How to have a healthy pregnancy

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The road to parenthood can be overwhelming, especially for new families! The OB and Maternity Support Services team at International Community Health Services (ICHS) is here to help. In this episode of Together We Rise, a wellness podcast from ICHS, Dr. Aisling Zhao, family physician, and Julia Shi, registered nurse, walk us through the services available for new parents and their babies, from prenatal care through delivery and beyond.

Transcription:

Maggie McKay (Host): Together We Rise, a podcast from International Community Health Services, ICHS, advocates for health as a human right and welcomes all in need of care regardless of health, immigration status, or ability to pay. Joining us today is Registered Nurse Julia Shi and Family Medical Physician Dr. Aisling Zhao, to discuss care of pregnant and postpartum people and maternity support services.

Thank you both for being here today.

Aisling Zhao, MD, MPH: Thanks for having us.

Julia Shi, PhD, RN, LCCE: Thank you for having us. Thank you.

Host: Absolutely. Dr. Zhao, let’s start with you. If a person is planning to have a baby, what steps should they take to ensure a healthy pregnancy?

Aisling Zhao, MD, MPH: This is a great question because we get it all the time. I think folks who are trying to ask this before they get pregnant, that’s a perfect time. And I would say the unfortunate reality is that there’s really nothing you can do to ensure a healthy pregnancy. I think there’s steps that we can all take to increase the likelihood that our pregnancies are healthy and remain healthy, things like making sure that any other medical conditions you have, you’re being treated for by a doctor.

Making sure that you are coming as early in the pregnancy as possible to get care so we can make sure you’re getting all the screening and support services that you need. But ultimately, as a family medicine doctor, and I’m sure this is true for Julia as well, my priority is to support anybody who wants to be pregnant or is already pregnant.

Your goals are the most important to us. We’re here to make sure that if you want to be pregnant, that’s an outcome that you get for yourself, and that if you don’t want to be pregnant, we also help you out with those options too. So those are the basics.

Julia Shi, PhD, RN, LCCE: From my perspective, I do let my patients know that single step counts. The very first step they want to do is to get all the vaccinations that their doctors would recommend during their office visit. And that brings the second major point, a reminder for all the expecting parents that they want to attend their scheduled OB visits regularly.

Because during the visits they can discuss with their doctors about their concerns, about their questions, about the whole journey, and come up with the solution and help them to make informed decisions. And also those visits are the opportunity to identify the issues like Dr. Zhao mentioned very early on and to ensure the best possible outcomes for their labor and delivery.

Host: And Julia, what’s considered a healthy amount of weight gain during pregnancy? Should expectant parents really eat for two?

Julia Shi, PhD, RN, LCCE: Well, that’s a good question. And I have many patients come to me. That’s their first question that they have. It’s like, how much weight do I need to gain? So I can start with the ranges that were suggested by the American College of Obstetrician and Gynecologist. Short as ACOG.

So according to ACOG, weight gain depends in part on your body mass index. So the BMI for a woman or expecting parent with a normal body, BMI, the expected weight gain would between 25 to 35 pounds. But if the woman is obese, the number will decrease to 15 to 25 pounds. However, if the woman is underweight, the recommended gain is about 28 to 40 pounds.

Again, those are the ranges for a single fetal pregnancy.

Aisling Zhao, MD, MPH: And I would say also if I could cut in as well. Truth be told, what I’m really paying attention (to) somebody’s weight when they’re pregnant, is to make sure they’re gaining enough weight. That’s one of my priorities. I think if people are not gaining fast enough or sufficient weight, it’s a red flag for me in terms of what could be happening to their pregnancy, the person’s nutrition levels, the fetus’s nutrition levels, et cetera.

And my other, piece of counseling I give to patients is we’ve actually done substantive research on the role of weight management in pregnancy, really meaning like, okay, if somebody is exceeding those weight goals that Julia outlined earlier, the recommended ones, what happens if we tell people then to do behavioral changes like exercise, eating differently, to try to get back on the correct weight curve or even to lose weight?

