“I’m Pregnant, Now What?” – with Dr. Stephanie Melka

Dr. Melka joins Dr. Fox on Healthful Woman to explain what women should do when they first find out they’re pregnant. She covers topics like when they should have their first appointment with an obstetrician, what types of appointments they will need to schedule when to start taking prenatal vitamins or adjusting their diets, and more.

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Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics of women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB/GYN and maternal fetal medicine specialists practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. All right, Melka, welcome back to the podcast. What’s going on?

Dr. Melka: Hi, happy to be here as always.

Dr. Fox: Always happy to see you. The idea behind this podcast was yours. You wanted to do this, and you said, “Hey, let’s do this, I’m pregnant now what podcast.” So what inspired you to this?

Dr. Melka: It’s sort of the same thing that inspired the “Advanced Maternal Age” podcast. This is something for years I’ve been getting questions on. From family, from friends, from not friends, from like people I went to like grammar school with that just send me a message like, “Hey, I just found out I’m pregnant, like what should I do?” and all sorts of variations of that.

Dr. Fox: So this podcast, like the others, just to make your life easier.

Dr. Melka: Exactly.

Dr. Fox: “Here, listen to this.”

Dr. Melka: This is how I’m gonna hack medicine. Anytime someone asks me a question, I’m just gonna send a podcast their way.

Dr. Fox: That’s gonna be like when you do those like you’re texting and doing online chat, with a supposed “human” where you type something and you get the automated response. Anytime someone texts Melka with a question related to medicine there’ll be an automated response of a podcast attached to it.

Dr. Melka: Sometimes a blog on our website, sometimes a podcast. So there will be crossover.

Dr. Fox: I think it’s an interesting idea, because, you know we had a podcast about what to do to prepare for pregnancy and obviously we’ve had podcasts about prenatal care and pregnancy. But there is, you know, that period of time between getting a positive pregnancy test, you know, usually at home, again, a urine pregnancy test, and showing up to the doctor. People are like, “What do I do, you know? Where do I go? What do I do?” Especially, obviously, if it’s a first pregnancy, and if people haven’t thought about it too much or haven’t prepared about that, which is fine.

And, yet that happens a lot. People usually call our office and they’re like, “I need to be seen tomorrow. You know, I have a positive pregnancy, I’m coming in, I’m coming in.” So, okay, so let’s talk about this. So why is it that we don’t see them tomorrow, right? Someone has a positive pregnancy test today, why are they’re not coming to our office tomorrow?

Dr. Melka: So when you get your positive pregnancy test, we could do a sonogram and see absolutely nothing. And then you’re looking at, are you sending blood tests, are you following them, are you just waiting? So it’s just logistically easier to say, “Come in around, you know, six, seven, eightish weeks. You know, take a look, we’ll see something at that time.”

Dr. Fox: Right. How do we date of pregnancy? When you say six, seven, eight weeks, so this is confusing to people, and I think it’s confusing intentionally to make us seem smarter than we are. But, explain, when we see someone at six weeks, what does that mean?

Dr. Melka: I’m gonna explain this and get it wrong because it’s so convoluted. So you’re saying six weeks from their last menstrual period, but you don’t conceive at the last period. You conceive two weeks after the period. So when we say, “When is your period, you’re X number of weeks,” it’s adding two weeks on to when you actually conceived.

Dr. Fox: Yeah. It is really weird. And, I think, the history behind this is, you know, this is before the time of pregnancy tests, ovulation cycles, anything like that. All we knew about timing was when did a woman get her last period? And, you know, typically women would get it about every month plus, minus. And so when someone would show up and they were pregnant, you know, and usually they wouldn’t know ’til, you know, three, four months later, because they didn’t get their period, and say, “All right, when was the first day of your last period?” and they would count from there. That’s how many weeks they were at that time.

But we know that you don’t ovulate until two weeks after that day so you can’t get pregnant really until two weeks, give or take, after that date. So when we say six weeks, we mean four weeks from conception. And it gets really confusing for people when they have IVF, right? So they have IVF, someone comes in and puts in an embryo and says, “You’re two weeks and five days today,” and they’re like, “What?” Like, he put this in two minutes ago.” But that’s basically how it works.

So we count from the last period. Sometimes I say we count from the life of the egg or whatever, it’s always confusing to people. But, again, when we say six, seven weeks, we mean from the period, which would be four, five weeks, again, from conception. And, usually there isn’t a positive pregnancy test until four weeks from the period or about two weeks from conception. So when someone calls with a positive pregnancy test, we assume they’re about what we call four to five weeks. So when we say, “Come at six to seven weeks or seven to eight weeks,” that’s just a few weeks later, yeah. And this does confuse people legitimately, why we haven’t switched to like something more scientific and normal. I don’t know. It’s just the convention.

