OB Reports

The term “morning sickness” is misleading, as this can occur in the morning, afternoon, evening or middle of the night. Although it is inevitable and unavoidable, here are 24 ways to ease morning sickness.

1. Avoid Morning Sickness Nausea Triggers

The most common offenders you should eliminate to ease morning sickness include body odors, stale or leftover food in the fridge, coffee, gasoline, solvent fumes, garbage, scented cosmetics and toiletries, and pungent aromas of cooking foods.

2. Make “Designer” Days

Compare your good and bad days. As much as humanly possible, design your day to avoid the known triggers that set off morning sickness. If wet dog smells or litter box stench gets to you, let someone else get them out of your way. WARNING! During pregnancy, avoid cat feces because they may contain toxoplasmosis bacteria, which can cause serious damage to the baby.

3. Eat Before Your Feet Hit the Floor

If you start the morning off sick, you are likely to stay sick all day. Set a tray of easy-to-digest favorites at your bedside to ease morning sickness. When you need to use the bathroom in the middle of the night, treat your stomach to a nibble or two while you’re up. Continue to munch all morning, carrying your nibble tray around with you; if necessary—yes, even in the car and by your desk at work.

4. Ease Into Your Day

If you don’t have to awaken at a set time, don’t. Ask your mate to get up quietly without disturbing you, and slowly wake up in your own time.

5. Graze to Your Stomach’s Content to Ease Morning Sickness

Low blood sugar can trigger morning sickness nausea, and it may occur when you wake up or anytime you go hours without food. Grazing on nutritious mini-meals throughout the day keeps your stomach satisfied and your blood sugar steady.

6. Nibble, Nibble and Nibble on Stomach-Friendly Foods

Because high-fat, spicy and some high-fiber foods are harder to digest, consume easily digestible foods to ease morning sickness, such as liquids, smoothies, yogurts and low-fat, high-carb foods. Avoid hard-to-digest fatty foods and fried foods when experiencing morning sickness, such as premium ice cream, french fries and fried chicken.

7. Eat Nutrient-Dense Foods

Include California avocados, kidney beans, cheese, fish, nut butter, whole-grain pasta, brown rice, tofu and turkey. If peanut butter is too strong, try almond or cashew butter, and spread it thinly on crackers, bread, apple slices or celery sticks.

8. Avoid Dehydration by Eating Foods that Stimulate Thirst

Remember the three P’s (pickles, potato chips and pretzels) to avoid letting your saliva hit an empty stomach. An empty stomach is hypersensitive to saliva, and nausea will soon follow. Ease morning sickness by lining your stomach with milk, yogurt or ice cream before eating a saliva-stimulating food such as salty foods, or dry foods such as crackers. Try peppermint candies or gum to help with nausea, but not on an empty stomach. Also chew gum containing sugar to avoid chemical sweeteners, and eat foods with a high water content to ease dehydration that aggravates nausea. You should include melons, grapes, frozen fruit bars, lettuce, apples, pears, celery and rhubarb.

9. Take Prenatals with your Biggest Meal

Vitamins can be a big trigger of nausea and morning sickness — unless they are taken with a large meal.

10. Eat High-Energy Foods

Complex carbohydrates act as time-release energy capsules, slowly releasing energy into your bloodstream and helping to keep your appetite satisfied. The main food group represented here is grains (rice, corn, wheat, oats, millet, barley), found in breads, cereals, pastas and crackers.

11. Stick to Feel-Better Favorites that Ease Morning Sickness

Make a list of foods that help you ease morning sickness. While this list may change, it can help you avoid food triggers that make you ill.

12. Make Yourself Eat

No matter whether you feel like it or not—eat something. If you don’t eat, you will get an acid-filled stomach and low blood sugar.

13. Get Out and See the World

Visit friends, go to a movie, rest in a hammock, take a walk at lunchtime or go to a park with friends. Any change of scenery may provide a stomach-settling distraction to morning sickness.

