Preconceptional Counselling

Hello Everybody. Thanks for coming.  I really appreciate all of you reading my blog. This blog has expanded much faster than I imagined. I now have readers from about 10 different countries all over the world.

Today was a busy Obstetrics day in my office. Since we have just finished a long weekend, a lot of the pregnant patients came to the office today, to catch up from yesterdays holiday. So my office hours were filled up with pregnant patients, and had just a few gyn patients in for checkups.

After my office hours, I've delivered two babies, and I assisted at one more. The babies are beautiful and healthy. One baby was a Cesarean Section.

I am now taking my shift in the hospital. Our hospital, The Valley Hospital in Ridgewood, New Jersey, has elected to always have an Obstetrician present on the unit. We stay here to cover the unit for emergencies. There are about 14 of us Ob's that share that particular duty. I am one of them. I am on duty now. We call ourselves the Doc In Box. The hospital's official title for us is the "Valley On Call Obstetrician". The official title is too hard to say over and over, so we just shorten it to Doc In Box. As in "am I Doc in Box tonight?"  We take 12 hour shifts, or two in a row for 24 hours. When here, we consult with the nurses whenever they ask, we assist in complicated deliveries, we examine laboring patients whenever we are asked, and we occasionally save lives of new moms and babies. Particularly we save lives when there is a placental abruption. We can try to get some sleep in between the calls. Some of us try to get some of our boards done. We all need to get about 30 hours of boards work done every year, to maintain our board certification.

But I promised I would write about preparing a women for pregnancy, so that someday, she can herself be here in labor and having a baby. What does a women need to do in order to be safe for the pregnancy, for optimal chances of health?

Sometimes a woman will make an appointment for a "preconceptional consult". Other times, a woman will be in for her annual checkup and in the course of that checkup I will determine that she is trying to get pregnant, or will be soon. Either way, we have to help her prepare for the pregnancy. This is what we should do:

First , we will review her history to determine if there are any health issues that need to be addressed. All medical issues in the past will need to be analyzed to make sure that whatever the problem was, it will be optimally managed. For instance, one in twenty people have a misbehaving thyroid gland. It could be either hyper- or hypo-thyroid.  These women will need their thyroid gland examined and her TSH checked to make sure it is optimal. A properly adjusted thyroid hormone will make it easier to get pregnant, and will keep the baby safe and growing well. Another example is if she has high blood pressure, we will need to change her pill to one that is safe for the fetus, and get her BP under good control. Virtually all medical problems in the past will need an analysis. Many young women will have no medical problems in the past, so this part will be easy for them. Many people have multiple mild issues. Everything is on the table here. More examples: Seasonal allergies, with or without allergic asthma. Yeast infections. Urine infections. Back pains. Sciatica. Palpitations. And on and on.

Second , she will need a complete checkup and an exam to make sure nothing obvious is wrong.

Then, I will ask her to get a dental checkup and cleaning. Proper dental care is important for the pregnancy. believe it or not, gingivitis is a cause for preterm labor. In fact, any infection anywhere in the body is bad for the pregnancy. Infections can spread into the baby. But even if it doesn't get into the baby, it can still release toxic substances that make the uterus and the placenta irritable and threaten preterm labor.

Then, we will discuss the diet. Special dietary needs will need to be discussed. Many women are vegetarian, or even vegan. It is possible to keep the baby healthy as a vegan, but we will need to make sure she is getting proper proteins from the veggies. Right about now, I will discuss the "fish rules". There are five fish that women should not eat in pregnancy. Many times I will write this down for women, because it hard to remember everything from this visit. So I will take notes for the women, and make sure that she gets this note when she leaves the office. The 5 fish that women cannot eat are: shark, swordfish, tilefish, monkfish, and tuna. They cannot eat these fish because they are all too high in mercury. Then, I will explain that salmon has no mercury and is therefore the best fish for pregnant women. Salmon also has very high DHA, which is an essential fatty acid and is great for the babies brain development. I blogged about salmon before in one of my prior posts. All of the whitefish varieties are healthy. This will include cod, flounder, tilapia, sea bass, etc. And shellfish is good, too. Unfortunately, some women still have the mistaken opinion that all fish is bad for pregnancy. Many times it takes a lot of discussion to explain to women why that opinion is incorrect.  Fish is so good for the baby that this discussion is worth having, if I can convince the women to actually eat it.

I will usually explain that hamburgers that are under cooked red or over cooked black are not good for her or her baby. Hamburgers and cheeseburgers must be medium only. Black burgers have toxic burned black material on them. This is the food equivalent to smoking. Red hamburgers are infectious with E.Coli and Salmonella. Eggs must be cooked through with no runny yolks.

If she has ethnic food requirements, I will try to address those requirements here.

All cheeses and juices must be pasteurized.

Now is a good time to discuss recreational habits, and exercise. All high impact exercise will have to be toned down to low impact only. Running is ok, but elliptical is just a bit safer because it is low impact on the baby and placenta. Skydiving, bungee jumping, and motorcycle racing are examples of activities that will have to stop. Any illegal or recreational drugs should stop before pregnancy. Alcoholic drinks should stop while pregnant, although a few glasses of wine near the end of the pregnancy will not likely hurt anyone.

I will explain to women that heat can damage fetuses. How can a women get overheated? Most commonly, it is hot tubs. Hot tubs are forbidden to pregnant women, or even women that might be pregnant. Incidentally, hot tubs damage sperm as well. A fever higher of 101F or so is dangerous to the baby. A fever can be reduced with a dose of acetaminophen and a cool shower. There are other ways to get overheated. Examples are: hot days outside, such as at Disney World, hot exercise, hot sex for a long time, hot waterbeds, hot baths, saunas, etc. So we will try to keep a woman's body cool during her pregnancy.

I might ask a woman to buy a pregnancy book. "What to Expect When Your Expecting" is a famous and good book.

Finally, I will ask a woman to call me anytime there is a question or a problem. Keeping the phone lines open can help keep the pregnancy safe.

I will ask a woman to call whenever there is a medical problem in pregnancy.

I will try to explain to women that the phrase "you can't take anything because you are pregnant" is commonly said, and frequently well intentioned,  but is actually a very dangerous notion. It is dangerous because it means that a woman will be tempted to ignore her medical needs. Since the baby and the mother are one, it is not possible to allow a pregnant woman to get sick, and have the baby better off by ignoring the illness. All medical illnesses need to be managed properly to keep the baby safe. All medical issues have pregnancy safe alternative management options.

All of the above is a 15-20 minutes or so discussion. I will many times keep notes as I go, and give her a copy of these notes. Because of the time required, this discussion is best done on a separate visit from a checkup or a problem visit. Women will commonly request preconceptional counselling at the time of a checkup. If there is time on the schedule, I might do this at a checkup. But sometimes, there is just not enough time. I may have to ask a woman to come back to have this discussion. Other times, I may convert the visit to a preconceptional consult, and delay the checkup or whatever reason she is there.

Remember, this is not medical advise. Please see your doctor for medical advise. This is just general information. 

Thank you for reading.

Sincerely,

John Marcus MD FACOG PC
Ridgewood, NJ, 07450
201-447-0077