Prenatal Vitamins

We had another ultrasound today, and it was more good news!  I’m 9 weeks now, and the fetus is still viable.

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I feel a little more relief now, since most miscarriages happen before this time.  What I wasn’t expecting is that my nausea improved a little last week.  Meaning I went from eating only bites at a time and feeling ill pretty much all the time, to now being able to eat maybe a 1/4 sandwich at a time.  It’s not great, but I’ll take it.

It freaked me out, since last time shortly before the miscarriage was diagnosed, I started to feel improvement of my nausea.  So last week I did a vaginal ultrasound on myself (quite awkward), and was relieved to still see a viable fetus in there.

At the height of the worst nausea, there was one Sunday that I stayed in my pajamas the whole day, and only left the house to go to the mailbox.  Now, I’m still tired all the time, but a little more motivated to do my normal activities.  It’s definitely frustrating to only be able to eat small amounts of food at a time.  I’m still having a lot of soup- I’m all about the chicken bone broth, which at least provides a decent amount of protein.  And I’m also snacking on simple starches.  Unfortunately, I’m not getting a lot of fruits and vegetables at the moment.  I can’t wait until I can eat more normally.  I’ve lost 10 lbs. thus far.

When it comes to prenatal vitamins, patients often ask if there is a particular brand that I recommend.  I tell them that the brand doesn’t matter- they all contain the necessary folic acid.  And it’s usually cheaper to just take 1000 mg of fish oil daily separately, as opposed to buying the fancy vitamins that have the DHA included.  For those of us who are very nauseous, the gummy/chewable vitamins are fine temporarily.

My husband recently came across a prenatal vitamin from Ritual that I decided to try:

https://ritual.com/products/essential-prenatal-multivitamin

I was aware that the folic acid that is normally found in prenatal vitamins is not always that well-absorbed.  These Ritual vitamins have the methylated folate version, which is more ideal.  The folate is most important in the first month or so after conception, so I started them a little late to really help prevent neural tube defects.

The capsule design is also supposed to be slow-release and not cause nausea.  I usually take them in the morning when I’m drinking my bone broth, so it’s hard to say if that really is the case.  They also have a little tablet in the bottle that is lemon-scented.  Sometimes it’s nice just to open the bottle to sniff the lemon scent to help with my nausea.  They also contain vegan DHA from microalgae.  Based on all of that, I figured they were worth a try.

The vitamins of course are pricey, at $35/month to subscribe, and they mail a bottle to you monthly.  You take 2 capsules daily.  Given the price tag, I’d say it’s most worth it right after you conceive, and to continue while you’re really nauseous.  After that, as I tell my patients, no vitamin is a replacement for a healthy diet.

I was curious to try them for a month.  If you try to cancel your subscription after that, they offer you 20% off for the next 3 months.  Also, if you refer others, you’ll each get $5 off.  Here is my referral link in case any of you are so inclined: https://share.ritual.com/x/mdhOWN

For most people, $35/month is a lot to shell out on vitamins, so it’s not realistic to take them for the entire pregnancy.  But given the methylated folate and capsule design, I think it’s worth it for the first month or two.

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The Parasite Diet

We got great news with the first ultrasound!

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There is a viable, 7 week fetus in there.  And thankfully, just one.  We’ll still have another ultrasound or two in the coming weeks to confirm that things are still progressing normally.  But it’s definitely a relief that things are going ok so far.

The downside is that the nausea this time around has been really bad.  It got bad quickly, and it’s the worst I’ve ever had in my 3 pregnancies.  Each time, I’ve had to limit the amount that I can eat, because I’ll feel sick to my stomach if I eat too much.  With WZW, 9 weeks was when I could only eat bites of food at a time and lost 5 lbs in a week.  With the miscarriage, the nausea started earlier and I lost some weight, but I was able to keep snacking and eat small meals.

This time, I’m already at the point of eating only bites at a time.  I think I’ve dropped 7-8 lbs in the past week.  I’ve never vomited, but my caloric intake is well below my usual.  I am eating far less than WZW is.  I stocked up on starchy snacks, but haven’t gone through them as quickly as I thought I would.  Even with the snacks, I can’t eat much at one time.

I seem to do better with soup and cooked food in general, which is contrary to some of my patients who have meat aversions and prefer fruit.  So I got some chicken bone broth and other soups.  At least they contain protein, so that will help with my nutrition to some degree.  And with the colder winter weather, the hot soups are comforting to eat.

In the past, I was all about the sparkling water because I couldn’t drink regular water.  The flavored sparkling water is still preferred over still, but I find that it doesn’t seem to help my stomach as much this time around.  Ginger tea, which I don’t love the taste of, seems to help my stomach the best.  Even then, it doesn’t take away the almost constant state of nausea that I’m in.