14. Drive, Don’t Ride

Some women find that by doing the driving instead of riding, they have less of a morning sickness problem. This explains why the helmsman on a boat is the least likely to get seasick.

15. Delegate, Delegate, Delegate

Ease morning sickness by delegating tasks to “Mr. Mom” or to older kids. Post a list of “These things bother mom…These things make mom feel better.” Let your spouse mop the floor, cook easier meals, and if the entire family has to eat cheese, crackers and carrots for a few meals, they will survive.

16. Plan Ahead

If you know what makes you miserable, arrange for detours around the things that trigger nausea. Follow this checklist:

If cooking odors bother you, consider cooking and freezing foods on days you feel well.

Buy more convenience foods.

If you are invited to another home for dinner, offer to bring a dish you know you’ll be able to eat.

Carry your reliable edibles with you. When a hunger surge hits, the nausea is sure to follow if you don’t have a tried-and-true tidbit handy.

17. Ease Morning Sickness by Reducing Stress

Prenatal researchers feel it’s better for a baby in utero to be spared a steady barrage of stress hormones—and stress can increase your nausea cycle. Learning to reduce stress now is good practice for maintaining serenity as a new mother. Remind yourself that what your baby needs most is a happy, rested mother, both before and after birth.

18. Try Acupuncture

Both Eastern and Western medical practitioners describe a pressure point about two inches above the crease on the inner aspect of the wrist. If this pressure point is stimulated, it may relieve nausea and vomiting associated with pregnancy. With other conditions similar to morning sickness, such as seasickness, Sea Bands® can be worn around one or both wrists. Each band contains a button to press on the vomiting-sensitive pressure point. These bands have been proven effective by research studies and are available without prescription at pharmacies and marine stores.

19. Dress Comfortably

Wearing loose clothing can help ease morning sickness. Many mothers find that anything pressing on their abdomen, waist or neck is irritating and nausea triggering.

20. Position Yourself for Comfort

Heartburn is another common part of the morning sickness package. This burning feeling, caused by reflux of stomach acids into the lower esophagus, occurs more frequently during pregnancy when hormones, again, relax the stomach walls. For heartburn, keep upright or lie on your right side after eating. Lying on your back is more likely to aggravate heartburn.

21. Sleep it Off

It’s fortunate that the extreme need for sleep coincides with the morning sickness phase, so you will want to ensure that sleep goes on as long as possible.

22. Have One Last Meal Before Bed

Before going to bed, eat a meal or snack, preferably fruit and long-acting complex carbohydrates (grains and bland pasta) to ease morning sickness. These foods slowly release energy into your bloodstream throughout the night, but are unlikely to keep you awake. Add to these natural antacid foods—milk, ice cream and yogurt— to neutralize upsetting stomach acids as you drift off to sleep. Also consider taking chewable calcium tablets, which act as antacids, before retiring or upon awakening.

23. Eat Anyway!

While it’s not uncommon for women to feel that nothing tastes good, not eating can actually aggravate the cycle of morning sickness nausea.

24. Be Positive to Ease Morning Sickness

Lastly, choose who you share your misery with. Mothers who have been there and felt morning sickness will understand; others won’t. When you’re having a day you can’t keep anything down, keep your eyes on the prize—the precious baby-to-be!

Fibroids (leiomyomata uteri) are the most common benign tumors of the uterus. They usually come in a variety of shapes and sizes, as well as numbers, in the uterus. Very rarely do they turn to cancer – the exact incidence being less than 1% in a patient’s lifetime. Women who are at risk usually have a family history, are Black or Hispanic, and may have an elevated Body Mass Index (BMI). As a matter of fact, because we are seeing more women with an increase in BMI, Caucasian women are presenting with fibroids more frequently as well. While there is still a lot to understand about the development of fibroids, they grow for two reasons: hormones, in particular estrogen, and blood supply.

