Pregnancy Power Salad

Jicama Pomegranate Salad

When I'm pregnant I can't get enough salad, especially in the summer. So I've complied a few of my favorite pregnancy super foods to make a super yummy pregnancy power salad.

• 1 small head of romaine cut with a knife
• 2 cups of raw spinach
• 10-14 walnuts loosely crushed
• 1 jicama, peeled and julienne
• 1/2 cup of pomegranate seeds
• 2 hard boiled egg whites chopped

** You can also add avocado, chunks of corn or mandarin oranges


Lime vinaigrette

• 1/4 cup fresh lime juice
• 1/4 cup apple cider or red wine vinegar
• 1/2 teaspoon salt
• 1 tablespoon honey or agave
• 3 tablespoons olive oil, avocado oil, walnut oil, or brown rice oil

Place the chopped romaine and spinach in a bowl and drizzle the dressing to taste. Cover with jicama, walnuts, pomegranate seeds and egg whites and enjoy.

Fetal Kick Counts

After the 28th week or the third trimester, a woman may become increasing aware of the baby kicking in the womb.  Before this, some women don't even feel the baby moving until the 20th week and it can be different with each pregnancy.  In general, I usually counsel a woman that she should  be aware of the movements regularly throughout the day,  paying attention that she perceives a grouping of movements in the morning, afternoon and evening. Babies can be active at different times of the day and usually by the 28th week,  a woman will gain a sense of what a normal amount of movement is for her baby.  Counting can be very helpful if she perceives a change in the frequency or a decrease in fetal movements.  Fetal movements are a great predictor of fetal well being and fetal kick counts is a way to quantify fetal movements.  Other reasons to do fetal kick counts are if a woman's provider instructs her to do so, she has a medical indication in which they are recommended, it's something she enjoys, or she feels a sense of calm and reassurance by doing so.

How to do fetal kick counts:

• It is best to count while sitting or resting.
• The woman should place her hands on her belly and time how long it takes her to perceive 10 kicks.
• Without being distracted, a woman should perceive 10 kicks in 1-2 hours.
• If after 30 minutes of waiting, a woman does not perceive movement, she should walk, change positions, drink something cold or have something sweet to eat.
• If there is any concern regarding the amount, frequency or quality of fetal movements, a woman should contact her provider for counseling. 
• The proper way to do fetal kick counts should always be reviewed with an obstetrical health care provider.**

• There are apps for smartphones and mobile devices that can be helpful  
• Baby Kick Counter and Wiggle Wrecorde

• Or check out this link for a handy chart.

Internet Information Overload

Nowadays, we are on internet information overload. For almost anything and everything we think up, we can find some internet article, website, group or post to back our claim.  We then discuss, distribute, and disseminate.  This can sometimes lead to having medical information backed by views or popularity as opposed to clinical evidence.  It can lead to a bit of confusion.  Is Sushi bad? What about induction if I've had a VBAC?  Should I take progesterone? and on an on.  This is why I strongly advocate women talking with a provider they trust about their questions or concerns.  As a provider myself, I strive to be an expert provider that has a moderation between experience combined with evidence-based practice and offer this continually to my patients.  The benefit of an provider who is experienced but also up-to-date on the latest research is invaluable.

The field of Obstetrics changes every month as new research is tested and trialed. There are new treatments, new recommendations, and new safe practices.  Because a lot in the field of obstetrics stays the same over time (giving birth has been around for a while!), even some providers can get complacent when it comes to reading research and changing their practices and conceptions.  It's common for even some long practicing providers to practice out-of-date care, so its not surprising that internet information can also be a bit behind the times. 

While the internet can be a great source of information, it can also be a scary and frightening place for an already vulnerable pregnant couple. I strongly advocate talking with your provider about the latest research regarding a question or concern that you have.  Most providers who read research regularly are happy to "get geeky" and talk shop for a while in terms that are easily understandable, even if they are in a rush.  So go for it and don't be afraid to ask about what the research says.

