high-risk pregnancy

Preventing Preeclampsia with Proper Nutrition

Preeclampsia is a prenatal and postpartum condition that is hallmarked by gestational hypertension and the presence of protein in the urine. It occurs in approximately 5-8% of pregnant women and can be life-threatening. Women who have had preeclampsia with a previous pregnancy are at a higher risk of developing it again.

The symptoms of preeclampsia can be varied and confusing. Edema (specifically pitting in the ankles), sudden weight gain, headaches or vision changes are all common complaints amongst patients with this condition, but presentation varies on the underlying cause.

Research has shown that nutritional deficiencies may play a role. [1] There have been several studies linking different nutritional deficiencies with an increased risk of developing gestational hypertension and preeclampsia. In this article I will address the individual nutrients linked in these studies, as well as nutritional principles to get you started.

NUTRIENT DEFICIENCIES ASSOCIATED WITH AN INCREASED RISK OF PREECLAMPSIA

Magnesium: Magnesium is essential for the proper development of the placenta from mid first trimester on. We see significantly lower levels of magnesium in preeclamptic patients. [2] Not only is Magnesium necessary for many of the other nutrients, like Calcium, Sodium and Potassium, to function properly, it is also necessary for the hormone receptors to accept certain hormones. Without proper levels of Magnesium, sodium and calcium build up in the blood causing increased blood pressure and increasing the risk of preeclampsia. Magnesium is a natural muscle relaxant, and deficiency can cause tightening of the blood vessels. The demand for magnesium grows exponentially from 28 weeks of gestation through childbirth.

Calcium: Calcium supplementation in pregnancies at a higher risk for preeclampsia has been shown to reduce the risk of hypertension and preeclampsia [3] as well as reduce the maternal mortality risk due to preeclampsia. Calcium supplementation help prevent dysfunction in the placenta by affecting Nitric Oxide Pathways. [4] Calcium also interplays with a other nutrients associated with an increased risk of preeclampsia, Vitamin D/K/Magnesium.

Zinc: Zinc is an important mineral for hormone development and immune support. It is one of the most essential minerals for pregnancy. Deficiencies are associated with an increased risk of miscarriage, birth defects, and stillbirths. Too much copper or iron can deplete zinc (there is a tricky balance), it is also necessary for proper B6 absorption. Zinc is the catalyst for the millions of enzymatic reactions that are occurring as your baby develops. It is also necessary in protein synthesis (protein is what your oxytocin is going to be made from). Zinc plays a role in the formation of red blood cells, and deficiency can lead to anemia. All things associated with preeclampsia. A 2015 study found lower zinc levels in preeclamptic mothers. [5]

Manganese: A new study, published in 2020, may possibly be bridging the gap among manganese deficiency, oxidative stress, and preeclampsia risk. This study was led by researchers at Johns Hopkins Bloomberg School of Public Health. The analysis found significantly lower levels of manganese in early pregnancy increased the likelihood of the development of both gestational hypertension and preeclampsia. [6] This is the first paper linking manganese to preeclampsia. Manganese makes up a very important enzyme called superoxide dismutase that helps to reduce inflammation in the placenta.

Vitamin D: Vitamin D is a hormone. It is formed from cholesterol in the diet which interacts with the UVB rays to create Vitamin D. It is a fat soluble vitamin in the diet, and there MUST be a fat present for absorption. We do know that Vitamin D plays a significant role in the regulation of the hormones of our body. The role of Vitamin D in hypertension is still not fully understood, but we know there is a connection between low Vitamin D preeclampsia. There is an interesting correlation between winter pregnancies (lack of sunlight) and preeclampsia rates. Vitamin D is necessary in the formation of several enzymes produced by the placenta, which are missing in preeclampsia. Vitamin D is necessary for Calcium and Phosphorus to function. Supplementing with Vitamin D is associated with a decrease in preeclampsia risk. [7] Vitamin D and K work together, and in combination with Calcium, Magnesium and Potassium. Without vitamin K, these nutrients cannot work together correctly.

COQ10: A 2003 study found a marked decrease in CoQ10 in women with preeclampsia. [8] The theory is that increasing oxidative stress “consumes” the CoQ10, decreasing mitochondrial function. Interestingly, this difference is more prominent in women living at altitude than women living at sea level, [9] and with age.

Folate/B12: Homocysteine is a byproduct of the methionine cycle. This is cycle is the “methylation” cycle and is dependent on folate and B12. [10] Homocysteine increases cardiovascular inflammation, and the decrease in proper methylation affects the stability of the placental cells and their function.

Sign up now for our BECOMING a Mother online course! Gain confidence and reduce fear in pregnancy, labor, and early parenting! We’d love to see you there!

HOW TO PREVENT PREECLAMPSIA WITH DIET

The idea that diet influences the onset of hypertension and preeclampsia is a huge component of the functional medicine approach to chronic disease. Bear in mind that the development of the blood vessels between the placenta and the uterus begin early in gestation. In prevention, it is important to begin proper nutrition prior to conception. This doesn’t mean that it cannot develop later, or that severity in symptoms cannot be prevented during gestation. The placenta is growing for several months, as your baby develops, and at any point proper nutrition can be used to grow these blood vessels properly, create healthy blood flow, and relax tense blood vessels and stabilize placental function, all to lower hypertension and preeclampsia risk.

Here are my top guidelines for preventing preeclampsia through diet.

REDUCE PRESERVATIVE SODIUM: Research shows that once you have come into a hypertensive state, you are more sensitive to sodium and will react stronger than you would out of the hypertensive state. Typically, because there is an imbalance in the sodium levels in the cells and out of the cells (in the blood). This imbalance causes a strain on the blood vessels and increases blood pressure. Preservative sodium is different than sea salt sodium, or table salt. This synthetic form of sodium is more difficult for Magnesium to transport and becomes built up in the blood more quickly. Learn to read the labels. Synthetic preservative sodium is found in most packaged products.

REDUCE EXCESSIVE AND ADDED SUGARS: In a natural and balanced diet, our body needs sugars. Fructose is a fuel for the brain, and Glucose is a fuel for every cell in our body. But in excess, or not properly balance, these fuels become toxins. In our society, we consume excessive amounts or processed and packaged foods that are full of refined flours and sugars, and typically lead very sedentary lives. These inactive lives and diets rich in unused fuels causes excessive weight gain, hormone disruptions, and internal damage. Stick to natural sweeteners, such as honey, maple syrup, and fruits and fruit juices when needing to sweeten a recipe. If you are craving sugar, it could mean that you are not consuming enough vitamins and minerals, or you are not balancing with enough fat. When your cells are malnourished, you will crave sugar.

LEARN TO LOVE FAT: Many nutritional fats work as anti-inflammatories in the body. Without a proper level of good fats in our bodies, our hormones cannot function (Our hormones are made from fats!), our brain slows down (over 60% fat), our nerves become hypersensitive to stimuli, and our cells become weak. During pregnancy fats and cholesterols are even more important. They are the building blocks of the hormones that sustain pregnancy.

TASTE THE RAINBOW, AND I DON’T MEAN SKITTLES: What I mean is embrace the rainbow of colors found in fruits and vegetables. Foods that are rich in color are also rich in nutrition. They are also higher in antioxidants. Greens, Reds, Yellows, Blues, Purples, all of these colors are associated with nutrients and antioxidants.

SPICE IT UP: Use herbs to flavor your meals. There is such an amazing array of herbs out there that not only add vibrancy to our meals, but are packed with nutrients, antioxidants, and anti-inflammatory phytochemicals. Garlic, Ginger, Turmeric, Parsley, Cilantro, Oregano, Lemongrass, Curry, Fennel, Dill, Mint, the possibilities are endless. Stimulate your body and your brain with these intense flavors, not added sugar. Many of these herbs are also important sources of pregnancy important nutrients (parsley – Vitamin K), others are specifically known to help treat hypertension (Basil, Cinnamon, Garlic, Ginger, Parsley, Dandelion)

CHOOSE QUALITY NOT QUANTITY: The adage of eating for two is a misnomer. The baby growing inside you, at the most, needs 300 extra calories a day at its biggest. What we do need is more nutrients that sustain the health of your body…not calories. Excessive meals are hard on the system and put strain on the body. Often those consuming poor diets, or nutrient deficient diets, find themselves craving more food, even though they are eating large amounts of calories (well over what they need). This is because the foods they are consuming are nutrient deplete but high in carbohydrates and sugars, and the cells are actually STARVING for nutrition. Choose nutrient dense foods and smaller amounts over large amounts of poor-quality foods. You’ll be surprised at how much your food cravings and excessive hunger go away when your cells are getting the correct amount of nutrients.

