“Myth Busters, OBGYN Style!” – with Dr. Stephanie Melka

Dr. Stephanie Melka joins us today to debunk some common GYN myths! Dr. Melka’s clinical interests include high-risk pregnancies, office gynecologic procedures, and laparoscopic gynecologic surgeries.

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Dr. Fox: Welcome today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB-GYN, and maternal fetal medicine specialist 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. How goes it?

Dr. Melka: Hi. It’s great. How are you?

Dr. Fox: I’m wonderful. We had a great session this morning with the residents.

Dr. Melka: We did. We did a forceps teaching and simulation session.

Dr. Fox: Teaching and simulation. Explain to our listeners, what is simulation?

Dr. Melka: Basically practicing something on a mannequin.

Dr. Fox: Yeah. So, we had our little birth mannequins, and we practiced placing forceps and doing it. It was great. It was very well received. Good job, Melka. You are an expert teacher.

Dr. Melka: I hope so. It’s been my goal in life.

Dr. Fox: It was very good. And what does it say in your T-shirt today, Dr. Melka?

Dr. Melka: “Forceps is my second favorite F word.”

Dr. Fox: Beautiful. Well, we decided after that great teaching session, we’re gonna come over and podcast a little. And we thought that a nice topic would be Mythbusters. So, there is a TV show, “MythBusters,” where they would bust certain myths, and we’re gonna do that OB-GYN style. So, we’re gonna go through some common, what we believe are myths that are commonly held and believed by people. And we are spending much time in our day-to-day lives dispelling these myths. And so, we’re gonna do it in a podcast so people can hear all about them. All right. So, we’re gonna take the MythBuster Wheel of Fortune, and I’m gonna randomly pick one. The first one is, myth number one, I have HPV, I am therefore going to get cancer, or I have cancer.

Dr. Melka: No.

Dr. Fox: Fake news. So, what’s going on there? What’s the myth? What are you hearing from people?

Dr. Melka: So, HPV is human papilloma virus, which is linked to almost all cases of cervical cancer nowadays.However, many, many women, many people who have HPV will never get cervical cancer in their life. The majority of HPV, the body clears it. You wait a few years, you never know you had it. In cases where it does progress, there are procedures, basically, to cure it or to remove abnormal cells.

Dr. Fox: Right. And I think also, there’s many types of HPV.

Dr. Melka: Yes.

Dr. Fox: And so, someone can be diagnosed with HPV, and it’s not a high-risk type for cancer, but maybe one that can cause just common warts, for example, which is a problem, but it’s not cancer, obviously. But even so, in those people, for sure, they’re not at risk for cancer, they’re just at risk for warts potentially. But even those who get the high-risk HPV types, the reason we screen for it, it’s not to say, “Okay, you now have cancer,” it’s to say, “Hey, you have this high-risk HPV, we have to either keep a closer eye on you or do another procedure or check this.” And so, it usually, almost always, rarely, however you wanna put it, it basically almost never is going to reach the point of cancer because you’re getting followed and treated and further screened appropriately.

And the point of HPV is to find that way before cancer would ever come.

Dr. Melka: Yes.

Dr. Fox: Got it. And then when you tell people about, you know, your pap smear results, what do they say?

Dr. Melka: So, I get this as a gynecologist a lot when I do a pap smear and I have to call someone. I mean there’s nuances and, what is the result? What type of HPV is it? But if it’s something concerning, the next step we recommend is a procedure called a colposcopy. Basically, kind of like a pap smear, looking at the cervix with a speculum, but then using a microscope to take a closer look at it, doing biopsies of abnormal areas. So, I’ll call patients, I’ll give them the results, and I’ll tell them that. I try to keep this relaxing, like, “We can schedule it in a month. I’ll work you into my schedule. What days are you available? Let me look at what days I’m available. I’ll find a time.” Most of the time, people are like, “Oh, okay. You know, I’ll three weeks, I’m free, I’ll come in then.”

And then every once in a while, someone will be like, “I have cancer.” It’s like, no, you don’t have cancer. And they’re like, “I need to do this procedure today.” That’s like, no, we don’t have to do it today. We can wait. And obviously, we do everything we can to accommodate people timely. And I have done some of these same day or next day, depending on schedules. But yeah, every once in a while, the response is, “I have cancer. I’m going to die of cancer.”

