Talk With A Doc

Talk With A Doc: Lifecycle: Health For A Better World
Episode 01: Healthy Beginnings: Steps to a Healthy Pregnancy

Dr. Emily Norland
The advice I would give someone searching for the right obstetric care provider for them would be to do some searching and dare to dream about what their hopes are for this experience and think about what type of care do they want to receive and then go out and find it.
Jennifer Semenza
I'm your host, Jennifer Semenza. We're kicking off the Lifecycle series with a two-part episode on prenatal care and why it's essential to ensure the health of both mother and baby. On the first episode, we'll cover the key steps for healthy pregnancy, like when to visit your OB/GYN. The must have prenatal vitamins, eating right during pregnancy, and the important milestones you'll want to keep an eye on.
For all your healthcare needs, visit providence.org to find general practitioners and specialists in your area and the latest in health care news. My guest for these first two episodes is Doctor Emily Norland, obstetrician gynecologist and chief of the OB/GYN Department at Swedish Medical Center in Seattle, on the 1st Hill Campus. Doctor Norman, welcome and thank you for joining us today.
Dr. Emily Norland
Jennifer, thank you so much for inviting. I love the opportunity to talk about obstetrics and labor and delivery and the work that I'm privileged to be here with you.
Jennifer Semenza
Talk with us a little bit about you. When did you realize that OB work was for you? And was there a specific moment or experience that confirmed that for you?
Dr. Emily Norland
I did not start out wanting to be a physician. I come from a family of teachers and I, myself was in the classroom. Unlike my brother and sister, who are great at managing a classroom. I am not. And I also saw my students really impacted in their learning. Being by health-related things in a landscape where snowbirds from the Midwest had great access to medical care. But my students who were the children of farm workers, did not. And I think it was. There that the seeds were. I also come from a family of people that love to use their hands and so years later in medical school, I realized that I love surgery. I was good at it and then in my OB/GYN rotation, all my passions seemed to be possible in one place. Reproductive justice service using my hands, connecting with patients, solving problems with a motivated group of people. Was just. A match. It was wonderful and I can't believe that I get to do this work for me. It's great.

Jennifer Semenza
And I would argue that there's still a fair amount of teaching in your current role too. Those skills are being put to good use.
Dr. Emily Norland
Yes, in a smaller classroom where I feel much more impactful.
Jennifer Semenza
So, let's start off by just talking about, general health and pregnancy. You know, my daughter had her first baby recently, and as she went through her pregnancy, I was really surprised at the differences between her experience and mine. And a lot has changed since I went. So, let's just start at the beginning. When a person receives a positive test result with an at home pregnancy test, what's their first step?
Dr. Emily Norland
Jennifer, thanks for sharing that. By the way, and yes, it's amazing how things are changing. And so we're really focusing on centering our patients and our care. Which I think is a great step in the right direction. When somebody gets a positive pregnancy test, I encourage everybody to take a deep breath in. And let it out. There can be such a range of emotions with that spanning the spectrum. Happy, sad, angry, confused, scared, surprised, terrified, joyful. The whole spectrum take it in. Breathe it out and then share that news with someone close to them, and then also reach out to establish care getting connected. If a healthcare professional that you trust early on, whether or not that's the person that ends up caring for someone during their pregnancy or helping them safely deliver their baby, whether or not that's the same person. Getting connected to a trusted source of information and a human who will care for you during. A really challenging part of pregnancy. The first trimester. I think that's really impactful.
Jennifer Semenza
Absolutely. And you're right, there's a gamut of emotions that can come with that. How often should they be scheduling prenatal visits?
Dr. Emily Norland
Generally in the 1st two trimesters of pregnancy, patients are seen about once a month and that's going to be adjusted depending on a pregnant person's individual situation. But in general, about once a month until. 28 weeks and then after that, every two weeks or so until 36 weeks. And at that point weekly until.
Jennifer Semenza
Perfect. And if this is not their first child. Do they still? Come in as often, or can they just come in as it's necessary?
