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Scott Webb: Family planning and birth control are topics where the expertise of a doctor is invaluable. And joining me today to discuss both of these topics and more is Dr. Anastasia Klick. Dr. Klick is a family medicine physician at Salinas Valley Medical Clinic Prime Care Salinas. Dr. Klick treats a broad spectrum of medical conditions, including adolescent medicine, full spectrum of obstetrics and transgender and LGBT medicine.

This is Ask The Experts, a podcast from Salinas Valley Memorial Healthcare System. I'm Scott Webb. So Dr. Klick, thanks so much for your time today. I want to ask you as we get rolling here, what does full-spectrum obstetrics cover?

Dr. Klick: Full-spectrum obstetrics really is our way to say that doctors that provide full-spectrum obstetrics can provide all of the care that a woman needs during her pregnancy, labor, delivery, whether that ends up being a vaginal delivery or a cesarean section and in the postpartum time, which is a really sensitive and important time for women to have a good relationship with their doctors. We can provide care for women of all ages and backgrounds. And also, a lot of the doctors that provide full spectrum care are obstetrics. I am a family medicine doctor, and not all family medicine doctors do deliver babies and provide obstetric care. But myself and several other of the doctors at Prime Care and Salinas do.

And because we are also trained in taking care of children and men, we can take care of the baby after the baby is born, take care of the baby's, dad. It really gives us an opportunity to treat the whole family unit and understand health concerns that the family has.

Scott Webb: That's really cool. That's really great. Brought a smile to my face. Just really awesome that you get to treat the whole family. And obviously, you mentioned that you deliver babies there. Let's talk about the other side of this. Let's talk about birth control and then we'll make our way to family planning. What are the best and safest methods of birth control?

Dr. Klick: Great. So I think the best methods of birth control are the ones that are most effective and that a woman feels comfortable with and is going to use consistently. Now, that being said, I tend to think about birth control in three big categories, either not very effective in preventing pregnancy, pretty effective in preventing pregnancy and very effective in preventing pregnancy. For those methods that are not very effective, these are methods like condoms, menstrual tracking or the pullout method that tend to have about a 10% to 20% failure rate, meaning out of 100 women that try and use these methods 10 to 20 of them will end up being pregnant, which is a pretty high number.

Scott Webb: It really is. Yeah.

Dr. Klick: Yeah. And I think a lot of women who use condoms don't realize that. Now that being said, condoms really are the only method that protects against sexually transmitted infections. So if you are in a non-monogamous relationship, having sex with more than one partner or a new partner, certainly that is a good method to use on top of another method that may be more effective.

Now, the next category is those that are what I call pretty effective, more or less effective. Those are things like the pill, the birth control pill, the patch, the vaginal ring, or the shot. These have about a 5% to 10% failure rate and they can be good methods as long as women use them consistently. The problem with the pill is that women forget to use it. And it's not just if you forget to use it, it's not just that one day that you could possibly become pregnant, it's actually the whole rest of the month until you get your period and start the new pack of birth control pills. A lot of women don't really understand that because it's confusing.

Now, the next category are those that are very effective. Methods that are very effective in birth control are the arm implant. The most common brand there is called the Nexplanon. And there's the IUD, which stands for intrauterine device that's the little T-shaped piece of material that goes into the uterus. We can put those in easily in the clinic. There are two different types of IUD, a hormone IUD, and a copper IUD. And then of course, sterilization, either what we call a tubal ligation for the woman or a vasectomy for the male.

Scott Webb: And so if a woman, if a mom-to-be plans on becoming pregnant, how long do they have to wait after having the we'll call them implantables removed?

Dr. Klick: Right. So the arm implant is good for three years. Now, that doesn't mean that you have to keep it in for three years if you decide you want to become pregnant. We can always take it out early. The same is true of the IUD. So the copper IUD is good for 10 years. And the hormone IUD is good for between three or five years depending on which one you choose.

And it really depends on the methods. Some women don't have regular periods. And so it might take them a bit longer to become pregnant after taking out an IUD or taking out the arm implant, but the reality is, as soon as you take it out, you could become pregnant. And so really women shouldn't be   removing that method until they're wanting to become pregnant.

I would say generally one to two to three months it can take for women whose periods have changed when they use one of those methods to start having regular periods again. But the studies actually show that when we look at nine months out that the fertility rate for women who have used one of these implantable methods is the exact same as the fertility rate for women who have not used any birth control at all. So really there are no long-term effects on fertility for these methods.