The outcome of those studies has actually shown that you don’t improve people’s health by doing that. You don’t magically restore people’s risk factors to before they were gaining too much weight. So there’s really not a lot of utility in counseling people who have already exceeded those weight goals to try to diet or exercise to get back on track. That shows no benefit to the pregnancy.

So a lot of my job is to reassure people like even if we’re above those weight goals, it’s okay. What’s important, most important, is making sure you’re still moving in a healthy way, doing some sort of joyful exercise. Eating as much of a well-balanced diet as you can to get nutrients for yourself and baby.

And I try not to focus too much on whether you’ve gained too much to be frank, because the research doesn’t show that that focus has any substantial benefit.

Host: That’s good to know. I have to say, when I was pregnant, I didn’t think about the weight gain at all, and my doctor didn’t make a deal of it, but I probably gained more than I should have. However, as far as exercise I did prenatal yoga for morning sickness and it really helped.

Aisling Zhao, MD, MPH: I love that. Especially because there can be so many of those inversions so the fact that it was still helpful is great. And I would also say too, people may gain a lot of weight in pregnancy, but also if you’re breastfeeding at the end of all of this, it’s a totally individual decision that we’ll get to later on in the podcast.

But breastfeeding consumes so many calories. Holy cow. That’s the stage of the pregnancy and postpartum care period that you really need to eat for two, truly. So I think it’s a time also where people can notice a lot of changes to their weight also in a, like a weight loss perspective. So there’s also that kind of what to expect at the end of the pregnancy period.

Host: Dr. Zhao, according to the Mayo Clinic, I had no idea 10 to 20% of known pregnancies end in miscarriage. Is there anything a pregnant person can do to increase their odds of carrying their baby to term?

Aisling Zhao, MD, MPH: Oh yeah. And that number, actually it’s, on the higher end of that percent range if, depending on how old you are, also at the time of your conception and delivery too. But, honestly, this is another one of those answers that I have to say unfortunately, no. People who have miscarriages have done nothing to cause them.

They are random occurrences often related to things like problems with genetics in the fetus during its development. And so the risk for that does go up with age. That is very true. So certainly above the age of 35, definitely above the age of 40, by the time of delivery, these risks will go up in terms of having a miscarriage.

But I really stress, and Julie and I both stress that there’s nothing that people do to cause their miscarriages. They’re very, very common and a part of the reason why this number is also high is because a lot of people might not even realize they’re having a miscarriage. There’s a large number of people who might think like, oh gosh, there’s like no way I could be pregnant.

Or like, maybe my period’s just a couple, it feels like a little late, but it’s just a little heavier than normal. And then I’m just going to go back to my regular cycle and, and turns out that was actually miscarriage. So there’s a lot of people who have them also without really realizing. And I personally, I think I have a lot of admiration for my patients who are willing to share their stories with friends and relatives. And I think that is a trend that has been happening more and more, I think in society. People being willing to share their miscarriage stories. I think that can be really empowering because it’s such a common experience and people should know that.

Host: Julia, let’s talk about breastfeeding. Is it better than formula? Can you share any tips for getting breastfeeding off to a good start?

Julia Shi, PhD, RN, LCCE: Well, thanks Maggie. I think that’s a great question and the topic by itself, we can probably talk for another 20 minutes. But we talk a lot with our OB patients when they come in for the visit. So we discuss the benefits of breastfeeding and also breast milk. So we let them know that their breast milk is made perfectly for their baby. It contains all the excellent nutritious minerals and fats, proteins and like the carbohydrates that their baby will need to grow. So that’s made perfect, it’s the right temperature. And we do encourage the mom and also the expecting parents to start breastfeeding early.

So we encourage them to do the skin to skin right after the baby is born to start breastfeeding early. We talk about the golden hour. That’s how important (it is) to have the little one be put on your chest and you hug them and you have them to suck your breast to ensure that the continuity of your hormones that will trigger your breast milk to come.

And we did talk with our patients about the six months exclusive breastfeeding that is recommended by many health organizations, including the WHO and ACOG. We previously mentioned that as well as the American Association of Pediatrics. So we do have a lot of discussions throughout the whole pregnancy journey with our patients, and we continue to support them early postpartum. Yeah. Aisling, what do you think?