Okay, so we don’t see people really early, because, again, there’s really nothing we’re gonna see. I mean, we can do blood work to get a, you know, an HCG and a blood test. But we’re not gonna see anything on an ultrasound. There are some people that, again, if they have a lot of like medical issues, there are things that we have to take care of or maybe adjust their medications or change like if they know that there’s a lot of stuff that has to be done and it wasn’t sorted out before pregnancy, maybe we would either see them earlier, talk to them on the phone, or do like a virtual, you know, consult or something like that. We wouldn’t typically see them in the office for, let’s say two, three, or four weeks give or take from the time that they get this positive pregnancy test. Okay, so they have this period with no counseling, know nothing. So this is what we’re addressing.

Dr. Melka: This is where I come in.

Dr. Fox: This is when Melka comes in and her text comes in. So what should people know at that time?

Dr. Melka: No one really likes my answer. Because it’s usually there’s not much to do differently. I’ll be like, “You’re young and healthy, correct?” Like, I don’t know all my friends’ medical problems, so I’ll just be like, “Are you on any medications? Have you had any like big surgeries? Have you had like an ectopic pregnancy before, where I think you’re somebody that should go in early?” And I’m like, “Nope, just live your life.” I mean, the big thing is exposures like if you’ve been drinking alcohol, stop, certain dietary changes, and then that’s sort of it. And then the big one for me as you know is exercise. It’s all like the people I know like running, yoga, swimming, biking for the most part, continue.

Dr. Fox: Excellent. So when should someone, they get positive pregnancy test, let’s assume it’s four weeks from their period, give or take, who should they call, right? Who do you call in order to make an appointment? Do you call your gynecologist? Do you call an obstetrician you don’t know, do you call a high-risk specialist, a midwife, what do you do?

Dr. Melka: All of the above. I mean, if you have a gynecologist, that’s usually the best place to start. GYN-only doctors won’t deliver so you’ll end up needing to see an OB. So some women might choose to just go right to an OB practice. Others will wanna see someone that they know already. That’s a little bit easier. They feel a little more familiar with them.

Dr. Fox: Right. So let’s talk a little bit more about that, how would someone know if their doctor, right, the person they see every year for their Pap smears or to get their birth control or apparently in this case to come off their birth control, how would they know if that person does or does not take care of women during pregnancy?

Dr. Melka: Usually just asking them. It’s either on their website or just calling the office directly.

Dr. Fox: Yeah. Because when we trained in obstetrics and gynecology, we learn both obstetrics, which is care during pregnancy, gynecology, which is basically women’s health care, and surgery related to gynecology. And the majority of people who finish that training, do both gynecology and pregnancy or obstetrics, but there are some that do just one or the other. So, for example, I really don’t do gynecology, I just do obstetrics. And we have people in our practice who just do gynecology. And they will typically be very, you know, forthcoming with this, say, “Hey, like when you get pregnant, they can see you, you know, verify it’s a pregnancy, you know, do an ultrasound, send blood work, you know, give your prenatal, whatever needs to be done. And then they will refer you to someone who does obstetrics.

And this is something you can either ask at any gynecology visit or like you said, call the office and say, “Hey, does Dr. So-and-so see patients during pregnancy?” And they’ll either say, “Oh, yes she does. She does. They deliver here. This…” or, you know, “They’ll see you for the first visit and then refer you to a colleague of theirs.” But that’s sometimes important to know, because some people are surprised to learn that the doctor they’ve been seeing all this times, suddenly says, “Oh, by the way, I don’t deliver babies. I don’t take care of people who are pregnant past the first trimester.” So that’s something you, if that’s gonna shock you, you may wanna find out on the front end that’s something your doctor does.

So if your doctor just does gynecology, you can either call them, and they typically will see you for the first pregnancy visit, again, to verify everything, make sure everything’s healthy and send you along to somebody else. Or, if you know where you plan to go for pregnancy, you can see that person. And how does someone decide if they’re gonna see an obstetrician or midwife? I’m curious how you think about this?

Dr. Melka: Midwifery typically is lower risk healthier patients, as well as uncomplicated deliveries. Clearly, you’re newly pregnant, you don’t know what your delivery is going to be like, but if you’re somebody that’s really thinking like you want a birthing center, you want like no epidural, you may gravitate more towards midwifery care.

Dr. Fox: Yeah. And I think a lot of people aren’t gonna be able to sort that out until they’re pregnant, and sometimes figure out what their risk factors are. Not everyone knows what the risk factors are, but someone would say, “I don’t know that. But, the fact that I, you know, had a heart transplant as a child makes me nervous.” Who knew, right? But, I mean, there are things that surprise people.

And so one option is you’re allowed to “shop around,” you can see a midwife for your first visit, you know, obstetrician the next day sort of see which vibe you like better. And, you know, all those things and try to sort it out and ask them. And people usually are pretty hopefully open and honest about who they take care of and who they don’t take care of, and what are their strengths or what are their weaknesses for themselves and for their practice.

Dr. Melka: Yeah. I see people early on who are asking, you know, “Can I deliver at home? Can I deliver in a bath tub? Can I deliver in a birthing center?” And, like that’s usually the segue of like we’re an obstetric practice, we deliver in a hospital. Like, yes we can do low intervention, but not to that extent.

