The Fourth Trimester NP Show

Why do we avoid therapy? Stigma against mental illness Fear of being judged Fear of being vulnerable May feel like it is a luxury activity instead of a health activity Treatment cost Insurance issues May have to discuss painful past events   How to choose a therapist? First, consider the type of therapy that they use… For perinatal depression & anxiety, the two most effective therapies are: Cognitive behavioral therapy (CBT) & Interpersonal therapy (IPT)   Second, look for a maverick. -Look beyond the years of experience and look for someone who is regularly learning. -Verify their baseline therapy credential (state and board certified) -Also look for someone who is specifically trained in perinatal mood disorders, e.g. by Postpartum Support International   Third, look for someone with similar life experience. -Look for someone of similar race, ethnicity, gender, lifestyle -Will make it easier to enter a safe space for therapeutic work to occur   Fourth, know that you are in control. -Meet for 15 minute free consult if possible -Schedule only if you were able to connect -If you do not agree with the treatment plan, or you don’t connect or you don’t think that you are being listened to, keep looking   Fifth, look for social emotional intelligence. -adaptable -flexible -self aware   In Summary, - You have to feel safe in your interactions with your therapist. - Feel free to shop around until you have the right fit. - Self evaluate mood for improvement and keep a journal or mood log.   References McNamara, J., Townsend, M. L., & Herbert, J. S. (2019). A systemic review of maternal wellbeing and its relationship with maternal fetal attachment and early postpartum bonding. PloS one, 14(7), e0220032.   Smith, K. (2021). How to choose a therapist? Retrieved from How to choose a therapist | Psyche Guides   Symes, E. (2017). The transition to motherhood. Psychological factors associated with pregnancy, labour and birth. Retrieved from The transition to motherhood: Psychological factors associated with pregnancy, labour and birth | APS (psychology.org.au)   Resources Psychology Today - Psychology Today Belgium: Health, Help, Happiness + Find a Therapist ZenCare - Find The Best Therapists & Psychiatrists Near You — Zencare Postpartum Support International - https://www.postpartum.net/   Guest Lydia Moore Allen is the Founder and CEO of Se-ReNew Therapy & Consulting Services LLC. She has been in the mental health field for almost 20 years. Lydia is a Licensed Clinical Social Worker, Certified Master's Level Addiction Professional, Certified Parenting Instructor and Qualified Supervisor. Lydia provides counseling for individuals, couples, families and supervision for registered MSW Interns. She also offers comprehensive Diagnostic Evaluations for Immigration Court for Hardships, Violence against Women (VAWA), U-VISA (for immigrants who were victims or witnesses to a crime in the U.S) and T-VISA (for victims involved in human trafficking. Lydia has dedicated her years working with individuals, couples and families facing life changing challenges, including addiction, marital/relationship conflict, mental health imbalance and parenting hurdles. She has experience working in residential and partial- hospitalization settings with clients of varying cultural, ethnic, and socioeconomic backgrounds. Lydia is transparent and compassionate while collaborating with her clients to achieve their goals. Furthermore, she dedicates time as a Board Member for Phoebe’s Fortress Non-profit Organization in Miami, Florida. Her commitment to Phoebe’s Fortress is geared towards supporting and equipping young ladies aging out of the foster care system with skills to advance into adulthood.

