Posts in pregnancy
Pelvic Health

I recently gave a talk to a group of women about the Pelvic Floor: what is is, what affects it, who is affected, and what to do about it. This was the 2nd time I’ve given this talk (for a monthly series) because it was so well-received the 1st time.

The first talk was a huge success.  There were several people that came to the talk AGAIN the second time around.

The first talk was a huge success. There were several people that came to the talk AGAIN the second time around.

In my talk, we dive right into the hormonal aspects of pelvic floor health, the personal history contributions, and the physical/mechanical factors at play.

I have long taken for granted the fact that people do not know their internal anatomy. I fell in love, head-over-heels-passionate-sleepless-nights-in-love with human anatomy when I was 19. I am visual. I locked in on where every organ, muscle, bone and ligament lived in the human body. Now, I’m teaching people in their 40’s where their bladder is relative to their uterus (or prostate!) and their colon and rectum. it feels like I have always known.

It is now believed to be true that 70-80% of the general population has some degree of pelvic floor dysfunction serious enough to warrant a doctor’s visit. The median age for females is 41. Let that sink in. That is why we decided the time had come for us to do a pelvic floor talk. My bootcamp leader at Wy’east Sisterhood and I were involved in a discussion with women who had never been pregnant, talking about incontinence.

Hold the phone.

People that had never been pregnant had pelvic floor issues? That’s when a light came on for me. I had treated tons of people for pelvic floor issues, but most of them were postpartum. I even said, “Every body that has a pregnancy needs pelvic floor work afterward”.

I had bought into the misunderstanding. People who had not been pregnant would not come to see me for things like constipation, low back pain, prostatitis, erectile dysfunction, or recurrent UTIs because those things haven’t been connected to pelvic floor muscle dysfunction in the mainstream. They didn’t know to come, and I hadn’t told them.

Well, I am telling them (and you) now. We are at a time when the importance of the pelvic floor muscles and organs is being realized. It’s about more than Kegels.

https://www.ncbi.nlm.nih.gov/pubmed/21160318

https://www.ncbi.nlm.nih.gov/pubmed/26926816

Radiation protection, re-visited

It's been just over a year since the Nuclear meltdown in Japan.  We had a lot of concerns about radiation for a month or two, and then things sort of simmered down. However, I recently had a patient ask me what she could do to protect her young children from the effects of increased radiation in our atmosphere.  There's a lot out there on the web.  Weeding through all of it to determine an effective set of guidelines for families with little ones (or pregnant ones!) has been my pet project for the past few weeks.

Without further ado, I present "Dr. Roe's Radiation Protection Plan"

1. An apple a day.  Pectins (found in apples) are probably the most well-studied food source for radiation protection, even after exposure has occurred.  People in the Chernobyl radiation zone have been advised for years and years now to consume apples on a regular basis to help the body absorb and eliminate excess radiation.

2. Eat iodine-containing foods, and keep a source of iodine on hand for your family in the medicine cabinet.  There is no need to supplement Iodine on a regular basis, and this can, in fact, put people over the age of 40 at risk for thyroid cancer.

3. Add Spirulina to Smoothies or, even better, applesauce a few times per week.  Spirulina also shows the ability to bind radioactive isotopes so that the body can more readily eliminate them.

4. Find a reputable source for Kombucha tea, and drink it 3-6 times per week (8oz serving).  Besides, the hot-link there, I was able to easily find lots of evidence to show the anti-oxidant, free radical scavenging, radiation-busting effects of this ancient beverage.

5. Most of all, be healthy.  Eat whole foods.  Drink water.  Take a daily multivitamin (a good one!!!!)  Avoid sugar and processed foods to keep all of your organ systems intact and functioning properly.  Your body's ability to combat radiation exposure is only as strong as it is healthy.

So there you have it, the naturopathic doctor-approved, weeded-out version of Radiation Protection, 101.

Maternity leave for the midwife!

  Hi everyone!  Most of you know that we're expecting our second baby in September, but I wanted to get the word out at any rate.  Next week is my last week at the office before I go into major mama mode and bring our new little one into the world.  I will be out of the office from 9/5/11-10/11/11.  When I come back, I will be in the office on a very part-time basis for the month of October.  I will add more hours in November and December, and will be back to my full schedule in January. While I'm out, Dr. Jenny Maurer (at our clinic) will be covering my practice.  She will be available to see you at the clinic for any of the concerns you would normally see me for.  If you have well-baby, well-child, or adult wellness checkups that are due, she is happy to do those too.  I will be in the office this Tuesday, Wednesday, and Thursday wrapping things up, so please give a ring if you have any questions!

