Woman to Woman

Pregnant? Bring on the Skinny Jeans!

This is part three of a

Many women mourned the inability to wear “skinny” jeans while pregnant until Emily Evans of 9 London introduced the “Koi” skinny jean under the Citizens of Humanity jean brand.

Yes, these jeans are very skinny and come in denim and black colors. Asa Silwerstern, a sales representative for 9 London, states the Koi is the “must-have” item in a woman’s maternity wardrobe.

The jeans have a very low seam, so the band will expand gracefully with the abdomen and still remain well-fitted across the hips and thighs. Asa also says that the Koi will expand an extra size to accommodate mom growth, but will still maintain unbeatable comfort and the skinny style.

A sought-after item of women throughout Europe, these jeans are super fashionable and worn by many women long after they have delivered their babies.

The Koi costs about $200 and can be found at Harrod’s, 9 London and at upscale retailers in the U.S.

three-part series in which Dr. Jacobs shares some maternity fashion findings she discovered on her recent trip to New York and London.

Rethinking the Diaper Bag

This is part two of a three-part series in which Dr. Jacobs shares some maternity fashion findings that she discovered on her recent trip to New York and London.

Diaper bags are overrated.

They can be too big, too heavy, too cumbersome and not so chic. But I recently learned that fashion-conscious moms have a chic alternative.

On my trip to New York City, I had the opportunity to visit Rosie Pope Maternity on Madison Avenue where I met Alison Milam, VP of Sales.

Alison showed me the ultimate glam diaper bag clutch (yes, a clutch bag, not a sac like most moms carry around.) This washable clutch comes in black leather with either nickel or gold hardware. It has a dust cover and holds a bottle, three diapers, wipes and a diaper changing pad. 

Retailing for about $130, the clutch is great for a quick run to the store, dinner with friends, church and other social outings that require glamour wear. It’s also a great accessory to have in your closet after the baby outgrows its use.

When the big baby bag won’t do, just go with the clutch diaper bag.

Pamper Yourself During Pregnancy

Do pregnant women really have glowing skin?

This is part one of a three-part series in which Dr. Jacobs shares some maternity fashion findings that she discovered on her recent trip to New York and London.

Bad skin happens to all women in various stages of life and pregnancy is not excluded. Dry skin, acne, blemishes and skin discolorations are common complaints among moms to be.

What's a girl to do and what are safe treatments during pregnancy? For starters, you can go get a facial!

Yes, moms-to-be can make a date with an esthetician. Being well-groomed is essential in both pregnant and non-pregnant phases of life.

I had the wonderful opportunity to receive a facial from Miriam Cardoss at Bliss Spa 49 at the W Hotel on Lexington Avenue in New York City recently and talked her about what expecting mothers can do.

“Because of hormone fluctuations during pregnancy, it is common for women to develop skin problems,” Miriam says. “Facials are great to treat the skin, are relaxing and can be performed throughout the pregnancy.”

She even discussed how leg, underarm, belly and bikini waxing is safe and convenient for clients because they just can’t reach those areas during pregnancy.

Many spas offer “pregnancy” facials, and if not available, it's quite easy for the esthetician to customize a safe skin treatment. Avoid certain chemicals during a facial such as vitamin A, salicylic acid and some essential oils.

Your doctor can provide information as far as what to avoid and what is acceptable. Certain types of microdermabrasion and chemical peels are safe because most of the abrasive materials are inert or inactive micro agents that are not absorbed by the skin.

These agents remove dead skin superficially and even out areas of skin discoloration.  Oxygen treatments for the face are safe, refreshing and destroy bacteria on the skin.

Drinking plenty of water and using moisturizers helps keep the skin hydrated and reduces dry patches on the face. If all else fails and one's skin is not "glowing," a trip to the dermatologist may be in order.

Congratulations on Your New Baby _________!

The decision to determine the gender of your unborn child is personal. Some want to know in order to choose a name, to buy gender specific baby items, to decorate a nursery, to bond early on with a specific baby, or for family lineage issues. What ever happened to the surprise factor around a child’s birth?

Day in and day out, expecting couples routinely want to know whether or not their unborn child is a boy or a girl. Before the very first OB visit, most couples have somehow determined the gender of their unborn child by some method conceived from urban myths. 

Gender prediction is probably one of the oldest practices known to humankind. Over the years, I’ve heard prediction methods such as the Drano test, the ring or key test, the shape of the mother’s baby, fetal heart rate and the Chinese Lunar calendar as some of the numerous ways folks guess a baby’s gender.