                                                      The Bonding Edition   What is a mother? Some definitions include: The female parent To mother is to bring up a child with care and affection “a mother understands what a child does not say” “Motherhood has the greatest potential influence in human life” “a beetle is a beauty in the eyes of his mother” J What is bonding? Must be attached first to bring up a child with care and affection. Bonding is the formation of a close human relationship Emotional and physical attachment between mother and offspring There are two important bonding types to consider: The first is maternal-fetal bonding or when a women is pregnant with the developing baby The second is mother-baby bonding or bonding with baby after delivery   Maternal fetal bonding spans three semesters: The first trimester includes adjusting to the idea of pregnancy Most report ambivalence May experience nausea, vomiting, fatigue and this may amplify anxiety During the Second trimester the baby’s movement is felt You may start thinking about who this person could be You start thinking about the baby as separate from self The Third trimester includes getting ready for baby’s arrival Prepping for labor or surgery Most experience fatigue Mother-Baby Bonding -acceptance of baby as a whole and no longer just an idea -may be some attachment concerns with difficult deliveries (PTSD) -or if delivery did not go as planned, like planned water birth and ended up with forceps delivery - or epidural during labor or c/s etc - or if baby ended up in NICU -or if preterm delivery Mother-Baby Bonding - perinatal time is one of identity shift - from own entity or person to mother of 1 - Identity is fluid, could be shift from mother of 1 to now mother of 2 - Bonding impacted by historical family relationships (mother was idolized or not?) Why do we care about bonding? - early attachment relationships between mom and baby improve baby’s psychological, cognitive, and social development - attachment styles impact how the baby interacts with humanity in the future - A mother who is bonded with her baby will try to know, protect, interact with, and meet the needs of her baby What impacts bonding? Social Support: Protective against stress & challenges Help with planning for baby’s future Allows for better adjustment to motherhood Could be partner, family of origin, close friends Self Esteem: Optimistic beliefs improve bonding Happy with appearance or self image improves bonding High sense of wellbeing Prepared for baby Mental Health: Depression decreases bonding (inverse relationship) Some studies anxiety decreased bonding Hollywood Bonding Versus Bonding in Reality I had Hollywood bonding with my second Maybe wisdom from having first Knew what to expect Knew that systems could be built to organize care Reality: With my first baby I was isolated It felt harder to bond It was comforting to know that Good to know bonding is a lifelong process Not a “one moment” or one time event Also, first pregnancy related to increased pregnancy stress   Pro Tips Never walk alone, social support protective If history of depression or anxiety stay on treatment or get treatment If you notice difficulty in bonding postpartum TELL PROVIDER The good news is that there is HELP Thank you so much for your time and wisdom. I believe you are joining us for a show on how to choose a great therapist Thank you for listening Your host Judith Wafe of The Fourth Trimester NP   Lydia’s Book Recommendations :- Parenting with PTSD by A Nation of Wimps by   Anxiety scale. Discuss score with healthcare provider. GAD-7 (General Anxiety Disorder-7) - MDCalc Depression Scale. Discuss score with healthcare provider. PHQ-9 (Patient Health Questionnaire-9) - MDCalc                                                                           Guest Bio Lydia Moore Allen is the Founder and CEO of Se-ReNew Therapy & Consulting Services LLC. She has been in the mental health field for almost 20 years. Lydia is a Licensed Clinical Social Worker, Certified Master's Level Addiction Professional, Certified Parenting Instructor and Qualified Supervisor. Lydia provides counseling for individuals, couples, families and supervision for registered MSW Interns. She also offers comprehensive Diagnostic Evaluations for Immigration Court for Hardships, Violence against Women (VAWA), U-VISA (for immigrants who were victims or witnesses to a crime in the U.S) and T-VISA (for victims involved in human trafficking. Lydia has dedicated her years working with individuals, couples and families facing life changing challenges, including addiction, marital/relationship conflict, mental health imbalance and parenting hurdles. She has experience working in residential and partial-hospitalization settings with clients of varying cultural, ethnic, and socioeconomic backgrounds. Lydia is transparent and compassionate while collaborating with her clients to achieve their goals. Furthermore, she dedicates time as a Board Member for Phoebe’s Fortress Non-profit Organization in Miami, Florida. Her commitment to Phoebe’s Fortress is geared towards supporting and equipping young ladies aging out of the foster care system with skills to advance into adulthood.   References McNamara, J., Townsend, M. L., & Herbert, J. S. (2019). A systemic review of maternal wellbeing and its relationship with maternal fetal attachment and early postpartum bonding. PloS one, 14(7), e0220032   Smith, K. (2021). How to choose a therapist? Retrieved from How to choose a therapist | Psyche Guides   Symes, E. (2017). The transition to motherhood. Psychological factors associated with pregnancy, labour and birth. Retrieved from The transition to motherhood: Psychological factors associated with pregnancy, labour and birth | APS (psychology.org.au)     Disclaimer Disclaimer: The primary purpose of this podcast is for private, non-commercial use. It does not constitute medical or professional advice. https://linktr.ee/fourth.trimester.np?subscribe  

What is a mother? Some definitions include: The female parent To mother is to bring up a child with care and affection “a mother understands what a child does not say” “Motherhood has the greatest potential influence in human life” “a beetle is a beauty in the eyes of his mother”  What is bonding? Must be attached first to bring up a child with care and affection. Bonding is the formation of a close human relationship Emotional and physical attachment between mother and offspring There are two important bonding types to consider: The first is maternal-fetal bonding or when a women is pregnant with the developing baby The second is mother-baby bonding or bonding with baby after delivery   Next week we will start with how to bond with your baby during pregnancy…                                                                     Guest Bio Lydia Moore Allen is the Founder and CEO of Se-ReNew Therapy & Consulting Services LLC. She has been in the mental health field for almost 20 years. Lydia is a Licensed Clinical Social Worker, Certified Master's Level Addiction Professional, Certified Parenting Instructor and Qualified Supervisor. Lydia provides counseling for individuals, couples, families and supervision for registered MSW Interns. She also offers comprehensive Diagnostic Evaluations for Immigration Court for Hardships, Violence against Women (VAWA), U-VISA (for immigrants who were victims or witnesses to a crime in the U.S) and T-VISA (for victims involved in human trafficking. Lydia has dedicated her years working with individuals, couples and families facing life changing challenges, including addiction, marital/relationship conflict, mental health imbalance and parenting hurdles. She has experience working in residential and partial-hospitalization settings with clients of varying cultural, ethnic, and socioeconomic backgrounds. Lydia is transparent and compassionate while collaborating with her clients to achieve their goals. Furthermore, she dedicates time as a Board Member for Phoebe’s Fortress Non-profit Organization in Miami, Florida. Her commitment to Phoebe’s Fortress is geared towards supporting and equipping young ladies aging out of the foster care system with skills to advance into adulthood.                                                                               References McNamara, J., Townsend, M. L., & Herbert, J. S. (2019). A systemic review of maternal wellbeing and its relationship with maternal fetal attachment and early postpartum bonding. PloS one, 14(7), e0220032 Smith, K. (2021). How to choose a therapist? Retrieved from How to choose a therapist | Psyche Guides Symes, E. (2017). The transition to motherhood. Psychological factors associated with pregnancy, labour and birth. Retrieved from The transition to motherhood: Psychological factors associated with pregnancy, labour and birth | APS (psychology.org.au)                                                                                  Disclaimer Disclaimer: The primary purpose of this podcast is for private, non-commercial use. It does not constitute medical or professional advice. https://linktr.ee/fourth.trimester.np?subscribe