Aisling Zhao, MD, MPH: Yeah, totally agree. I love the guidance for the first six months of exclusive breastfeeding that’s been born out in the research very strongly. I think that also the first part is I think a lot of our patients feel that maybe breastfeeding won’t be as convenient as formula feeding, which I totally get.

Formula feels like you can pre-mix it. Anyone can kind of feed it to baby. So that makes a lot of sense to me. I would also add that in terms of convenience, we all recommend that putting baby on their back to sleep is the safest position. That’s from all the research, the Back to Sleep campaign to help prevent sudden infant death syndrome SIDS from occurring in infants. But what a lot of people don’t know is that though we do technically recommend having baby in like a separate kind of bassinet or a crib of their own, actually co-sleeping, so the parent and the baby sleeping in the same bed together or like co-located, can actually be quite safe depending on your individual risk factors and your doctor can talk about it with you, as a recently birthed person who is breastfeeding. Sleeping in a C state position where you’re on your side and your baby is, this line right here can make overnight feedings much easier. You don’t have to actually get up from bed. You and baby can like both basically be feeding and eating and then go right back to sleep.

So it’s actually a lot more convenient actually than I think some people realize. That said point number two is that the most important, honestly, fed is best. I really think that we, as a society, just really love to jump on mothers and criticize a lot of things that they’re doing, period.

This is just like a societal phenomenon. I think doctors are not exempt from this, and at the end of the day, whatever method is allowing you and your family to keep your sanity, what is working for you and your family, that’s great. If what that means is that overnight, you’re breastfeeding, but during the day, you’re supplementing with formula. That’s totally okay. At the end of the day, it’s whatever is the rational method for you and your family and for everybody that’s different. So we just try to support those choices.

Host: I don’t know how it is across the nation, but I know in California it’s the law that the workplace has to have a separate room to pump. Because if you’re working, and you want to pump milk for later and put it in the fridge, they have to have a special room. Is that nationwide or do you know?

Aisling Zhao, MD, MPH: There are breastfeeding protection laws for workers here in terms of, you have to have extra time to do it. I’m not a hundred percent sure on if you can get a separate room necessarily. Julia, do you know?

Julia Shi, PhD, RN, LCCE: I know that we do have the two separate rooms, at least at ICHS buildings to be able to help to support the breastfeeding and also breastfeeding parents. We do have one at the WIC office, and then we do have another one on the second floor and the third floor. But yeah, like Aisling, mentioned that we do secure a place and it’s soothing and it’s comforting for those like breastfeeding parents.

Aisling Zhao, MD, MPH: I will say from my colleagues who are in like family medicine, doctors and residents and stuff, people just pump in the open and that’s okay.

Host: Yeah, but not in a male dominated workplace.

Aisling Zhao, MD, MPH: Say that’s, that’s very true. We are fortunately, very non-male dominated, I would say.

Host: And the other thing is the law doesn’t say it has to be a fancy room. Our room was literally the control box for the fire department. Like a closet basically, but whatever. It was private. Anyway, Dr. Zhao, how can parents care for themselves postpartum, because it is a transition, at least your first baby. It’s all about the baby, and sometimes you forget about yourself.

Aisling Zhao, MD, MPH: Oh yeah. And I think that, again, like just speaking to how society views pregnant people, views mothers, I think there’s like so much value placed on this time of your life where you’re pregnant and you’re kind of by proxy caring for this fetus and later baby. But yeah, postpartum period is really, really important too.

And I think we lose a lot of patients during that period because people are deemphasizing their own health and frankly, society is deemphasizing their health too. So I really encourage people if you can, please come to that postpartum visit. It’s usually about six weeks after.

And then I think one of the things I love about being a family medicine doctor is I get to have touchpoints with my patients all the time when they come in for their Kids, well-child checks. So when they come in for that two month visit, for that four month visit, six month visit, et cetera, all the time, I’m like, okay, and by the way, mom you’re due for your pap smear and your annual exam.

