Rania Habib, MD (Host): Many people think about pregnancy and babies when thinking about their OB GYN. But there are plenty of other questions you should be asking your doctor. Welcome to FirstHealth and Wellness Podcast, connecting you to people and medical services that make your life healthier. I'm your host, Dr. Rania Habib.

Joining me today is a Pinehurst Surgical Clinic, OB GYN, Dr. Michelle deBlaquiere. Thank you so much for joining me today. How are you?

Michelle deBlaquiere, DO: Thank you for having me. I appreciate the opportunity to talk with you.

Host: We're so excited to have you here. So, to begin, what are things that people should be asking their OB GYN, that they may not always think about?

Michelle deBlaquiere, DO: That is a good question. I think that when you think about going to the OB GYN, you should think about two kind of purposes. One is preventative healthcare. So knowing all the different things you can do to kind of find illness or make yourself healthier as you're going. And the other thing is for, to find out if there's anything that's not going well with you.

So, questions you can ask the OB GYN would include things like am I up to date on all my vaccinations? Am I up to date on PAP smears and do I need any testing? Are my periods normal? Any kind of questions like that. And then the other thing you should know is OB GYNs talk about all sorts of things with patients all the time.

So you really have to remember, we hear a lot of different conversations and so we are very comfortable and open to questions you may have regarding your periods, regarding sexuality, regarding sexual function, any problem that you're having in your pelvic floor, like problems with urinary incontinence or fecal incontinence. Those are things that we talk about all day long with lots of patients, so please always feel free to talk about that with your OB GYN.

Host: You know, one thing that we don't always think about is exactly that preventative question that we're always asking, so I really appreciate you breaking that down very simply into those two categories. If I am ready to start a family, how should I talk about that with my OB GYN?

Michelle deBlaquiere, DO: Usually you would do that at a well check. We recommend an annual well check just to touch base with your OB GYN again to making sure you're up on your preventative health needs. And also to kind of guide you for the future. In pediatrics they call it anticipatory guidance, and it's very similar in OB GYN and what that means is kind of planning for your future with you and expectations of the future.

And so one of the things you want to do on your well visit, and one of the things you can talk to the doctor about is contraception. Are you desiring pregnancy, not desiring pregnancy? Kind of what are your plans? And a good question that comes with that is if I want to get pregnant, is this a good contraception to take right now?

Also, what do I need to do to prepare my body for pregnancy? So one thing that we really emphasize is trying to get on folic acid, a folic acid supplement at least one month depending on what you read, up to three months prior to pregnancy. And that actually helps prevent birth defects with the neural tube, which is the spinal cord formation in the baby. So that's super important. Other things you might want to know would be, am I healthy for pregnancy or is there anything about my medical history that the doctor or I need to adjust? For example, what medicines am I taking? We can go through all the medications you're taking and make sure if they're not safe for pregnancy, you know when to stop them and what else to take. Or for example, if you have diabetes or a history of any type of medical complication, prior surgeries, there's things that we may be able to address there that kind of help you to know what to expect with pregnancy and help you to have the safest and healthiest pregnancy.

Host: Absolutely. And I think people often forget that very benign medications can cause serious defects. So I love that you're incorporating that into that conversation. So patients are safely coming off of things like retinol that they may not understand can be a major cause of birth defects. So let's say I'm pregnant now. Now what? What, how do you help me enter that phase?

Michelle deBlaquiere, DO: Well, congratulations.

Host: I'm not, but let's just say theoretically.

Michelle deBlaquiere, DO: Um, still say that's very exciting. Let's kind of break this down. When we see you, we usually like to see you, if you call us and let us know when you have a positive pregnancy test. That kind of helps us get started on visits. We usually like to see you one time, just again to review medications, questions how you're feeling, address any early pregnancy nausea or early pregnancy problems.

And then we like to see you for what we call a confirmation of pregnancy visit, and that is done at around six to seven weeks, and that's where we ultrasound the baby and make sure that everything is going as anticipated with the pregnancy to that point. After that we do a new OB visit, and that's sort of the time when we go through what the process of prenatal care is, what types of things we're looking for, what types of things we recommend. We typically see patients about every four weeks during the first trimester, and that goes up to about 28 weeks. And then we see patients every two weeks until the third trimester, and then we go to weekly visits.

Host: Okay, so during that time, when do patients actually find out the sex? Cause I bet that's a question they always have.

Michelle deBlaquiere, DO: Typically they'll find out pretty early. We recommend and offer a test that looks for the risk of genetic problems, with the baby either what we call aneuploidy, which means if you have too many chromosomes or not the right chromosomes, or even genetic problems, which might be genes that you inherit, for example, cystic fibrosis risk or sickle cell risk, or some type of other risk that you might inherit.