Dr. Emily Norland
That is a really, really, really, good question. You know, I think pregnancy and prenatal care are one of those triumphs of preventative medicine, prenatal care. Reduces a lot of risks for both mom and baby during pregnancy, and each pregnancy can be really, different. I love is that our professional organization, ACOG, American College of OBGYNS. They acknowledge that in certain circumstances. A pregnant person and their physician or midwife can decide together to personalize that general framework of prenatal care. Sometimes visits can be done. Sometimes they can be adjusted in or out depending on a person's particular situation work. Family support, transportation, the whole thing. But in pregnancy, sometimes things can come up and be sneaky, and so those regular check ins be really powerful for making a. As safe as possible.
Jennifer Semenza
I love that you mentioned virtual visits because I know like in my daughters case she really needed to save her PTO for time off after the birth. Some. Those appointments really can be virtual then, right?
Dr. Emily Norland
Some of them can be. Some of them can be because a lot of prenatal care is educational. And relationship. And there are also some things that like, there's just no substitute for that hands on interaction. If I could think really hard about what is happening with the cervix. And just. But still that requires a physical exam listening to the baby�s heartbeat. For example, we also need to do that face to face, taking a blood pressure can be done virtually, but if it's not normal or if it's elevated, that follow up will need to be in person and so. It's great that we can utilize all of our tools to meet our patients where they're at.
Jennifer Semenza
Yeah, I'd imagine it just depends on so many different factors, it's really just. That people has with their doctor.
Dr. Emily Norland
Yes it can. Yeah.
Jennifer Semenza
One of our goals is to really educate our listeners and help them make better healthcare. So for first time expectant parent attending their first doctor's appointment, what are the essential questions they should be asking?
Dr. Emily Norland
Jennifer, thank you for that question. I love. I really try to encourage patients. To just let the questions that are important to them rise to the surface and come out, I do think that some really crucial things to get clarified and connect on in that first visit is who is this provider? Are their philosophies? Who's on their team? Who's going to be with them and caring for you during the pregnancy? During the delivery and afterwards, I think it's a great time to ask about doula services.
I wish every patient had access to a doula. Though kind of getting that clarified would be a really good one. And then I think also it's a really great time to share a patient's hopes and dreams for that experience. Because, you know, sometimes it's just not a great fit and getting that out there as soon as possible, I think is a win win for everybody. Most likely it's going to be a great fit because nobody chooses obstetrics and they'll say. Totally love taking care of patients and it's such an exciting time in our field where again, we're really personalizing our care for our patients. Really. So I think I love that first visit and.
Jennifer Semenza
It sounds like there's really just no question that's off limits during that first visit.
Dr. Emily Norland
Oh, I'm so happy you said that. Absolutely not. Everything is fair game.
Jennifer Semenza
Let's talk about the actual pregnancy and key milestones. What should someone expect in their first trimester with those different milestones?
Dr. Emily Norland
OK. I just can't emphasize enough how everyone�s pregnancies are the same. My mom says that the best she ever felt in her whole life was when she was pregnant. You know my sister and I are her pregnancies with us were identical, which is. Like amazing to me in that first trimester. It can be. Rough. Most people generally don't feel all that great. And there's a lot of information coming at a person, a lot of decisions, a lot of lab tests, ultrasounds do I do genetic testing?
And when someone is barely able to eat or drink because they're so nauseated and so exhausted and their body kind of feels uncomfortable as it's really. Changing all day, every day in response to being pregnant. That can be a. And early pregnancy loss is really, really common. In the first trimester and it is really not spoken about. Hurts my heart because a lot of patients are scared. Blame themselves. They didn't do something well enough. And nothing could be further from the truth. And so it's a time of intense vulnerability, emotionally, physically, psychologically. And so I really love to lean in on that because for better for worse, all of that is generally part of a really routine normal, healthy pregnancy. Pregnancy can be so mean.
Jennifer Semenza
Thank you for sharing that, that compassionate, because that really is something that we can talk about more. OK. Totally.
Dr. Emily Norland
OK.
Jennifer Semenza
Why is it important to know and keep track of these milestones by trimester?
Dr. Emily Norland
Well, it really helps us. Most importantly, do some anticipatory guidance in. You know, really reinforce the benefits of activity, nutrition. It helps us make sure that patients are gaining the right amount of weight. We can monitor the baby's heartbeat regularly, monitor our patients� blood pressure, regularly catching things early allows us to adapt and modify. Our prenatal care so that it's optimizing everything that we can in the second trimester. That can be a time where there's a resurgence of energy. Feeling really well, a lot of first trimester is survival mode and then a lot of second trimester can sometimes be returning to a more. Nutrition plan, exercise and activity plan and then a lot of thinking ahead about third trimester and preparing for being parents and then.