So why don’t we schedule that at the same time as your six month visit? Or like, you know what, like you had this issue that we’ve been following up for you. Your kid’s going to be here again in three months, so why don’t we just schedule an appointment for you too? That’s what I really love about our jobs and like me and Julia being able to meet people where they’re at for that, especially for our patients who might have a lot of difficulties with access, transportation, financial access, you name it. So, I like that we can offer that too.

Julia Shi, PhD, RN, LCCE: Like Dr. Aisling mentioned that we try to get in touch with them right away after they deliver their baby. So we often make the phone call to check on them, see how they’re doing, and we do emphasize the importance to make sure that they have the medication for the pain management. They pick up their medication before they leave the hospital, and we do the preliminary assessment to see if there’s any need, particularly like the diapers and transportation or there’s any housing needs or there’s any food needs in general in the family.

So we do have the patient navigator team at the ICHS. If we identify them, the mom who just gave birth will potentially have those needs, as I mentioned that we’ll get them in touch with the patient navigator. So on the second part of this postpartum care, we do want the birthing parent to know that it is important to take care of themselves because like when the newborn is at home, they have all the focus, they have all the attention. So we need to let the patient and also their partner know that it’s important and to focus on the new mom as well. And we encourage them to not be hesitant to reach out for help. When they’re busy breastfeeding their new kid, when they’re busy with having their pain under control, we want somebody else to be able to help them to clean the diapers or clean the room, make a meal for them. So those are little things that we want them to make sure that they have the help they need at home.

Host: Dr. Zhao, I probably should have asked this before, but how common is postpartum depression and what is it?

Aisling Zhao, MD, MPH: So common, unfortunately. So there are some statistics that say it’s up to 20% of pregnancies and of pregnant people who can experience postpartum depression after they deliver. I think that the best way I had it explained was to me when I was in medical school. There’s, you know, the phenomenon that we recognize as baby blues, which are the mood swings that come with frankly, it’s sleep deprivation, hormonal shifts, everything after you have a baby, right? You really feel that like, wow the incredible joys of being a parent. This divine sense of this baby is adorable. My life is incredible and fulfilling and rewarding, but also I am really sad about the fact that I can’t sleep.

I’m constantly up for this baby. This is a really dark time for me. So there’s a distinction between that and what we call postpartum depression, which is when those feelings of like, those dark feelings, the feelings that there’s nothing to look forward to become so overwhelming that it actually becomes difficult for you to care for yourself or to care for the baby or the people around you.

Postpartum depression is a very treatable condition, first of all. We have many medications. We have actually psychiatrists who are dedicated to perinatal psychiatry that kind of talk about specifically this postpartum depression period, medications, therapies. So you name it, there’s things that we can do for mood problems in the postpartum period. I would say that I think a lot of people don’t recognize postpartum depression. So if you notice that people are having those mood swings of postpartum, but you’re not having any of the highs, it’s really just the lows. That’ll be one warning sign.

And then another thing would be that the really scary parts about postpartum depression are if people are starting to notice that they’re having a lot of thoughts about being better off dead, about killing themselves, hurting themselves, or even hurting other people. The suicidal ideation part is something that unfortunately takes the lives of a lot of postpartum people.

So, that’s something that we also tell people to let people know that and ahead of time, and also for people who’ve had, had problems with their mood in the past, histories of depression or anxiety; as doctors we also try to tell them to like keep an eye on their symptoms a little more closely.

Host: Also half of all US births are to people of color, yet Black people are three to four times more likely to die from pregnancy related causes than whites and maternal mortality is also higher among American Indian, Alaska Native and Native Hawaiian or Pacific Islander people. So what’s causing this huge health disparity and how can we attempt to address it?

Aisling Zhao, MD, MPH: Such a good question. I’m so glad you asked this because actually when I was looking at those numbers about postpartum depression recently, the highest rates are among Black and Native folks because of these racial disparities that we see in health. I think it’s important to remember that when we say racial disparities, what we really mean is racism and how racism imposes these disparities (and that race is basically) a rough proxy for people’s experiences of racism.