Dr. Fox: Right. “And you can do those things, but we can’t take care of you. We don’t have bath tubs.” No, but that’s an important thing, and then sort of like next level, who need to see a high-risk practice? And, I think, generally people would, you know, if they know that, they may have already met with this person, or spoken to their doctor, “Hey, when you’re pregnant I’m gonna send you to this high-risk practice.” But, again, if you’re not sure, that’s a question you could ask, you know, either the midwife or the obstetrician, or make an appointment with a high-risk doctor who takes care of women during pregnancy.

You know, sort of fortunately when you just get pregnant, there is a lot of time to sort that out in the first trimester to figure out who’s gonna ultimately take care of you during pregnancy. But, usually, I advise people to call sort of shortly after they know they’re pregnant. But, again, the appointment’s not gonna be until two, three, four weeks from that point mostly just to get something, you know, on the calendar if it’s a time or date you want, if you want someone to come with you, you know, whether it’s your partner, whether it’s a friend, whether it’s a family member, or whether, you know, again, for work, and all these things just to make sure that you can try to get the appointment you want.

Dr. Melka: Yeah. And that’s also hard because there’s very limited information we can give over the phone. So, like, you know, one thing that we’ve talked about is like a VBAC. You know, I know patients who call our office and say, “I want a VBAC. Can I have a VBAC with you guys?” And like you can’t have that conversation over the phone. So, yeah, that first visit just to be seen in-person, have those questions answered really helps.

Dr. Fox: Yeah. And it’ll help sort of gauge on both ends. We’ll be able to ask her sort of about her last delivery, about her health history, and sort of get a sense for her whether we think it’s, like in your VBAC example, whether it’s safe to do it or not safe to do it, whether we think it’s absolutely not gonna be an option versus, yeah, it is an option. And, on the flip side, the patient herself can say, “Okay, are these people who seem to be in favor of it, are these people who do it, do these people know what they’re, do they have a reputation, all these things and get a sense of their attitude for it?”

And the same thing, again, if it doesn’t seem right then make another appointment with somebody else, and then you can always decide who you’re gonna follow with. And, I think, that that’s a really important thing. You can change doctors. Obviously, when you get late in pregnancy it becomes more difficult logistically, but certainly, early in pregnancy, very, very easy to see a couple of people or a couple types of practices, and then make a decision whom I’m gonna follow with. I think, it’s a courtesy to tell all the people you saw, what your plan is afterwards.

Like, if someone saw me for new pregnancy visit and then they never show up again, I might assume that they went somewhere else, but I also might be worried like what happened to this person? Is she okay? You know, did she have an ectopic pregnancy and stuff? So, it’s nice to call say, “Hey, I ultimately went with another practice.” No one takes that personally. We just say, “Okay,” and we close out your pregnancy, and if you need any of the blood work we sent, sent over, we’ll send it. So that’s a nice courtesy.

And then what about for people picking like a group practice versus a solo practice? Is it the same thing where they should just, you know, meet with that person or that group and figure it out or are there things that they might know on the frontend to help guide them?

Dr. Melka: I think on the early on some people might feel very strongly of, “I want to know exactly who is going to deliver me,” and end up either in a solo practice or maybe in like a group of two or three. Do you care if it’s only females, if there’s male doctors? And I think, it kind of all comes into play together. You know, my understanding the big downside of a solo practice is if you could have a scheduled appointment and then if the doctor is doing a delivery, your appointment can get moved at the last minute or canceled, and that’s a barrier to some people.

Dr. Fox: Right. Yeah, I think it’s probably a totally separate podcast on the, you know, advantages and disadvantages of a group versus a solo practice. And there is advantages and disadvantages to both, but it’s something to think about. Like you said when you’re signing up for practice, “It doesn’t matter to me if they’re all women or not.” And if it matters, you may just wanna find practices that are all women, and nowadays it’s all on the website. It’s very easy to figure this out. Yeah, geographically insurance…

Dr. Melka: It’s still not though. I mean, every couple of weeks I’ll get somebody that’ll come in and will say like, “I only want female doctors.” And I’ll be like, “I’m sorry like we can’t do that.” Of our, what, 9 or 10 delivering doctors like half are men. You know, we can do what we can to an extent, but things happen at all times of day or night. If that’s a deal breaker, like you said, “We don’t get offended,” you know, like people end up going elsewhere.

Dr. Fox: Yeah. No, definitely those things are important to people in various, and everyone’s got their own thing that’s important to them. For, some people, it’s geography. “I wanna be within X miles in the hospital.” For other people it’s, “I wanna be 1000% certain that everything’s on my insurance. Other people don’t care. I mean, there are really a lot of variables that go into it. Okay.

Dr. Melka: Some people choose based on what hospital they wanna deliver at. Whether it’s a positive or a negative, you know, someone may deliver at a certain hospital, and then they tell their friends like it was an awful experience like the rooms were ugly or this or that, and don’t go there. And then other people will rave about the hospital, and then people will choose based on that.