Jennifer Semenza
And then the excitement really builds to, yeah, exactly, exactly. And I. That screenings and different tests are part of a normal pregnancy.
Dr. Emily Norland
They are.
Jennifer Semenza
Test and screenings that that pregnant people should be. By trimester.
Dr. Emily Norland
That's a great question. In the first trimester, at the first visit, there's a lot of tests, a lot of blood work. We do, we look at patient�s blood type. We look at screenings for anemia because if we identify anemia or low iron, low red blood cell count. And we can start supplementation and correct that and that really helps patients� energy level and it actually helps keep them safe from extra bleeding at the time of delivery. We do some for infections, some patients immunity to measles, mumps and rubella has waned, and so if that's the case, you know, we want to know that so we can get patients vaccinated after delivery, we check for. Urine infections. Bladder infections because those can present differently without symptoms and pregnancy and we want to treat that to minimize risks of infection and early delivery.
We also do some tests, for example. Test exposure to hepatitis because again. Managing these conditions during pregnancy, if they're there, allows us to keep mom and baby as healthy as possible and also identify opportunities to benefit both mom and baby after delivery. So that's really great. And then you know a hot topic for everybody is to do genetic screening for increased risk of chromosomal problems with babies. Or. And that's a really personalized choice that every obstetric care provider, midwife or physician is really eager and well equipped to discuss with patients, so that their choices can align with their personal values.
Jennifer Semenza
Perfect. Thank you. What about parents who don't have health? Because as we know, there's a lot of doctors� visits involved that can be a real overwhelming concept for a lot of parents. What's the first step for someone who doesn't have health insurance coverage to go for care?
Dr. Emily Norland
Oh, I'm so happy that you asked that because healthcare in the United States cost is so expensive. I'll speak specifically to the state of Washington because that's where I'm fortunate to practice in the state of Washington. A pregnant person immediately qualifies for health insurance through the state, and it's actually really amazing coverage. Covers all of prenatal care, ultrasounds, all the lab tests that are needed. Delivery at the hospital or the location of the patient's choosing. It also provides coverage for the newborn immediately and through the first six years of life. It automatically renews state coverage through the Washington Health Care Authority, covers the pregnant person for an additional 12 months after delivery. It covers maternal support services, which include access to nutritional advice, dietitian services, behavioral health, women, infant and children nutrition support.
Also, potentially transportation to and from appointments. There's pregnancy loss or termination if that's something that arises. It covers postpartum support, social work, potentially a community health worker if that's indicated, and childbirth education, as well as postpartum parenting support. I'm really proud of that and I suspect that there in other states where Providence is that there are similar programs, but here in Washington state. The first step would be if somebody has Internet access to get online and go to the healthcare authority. Hca.wah.gov when the application is all online.
Jennifer Semenza
And I think you're. I think most states do have similar. Washington's might be a little more robust, but I know that there are resources in every state where we practice. This is talk with a dock Lifecycle and I'm speaking with Doctor Emily Norland, an obstetrician and gynecologist and chief of the OB/GYN department at the First Hill campus Swedish Medical Center in Seattle. She joined me to discuss good prenatal care and is offering upgrade advice and some wonderful tips for a healthy pregnancy and baby.
So, let's chat about diet, nutrition and I'm really excited about this. Next question I get to ask you. I needed by cravings. For me it was strawberries with my first pregnancy. And then during my second it was like ribs and tamales. And which ironically, really ended up describing their personalities as well.
Dr. Emily Norland
I love that. I love that. Why do we have food cravings?
Jennifer Semenza
And should we indulge those cravings?
Dr. Emily Norland
Oh my gosh, may you and I figure that out. Then we will be set for life. Men are so fascinating and so much of that, you know, is it biological? It. Is it emotional? Is it psychological? I love. I love all of it and the answer is I have no idea why we have cravings, and I think that within reason it can be really important way to nurture our humanity. And to comfort ourselves, to indulge our cravings within reason. And I think in pregnancy as well as outside of pregnancy. You know, depending on what they are, let's make that the exception as opposed to the rule.