This is the conclusion of the conversation with Ivette. Please enjoy, we start abruptly and dive into acne. If you get acne during pregnancy, take these steps to treat your skin -   Wash your face twice a day with a mild cleanser and lukewarm water. If you have oily hair, shampoo/cowash every day and try to keep your hair off your face. Avoid picking or squeezing acne sores to lessen possible scarring. Choose oil-free cosmetics.   Additional ACNE Tips Over-the-counter (OTC) products containing the following ingredients can be used during pregnancy: Topical benzoyl peroxide (Clean & Clear, PanOxyl) Azelaic acid (CeraVe, Clinique) Topical salicylic acid (Noxzema, Neutrogena) Glycolic acid (L’Oreal) If you want to use an OTC product that contains an ingredient not on this list, contact your obstetrician–gynecologist (ob-gyn)   AVOID!!!!! No to retinoids (synthetic Vit A) No to hydroquinone (skin lightener) No to phthalates (disrupt hormones) Hell No to formaldehyde or formaldehyde releasers   During the show facts- On shea butter, I couldn’t find a distinct recommendation that it is safe in pregnancy! On chamomile tea, is not safe to drink in pregnancy, so I say AVOID in pregnancy. Common formaldehyde releasers that you are likely to see in a product and should AVOID are DMDM hydantoin, methylene glycol, quaternium 15, and 3 dioxane EltaMD Skincare was recommended by Ivette for their sunscreen line - Sun Care– EltaMD Safe Cosmetics database - Campaign for Safe Cosmetics - Making Cosmetics Safer for All Tattoo Art for Stretch Marks - Tattoo Artist Hides Stretch Marks With Skin-Colored Ink - Before and After Photos | Allure   Guest Information Ivette Guttierez was born in Nicaragua and came to the US at the tender age of 6 months. She is the youngest of 3 children and was raised by a strong single mother. As a child she showed an interest in teaching and loved everything related to makeup. After high school she enrolled in Beauty School. While in school, her artistry skills flourished and she was found to be naturally talented at eyebrow shaping. Ultimately she became a professional esthetician and makeup artist.  She then worked with Christian Dior cosmetics and has spent 17 years working with prestigious cosmetic brands, and 12 years as a Senior Executive sales manager for a multi-million dollar company. She was also a state board educator for future licensed estheticians. In 2018 she obtained her permanent make-up certification. During the pandemic she was no longer fulfilled in the corporate realm and started her own business dedicated to all things eyebrows. She then further ventured into the paramedical space and works with women and men that are survivors of trauma, cancer, alopecia, areola reconstruction, SMP, scar camouflage etc.  Her slogan is “beauty should be used to illuminate our inner beauty and not mask it!”     References ACOG. (2023). Skin Conditions in Pregnancy. Retrieved from https://www.acog.org/womens-health/faqs/skin-conditions-duringpregnancy#:~:text=As%20your%20belly%20grows%20during,Sometimes%20the%20marks%20are%20faint. Cleveland Clinic. (2020). Melasma. Retrieved from Melasma: Treatment, Causes & Prevention (clevelandclinic.org) Food and Drug Administration. (2022). Cosmetics & Pregnancy. Retrieved from Cosmetics & Pregnancy | FDA Medical News Today. (2022). Pregnancy and skin care: What products are safe to use? Retrieved from What is safe to use for pregnancy skin care? (medicalnewstoday.com) Sharma, Jharaik, Sharma, Chauhan, & Wadhwa. (2019). Clinical study of pregnancy associated cutaneous changes. International Journal of Clinical Obstetrics and Gynaecology, 3(4) 71-75. Retrieved from 3-4-1-996.pdf (gynaecologyjournal.com)     Disclaimer Disclaimer: The primary purpose of this podcast is for private, non-commercial use. It does not constitute medical or professional advice. https://linktr.ee/fourth.trimester.np?subscribe

Self-Love while pregnant can be anything that restores you. I think that the basics are essential to consider, nutrition, exercise, keeping your prenatal appointments, paying attention to dental hygiene, following your healthcare provider’s advice and attending childbirth education classes. Other important things are the ones that you choose. If you are not sure what restores you consider journaling and observing what brings you joy during a week. Things that brought me joy during pregnancy were: Lathering my skin with oil Getting my toes done Wearing makeup Immersing myself at the beach Watching a funny movie Exercise Going for walks outside Giggling with my husband Resting when my body told me to while understanding that it was making a human being Staying away from negative people Staying in the present moment Next week - how to choose clean cosmetics   #fourthtrimesternp #selflove #selfaware #selfawareness #healthymom #healthymomhealthybaby #momlife #bumplife #selfcare #loveyourself #positivevibes #happiness #inspiration #happy #goals #podcast #healthpodcast #happymom #baby #selfaware #selfcare #duke #dukealumni 