I’m trying to be happy that things are going well so far in the pregnancy, and keep telling myself that it could be worse (as is with my poor patients with hyperemesis gravidarum).  But it’s a pretty miserable state.  In addition to the constant nausea, I’m feeling really tired as well.  It definitely makes getting through my work days more challenging.  Today is a Sunday, and I stayed in my pajamas all day.  I only left the house to go check the mail.

I’ve been telling WZW that Mama’s stomach doesn’t feel well because I have a parasite.  Shortly after the embryo transfer, we’d explained a little of it to him.  Well, next thing we know, one of his preschool teachers said that he said something about Mama having a baby, but it’s too small to see.  We tried to play it off, but I’m sure they suspect something.  We decided that in order to prevent him from spreading the news too early, we’ll call the baby a parasite.  Hopefully that is not as clear to others what he’s talking about.

And So It Begins…

With WZW, the nausea started at 7 weeks and peaked from 9 to 12 weeks.  When I got 9 weeks with him, I lost 5 lbs in a week because I could barely eat anything- just bites at a time.  With the pregnancy that ended in miscarriage, the nausea started at 5 1/2 weeks, and continued until I miscarried, granted it improved a little in the week before I found out the pregnancy wasn’t viable.

This time, I thought I’d try taking vitamin B6 prophylactically.  Vitamin B6 (pyridoxine) is commonly used to treat nausea/vomiting in pregnancy, and I’d read that women who take prenatal vitamins prior to conception tend to have lower rates of nausea/vomiting, thought perhaps to be due to the vitamin B6.  So I tried taking 50 mg daily with my prenatal vitamins.

Alas, this time at about 6 weeks, it started.  At first I could eat normally, but would just feel gross after.  It quickly progressed to feeling nauseous constantly.  So the vitamin B6 definitely didn’t help prevent the nausea.  So far, all I know is that the initial hCG levels were going up appropriately.  I am still waiting for the first ultrasound to find out if this pregnancy is even viable.

I know it’s a good sign that the nausea is developing and worsening.  But it’s hard to feel very happy when you feel terrible all of the time.  This time, it seems worse and constant, as opposed to before when I’d mostly feel it after eating and therefore have to eat small amounts frequently.  Once again, I made a trip to Trader Joe’s to pick up a bunch of starchy snacks and flavored sparkling water.  Definitely not Paleo snacks- at this point, I’m just doing what I can to get by.  Since I’m so early in the pregnancy, I’m dreading it getting worse and worse.

I feel so bad for my patients who have really bad symptoms of nausea and vomiting, aka hyperemesis gravidarum.  I recently saw a patient who is having her third child, and she had already started getting IV hydration before her formal prenatal intake appointment at 8 weeks.  She also said that instead of it getting better after the first trimester, it lasted 5 months with her other pregnancies.  She wants to work, but can’t due to the debilitating symptoms.  How terrible that must be for her.  I really hope my symptoms don’t get worse than they did with my previous pregnancies.  It was very uncomfortable, but I was able to handle them and still work.

Welcome MDA Readers!

Welcome to those of you checking out my blog through Mark’s Daily Apple.  My husband had told me he emailed Mark and crew to spread the word about my blog.  What he didn’t tell me was that Mark had written back that he was going to include my husband’s email in his post today.  Thanks to both my husband and Mark!

Also, I appreciate the advice I’ve already gotten about things that have helped other women with nausea and vomiting in pregnancy.  The good news is that this past week (Week 12), I’ve started to feel better.  I’ve gone from eating bird-sized portions to half-human portions.  Definitely a welcome relief.  Hopefully other women can benefit from the helpful advice in the comments as well.

My husband and I were lucky enough to spend the weekend in Santa Cruz.  It was so nice to drive there and back on Highway 1, with gorgeous views of the ocean.  It’s a strange thing to see a bunch of cows on the side of the road, and see the ocean behind them.  Despite the rain (and the event we were attending), we were able to get some outdoor time and because of the rain, saw plenty of rainbows.  In fact, on one morning walk, we saw rainbows as well as dolphins in the distance in the ocean.  Definitely not things you see every day.  I just need to add a leprechaun to the story to make it sound totally made up!

On a completely separate note, I wanted to mention an interesting medical news blurb I came across recently.  I get daily emails from the American Medical Association (AMA) with headlines and short blurbs about general medical news, as well as from the American Congress of Obstetricians and Gynecologists (ACOG) with OB/Gyn-related headlines in the current news.  On the same day that they reported about early exposure reducing children’s peanut allergies (which I’m sure you can easily learn more about elsewhere), they also had a headline about mother’s voices and heartbeats helping their fetuses’ brains develop.

They exposed premature babies to sounds of their mother’s voices and heartbeats.  Compared to those who did not have this exposure, they developed a larger auditory cortex.  The study suggests that in utero, the sounds of its mother’s voice and heartbeat help the hearing centers of the fetus’ brain develop.  Fascinating stuff!

http://well.blogs.nytimes.com/2015/02/23/mothers-sounds-are-building-block-for-babies-brains/?_r=0

Cheese Puffs

Mindy Kaling recently tweeted that “One embarrassing Hollywood thing about me is I’m into the organic or homemade versions of popular junk food.”  That’s totally what I’ve been doing lately.  I can’t get enough of whatever organic/non-GMO fancy cheese puffs I can find.  I mean, it’s not like I’m eating the questionable chemicals in Flamin’ Hot Cheetos, right?