Jennifer Semenza
That makes sense.
Dr. Emily Norland
It's a Midwesterner in me that, like all things in moderation.

Jennifer Semenza
Including moderation is that that this is a famous saying.
Dr. Emily Norland
Yes it is.
Jennifer Semenza
And I think that we all know that, you know that eating for two is a myth. What should a pregnant person's daily nutritional intake look like during pregnancy?
Dr. Emily Norland
Yeah, that's a wonderful question. I I have a lot of opinions to share with the person that came up with that myth, and it is a myth. It's. That idea has done a tremendous disservice to. You know, it's a recommendation for nutrition and nutritional intake depend on a number of factors that depends on a woman's nutritional status as they enter pregnancy and then also. You know their BMI or body mass index, which is a calculation that includes weight and height. It's flawed. It's not perfect. By any stretch, but it's a place to start the conversation about. How can a clinician and patient work together to make sure that a patient has the healthiest pregnancy possible?
Excessive weight gain can cause a lot of risks in pregnancy that could potentially be avoided. Like long labor, big baby C. section And we all want to minimize those risks. And so and then also twins. If a patient has a Singleton or one bun in the oven, that's going to be a little bit different than two babies. I know if a person is anemic, we identify anemia on those first blood tests or in the blood test at the beginning of the third trimester where we screen for diabetes. If we find anemia, we'll need to adjust nutrition. To accommodate that, and I think nutrition is also a balance of activity and exercise too.
Jennifer Semenza
Right. So let's let's make this more. What? What are the common foods that are most beneficial or considered superfoods for an expecting person?
Dr. Emily Norland
Oh my goodness, I think all whole food can be a superfood. When you ask me that question, the first thing that came to my mind here in our beloved Pacific Northwest is our beloved wild Alaskan salmon. You know, culturally to this area as well as nutritionally wild fish have a tremendous amount of benefits, including healthy omega-3 fatty A/C. Lean protein that can be very. There are certain fish that concentrate mercury and so those need to be avoided, but there's lots of healthy. Choices. Shrimp Pollock, cod, wild salmon.
Friends don't leave friends eat farm salmon. Ever. But I think as much whole food as possible is really a great way to go. You know, fruits and vegetables. Lean protein and really try as best as we can to minimize processed foods and also simple carbohydrates. We're leaving behind the era in the 80s where. No fat was heart healthy and that really kind of shifted towards a lot of processed foods. And fortunately there's just so much data coming back about the hazards of really processed foods now. Bear in mind, you know, in the state of Washington, we have a robust small farm system and so like a lot of people have access to real high quality, locally grown food. That is also curious with it. A lot of privilege. And so I think that doing the best that one can. Is the best that one can and will result in a healthy pregnancy.
Jennifer Semenza
So and on that note, what are some of the common foods that pregnant people should avoid? And obviously, the real processed foods? But are there other specific ones?

Dr. Emily Norland
Yes, please and thank you and some of that goes to our food system again, you know fruits and there are kind of two things that we're worried about. Is foodborne illness and infection and the one we really worry about in pregnancy is listeria. Because that can different than other types of food borne illnesses. I learned a lot about this because my husband is a. Chef and he knows more than I do about preventing transmission of foodborne illnesses, but we really need to be diligent about washing our fruits and vegetables and thoroughly cooking meat eggs, and we need to watch out for unpasteurized soft cheeses. Raw milk is like the standard recommendation is to avoid it. Is definitely a controversial can be a controversial topic.
I will say if you know where your food is from, whether that is raw milk or raw fish, because culturally pregnant women for generations in certain parts of the world have eaten raw milk and raw fish and have done fine. I would say for the vast majority of Americans, with our current food and health. System pasteurized food and well cooked fish and seafood are safer choices in. And then deli meats as a common one, those need to be cooked to steaming. Because think about what those deli meats do when we're not at the grocery store. They're just in that case all by themselves and a lot of our fruits and vegetables these days travel long distances and pass through many hands.
And so, you know, again, pregnancy is a vulnerable time, so it can be. Really scary to think about all the things that could happen. And I think it's a wonderful time to kind of practice that mindfulness and do what we can in the ways that we can. Often times it's those simple. Simple Whole Foods movement everyday as much rest as we can possibly get. And like you said, all things in moderation, especially moderation. Absolutely.