Skin Changes in Pregnancy Skin Changes in Pregnancy occur because of - Hormonal changes (estrogen, progesterone, relaxin, human placental lactogen, Hcg, prostaglandins) Vascular changes – blood vessels Metabolic changes – chemical changes that make energy Immunologic changes – ability to resist or avoid disease   Hyperpigmentation Excess coloration or darkening of skin Melasma – mask of pregnancy, “freckles”, brown or blue-gray patches fades after a few months Linea nigra - dark line on central aspect of stomach that fades after delivery, runs from top of abdomen to pubis Moles & areola – darken Secondary areola – spilling of surrounding pigmentation   Connective Tissue Changes Striae Gravidarum – dreaded stretch marks Mollusca Fibrosa – soft pink swellings of the skin   Vascular Changes Peripheral edema – swelling of hands, legs, feet Palmar erythema – redness of palms Spider veins (red, thready & smaller) Varicose veins (larger, twisted, enlarged)   Glandular Changes Montgomery tubercles – more prominent (good for lactation) Breasts enlarge prep for lactation   Skin, Nails & Hair Skin – drier, more acne/less acne, eczema Hair – Lengthen, fuller Hair – present where it was not before (between breasts, face, abdomen, arms) Nails – grow faster in pregnancy Nails - may be weaker and break more easily   So what can we do? Keep skin hydrated and use excellent moisturizer Nothing improves or prevents stretch marks Mustela Stretch Marks Cream Earth Mama Belly Butter Glow Organics Belly Butter Bio-Oil Skincare Oil Burt's Bees Mama Bee Belly Butter Palmer's Cocoa Butter Formula Massage Lotion for Stretch Marks Munchkin Milkmakers All-Natural Belly Balm   If you get acne during pregnancy, take these steps to treat your skin -   Wash your face twice a day with a mild cleanser and lukewarm water. If you have oily hair, shampoo/cowash every day and try to keep your hair off your face. Avoid picking or squeezing acne sores to lessen possible scarring. Choose oil-free cosmetics.   Additional ACNE Tips Over-the-counter (OTC) products containing the following ingredients can be used during pregnancy: Topical benzoyl peroxide (Clean & Clear, PanOxyl) Azelaic acid (CeraVe, Clinique) Topical salicylic acid (Noxzema, Neutrogena) Glycolic acid (L’Oreal) If you want to use an OTC product that contains an ingredient not on this list, contact your obstetrician–gynecologist (ob-gyn)   AVOID!!!!! No to retinoids (synthetic Vit A) No to hydroquinone (skin lightener) No to phthalates (disrupt hormones) Hell No to formaldehyde or formaldehyde releasers   During the show facts- On shea butter, I couldn’t find a distinct recommendation that it is safe in pregnancy! On chamomile tea, is not safe to drink in pregnancy, so I say AVOID in pregnancy. Common formaldehyde releasers that you are likely to see in a product and should AVOID are DMDM hydantoin, methylene glycol, quaternium 15, and 3 dioxane   Guest Information Ivette Guttierez was born in Nicaragua and came to the US at the tender age of 6 months. She is the youngest of 3 children and was raised by a strong single mother. As a child she showed an interest in teaching and loved everything related to makeup. After high school she enrolled in Beauty School. While in school, her artistry skills flourished and she was found to be naturally talented at eyebrow shaping. Ultimately she became a professional esthetician and makeup artist.  She then worked with Christian Dior cosmetics and has spent 17 years working with prestigious cosmetic brands, and 12 years as a Senior Executive sales manager for a multi-million dollar company. She was also a state board educator for future licensed estheticians. In 2018 she obtained her permanent make-up certification. During the pandemic she was no longer fulfilled in the corporate realm and started her own business dedicated to all things eyebrows. She then further ventured into the paramedical space and works with women and men that are survivors of trauma, cancer, alopecia, areola reconstruction, SMP, scar camouflage etc.  Her slogan is “beauty should be used to illuminate our inner beauty and not mask it!”     References ACOG. (2023). Skin Conditions in Pregnancy. Retrieved from https://www.acog.org/womens-health/faqs/skin-conditions-duringpregnancy#:~:text=As%20your%20belly%20grows%20during,Sometimes%20the%20marks%20are%20faint. Cleveland Clinic. (2020). Melasma. Retrieved from Melasma: Treatment, Causes & Prevention (clevelandclinic.org) Food and Drug Administration. (2022). Cosmetics & Pregnancy. Retrieved from Cosmetics & Pregnancy | FDA Medical News Today. (2022). Pregnancy and skin care: What products are safe to use? Retrieved from What is safe to use for pregnancy skin care? (medicalnewstoday.com) Sharma, Jharaik, Sharma, Chauhan, & Wadhwa. (2019). Clinical study of pregnancy associated cutaneous changes. International Journal of Clinical Obstetrics and Gynaecology, 3(4) 71-75. Retrieved from 3-4-1-996.pdf (gynaecologyjournal.com)     Disclaimer Disclaimer: The primary purpose of this podcast is for private, non-commercial use. It does not constitute medical or professional advice. https://linktr.ee/fourth.trimester.np?subscribe