I have to admit, I find some of these methods quite intriguing. Even though as a physician, I tell these parents that gender is determined at conception by the male partner, not by a women’s ovulation, the season or time of day of conception, what one eats or drinks, etc., my words seem to fall upon the deaf ears of parental glee.

Here’s a list of testing methods that will likely give you a better idea of what to expect from the baby growing in your belly:

Ultrasound and genetic testing are the most accurate ways of predicting gender before a child is born. These methods should not be used solely as tools for gender determination, but as diagnostic tools to manage a pregnancy. Ultrasound for the purpose of finding out the sex is best done between 18 and 26 weeks gestation. Of course, ultrasound is only as good as the equipment, the technician and the baby’s cooperation.

Chorionic Villus Sampling (CVS) and Amniocentesis are the most accurate methods for determining sex. CVS is a diagnostic test usually performed between 8 and 11 weeks gestation and best used for patients who a have high risk of genetic abnormalities. CVS has a 4 percent miscarriage rate and a risk for fetal limb deformities.

Amniocentesis is a diagnostic test performed between 9 and 18 weeks and carries a 1 to 1.5 percent risk for miscarriage and other complications such as premature labor, rupture of membranes, infection and injury to the fetus.

So, how and when do you plan to choose your baby’s name?

What you should know before trying to conceive

So, you’re ready to have a baby. But is your body ready? Pregnancy is more than months of strange food cravings and maternity clothes. Before you conceive, it is important to be in good health!

A pre-conception visit to your OB/GYN is a great start. Your OB/GYN will review any past pregnancies and will know what tests to suggest if you’ve had a complicated pregnancy, a previous baby born with a birth defect or multiple miscarriages. They’ll also review any health issues that might require medical attention before you conceive or during pregnancy. For example, diabetics with poor blood glucose control prior to conception have a higher risk of miscarriages, fetal deaths and having newborn babies with birth defects.

Your doctor may discontinue certain medications or nutritional supplements (supplements with more than 10,000 IU of vitamin A are known to cause birth defects in fetuses as well as certain classes of blood pressure medications).

If indicated, a breast exam, and possibly a mammogram, should be done. Checking for breast cancer before conception is essential, as well as a Pap smear, pelvic exam and STD screening. If you have a family history of genetic disorders, genetic counseling and  testing can be arranged by your doctor.

The Importance of Folic Acid
All women of childbearing age should take 0.4 milligrams or 400 micrograms of folic acid daily at least one month prior to conception and during the first three months of pregnancy. Folic acid helps to prevent birth defects of the spinal cord.  Prenatal vitamins can be purchased over the counter and each tablet contains .4 milligrams of folic acid.  Women with a history of birthing a child with either a spine or skull defect will need to take 4 milligrams daily of folic acid take one month prior to pregnancy and during the first three months of pregnancy. These women should take a prenatal vitamin along with an additional folic acid supplement. Where can you find folic acid? Look no further than dark, leafy greens and vegetables such as spinach, collard and turnip greens, broccoli, and asparagus. Other great sources include enriched breads, cereals, citrus fruits, juices, dried peas and beans such as pinto, black, navy, chickpeas and lima beans, and meats like liver.

Your Ideal You
Being in good health and at your ideal weight will help you have a healthy pregnancy and avoid gaining too much weight. A healthy diet consists of fresh fruits, vegetable, lean proteins, whole grains, at least 64 ounces of water a day and either fat-free or low-fat dairy products. 

Avoid diets high in sodium, fat and sugars. Limit consumption of processed foods and, if possible, avoid fast foods. Caffeine and artificial sweeteners should be used in moderation. Some doctors suggest avoiding these substances during the last two weeks of your cycle, when you are ovulating and more likely to conceive.

Try to get in at least 30 minutes of moderate exercise most days of the week. Swimming and walking are good forms of exercise. More strenuous forms of exercise, such as jogging and cycling, are fine if you are in good shape and were already doing these activities before you conceived. 

What to Avoid During Pregnancy
Alcohol, illegal drugs, and tobacco should be avoided. Alcohol in any amount is associated with growth restriction and mental retardation. Illegal drugs are associated with placenta abruption, preterm birth, fetal death, brain injury and developmental problems. Tobacco is linked to low birth weight babies, still births and sudden infant death syndrome.