Jennifer Semenza
So I am thinking about, you know, the pregnant person who might have given into that sushi craving. Or found out that they accidentally had too much caffeine that day.
Is there a risk to them for those for those isolated incidences or how should they handle those?
Dr. Emily Norland
Yeah, that's a great question. Really, poignantly, a very panicked patient who called me in the evening really concerned about. A hot dog that they had eaten at a 4th of July barbecue and this poor patient was so terrified that they'd harmed their baby, and I try to. And myself and try to help remind our. That women have been pregnant for millions of years and a. Wide variety. Circumstances and a well-intentioned pregnant person is not going to do something inadvertently that is catastrophic for their pregnancy and so. A little too much caffeine or indulging a sushi craving at their like favorite top quality sushi restaurant.
Those kinds of things are very, very unlikely to do any harm to the pregnancy. Things that we. Routinely, every day without even thinking about it, like crossing the street, carry much more risk than a accidental thing like that. At any point in time that a pregnant person is concerned. I really encourage them to reach out to their OB provider because the benefit to that relationship of reaching out with a concern and then getting reassurance, that's invaluable.
Jennifer Semenza
Absolutely sounds like they are just, you know have grace for yourself during that.
Dr. Emily Norland
Well, it's such a time of grace for oneself, absolutely.
Jennifer Semenza
So let's talk about weight gain. Considered healthy and. And I know that you mentioned that you know a lot of this will be discussed between the OB provider and the patient. But in general, what can people expect as far as weight gain goes and what's considered normal?
Dr. Emily Norland
Exactly for a patient who's coming into pregnancy at a normal weight for their height, anywhere from. 25 to 35 lbs. Over the course of the pregnancy, can be normal, and if patients are underweight. Their height. Then they should gain a little bit more because that baby will be inside them, mining them for everything that it wants. And pregnancy is very physically demanding, as is labor, as is delivering a baby. And so helping Mom or the pregnant person. As robust a nutritionist, possible everybody wins for patients who. Have obesity or who are a little higher weight for their height. Then we want to help support them to gain a little bit less weight than that, and so those can be really tough conversations to have.
A lot of. Really screwed up ideas in our culture for women, people who identify as women and also men about weight and fitness and body image. A lot of us can have some trauma around that previously and pregnancy where. Our bodies are changing relentlessly all day, every day, even when we want that to happen can be really challenging and. That's where I really encourage sharing and talking with the OB provider about that so that we can. Personalize OB care so that the OB care itself is supportive and not triggering. We can do that.
Jennifer Semenza
Yeah. And I imagine that there's also some ramifications to the mom and the baby, potentially of not gaining enough weight or gaining too much weight. That right?
Dr. Emily Norland
It is right. That's really true. For that. So when there is too much weight gain in pregnancy, the baby can gain too much weight. It can be a risk for prolonged pregnancy longer later. Slower labor, which can present some risks for infection and bleeding, and also increased chance, not a promise. Increased chance of an assisted delivery or a c-section. But. Also, don't want people to freak out if they are at a particular visit. All of a sudden, their weight is a little higher. All of the blogs and the articles and the books show this steady trajectory of weight gain, and in my experience, I find that sometimes in real life. We kind of gained weight and pregnancy in a little bit more of a stair step and that's one benefit of those that regular cadence of appointments. Jennifer is that they present some opportunities for check in and course correction and so. A. A lot of room for grace in that process. So glad you mentioned that.
Jennifer Semenza
You bet. Yeah, I know that one of the hardest parts, at least for me, you know, all those years ago, one of the hardest parts of pregnancy was the array of symptoms that you experienced. Oh yes, kind of walk us through managing some of those pregnancy related issues like. Nausea. Heartburn. Constipation. Yeah, absolutely.

Dr. Emily Norland
You know, for nausea in the first trimester. Sometimes home remedies like ginger tea, ginger candy, ginger ale can really help. Ginger is an. That for generations has a. A calming impact on the day justice system. Actually, a ton of great. Ideas and recipes in the cancer world that present really, really healthy, simple things to get nutrition in while respecting nausea.
