An Interview with Family Nurse Practitioner and Labor & Delivery Nurse - Top Pregnancy Questions


When I first met Christina, it was over Thanksgiving dinner through a mutual friend from out of town. Her warm smile and inquisitive nature were apparent from the beginning. At that point, years and years ago, I had no idea she would be one of my primary caregivers during the months of trying to conceive and during my short-lived pregnancy.

Getting to know her better through my office visits, I reached out to her when I started this blog to have her answer some questions about fertility, pregnancy and healthy living. I am so grateful to have had this chat with her and hope you will learn something from it as well!

Christina and her daughter, June.


  • How long have you been practicing?
10 years as a family nurse practitioner and prior to that I was a labor and delivery nurse for 4 years.


  • What made you decide to go into this specific field?
Truly it was a calling with lots of synchronicity on my path. My parents were both doctors and at age 13 I befriended one of their OBGYN colleagues who invited me to attend my first birth. That was a trans-formative moment and I will never forget it. Then during my freshmen year at UC Santa Cruz I took female physiology and feminism during the same semester and was enraptured by midwifery and the natural birth movement of the seventies. I started volunteering at a midwifery clinic and became a doula and did my senior thesis project on the benefits of doulas in childbirth. Later I went on to attend Columbia University's nurse practitioner program where I changed fields from midwifery to family practice. Now I get to blend all the things I love by working alongside midwives and OBGYNs at Gros Ventre OBGYN.


  • What is the most common question you get as an OB/GYN practitioner?
Very commonly women ask me what can they do for low sex drive or libido. I get this question at least once per day and when I did volunteer work in rural Fiji I would get this question in women's homes while talking with them on their grass mats on the living room floor! So I always reassure women that this is a universal complaint and extremely common but unfortunately not an easy fix. Men have it easy by taking Viagra or Cialis but there is no such pill for women simply because we are more complicated. Low libido in women is a multifaceted issue that has psycho-social components to it. Sometimes I recommend counseling or simply trying a different birth control such as an IUD so that they will ovulate. Most forms of birth control suppress ovulation and with that we get suppression of libido. Usually combating the issue from various angles is most helpful.


  • What’s your favorite part of your job?
I love taking care of and spending time with my patients. Women are so resilient and strong and I gain just as much if not more from my patients than they do from me. Sharing in my patients' joy and pain and being there for them throughout the years is my greatest joy and truly feeds my soul.




  • Have you read about/researched/learned anything about certain foods that might affect fertility? In a good way or negative way.
  • Any supplements?

Sometimes adding good fats into your diet especially if you are very lean with a low total body fat percentage can help fertility. For women with this issue I recommend increasing dietary intake of nuts, avocados and coconut oil. I would limit caffeine intake to 1 cup of caffeinated beverage per day or 200 mg/day.



  • What are the 3 most important things women who would like to conceive do?



  1. Go see your provider and talk about getting ready for pregnancy making sure you are healthy and that your menstrual cycles are regular, discuss preconception genetic screening tests that he or she may recommend for you. 
  2. Start a prenatal vitamin with DHA in it and take it daily.
  3. Start moderate exercise 3-5 times a week and avoid alcohol, tobacco, drugs and unnecessary medication.
  4. Do not travel to a Zika affected area with your partner within 6 months of trying to conceive. If you are unsure if an area that you want to travel to is still affected by Zika you can call your OBGYN or look on the CDC website.
  5. Make sure you get your teeth cleaned regularly as poor dental health has been linked to preterm labor.
  6. Make sure you are up to date on your flu vaccine, varicella vaccine and measles mumps and rubella vaccine before you conceive.

  • Once pregnant: What nutrients are important to get during pregnancy?
Women who are pregnant should eat plenty of fruits and vegetables as well as whole grains, dairy, and a variety of proteins.
A standard prenatal vitamin with iron and folic acid satisfies the daily vitamin and mineral requirements of most pregnant women. The multivitamin should include 15-30 mg of iron to prevent deficiency and folic acid 0.4-0.8 mg per day to prevent open neural tube defects during fetal development. For this reason, I like to have my patients start a prenatal vitamin prior to conception to build up folic acid stores. Amino acids that make up protein are the building blocks of your body's cells and of your baby's as well. Protein intake is important for a developing pregnancy and I recommend roughly 40-70 grams per day depending on maternal weight. You can achieve this by eating a little protein at each meal and eating one to two protein rich snacks throughout the day such as a hard boiled egg or yogurt with dried fruit and nuts on top. Other great sources of protein are beans, lean meats, poultry, fish , eggs, milk, cheese and tofu. In general, pregnant women of normal weight with a singleton (single fetus) pregnancy need to increase daily caloric intake by 340 and 450 additional kcal/day in the second and third trimesters respectively, for appropriate weight gain. DHA and long-chain polyunsaturated fatty acids are important for a developing fetuses brain. I recommend a serving of seafood high in polyunstaurated fatty acids but low in mercury 1-2 times a week in addition to a quality DHA supplement (200-300 mg/day) that is well sourced and screened for the lowest possible mercury contamination. You can get a list of recommended seafoods for pregnancy and portion recommendations at http://www.eatright.org



How common are miscarriages? Really?

Miscarriage or spontaneous abortion is defined as clinically recognized pregnancy loss before the 20th week of gestation. Spontaneous abortion or miscarriage is the the most common complication of early pregnancy and the incidence is anywhere from 8-20%. The incidence after 15 weeks gestation is much lower at 0.6%.
        