Dr. Fox: Right. Okay, so someone is pregnant, they’re making their appointments. You’re not gonna get a lot of information from the people who pick up the phone to schedule your appointment. Maybe, the practice has a website that will give you some information about, you know, things to do, things not to do. But, just general advice, so prenatal vitamins so someone’s pregnant and they’re not already on one, and they’re like, “Oh, my God, did I hurt the baby? Is it, you know, is there a problem?” What would you tell them?

Dr. Melka: Very, very rare that there’s a problem. But worth starting on one when you know. Mainly, the folic acid component.

Dr. Fox: Yeah. And that’s an important point. Because, you know, really the only part of the prenatal that’s potentially important early, early in pregnancy is the folic acid. So a lot of people when they get pregnant, they’re nauseous on pretty quickly. And prenatals tend to be pretty big and they have a hard time swallowing them. So if you either pick up a prenatal or a multivitamin or whatever, and it’s not working for you, just take folic acid. Those tend to be very, very small pills, usually easy to tolerate. The recommended dose is 400 micrograms, which is also 0.4 milligrams, in case, it’s written like that.

A lot of times people take double that to 800 or 0.8. Typical prenatal has either that or sometimes close to 1 milligram or 1000. But that’s one of the things that probably should be taken. All the other parts of the vitamin, yeah, it’s fine if you’re on it, and it’s nice. But it could wait if needed. It’s not a big deal if you’re on it or not on it. And, again, most people who aren’t on folic acid, their babies will be fine. But it does lower the risk of certain birth defects so it’s good to be on it either before you get pregnant or right after you get pregnant.

Dr. Melka: There are some foods fortified with folic acid or Folate nowadays. So a lot of people do get it somewhat in their diet, but, yeah, ideally started a few months before you try to get pregnant or once you find out.

Dr. Fox: Right. And this also a lot of people call up and say, “I need you to prescribe me.”

Dr. Melka: I don’t like prescription prenatal vitamins. I think they’re expensive. I mean, they’re really expensive. They could be like a dollar a day for something that you could get like, you know, four times cheaper store brand. There’s a lot out there of like, you know, clean pharmaceuticals and like the CVS brand has too many additives. And this other one doesn’t, but they all give you the basic stuff that you need.

Dr. Fox: Yeah. I mean, I think it really…a lot of it needs to be personalized. I mean, ultimately, for the vast majority people, any prenatal that has folic acid in it is gonna be fine. I mean some are…

Dr. Melka: There are some that are smaller. There’s some that are chewable. There are some that have DHA or don’t have DHA, and then in the DHA family, there are some that’s plant-based, which is a little more expensive than the fish-based. Fish-based ones taste like fish. People are like, “I get fish burps after I eat it.” Like, yeah, if you’re taking a prenatal and it’s making you like puke your brains out 20 minutes afterwards, switch, find another one. If you can’t swallow pills, take a chewable one or take like one of the smaller ones.

Dr. Fox: Yeah. I mean, there’s a lot of prenatals that are marketed, and some of them have their own, I don’t want to say, gimmick, but there are gimmicks in a bad way. But I don’t mean this in a bad way. For example, there’s one that’s, you know, designed to also include more things that’ll help with nausea in pregnancy. And, you know, okay like maybe that’s gonna help more than a different vitamin. There’s other ways to do it obviously and some of them, again, their gimmick is that they’re chewable, which is nice. And some of them, you know, have more of this and less of this and, you know, the size, all those things.

But, ultimately, you know, particularly if in your own insurance plan, it’s gonna be expensive. It’s rarely needed that your prescription is…you need a prenatal’s prescription, very, very unusual. We would say, “Oh, no you need to be on the prescription brand, prescription strength.” For some people their health plans are such that the prescription prenatals are like dirt cheap and great. You know, but God bless that’s fine on our end. But usually that’s not the case, and it’s very rare that it matters in our end.

People are usually shocked when they say, “Which prenatal should I take?” And we’re like, “I don’t care.” You know, it really just depends on the situation. There are some things about, again, tailoring, you know, what you need per trimester this. But, for the most people who eat a well balanced diet, as long as you get the folic acid, you should be okay. Calcium is another thing, but hard to get that in prenatals. Some people need supplements and we give it to them. But, from the point of the positive pregnancy test, until the first visit, folic acid is typically all you should be getting. Okay, so you mentioned alcohol.

Dr. Melka: Yes.

Dr. Fox: This is a big one. I got pregnant, I did know I was pregnant for a week. I’ve been drinking, I’ve been partying, I’ve been going out, by the way, not I. Because, I do not do these things, and I’m like the biggest like loser you ever met in your life. But, maybe, someone has more of a social life than this podcast host does. Should they be worried?

Dr. Melka: I think, it’s a normal reaction to be worried, but medically no.

Dr. Fox: Right. And why is that?

