Episode 54: Prenatal care is about caring for yourself and your baby

Dr. Sophia:
Welcome to the Dr. Sophia ObGyn podcast. I'm an obgyn practicing for over 15 years in my native New York City. And I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician.

Hello everyone and welcome to the Dr. Sophia ObGyn podcast. Today I'm just gonna share one of my patient stories. I have so many, and of course, when Touseef and I get into talking, it always lands at whatever happens at some point in my day.

Touseef Mirza:
And I'm just like, okay, we have to talk about this, and this is one of them.

Dr. Sophia:
And here we are. And here we're, this is another one. So thank you Touseef for being here. I love having you as my co-host. So welcome.

Touseef Mirza:
Thank you. I love being here, Dr. Sophia.

Dr. Sophia:
So we were talking and I had this patient who came in, well, the labor floor for me is like the ER for pregnant people. It's interesting because most people think of the labor floor and oh, okay, she's coming to have a baby. But in essence a labor and delivery is also what I consider as the emergency room for women who are pregnant most of the time over a certain number of weeks, on our labor and delivery. We typically see women after 20 weeks of pregnancy. And today I had this patient who came in, she was about seven months, and in my world, that equals about 32 weeks.

Touseef Mirza:
Thank you for doing that. Instead of just talking about the weeks. I appreciate that.

Dr. Sophia:
So seven and a half months, almost eight months, basically eight months pregnant. And she came in with a complaint of back pain.

Touseef Mirza:
So this was not a scheduled visit?

Dr. Sophia:
No, no, no, no, no. This was not a scheduled visit. She came in just because she was having pain. And she was having pain and she was having this back pain. And she describes the back pain as pain in her spine. And so I'm like, pain in your spine, okay. Have you had any trauma? Have you had any injury? Have you, did you fall? Did you have a previous issue with your back? Do you have scoliosis?

Touseef Mirza:
You're going through all the different, all this, the different reasons why.

Dr. Sophia:
Someone could have back pain. And she's like, no, no, no, no. My pain just hurts and it just hurts in the middle of my back. And I'm like, okay, is it your entire back? Is it the middle of your back? Is it your lower back? Well, kind of a little bit all over from the top to the bottom.

Touseef Mirza:
So one thing though, I think you had told me also that this person had not come for prenatal care before.

Dr. Sophia:
That was the other thing. So this patient had not had any prenatal care.

Touseef Mirza:
So what does that mean? No prenatal care.

Dr. Sophia:
She hadn't seen a provider for this pregnancy. So here she is, she's basically seven and a half or eight months pregnant. She's eight months pregnant. And she has not yet seen a provider.

Touseef Mirza:
Since she's become pregnant?

Dr. Sophia:
I like how big your eyes are getting.

Touseef Mirza:
Like, I just thought that's a default. Like when you get pregnant, you go see your obgyn and say, I'm pregnant.

Dr. Sophia:
And take care of me for this pregnancy because–

Touseef Mirza:
There's rudimentary processes around this that need to be checked. But there's still some people that don't show up.

Dr. Sophia:
There are some people who do not take good care of themselves. Yes.

Touseef Mirza:
Wow. Okay. And so we can even say that if this person didn't have back pain, she might have not even come at seven months. She would've just showed up like when she was ready to deliver.

Dr. Sophia:
Yeah, for sure. And the only reason why we even knew how pregnant she was was because she did come in at some point in the very beginning of her pregnancy, she came into our ER and had had a sonogram that was like, at seven weeks. That's a very accurate time to have a sonogram to know what's the age of your pregnancy.

Touseef Mirza:
So when a woman finds out that she's pregnant, she should schedule an appointment with an obgyn to let them know, or usually there's a timeframe in which you should make that connection.

Dr. Sophia:
I would say the second that a woman knows that she is pregnant and that this is a pregnancy that she would like to carry and keep. And I'm not saying that that's a decision that she knows to make in that instant per se. But I would, I would give or take, I would say you, you get a positive pregnancy test within a week, you should reach out to a provider and see when they can schedule you for an appointment. And typically a woman who finds out she's pregnant, it's because she's missed her period. Like a week or two has gone by. She was supposed to get her period, and she realizes she didn't. And then she'll take a home pregnancy test and she'll find out that she's pregnant.