STAY HYDRATED: Water makes up the majority of our body (80+%). It is a cooling, and lubricating mechanism. When we are deficient the body can heat up and dry out, causing friction and inflammation. Dehydration also causes an increase in pain perception, and reduction in blood flow to the brain. Over time, chronic dehydration can affect the neurotransmitters of the brain. Even mild dehydration can affect your mood, causing mood swings and depression. During pregnancy, your body is making and filtering amniotic fluid, which is a combination of water Vitamin C, E, and other electrolytes. You need to consume enough for your needs, the amniotic fluid, and your developing baby. The old adage of eating for two, should really be drinking for two, which would be more accurate. A little drink to absorbing more and peeing less…. add fruit, lemon, trace minerals, etc.…to your water. Tap water is lacking in naturally occurring minerals, they are removed during filtering, and processing. Traditional peoples didn’t carry around and fill 32 oz water bottles 2-4x per day…they didn’t have to, the water they drank was more nutritional with little bits of soil and debris which aided in absorption.

Sarah Thompson founded Sacred Vessel Acupuncture in 2012, after years of working alongside western medicine physicians. Sarah has dedicated her practice to those with complicated conditions, and those seeking to improve their health. ​​She brings over 20 years of experience working directly with medical doctors in the fields of Pain Management, Obstetrics & Gynecology, and advanced studies in both Acupuncture and Functional Medicine.

Want to know more? Pick up her new book, Functional Maternity – Using Functional Medicine and Nutrition to Improve Pregnancy and Childbirth Outcomes.

 

Citations

1. Grum T, Hintsa S, Hagos G. Dietary factors associated with preeclampsia or eclampsia among women in delivery care services in Addis Ababa, Ethiopia: a case control study. BMC Res Notes. 2018;11(1):683. Published 2018 Oct 1. doi:10.1186/s13104-018-3793-8

2. Kharb S, Goel K, Bhardwaj J, Nanda S. Role of magnesium in preeclampsia. Biomed Biotechnol Res J 2018;2:178-80

3. Hofmeyr GJ, Lawrie TA, Atallah AN, Duley L, Torloni MR. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochran Database Syst Rev. 2014;6. doi:10.1002/14651858.CD001059

4. DeSousa J, Tong M, Wei J, Chamley L, Stone P, Chen Q. The anti-inflammatory effect of calcium for preventing endothelial cell activation in preeclampsia. J Hum Hypertens. 2016;30(5):303-308. doi:10.1038/jhh.2015.73

5. Ma Y, Shen X, Zhang D. The Relationship between Serum Zinc Level and Preeclampsia: A Meta-Analysis. Nutrients. 2015;7(9):7806-7820. Published 2015 Sep 15. doi:10.3390/nu7095366

6. Liu T, Hivert MF, Rifas-Shiman SL, et al. Prospective Association Between Manganese in Early Pregnancy and the Risk of Preeclampsia. Epidemiology. 2020;31(5):677–680. doi:10.1097/ EDE.0000000000001227

7. Fogacci S, Fogacci F, Banach M, et al. Vitamin D supplementation and incident preeclampsia: A systematic review and meta-analysis of randomized clinical trials. Clin Nutr. 2020;39(6):1742-1752. doi:10.1016/j.clnu.2019.08.015

8. Teran E, Hernandez I, Nieto B, Tavara R, Ocampo JE, Calle A. Coenzyme Q10 supplementation during pregnancy reduces the risk of pre-eclampsia. Int J Gynaecol Obstet. 2009;105(1):43–45. doi:10.1016/j.ijgo.2008.11.033

9. Teran E, Chedraui P, Racines-Orbe M, et al. Coenzyme Q10 levels in women with preeclampsia living at different altitudes. Biofactors. 2008;32(1–4):185–190. doi:10.1002/biof.5520320122

10. Mujawar SA, Patil VW, Daver RG. Study of serum homocysteine, folic Acid and vitamin b(12) in patients with preeclampsia. Indian J Clin Biochem. 2011;26(3):257-260. doi:10.1007/s12291-011-0109-3

 

COVID-19

COVID-19 Reduce Your Risk!

 

Reduce Your Risk by Megan Mouser, NP.
March 31, 2020

STATISTICS COVID-19
With statistics regarding the novel coronavirus changing daily (and even hourly), the most up-to-date information can come from Michigan Department of Health and Human Services as well as the Centers for Disease Control. To date, at the time of this publication, there have been over 163,000 cases in the U.S. alone with over 2,860 deaths. Michigan appears to be an emerging epicenter for COVID-19, making our efforts to reduce the spread of this virus even more emergent.

WHAT ARE WE SEEING? WHY SHOULD WE BE CONCERNED?
Locally we are beginning to see an increase in cases. Today there are 108 presumed positive tests with 119 tests pending. You can find local updates for Kent County on the Access Kent website.

With coronavirus being a new (novel) virus, very little is known about best practices. This is why you are seeing information and decisions varying day to day. The clinical picture for those suffering from this virus can range dramatically from very mild symptoms (including some with no reported symptoms) to severe illness resulting in death. Current treatment options are fairly limited, however new therapies and studies are emerging. Even with recovery from the illness, long-term consequences are possible. Coronavirus is also very easily transmitted, even without an individual ever presenting with symptoms. This is why socially distancing and practicing preventative measures is so important! In regards to healthcare resources here in West Michigan, we are preparing for a large influx of possible patients from this virus which will put a strain on our healthcare resources if we do not slow the spread. We are already beginning to see this in the metro Detroit area.

GENERAL RECOMMENDATIONS
We cannot stress enough the importance of washing your hands often with soap and water for at least 20 seconds (if not available, use hand sanitizer with at least a 60% ethanol or 70% isopropanol alcohol content), covering your mouth and nose with your elbow when coughing or sneezing, avoid touching your face, cleaning “high touch” surfaces daily, limiting your contact to only people in your household, and practicing social distancing by remaining at least 6 feet apart from anyone else if you absolutely must go out.

I also think it is important to recognize that this is a very stressful time for many of us and it is important for our overall health to make sure that we are taking care of ourselves including getting adequate sleep, regular exercise, eating a nutritious and healthy diet, getting out for some fresh air (while maintaining social distance), reaching out to our support systems, and allowing yourself some “slack” regarding loss of control and frustrations.

In regards to specific populations, this virus does pose a higher risk to people who are older or have other serious chronic medical conditions such as heart disease, diabetes, or lung disease. Women who are pregnant are also considered at increased risk, however to date limited data is available regarding this illness during pregnancy. Coronavirus has not been shown to cross into amniotic fluid or into breastmilk at this time. However, if a pregnant woman became ill with the virus, additional precautions would certainly need to be taken at the guidance of your healthcare team. While on the topic of pregnancy, we can rest assured that healthcare providers and hospital staff are working diligently to reduce the risk and spread of COVID-19. While locally there has been visitor restrictions in place at the hospitals, your support person (as long as healthy) will be able to support you through delivery and hospitalization at this time.

Infants are also considered to be more at risk for not only COVID-19, but illness in general due to underdeveloped immune systems at birth. I would encourage all new parents to continue to practice not only standard precautions (including hand washing, cleaning surfaces, avoiding sick contacts, etc.) but also to continue to restrict visitors to the home after delivery to only members of the household. While this is certainly a time to celebrate your new addition, our primary goal is a healthy baby and family!

As for older children and teenagers, we know that this is very challenging time with the cancellation of schools or daycares and changes to routines and schedules. The risks for these age groups from coronavirus continues to be present, therefore as difficult as it can be to enforce and practice social distancing, it is imperative for parents to not only model this behavior but to also help our children understand why this is necessary. In a time of uncertainty, parents can continue to lessen anxiety in children by discussing together as a family, remaining calm, and continuing to offer love and support.

As a community we all share responsibility to continue efforts to reduce the significant risk from COVID-19!

Reputable Resources:
Centers for Disease Control and Prevention
Michigan Department of Health and Human Services 
World Health Organization

Megan Mouser is a board certified Family Nurse Practitioner serving the Grand Rapids area since 2014.  Born and raised in the Upper Peninsula of Michigan, she completed her Bachelor’s of Science in Nursing through Northern Michigan University and went on to obtain her Masters of Science in Nursing through Michigan State University.  She has over a decade of experience working with infants and children in the Neonatal Intensive Care Unit, and most recently seeing both adults and children in her outpatient family practice office. She also volunteers her time teaching graduate students as an adjunct clinical faculty member with Michigan State University School of Nursing’s graduate program.  Megan is passionate about preventative medicine and creating strong relationships with her patients and families in order to provide personalized, high-quality healthcare. Megan resides in Grand Rapids with her husband Matt and two golden doodle rescues “Max” and “Marty”. In her free time she enjoys spending time with her family and friends, traveling, being in nature, cooking, and gardening.