And along with that testing, we offer checking for the fetal gender, and then we will tell our patients we know the fetal gender. Do you want us to tell you or do you want us to put in an envelope? Because a lot of patients want to do different fun things when they're doing, when they're learning about the gender of their baby.

Host: Okay. That is fantastic. We've talked about unique questions people should ask their OB GYN, starting a family and pregnancy. So let's switch gears and talk about if I'm an older patient and have questions about incontinence, can my OB GYN actually help me?

Michelle deBlaquiere, DO: Absolutely. And this is a very common topic and even one that we try to ask all our patients are they having any problems with. And you don't even have to necessarily be older to have some issues with incontinence because if you think about it, your pelvic floor, the bottom part of your pelvis, is sort of what supports the pelvis and supports your bladder and your bowel; that's a place that gravity hits. That's a place that when we cough or do heavy lifting, different things can happen in that area as well, pregnancy itself, can cause some weakness with the pelvic floor, and so anytime you're having any problems with urinary incontinence, or urinary leakage of any type or any bowel leakage of any type, that's a great topic to bring up with your OB GYN. We have different modalities for treatment for this, and it can range from pelvic floor physical therapy and advice on how to strengthen the muscles in your pelvic floor all the way up to surgical treatment that can actually reconstruct pelvic floor and help with these symptoms.

Host: That's wonderful. Now, when do you, as the OB GYN do the surgery versus refer it out, let's say to a urologist?

Michelle deBlaquiere, DO: So we actually have in OB GYN, in the OB GYN world, we have a fellowship called Urogynecology. After you do your OB GYN residency, if you want to do pelvic floor reconstruction, you go into a fellowship called Urogynecology. And this is a four to five year fellowship where physicians specifically learn how to treat pelvic floor dysfunction, surgically and non-surgically.

So, if it's as simple as it's mild and you want to try pelvic floor physical therapy, that's an easy thing from your general OB GYN. Once you start getting into kind of more complicated incontinence or like if you've had surgery before or it's pretty severe, I always recommend to my patients to consider a Urogynecology consult. And a lot of urologists also take care of female incontinence. So depending on the area and your preference, either one is very reasonable.

Host: It's so wonderful to hear that you guys have so much experience.

Michelle deBlaquiere, DO: The cool thing is, and the thing to think about with Urogynecology is going to meet with someone and doing a consult does not commit you to surgery. It just gives you more information about options for treatment. And they also will recommend things that may not be surgical. For example, estrogen replacement in the vaginal area often helps with urinary incontinence.

Host: That is fantastic information. So let's switch gears because you alluded to the estrogen therapy. Can you discuss hormone therapy? That term now has been thrown out on social media and a lot of people are claiming to be hormone therapy experts. Can you just describe that to us and how an OB GYN can help?

Michelle deBlaquiere, DO: This is an area that I really hope we gain a lot more insight into. I feel like it's an area that nobody really knows what all the correct things are to do and how to kind of guide patients through perimenopause, which is the several years before menopause or menopause, which is once you've gone 12 months without having a period, and then the post menopause, which is after that.

The way I've learned the most about menopause that I can learn is by joining the North American Menopause Society. They have lots and lots of patient information. It's if you go to menopause.org that is all very clinically accurate and relevant information on hormone replacement therapy and that's really a better place to go than some of the news articles or other things cause they can sometimes be slanted to gain your interest, and may not give you the most accurate information.

Host: Right, and it's always important to be evidence-based when you're trying to gather information about your health.

Michelle deBlaquiere, DO: Absolutely. You, you really want to know what the safest things are and what the risks and benefits to a treatment are as much as possible when you're making decisions about what to put in your body.

Host: Absolutely. I could not agree more. Well this episode is coming to a wrap, are there any final take home points, Dr. deBlaquiere that you would like to leave with our listeners?

Michelle deBlaquiere, DO: I would say this, I think OB GYNs in general, just love preventative health and helping to make you healthy. And so coming in and talking to us, asking us any questions, kind of going over your health, we're always going to help you get to the right place, if it's not in our clinic or if it's in our clinic.

So please always feel free to reach out to us, ask questions, get our opinions. We always want to promote and support women in their health. I think all OB GYNs probably have a pretty significant passion for this, and I know I do.

Host: You can definitely tell that. And I thank you so much for your expertise today.

Michelle deBlaquiere, DO: Thank you. I appreciate the opportunity.

Host: Need to schedule an appointment with an OB GYN? Visit www.firsthealth.org/women to learn more. You can schedule an appointment with Dr. Michelle deBlaquiere at the Pinehurst Surgical Clinic, OB GYN. Thank you for listening to the FirstHealth and Wellness podcast, brought to you by FirstHealth of the Carolinas. I'm your host, Dr. Rania Habib. Wishing you well.