Touseef Mirza:
So that's about like six weeks, right? Six weeks that she's probably pregnant.

Dr. Sophia:
Exactly. Most people by the time they see a provider, are typically around six weeks. And it's also when they start feeling really yucky. So they, you know, this is also the time when they start having morning sickness and you know, they're extremely tired and perhaps they've actually had a positive pregnancy test, but then they have a bleeding episode and then they're concerned about that. So for whatever reason, this woman had come in at some point earlier in her pregnancy through the emergency room and found out that she was pregnant. They did the ultrasound, they were able to see how pregnant she was. And so that's the only reason why we even had a due date for her. In order to understand how pregnant she was at that moment, she was already somewhat in the system.

So she comes in with this back pain and we're like, okay, anything else? She's like, no, I just, you know, I really need you to help me with this pain. It's not going away. I said, well, when did this pain start? Well, today I'm like, okay, well what were you doing before today? All I did was lay, lay in bed for the last three days. I said, well, have you been drinking enough water? I probably could be better at that. She says to me, okay. I said, okay, alright. I said, well, did you try anything for the pain? Did you take anything, apply a warm compress? Did you maybe try some Tylenol? And she says, no. And I said, okay. And you for sure didn't injure yourself. No, but the pain feels like it's kind of in my spine. And I'm like, okay, so first things first, let's get her down to the emergency room. That would deal with like an, the actual emergency room that would deal with if she had some type of extra thing going on with her actual spine. Like the vertebrae? Yeah. Like, I don't know, is this meningitis, is this anything.

She gets evaluated by the ER, they give her some IV Tylenol and they give her a lidocaine patch and they give her some IV fluids and they send her back to me. So mostly for managing the pain, really mostly for managing the pain, they had already excluded any other potential like acute spinal process. So she comes back to me again, just to be clear that everything is okay with the baby, with the pregnancy, that she's not in preterm labor and things like that. And so, she wasn't in preterm labor. Preterm labor meaning that she is, is she having back pain because she is just in labor and having labor pains that are going to her back. But that was not the case.

Touseef Mirza:
The baby wasn't ready to come out. That's not it.

Dr. Sophia:
The baby was not ready to come out. That wasn't the problem. But it just made me think, okay. First of all, like I said, the labor floor is like an ER.

Touseef Mirza:
So is the labor floor usually connected like the other maternity rooms or it's like next to the ER?

Dr. Sophia:
No, it's usually like the maternity floor. Okay. So that is like both the labor rooms in our hospital, let's just say. Okay. Okay. It has the labor rooms on one side of the floor, and then on the other side of the floor is maternity, where the women go after they've had a baby. And it also has our nursery. So that's where the babies are after the woman has, you know, after the women have had their babies.

Touseef Mirza:
Okay. And if somebody's coming at it more from an ER labor perspective, where did they go?

Dr. Sophia:
They go to the labor floor. Labor. Labor part of the floor. Labor rooms.

Touseef Mirza:
Okay. Labor rooms. Yes.

Dr. Sophia:
Okay. And so why did I bring up this case? Because A, in this particular patient, if she had had her own provider, like if she actually had prenatal care, then she would've been able to actually go to her doctor's office in order to have her initial evaluation for this pain. Ultimately, it really was that she was severely dehydrated, not exercising at all, like not moving. And people take for granted the fact that your muscles actually need to move and the weaker they become, the more they can actually have pain. And so pregnancy doesn't stop you from being able to move unless you have a special condition that makes it, that we don't want you to move, we want pregnant people to be active. Now does that mean you go and run a marathon for the first time? Maybe not, but it doesn't mean you become a complete non-mobile person.

Touseef Mirza:
Just sitting or just lying around period.

Dr. Sophia:
Exactly. And so I feel like it was a combo of two things that was happening with her, which was the severe dehydration as well as immobility that kind of triggered her back having basically spasms.

Touseef Mirza:
Does it have to do with the weight of the, if you're lying down for a long time and you have like the weight of the baby pushing against your back.

Dr. Sophia:
Sure. That's the real thing. At eight months pregnant, your baby's already at least five, five and a half, six pounds. And so there's that, there's the actual baby. There's all the fluid around the baby or the amniotic fluid, the uterus that has grown to accommodate this baby. And so all of that is just sitting on you. Mm. . If all you've done is laid on your back, all that time.

