoid ACE inhibitors, angiotensin II receptor antagonists

• If history (hx) of Epilepsy – consider increased dose of folic acid & possibly changing medications

• If hx of blood clots (DVT) – switch from warfarin (Coumadin) to heparin

• If hx of Acne – stop isotretinoins (e.g. Accutane)

• If hx of depression/anxiety and other mental health issues-discuss current benefit/risk medication data, need for therapy, need for specialist consult Lifestyle

• Recommend regular moderate exercise (75-150 minutes Walking!)

• Avoid hyperthermia (hot tubs)

• Maintain a healthy weight, lose weight as needed

• Assess risk of nutritional deficiencies:

• Vegan

• Pica

• Milk intolerance (calcium supplementation)

• Calcium or iron deficiency

• Avoid overuse of:

   • Vitamin A (750 micrograms for ages 14 to 18; 770 micrograms for ages 19 to 50)per day) ACOG

   • Vitamin D (limit to 600 IU per day) ACOG

   • Caffeine (limit to two cups of coffee or six glasses of soda per day) 

   • Screen for domestic violence (increases in pregnancy, 1 in 4 women) if this applies to you, let your          provider know.

    • Screen for social issues (e.g. place to live, child care, employment, transportation)

    • Counsel on the use of over-the-counter medications, nutritional supplements, and naturopathic                substances

Deep Dive into Pregnancy Hx

• All prior pregnancies (cerclage use, inpatient stay etc) & outcomes

• Cesarean section or vaginal delivery

• Premature delivery

• Hypertensive (high blood pressure) disorders of pregnancy

• Diabetes or Gestational diabetes

• Blood type? Rh incompatibility? or hx of receiving RhoGAM

• Postpartum hemorrhage

• Thrombotic event (DVT/PE)

• Mood changes in perinatal (during and after pregnancy) period

What can you do to get ready today?

- Start taking a multivitamin that has at least 400 mcg of folic acid

- Maintain healthy diet and weight

- Be physically active more days per week

- Quit smoking anything 😊 includes vaping

- Avoid alcohol

- Screen all medications & supplements with your healthcare provider

- See your medical team for chronic health conditions

I’m pregnant now what???

-establish prenatal care ASAP

-seek childbirth, newborn and parenting education

                                          About our guest Crystal-Ann Roberts

Crystal-Ann Roberts is a Registered Nurse currently practicing in the field of High-Risk Obstetrics in South Florida. She is also the founder and childbirth educator with Jonah’s Birth. Crystal-Ann Roberts received her Bachelors in Psychology from Nova Southeastern University and her Associate Degree in Nursing from Miami Dade College. She obtained her certification as a Hypnobirthing Childbirth Educator because of her love for maternity and her passion to influence the birthing world. Crystal-Ann has been married for 11 years and has 2 children. It was the birth of her sons that influenced the founding of Jonah’s Birth. She believes every woman has the right to safe maternal care and should have access to evidenced based birthing education. Look her up on IG @Jonahsbirth

                                                             References

The American College of Obstetricians and Gynecologists. (2019). Prepregnancy Counseling. Retrieved from Prepregnancy Counseling | ACOG

Centers for Disease Control and Prevention. Planning for Pregnancy (2023). Retrieved from Planning for Pregnancy | Preconception Care |

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I had my first guest for my podcast today. Crystal Ann Roberts is a high risk antenatal nurse and a business owner of a health education company specializing in childbirth education. We discussed all that you need to know before you become pregnant. This was so great, as we were candid and revealed quite a bit about our personal experiences. This is Part 1 of 2. The second part will be published on 3/17/2023. All resources will be provided on the show notes of that episode. In the meantime follow Crystal Roberts @jonahsbirth and me, Judith Wafe @fourth.trimester.np Here is my Link Tree for Youtube, TikTok so that you can see the associated video. https://linktr.ee/fourth.trimester.np https://www.tiktok.com/@fourthtrimesternp?lang=en https://www.youtube.com/@fourthtrimesternp/featured