 

Kaysie Lancaster

Staying Fit and Healthy During Your Pregnancy

My name is Kaysie, and I am currently 20 weeks pregnant. This is my 4th pregnancy and the first one where I have maintained a very healthy and fit lifestyle. I am a mom of three – 16, 13, and 7. After my last child was born I was the heaviest I had ever been and I knew I wanted better for myself. I wanted to set a good example for my children as they grew up. It took a year to lose the weight but almost 6 years to be in the best shape of my life, and I continue to maintain it!!

After I had lost the weight I competed in the NPC bikini competition in 2017 just to say I got up on stage and did it!! Even though the stage was not my favorite, the road it took to get there was what made me who I am today. I surrounded myself with women that empowered me and supported me. After a lot of hard work and dedication, I decided I wanted to be the light for someone else in a tough spot. I wanted to be the woman that supported and empowered other women to be the best versions of themselves. In 2018, I received a certification as a group trainer. Along with that, my knowledge of nutrition has put me in a place to teach others how important their food choices are along with exercise.

I think most of us know how important it is to stay healthy and fit throughout our lifetime. Whether we choose to execute this or not is the hard part. To some it comes easy and natural. To others it may be a very difficult task to complete daily. Now that you’re pregnant, it’s even more important to maintain a healthy lifestyle and some type of daily exercise.

Personally, I am in the gym 4-6 days a week and my workouts last 1.5 hours-2 hours consisting of cardio warmup/HIIT, strength training, and stretching. I eat 1700-2000 calories a day and I carb cycle two days of the week and I drink 90-120 ounces of water daily. I choose to eat organically 98% of the time.

If you’re new to exercise, I don’t recommend starting out as heavily as I do. Even though my body has been used to doing hard exercise for a long time, I keep an eye on my heart rate and don’t go over 150 per my OB’s recommendation.

Here are some tips you can try daily to ensure you continue to have a healthy and fit pregnancy.

Exercise at least 30 minutes daily
(please talk to your doctor/midwife/OB before starting a new exercise routine)

Drink at least half your body weight in ounces of water daily. If you weigh 140 you should be drinking at least 70 ounces if not more.

Eat lots of veggies, some fruit, organic grains, and limit your fat content. Stick to healthy fats like avocados and nuts. (I personally chose to buy all my foods organic.)

Stay away from sugars. Try to only consume sugars from fruits and veggies

Get a good night’s rest.

Stay positive. Surround yourself with people that support you, uplift you, and motivate you to make positive choices for you and your family.

For more health and fitness tips. follow Kaysie on Instagram.

 

Rise Wellness Chiropractic

Symphysis Pubis Dysfunction with Rise Wellness Chiropractic: Podcast Episode #90

Dr. Annie and Dr. Rachel talk to Alyssa about Symphysis Pubis Dysfunction (SPD), how to prevent it, how to treat it, and things every pregnant and postpartum woman should be doing!  You can listen to this complete podcast episode on iTunes or SoundCloud.

Hello.  Welcome to another episode of Ask the Doulas.  I am Alyssa, and I’m talking with Dr. Rachel and Dr. Annie again of Rise Wellness Chiropractic.  How are you?

Great!

So I got asked by a client about symphysis pubis dysfunction, and I’m not even exactly sure what that is, but you knew.  Right when I told you, you knew.  So can you tell me?

So SPD — sometimes people think of sensory processing disorder, which is with older kids, but in relation to pregnancy, it’s symphysis pubis dysfunction.

And what the heck does that mean?

It’s a mouthful!  So basically, where your two pelvic bones meet in the front is called your symphysis pubis, so that’s where the two bones meet together.  There’s cartilage in between there, and that area widens for birth.  So usually late second to third trimester, we’ll see some women will start having pain.  That can be related to the relaxin that’s in their system that’s helping the ligaments loosen and helping that area separate, but what we usually find is it’s more due to pelvic imbalances.  Usually one side of the pelvis is higher than the other or something like that or it’s rubbing in a weird way.  That’s usually what causes that symphysis pubis dysfunction.

So it’s strictly for pregnancy?

Yes.

And are there any ways to not get it?  Avoid it?  Treat it?

Get adjusted!

Yeah, just because if it’s caused from a misalignment —

Exactly.  Yeah, if it’s caused from pelvis imbalances, then that is directly a chiropractic issue.  It’s biomechanical.  That’s something that we can address through adjustments.  And then we also have stretches that you can do, and there’s also a Serola belt which is like an SI  belt.  It goes around your sacroiliac joints, and it’s just a low belt.  It doesn’t really do anything in terms of — it’s not like a belly band or something that you would wear to support the baby, but it does help to support the SI joints and keep everything together.  Really, it’s hypermobility in that joint that’s causing that pain.

It’s too mobile?

It’s too mobile.  Yeah, so we usually see it with not first-time pregnant moms but usually second or third, especially if they’ve had some kind of fall or something like that while pregnant.  They can injure their pelvis, and that’s usually what brings those things up.  I actually had a patient a couple weeks who came to us for SPD, and under care, she was doing great.  All her pain went away.  But she had fallen during her first pregnancy, and then during her second pregnancy, she started having all this pain and stuff come on. 

So falling during pregnancy; it’s not just like a random fall at any time in your life that could affect this?

It could be.  Pregnancy is really good at exacerbating existing issues or past issues.  Like if you’ve had any pelvic imbalances in your past and then you’re pregnant, just that relaxin is going to kind of flare things up.  Typically, what we see is pain with putting weight on one leg.  Climbing stairs is when your pelvis is moving the most, so that’s usually when a lot of the pain is flared up.

Walking; something that you don’t have to do very often.

Yeah!

Sounds horrible!

But sitting is not good for it either.  It’s one of those things that nothing is good for it.

Laying hurts; turning while you’re laying.  Like that’s not already hard when you’re in the third trimester!

Does it actually cause any more pain or discomfort during labor and delivery?

It can.  It depends on really, like, what the pelvis — because if you think of the pelvic bowl, if there’s imbalances in the pelvis, it’s not just affecting the bones.  It’s also affecting your pelvic floor muscles.  It’s affecting all of your stabilizer muscles.  So it can potentially affect how things go during labor.  I don’t know if it creates more pain, necessarily, or if it would be, but any pelvic imbalance is going to effect, probably, the efficiency of your labor.

Plus, it doesn’t necessarily clear up after.

That was my next question.

Yeah, it’s not like you deliver the baby and then it’s gone.

Because you still have that imbalance?

Exactly.

Exactly, yeah.

So then what do you do for that?  Just keep getting adjusted?

Well, it should clear.  If you’re getting adjusted, it should help clear it up while pregnant.  So I guess what we’re saying is, you should get checked if it’s happening.

I mean, it’s definitely like you have to retrain that pelvic imbalance somehow, and you do that through chiropractic adjustments or through exercises, through physical therapy, sutff like that.

Yeah.  PT floor rehab, yeah.

Probably a combination of both, right?

Right.  If you do it all, then you probably have best outcomes. 

Yeah, I don’t think we understand how important the pelvic floor is, and all we’ve learned is Kegels.  That’s not necessarily even a good thing to think.  When I saw a physical therapist for pelvic floor issues specifically, I was, like, that makes so much sense!  Even just the way we breathe; I didn’t know that my diaphragm was part of — what would that be?  The top?  The diaphragm is the top of your pelvic floor?

Yeah.  It’s the top of your —

Like the space?  I guess I can’t say top of the floor.  Your pelvic floor is the floor.

Your intrabdominal space.  So it’s like the lid, and then your pelvic floor is the bottom.  But it’s a big airtight balloon, pretty much, so when you breathe, it affects everything.  But pelvic floor is an issue that we don’t talk about, really, with women in birth, but it’s a huge thing.  Every woman who pushes out a baby has pelvic floor issues.  Every woman who has a C-section has pelvic floor issues because those are attached to your abdominals, too.  So, really, every woman should be getting some kind of rehab on pelvic floor after birth.  That’s my soapbox!

I’m in these group exercise classes, and every woman is, like, oh, jumping jacks.  I’m going to pee my pants!  I had one friend who was, like, I was working out and I didn’t know if it was sweat or I had peed my pants!  Yeah.  I get it!

Well, pelvic floor and core strength, too, are both things that get overlooked with women after pregnancy, and then we see women with back pain later, and it’s because their core is so weak.  So, really, we’re just promoting physical therapy pelvic floor rehab.  It’s what needs to be done.

And chiropractic care.  Retraining all that neurology is important.

I think even just learning about it!  I’ve done yoga classes forever, and they will say, like, during this pose, tighten your pelvic floor.  I’m, like, what the hell are they talking about?  What?  How do I do that?  But now after learning that even breathing is different and the feeling of — I hate saying Kegel because it’s not even what it is, but I guess that is the feeling of what you would do to stop your pee, but doing that during certain exercises is a whole different feeling, but I think now that I’m conscious of it, I’m, like, oh, that makes sense.  Oh, I can do that here.  Okay.  It’s gotten a lot better, but I still can’t do jumping jacks.

