Transcription:

Scott Webb: Having a baby is a joyous time for most people, but it can also be a stressful time between choosing an obstetrician, knowing when to start prenatal vitamins and which labor option is best. Joining me today to help answer these questions and more is Dr. Stephen D’Abreau. He's an OB-GYN with Summa Health.

This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to take women through finding an obstetrician, what they can do before they get pregnant, what they can do during pregnancy, the different types of labor options that they have. Before we get rolling here though, what are some things that women should ask when they're looking for an obstetrician?

Dr. Stephen D’Abreau: I think, you know, one of the biggest things that women should consider, and usually we kind of overlook it is the demeanor of the physician. Basically, somebody who literally has the same sort of, not just a value system, but same sort of disposition as they do. It's common that they ask about the education and the training and then stuff like that. But they need to find out basically the mannerisms, the disposition of that physician. Because if they don't jive with that physician, obviously it's gonna adversely affect their whole pregnancy and the whole reaction with them.

So one of the things that I do recommend is that they should take time to request an interview with the prospective physician. I mean, physicians will do this. They will actually say, yes, you can come in and you could have 30 minutes in which you can talk with me. And that way they can get a feel for the physician. They can get a feel for the office staff and the office environment. Because sometimes, you know, it's not just the physician, sometimes dealing with their office, which they will interact with greatly can really affect how they feel about that physician.

So one of the things I greatly recommend in choosing a physician, obviously, they'll hear from their friends and you can talk to the nurses at the hospital about different physicians. You can look up their education and training. Once that's accomplished, it's probably a good idea to go ahead and schedule an interview with physicians and physicians will do this just to get a whole sense of that person's disposition, the office environment and office staff.

Scott Webb: Yeah, that's a great suggestion. Being a dad myself and having been through this process a couple of times, you know, it's a very personal relationship between a woman, between a couple and the obstetrician and the staff. And I want to have you take women through their preconception checklist, if you will. In other words, what should women do before becoming pregnant?

Dr. Stephen D’Abreau: I think you have to consider that pregnancy literally is like if you were going to run a marathon race, so say a 10K and you wouldn't do that without any preparation or without any training and certainly without having a coach. So one of the things that women could make sure and look for is try to get a status of their health concerns. I mean, where do they stand in terms of, you know, their just general medical conditions, diabetes, high blood pressure, thyroid problems, different things like that. They need to get those things under control. And certainly, things like weight, diet, and exercise, they can look at, but they need to optimize those things. So you want to get your chronic medical conditions, if you have those, under control by actually, you know, talking to your family doctor, your OB-GYN. And certainly once we stabilized those, then obviously you start to look for optimal weight and diet and exercise regimens, and I think that's a good place to start.

Scott Webb: Yeah, it sounds like it. And I'm assuming you're probably a fan, if you will, or a proponent anyway, of prenatal vitamins, which is something women can do before they become pregnant, right?

Dr. Stephen D’Abreau: Oh, definitely. Yeah, definitely prenatal vitamins and certainly folic acid and taking at least folic acid in their prenatal vitamins, at least four milligrams of folic acid should be helpful. And it's not just about taking the vitamins obviously is going to optimize the health. So I really want to stress that we think sometimes you can just take the vitamins, but they really have to take a stock off just their medical conditions, because that needs to be optimized because that will render them high-risk quickly, and the pregnancy can really go downhill fast. So vitamins are good, but the difference between a healthy outcome and an unhealthy outcome is going to be starting from a medical state that is optimal.

Scott Webb: Yeah, definitely. Overall health, mental, physical, otherwise. Do you have any tips for partners? You know, for dads to be, let's say, anything that they can do preconception or during pregnancy to both help themselves and help the moms-to-be?

Dr. Stephen D’Abreau: That's a good question about dads. I mean, usually, you know, it's dads just trying to stay out of the picture. But in terms of a preconception, what they can do is because of obviously in order to become pregnant because the testes lie out of the body, it has to be at lower temperature. So we asked them to wear a loose-fitting underwear, that sort of thing to optimize sperm quality and amount. Also, they themselves could try to maintain good physical health themselves because not only that obviously it's going to help achieve pregnancy, but going forward, once, you know, their partner becomes pregnant, you might find an emotional state in which mom's actually emotional state varies and vacillates, and the partner should obviously be not only prepared for that, but in a physical and mental state to really support mom during the pregnancy.

And I think that's the biggest they can do is support because sometimes the partners, they get a little bit left out when moms gets pregnant. And then it starts to create some problems during the pregnancy because they feel like they're being left out. So one thing they can actually really, really focus on is focusing on supporting mom emotionally and mentally and it will be tremendously helpful throughout a pregnancy instead of just trying to focus on themselves as they get left out.

Scott Webb: So let's talk about the actual pregnancy and things that women can do during pregnancy to increase their chances of having a healthy baby.

Dr. Stephen D’Abreau: Well, one of the first things they can do is obviously is their diet. You know, sometimes you have certain cravings during pregnancy and, women, they can overeat and they can increase their weight. A lot of unnatural weight gain can lead to elevations in the blood pressure and obviously lead to difficult deliveries. So healthy diet is one of the first things they can do. And secondly, is exercise. Obviously, I don't expect them to do things that they were not doing before pregnancy, but they're supposed to actually keep themselves in physical shape, because you have to remember that pregnancy is a stressor to life. It's a stress test on the system. So we ask them to go for walks. I mean, you don't have to be a totally active person. We don't certainly want you doing anything high impact, but go for walks and actually maintain some physical activity and watch that diet.