How to choose a supplement with pharmacist Dr. Azelia Brown First Nutrition is the key- Eating a variety of foods is the best way to obtain your vitamin and mineral needs- Supplements are just an aid How are supplements regulated?- Food & Drug Administration (FDA) does not do premarketing analysis but they perform post marketing surveillance- However they must adhere to current good manufacturing practices (CGMP) So what can we do?-Look for third party testing -companies decide to choose an independent third party-most recommended was USP-others are NSF, BSCG & Consumer lab What does regulation mean?-The supplement contains what is stated on the label- Products are standardized from batch to batch- The supplement is free of harmful levels of contaminants or potential drug contaminants-The product doesn’t contain any undeclared ingredients Major concerns- Toxicity with high doses- Side effects- Drug interactions- Supplement may have no effect- If you are a vegan, make sure that the product is certified vegan- Allergic reactions (Food Allergen Labeling and Consumer Protection Act means that they must check for 8 major allergens) Pro Tips-Eat a Healthy diet-Make sure supplement is Third Party approved- Look for Recommended amount of vitamins, minerals and DHA- Always discuss supplements with your healthcare provider Upcoming-Plan to do aspirin use during pregnancy with Dr. Azelia Brown in the future-Next week we discuss the beauty and the beast of pregnancy -With esthetician Ivette Gutierrez Guest Information DR. AZELIA BROWN IS CLINICAL PHARMACY SPECIALIST WITH OVER 5 YEARS OF EXPERIENCE IN THE HOSPITAL SETTING. SHE COMPLETED HER UNDERGRADUATE STUDIES AT THE UNIVERSITY OF FLORIDA. SHE THEN RECEIVED HER DOCTOR OF PHARMACY DEGREE FROM MERCER UNIVERSITY AND COMPLETED POST-GRADUATE TRAINING AT WELLSTAR ATLANTA MEDICAL CENTER. THOUGH SHE PRIMARILY PRACTICES IN THE CARDIOLOGY AND CRITICAL CARE SETTING, SHE HAS EXPERIENCE TAKING CARE OF A WIDE VARIETY OF PATIENT POPULATIONS. SHE IS PASSIONATE ABOUT HELPING HER PATIENTS OPTIMIZE THEIR MEDICATION THERAPY AND IMPROVING THEIR HEALTH OUTCOMES. References-ACOG. (2022). NUTRITION DURING PREGNANCY. RETRIEVED FROM HTTPS://WWW.ACOG.ORG/WOMENS-HEALTH/FAQS/NUTRITION-DURING-PREGNANCY-AMERICAN PREGNANCY ASSOCIATION (2023). PRENATAL VITAMINS. RETRIEVED FROM PRENATAL VITAMINS | EVERYTHING YOU NEED TO KNOW (AMERICANPREGNANCY.ORG)-BIOSSAT, G. (2019). PRENATAL VITAMINS: A SMALL INTRODUCTION TO A BIG PILL. RETRIEVED FROM PRENATAL VITAMINS: A SMALL INTRODUCTION TO A BIG PILL - CHICAGO HEALTH (CHICAGOHEALTHONLINE.COM)-NHS. (2023). VITAMINS, SUPPLEMENTS AND NUTRITION IN PREGNANCY. RETRIEVED FROM HTTPS://WWW.NHS.UK/PREGNANCY/KEEPING-WELL/VITAMINS-SUPPLEMENTS-AND-NUTRITION/ -U.S. Pharmacopeia (USP). (n.d.). Products and Solutions. Retrieved from USP Products and Solutions Disclaimer: The primary purpose of this podcast is for private, non-commercial use. It does not constitute medical or professional advice. https://linktr.ee/fourth.trimester.np?subscribe  