Treatment Options for Heavy Menstrual Cycles

Many women experience excessive bleeding during their period find themselves severely anemic in the process. Are you one of those ladies?

This type of bleeding is called Menorrhagia. The menstrual flow from the uterus starts on schedule but is heavier than usual and may last longer than usual.

Menorrhagia may be a sign of an underlying disorder, such as hormone imbalances that include polycystic ovaries, thyroid disease, endometriosis, adenomyosis, pregnancy, obesity, uterine fibroids, endometrial polyps, medications or cancers of the genital tract.

Menorrhagia or heavy menstrual bleeding can be treated many different ways depending on its cause.

The following are treatments options for Menorrhagia:

Hormone therapy - oral contraceptives or other medications that treat hormonal imbalances.

Dilatation & Currettage (D&C) - a surgical procedure that involves scraping the inside of the uterus.  For a majority of women, this is only a temporary solution that reduces bleeding for a few cycles.

Endometrial Ablation - this treatment may be recommended by your doctor if you do not plan to have children in the future.  There are several methods of this minimally invasive surgical treatment including laser, electro-cauterization or heated fluid.  The procedure requires no incision, takes a short amount of time, and the patient has a rapid recovery time.

Hormone-containing IUD (Mirena) - a small device inserted into the uterus releases low levels of progesterone and results in lighter or no menses after several months.  The device is placed during an office visit, causes minimal cramping and lasts for five years.

Myomectomy - surgical removal of the fibroids, which are benign tumors, from the uterus. This is ideal for women who desire to have children because the uterus remains in place.

Uterine Artery Embolization - this treatment is recommended for the treatment of fibroids in women who have medical problems prohibiting surgery.  This involves blocking the blood flow to the uterus and fibroids resulting in either reduced or no menstrual flow. 

Hysterectomy - surgical removal of the uterus is the only definitive treatment for Menorrhagia. It is a major procedure performed under general anesthesia in a hospital. The recovery period is usually up to six weeks.

Menorrhagia is a significant medical issue that adversely affects the well being of many women if not addressed and treated promptly.

Abnormal Vaginal Bleeding

Are your periods normal or abnormal?  How often do you bleed each month, if at all?  Have you ever had accidents at work? Many patients report these symptoms and wonder why.

Vaginal bleeding is normal when it occurs during the menstrual cycle, which is about every 21 to 35 days. In a normal case, vaginal bleeding occurs when the lining of the uterus is shed. The bleeding may be light or heavy and occurs for a period of a few days.

When Does Vaginal Bleeding Become Abnormal?
Abnormal vaginal bleeding is generally based on the time of the month when the bleeding takes place, as well as the amount of bleeding that occurs.

In premenopausal women, abnormal vaginal bleeding may be characterized by the following:

• Bleeding in between menstrual periods
• Excessive amount of bleeding during the menstrual period
• Menses lasting seven days or longer
• Anemia due to bleeding
• Abnormal genital tract bleeding due to abnormal uterine tissue such as endometrial polyps, endometrial hyperplasia, infection, etc.
• Benign tumors of the uterus such as fibroids
• Uterine cancer
• Cervical cancer
• Obesity
• Polycystic Ovaries

Abnormal vaginal bleeding in premenopausal women may also occur when the woman has just given birth, when a miscarriage takes place, or when the pregnancy is ectopic. In addition, abnormal vaginal bleeding in pregnant women can occur when the placenta overlies the cervix either partially or completely, and when the placenta tears away from the uterine wall during an abruption.

For a woman undergoing menopause where she has not had the menstrual period for twelve consecutive months, abnormal vaginal bleeding might be a cause for concern. Causes of this condition among postmenopausal women may include the following:

• endometrial hyperplasia
• cervical or endometrial polyps
• endometrial cancer
• vaginitis
• unopposed estrogen

Evaluation of Abnormal Vaginal Bleeding
If you suspect that you have abnormal vaginal bleeding, then you should consult an OB/GYN for further evaluation of your condition. However, you will need to provide the doctor specific information regarding your abnormal vaginal bleeding. In particular, you should be able to provide your menstrual history and information about any irregular or accidental occurrences.

The Benefits of Birth Control

Many of my patients have found themselves having a period during some of the most important events in their lives. Usually, the important event is either a wedding day or senior year trip. 
 