Dr. Fox: Right. So, not true?

Dr. Melka: That’s correct.

Dr. Fox: Very good. Correct that it’s not true?

Dr. Melka: Sorry, double negative.

Dr. Fox: Got it. All right. Excellent. So, that was myth number one. All right. Number two, going through my Wheel of Fortune again, randomly picking one. When you are pregnant, you must be sleeping on your left side every night.

Dr. Melka: No.

Dr. Fox: Not true. Okay. So, let’s talk about that. Why is that even a thing?

Dr. Melka: So, physiologically, in the body, you have a large blood vessel that brings blood from the legs back up to the heart, and that’s called the inferior vena cava. And in the body, it’s positioned towards the right side of the spine. So, when you think about it, if it’s on the right side of the spine, if you’re laying on your left side, you’re shifting the weight of the baby away from that. If you’re lying completely flat on your back, there is some compression of it, but it’s not like a hose that you’re completely compressing and turning off fluid. Like, you are not completely obstructing blood flow from your legs back to your heart. And if you’re laying completely on your right side, you’re far enough to the side, it’s not compressing the vena cava.

So, people are worried, if I lie flat, I’m gonna suffocate the baby, and you won’t. If you’re pregnant, even if you’re at term, if you lie completely flat, it’s not comfortable, you’ll feel like you get a little short of breath, you may feel your heart racing a little bit, but you are not gonna hurt yourself or your baby.

Dr. Fox: Yeah. I mean, there’s a lot to this, and it’s so prevalent a thought. It sort of came from women who are full term with a large uterus, maybe in labor, that yeah, if they lie flat on their back for a long time, number one, they may become a little bit lightheaded, which is a possibility. Or sometimes in labor, if they’re flat on their back, you can sometimes see changes in the fetal heart rate that are suggestive that maybe there’s some decreased blood flow back to heart, and then consequently, to the baby. And so, a few things got extrapolated from that, which are not correct. That number one, this is true earlier in pregnancy. So, it’s definitely not true earlier in pregnancy because the uterus isn’t big enough. It’s sort of not relevant earlier in pregnancy.

Number two, that it must be the left side versus the right side, which is not really true. Number three, the biggest problem with this myth is that since that was a thing, what happened was there was a lot of studies where they would ask women who had stillbirths, they would say, “Hey, hey, did you sleep flat on your back in pregnancy?” And they’d be like, “Oh my God, yes I did.” And then they would say, “All right, lying on your back increases the risk of stillbirth.” And there was a bunch of stuff that was published a while ago that suggested that one of the causes of stillbirth was women sleeping on their back, and one of the ways to prevent stillbirth is to sleep on your side.

That’s a big matzah ball to put out there, because number one, it implies that women are the cause of the stillbirth, which is very, very distressing, obviously. And number two, that it can be prevented from this. And number three, that somehow women have control over how they sleep when they’re pregnant. So, you could fall asleep on your side, but usually, you wake up in another position because when you’re asleep, you roll around, you move based on what’s comfortable.

Dr. Melka: And I think when they did the studies, because it was just reporting, there was no way you could have woken up on your back.

Dr. Fox: Yeah, you can’t.

Dr. Melka: And that’s what you reported. “I slept on my back because I woke up on my back.”

Dr. Fox: These things aren’t verified. They’re on in like sleep centers. And so, that sort of myth has gotten absolutely perpetuated everywhere. And so everyone here, sleep on your left side, sleep on your leftside. But actually, when they’ve done studies looking at it prospectively, meaning you look at people who they report how they sleep, how they fall asleep, how they wake up moving forward in time, and you sort of look at those who either intentionally or unintentionally end up on their back, their rate of stillbirth and adverse outcomes is not different from the ones who intentionally sleep on the side or end up on their side. And so, really, the better designed studies, essentially, have never shown an increased risk of stillbirth based on how you sleep. Or on the opposite, a decrease for [inaudible 00:09:15] birth based on sort of intentionally trying to sleep a certain way.