How to choose a prenatal vitamin (PNV) with pharmacist Dr. Azelia Brown Fast Facts -IF YOU ARE OF CHILDBEARING AGE YOU SHOULD BE TAKING A PNV -MOST WOMEN (97%) TAKE A PNV BUT ONLY AFTER THEY ARE FOUND TO BE PREGNANT -TO AVOID THE DELAY IF YOU ARE NOT PREGNANT START TAKING A PNV TODAY Why do we need a prenatal vitamin? -VITAMINS & MINERALS ARE NEEDED FOR GROWTH AND DEVELOPMENT. -THERE ARE 13 IMPORTANT VITAMINS: BACKED OR IN OTHER WORDS VITAMINS B (DIFFERENT ONES) A, C, K, E, D. -APART FROM VITAMIN D, WHICH WE GET FROM SUNLIGHT, MOST VITAMINS COME FROM OUR DIET. -DEPENDING ON WHERE YOU LIVE IN THE WORLD, OR YOUR ETHNICITY IT IS QUITE COMMON FOR PEOPLE TO BE LOW IN VITAMIN D (1 BILLION IN DEFICIT) -DEPENDING ON YOUR DIET YOU MAY BE LOW IN FOLIC ACID (VITAMIN B9). -THESE VITAMINS ARE IMPORTANT IN PREGNANCY. -YOU CAN BOOST YOUR LEVELS BY TAKING A VITAMIN SUPPLEMENT IRON -ANOTHER COMPONENT OF MOST PNVS IS IRON -IRON DEFICIENCY ANEMIA IS COMMON IN PREGNANCY -AS IRON NEEDS INCREASE IN PREGNANCY (40-45% BLOOD VOLUME) -SUPPORTS DEVELOPMENT OF PLACENTA AND FETUS -SOURCES – MEAT, FISH, BEANS, LEGUMES, BLACK STRAP MOLASSES -RECOMMENDED 27 MG DAILY -IF ANEMIC YOUR PROVIDER WILL RECOMMEND ADDITIONAL SUPPLEMENTATION THAT SHOULD BE PAIRED WITH VITAMIN C TO INCREASE ABSORPTION                                                                           DHA -AN OMEGA-3 FATTY ACID -IMPORTANT FOR FETAL VISUAL AND COGNITIVE DEVELOPMENT -DEMANDS INCREASED IN LAST TRIMESTER -RECOMMENDED 300 MG DAILY -EAT 2 SERVINGS OF SAFE/LOW MERCURY FISH (WILD CAUGHT SALMON, SHRIMP)                                                       Folic Acid Shout Out -PREVENTS NEURAL TUBE DEFECTS -SEVERE BIRTH DEFECTS OF THE BRAIN & THE SPINE -SUCH AS SPINA BIFIDA & ANENCEPHALY -400 MCG OF FOLIC ACID IS RECOMMENDED FOR MOST -4 MG FOR OTHERS DEPENDING ON MEDICAL HISTORY -START 1 MONTH PRIOR TO CONCEPTION -HAVE CONVERSATION WITH HEALTHCARE PROVIDER                                                         Choline Shout Out -REDUCES NEURAL TUBE DEFECTS -INDEPENDENT EFFECT REGARDLESS OF FOLIC ACID SUPPLEMENTATION -IMPROVES COGNITION, ATTENTION SPAN, MEMORY AND PROBLEM SOLVING (APA, 2023) -BEST SOURCE ARE EGG YOLKS, BEEF LIVER, BEEF, SALMON -RECOMMEND 450 MG -Nature Made PNV with Folic Acid + DHA+ Choline - Women's Prenatal Gummy Vitamin | Nature Made®                                                 How to choose??? -A healthy, well-balanced diet in combination with prenatal vitamins is the best way to ensure that you get all your necessary daily vitamins, minerals and omega-3 fatty acids. -As with any over-the-counter dietary supplement or medication, choosing a prenatal vitamin is a discussion to be had with your healthcare provider.                                                           Pro Tips -Let provider know the type of PNV that you are taking -Bring a bottle in for them to review during a visit -Take PNV with food -Take daily when of childbearing age                                                       Beef, Iron & Wine -contains pre-digested beef -believed to be a medicinal tonic - sold under different brands -some contained alcohol up to 22% -some overproof -Not for pregnant moms!                                                      Guest Information DR. AZELIA BROWN IS CLINICAL PHARMACY SPECIALIST WITH OVER 5 YEARS OF EXPERIENCE IN THE HOSPITAL SETTING. SHE COMPLETED HER UNDERGRADUATE STUDIES AT THE UNIVERSITY OF FLORIDA. SHE THEN RECEIVED HER DOCTOR OF PHARMACY DEGREE FROM MERCER UNIVERSITY AND COMPLETED POST-GRADUATE TRAINING AT WELLSTAR ATLANTA MEDICAL CENTER. THOUGH SHE PRIMARILY PRACTICES IN THE CARDIOLOGY AND CRITICAL CARE SETTING, SHE HAS EXPERIENCE TAKING CARE OF A WIDE VARIETY OF PATIENT POPULATIONS. SHE IS PASSIONATE ABOUT HELPING HER PATIENTS OPTIMIZE THEIR MEDICATION THERAPY AND IMPROVING THEIR HEALTH OUTCOMES.                                                               References -ACOG. (2022). NUTRITION DURING PREGNANCY. RETRIEVED FROM HTTPS://WWW.ACOG.ORG/WOMENS-HEALTH/FAQS/NUTRITION-DURING-PREGNANCY -AMERICAN PREGNANCY ASSOCIATION (2023). PRENATAL VITAMINS. RETRIEVED FROM PRENATAL VITAMINS | EVERYTHING YOU NEED TO KNOW (AMERICANPREGNANCY.ORG) -BIOSSAT, G. (2019). PRENATAL VITAMINS: A SMALL INTRODUCTION TO A BIG PILL. RETRIEVED FROM PRENATAL VITAMINS: A SMALL INTRODUCTION TO A BIG PILL - CHICAGO HEALTH (CHICAGOHEALTHONLINE.COM) -NHS. (2023). VITAMINS, SUPPLEMENTS AND NUTRITION IN PREGNANCY. RETRIEVED FROM HTTPS://WWW.NHS.UK/PREGNANCY/KEEPING-WELL/VITAMINS-SUPPLEMENTS-AND-NUTRITION/ Disclaimer: The primary purpose of this podcast is for private, non-commercial use. It does not constitute medical or professional advice. https://linktr.ee/fourth.trimester.np?subscribe

