Contraception Options

Women use contraception for many reasons, but the primary reason is to prevent pregnancy.  There are many options for contraception and some options are more effective than others.  Choosing the right method for YOU can be confusing at first, but a conversation with your midwife or provider can help.

 

Natural Family Planning/Fertility Awareness:

1 in 4 women will be pregnant within a year using this method.  The sad, tired, worn out joke goes:  What do you call couples that practice Natural Family Planning?  Answer: Parents.

 

Natural Family Planning involves a commitment to learning about your cycle, reading your body signals daily, and a commitment by both partners to practice abstinence during your fertile periods.  This method can be highly successful for motivated partners.

 

Barrier Methods: 1 in 4 women will be pregnant within a year using this method, but you can purchase these over the counter without a prescription from a provider.

 

Diaphragm:  The only diaphragm on the market currently is the Caya.  It is a one-size fits all diaphragm that can be purchased over the counter at pharmacies.  Coupled with a spermicide, it can be effective if used properly.  This is a great option if you do not wish to become pregnant, do not want an implant inside your body, and are willing to use the Caya every time you have sex.

 

Condoms:  This method has the benefit of protecting against sexually transmitted infections.  Your partner must be willing to use the condom every time you have sex.  The downside is that they can break, leak, slip, or just not be used.

 

Hormonal contraception options: About 1 in 15 women will become pregnant within a year using these methods.  All of these methods require a prescription by a provider, but there is legislation in some states to make some of these methods available in the pharmacy without a provider visit.

 

Pills:  The tradition birth control pills contain two hormones, estrogen and progesterone.  The Mini Pill contains only progesterone.  They do have a slight increased risk of blood clots, so your provider will investigate your medical history and ask questions related to migraines, heart disease, blood clotting disorders, seizures, and other medical complications.  The pills are very effective if taken every day, but missing even one pill can cause you to ovulate and place you at risk of pregnancy.

 

Patch: If you choose the patch, you place a new patch on your skin every week for three weeks.  The fourth week you do not wear a patch and you get your period.  The hormones in the patch are both estrogen and progesterone.  If you are overweight, the hormones might not work as effectively for you due to absorption issues through the skin.

 

Ring:  The NuvaRing is a soft plastic ring that you can place in the vagina for three weeks.  The hormones estrogen and progesterone slowly absorb into your body.  The fourth week, you remove it and have your period.  Some women love the convenience and some women report being able to feel the ring in the vagina.

 

Depo Shot:  The hormonal method of birth control that has the greatest documented side effects is the Depo shot.  It is an injection of high dose progesterone that you get every 3 months.  For the first 3-6 months you can have very irregular spotting and bleeding, but usually after the 2nd or 3rd dose, your periods go away.  It can take 18-24 months for your fertility to return after you stop the Depo shots.  Major side effects include depression and weight gain.

 

Long Acting Reversible Contraception (LARC): <1 in 100 will get pregnant using these methods.  They are as effective as tying your tubes but completely reversible.

Nexplanon:  The Nexplanon is a small plastic rod that is inserted into your arm.  It stays there for 3 years, slowly releasing progesterone every day to keep you from ovulating.  The side effects can include unpredictable spotting, headaches, increase appetite, and depression.  After about one year, many women report that their periods have stopped, but they will return when the Nexplanon is removed.

 

IUD:  There are two forms of IntraUterine Devices: the Mirena and the Paragard.  Both are inserted into the uterus and act primarily against sperm to prevent pregnancy.  The Mirena lasts for 5 years, releases a small amount of progesterone to thin the lining of the uterus, and many women report lighter or no periods while using the Mirena.  The Paragard lasts for 10 years, contains no hormone, but your periods might be heavier with heavier cramping.  Both of these must be placed by a trained provider.

Gestational Diabetes: Do I HAVE to drink that?

 

Short Answer:  Yes.

Long Answer:  You actually don’t HAVE to do anything you don’t want to do.  We won’t MAKE you do anything you don’t want to do.  This concept supports your autonomy as a patient.

However, you trust us to be the lifeguard of your pregnancy.  Throughout your pregnancy, we will monitor your blood work, vital signs, and the baby’s growth and development by using ultrasound, drawing your blood, listening to your baby’s heartbeat, and measuring the size of the uterus.  Trust us when we say that the second trimester glucose screen is very important to the health of both you and your baby.  We might even recommend it earlier in the first trimester if we are concerned about impaired glucose tolerance.