See?  The jumping jacks!  I don’t do them either.  They’re like, do jumping jacks to warm up, and I’m like… No.

I do the ones where I just put my hands up.  I just kick my leg out.  I’m fine with it!

It’s what everyone’s doing!  They call those jumping jills.

Is there anything else pregnant or postpartum women need to know about symphysis pubis dysfunction?

It’s not something that you need to suffer through.  There’s a lot of chiropractic studies where it helps in a lot of case studies, but also, biomechanically, it makes sense.  You don’t have to feel like you can’t walk up the stairs or sit or that you have to be in a lot of pain when you’re trying to sleep.  Find out you’re pregnant and get under care.  That’s really what we tell people. 

Tell people where to find you!

We are in East Town in the Kingsley Building right next to Gold Coast Doulas, or you can find us at our website or on Facebook and Instagram.  You can message us on those platforms.

Well, as always, thanks!  We’ll have you on again soon!

 

Health for Life Grand Rapids

Preparing Your Body For Pregnancy: Podcast Episode #84

Dr. Nave now works with queens through her virtual practice Hormonal Balance.
We talk this time about how a woman can prepare her body for pregnancy.  You can listen to this complete podcast episode on iTunes or SoundCloud.

Alyssa:  Hello!  Welcome to another episode of Ask the Doulas Podcast.  You have Kristin and Alyssa here today, and we are excited to be back with Dr. Nave, the naturopathic doctor at Health for Life GR.

Dr. Nave:  Thanks for having me again!

Alyssa:  Thanks for coming again!  Last time, we had an amazing conversation about a woman’s cycle, and today, we want to talk about actually preparing your body for pregnancy.  What do you want to say?

Dr. Nave:  Well, that ideally, we would start a year ahead.

Alyssa:  One year ahead?

Dr. Nave:  One year ahead.

Kristin:  Does that mean they should be off birth control one year ahead, or would you advice getting off of an IUD or birth control pills in advance of that year?  That’s my question because that’s something that is commonly asked.

Dr. Nave:  That’s a great question.  Even though ideally I say a year, if a woman wanted to, say, get pregnant in less than a year, then I would suggest, if she’s coming off of an IUD that has hormones in it or an oral contraceptive, to stop taking it at least three months before starting to try to conceive.  That’s because the oral contraceptive and the IUD with hormones is basically producing the hormones that your body should be responsible for making, and what women often find is that once they stop using those — because, basically, it’s suppressing the body’s own production of hormones.  She’ll find that she doesn’t have a period for an extended period of time, and I would also want her to detox her body and make sure that she’s pooping regularly, that her hormones are being made at an optimal level, and basically establishing what the normal and optimal cycle should look like.

Alyssa:  So if you’re preparing your body for a year, then that means you can stop at three months?  So the three months is just a part of the year?  Twelve months ahead of time of when you would ideally like to be pregnant, you’re going to talk about what to do; but then three months before, minimum, is when you should get off a hormonal birth control pill or IUD?

Dr. Nave: Yes, because it gives your body time to normalize your cycle and it prepares your body to actually hold a baby so that it can grow.

Alyssa:  So then what do we start doing at twelve months out

Dr. Nave:  It’s basically a multifactorial approach.  It’s stopping the things that interfere with your hormones, like oral contraceptives or getting the IUD removed.  Also cleaning up her environment, so skin care products, household items, household cleaning supplies, being more environmentally aware of the things that she’s using, the foods that she’s placing into her body.

Kristin:  If she’s coloring her hair and things like that?

Dr. Nave:  Right, if she’s coloring her hair, nail polish, things like that.  And then we would also want to address nutrition.  A lot of the foods that are really accessible, like going to fast food or going to a restaurant, are foods that promote inflammation.  They tend to be higher in trans fats and refined sugars, which are all shown to increase inflammatory products in the body.  We want to reduce that by making sure that the woman is eating more whole foods.  When I say whole foods, I mean from the earth; no one processed it.  If you’re getting it frozen, that’s fine too, as long as someone didn’t already make it into a meal, so that you have more control and autonomy over what is being placed into your body.

Alyssa:  What does inflammation do to affect fertility?

Dr. Nave:  With inflammation, we have more cortisol.  We have dysregulation of blood sugar.  We have greater likelihood of mental and emotional disorders.  It wreaks havoc on us.

Alyssa:  It’s a lot of what we talked about last time with the cycles; if you’re not having a regular period, your cortisol levels could be too high, and that disrupts everything else?

Dr. Nave:  Right.

Alyssa: And inflammation kind of does the same thing to your body?

Dr. Nave:  Right, and things that can influence inflammation is not just the food that you eat, but being in a constant high stress environment and not managing that effectively or not having tools to really take care of yourself and having self-care.  Self-care is not selfish the way that people typically think of it as being, but more so, it’s nurturing.  Nurturing of yourself.  Think of the year leading up to pregnancy as rediscovering yourself, as reconnecting to who you are, and getting in the mode of, “I am ready to carry a baby to full term.  I am ready to add a new life to my life.”  It’s getting connected to that.  Also processing your past traumas.  Mental and emotional health is absolutely important with regards to getting ready to conceive.  Ideally, I wouldn’t want someone to be seeing conception as a solution to a relational issue because it probably won’t be, and it will probably exacerbate a lot of those things.  So during that year leading up, it’s dealing with your past traumas, whether they be related to a miscarriage previously; processing what happened and how it affected you, not just trucking along to get pregnant again, but really fully processing it.  Not necessarily living in it, but not pushing your emotions aside because they are valid.  Whatever you haven’t dealt with — and this is not guilt any woman by any means — but whatever we haven’t dealt with, that influences the baby.  That influences the baby’s risk for depression and anxiety.  It influences the genes and their susceptibility to different types of conditions.  In that year, by you taking care of yourself, you’re taking care of that baby in advance, as well.

Alyssa:  The baby you haven’t even had yet?

Dr. Nave:  The baby you haven’t even had yet; you haven’t even conceived yet.

Kristin:  So what if a woman is a constant dieter?  How do you handle women who are, say, on a fad diet, if they are wanting to conceive?

Dr. Nave:  I really like the book Intuitive Eating.  It’s written by two dieticians, and before mindfulness eating was a thing, these two dieticians came together, and they were like, diets don’t work.  Diets are a lie, and I completely agree with that.  If you think that, oh, I don’t have enough will power — you’re not the one failing.  The diet is failing you, because they weren’t built to work.  They’re not sustainable, at least the diets that people often purport.  Now, I would like to reclaim the term diet, because diet just means eating.

Alyssa:  What you’re eating, right?

Dr. Nave:  Right, right.  And so if you view your diet, if you view your food, as nourishing yourself, as honoring yourself, you fully immerse yourself in the experience of eating, like smelling the food.  You eat with your eyes first, so viewing it; it’s appetizing.  You smell it; you taste it.  You savor the textures that are in your mouth and the flavors that are bursting on your tongue and really immerse yourself in that and sit in that and be mindful.  Then you have a greater connection to yourself.  You are then more apt to tell when something isn’t going well.  If a woman is a fad dieter or is using food as a coping mechanism, we would then assess what is food giving you that you are not at this time receiving.  And so talking about that, having her read the Intuitive Eating book, because it goes through what type of eater are you, and reconnecting yourself to that intuitive eater, because as children — have you ever watched children eat?  They do not sit.  They get up, they eat what they want, and then they go back around and play.  At some point, we lose that ability to tell when we’re hungry or when we’re craving something and really honoring that, and intuitive eating is all about getting back to that.  SO I would definitely work with her and address, when did this first start?  What is it giving you?  What is it not giving you?  What is your motivation for doing things in this way?   Because what is encouraged by the media as what a healthy weight looks like is very cookie cutter, and I’m all about individualized care.  If you look at someone’s bone frame and they’re really thin and they have big bones and they look sick or they don’t feel well, that’s not good.

Kristin:  And then fitness is obviously a big question many of my birth doulas clients have.  What should they do in preparation?  If I was with them for the first delivery and then they want to conceive again, what would be an acceptable form of fitness as you’re trying to conceive?  What should you do to get your body ready for birth and postpartum time?

Dr. Nave:  If you’re already exercising, just maintain it.  Don’t go overboard.  Don’t become sedentary.  Moving your body at least ten minutes per day — ideally, thirty minutes, but that thirty minutes doesn’t have to be in one chunk.  Being consistent is more important than doing things really hard and really intense in a short period of time, so if she’s already exercising, just keep doing it.  You’re doing great, Mom.  Now, if she’s excessively exercising, that could be another thing that’s causing amenorrhea.