Scott Webb: That's good to know that there's no long-term effects, but as you say, some careful planning is needed here. And to know that once you've removed, you know, the I think this should be "implant" or the IUD that, you know, anything can happen. And that may be a good thing, but it's just good for women to know that it's possible, right?

Dr. Klick: Exactly. And that being said, I usually recommend that women start taking the prenatal vitamin about three months before they are actually planning on trying to become pregnant. So three months before you take out your IUD, three months before you stop using the pill, whatever it is, to start the prenatal vitamin then, because that vitamin is actually important at the very beginning of pregnancy before most women even know that they're pregnant.

Scott Webb: Yeah, we're going to talk more about that as we go into the sort of family planning section of the podcast here. So let's talk about that. What should women do before trying to get pregnant for a healthy pregnancy? And I know that's probably a lengthy list, but let's go through this.

Dr. Klick: Yeah. It is a lengthy list, but it starts with the most basic things like good physical and mental health, regular exercise, maintaining or working towards a healthy weight. We don't want women to be underweight or very overweight during pregnancy because that increases the risks of complications and also participating in activities to promote good mental health.

I like to tell women that labor and pregnancy are like a marathon. It is so much work for your body and you wouldn't go out and try and run 26 miles, run a marathon without training beforehand. And so similarly if you're totally sedentary and don't do any exercise, then asking your body to do this extraordinarily difficult thing and push out a baby is like running a marathon without doing any training. So that's one really big thing.

Also, of course, women shouldn't smoke. Really minimize or abstain from alcohol at all. Avoid all illicit drugs. And then for women who have chronic diseases like diabetes or thyroid issues or high blood pressure, seeing their doctor to be sure those conditions are very well-controlled before she were to become pregnant and to review any medications that she may be taking for those patients, to be sure they're safe in pregnancy.

Now, that doesn't mean that if you find out you become pregnant, you should stop taking your medications. Please talk to your doctor before you stop any of your medications. And also considering workplace hazards for women who work in exposure to chemicals or pesticides or radiation or things like that, talking to your doctor about those before you become pregnant.

And of course, not many of us are doing a whole lot of international travel right now, but that will start again, we are hoping. And so if you're thinking about becoming pregnant or are pregnant, speaking to your doctor about traveling internationally beforehand to consider any infectious disease risks that might exist in the place that you're planning to go.

Scott Webb: Yeah, that's always good advice. Talk to your doctors first, especially if this is a part of a long-term plan, right? Women are asking their bodies to do something incredibly difficult and we want to make sure that they're prepared for it mentally, physically in all the ways that you've described here. Are there any specific tests or screenings? And when we talk about those, how about for dads to be, for fathers?

Dr. Klick: Yeah. So there are no specific tests or screenings that we tend to do before a woman is pregnant other than routine health checks, including your Pap smear, STD testing if you're at risk, if you have sexual activity with more than one partner. And if you've never had blood tests to check for things like diabetes or cholesterol, doing that at least once in your lifetime or more frequently depending on your risk factors.

Now, once a woman becomes pregnant, there are a number of tests that we do, including checking for certain types of infections, doing genetic screening for being a carrier for the diseases such as cystic fibrosis or sickle cell disease. But those we do after the woman becomes pregnant.

Now, when it comes to men, there really are no specific screenings, unless there is the concern in the woman or the man's family for a history of genetic problems. In which case, the partners should really go and speak with a genetic counselor before they start to think about pregnancy to see what their risk would be. And of course it's good for dads to be healthy too. So he should be sure that he's up to date on all of his routine health things as well.

Scott Webb: Doctor, are there certain procedures that a woman can undergo to improve her chances of becoming if she's having certain issues? And what are those issues?

Dr. Klick: So the first thing I want to do is reassure women, because I think there's a lot of fear about not being able to become pregnant. And really, trying for up to a year, so 12 months to become pregnant can be normal. And so the first thing is really just having faith in your body and yourself and your partner's body. But if you have concerns or also if you have irregular periods, going to speak with your doctor about initial screenings, such as just normal regular health checks.

Now, the other thing that women can do is something called ovulation tracking. There are all sorts of apps that can help with that and help which part of the menstrual cycle is your most fertile time, because that's a very confusing cycle, and so helping to know when you're ovulating.

There are also something called ovulation testing kits. They are urine strips that test for a hormone called luteinizing hormone. So you can buy those online or at the pharmacy. And they tell you when you're ovulating, so you know what you're most fertile days are. That will be sufficient for most women.