One complication of pregnancy that we screen for and treat is called gestational diabetes.  Gestational diabetes can occur in women of any size, even without a personal history of family history of diabetes.  Insulin is a hormone produced by the pancreas, and the body uses insulin to help transport blood glucose (sugar) from the bloodstream into the cells of the body.  The hormones of pregnancy can cause you to be resistant to insulin.  If you become resistant to insulin, your blood glucose levels become elevated and the glucose easily transports across the placenta to your baby.  This can cause the baby to grow very large, and at the same time it impairs the development of the baby’s lungs.  You can end up with a very large baby who, at the same time, has very immature lungs and needs help breathing after birth.

Maternal Complications of Gestational Diabetes:

  • You have a 70% chance of developing Type 2 Diabetes within 10 years
  • You are at a higher risk of high blood pressure or preeclampsia in pregnancy
  • You might require medication to help manage your blood glucose
  • You are at higher risk of miscarriage or stillbirth

 

Fetal Complications of Gestational Diabetes:

  • Your baby can grow very large
  • Your baby might experience a shoulder dystocia at delivery, which is an emergency situation where the head delivers but the large body is stuck behind your pelvic bones.  We might have to break the baby’s collar bone to help your baby deliver.
  • Your baby might require assistance breathing at delivery or in the first few days
  • Your baby might need to be observed or treated in the special care nursery for low blood glucose.

What happens if your one hour glucose screen comes back elevated? 

We will ask you to take a three hour glucose screen.  If the three hour glucose screen comes back elevated, you will have the diagnosis of Gestational Diabetes.  At that time, we will send you for a consultation with a Maternal Fetal Medicine physician called a Perinatologist.  These physicians are specially trained in high-risk pregnancy and obstetric ultrasound.  They can help us monitor the growth of your baby.  In addition, a diabetic educator will teach you how to test your blood glucose daily.  They will also teach you how to eat well to keep your blood glucose as stable as possible.  You will also be asked to increase your daily exercise, which will help your body be more sensitive to insulin and help you regular your blood glucose.

 

The glucose screen is usually done at the 24-28 week visit.  We ask that you eat normally that day, with good protein and not a heavy carbohydrate load.  Plan for the visit to take at least an hour because we have to draw your blood one hour after you finish drinking the liquid.  Pack a healthy snack with protein for the ride home.

 

So… yes.  Your midwives are aware that the glucose screen can cause nausea and discomfort.  You may not like the taste of the drink.  However, it is an important screening test that can help us provide the very best care for you and your baby.

 

For more information:

http://www.diabetes.org/diabetes-basics/gestational/

http://www2c.cdc.gov/podcasts/player.asp?f=11504&loc=WhatIsGestational

By: Kirsten Johnson | Certified Nurse Midwife

Birth Plans!

Should I write a Birth Plan?

Many women want to write out a birth plan to clarify the care they hope to receive while they are in labor.  A birth plan can be a short wish list or a long explanation of your circumstance, such as if you are adopting the child out or if there are known anomalies incompatible with life.

Is a Birth Plan required?  No.  The nurses, midwives, and physicians are highly trained professionals who will take care of you to the best of their abilities.  We have not performed routine shaves, enemas, or episiotomies for over 25 years, so you do not need to request that we refrain from these procedures.  We have many tools in our bag of tricks to help your labor progress well and hopefully avoid complications.

In addition, every woman and every labor is different.  It is a good idea for you to relax, let go, and accept the labor that comes to you.  There really is no other choice but to deal with the reality of the moment.  Your care providers will help you.  Honest.  That’s what we have chosen to do for our career.  We want the best outcome for you and your family.

I do recommend that my mammas write up a short, one-page wish list that gives the labor team a frame of reference of what experience you are hoping for in labor and delivery.  It is a good idea to designate one person to speak for you if you are unable to speak for yourself due to an intense labor.  It tells us if you have specific requests, such as dad cutting the umbilical cord or your desire to avoid an epidural or even GIVE ME THE EPIDURAL THE MOMENT I WALK IN THE DOOR!

Bring your birth plan to one of your prenatal visits to discuss with your midwife or physician.  Then when you have a final draft, bring a printed copy for the nurse caring for you in labor and delivery.  That way, your entire team is on board with the plan and works with you!  Remember to keep it short and flexible.