And so, really, the messaging that’s data based is sleep in any way you can that’s comfortable, because telling women they have to sleep a certain way, again, puts so much weight on them, like, emotionally that somehow if, God forbid, there’s a stillbirth, it’s their fault, which is not true. Number two, it gives them so much anxiety however they might fall asleep. And number three, it’s gonna ruin their sleep. And then not sleeping has its own consequences as well. And so, it ends up sort of overall causing more harm physically because they’re not sleeping, and emotionally and mental health from, like, anxiety over this. And it ends up being a counterproductive recommendation. So, we don’t say you must sleep on your left side. Yeah.

Dr. Melka: You can sleep, you know, for people that are back sleepers, I even encourage them just to take a small pillow and put it underneath one of their hips. So, like, their hips are angled to the side, but you still kind of feel like you’re lying on your back. And then you get a lot of people that spend a ton of money on the fancy pregnancy pillows that take up over half of the bed. They go around your back, over your shoulder and they’re designed to keep you from rolling over.

Dr. Fox: Yeah. I mean I basically tell people, “If you can sleep when you’re towards the end of pregnancy, God bless you.” You know, because it’s not easy, and any way you can sleep is probably the right way to do it. And so, find what’s comfortable for you. People think early in pregnancy or whatever, if you’re sleeping on your stomach, you’re gonna hurt the baby. Totally not true. Again, at the end of pregnancy, it’s hard to sleep on your stomach. It’s just physically the same way. And you may not feel comfortable sleeping flat on your back. And so you may wanna shift a hip or do that. But if you can sleep on your stomach, it’s really is not dangerous to the baby. You’re not crushing the baby. Nothing like that.

Good. All right. That’s a big myth. All right. So, we’re gonna cross that one off of our list. Next one. Here’s a good one.

Dr. Melka: Oh, let’s hear it.

Dr. Fox: My OB-GYN is going to judge me.

Dr. Melka: No. Or at least a good doctor should not judge you.

Dr. Fox: All right. So, what are we talking about here?

Dr. Melka: So, many things. In gynecology, it’s often about sex, sexual orientation, sexual partners, number of lifetime sexual partners, number of sexual partners at one time, use of birth control, not using birth control. And people are often very hesitant to be honest. We don’t care. We don’t care if you have sex with men, women, or both. We don’t care if you have three partners at a time, one partner at a time. We need to know to give you the right counseling in terms of safer sex practices. Somebody that has three partners at one time, you are gonna counsel a little differently than somebody that has one partner, and as long as that partner doesn’t have other partners. Sometimes they have one partner, but whoever they’re with has other partners, and they’re hesitant to say that. And it changes somewhat the counseling in terms of risk of infection and, you know, decreasing that risk.

Dr. Fox: Yeah. Most of us have been around the block, and it’s unusual that someone’s gonna tell us something that’s gonna either shock us like we’ve never heard it before or make us think differently of them. I mean, yeah, sure. From time to time, someone will tell you something you haven’t heard before. Okay. Like, you know, if somehow that show is on our face and we don’t have good poker face, fine. But ultimately, like, our role is to hear what’s going on and to help you in the best way we can. And so, ultimately, it’s not about any judgement. And that’s true for a lot… And people are sometimes…this sort of works in both directions. Like, one of the myth is people think that they’re gonna get judged, and so they may not say things.

And then the other side, others, when I talk to them, they’re like, “Oh, patients must never tell you about this and this.” I’m like, “Oh no, they tell me.” We know.. On the other hand, people, fortunately, usually will tell their doctors everything. Which is good. Like, you know, using drugs? Tell us. That’s okay. You know, we’re not gonna start reprimanding you, or this or that.

Dr. Melka: I’m not calling the cops because you tell me you’re using a drug that’s not legal in New York state. I just need to know for your health.

Dr. Fox: Yeah. I mean it’s true with a lot of things.

Dr. Melka: And it comes up with intimate partner violence as well. Are you in a relationship with somebody? Do they help you feel safe? Do they take care of you? People are often very hesitant to share that.