We don't know if our baby is a boy or a girl (YET), but I will post here when the baby is safely born.  See you all this coming fall!!!

Oregon is Rocking the breast-feeding stats!

Just read an interesting article about how the U.S. is really making the effort to ensure that babies are not only breastfed, but that they breastfeed for longer.  The recommended length of breastfeeding is 12 months for each baby. Last year, 75% of all newborns started life at the breast.  By 6 months, only 43% still nursed, and by 12 months, only 22%.  In Oregon, 40% of babies still nurse at their first birthday.  We know that breastfeeding is important in the prevention of asthma, diabetes, and childhood leukemia.  If you want to read the full article click here.

Green Baby Showers!

I love this article on how to love up a new mama, sustainably.  Babies are the biggest consumer population in the U.S. and there's so much available that's been gently used, or hardly used at all! Dr. Jenny and I will be at the Green Sprouts Portland festival again next month (Sunday, Sept. 26th), so mark your calendars!  We'll be doing a fabulous prize drawing and giving tips for Green Baby Showers & other health care pearls.  Best of all, it's FUN and FREE!  Lots of interesting talks and information---see you there.

Naturopathic care for Postpartum Mood Issues

Naturopathic doctors are trained to look for the root problem causing someone's symptoms, rather than just making the symptoms go away.  If we address the underlying cause, we can allow the symptoms to recede for good.  This is no different for postpartum women, and there are a number of reasons WHY women develop postpartum mood disorders.  Naturopathic doctors, especially those trained in the art of midwifery or who have had special training in pregnancy and birth, are very well-equipped to figure out how to best help each woman on an individual basis. Dr. Adriana Azacarate-Ferbel is a Portland area Naturopath who has studied Postpartum depression extensively.  I met with her last fall when I began researching this topic more myself.   She outlined the most common underlying reasons for development of Postpartum depression:

  • Fatigue and Sleep Deprivation
  • Hypothyroidism
  • Hyperthyroidsim
  • Immune system dysregulation
  • Pain
  • Low Cholesterol levels
  • Hormone imbalance
  • Neurotransmitter
  • Insulin resistance

Sometimes, it may be a combination of one or more of these that can cause postpartum mood disorders to develop.  Because this is true for many women, the Naturopathic approach is multifactorial as well.  The earlier we can recognize the symptoms and determine what's actually going on, the better.  In my office, a primary work-up to determine the underlying cause may include:

  • Thyroid testing, followed by nutritional supplementation and/or medicine to balance the thyroid gland (if needed)
  • Combination Hormone and Adrenal Saliva testing, followed by treatment with herbs and nutrients known to balance female hormones, DHEA, and/or cortisol (and are safe for breastfeeding).
  • Lipid panel, to look at cholesterol levels, followed by nutritional counseling to ensure adequate levels.
  • Comp. metabolic screen, Iron panel, and Complete blood count, to assess for blood sugar issues, anemia, and immune system problems
  • Musculoskeletal assessment to determine sources of pain that may be adding to increased stress and fatigue, followed by massage, acupuncture, or other forms of physiotherapy
  • In some cases, neurotransmitter testing will be done first.  This is especially true if someone has a marked history of depression, anxiety, or psychosis.

I could write pages and pages on this topic.  This is just a jumping-off point.  There is still a lot to learn about this realm of women's health, but we have a very good grasp on how to make the transition to motherhood a happy and healthy time.

Be strong.  Live healthy!images

Baby blues

imagesDid you know that about 80% of all new moms experience some form of postpartum mood flux?  There is a normal drop in mood, increase in anxiety and tearfulness that occurs in most women right after they have a baby.  In most of these women, it is hormonal.  The pregnant body is pumped full of estrogen, progesterone, relaxin, prolactin, and oxytocin.  When the baby is born, all these amounts shift---mostly dropping off like the cliffs of the Grand Canyon. Having a baby opens women up in so many ways: physically, emotionally, and spiritually.  It is a very wonderful and overwhelming time in all regards.  It is also a very vulnerable time because the body is going through so many changes AND there is a tiny little being that must be tended to 24 hours a day.  "Baby blues" affect up to 80% of new moms within the first few days postpartum.   I've seen that days 4-6 postpartum tend to be the most difficult for women mood-wise.