Some ideas of what women specify in a birth plan:

  • Who will be present for the birth?
  • Are you bringing a doula?
  • Will there be siblings present?
  • Do you want mobility or do you want to stay in bed?
  • What activities or positions do you plan to use (walking, birthing ball, standing, tub, squatting, etc)?
  • What is your plan for pain relief (massage, hot packs, position changes, hypnobirthing, Lamaze breathing, jacousi tub, medication)?
  • How do you feel about fetal monitoring?
  • Who will care for the baby?
  • What is your plan to feed your baby?
  • Do you want to wear your own clothing and listen to music?

 

You can always google “birth plans” on the internet for more ideas, remembering to keep your wish list to one page!

-Kirstin Johnson, Certified Nurse Midwife

Preventing Pertussis or “Whooping Cough” in the newborn.

whopping-cough-babies-2160x1200

 

Pertussis, also called “Whooping Cough” is a bacterial infection that you or your baby can catch when an infected person coughs or sneezes.  Infected droplets can travel through the air, and if you inhale the droplets you can become infected with pertussis.  Whooping cough begins like a cold, with a mild fever and runny nose.  Most adults do not have severe symptoms, but they can pass pertussis on to a newborn very easily without realizing it.

Whooping cough is especially dangerous for a newborn because their immune system is not fully mature and they cannot fight this infection.  Babies cannot get the vaccine for pertussis until they are two months old.  Even after they start the vaccinations, they are not fully protected by the vaccines until they are a year old and have had three vaccinations for pertussis.  Whooping cough in a newborn is a very serious illness, and it often requires that the baby be admitted to the hospital for breathing problems or pneumonia.  Some babies who get whooping cough do not cough at all – they just stop breathing.  Newborns can die from whooping cough.

The entire family can help protect your newborn from whooping cough.  All teenagers and adults who are around your baby should get a pertussis booster, called Tdap.  The Tdap shot is a tetanus vaccine that includes pertussis.  If you are pregnant, the best time to get the Tdap vaccine is between 27-36 weeks of pregnancy.  Your body will have time to make antibodies against pertussis.  These antibodies are passed through the placenta to protect your baby.  You can protect your baby with antibodies long before your baby is old enough to get the pertussis vaccine.  After the baby is born, the antibodies are passed through your breast milk.

For more information:  http://www.cdc.gov/features/pertussis

-Kirstin Johnson, Certified Nurse Midwife

Talking with baby

Community Health Association of Spokane Valley Clinic

 

Did you know something as simple as talking to your baby can help them be more successful in school?  75% of your baby’s brain development occurs in the first 2 years of life.  You are your baby’s first teacher!  The more words they are exposed to during this time the better.  Simple things like telling your child what you are doing, “Mommy is making your bottle now,” and pointing out things you see, “Look at the big red ball,” help their language develop.  You may be tempted to turn the TV on and let your baby be exposed to language that way.  Unfortunately, studies have shown this actually makes their language development worse.  Instead, turn the tv off and talk directly to your baby throughout the day, making eye contact with them, and giving them a chance to respond.  This helps with language and communication skills that are needed throughout life.

Books and songs are another way to help develop their language skills.  Sing simple songs over and over again, and you will quickly see that they will begin to recognize the song.  Exposing them to books is a great opportunity.  You might find your 6 month old baby has no interest in sitting down and reading a book, but let them explore books.  They will probably start by sticking it in their mouth, but soon they will start looking at the pictures, and before you know it they will have their own favorite book.  Your baby may not want to sit on your lap and read the entire book.  That’s ok!  Flip through the book with them.  Point out different pictures.  Practice animal sounds.  Your baby will enjoy the time spent cuddling with you, while also building a foundation for their developing language and a love for reading.

By Ashlee Mickelson, Physician

Pregnancy Care at CHAS

Hello!

My name is Dannette and I am the OB (Obstetrics) Program Coordinator for the CHAS clinic. If you didn’t know that CHAS offered pregnancy care, I encourage you to investigate what we have to offer. In short, we offer prenatal care by midwives or family doctors… you choose! We also have a great program called First Steps, which offers an enormous amount of support through the course of your pregnancy. I hope you will contact us and get the best care for your baby as soon as you know you are pregnant. The best thing you can do for yourself and your new little one is to take care of yourself now and establishing with a provider to care for you and your baby is the best way to start. Browse our website to find out about First Steps and other great programs!