                                                         Preconception Care Preconception Care helps to decrease poor outcomes for mom and baby. It has been found that health decisions that are made prior to conception can decrease the likelihood of gestational diabetes, pre-eclampsia and other possible detrimental events. Ng et al. (2020) put it beautifully when they said “it is not the seed but the soil that makes the plant healthy”. What should you expect from your healthcare provider? Screening for Infectious Diseases, Treat, Immunize, Counsel • HIV • Syphilis • Gonorrhea/Chlamydia • Hepatitis C in those with tattoos and/or body piercings • Immunizations: • Rubella, varicella, hepatitis B • Influenza vaccine if woman will be pregnant during influenza season • Toxoplasmosis – avoid raw meat, cat litter, garden soil • Cytomegalovirus, parvovirus B19 (fifth disease): - encourage frequent hand washing Environmental Toxins • Smoking cessation including Marijuana 7% (CDC, 2016-2017), Vaping etc. • Screening for alcohol use or abuse • use of illegal drugs • Occupational exposures – Material Safety Data Sheets from employer • Household chemicals – avoid paint thinners/strippers, other solvents, pesticides • Radiation exposure in early pregnancy Medical Assessment • Evaluate overall health and opportunities for improving health • Labwork which will help determine if woman suffers from any undiagnosed or uncontrolled medical problems (e.g. diabetes, thyroid disease, dental caries or gum disease, heart disease, asthma) • If history of Diabetes – optimize control HbA1C < 6.5 • If history of Hypertension – avoid ACE inhibitors, angiotensin II receptor antagonists • If history (hx) of Epilepsy – consider increased dose of folic acid & possibly changing medications • If hx of blood clots (DVT) – switch from warfarin (Coumadin) to heparin • If hx of Acne – stop isotretinoins (e.g. Accutane) • If hx of depression/anxiety and other mental health issues-discuss current benefit/risk medication data, need for therapy, need for specialist consult Lifestyle • Recommend regular moderate exercise (75-150 minutes Walking!) • Avoid hyperthermia (hot tubs) • Maintain a healthy weight, lose weight as needed • Assess risk of nutritional deficiencies: • Vegan • Pica • Milk intolerance (calcium supplementation) • Calcium or iron deficiency • Avoid overuse of:    • Vitamin A (750 micrograms for ages 14 to 18; 770 micrograms for ages 19 to 50)per day) ACOG    • Vitamin D (limit to 600 IU per day) ACOG    • Caffeine (limit to two cups of coffee or six glasses of soda per day)     • Screen for domestic violence (increases in pregnancy, 1 in 4 women) if this applies to you, let your          provider know.     • Screen for social issues (e.g. place to live, child care, employment, transportation)     • Counsel on the use of over-the-counter medications, nutritional supplements, and naturopathic                substances   Deep Dive into Pregnancy Hx • All prior pregnancies (cerclage use, inpatient stay etc) & outcomes • Cesarean section or vaginal delivery • Premature delivery • Hypertensive (high blood pressure) disorders of pregnancy • Diabetes or Gestational diabetes • Blood type? Rh incompatibility? or hx of receiving RhoGAM • Postpartum hemorrhage • Thrombotic event (DVT/PE) • Mood changes in perinatal (during and after pregnancy) period   What can you do to get ready today? - Start taking a multivitamin that has at least 400 mcg of folic acid - Maintain healthy diet and weight - Be physically active more days per week - Quit smoking anything 😊 includes vaping - Avoid alcohol - Screen all medications & supplements with your healthcare provider - See your medical team for chronic health conditions   I’m pregnant now what??? -establish prenatal care ASAP -seek childbirth, newborn and parenting education                                             About our guest Crystal-Ann Roberts Crystal-Ann Roberts is a Registered Nurse currently practicing in the field of High-Risk Obstetrics in South Florida. She is also the founder and childbirth educator with Jonah’s Birth. Crystal-Ann Roberts received her Bachelors in Psychology from Nova Southeastern University and her Associate Degree in Nursing from Miami Dade College. She obtained her certification as a Hypnobirthing Childbirth Educator because of her love for maternity and her passion to influence the birthing world. Crystal-Ann has been married for 11 years and has 2 children. It was the birth of her sons that influenced the founding of Jonah’s Birth. She believes every woman has the right to safe maternal care and should have access to evidenced based birthing education. Look her up on IG @Jonahsbirth                                                                References The American College of Obstetricians and Gynecologists. (2019). Prepregnancy Counseling. Retrieved from Prepregnancy Counseling | ACOG Centers for Disease Control and Prevention. Planning for Pregnancy (2023). Retrieved from Planning for Pregnancy | Preconception Care | New York State Department of Health. (2009). Components of preconception care. Retrieved from Components of Preconception Care (ny.gov) Ng, S. W., Norwitz, G. A., Pavlicev, M., Tilburgs, T., Simón, C., & Norwitz, E. R. (2020). Endometrial Decidualization: The Primary Driver of Pregnancy Health. International journal of molecular sciences, 21(11), 4092. https://doi.org/10.3390/ijms21114092 World Health Organization Regional Office for South-East Asia. (‎2013)‎. Preconception care to reduce maternal and childhood mortality and morbidity. Retrieved from Preconception care to reduce maternal and childhood mortality and morbidity (who.int) Disclaimer: The primary purpose of this podcast is for private, non-commercial use. It does not constitute medical or professional advice.   https://linktr.ee/fourth.trimester.np?subscribe

I had my first guest for my podcast today. Crystal Ann Roberts is a high risk antenatal nurse and a business owner of a health education company specializing in childbirth education. We discussed all that you need to know before you become pregnant. This was so great, as we were candid and revealed quite a bit about our personal experiences. This is Part 1 of 2. The second part will be published on 3/17/2023. All resources will be provided on the show notes of that episode. In the meantime follow Crystal Roberts @jonahsbirth and me, Judith Wafe @fourth.trimester.np Here is my Link Tree for Youtube, TikTok so that you can see the associated video. https://linktr.ee/fourth.trimester.np https://www.tiktok.com/@fourthtrimesternp?lang=en https://www.youtube.com/@fourthtrimesternp/featured

                                             Postpartum Psychosis Postpartum Psychosis is rare, however the impact on the family unit can be catastrophic. As promised, I have included the link for support groups for moms with a history of postpartum mood disorders. There are 30 different groups run by Postpartum Support International. So select the one that is best for you. PSI Online Support Meetings | Postpartum Support International (PSI) https://www.postpartum.net/get-help/psi-online-support-meetings/ Here are a list of my references. This is not a comprehensive list but the major points came from these two resources. To all my nursing professors, I am sorry but I used a creative means to cite 😊. Next episode I will do better. So stay tuned…                                                           References Friedman, S.H., Reed, E. & Ross, N.E. Postpartum Psychosis. Curr Psychiatry Rep 25, 65–72 (2023). https://doi.org/10.1007/s11920-022-01406-4 Kutty, H. (2023) PMADs Don’t discriminate, and neither should we. Blog Post. PMADs Don’t Discriminate and Neither Should We | Postpartum Support International (PSI) Maternal Mental Health Leadership Alliance. Fact Sheet – Pregnancy & Postpartum Psychosis. (2022). Fact Sheets — Maternal Mental Health Leadership Alliance: MMHLA                                                               Disclaimer Disclaimer: The primary purpose of this podcast is for private, non-commercial use. It does not constitute medical or professional advice.