To avoid the inconvenience and embarrassment during that time of month, many of my patients have benefited from taking their birth control pills continuously. It’s an easy way to have control over your cycle.

Traditional birth control pills make your body mimic a typical 28-day period cycle. For the first 21 days, you take active hormone pills containing estrogen and progesterone. Placebo pills that contain no hormones are taken the last seven days, which triggers your body to begin menstruating.

Continuous birth control pills contain active hormones for each day of the month.  Lybrel is a low-dose pill that's taken for one year and is meant to suppress menstrual bleeding. Spotting or bleeding can occur, but many women find that not having a regular period outweighs this inconvenience. This usually only happens during the first six months.  

Two other specially designed, continuous pill regimens — Seasonale and Seasonique are taken every day for three months. With Seasonale, you take one week off and replace the hormone pills with a placebo. With Seasonique, low-dose estrogen pills replace the hormone pills. With both, you’ll experience menstrual bleeding every three months.

Periods can be inconvenient. But using birth control pills can help you avoid menstruating during important occasions.

Women who may benefit from the pill include:

• Women with heavy, prolonged and painful periods.
• Women who have endometriosis (anemia due to menstrual bleeding)
• Women who suffer from pre-menstrual symptoms.
• Women who have menstrual migraines and disabilities that make monthly hygiene care difficult. 

Continuous oral contraceptive pills have the same side effects and efficacy in preventing pregnancy as traditional birth control pills. Breakthrough bleeding is the most common side effect and is self-limiting. The effect of birth control pills on weight is small, if at all. There’s a reduction in risk for ovarian cancer and endometrial cancer.

Contraceptive patches: Is Ortho Evra right for you?

Some of my patients aren’t fans of the pill. Their busy schedules and active lifestyles make it difficult to remember to have to take a pill every day and they prefer the convenience of a birth control patch.

The contraceptive patch, or Ortho Evra, is a thin, beige-colored, four-and-a-half centimeter square patch that is applied to the skin once a week. Each patch contains hormones (progesterone and estrogen) released into the bloodstream to prevent ovulation.

The patch should be applied to one of four areas of the body (the abdomen, buttocks, upper arm or torso) for three consecutive weeks. On the fourth week, the patch is not applied and menstruation will begin. 

The trick to making sure that the patch is effective is to apply the patch the same day each week. The patches are water- and sweat-proof and can be worn while tanning. They may not stick well if soap and other skin products are applied directly on the application site, so try to avoid applying lotion to the area you plan to adhere it to.

Ortho Evra’s side effects are similar to birth control pills, such as breast tenderness, fluid retention, irregular bleeding, menstrual cramps and nausea.

Additional risks associated with Ortho Evra include skin irritation and rashes at the application sites as well as a slight increase risk for venous thrombosis or blood clots forming in the legs or lungs. 

Ortho Evra is perfect for healthy women, who have trouble remembering to take a pill daily.  It’s safe, convenient and simple, and allows a woman to remain on the go.

Women with heart disease-related risk factors shouldn’t use Ortho Evra. Be sure to consult your OB/GYN to determine whether or not it’s right for you.

Permanent Birth Control Can Happen with Essure

Have you ever forgotten to take your birth control pill?  Does the “pill” not agree with your body?  Do you need a permanent birth control solution without the inconvenience of having a surgical procedure?  Then you must consider Essure as a choice for permanent birth control.

Essure is a safe, non-surgical, in-office procedure that requires no anesthesia.  An OB/GYN uses a hysteroscope or camera to guide micro-inserts through a woman’s vagina and uterus for placement inside her fallopian tubes.

These micro-inserts are made from the same materials used for many years in cardiac stents. In three months, the body forms a natural barrier around the insert so sperm cannot reach the egg.  A confirmation test will give a woman peace of mind knowing the inserts have completely blocked both fallopian tubes; thus, no more pregnancies!

How effective is the Essure procedure?  Studies show that Essure is 99.7 percent effective at five years compared to 98.6 percent for laparoscopic tubal ligation.  Essure cannot be reversed. You must be sure that children you are sure you don’t want children before undergoing the Essure procedure for permanent birth control.

Essure is effective, convenient, and takes less than 10 minutes for an Essure-trained physician to perform.  Most insurance companies cover the procedure.

There is no “down time” and minimal if any discomfort from the procedure.  You can have Essure done in the morning at your doctor’s office and be out on the town that evening.   There are no surgical incisions and no risks of anesthesia.