Alyssa:  Yeah, I’ve had friends who have been extreme athletes who just don’t get their period.

Dr. Nave:  Right, because all the hormones are being turned into something else as opposed to getting turned into progesterone and having adequate levels of estrogen so that you can bleed.  And I know some women are, like, oh, I didn’t bleed for a really long time and I’m so happy, but…

Alyssa:  Our bodies do this for a reason, right?  It needs to happen.

Dr. Nave:  Right, it needs to happen.  When you shed the old — think of it as shedding the old.  It’s a new month; I’m shedding the old from last month.

Alyssa:  It’s like a natural cleaning, almost.  It’s like a detoxifying — yeah, just — it seems like anything else that stores up in your body that needs to be shed can create toxic levels of something.

Dr. Nave:  Right, absolutely.  It can create adverse symptoms.  Having too much estrogen is not the best thing in the world.  Last time, we talked about estrogen dominance and how that can influence having more PMS symptoms like bloating, for instance, and being more weepy on your period.  If you’re not having your period, then you’re basically reabsorbing the estrogen and that could by your PMS looks that way.  But I digress.

Alyssa:  I have one question before we move on to whatever you want to talk about next.  Even with, like, what we’re putting on our body and our environment — so there are things that are called hormone disruptors, things that will disrupt your hormones, right, like in the products that we’re putting in and on our body?

Dr. Nave:  Yes.

Alyssa:  What do you know about that?

Dr. Nave:  Those are parabens or phthalates.  They’re actually made from crude oil, which is refined and you can get parabens and phthalates.  You get mineral oil from it; you get the gas that you put in your car from it.  All of these things come from this product.  Why parabens and phthalates are an issue is that, basically, they act like estrogens.  Then that can be part of the estrogen dominance.  It can also affect increased risk for breast cancer.  It can affect mental and emotional health because remember I said that estrogen can increase weepiness or having a lower mood on your period.  Ovarian cancer; you have an increased risk for that because it’s an exogenous estrogen.  It acts like estrogen; technically it’s not estrogen, but our bodies respond to it in that way, which can also lead to extra weight.  On the topic of weight, if you want to lose weight before getting pregnant, you would want to do that in a year before trying to conceive because with exposures to things like parabens or phthalates, which — technically, they’re solvents, so you would usually pee them out; however, if you have higher levels of them or if you’re being continuously exposed to it, our bodies store it as fat.  Then, when you’re trying to lose the weight, you’re releasing it back into your bloodstream, which can create symptoms like headaches or feeling really lethargic when trying to work out.  It’s not necessarily because you’re working too hard, but it could because your body is working on detoxifying or biotransforming these things so that they’re no longer toxic to you so you can pee it out and poop it out.

Alyssa:  So if you need to lose weight, that needs to happen before this twelve-month timeframe of detoxing before you get pregnant?

Dr. Nave:  It can happen in that twelve months.  You can start it before that because then you don’t have as much to do during the twelve months.

Alyssa:  But it should be one of the things that you’re thinking about a year ahead of time?

Dr. Nave:  Yes, because there are so many things that we use on a daily basis that, if we really thought about them, I think most of us would be scared to leave our homes, but we have to live, you know.  We need things in order to live efficiently and not work as slow, I guess.

Alyssa:  Well, if you think about the chairs we’re sitting on.  These are as eco-friendly as we could find, but the majority of them — there’s sprays on everything.  I looked at the new pajamas I got my daughter, and it said the flame retardant — it said that I can’t wash it in soap because the flame retardant will come off.  I was like, no.  I’m washing it.  I’m washing all the flame retardant off, actually.  But you don’t think about that.  My daughter needs a new nightgown.  You buy her a nightgown, and it’s covered in a chemical so that it doesn’t go into flames.

Dr. Nave:  Yeah.  Another of the things that the woman can do to help get herself ready before even consulting with a physician is that, with regards to environment medicine, opting to eat the dirty dozen — you can look at www.ewg.com, so that’s the Environmental Working Group.  The release the dirty dozen each year, and these are the fruits and vegetables that are the most heavily sprayed.  Opting to eat those things in season and organic, as opposed to nonorganic, and what that will do for you is — pesticides have solvents, which parabens and phthalates are a type of solvent, so they have some of those components to them.  By opting for organic fruits and vegetables that are on that dirty dozen, you don’t have to do all your fruits and vegetables organic.  Preferably, if they’re thin-skinned, like if you eat the skin of it, like tomatoes and strawberries and berries, you would want to opt for organic, but if not, at least the dirty dozen.  Make sure those fruits and vegetables are organic because those pesticides have the endocrine disruptors.  They’re things that affect your estrogen and your progesterone, and it’s not just those things it affects but your overall well-being.

Alyssa:  So because it’s disrupting hormones, it can affect your ability to get pregnant, but let’s say even while doing all this, you get pregnant.  It’s essentially affecting, again, your growing baby?

Dr. Nave:  Yes.

Alyssa:  Because you’re disrupting the hormones that the baby is using to grow?

Dr. Nave:  Yes.  So if you’re already pregnant, don’t freak out.  Don’t try to lose weight.  That’s one, because you’re pregnant, so your body is trying to use all the energy to make baby, as well as the fact that we don’t want to release any of the stored toxins in your fat to the baby.  What you can do is, if you’re going to eat fish, make sure it’s not one that’s high in mercury.  Avoiding things like swordfish, and if you’re going to eat tuna, make sure that — I think it’s albacore tuna, but don’t quote me on that — you can look at the Environmental Working Group, and there are other resources as well that list out the fish that are lowest in mercury.  Looking at your skin care products and, as much as you can and as much as is possible, avoiding shampoos and skin care products that have parabens or phthalates or sulfates in them.  It’s also because sulfates rub down your skin and it’s not as moisturizing.  We want you to look glowing and magnificent!  You can avoid those things in your skin care products and your household items and the food that you eat.

Kristin:  So cleaning products, obviously, as well?

Dr. Nave:  Yes, cleaning products.  And if anything has any fumes and you have to spray it, make sure that you have all the windows and doors open so it can air out.  If you get your clothes dry-cleaned and you have a garage, leaving them in the garage to off-gas before taking them into your house.  If you don’t have a garage, if you have them in a room where you can remove the plastic and open the door and let them air out so that you’re not exposing yourself to those fumes.  Just do that.  And then after the fact, then we can address those things then.

Kristin:  And then they would meet with you for a consultation preconception to try to get their body as healthy as possible?

Dr. Nave:  Yeah, and even if she is already pregnant, what can we do to maintain the pregnancy while also minimizing her exposure to these environmental toxins.  And her addressing her mental health during that time, if she hasn’t already started that process.  Is she eating adequate amount of calories?  Since we’re on the topic of nutrition, prenatal vitamins — you would start that at a year out.  A year ahead of time.

Kristin:  And, obviously, food-based versus the generic that you get at the normal doctor’s office?

Alyssa:  Yeah, you know, you get free prenatals at the pharmacy but they’re basically junk.

Dr. Nave:  We have very good-quality ones as naturopathic doctors, and I think DOs also have really high-quality ones, as well.

Alyssa:  So for somebody who can’t afford it, what are those over-the-counter free prenatals doing?  Are they doing any good?

Dr. Nave:  Yes, because they have folate and they have an adequate number of B vitamins.  It’s like a multi that’s specifically geared towards not only the mother’s health but also making sure that the baby can develop well.  Folate is the one that I’m most thinking about at this present time because folate is important for neural development, like the spinal cord.  What happens if there is insufficient or no folate is that the neural tube doesn’t close, and then that can cause spina bifida, which is a preventable condition if the mom is getting adequate vitamins.  Folate is B9.

Alyssa:  Oh, folate is a B vitamin?

Dr. Nave:  Yeah, it’s a B vitamin, so it’s a water-soluble vitamin that’s very important for the neural tube development.

Alyssa:  So my best friend found out she has this, and what’s the name — your body can’t absorb folate.

Dr. Nave:  Oh, right.  I know what you’re talking about.

Alyssa:  So she actually had a really hard time getting pregnant because she was taking too much folic acid.  But if you don’t know you have this, then…

Dr. Nave:  If you don’t know you have it, if possible, choosing a supplement that has methylated B vitamins, so methyl folate as opposed to hydroxylated folate is better.  What Alyssa was talking about is call MTHFR.  It’s methylenetetrahydrofolate reductase, so that’s an enzyme that basically, when you take in folate, for most people, they can then attach a methyl group to it, which makes it bioactive. There’s this cycle that you need methylation to occur in order to make the B vitamins active, which is important for making your red bloods cells, which is important for energy production, which is important for getting energy from your food.  B vitamins — I think of them as, like, the power house side kick.  Almost every enzyme in the body requires B vitamins.  I have this lovely chart right here that shows the citric acid pathway, basically the utilizing our food to make energy pathway, and almost every single step in here requires two or three different types of B vitamins.  There are even B vitamins that are enzymes themselves and carry things along.