Touseef Mirza:
And so you're saying that if she had started to have care from a provider, from a healthcare provider, from an obgyn, then the obgyn would've talked to her about these things as well?

Dr. Sophia:
Right. I, I tell my patients, oh my gosh, they must be sick of me with how many times. I'm like, okay, so how much water are you drinking? Okay, I just need you to drink more. Like I tell them, drink more water at least 20 times.

Touseef Mirza:
And why is water so important, especially in pregnancy?

Dr. Sophia:
In pregnancy? Because your uterus is also a muscle and we don't want that muscle contracting before it's time. I want your uterus to feel very just cushiony. It will eventually as you get closer and closer towards your delivery. The uterus will do some practice contractions, what we call Braxton Hicks contractions. And the purpose of that is exactly that. It's like practicing for the real day. We don't want the uterus to contract prematurely because contractions lead to changes on your cervix, which leads to labor.

Touseef Mirza:
So the cervix is at the bottom part of the uterus.

Dr. Sophia:
The cervix is the lowest, most part of the uterus that has to open in order to deliver.

Touseef Mirza:
And we don't want the cervix to open anytime before its time until before the baby actually comes out, supposed to come out. So then by having the uterus nice and cushiony and moist. Hydrated, then it has a less of a tendency to have those types of contractions. That could cause those issues.

Dr. Sophia:
Water is just so important in our health and it's just so important when we're pregnant.

Touseef Mirza:
Okay. I did not know that. So how many glasses do you recommend your patients take when they're pregnant?

Dr. Sophia:
At least, in ounces, almost their body weight.

Touseef Mirza:
Because I think for a normal human being, it's something like for like, for a nice tall glass of like 16 ounces, we should be having like six.
Dr. Sophia:
So you said 16. And we usually think of it as actually eight ounces.

Touseef Mirza:
Eight ounces.

Dr. Sophia:
Eight. Eight ounce glasses. Like 64 ounces.

Touseef Mirza:
Okay.

Dr. Sophia:
So I'm talking on average, at least double that.

Touseef Mirza:
So double what you usually take. And then on top of that, it might be uncomfortable for the women because-

Dr. Sophia:
They gotta pee every second. Is it uncomfortable? A hundred percent. It's very uncomfortable.

Touseef Mirza:
Okay. That's just what happens.

Dr. Sophia:
It's a part of the process. Small sips so that the fluid actually gets to your tissues. Okay. So it's not that you're guzzling this water. You're not just grabbing a bottle of water and drinking it as fast as you can and saying, Hey, I've done my eight bottles. Okay, I'm done. I want women taking small sips. Okay. 'cause We want that water to actually get to your tissues.

Touseef Mirza:
Because it has too much to process. So it just goes straight there.

Dr. Sophia:
It's just gonna go straight to your bladder. But back to this woman, why did we bring her up? Mostly because A, understanding the concept of a labor floor as an emergency room B, really understanding the concept of prenatal care, like how important it is, why we do it, why it should just come as second nature to a woman, and how something so simple as talking about how much water to drink and how to manage certain common concerns are important outside of everything else that has to happen in a pregnancy. In terms of prenatal care, actual blood work and lab work that needs to be evaluated to make sure you don't have certain deficiencies, anemia and other issues. Making sure you get certain vaccines that you may need during the pregnancy. Making sure that your baby is healthy during your pregnancy.

Things like making sure you don't have a risk factor for gestational diabetes, a risk factor for preeclampsia, that if you have any other comorbidities, meaning medical conditions before you're pregnant, that we have an opportunity to address them. Thyroid disease, asthma, a high blood pressure that we have an opportunity to intervene and make sure that those conditions are managed well while you're pregnant so that they're, they don't become emergencies actually and crises for you while you're pregnant. We get a chance to look at the baby on ultrasound and do things like an anatomy scan and make sure that your baby has 10 fingers, 10 toes, nose, lips, heart is pumping well, kidneys are functioning, the brain is well developed. There's so many things that go into having adequate prenatal care. And so if you are someone who is pregnant, considering a pregnancy, identify a provider that you're gonna be comfortable with so that you can actually go, remember a pregnancy has two patients so that you are being cared for and your baby's being cared for.