So there’s all sorts of things I think from Black and Brown women in the beginning, not being able to access as much care as their peers, not being believed as much as their peers when going to the doctor. A lot of us in this field, remember the story of Serena Williams in her postpartum period.

This was like seven years ago or something like that at this point where she recognized the symptoms of a dangerous blood clot in her lungs of pulmonary embolism and had to really strongly advocate for herself with her doctors in order to get the scans to recognize that that was a problem.

It’s just something that I think Black and Brown women disproportionately have to deal with in our society being taken seriously by doctors and having their health concerns taken seriously. There’s also like, this is going to potentially date this podcast, but thinking about economic justice and how it dovetails into racial justice in access to healthcare like thinking about SNAP benefits being cut right now at the federal level and the largest category of SNAP benefits are still white people, but disproportionately a lot of Black and Brown people are receiving benefits from that.

And so, what does food insecurity do to the health of her pregnancy? One can imagine if you’re not eating enough, that will probably have negative effects on your ability to carry a baby, to term. So it’s all of these things together. And not to say that I think we don’t have any hope in this business.

I think that what has been really motivating me is that I think more and more people are turning their attention to pipeline work in medicine which really means, how do we recruit people from the communities they serve and the communities they’re part of to become physicians and nurses.

Like leaders in medicine and to advocate for those perspectives and their communities. As a former graduate of the Swedish Cherry Hill Family Medicine residency, pipeline work is something that we focus a lot on. How do we recruit people from our communities to later serve our communities in a thoughtful way? So, I think for me, that’s one of the frontiers of how we can address this problem.

Host: Julia, there’s an old proverb about it takes a village. We’ve all heard that to raise a healthy child, meaning parents and families sometimes need additional support, often. Can you give a quick overview on how the OB professionals and maternity support services at ICHS can help a new parent and baby, including prenatal and postpartum care?

Julia Shi, PhD, RN, LCCE: First and foremost, I want to say we are here for you. Each pregnancy is unique and that’s why at ICHS we provide this maternity support services and it’s a team approach. We have a team of OB providers like Aisling Zhao and we have nurses like myself, and we have Registered dieticians and we have behavioral health specialists. So we are here for you. So we will want to make sure that you feel empowered with all this information that we will be able to provide for you.

And if there are times that you feel like you need someone to talk about your family dynamics and the difficulties that you have during the pregnancy, we have the behavioral health counselors, you can feel safe to talk about. And also we have the WIC office right on-site. So you don’t have to go to different locations to have the nutritional support for you, and it’s just right around the corner within the same building.

We offer this asset services at four main sets of ICHS clinics, which include in Seattle campus, Shoreline clinics, and also the Bellevue Clinic.

Aisling Zhao, MD, MPH: The only one thing that I would add to Julia’s excellent explanation of our services is that as providers also, we’re not alone. We have a team of excellent OBs that we consult at Swedish Medical Center. And logistically during your delivery when you come to Swedish, First Hill to deliver with us, there’s some other hospitals that we deliver with too. But that’s the bulk of the patients. You can access not only our care like on-call physicians, but also the care of the whole hospital. You’re always going to have a team of on-call OBs, obstetricians who can be there in a pinch, say the worst happens, there’s an emergency during your pregnancy and you need to go to the delivery room right now for a c-section.

There’s excellent in-house doctors who can do that, like on the drop of a dime, like they can do as needed emergency services. Not only that, they’re also going to be monitoring your vital signs during your labor, making sure that everything is safe and they’re just always on hand in case we need them.

So to me that’s also kind of part of the, it takes a village equation, is having our specialists on call when needed to provide that support for us and our patients too.

Host: Well, thank you both so much for sharing your expertise. This has been so informative and very, very helpful. Thank you for your time.

Aisling Zhao, MD, MPH: Thanks for having us, Maggie. I appreciate it.

Julia Shi, PhD, RN, LCCE: Thanks, Maggie. Pleasure.

Host: Absolutely. Again, that’s Julia Shi and Dr. Aisling Zhao. To learn more, check out our website at ichs.com. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I’m Maggie McKay. Thanks for listening to Together We Rise from International Community Health Services.