Alyssa:  You love B vitamins!

Kristin:  So the free prenatals are helpful, just not…

Alyssa:  It’s better than nothing?

Dr. Nave:  Yes, it’s better than nothing, but if possible, there are different brands that we use as naturopathic doctors that you can probably try to get on Amazon, like Ortho Molecular or Integrative Therapeutic Initiative, I think is the name of it, ITI.  SO I know those are pharmaceutical-grade, and when I say that, I mean that they have enough of the vitamin.  It’s beyond the recommended dose, like what the government says this is minimally what you need, and it’s of good therapeutic value, so we know that it will do what it says it’s going to do.  They tend to have more of the methylated form, so whether the mother has a different time methylating her B vitamins, or if she doesn’t, it takes out more work for the body to do so then it can go right to where it needs to go.

Alyssa:  That’s fascinating!  Is there anything we didn’t touch on?

Dr. Nave:  I don’t think so.  We talked about environment medicine and reducing your exposure.  We talked about nutrition and making sure you’re getting enough calories.  Oh — fish oil, vitamin D3, specifically, vitamin D3, because that’s the active form, and prenatal vitamins with regard to eating whole foods.

Kristin:  We don’t get enough vitamin D in Michigan anyway, and I know that — and, again, I don’t have a medical background, but I know a lot of research on preeclampsia shows a lack of vitamin D3.

Dr. Nave:  Yes.  Another thing about preeclampsia is calcium and magnesium.  If a woman starts to experience preeclampsia, making sure that — sometimes, it’s due to an electrolyte imbalance and not getting enough protein, so we would want to look at how much protein is she getting.  The ratio that we usually look for is at least 0.8 to 1 gram of protein per kilogram of weight, so however many pounds you weight, divide your weight by 2.2, and that tells you how many kilograms, and then it’s 0.8 to 1 gram per that number that she should be getting.  If she’s getting adequate protein and has enough calcium and magnesium, then she shouldn’t get preeclampsia.  If she has a history of hypertension, making sure we’re managing that, whether naturally or if she’s taking medication, as long as it’s not one that would interfere with conception, would help to prevent it from happening.  But even if a woman experiences preeclampsia, it doesn’t automatically mean that she will get eclampsia because we can still, at that point in time, address what’s going on.

Alyssa:  Right.  Well, thank you so much.  I just feel like we could keep going and going.  You probably have 80 other topics we could talk about.  We’ll just have you back once a week!

Dr. Nave:  Oh, I’d be down for that!

Alyssa:  We’ll set up a couple more!  Well, tell our listeners where to find you if they want to reach out.

Dr. Nave:  You can find me at our website, and you can find me on Instagram, @drgaynelnavend, and I’m also on Facebook at the same handle.

Alyssa:  Great!  Thanks again!

 

Dr. Nave Health for Life Grand Rapids

Understanding Your Cycle: Podcast Episode #82

Dr. Nave now works with queens through her virtual practice Hormonal Balance. She talks with us today about a woman’s monthly cycle. What’s “normal”?  What if you don’t get a period at all? Is PMS a real thing?  You can listen to this complete podcast episode on iTunes or SoundCloud.

Alyssa:  Hello, welcome to Ask the Doulas.  I am Alyssa, and I’m here with Kristin.  Our guest today is Dr. Nave, who is a naturopathic doctor at Health for Life Grand Rapids.

Dr. Nave:  Hi!

Alyssa:  We were excited to meet you – what was it, a few weeks ago?  We presented to your team, and you – I was really intrigued.  Tell everyone what you specialize in as an ND, and then they’ll know why I wanted to talk to you so bad.

Dr. Nave:  I am especially excited about assisting women to reconnect to their identities, and the way in which I do that is by really looking at their hormones, their mental health, their physical health, and other aspects of their life.

Alyssa:  Do you only work with women?

Dr. Nave:  No, I do not, but my passion is women.

Alyssa:  So today you’re going to talk about cycles, and I know you have a couple specific thing about a woman’s cycle that you want to talk about, so explain what those are, and then let’s just dive in.

Dr. Nave:  Okay.  I want to talk about what a typical cycle should look like, so this is how your cycle should look if nothing is going wrong.  And then we’ll transition to talking about PCOS and what is going on with that.

Alyssa:  And what does PCOS stand for?

Dr. Nave:  PCOS is polycystic ovarian syndrome.  In medical terminology, a syndrome just means a cluster of symptoms that fit this particular diagnosis, and so with PCOS, what’s happening is that the woman isn’t bleeding or she has skipped periods, and that is due to low progesterone, which is an important hormone that allows the endometrial lining, basically, in the uterus so that implantation of the fertilized egg can happen.

Alyssa:  Okay.  So let’s talk first about what it should look like.

Dr. Nave:  Sure.  With our cycle, there are five main hormones that influence a woman’s hormonal cycle.  We have LH and FSH, which are the hormones that are produced by the brain to tell an egg to mature and to allow the endometrial lining, which is basically the build-up of tissue in the uterus that allows the implanted fertilized egg to become a baby.  So we have those two hormones that are produced by the brain, and then we have estrogen, testosterone, and progesterone that are produced in the ovary.

Alyssa:  All the time, or only if an egg is implanted?

Dr. Nave:  At specific times.  A typical cycle, in terms of what we would call the normal cycle or the optimal cycle, would be a 28-day cycle.  We have some leeway in terms of, in the medical community, how we diagnose whether it’s too long or too short, whether it be above 35 days or less than 21.  For me, I think it’s best if it’s 28 days because it’s kind of like cycle with the moon, so the lunar cycle, because it also helps with the math.  So we’ll just use 28 for the typical just for explaining what happens.  In the first 14 days, that’s what we call the ovulatory – like, the building up of estrogen.  The brain tells the ovary, by way of follicular stimulated hormone, FHS, to make one of the eggs mature.  So it’s like, hey, ovary, let one of these eggs become the mother, so to speak.  The brain does that, and then the ovary responds by allowing one of the eggs to become mature. We have multiple eggs that are responding during this time in different life stages, but the one that is the oldest usually gets picked, in terms of its life phase.  It becomes mature; the estrogen is being made by the egg itself, which allows for that ovulation to occur.  FHS tells the egg to become mature, and then the egg itself makes estrogen so the egg can further mature.  It’s a fascinating, interesting thing that’s happening.

Alyssa:  That’s during ovulation?

Dr. Nave:  Yes, so during the first 14 days of your cycle, the estrogen is building up so that the egg can fully mature.  Then what happens is that there are two types of cells that are a part of the egg.  One produces estrogen, and the other aspect makes testosterone, so those are the other two hormones that we’re talking about.  Once the egg matures and it’s released, the thing that’s left behind is called the corpus luteum, also known as the yellow body.  That then makes progesterone.  All of this is sort of happening at the same time, so we say 14 days for the ovulatory phase, but really, it’s like the brain is telling the body to make progesterone at the same time it’s telling the body to make estrogen.  It’s just that it’s at a lower level.  Until the egg is released.  You don’t really have that progesterone being made.

Alyssa:  It’s ebbing and flowing based on the day of your cycle?

Dr. Nave:  Yes, yes.  Around day 14 is when the egg is released.  It’s the highest level of estrogen at that point in time, and then the yellow body that’s left behind – the brain told the egg, by way of the luteinizing hormone, LH, to start making progesterone.  Are you following?

Alyssa:  Kind of, yeah.  In my head, that little egg is moving along, following a timeline.

Dr. Nave:  Right!  At day 14, we have the highest estrogen, and progesterone starts to climb up.

Alyssa:  And estrogen is decreasing and progesterone is increasing?

Dr. Nave:  Yeah, estrogen is at its peak; progesterone starts to spike up a lot more.  I’m grossly simplifying it, sorry!  As the progesterone is being built up – so the corpus luteum is making the progesterone because the brain told it, hey, make progesterone by way of the LH, the luteinizing hormone.  That causes, then, the endometrial lining in the uterus to build up so that implantation of the egg can happen.  Towards day 28, which is when you expect bleeding to occur – basically, the reason why bleeding occurs is that the progesterone starts declining at that point because progesterone is necessary for the build-up of the uterine wall so that implantation can happen, but if there’s no fertilization off the egg, then it basically is a withdrawal of the progesterone, and then it just sloughs off.

Alyssa:  So day number one is not the – is that the day your period starts?

Dr. Nave:  Yes.

Alyssa:  So day 28, then, is the day before you period starts?  Okay, I’m seeing the timeline in my head.