Dr. Melka: So, early on, if there is any kind of exposure, it’s thought to be what’s called all or nothing. Meaning, if there’s harm done, the pregnancy will not implant or will miscarry and miscarry very early. But it’s really unlikely to get significant birth defects from social alcohol consumption or even more than just casual social consumption, early on until you get that positive test.

Dr. Fox: Yeah. I think, there is really two important points you said. The first is that typically the volume that people consume is not gonna be dangerous at any point pregnancy, meaning, a lot of people call and say, “Oh, my God I had a drink last week or I went out to dinner and had two drinks at dinner.” That type of volume, sure we discourage alcohol during pregnancy, but the volumes we’re talking about really probably never cause problems at any point in pregnancy. But even someone says, “Oh, man like I was at that the bachelorette party the other night. We got trashed and then suddenly I’m, you know, pregnant. Is there a problem?” If you think about it when there are something that could cause a problem in a developing, you know, baby fetus, embryo, it’s only gonna affect that organ when it’s developing. So, for alcohol, we worry more about the brain, right?

From the point you get pregnant, going backwards, there is no fetal brain, it’s a sperm and an egg. That’s it. And they come together as just a clump of cells. Even for several weeks, there’s no brain developing. So it can’t affect the brain. Alcohol doesn’t last in your system, right, once you’re, you know, when you’re hungover it’s out of your system essentially. So unless someone really didn’t know they were pregnant and they’re like, 10 weeks pregnant, 11 weeks pregnant, somewhere in that point and they had a ton of alcohol, right, that puts them at risk.

Now, it doesn’t mean it’ll happen, most of those people it still won’t happen. But those are the people who there is a concern. But if you’re like seven, six, five weeks in that range, really there’s no concern. If there was something so crazy when your system like you said, you’re probably gonna either not get pregnant at all, or you’re gonna miscarry early, but it should not have an effect. And that’s true with most things that people are concerned about. So, again, rarely, rarely, rarely is there an issue with any drinking that was done before the pregnancy, that’s pretty much zero. And, even afterwards, if it’s in a short time afterwards, it should not be an issue.

Okay, so food. So now that someone is pregnant, are there any foods they need to avoid between now and their first visit?

Dr. Melka: Probably not. You know the things that are, you know, concerning, are the things where you could physically get ill from eating. So like raw and undercooked things, like a raw egg could have salmonella. Things where you could get exposed to Listeria so that’s like deli meat, unpasteurized dairy, and then mercury consumption, which is large fish.

Dr. Fox: Predators.

Dr. Melka: Yes. Shark, swordfish, mackerel that type of stuff. And even then those exposures early in pregnancy like, again, the mercury is brain development and the thought is like if you’re eating a lot of it that might not leave your system right away.

Dr. Fox: Yeah. Mercury sticks around a long time. So, I guess, if someone is truly on a high mercury diet, right, that’s probably the time, you know, to cut back when you know you’re pregnant, just because this lasts in your system a while. You’re gonna want to give your body time to sort of get rid of it as best as possible. So if you’re a big shark eater, you know, maybe, when get pregnant, you should back off. The truth is that something you probably should back off before you get pregnant if you can, because it really last your system for a long time. But most people, even if they’re having that are not mercury toxic or anything like that.

Tuna is the one a lot of people ask about. There’s not a lot of mercury in Tuna. So if you’re eating it in the range of once a week, you know, maybe twice a week, it’s probably fine either way. And I’d let, you know, people do it the whole pregnancy so I certainly wouldn’t tell them to stop. You mentioned exercise, again, people are very worried that at the point they get pregnant until they see the doctor, if they exercise they’re gonna miscarry. True or false?

Dr. Melka: False.

Dr. Fox: False, capital F. False.

Dr. Melka: Capital F-A-L-S-E, false.

Dr. Fox: Yeah. It will not cause a miscarriage.

Dr. Melka: Look, there are pregnancies that are going to miscarry anyway, no matter what someone does, but exercise will not. There’s nothing physical like people will say like, “Can I run, but isn’t running gonna shake the baby out?” No, it’s not.

Dr. Fox: Right. Yes.

Dr. Melka: No.

Dr. Fox: It’s important for people to know that from the point of a positive pregnancy test, there’s a very high chance of miscarriage. It’s kind of, you know, a bummer and it’s kind of a downer to talk about this. But that’s just how nature is. And when people quote like the percentage of miscarriages and, you know, you look it up in this, you have to keep in mind, it depends what is your starting point, right? So the likelihood of miscarrying once there’s an ultrasound of the heart beat is typically some number under 10%, right? And based on how old you are and miscarriages you’ve had, okay, you can modify that.

But, before that point, it’s much higher, right? So someone gets a positive pregnancy test, it could be as high as 40%, 50% chance of, you know, getting your period a week later. We call that like a chemical pregnancy, meaning the only evidence “you’re pregnant” is either a blood test or a urine test, never saw any ultrasound. And so this isn’t meant to, like, depress people, but it’s, A, people should know that so just the expectations are realistic, and also, B, that even though it’s very sad to lose a pregnancy very early, people shouldn’t think it’s uncommon or that that means or something wrong with you, almost never is that the case.