Touseef Mirza:
You know, that's an important point in the sense that you might be feeling okay, but you also have to check how the baby is doing, which you might not know right away. Unless you actually go through these prenatal care visits.

Dr. Sophia:
Exactly. And I mean, ultimately I'm just, I'm happy that this woman did not have any life-threatening condition. That she also was not in preterm labor, that her back pain was easily resolved. But it was so interesting to me how her coming in with back pain led to so many other things. And she really didn't articulate exactly why she wasn't getting prenatal care in, in all honesty, it was hard to tell if she just doesn't have a stable home? And she just wasn't forthcoming with the information in those circumstances. It's kind of hard sometimes. It's not like she wasn’t safe. So it's not like we were mandated to do anything, you know, other than get her an appointment, see a provider as soon as possible. But it left me feeling kind of like, what else?

Touseef Mirza:
Did you book her, like another appointment?

Dr. Sophia:
Yeah. That she's not gonna come back to the labor floor. She's gonna go to a doctor's visit.

Touseef Mirza:
And she agreed to that?

Dr. Sophia:
She agreed to that.

Touseef Mirza:
She agreed to the water?

Dr. Sophia:
And she definitely understood that she needed to drink more water. Yeah. I mean, like any other ER going to the labor floor, you don't wanna have to spend hours in a place just to be told you need more water.

Touseef Mirza:
Because at the labor floor, like at the ER, you could wait a long time.

Dr. Sophia:
She was, she was lucky she didn't have to wait too long. Right. But sometimes if our rooms are completely booked, if our, you know, you can have a, there can be a waiting time and there is a triage process to see and assess, well, who is more acute, you know? That kind of thing. But either way, I just felt like, how can she get the information of how to care for herself in her pregnancy? And this actually was her first pregnancy, so it's not like, it's not like sometimes I get the moms who've like, this is their fourth pregnancy. They're like, okay, this is not my first rodeo.

Touseef Mirza:
Been there, done that.

Dr. Sophia:
I've been there, done that. And then those women sometimes tend to kind of become a little lax. With getting their prenatal care or feeling like they can skip appointments. Because they're like, oh, I already know what, what, you know what to expect. I know how my baby is. I know I'm doing fine. Kind of a feeling. But I was really surprised. This is her first pregnancy and she seemed happy about it. And yet wasn't doing her part in caring for herself.

Touseef Mirza:
When you told her, you know, you didn't have any prenatal care visits, was she surprised by the question or she just answered it?

Dr. Sophia:
She just was like, oh, I tried to make an appointment. Oh, I know they called me. I missed that one. Oh. And it was very like lackadaisical.

Touseef Mirza:
This is like how I deal with my dentist appointments. I'm like, yeah, okay. All right. I'll get there. I'll get there when I get there. I'll get there when I get there. But this is, this is a whole other ball game.

Dr. Sophia:
Six months later you might have a baby
Touseef Mirza:
This is a whole other ball game.

Dr. Sophia:
This is not, yeah. Just a tooth clean, a teeth cleaning It’s not just about you. It's not just about you. And I think it's important for women to recognize that medical care, there's a portion of it that is on you. There is a portion of it that is how you actually care for yourself. And I'd like to partner with my patients 'cause I wanna be as supportive as I possibly can be.

I hope she has some support system in place that would consider doing that for her. Like I would if it were my sister that if she were struggling for whatever reason, but this, this woman would not, she did not let on what her challenges were. You know, despite asking her, and sometimes I get it, it could be out of shame, it could be out of fear, it could be out of, there's so many other layers to this.

Touseef Mirza:
It could also be a very personal thing that you're going through and you're pregnant and you're trying to wrap your brain around like, there's so many things right. That could be going on.

Dr. Sophia:
Yeah. Financial barriers.


Touseef Mirza:
But you know, as you're talking, one of the things I think, especially when it comes to pregnancy, is to have prenatal care visits, even if you think anything is fine.

Dr. Sophia:
Yes. Right.

Touseef Mirza:
That, because usually we go see a doctor aside from our yearly, unless there's a, there's a problem, we go. But with prenatal care visits, it's a different mindset where it's more about, well, we just, you, you need to go no matter what.