Dr. Nave:  Yeah.  Day one, when a doctor asks a woman, okay, what’s day one of your period, he or she is technically asking, when’s the first day of your bleeding.  Technically, we’re always cycling, but we consider day one the last time you bled.  That’s what the cycle should look like.  Now, when we experience our periods, even though people consider it the status quo that we experience PMS, we don’t have to experience it.  Does that make sense?

Alyssa:  The hormonal changes don’t necessarily mean that we’re going to have the mental and – becoming angry or disorganized or frustrated?

Dr. Nave:  Yeah.  Seeing those symptoms for a woman, that would indicate to me that maybe the ratio is a little bit off.  Some examples are acne or being really bloated.  Being bloated, puffy, having water retention and having really heavy bleeding – that could be a sign that the woman is experiencing what we call estrogen dominance.  Now, estrogen dominance doesn’t necessarily mean that she has high estrogen.  It could just mean that her progesterone is low and therefore throwing off the ratio so that when she’s experiencing premenstrual syndrome, PMS, she’s experiencing these symptoms, even though if it were normal, she wouldn’t have to.

Alyssa:  So you’re not saying that PMS is made up.  It’s a real thing; it just means there’s an imbalance somewhere?  It can be fixed, that you don’t have to deal with this stuff?

Dr. Nave:  Absolutely.  And the weepiness: estrogen.  Estrogen is important for our bone health, our cardiovascular health.  It’s the reason why we as women don’t get heart attacks until much later in life because it protects our hearts; it’s important for our bone health, which is why when you experience menopause or perimenopause, it’s very important to get your bone density checked.  That’s the importance of estrogen.  And then testosterone, which is produced by the egg, is important for sex drive and being able to be aroused.

Alyssa:  What happens in a woman’s body when they’re aroused that helps with implantation?

Dr. Nave:  When the woman is aroused, that allows the cervix to sort of pulsate so that when climax is achieved, the sperm can travel up into the uterus and, hey, let’s get to the egg wherever it is.  It also allows for the vaginal canal, which typically is around three inches, which sounds crazy, but it actually lengthens and stretches.  It’s a muscle that moves to accommodate the penis, if you’re having that kind of intercourse, or allow for artificial insemination in that way.  So it increases the likelihood of implantation successfully occurring.  It’s so cool!

Alyssa:  We’ll pause so everyone can visualize!

Dr. Nave:  Our bodies are amazing!  In order for conception to occur, not only do the hormones have to cycle how they should, but you have to address your mental health; are you in the space that you can have intercourse or whatever it is?  The ovary itself isn’t even attached to the uterus.  There’s a gap between the two of them, and we have chemotaxis – basically a chemical, like how your body produces the hormones, that attracts the egg to go down the fallopian tube as opposed to staying in your abdominal area.

Alyssa:  So every time you see a picture, it looks like…

Dr. Nave:  They’re attached?  Yes.  But they’re not.

Alyssa:  So they have to let go and then actually be drawn up by the fallopian tube and then into the uterus?  They’re not attached?

Dr. Nave:  No.  We have connective tissue or fascia that’s in that area –

Alyssa:  Which helps kind of push it in the right direction, probably?

Dr. Nave: Not exactly.  It’s more like it creates this compartment so that your uterus isn’t just floating around in your abdominal cavity.  We have this connective tissue that anchors it in that area so there’s less likelihood that a fertilized egg will end up outside of the uterus, which is why ectopic pregnancies are so low in terms of their incidence.  But we also have these finger-like projections in the fallopian tube that brushes the egg along.  So it’s not just the hormone that’s attracting the egg to where it needs to go and we have all these other signaling processing that are working.

Alyssa:  I’m picturing a crowd surfer pushing it along.

Dr. Nave:  We’re all supporting you!  So that’s what a normal cycle should look like.

Alyssa:  Ideally, that’s what it should look like?

Dr. Nave:  Yes, ideally, that’s what it should look like.

Alyssa:  And when a woman doesn’t have her cycle?

Dr. Nave:  When she doesn’t have her cycle, then we have to consider two different things.  Is it that she’s not bleeding at all, which we call amenorrhea, or are there greater than 35 days between each cycle, in which case we call that oligomenorrhea, or many menses, technically.

Alyssa:  It seems like it would be the opposite because there’s a big space between.  But either way, it’s a problem, and that will help determine how you treat it?

Dr. Nave:  Yes.  And so if it is that a woman isn’t bleeding, as in amenorrhea, then we have to consider why is that the case.  Is it that she’s pregnant?  That would be the first thing to assess.  Is she pregnant?  Okay, she’s not.  What exactly is going on?  One particular condition that I’ve been hearing or rather seeing more women experience is called PCOS.  We mentioned it earlier, that PCOS stands for polycystic ovarian syndrome or Stein-Leventhal syndrome.  Basically, what’s happening is that instead of the progesterone going up around day 14 to day 28, instead of it increasing, the body is changing it into another type of hormone.  Just to give you some context, our bodies use cholesterol to make all our steroid hormones, which are all our sex hormones as well as cortisol.  Our bodies use the cholesterol and then turn it into pregnenolone which is like the mother of all of those hormones. Pregnenolone can then become progesterone. It can become testosterone.  It can become estrogen, which we have three different types of estrogens, or it can become cortisol.  In PCOS, what’s happening is that instead of the pregnenolone going down to becoming progesterone, it’s getting turned into either testosterone, estrogen, or cortisol.  A woman who potentially has PCOS or has been confirmed with that diagnosis – in addition to having amenorrhea, for her to be diagnosed with it, she also has to have two out of three symptom criteria.  We have what’s called hyperandrogenism, which is high testosterone, and some of the symptoms she could experience would be cystic acne or hirsutism, which is just a fancy term for hair in unwanted places, like coarse, thick hair along your hairline or along your breast or in places that aren’t typical areas that you have hair distribution.  That’s one, and then the amenorrhea that we talked about, and the last one is seeing cysts.  The only way that we can really assess if there are cysts in the ovary is if we do a transvaginal ultrasound.  I say we, but not me, but the actual tech would do that for you, and basically, they place a probe inside the vaginal canal, and they use an ultrasound on top of the abdomen to visualize if there are any cysts in the ovary.  The reason why we get the cysts – to back up again to looking at the cycle, instead of the egg being released, the egg just stays there, because you need the progesterone to tell the egg, hey, release.

Alyssa:  It stays where?

Dr. Nave:  It stays in the ovary.  And then in the ovary itself, you have all these eggs that look like they’re just about to release, but they end up forming what’s called a cyst.  It can be fluid filled.  Cyst is just a fancy term for a ball, kind of.

Alyssa:  I didn’t know a cyst could be an egg that didn’t move.

Dr. Nave:  That didn’t move, yeah.

Alyssa:  So when people say they’ve had ovarian cysts burst, it could be an egg that didn’t move?  Could be, doesn’t have to be?

Dr. Nave:  Could be, doesn’t have to be.  It could just be fluid.  But in the case of PCOS, it’s like the ovary doesn’t release the egg, so it becomes mature, kind of, but not to the point where it actually releases because we don’t have any progesterone, or there’s minimal levels of progesterone so that if and when a woman experiences bleeding, if she has PCOS – so long cycle or no bleeding at all – in the long cycle aspect of things, there’s no egg.  It’s just blood or tissue that got to build up a little bit.

Alyssa:  So the egg still is stuck in the ovary?

Dr. Nave:  Yes.  I mean, you could have some release at some point if her progesterone can get high enough that that can occur, but it’s kind of scattered.  You can’t really track it per se because it’s insufficient.

Alyssa:  So she’s having them, just not – I guess 35 days instead of 28 – wouldn’t most women just go, oh, that’s no big deal; I just have a long cycle?  What are the other symptoms?  What else would they see?

Dr. Nave:  She could have the symptoms of PMS but never actually bleed.  So she’s still cycling, because remember you’re still cycling, always, whether you bleed or don’t bleed; the hormones are still doing their thing.  She can experience the PMS symptoms but not bleed, which means that she’s not able to get pregnant.  And even if you don’t ever want to get pregnant, our uterus is what I like to call an emunctory.  An emunctory is basically an organ that our bodies use to detox or remove toxins.  If we are not bleeding, that means those hormones are getting reabsorbed into our bodies, which for a woman, if she’s estrogen-dominant, it basically reinforces the estrogen dominance because she’s reabsorbing it in her intestines, which makes the symptoms to get worse.  Because to get rid of our hormones, once they’ve done their thing and we’ve shed our lining and we bleed, the other way in which we get rid of our steroid hormones is by poop.  So if you’re not pooping, then…

Alyssa:  Is that another symptom or side effect?  Is that a cycle issue, or not?