But also just to understand why there’s so much out there. Like, someone can say, “Oh, I had a positive pregnancy test, then I went for a run. And three days later I got my period, it caused it.” And, yes, it seems that way temporarily, but if you look at the people who didn’t run the same percentage of people have bleeding three days later and lost the pregnancy so to speak. And when we look at these things in bigger studies that’s why we have such a high level of confidence that those things do not cause the miscarriage, right? Your chance is 40% miscarriage, 40% whether you run or whether you lie down in an oxygen tent, doesn’t make a difference.

Dr. Melka: And I’ve seen it with everything, you know, getting a massage, getting a pedicure, getting on an airplane, swimming, carrying their toddler, everything. There is someone that says, “I did that, and then a few days later miscarried.”

Dr. Fox: Right. It’s hard to make your brain not see that connection because it seems so obvious, but, again, when you look at groups of people, it’s no more likely in the people who do all those things versus those who don’t. The reason people miscarry from early pregnancy is almost always from day one the embryo was genetically abnormal, and there’s no control over that. Obviously, it’s already been determined the second the sperm and the egg meet. And so, clearly, what you can do is that could affect the genetics one way or other.

Dr. Melka: The big thing with exercise that I will just add is, you know, the same thing I tell people in pregnancy. Like, this is not the time to be pushing yourself like crazy. I was super early pregnant, and I knew it, because I went out for a run. And I was like, “I feel miserable.” And just I couldn’t do it. And I’ll tell people like yes you can keep doing what you’re doing, but don’t go crazy like feeling you have to be hitting the same level.

Dr. Fox: Right. It’s very difficult to do. Pregnancy…

Dr. Melka: For some people. Other people are totally fine.

Dr. Fox: Yeah. But just like symptoms, some people are like puking all day and some people don’t throw up at all. And the same thing with being, you know, fatigued or exercise intolerance, all these things it’s different people experience pregnancy differently. We don’t really understand why that is so much. It could even be the same person, different pregnancies. Some people have like, “Yeah, this pregnancy I was nauseous. This pregnancy I wasn’t.” And we really don’t understand that so well, but it’s definitely the case. So getting back, sex is the same thing. It may cause some spotting. The cervix gets little friable, gets a little more sensitive. But it certainly will not cause a miscarriage, and doesn’t work like that.

Dr. Melka: Some people notice cramping as well.

Dr. Fox: Yeah.

Dr. Melka: But, again, not gonna cause a miscarriage.

Dr. Fox: Right. How about, okay, now I’m pregnant so I have to sleep on my left side, right?

Dr. Melka: Never.

Dr. Fox: Right. So why is that?

Dr. Melka: You have a blood vessel called the vena cava that brings blood from your legs up to your heart. Later, in pregnancy, as the uterus gets bigger, if you lie completely flat, the uterus will compress it a little bit. You don’t suffocate yourself, you don’t suffocate the baby. But because that blood vessel is a little bit to the right of the spine, people say you should sleep leading towards your left or on your left side to move the uterus off of it. So, early on that is absolutely not a factor. Any sleeping position is fine.

Dr. Fox: Yeah. Even late in pregnancy, I’m fine with any sleeping position. All that stuff was from like data for women in labor, like while they’re laboring will sometimes notice if they’re flat on their back, you can tell that their blood pressures is a different, the baby’s heart rate’s a little different and we move them to left or right side, doesn’t matter what side and it improves, but there’s a lot of evidence it makes no difference. And, particularly, early in pregnancy, sleep any way you want to. God bless.

Dr. Melka: I’ll even sleep. Yeah, you can sleep flat on your stomach, you’re not going to crush the baby, and sleep on your back either side. Even closer to term, a lot of women wake up flat on their back and they’re like, “Oh, my God what did I do?” You did not do anything. It’s not an ideal position. I do tell people, maybe, like 20 weeks like if you really are like a back or stomach sleeper, like start changing sleep positions a little early, but, yeah, really early on nothing different. And then what about medications people are on, how do they know if they’re safe to continue in pregnancy? Let’s start with pills. We’ll get to creams and lotions and stuff after.

Dr. Melka: Probably have to ask whatever doctor prescribed them. Generally, it’s not a good idea to stop pills without talking to your doctor. And it could be something simple like a thyroid pill, like any endocrinologist should be able to say like yes you can continue this.

Dr. Fox: Right.

Dr. Melka: We have women that are diabetic, that have high blood pressure, that are on pills that are not ideal to take during pregnancy. And, again, their physicians can tell them like, “Okay, stop this, but start something else.”

Dr. Fox: Yeah. And there’s leeway with this, meaning, the pills that are like red warning, black label, skull and crossbones danger, everyone who’s prescribing them will say to a woman, “Are you pregnant, like to be pregnant, can you get pregnant, don’t get pregnant.” Like, the all over, they’re like, “Please have six forms of birth control and sign this form.” And you’ll know like this is this dangerous. Yeah.