I direct patients there. C bands can really help. The symptoms are so severe that we need medication and there's medications that are safe and pregnancy to try to help with nausea unisom vitamin B. Six, there's a combo pill now for. Anti nausea medicines are can also be considered and are safe in the first trimester. In general, that nausea can resolve 12/13/14, fifteen, 16 weeks. Some patients it. But for most it does. And then it can kind of come back at the end of pregnancy when the baby is so big, putting a lot of upward pressure on the baby. Stomach. And so at that time, I think adjusting the nutritional intake to be in smaller doses as opposed to you know a big lump of three meals a day can help activity hydration also really help.
Keep that bowel motility going and that's an important part of managing nausea, is making sure that what comes in is also going out. Common bowel regimen options like fiber soluble fiber are very safe in pregnancy and can be quite beneficial because hormonally the milia of pregnancy slows down. The motility in the movement of the muscles of the stomach and intestines and in terms of heartburn, you know that's a good question some people. Do and it can be very. Some people do well, you know, with dairy kind of coding the stomach.
Other people do not do well with. Some people will need to shy away from, you know, really acidic foods. Juice tomato products. I think everybody should walk away from soda pop. Particular turning. But also outside of pregnancy. But that's not going to help for some people. Kind of settles their. For other people, it's very activating. There's a lot in pregnancy, that is. Trial and error, honestly. But also like, that's where that relentless change in the. The body's different every day, and so there's a blessing side to that burden, which is that something that didn't work one day very well might. The next day. And this is where I think that oral tradition. I love those stories of like patients chatting with their moms, their aunties, their grandma's about what worked for them 'cause often times. Those things can be the most effective.
Jennifer Semenza
Imagine there's probably a lot of hesitation for people to try, you know, over the counter remedies. There's so much what we you know about medications and supplements that we can and can't take.
So let's clear up some of that misinformation. Listeners, you know, in addition to eating healthy, are there premium vitamins or supplements that they can take?
Dr. Emily Norland
I would love it if anybody who's considering pregnancy in the next year just started taking folic. That's really important for the neural development of the baby and over half the pregnancies in the United States are unplanned. And so that I think it would be an amazing thing. Know some? There's not one magic prenatal vitamin. What's magic is the prenatal vitamin that you can afford and the one that you can stomach and remember to take one is not better or worse than any other.
The supplement industry in the United States. Is a bajillion dollar industry. And I think you know, for patients, it's fascinating to me that supplements seem to feel. Safe. Fur and from nerdy Dr. perspective, this is a sector of our economy that is like unregulated and there's no promise like there's no requirement that or promise that companies have to make that. On the label is actually in the bottle.
And there are 10s of thousands of emergency room visits every year due to toxicity from supplements. Now I take supplements myself. I encourage my husband to also take supplements. But we've done a lot of research and most of the time gotten some recommendations from our doctors about ones that they've researched and that they trust. And even then I think it's important for patients to know it's still a leap of faith.
And nobody has more issues with Big Pharma than I do. And for medications that were recommending people consider in pregnancy, those have at least been studied. There is at least some data about. Impacts of those medicines. On pregnant people and their babies, I will say this is an exciting area of medicine as we're starting to recognize that Western medicine is a lot about solving problems. Pregnant people in general really want to be well. And so we're leaning into and learning from our colleagues and other areas and traditions of healing. And there is starting to be some research about. Non pharmaceutical. Treatments and remedies more to come.
Jennifer Semenza
Great. So it sounds like, say yes to prenatal vitamins and discuss other supplements with your with your OB provider.
Dr. Emily Norland
I think. I think fish oil is one that can be very beneficial because fish oil and DHA is important for the development of the baby's brain and eyes and our American diet, for the most part. Is low in those important omega-3 fatty acids. Other cultures and traditions where they have access to wild fish, their diets may be different and have a higher proportion of those very healthy fats, but for many. People omega-3 fatty acid supplementation is important, but I think those are the two that I feel most strongly about.
Jennifer Semenza
Yeah. And you mentioned, you know, being able to tolerate the prenatal vitamins as well. So if a person isn't tolerating them or or somebody who maybe they can't afford, those prenatal vitamins, are there less expensive natural alternatives?