Obama Care

The Affordable Healthcare Act
It's hard to completely understand how this change will impact us each specifically. The Obama campagin has a tool on their website where you can put in specific factors about the health care you have now and it will generate a read out of how your care will change.  Linked here

The Pros include: (taken from Slate, the Wall Street Journal and Barack Obama and Mitt Romney's campaign websites)

• An increase in benefits for the uninsured
• Senior citizes will gain acess to billions of dollars in prescription benefits
• Everyone withinsurance will get free preventive serices
• It will increase coverage for those with a pre-existing condition
• Working families are protected from losing their health care or being forced into bankruptcy when a family member gets sick or is in an accident
• adult children can stay on their parent's health plan until the age of 26
• Mammograms, pap smears and immunixations will be covered without a co-pay including breastfeeding support, contraception, HPV testing, and domestic volence screenings
• Insurance companies are now required to justify rate hikes, and consumers have the ability to appeal to an independent third party when insurance companies refuse to cover services or care
• Starting in 2014, all Americans will have access to affordable health insurance no matter their circumstances—whether they change jobs, lose their job, decide to start a business, or retire early
• For patients, there will be fewer cash payments and lower fees.
• States can opt out of the act
• The law is expected to reduce the deficit by $127 billion from 2012 to 2021.

The Cons

• The act forces an insurer to sell a policy to someone who is already sick, which severely limits the insurer's right to charge that person a higher premium
• The bill, itself more than 2,400 pages long, relies on a dense web of regulations, fees, subsidies, excise taxes, exchanges, and rule-setting boards to give the federal government extraordinary control over every corner of the health care system
• States can opt out of certain sections of the act
• It you don't purchase health insurance you are responsible for a tax
• Flexible Spending Accounts will shrink to a maximum of $2,500
• You will only be able to deduct a medical expense from your taxes if it exceeds 10% of your gross income
• The costs are unknown

The unknowns:

• It is not known exactly how much this act will cost.  Speculation on both sides report a drastic increase in governement spending while democrats boast a reduction in spending and the overal deficit.  It remains unknown.
• The effect of “comparative effectiveness” practice guidelines on individual practioners. This is a part of the act that is aimed at improving quality while reducing costs. Republicans argue that it will be a way to manipulate provider freedom. This is explained in more detail in this NYT article. Click here

The Birth Plan

It's true, there is a common belief among labor & delivery nurses and obstetricians that birth plans lead to the BIG ROOM, aka the operating room. While this stereotype is entirely unfair (as many stereotypes are), in their defense, I think it may be that a few women who "birth plan" sort of ruined it for the rest, by zealously typing up binders full of planning and structuring for their exact, idyllic birth.

The birth plan, theoretically makes sense. Planning in any situation usually makes that situation less stressful and more enjoyable. That's the funny thing about the birth plan - you can't! And birth often is more than idyllic without adhering to a plan.

The best way to "birth plan."

1) Prepare. Prepare for the unexpected. Labor will most likely begin at an unexpected moment. Pack ahead of time and have plans for different scenarios with work, transportation, and childcare (if needed). Tour the facility where you plan to give birth.
2) Communicate. Talk to your partner and your provider about what your preferences are for the birth. Ask your provider about what you expect and any protocols at the facility where you will give birth. A lot of your preferences may be what your provider already practices like skin to skin and not performing episotomies.
3) Trust. Trust your body and your ability to birth. Trust your provider to have your interests at heart. Trust your provider to take your preferences and make them happen whenever possible.
4) Be flexible. Plan to go with the flow
5) Relax and enjoy. As much as possible, try to relax and enjoy the birthing process.

Filling out a birth plan or a list of preferences can be a good way to go over your preferences with your provider.  In the birth setting, it can prevent you from having to constantly repeat yourself.   Keep it brief and relevant.