Fibroids can be located in different parts of the uterus. There are some fibroids that are located underneath the surface of the uterus, which are called subserosal; these generally do not cause bleeding but can cause pressure. There are those that are embedded in the muscle of the uterus, which are called intramural. Finally, there are those fibroids that affect the lining of the uterus, which are called submucosal, and these are the ones that usually present with excessive bleeding.

Symptoms and Tests

The most common symptoms of fibroids are heavy bleeding, pressure, increased frequency in urination and pelvic pain. Although most fibroids do not usually cause pain, if they outgrow their blood supply, it can cause pain due to degeneration (which means tissue breakdown). Fibroids are usually diagnosed with a pelvic exam and a pelvic sonogram. Transvaginal sonography is very good at detailing whether a fibroid is affecting the uterine lining or not.

Treatment

While the leading cause of hysterectomies is fibroids, there are many more conservative treatments that are available now. Birth control pills are one of these treatments; not only can they suppress bleeding, but they can also suppress the hormones that can control the growth of the fibroid. Decreasing weight also decreases the amount of exogenous estrogens that can control the growth as well. Uterine artery embolization can cut off the blood supply to the uterus, thus controlling growth and bleeding. In the case of submucosal fibroids, they can be resected hysteroscopically by going into the uterus and removing the fibroid through the vagina. Another procedure called a myomectomy just removes the fibroids, thus conserving the uterus. Lastly, you can also just watch them: If they don’t bother you, don’t bother them. Specific treatment modalities should be discussed with your physician to see what works best for you.

Types of Fibroids

All uterine fibroids are made of abnormal uterine muscle cells growing in a tight bundle or mass.

Uterine fibroids are sometimes classified by where they grow in the uterus:

• Myometrial (intramural) fibroids are in the muscular wall of the uterus.
• Submucosal fibroids grow just under the interior surface of the uterus, and may protrude into the uterus.
• Subserosal fibroids grow on the outside wall of the uterus.
• Pedunculated fibroids usually grow outside of the uterus, attached to the uterus by a base or stalk.

Uterine fibroids can range in size, from microscopic to several inches across and weighing tens of pounds.

Symptoms of Uterine Fibroids

Most often, uterine fibroids cause no symptoms at all -- so most women don’t realize they have them. When women do experience symptoms from uterine fibroids, they can include:

• Prolonged menstrual periods (7 days or longer)
• Heavy bleeding during periods
• Bloating or fullness in the belly or pelvis
• Pain in the lower belly or pelvis
• Constipation
• Pain with intercourse

Some experts believe that some uterine fibroids can occasionally interfere with fertility and pregnancy. Although it's rare, a uterine fibroid projecting into the uterus might either block an embryo from implanting there, or cause problems with the pregnancy later.

Effects on Pregnancy

One of the most common concerns that I am asked about in my clinical practice is whether the patient can become pregnant with a fibroid. Again, location is key. Depending on where it is, whether it affects the cavity where the baby grows or blocks the fallopian tube for fertilization, treatment will be dictated by these factors. If those issues are not present, women can become pregnant and have a normal pregnancy. All these issues should be discussed with your physician prior to pregnancy to determine your specific needs. Fibroids will grow during pregnancy, often experiencing the greatest growth during the first trimester.

Conclusion

Although intimidating at first, fibroids are not as scary as they sound. Not everyone must have them removed, and a solid relationship with your physician will help guide you as to the best treatment.

If you are ever in doubt, seek a second opinion. If your physician does not perform minimally invasive procedures, there are many specialists that do.

Source: DoctorOz, WebMD

Taking antidepressants during pregnancy might pose health risks for your baby — but stopping might pose risks for you. Get the facts about antidepressants and pregnancy.

Antidepressants are a primary treatment option for most types of depression. Antidepressants can help relieve your symptoms and keep you feeling your best — but there's more to the story when you're pregnant or thinking about getting pregnant. Here's what you need to know about antidepressants and pregnancy.