Day after day of feeling queasy most of my waking hours, and having to force myself to stop eating well before I’m full, has been taking its toll.  I can’t wait till I can eat normally again.  So for now, what little at a time I can eat, I admit I’ve been eating cheese puffs and other very non-Paleo foods.

In the past, I’ve had issues with worrying too much about my weight, and obsessing over what I’m eating.  So it does bother me that now I’m so focused on food and eating all the time.  And it’s an unhealthy mindset to feel like I can sort of eat what I want because I can’t eat enough to gain weight.  Since I can’t eat as much as I normally do, I’ve plateaued at 5 lbs. less than my baseline weight.

I realize it’s not exactly the best thing to be eating junk food (even if it’s the fancy kind), but I feel so gross most of the time, I just want to eat whatever makes me feel temporarily better.  And at some point, when I do finally feel better, I intend to go back to healthier eating for the sake of my fetus.  That is, after I get some gluttonous eating out of my system.

Aromatherapy

This is something that I unexpectedly discovered.  I happen to have a lemon-scented hand wash in the bathroom, and noticed amidst all of the unpleasant smells that I’ve been more sensitive to lately, the lemon smelled heavenly.  So I thought to counteract the unpleasant odors, I’d get something lemon-scented to sniff when needed.  Whole Foods sells a bunch of essential oils, but I found that the lemon ones didn’t smell that great.  Maybe the tester bottles had been sitting out for a while.

Well luckily, they had their table with natural soaps and I found one that had a lemon rosemary scent that was really nice.  When I brought it home, I noticed that when I sniffed it, I’d temporarily feel better.  Briefly, though- just seconds.  It wouldn’t be practical to carry the bar with me everywhere and sniff it constantly.

I decided to Google aromatherapy and pregnancy, lemon, and rosemary.  And look what I found:

http://www.ncbi.nlm.nih.gov/pubmed/24829772

At least someone has done a study and found that inhaling lemon essential oil reduced symptoms of nausea and vomiting in pregnancy.  Other sites also mentioned lime, peppermint, and spearmint as aromatherapy scents that can help as well.

I did also come across some websites that said that rosemary essential oil is to be avoided in pregnancy.  Apparently it might induce miscarriage or something.  I’d never heard of that as an obstetrician, and certainly the amounts of herbs used for cooking are safe.  But I guess I’ll avoid rubbing rosemary essential oil all over my body.  I’m sure sniffing the bit of rosemary in my soap isn’t a big deal.

Frustration

I continue to have to eat small amounts at a time, and don’t feel well much of the day.  I’m definitely not staying strictly Paleo, and am happy to eat what I can.  I’ve never had this happen to me before- I’ve dropped 5 lbs in a week.  One of my colleagues said that when she was in her first trimester, at work she was wretching mid-pelvic exams.  Like when the patient was lying down and in the stirrups and couldn’t see her, she’d be quietly wretching.  And vomiting between patients.  Thankfully, I haven’t actually been vomiting and can get through my work days without disruption, so I think to myself I shouldn’t complain.  But I still do, because it sucks to not be able to eat normally and to feel gross most of the time.

I guess I’ve been trying not to let out my frustration too much to my husband (though I still complain plenty to him) and cry about it all.  But it must have been bottling up because I woke up in the wee hours this morning with a sorta bad dream.  I was arguing with my husband about something unimportant, and then woke up crying as I realized consciously that I’ve been withdrawing myself more from him due to how I’ve been feeling.

One of my friends (also an OB/Gyn) says she hates the first trimester because she gets depressed.  While mood changes in pregnancy are certainly common, I can’t say I’ve been feeling depressed per se.  It’s more like these days on end of feeling gross, and having my thoughts consumed by food all the time makes me frustrated and upset.  It just wears on you after a while.

I’ve had one patient and her partner recently tell me that she gets short and blows up at him all the time.  While some hormonal changes are to be expected in pregnancy (and PMS), I still think that going to the extreme of blaming your behavior on it and not taking responsibility for your ability to control your actions and how they affect other people is wrong.

I did want to acknowledge that all of this can be tough on partners as well (like the poor guy above).  Although they may not be going through the actual symptoms themselves, they still feel the effects.  Guess this is a good warm-up.  Just wait till she’s in full-blown labor and is in extreme pain for hours on end!  Talk about feeling helpless seeing her going through that.

It makes such a huge difference to have a supportive partner through all of this.  I feel for all of the women out there who feel alone and/or unsupported as they are going through the difficulties of pregnancy.  And I feel grateful for my always supportive and patient (and silly) husband. ❤