Now, if a woman is having difficulty becoming pregnant, if she's been trying for 6 to 12 months having regular intercourse, going and speaking to her doctor about maybe having some very basic labs checked, some hormone levels. And if it's been 6 months to 12 months or if the woman has other risk factors for infertility, the possibility of seeing a fertility specialist for further testing, like ultrasounds or certain procedures that look inside the uterus for problems.

The other thing we need to remember also is that not all infertility is because of the woman's body. So if you've been trying for more than 12 months to become pregnant and you haven't achieved pregnancy, it's also important for the man to see his doctor, to make sure that there aren't problems with sperm count or sperm motility that might be contributing.

Scott Webb: Yeah. And you mentioned earlier about possibly genetic counseling as well, just to understand the genetics and family history that might be involved. Let's talk about age. You know, when my wife got pregnant with our daughter. she was 36. The doctor said, "Well, of course, you're of advanced maternal age." And I remember my wife looking so insulted that she was referred to as being of advanced maternal age. But the truth is 36, advanced maternal age. So when we talk about age and women wanting to get pregnant and have a family, maybe start a family, what's the best age range to do that?

Dr. Klick: The first thing I'll say is the best time to become pregnant is when a woman and her partner feel ready. And for some women that will be at age 23 and for some women that will be at age 36. But I will say pregnancies very young, less than 18 or very old, over 40 or even over 35, do have increased risk.

Now, very old, being over 35, I agree, it's hard not to be offended by that. My first pregnancy was when I was 36. And we do use that term, advanced maternal age in medicine, that is not to say that women over the age of 35 should not become pregnant or that they can't have completely normal pregnancies and healthy babies. The vast majority of women over the age of 35 will have normal, healthy pregnancies and healthy babies.

After the age of 35, we do see the risk of certain genetic problems go up, which is why we have denoted that age 35 of advanced maternal age. It used to be called elderly gravida. I'm not sure which one is more offensive. But the reality is most of those women will go on to have completely normal and healthy pregnancies.

Scott Webb: Yeah, as did my wife. Our daughter is amazing and healthy and great and so is my wife. So, you're so right. I can just remember the look on her face, like, "Excuse me? What did you call me?" Doctor, this is really great. As we get close to wrapping up here, you mentioned earlier about prenatal vitamins. And I want you to set the record straight on that. That's something that women should do months before they actually start trying to get pregnant, right?

Dr. Klick: Ideally, we recommend starting prenatal vitamins three months before you really start trying to become pregnant because that allows the stores of certain minerals and vitamins to build up. And certainly, if you find out you're pregnant and you're not yet taking the prenatal vitamin, start one as soon as you can.

Scott Webb: Right. Definitely. Well, as I said, this has been a great conversation and really fun to just laugh a bit with you about, you know, this age stuff. I'm going to reminisce with my wife when I finish this. But doctor, as we wrap up, we do put a period at the end of the sentence here. We've covered a lot of territory today. Anything else you want to add for listeners?

Dr. Klick: Well, really just that before you start thinking about becoming pregnant, please do go and talk to your doctor because there are so many things we can help with, planning and also mostly just reassuring you that you can trust your body and give you the opportunity to ask any other questions you may have.

And for those women who are not yet ready to achieve a pregnancy or to have a pregnancy, please do come talk to us about birth control methods because women's bodies are designed to become pregnant. They've been doing this for centuries and centuries. And if you're having intercourse and you're not using protection, you will become pregnant. And there are so many methods of birth control out there that we can help you find which one is right for you, so that if you don't want to become pregnant, you don't. And then when you're ready, we can help you achieve that too.

Scott Webb: That's great advice from an expert today. You know, doctors have the answers and especially for most, for many probably, this is a part of a plan, right? A long-term plan. And so getting started on the right foot, being healthy, mentally, physically at working with their doctors, it's all good stuff. And I really thank you for your time today. Thanks so much. And you stay well.

Dr. Klick: Yeah. Thank you. You as well. It's been lovely talking to you.

Scott Webb: Dr. Klick is accepting new patients at SVMC Prime Care Salinas. For more information, please call (831) 751-7070 or visit svmh.com.

And we hope you found this podcast to be helpful and informative. This is Ask The Experts from Salinas Valley Memorial Healthcare System. I'm Scott Webb. Stay well, and we'll talk again next time.