Certainly at this point in time, we certainly really want them taking their prenatal vitamins because that folic acid could prevent some neural tube defects and different things, birth defects that might occur. So it's totally essential, especially in the first trimester to do that. But, again, like what we talk with dads, it's important for mom to actually maintain their psyche because, you know, just having a mental stress and emotional stress in a relationship, obviously, We can't really overstate how much that affects the pregnancy. And we find that sometimes, you know, these can lead to spontaneous miscarriages early in the pregnancy, just due to stress. So lowering stress, moderate exercise and a healthy diet is probably the big things they can be doing.

Scott Webb: And so doctor, when we talk about labor specifically, what are some of the different options that are available during labor?

Dr. Stephen D’Abreau: There's This refour main areas in which I think women should look at when they go into labor. And it's basically a support person, having a support person; the labor environment itself; laboring positions and pain relief; and obviously now, choices during and after delivery.

So with that in mind, you know, having support in labor, obviously certainly increases the chances of a healthy delivery and actually shortens the time the moms spends in labor. Some women might actually choose to have a specialized person that is called a doula, which is specially trained to provide that emotional, physical support. But that's not necessary all the time. Just having someone there, and it could be obviously the partner or it could be a parent or even a friend.

The labor environment is important also. And moms-to-be should know that they can request like few interruptions as possible, you know, nurses and doctors coming in a quiet environment. They can actually have clear liquids and ice chips that they can eat. And in some cases, some physicians do allow their patients to actually eat solid food to keep up their energy level during labor. And they can ask the limit examinations or decrease the amount of fetal monitoring that we do.

One other thing is the laboring positions itself. And they can request changes in their positions. You know, you can use a birthing ball. They can actually walk up and down the hallway. It's amazing how that walking and especially with their partner up and down the hallway can actually shorten that time in labor. And, if they want, they can at times sit in a rocking chair.

Pain relief is another important area. And most patients want to "go natural," but natural may not be the best option for everyone. So I try to tell moms-to-be that there is no awards being given for patients who do in fact go naturally. There's no extra award for you. So if you have breathing techniques and concentration techniques that are not working, certainly we have narcotics that we can put in the IV and they usually work for a little while, and then you can also request getting an epidural.

But most important thing is for them not to feel like they're being defeated if you have to ask them for an epidural, because I tried to explain to them that if this were say a gallbladder surgery, a laparoscopic cholecystectomy, which is a gallbladder surgery, which is done through you know, a laparoscope, we have fewer incision, a shorter surgery, and no one would conceive of not giving that patient any sort of anesthesia. So I try to relate that to them. And they seem to kind of come around to realize that it's okay. But it's okay too if they don't want anything. And some patients are quite comfortable with just basically, as I said, concentration techniques and breathing techniques.

Some of the choices during labor, they can actually choose to like labor down when they actually get to complete. They can use like a mirror to see the baby to help them focus a little bit better. Use mineral oil or lubricating oil in the perineum. They can choose to touch the baby's head or even have their partner or themselves deliver the baby.

And one of the things though that I see often enough is that the moms want immediate skin to skin and early breastfeeding. And then that bonding that happens right away, that seems to really increase, not just the bond between mom and the baby, but especially if the partner's around, that seems to just bond that family right after delivery.

Choices after delivery, they request maybe be present when the baby is being examined. They can request when to have the baby's first bath. Even dad can be involved after delivery.

Scott Webb: Definitely. And I definitely was with my kids. As we get closer to wrapping up here, what's the difference between a low-risk and a high-risk birth?

Dr. Stephen D’Abreau: Well, the difference between a low-risk and a high-risk birth primarily has to do with any pre-existing health conditions for mom and the conditions for both mom and baby that may arise during the pregnancy. So, some examples of some conditions and we've touched on them earlier, like you might have conditions of diabetes or high blood pressure that might adversely affect the pregnancy and that certainly will render moms high-risk. Problems with the pregnancy itself, sometimes you might have positions with the placenta that might be low-lying. The baby itself might have a low birth weight problems. They may see something on ultrasound that they may want to investigate further, but it's important for moms to know that whether their pregnancy is low or high-risk kind of depends on their specific situations. And it's kind of in collaboration with their physicians what the necessary precautions they need to do and whether they should be delivering at what we call a level one hospital, which just doesn't have the advanced neonatal care as level three hospitals, but that's kind of an individual life decision.

Scott Webb: Yeah, it sounds like it. This has been a great conversation today, doctor. As we wrap up, what are your takeaways for women? Whether it's choosing an obstetrician, preconception, during pregnancy, labor options, what are your takeaways?

Dr. Stephen D’Abreau: Well, believe it or not, I think the biggest thing that I want pregnant women to know is that pregnancy is a state of health, just an alteration in the state of health. It's not an aberration, which is a disease state. So being a state of health, what they have to know is that usually it involves a partnership and a coach in a state of health.

So the things that happening to them, you know, sometimes they feel like it's really unnatural and you have to kind of bring them around to remind them that this is a healthy state, this is normal, this is what your body is designed to do. And in partnership with your obstetrician or midwife, I mean, you could have a healthy and safe outcome.

Scott Webb: Yeah, that's great. As you say, this is healthy, this is normal and there's, you know, individualized care and so much support available to have healthy moms, healthy dads, healthy babies. So, doctor, thanks so much for your time today and you stay well.

Dr. Stephen D’Abreau: You too. Thank you very much.

Scott Webb: For more information, visit summahealth.org/maternity. And if you found this podcast helpful and informative, please share it on your social channels and be sure to check out the entire podcast library for additional topics of interest. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.

Listen to more podcasts.