Dr. Fox: Like, you take Accutane, you need a contract with your dermatologist that you’re on two forms of birth control.

Dr. Fox: Yeah, it’s like stranger danger. I mean, they’re all over it. So, yeah…

Dr. Melka: I had someone once that like couldn’t use two forms, like she couldn’t take hormone like estrogen. She couldn’t have an IUD, this, that. I had to like write a letter saying like, “I have counseled this woman on contraception, right?

Dr. Fox: Right. And those medications, so if you’re on one of those, you’ll typically know about it. The other ones are usually ones that are probably okay, but even if it was something we’d prefer you switch, again, from the time you get pregnant, you got weeks typically ’til you would have to switch. Again, if you’re on a blood pressure medicine, we prefer you be another one, you got a couple weeks, all these things. So it’s not something that someone if you need a pill for your own well being, medical, mental health, whatever is it, don’t stop them. Like, call whoever prescribe them or call your OB/GYN like try to get that sorted out. You do have some time. But stopping them, I would say, more often than not is gonna cause more harm than good. And so it’s probably not a great idea to do that.

And if you’re someone who’s really concerned about these things, obviously those are great questions to ask before you get pregnant. Like, “Hey, when I get pregnant, do I need to stop this or switch or something?” But we’re talking about for the people have not made those plans. Okay, we love it too. It’s all good. And what about things like we get a lot about skin products, right? Whether it’s prescribed or over-the-counter or whatever it is to people need to stop those?

Dr. Melka: For the most part no. The big one that people will stop are the retinoids. You know, Tretinoin is the big one that’s prescribed, because of that thought of it being absorbed into the skin and converted into X, Y, or Z.

Dr. Fox: Right. If you ate it, it’d be a problem.

Dr. Melka: Correct. But you’re not going to get those levels in absorption. But people still to play it safe, will say, “Don’t use it during pregnancy.”

Dr. Fox: Right. But the rest are fine basically, yeah, makeup over-the-counter stuff, yeah. It’s all good.

Dr. Melka: Even, yeah, even like benzoyl peroxide, whether it’s the cream or a wash, like I tell people yes, you could stay on them. Which sometimes is upsetting to women, because they’re like, “My dermatologist said I should stop it.” And I’ll like explain, you know…

Dr. Fox: Take it up with your dermatologist. I’d say, “Have them call me.” And some dermatologists are like, “Oh, it’s okay with you. I’ll go, “Yeah, it’s fine.” “Okay, great.” And some of the like, “You know what, I hear you, but I’m not comfortable with it,” Fine. Like what you’re gonna do? Doctors disagree sometimes. This is the world we have to navigate, we can’t all agree.

Dr. Melka: This is another area you look online. If you look up like skin lotions or creams in pregnancy, like huge rabbit hole of like clean beauty and preservatives and all that stuff.

Dr. Fox: My beauty is clean beauty. This is all natural. I’ve got no makeup on, Melka.

Dr. Melka: I have no idea.

Dr. Fox: This face you see is just, you know, the face I was given. And then what about like cleaning products? You know, “Oh, my God, they were painting my house when I got pregnant. I walked by a construction site, all these things.”

Dr. Melka: All fine. You know, you’re getting so little exposure, a lot of the chemicals that smell, you’re not inhaling high quantities of the concerning chemicals.

Dr. Fox: Right, you’d probably pass out.

Dr. Melka: Correct.

Dr. Fox: Yeah, yeah. I say if it’s enough to harm the baby from that type of exposure, it would harm you first. You would be very very ill.

Dr. Melka: Absolutely.

Dr. Fox: People get like carbon monoxide, like, “Do I have an issue?” If you’re like okay and breathing, it’s not gonna do anything. You’re gonna be okay. The one thing people ask about which I think there is some evidence to support is stopping to use like hot tubs in the first trimester when they get pregnant. It’s not great data, meaning, it could be total bogus, but there’s some data that women who use hot tubs use or go in hot tubs, there’s a slightly higher risk of miscarriage. And so a lot of people tell women to avoid it like from their pregnancy tests or first trimester. Again, we’re not certain it’s the case, but they’re probably avoidable for most people. And so why not…

Dr. Melka: I’ve heard it’s the increased maternal body temperature and increased neural tube defects, so avoiding the hot tub because of that. And that is not a bath tub. A lot of people ask this and I’m like sitting submerged in a Jacuzzi is not affecting your body the same as sitting in your bath tub even with really hot water. You’re not getting that same level.

Dr. Fox: Right. And also the bath tub you’re in is not heated, meaning it cools off. So when you get in, your body temperature and the water temperature start to equilibrate. So yours won’t go up, whereas a Jacuzzi, it’s continuously heated. So it’s like boiling so to speak.

Dr. Melka: Yeah. I do tell people, you know, probably worth it to avoid hot yoga, because you are in a hot room for a long period of time. And, with exercise, it’s just so unpredictable how your body’s going to respond, especially, if you’re doing a lot of inversions. But, again, like I have, you know, patients that are experienced yogis, that are like, “I can hydrate. I know my body, I’ve done this before.”