Dr. Emily Norland
I don't know what a natural alternative to prenatal vitamin might look like. Other than whole food, but there are certainly less expensive prenatal vitamins and. Some insurance plans state insurance will. Cover the cost of prenatal vitamins if the OB. Can write a prescription, so I think that if someone is worried about not being able to afford their prenatal, they should talk to their OB provider a lot of times, taking the prenatal vitamin at nighttime can be really helpful. With a meal and then right before bed so that if they have iron that can kind of be upsetting to the stomach sometimes. Large and so taking it at night can really help with not tolerating it.
Jennifer Semenza
Yeah, let's talk about over-the-counter medications are the ones that are common to take during pregnancy and safe to take during pregnancy.
Dr. Emily Norland
Yes, there are. Most of the remedies for cold symptoms are safe to take. Syrup. Emergency antacids. Anti gas medicine. You know, those are typically safe. Pregnant women should avoid Pepto Bismol for the bismuth. That's not recommended in pregnancy, but in general many over the counter remedies are safe. Ibuprofen is something that we don't recommend patients take routinely. And we don't recommend that patients take that independently for musculoskeletal REM. It is used in obstetrics for certain conditions and that is a for very specific reasons. Short periods of time. So if someone's accidentally taken ibuprofen one time, I don't want them to worry or freak out. That one dose is unlikely to cause any harm whatsoever, however, for. The. And pains of pregnancy or the occasional headache OB is much prefer Tylenol.
Jennifer Semenza
Got. So part of having a healthy pregnancy I'm sure is also remaining physically. Too, yes. Can be especially challenging since during a good part of your pregnancy, you're exhausted. So what types of exercise are? And recommended during pregnancy.
Dr. Emily Norland
I'm so glad you asked that question. A huge fan. A lot of people are concerned about the safety of exercise and pregnancy, and thankfully this is an area of medicine where we actually know a lot. Exercise, even strenuous exercise, is safe in pregnancy. However, there's some certain things to keep in mind.
Our bodies are changing. Our center of gravity is getting lower, which impacts our back. Our abs are getting stretched apart and also some of the hormones are making the connections between our bones and the way that our skeleton moves. That's changing, and so we need to be mindful of that. But as little as 30 minutes, more days of the week than not. Is sufficient and more is great.
A lot of people wear Fitbits or heart rate monitors. I wear an aura ring. And those will tell us at any time of the day or night what our heart rate is. And a common thing that is perpetuates, I'm not going to say it's a myth, but what I will say is that a lot of folks encourage pregnant women to keep their heart rate below 140. And I think we know now that that's not necessary.
So what I recommend to Patients is to move your body in ways. Feel great. And ways that feel safe. And it's OK to get sweaty. OK to feel. It's OK to feel discomfort. It's important to work on strength because pregnancy only gets worse in terms of the physical demands. And then there's labor and delivery. And so I think approaching it with. Wonder and also some determination to prepare our minds and bodies the same way we prepare our nurseries or our homes or our pets for this brand-new baby. Prepare our bodies. The world needs lots of strong women.
Jennifer Semenza
This is Talk with a Doc: Lifecycle coming up on our next episode. Doctor Norland will return to talk about how to best handle any complications that may arise during pregnancy. She'll offer Up tips how to handle some of the most common pregnancy issues, like nausea, as well as how to handle some of the more serious issues like gestational diabetes and preeclampsia. Know we've discussed all of everything leading up to birth, but now let's actually talk about the labor and birth process. Wonderful. What advice would you give to someone who's searching for their OB care provider? Who's right for them?

Dr. Emily Norland
You know, this is where doing some thinking about what do you want this experience to? What are your hopes and dreams? And then finding someone that can meet you there is really important. That being said, pregnancy is a time where some things can come up. And it's important to be in the right situation so that labor and delivery can be as safe as possible. And so for some people, that means a hospital. For some people, that can be a birth center and some people will want to plan a birth. Home and I would encourage people to really be honest with themselves but also. See their situation so that that way they're prepared and things go the way that everybody wants them to. To say. Exercise can lead to a shorter labor.
Jennifer Semenza
That's a. That's a great, great answer. Thank you so much. We know that there. Other episodes on on our website and as well as through subscriptions. This podcast that. Information about zool. But for our listeners today who are unfamiliar, you explain the role of doulas and midwifes are during the birthing process and identify who might benefit from their services.