Eat Well To facilitate postpartum recovery: Continue prenatal vitamin Prioritize Protein (meat, fish, beans, peas, nuts)  Eat a variety of Fruits  Eat a variety of Vegetables Consume Fats like avocados, nuts, olive oil and seeds  Drink enough Water Ask your healthcare provider if you should supplement: • Vit D3 • Iron • Vit B12 • Folic acid • DHA Try to obtain these in a natural form in your diet. Recovery Shopping List: Supplements,  Prenatal Vitamin, Protein, Fruits, Vegetables, Healthy Fat  On exercise: First, ask your clinician if you are cleared to engage in exercise Try to walk at least 20-30 minutes most days of the week preferably outside in a natural setting  Try exercise apps like “Tone it Up: Workout & Fitness” or “Sweat: Fitness App for Women”  Search for classes that you can try on the “Mindbody” App that are both virtual and in person Tour your local fitness club or the YMCA. Ask about their class variety. Sleep & Rest Tips Make a sleep schedule and ask significant other or family member to help.  Make bedroom cool, quiet, and dark  Consider blackout curtains Limit caffeine intake  Disconnect from all devices Sleep when baby sleeps  Do not do household activities if you have childcare  If thoughts about what you could be doing instead STOP you from falling asleep, keep a notepad and pencil next to you and jot them down to be completed after rest. Religion & Spirituality What do you believe? How do you practice your beliefs? Create or find your own mantras, example - The scary moments are temporary. Disclaimer: The primary purpose of this podcast is for private, non-commercial use. It does not constitute medical or professional advice.

Here is the link for online support groups that are facilitated by PSI:  PSI Online Support Meetings | Postpartum Support International (PSI) Postpartum Support International (PSI) What to expect: First choose a group, there are about 20 different ones. Groups are 90 minutes (1.5 hours) in length. The first ~30 minutes is providing information, education, and establishing group guidelines. The next ~60 minutes is “talk time,” in which group members share and talk with each other. Group members must be present for the group guidelines before joining in the discussion or “talk time. What to discuss with your family or friends: 1. meals for at least 2 weeks 2. rest (creating a schedule so that you can sleep) 3. company, not being alone for long periods of time (watching movies, chatting, playing games, discussing motherhood) 4. chores (allows your body to rest and heal)   Disclaimer: The primary purpose of this podcast is for private, non-commercial use. It does not constitute medical or professional advice.

This is our initial foray into Postpartum Depression. As promised there is a link here for the screening test for Postpartum Depression. If your score is greater than 10 please let your healthcare provider know. If you answer "Yes" to Question 10, please discuss with your healthcare provider asap. In the next episode we will discuss creating a community. Edinburgh Postnatal Depression Scale  (EPDS) Calculator (perinatology.com) Disclaimer: The primary purpose of this podcast is for private, non-commercial use. It does not constitute medical or professional advice.

We would like to help improve maternal health in the USA. The US has the highest rate of maternal death in developed countries. We would like to tackle that with evidenced based health education. This episode explains the why? We included our ribbon cutting ceremony (tongue in cheek) after minute 4 for your amusement.  If you would like to see the video use the link below: https://youtu.be/bvxoMadktoo   Transcript as follows: Hello, my name is Judith Wafe and I am a Women’s Health Nurse Practitioner. I have been in the healthcare field for 17 years and I like to help people. It was back in 2005 when I was at the University of Miami that I saw my first birth. I remember it as the patient was laboring all alone without any family. Her first language was not English and I was concerned about how frightening it must be to be completely vulnerable. Her primary nursing team was attentive and helped her as she labored. The attending physician was patient and did not perform any unnecessary interventions. Ultimately, she had a healthy baby girl. We then scurried off as nursing students, to see another delivery. However that delivery left an indelible impression on me. Now that I think about it, that is probably the moment when my desire to advocate became concrete and my wish to work in women’s health was solidified.So why the podcast? If you read the health news headlines, you can see that maternal health is in trouble. The United States has the highest maternal mortality rate in developed countries. And the women at highest risk are African American and Hispanic. It has also been found that 80% of these deaths are avoidable. I will say that again, 80% of deaths are preventable. I started to think about how this number could be reduced and I considered health promotion. I would like to use this podcast as a health education device with the primary aim of getting the best information out there. It will include all things related to pre-conception, pregnancy and postpartum. You can expect evidence based presentations, exploration into cultural practices related to pregnancy, unscripted guest interviews and much more. We will release at least one podcast per week…Tune in. Our next podcast will be on postpartum depression. We will also use a cliff notes version on postpartum psychosis as there has been a recent event in the news. Ribbon Cutting Hello everyone, Thank you so much everyone for being here and taking time out of your busy schedules. I would like to thank my parents and my husband for believing in me and who have always gone the extra mile with me. So please enjoy the food and the drinks. We have some low calorie snacks, and lets proceed with the ribbon cutting ceremony. Yeah!!!!!!!! Thank you guys…Fourth Trimester NP Podcast.