Dr. Fox: When should people expect to start having symptoms of pregnancy?

Dr. Melka: Yes, at any time. Usually not at the first pregnancy test, which I think is why a lot of women are surprised when they get a positive test. Because they’re like, “I feel fine.” And sometimes it’s not until six, seven weeks that they start really feeling fatigued or nauseous.

Dr. Fox: Nausea is definitely a sign of pregnancy, but it tends to come actually a little bit after things like feeling tired or what we call fatigue. Breast tenderness is usually a very early sign because that’s just like from the progesterone. Sometimes it’s people feeling like they’re peeing a lot more than they were. Those are lot of early signs of pregnancy. And, again, some people of none of these symptoms, some people have a lot of these symptoms. It’s not that will correlated with how “good” the pregnancy is. I mean, sort of as soon as lot of symptoms we say all, you know, it’s positive, because it’s a good pregnancy. It’s just mostly to make people feel better. You know, but it’s not always correlated that well. People ask me all the time, “When should I tell that I am pregnant? When should I tell people?” You get that question a lot?

Dr. Melka: Yes.

Dr. Fox: Yeah, like all the time.

Dr. Melka: Which is interesting, because, again, these are like people that like I know socially. And I’m finding out before like their parents sometimes or like they’re, you know, closer friends. You know, I usually start with, you know, “How far along are you in the pregnancy and like what’s the miscarriage risk? And are you okay with these people knowing that you had a miscarriage?” What I usually say to people is like positive test to first visit, you’re probably only telling a few like really close family and friends.

And then, maybe by 12 weeks, you’ve done genetic testing. You know, things are growing while you’re starting to tell like closer family and friends. And then 16, 20-week anatomy scans are the Facebook pictures are like the Instagram announcement when like, “Hey, now the world knows.”

Dr. Fox: Yeah. It’s like this whole like ritual that people go through. Like you said, it’s really just how some people are very comfortable with everyone knowing what’s going on in their life. Great. Tell everyone immediately. Like if you would prefer everybody know that you got pregnant, had a miscarriage, you know, again if you miscarried, had a miscarriage so that they understand why you’re going through a tough time, why you may be in a bad mood, or why you didn’t show up for this, or why you’re not drinking at at your friend’s party, or whatever it is. If your life is like an open book with your friends and family, tell them immediately, like whatever, it’s your business. Like, there’s nothing on our end, we don’t care if you tell people.

And if you’re more the type person that says, “I’d rather people not know my business. I’d rather if I had a miscarriage I just wanna keep real tight in my family, and that’s it.,” then, yeah, you’re not gonna tell people until you’re highly confident that’s not gonna happen sometime after 12 weeks. And, again, from our end we’re fine with anything. You know, God bless, you know, whatever makes people, you know, go through this world more comfortably, that’s fine with us. But I do get asked all the time, “When should I tell?” It’s like when do you want to tell? You told me, yeah, I’m happy to know.

Dr. Melka: One of our next episodes can be like, “How do I fake drink at my blank?”

Dr. Fox: Fetus of the dog.

Dr. Melka: I did that at my cousin’s wedding.

Dr. Fox: Fake drink?

Dr. Melka: Yes. People do so many different things. You can have the same glass as what your partner’s drinking, and you just carry it around. You can just get soda water with a splash of cranberry juice and a lime in it, and make it look like alcohol. There’s a whole thing on this. Because if a reproductive-aged women who usually drinks is not drinking, everyone will assume they’re pregnant.

Dr. Fox: Right.

Dr. Melka: Yes.

Dr. Fox: There are so many…

Dr. Melka: There is many listeners out there right now that are nodding their heads.

Dr. Fox: Yeah. There are so many reasons why that doesn’t apply to me. I’m not reproductive-aged, I’m not a woman, I don’t drink. All right, all the above. Okay, so overall take away from the point of the positive pregnancy test, there’s not a ton to do. There’s not a ton not to do, you know, maybe pick up a folic acid if you’re not on it already, or prenatal whatever, you know, something that has folic acid. Don’t do anything crazy dangerous. Figure out, you know, what appointment you’re gonna make and with whom. And, again, not to be a downer, but it might happen that you’ll miscarry, and it does not mean it’s because if you did, in fact, it’s not because of anything you did.

And then, again, for some people they find that comforting to know that it’s out of their hands. For other people they find it horrifying that it’s out of their hands, but that’s just sort of the reality of it. But, again, for the vast majority of people who call, we’re going to see them a few weeks later, everything’s gonna be fine. And then we’re going to be rolling.

Dr. Melka: Yeah.

Dr. Fox: Amazing, “I’m pregnant, now what?”

Dr. Melka: Listen to this podcast. Now, what?

Dr. Fox: Thanks for coming on, Melka.

Dr. Melka: Thanks for having me.

Dr. Fox: Thank you for listening to the “Healthful Woman Podcast.” To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healtfulwoman.com. Have a great day.

The information discussed in “Healthful Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.