How does pregnancy affect depression?

Pregnancy hormones were once thought to protect women from depression, but researchers now say this isn't true. In addition, pregnancy can trigger a range of emotions that make it more difficult to cope with depression.

Is treatment important during pregnancy?

Depression treatment during pregnancy is essential.

If you have untreated depression, you might not seek optimal prenatal care, eat the healthy foods your baby needs or have the energy to care for yourself. You also might turn to smoking or drinking alcohol. The result could be premature birth, low birth weight or other problems for the baby — and an increased risk of postpartum depression for you, as well as difficulty bonding with the baby.

Are antidepressants an option during pregnancy?

A decision to use antidepressants during pregnancy is based on the balance between risks and benefits. Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is very low. Still, few medications have been proved safe without question during pregnancy, and some types of antidepressants have been associated with health problems in babies.

Which antidepressants are considered OK during pregnancy?

Generally, these antidepressants are an option during pregnancy:

• Certain selective serotonin reuptake inhibitors (SSRIs). SSRIs are generally considered an option during pregnancy, including citalopram (Celexa), fluoxetine (Prozac) and sertraline (Zoloft).
•  Serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs are also considered an option during pregnancy, including duloxetine (Cymbalta) and venlafaxine (Effexor XR).
• Bupropion (Wellbutrin). This medication is used for both depression and smoking cessation. Although bupropion isn't generally considered a first line treatment for depression during pregnancy, it might be an option for women who haven't responded to other medications or those who want to use it for smoking cessation as well.
• Tricyclic antidepressants. This class of medications includes amitriptyline and nortriptyline (Pamelor). Although tricyclic antidepressants aren't generally considered a first line or second line treatment, they might be an option for women who haven't responded to other medications.

Some research associates use of citalopram, fluoxetine and sertraline with a rare but serious newborn lung problem (persistent pulmonary hypertension of the newborn) when taken during the last half of pregnancy.

Other rare birth defects have been suggested as a possible risk in some studies, but not others. Still, the overall risks remain extremely low.

Which antidepressants should be avoided during pregnancy?

The SSRI paroxetine (Paxil) is generally discouraged during pregnancy. Some research suggests that Paroxetine may be associated with a small increase in fetal heart defects.

In addition, monoamine oxidase inhibitors (MAOIs) — including phenelzine (Nardil) and tranylcypromine (Parnate) — are generally discouraged during pregnancy. MAOIs might limit fetal growth.

Are there any other risks for the baby?

If you take antidepressants throughout pregnancy or during the last trimester, your baby might experience temporary discontinuation symptoms — such as jitters or irritability — at birth. However, tapering dosages near the end of pregnancy isn't generally recommended. It's not thought to minimize newborn withdrawal symptoms. In addition, it might pose challenges for you as you enter the postpartum period — a time of increased risk of mood and anxiety problems.

Should I switch medications?

The decision to continue or change your antidepressant medication is up to you and your health care provider. Concerns about potential risks must be weighed against the possibility that a drug substitution could fail and cause a depression relapse.

What happens if I stop taking antidepressants during pregnancy?

If you stop taking antidepressants during pregnancy, you risk a depression relapse. In addition, stopping an SSRI abruptly might cause various signs and symptoms, including:

• Nausea and vomiting
• Chills
• Fatigue
• Anxiety
• Irritability

What's the bottom line?

If you have depression and are pregnant or thinking about getting pregnant, consult your health care provider. Sometimes mild to moderate depression can be managed with psychotherapy, including counseling or other therapies. If your depression is moderate to severe or you have a recent history of depression, the risk of relapse might be greater than the risks associated with antidepressants.

Deciding how to treat depression during pregnancy isn't easy. The risks and benefits of taking medication during pregnancy must be weighed carefully. Work with your health care provider to make an informed choice that gives you — and your baby — the best chance for long-term health.