  • What causes miscarriages? Is it something we did? 
Most first trimester miscarriages occur because of chromosomal abnormalities that are completely out of our control. Generally miscarriages happen whether or not we do everything perfectly. I always try to reassure my patients that they did not do anything wrong or cause there miscarriage to occur. However risk factors commonly associated with pregnancy loss are advanced maternal age, previous miscarriage , and maternal smoking.
        

  • What should we ABSOLUTELY avoid to increase the chance that we don’t miscarry?
If you smoke do everything you can to cut down or quit. Check in with your OBGYN or midwife and review your health history, use of medications and risk factors and make a sound plan to reduce your risk. 





  • How important are kegels? How do we know if we’re doing them correctly?

Kegel exercises are very important to strengthen and maintain flexibility of the pelvic floor muscles which support the uterus, bladder, small intestine and rectum. Doing kegel exercises can help prevent postpartum urinary incontinence among other common pelvic floor dysfunction issues. I am a huge promoter of pelvic floor physical therapy and we have wonderful female physical therapists in Jackson that specialize in this field. In brief the way you do a kegel is by contracting the muscles in your pelvic floor that you associated with starting or stopping the flow of urine. In fact to identify the correct muscles, stop urination in midstream. If you succeed, you've got the right muscles! I recommend contracting and releasing these muscles 30-40 times a day to strengthen the network of muscles in your pelvic floor. Start by contracting for five seconds then relaxing for five seconds and build up to holding the muscle for ten seconds.




  • What signs should women look out for if they think they might be miscarrying?
Vaginal bleeding and severe cramping are the two most common signs of miscarriage. Call your doctor or midwife any time you have either of these symptoms. Sometimes women will feel mild cramping or sharp shooting pains down into their groin that have sudden onset and sudden resolution these are usually normal in pregnancy and are due to the stretching uterus and strain on the pelvic ligaments that hold the uterus in place. We commonly call this "round ligament pain" and should not be confused with the more persistent and painful cramps associated with miscarriage.
Is sex safe during pregnancy? Is there a chance it’s not safe, what should we be aware of.
Yes sex is safe during pregnancy with very few exceptions. If you are having vaginal bleeding or are unsure if your amniotic fluid sac is leaking check with your doctor or midwife before continuing to have sexual intercourse while pregnant. They can do several tests to let you know if its safe for you to continue having sex during your pregnancy. During the end of pregnancy when women are waiting to go into labor I often recommend sex because not only does it create bonding between partners it promotes the release of oxytocin (a hormone released during orgasm) which can help stimulate contractions. Also the prostaglandins present in sperm can soften and ripen the cervix both helping the mothers body get ready for labor.

  • When it comes to trying to conceive, what advice would you give women who are struggling to get pregnant?
One common problem I see is women who are trying to get pregnant and have been unsuccessful may be the need for guidance on how to have "timed intercourse" to optimize there chances of conceiving.Timed intercourse is one of the simplest treatment options for infertility and is a good starting point for many couples trying to conceive. Timed intercourse is having sex every other day around the time of ovulation. YOU CAN PREDICT YOUR OVULATION WINDOW WITHIN ONE OR TWO DAYS BY USING AN OVER THE COUNTER OVULATION TEST OR BY CHARTING YOUR BASAL BODY TEMPERATURE. I also like to recommend apps like period tracker which helps you nail down your more fertile period. A woman is fertile approximately five days before she ovulates each month until 24 hours after ovulation. Sperm has a lifespan of 5 days and an eggs lifespan is 24 hours after ovulation. For example, if a woman has a 28 day menstrual cycle meaning 28 days from the first day of bleeding until the next first day of bleeding she will typically ovulate (or release an egg from the ovary) on day 14. Therefore her ovulation window would be from day 9 to day 15.  If you are under 35 years old and have been trying to conceive for 12 months or if you are over 35 and have not conceived in 6 months you should seek help from your OBGYN or midwife so they can run more tests on both you and your partner.

  • When it comes to being pregnant, what advice would you give women who want to have a healthy pregnancy?
Eat a well balanced diet, get regular moderate exercise, make sure you get routine prenatal care, take your vitamins, get plenty of rest, drink 3 liters of water per day and reduce stress as much as possible.
Staying fit during pregnancy, how much is too much working out? What guidelines would you give your patients?

I encourage women to engage in aerobic and muscle strength exercises while pregnant for 30-60 min at least 4-5 days a week. Pregnancy is not the time to start a new and vigorous exercise regimen but it a good time to maintain. Great low impact exercise for pregnancy include yoga, swimming, pilates, and cycling. Walking and hiking is extremely beneficial too. As a general rule of thumb we tell mothers is not to get breathless for too long and if they are slow down or back off so that they still maximize blood flow to the placenta during workouts. In general keep you max heart rate around 150 bpm. 

  • What are some common topical items women who are pregnant should avoid? 

I generally try to keep your skin care and cosmetic regimen as natural as possible. Unfortunately the U.S. has not passed any federal regulation for the safety of personal care products since 1938. Nowadays there are lots of good companies that want to provide safer alternatives to their customers one I like is Beauty Counter. I tell my patients to try to avoid parabens and phthalates as these are known hormone disruptors and common ingredients in shampoos, lotions and nail polish. And as far as skin care is concerned absolutely no retinoids, hydroquinone or botox.  





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