Dr. Emily Norland
That's a great question and one of my favorite things to talk about doulas and midwives are often grouped together, and I'm really glad that you did ask me that question because they play different roles and provide different services.
A doula is a skilled, trained professional who provides. Physical, psychological, emotional and educational support. Usually throughout pregnancy and delivery and often. Some doulas have particular areas of expertise, and a doula really can be a great sounding board. There's someone. Who supported other patients through birth and can be tremendously experienced with? Ways of preparing but also supporting patients during labor and delivery. They can be great sources of childbirth education and working with a doula in pregnancy and in labor.
There's great evidence about the benefits of doulas, and I just love talking about this all the time. Shorter labor. Interventions meeting and wanting less pain medication. Lower epidurals. Less chance of a long labor in that all of that means less chance for C-section, and that's what everybody wants. So I really. Would encourage everybody to seek out and at least read about doula services. Tremendously beneficial and especially when patients can find a doula that matches their cultural background.
A. Midwife is an obstetric care. And whether they're a licensed midwife or a certified nurse midwife, they are going to provide obstetric care throughout the pregnancy and then also care for somebody during the delivery process. And many times after the delivery, the midwife will provide medical care both for the pregnant, now, newly unpregnant person, and also the baby. I look forward to that podcast. And glad that you all are going to talk about those folks and their roles.
Jennifer Semenza
Roles, yeah. No, I mentioned my daughter that had a baby just about a year ago. She had an incredible doula during her pregnancy. And you know, selfishly as the mom of the of the mom to be.
I guess you know, selfishly, I was a little worried if I would feel out of place in the delivery room with a dinner, but that wasn't our experience at all. Having her extra expertise available, it just helped it to be a really great experience. I was able to be a support person for my daughter. And then really watch her excel going through this whole process and just remarkable strength that she had. I'm glad she made the choice to have a doula involved in her delivery. Boy, I just Can't Sing their praises enough.
Dr. Emily Norland
I'm glad we're joining in the chorus together. I. It's been wonderful to welcome them as part of our. At Swedish and see how their very presence on the unit has impacted the communication and the dynamic amongst the professionals on the unit and then our nurses are learning all about, you know, positions to help get babies into the pelvis in the best way. I mean it's it.
Jennifer Semenza
Yeah. Before we wrap up this conversation today, is there anything else we haven't talked about that you want to be sure to mention?

Dr. Emily Norland
I just want to encourage everybody who's listening to. Give yourself some grace. Take the best care of yourself that you can. The best thing for the baby is to have a healthy Mama, healthy pregnant person and your OB provider. Whether you choose a midwife, a family medicine physician, or an OB GYN or a maternal fetal medicine specialist. We're all on your side and we want to do the our best for you. Want you to have the best experience and the safest pregnancy possible. And regardless of what happens, we're right alongside you every step. The way. Thanks for listening.
Jennifer Semenza
This has been such a helpful conversation. You so much, doctor. We really appreciate your time today.
Dr. Emily Norland
My pleasure. Thank you for giving me this opportunity.
Jennifer Semenza
I'd also like to thank everyone for joining us today. On top of the docs lifecycle, we hope that we have provided you with valuable insight and a deeper understanding of why good prenatal care is so essential to having a healthy baby and to the health of the mother. Be sure to listen to our next episode where we will continue this discussion about prenatal development as we examine which essential screenings you should do and what you should know.
If you have complications during your pregnancy to get continued information on other important healthcare topics please subscribe to talk with the doc on your favorite podcast platform. You can connect with us on Facebook, Tiktok and exit Providence and on Instagram and LinkedIn. Under Providence Health systems for additional information about this and other health related topics, please check out the Providence blog at blog. Province org. To learn more about our mission programs and services, go to Providence Org or download the Providence app. To access all this information and more, thanks for listening.
Here's a sneak peek at our next episode.
Dr. Emily Norland
Depression in pregnancy is really, really common, even up to 27% of women in the United States will struggle with a mental health condition and in. The potentially one in five women might have a mental health challenge, and so I say that not again, not to make people afraid, but just to let people know that you are not alone, but also that we're here to help. Support you? Whatever it is that you're going through.