Dr. Sophia:
Well, you need to make sure you're still healthy. In pregnancy, everything is still going well, and it's not because you're looking for something bad or that you expect something bad, or you're, you know, there's going to be a problem. But in pregnancy, you only have those nine months. So you have to be able to anticipate, and that's what I feel your prenatal care can do. Having those touchpoints with your provider allows you to have an opportunity to discuss if you're having discomfort, pain, nausea, vomiting, feeling the baby moving a lot, not feeling the baby moving enough. You know, just all kinds of things that can come up.

Touseef Mirza:
And then also sometimes you just don't know. That's what I've learned with my acid reflux is sometimes you just need professional help because no matter what you do, it ain't gonna work.

Dr. Sophia:
Exactly. And I'm telling you, this is, and this goes, even the professionals need professionals, you know, I, I can't treat myself to some extent. I really can't. I still need to speak to my doctor, who happens to be a friend of mine, but it doesn't change the fact that I still need to check in.

Touseef Mirza:
Well, it's like people say even a therapist needs a therapist.

Dr. Sophia:
Even a therapist needs a therapist.

Touseef Mirza:
We all need each other.

Dr. Sophia:
We all need each other. Yeah. We do. At the end of the day, prenatal care is just so important. And the same way we want the labor floor to be for the women who are in labor. And also, of course, the other critical things that can happen during the course of pregnancy. But it's like the ER and it's like when you say to someone, I don't know if you should be in the ER to manage your high blood pressure, if you've never seen your regular primary care doctor or your cardiologist. Yes, of course. In a hypertensive emergency, a heart attack or something, you need to be in the ER. That's what you need to be in the ER for. But a refill on your blood pressure medication. We should do better at making sure we have the right providers that can help support our health and that includes pregnancy. And the best way to do it is with good prenatal care.

Touseef Mirza:
Well, I'm happy to hear that this woman finally, considering that she was seven months in.

Dr. Sophia:
That was the only, yeah. Almost eight months. Almost like 32 weeks.

Touseef Mirza:
And that, you know, that was the only issue. And it seems like everything was fine. So that's good news. And that it was only, you know, with some Tylenol and everything that you were able to resolve that.

Dr. Sophia:
Yes. But it's not always so simple. And so I'm happy to use a very simple situation to bring up a much more important and, and bigger topic ladies, those of you who are considering a pregnancy, excited about a pregnancy, planning a pregnancy, find your doctor now. Find the person you're gonna be able to connect with so that you're happy to go.

Touseef Mirza:
But start the relationship even before you're getting pregnant.

Dr. Sophia:
Start that relationship so that it's an easy one to have.

Touseef Mirza:
And you can shop around and you can figure out what's right for you. What's interesting is that when we talk about these patient stories, there's just so many different aspects that latch on. You know, it's not one thing, it's that one thing. Oh, and we have to think about this and we have to think about that, that it becomes quite substantial. We were talking about like, she didn't have enough water. Okay. Why didn't she have enough water? Okay, now we're talking about the uterus. Okay, now we're talking about the cervix. We talked about prenatal care and, and all the different things that need to be done. And, and it's just you, we talk about one person, but there's so many different aspects.

Dr. Sophia:
A lot of moving parts.

Touseef Mirza:
Like Yeah. Like that are coalescing together, that are combined together. And that's why I find this super interesting because It's never on the straight and narrow.

Dr. Sophia:
It's never on the straight and narrow. No. Well, ultimately she's better. Ultimately, I hope she comes in for her appointment and hopefully she develops a relationship with a provider that she can at least open up to. 'cause I did feel like there was a lot that she was hiding or holding in and not sharing or disclosing. And sometimes it takes a few visits to build that kind of relationship and trust and to really understand where a patient is coming from, both from a provider standpoint and the patient standpoint. Having all of those interactions just builds up that partnership. And it's just so important. So today, if you haven't already, think about how you're building your partnerships, especially with your medical providers, especially a woman who's thinking about creating or building her family. A part of just embracing your body and embracing yourself is embracing the relationships that you build with your community, specifically with your healthcare providers. Thank you everyone so much for listening to the Dr. Sophia ObGyn podcast. Bye for now.

This is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Until next time, embrace your body. Embrace yourself.