About 10% of new moms will go on to develop postpartum depression.  The onset of postpartum depression actually tends to be anywhere from 6 weeks to 6 months after the birth.  The symptoms are similar to depression: low mood, sleep issues, appetite changes, panic, anxiety, disinterest--plus constant concerns about ability to care for the new baby, and possible fears of actually harming the baby.  If a mom has had issues with depression prior to pregnancy, she is at a higher risk for developing postpartum depression.  Sometimes, it can be due to underlying physiological issues like hypothyroidism (which can also develop in the postpartum period).  So it's good to rule out root problems to best help with treating the symptoms.

Roughly 2% of new moms will suffer from postpartum psychosis.  This is a very serious condition that must be addressed immediately and is thought to also be due to the drop-off of hormones that occurs after the birth.  Symptoms of postpartum psychosis are seen within the first 2-3 weeks following the birth and include:

  • insomnia (other than not being able to sleep because the baby is awake)
  • mania
  • flight of ideas
  • self-harming
  • constant thoughts of harming the new baby
  • disinterest in the new baby
  • complete shift of mental status (that friends and family easily notice)

Often, these women need in-patient help with stabilizing mood, but there is a lot that can be done naturopathically to support a woman in this situation.  With the right support, these women go on to embrace being a mother.

There is a whole slew of new research coming out on postpartum and antepartum mood disorders.  More prenatal care providers are broaching the subject with their patients as well.  One of the best tools we have is to educate the patient and her family about the signs and symptoms so early intervention can occur.images-1

Next week, I'll be writing about some of ways naturopathic doctors help women who may be at greater risk for developing postpartum depression, anxiety, or pychosis.  Until then, enjoy the days as we begin to welcome Summer this year!

Postpartum Nutrition

Good Morning!  It looks to be another beautifully sunny morning here in Portland, Oregon.  Wow, we have really been blessed with some fantastic weather the past few weeks.  Our clinic garden is looking great as well as the garden my family and I are growing at home.  I'll be taking some photos to show you all just what I mean! imagesToday I'd like to round out this series on Nutrition during pregnancy by providing some guidelines about postpartum dietary needs.  The postpartum period is defined as the time from the birth of the baby and placenta to 6 weeks afterwards.  I personally believe that this extends to 3 months after the birth at minimum, with the first 6 weeks being the time when the body makes most of it's transition back to "normal".

I put normal in quotations because it is very common for women to feel like they have a totally new body after having a baby.  images-1To a certain extent, it's true.  It's not the same body.  It looks, acts, and feels different than before pregnancy.  Therefore, it has different needs.  This is especially the case if the new baby is breastfeeding. Let's have a look at some guidelines for women in the postpartum period:

  • During pregnancy, women need 200-300 extra calories per day to grow a baby.  During breastfeeding, women may need up to 500 extra calories per day to make enough milk to feed their new baby.
  • Also needed for milk-making is WATER.  Most women will need between 2-3 LITERS of water a day to keep up with the demands of making milk.  I like to get the whole family involved in the process, stashing bottles full of water wherever mom might end up nursing the new baby.  Intense thirst universally follows feeding the new baby, and moms everywhere love having a big glass of water while they nurse.
  • Many women need extra iron after having a baby.  Moms who had a lot of bleeding with childbirth are in a higher risk category for developing postpartum anemia.  To prevent severe anemia (which can lead to excessive fatigue and lowered mood):
  1. Increase iron in the diet: red meat, eggs, enriched cereals, and blackstrap molasses are good ways to get iron.
  2. Increase Vitamin C intake: Vitamin C helps you absorb more iron from your food.  Take with meals.  Do not exceed 3000mg/day unless being supervised by a health care practitioner.
  3. No black tea: Tannins in the tea decrease iron absorption.
  4. Cook with cast-iron pots and pans.  Believe it or not, you will get good doses of iron from doing so.
  • Continue to take your prenatal vitamins through the end of breastfeeding.  You still need the nutrients.  Plus, the extra B vitamins will give you much-needed mental and physical stamina.
  • Omega-3 fatty acids with a higher DHA:EPA ratio.  Studies show that infants benefit (neurodevelopmentally) from DHA supplementation in pregnancy and breastfeeding.  Moms also need these healthy fats to help heal and replenish the reproductive and nervous system.  DHA can be found in coldwater fish and algae most readily.  Taking an encapsulated form of DHA is a sure-fire way of getting enough.

Next week I'm going to address Postpartum depression, anxiety, and mood disorders.  It's more common than you think, and there's more that can be done to help prevent it from affecting you and the ones you love.  images-2