Transcription:
Planning a Pregnancy

Bill Klaproth: So, how do you plan a pregnancy and what about developing a birth plan and what are the important things you need to remember? Well, let's find out what Dr. Tamar Segev, an OB GYN, at Marin Health. This is the Healing Podcast  from Marin Health. I'm Bill Klaproth  Dr. Segev thank you so much for your time. First off, do you have patients who come to you to plan a pregnancy?

Dr. Tamar Segev: Thank you for having me. Yes, they do have patients that come to plan a pregnancy.

Host: It's very interesting. So how far in advance should a woman start planning if they want to have a baby?

Dr. Segev: It really depends. Most often women can just start a month in advance.

Some women, if you have chronic health conditions might want to start a few months earlier. For example, if a woman has diabetes, high blood pressure, autoimmune  disease or thyroid disease, it's also important to note a patient's BMI. BMI is the body mass index. You can easily find a calculator online and just input your weight and your height to find your BMI.

If the BMI is elevated or too low, a woman can have difficulty in conceiving and she could also have challenges during the pregnancy. So it might take a few months to achieve the best weight and achieve control of chronic health conditions  in order to be healthy as possible for pregnancy.

Host: Is seeing an OB GYN necessary at this early planning stage.

Dr. Segev: It is recommended that women should seek medical care before attempting to become pregnant, or as soon as they believe they are pregnant to aid and correct dating and to be monitored for any medical conditions in which treatment should be modified during pregnancy. Also, if you're taking multiple medications, You might want to consider changing it to one medication or reviewing your medications with an OB GYN to know which ones are safe in pregnancy.

Host: So what if a woman doesn't have an OB GYN? How does she select the right one?

I think that's a great question. And most important thing would be to find someone that you're comfortable with and that you trust because most providers are well trained and practice evidence based medicine. In terms of where to deliver, many women choose to deliver at a hospital that is near their home for convenience.

And it's recommended to deliver in the hospital setting rather than at home. Because even though everything usually goes really well in case there's an emergency such as the baby's heart rate going down. Or bleeding with delivery at the hospital. We do have the best resources to help.

Host: So then one of the most important things a woman needs to do to prepare for a pregnancy

Dr. Segev: in that first appointment, we might go over immunizations drug and alcohol use and prenatal vitamins, prenatal vitamins can be started a month before conceiving, doesn't really matter which brand you use, but what's important is to have enough folic acid.

You want 400 micrograms of folic acid to help with the neural tube development. This later becomes the spine and the brain, and it develops in the first few weeks of pregnancy before most women even know that they're pregnant. In terms of drug or alcohol use. It's important to stop smoking, using drugs or drinking when planning to become pregnant, because we really don't know how much of these substances or when in the pregnancy they can cause harm.

Host: So then how long does it typically take for a woman to conceive and is her age a factor?

Dr. Segev: Unfortunately, it can be difficult to conceive even if you had a hundred healthy couples trying to conceive only one in four would become pregnant within that first month. So I can take some time and that's normal for women under 35.

They can take a year and that's considered safe.  If it's taking longer than a year, then they should seek additional testing or see a specialist. For women above 35 fertility decreases. So if they don't conceive after six months, then they should seek help.

Host: So then when it comes time to get pregnant, do you have any tips for helping to get pregnant such as when is the best time in the month to have intercourse?

Dr. Segev: Yeah, the best time is during ovulation, which is when the egg is released and the way to calculate that is if a woman monitors her cycle and then subtracts 14 days. So let's say it takes 30 days from the first day of the period to the last day, then 30 minus 14 would be 16. So day 16 of the cycle would be when she ovulates.

If she has a 26 day cycle, then on day 12 is when she would have an oblation. Because of the lifespan of the sperm and the egg, the most fertile time is between five days before, until one day after ovulation.

Host: So let me ask you this. Are there things your partners should do, is the health of the man important as well?

Dr. Segev: Definitely, future partners are also encouraged to become healthier by eating healthy and exercising and giving up smoking and drug use. Male infertility can occur due to smoking tobacco, using drugs, disease, medications, or steroid use. If you have difficulty becoming pregnant, the male partner would want to visit a urologist to analyze his sperm.

Every partner is also encouraged to offer support and attend prenatal appointments.

Host: So how does this change or does this differ if it is your first baby versus a second child.

Dr. Segev: It changes just a little bit. We do recommend waiting 18 months between delivery and conception so that your body can replenish the nutrients that went into making the first baby. Also really important to share with your new provider or if it's the same provider, any adverse events that happened in the previous pregnancy or delivery. So things like gestational hypertension, preeclampsia, gestational diabetes, would help, will help us to know to treat you differently for, a subsequent pregnancy.

And then complications during the delivery like heavy bleeding or tearing would also be important to know.

Host: And then once a woman does become pregnant, what are some things she should be aware of early in the pregnancy.

Dr. Segev: Stopping any alcohol, tobacco or drug use is important. It is considered safe to drink 200 milligrams of caffeine, which is about one 12 ounce cup of coffee a day.

Other really important diet modifications include washing food properly, keeping the kitchen clean and avoiding all raw and under cooked seafood, eggs, and meat. And this can help prevent food poisoning, which can cause your body to lose too much water and disrupt chemical balance. It's important not to eat raw fish like sushi.

You can have cooked sushi and if you eat beef, pork or poultry, make sure that it's cooked all the way. Listeriosis is a food born illness caused by bacteria that can be dangerous to pregnancy. And the way to avoid that is by not eating unpasteurized milk product. And then avoiding hot dogs, luncheon  meats and cold cuts, unless they're heated all the way.

Host: So when having a discussion about pregnancy, not a fun topic, but miscarriages are something that should be mentioned and talked about. So miscarriages are not uncommon in the first trimester, is that correct?

Dr. Segev: Unfortunately, that is correct. And depending on a woman's age, pregnancy loss, can be as common as 17 to 40%.

It is important to know that it's not the woman's fault or her partner's fault. Usually miscarriage occurs because of a chromosomal abnormality, because it's so hard for everything to come just right to make a person. Luckily, most often it happens only once and the patient and her partner can go on to have healthy pregnancies.

This is part of why it's important to establish early prenatal care. So we can go over these risks.

Host: And then last question Dr. Segev, thank you so much for your time. Can you tell us about what a woman can expect at different OB appointments throughout her pregnancy?

Dr. Segev: Definitely. The prenatal appointments usually start around six to eight weeks because that's when we can see the developing fetus on the ultrasound.

Before that we can't see anything on ultrasound. So usually we wait until six to eight weeks. we usually do a first trimester ultrasound in the first appointment to make sure, that there is indeed a pregnancy in the uterus. And then, there's often another first trimester ultrasound around 12 to 13 weeks.

And then there's the anatomy scan around 18 to 22 weeks. That's a fun appointment. You can see baby's brain, little fingers, little toes, heart, and hopefully the gender. And then if everything goes well, we don't do another ultrasound until 36 weeks to make sure baby's head is down. Usually appointments are every four weeks starting at eight weeks.

And then after 28 weeks, you have an appointment every two weeks. And then once a week from 36 weeks to delivery.

Host: Well, Dr. Segev this has really been informative. Thank you so much for your time.

Dr. Segev: Thank you. I appreciate your time, it was fun.

Host: That's Dr. Tamar Segev. For more information, please visit mymarinhealth.org.

And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is the healing podcast brought to you by Marin health. I'm Bill Klaproth. Thanks for listening.