Dr. Nave:  It could be a cycle issue.  One of the symptoms that women sometimes experience is when they’re on their periods, either they’re constipated or they have really loose stool, and that’s because of hormones.

Alyssa:  They call it period poop, and I never knew why.

Dr. Nave:  Yeah, it’s because of the hormones.

Alyssa:  So it’s normal?  If you’re having a regular cycle and you have a day of poop that’s not normal, it’s just your hormones?  That’s normal?

Dr. Nave: Normal in the sense of it’s to be expected with what you’re experiencing, yes.  Other things that can happen with PCOS, and this is not with every woman, is that some women gain weight.  Some don’t.  For a woman that does gain weight if she has PCOS, what’s happening is that the body is converting the progesterone into cortisol.  And cortisol is the hormone that affects our sleep-wake cycle.  So when you first wake up in the morning, the reason why you’re fully awake is cortisol.  It spikes at that point.  What happens when we’re under a lot of stress, or if you have PCOS, our bodies are making a lot more cortisol, and that cortisol allows for the breakdown of stored glucose and the conversion of other proteins and fats into glucose.  This issue with that happening for prolonged periods is that the woman can experience what’s called insulin insensitivity, so her body is no longer able to respond to insulin, which means that when she eats, then she can’t stabilize her blood sugar, which means that the sugar stays longer in the bloodstream, which causes damage to small blood vessels and nerves, which is what happens in diabetes.  That’s why for a woman with PCOS, having metformin might work, which is why some doctors place a woman with PCOS on metformin to increase her chances of conceiving.  It’s not just the hormones that affect your cycle; hormones influence every aspect of our lives, from the moment we wake up and take our first breath to the moment that we pass on into the next life.  It’s this orchestra that each hormone has a part to play and influence each other in term of how effectively each part is able to do their part.

Alyssa:  So let’s say I came in and I had questions about my cycle.  What’s the first thing that a woman could expect?  Bloodwork?

Dr. Nave:  The first thing I would want to know is what labs she’s already gotten done.  Has she gotten her thyroid checked?  And when I say thyroid, I don’t just mean THS because THS is just your brain telling your thyroid, hey, make the thing.  It’s also looking at the levels of the thyroid hormones because you have two types of those.  You have free T3 and free T4.  Their ratio is also important.  So thyroid function; CBC, which just stands for a complete blood count.  It’s checking for anemia, because that could be another reason for amenorrhea.  You may not be bleeding because you’re iron deficient.  And then I would also want CMP.  That’s a complete metabolic panel, and that looks at the kidney and liver function, which are affected if blood sugar isn’t being regulated effectively.  On the CMP, there’s also a fasting blood glucose on there, so that would be something to look at.  I would also want to review her symptoms.  What symptoms are you experiencing?  Are you experiencing acne?  Are you experiencing bloating and irritability on your menses?  Do you experience depression on your period?  There’s also the consideration that we have PMS, and then we have PMDD, which is premenstrual dysphoric disorder, which is basically PMS on steroids.  It’s like the cycle overall is so horrendous that the woman can’t go to work.  It’s affecting her daily life, affecting her mental health.  She’s more depressed on her period, more irritable, or really angry, or in so much pain that she can’t leave her home.  Looking at her as a whole person is what I’m about.  And she’s the expert in her experience, right?  She knows what it’s like to walk in her body, to experience these symptoms, how they affect her life, and then both of us taking our expertise to work together to get to the root of why this is happening and give the body the tool that it needs so it can rectify it.

Alyssa:  You just reminded me that I need to make an appointment with you.  I remember when I met you the first time, I was like, yeah, I need to see her, because not only have I turned 40, but I know my hormones are changing.  My periods are changing.  Just weird things happening.  So how do people find you?  What’s the best way to get ahold of you?

Dr. Nave:  I am at Health For Life Grand Rapids, and you can check the website and look for my page.  There’s a 15-minute free meet and greet and consult, so we can see if we’re a good fit.  I can hear about your concerns, and you can get the cure that you need.

Alyssa:  I love it.  Thank you so much for joining us.  We’re going to have you on again, and we’ll talk about some other intriguing topics.  Again, thanks for tuning in. This is Ask the Doulas Podcast; you can always find us on our website and on Facebook and Instagram.  Remember, these moments are golden.

 

Pregnancy Yoga

Pregnancy Shouldn’t Be Painful

Gold Coast is thrilled to present a guest post by Sally Talbot, PT, Senior PT and co-owner of Health Motion Physical Therapy.

Pregnancy is a wonderful and amazing time.  However, creating a new life does create some major changes in the body. Pain in different areas during pregnancy is a common complaint. Physiopedia.com states that back pain occurs in 60-70% of pregnancies. While pain can be common, it is NOT normal and does not need to be tolerated. Pain can be stressful, and we know that increased stress for a mother can cause increased stress for baby.

Pain with pregnancy is not normal, and something can and should be done about it. Physical therapists are very helpful at safely decreasing pain and increasing function in pregnant women, helping them have a more enjoyable experience.   

Here are some common pain complaints often associated with pregnancy and how PT can help: 

Low back or sacroiliac pain:  With increased weight gain (all out front), the center of gravity shifts and pulls the back into more of an arched position. Try standing this way – it is not comfortable. Also the abdominals are weakened due to being stretched with the increasing size of baby. This causes more work for the lower back. It is also common for the pelvis to become mal-aligned during pregnancy due to increased ligament laxity. All these factors put more stress on low back muscles and joints and can cause pain. Physical therapy can restore alignment of the back and pelvis and loosen tight muscles and strengthen others to make sure you can feel your best. 

Mid back pain: Increasing weight of the breasts requires more work from the mid back to sit up straight and to lift and carry things. This overwork can result in pain and, if left untreated, it can continue well into the postpartum period, especially if mom is breastfeeding. Holding that newborn is harder than it seems. Physical therapy can assure that the joints of the upper back are moving well, loosen tight muscles, and stretch others to help improve posture and decrease pain. 

Groin and pubic symphysis pain: Later in pregnancy, as the baby drops lower in the pelvis, there is more pressure on the pelvic joints (SI joint and pubic symphysis) and nerves that serve the groin and legs. This can cause pain, making it hard to walk or turn in bed. Weakness or muscle imbalance can contribute to this and make it worse. This is the one diagnosis that most people think that they have to live with – not necessarily true…..  Maintaining good pelvic alignment is key with this – PT can do that as well as recommend positions and strategies when that new bundle of joy gets on your nerves literally.   

Headaches: Headaches can be more common with pregnancy due to changes in posture, increased weight of breasts, hormonal changes, or general fatigue. Tight muscles and weak muscles will make these headaches worse. Even if headaches are hormonal, treatment to the muscles and joints of the neck and upper back can lessen the severity and intensity of the headaches and the need for medication.  

Carpal Tunnel Syndrome: Numbness in the palm of the hand focusing on the thumb and first 2-3 fingers can be a common complaint later in pregnancy, especially at night. Increased fluid retention can cause compression of the nerve that passes through the carpal tunnel in the wrist. This can be greatly improved with physical therapy 

How PT can help. A physical therapist will be able to thoroughly evaluate the issue you are having and locate the source of the problem and all the contributing factorsThey will then create a specialized program to correct the cause of the issue and help you adjust to the changes that your body is going through. This program will includemanual therapy to loosen tight muscles or align the spine and pelvis better, modalities (such as electrical stimulation – yes it is safe!) to speed healing and recovery and provide pain relief, positioning or bracing solutions if needed, and exercises that will help the body keep up with the increasing demands of the pregnancyPhysical therapy decreases the need for medication and missed days from work/life. Help is available. 

If you are having pain and wonder how/if physical therapy could help you, call and a come in for a free consultation. Just mention that you saw this blog post. You can also schedule through the website at healthmotionpt.com.   

Health Motion Physical Therapy
South East: 3826 44th St, SE Kentwood, MI 49512  616-554-0918
North East: 3001 Fuller St NE Grand Rapids, MI 49505  616-451-4284

Remember PT is safe for mom and baby.  You don’t have to hurt.  

 

high risk pregnancy

High-Risk Pregnancy Support

Being on bed rest can be challenging. I know this from personal experience, as I was on bed rest for several weeks with preeclampsia during my first pregnancy. I was lucky enough to live above the Electric Cheetah at the time. The staff delivered healthy meals to my door when my husband was at work. They treated me like family. I could have used an antepartum doula back then.

Gold Coast Doulas want women to feel supported and secure during this time in waiting. We offer antepartum doula services in the home and in the hospital. Our trained and experienced doulas can offer the following services: in home childbirth education, sibling care, errands, baby shower planning, nursery set-up, meal preparation, light housekeeping, laundry and more.

We offer practical and emotional support focusing on the needs of the mother and her family! Call today for a free consultation. 616-294-0027

Posted by Kristin Revere