Dr. Fox: Yeah. I would say the bottom line is the assumption should be that your doctor is not going to judge you. Your doctor’s there to listen to you and to help you. If you happen to run into one of those doctors that does judge you or this, yeah, get a new doctor. But I would say that’s really the exception.

Dr. Melka: Especially with what we do.

Dr. Fox: Yeah. I mean, we see patients all day every day. There’s a lot of different people out there with a lot of different…you know what I mean? There’s such a wide variety of humans that it’s really unusual that we hear something that we’ve never heard before. Okay. Another good one. So, doctors are not going to judge me. All right. The next one. We’re going back to pregnancy. Bedrest works.

Dr. Melka: No.

Dr. Fox: No.

Dr. Melka: For nothing, other than boredom,

Dr. Fox: It causes boredom. So, yeah, bedrest is a big thing. And I would say it really got its legs in medicine and in pregnancy before we had any treatments for anything. It was like, “All right, this is bothering you? All right.”

Dr. Melka: Go home and get

in bed.

Dr. Fox: Go home and rest. Rest for a week or two, and we’ll come back and see how things are doing. Because honestly, there was no other options. And so, we sound pretty, you know, scientific, “Oh, you know, go rest this.” But the things that people think it’s recommended for, or that it has been recommended for in the past is quite wide. That if you have early pregnancy bleeding, you should go home and rest. If you’re having contractions, you should go home and rest. I have no idea what else people… I don’t do it anymore. It’s so crazy.

Dr. Melka: Blood pressure.

Dr. Melka: You have high blood pressure? You should go home and rest, and all these things. Rest is lovely if you’re tired or if you’re weak, if you have severe heart disease where you can’t, like, move around. Okay.But for all those other things, all the studies have shown it doesn’t work. It doesn’t prevent preterm birth. It doesn’t stop preterm birth. It doesn’t prevent miscarriage. It doesn’t stop miscarriage. And ultimately, okay. So, what’s the harm? Like, what’s the big deal about it? You know, why do we care?

Dr. Melka: So, immobility, meaning not being mobile, being in bed for long periods of time, especially while pregnant increases risk of complications like blood clots, like clots of the legs, increased risk of urinary infections, I think pneumonia in some studies, but that’s less likely with pregnancy specifically. But it does increase mainly risk of blood clots.

Dr. Fox: Yeah. I mean, when I talk to people about this, generally, they’ll be asking me, “Do I need bed rest?” Or sometimes if the mom is young, her mom might say…

Dr. Melka: “You should bedrest.”

Dr. Fox: “Doesn’t she need bedrest, is what I was told?” My party line is generally, like, if you feel more comfortable lying in bed and you want to lay low, that’s okay if it’s gonna give you some sort of mental health benefit to just say, “All right, I’m not doing things,” whatever, that’s fine. I don’t want anyone in complete bed rest because of what you said. I don’t want them increasing the risk of clots. So, that to me would mean, all right, you know, you’re basically like being lazy. You’re pretending you’re like, you know, one of my teenagers, you’re just lying around, you’re sitting on the couch, you’re hanging out, you’re not going out, you’re not walking the dogs, not taking out the garbage. Fine.

Like, if that’s how you want to be because it’s gonna sort of make you feel like you’re doing something, God bless. Like, that’s fine. But the problem is not sort of, in my opinion or my experience, patience, trying to put themselves on bedrest and me trying to pull them off. It’s more so people who were told, “You need to be on bedrest,” who don’t wanna be. And so, the issue there is, as you said, all the complications of complete bedrest. But also, it’s not great for mental health to be told you have to stay indoors and stay in bed if someone’s used to going out, seeing people, getting fresh air, going for a walk, those types of things.

Economically, let’s say they can’t work from home, they can’t work from sitting in bed, and now they’re going on disability, they’ll get paid. There’s all these things. Or childcare, they have another child at home, and now I don’t have someone to take care of that child because I’m lying in bed all day. Those types of things are significant for people’s lives. And that’s why when sort of we as doctors just throw around, “Hey, you wanna just, like, do bed rest for the rest of your pregnancy or for a month or for a week or two?” It has significant practical implications for people that are gonna be much more concerning for them than maybe the doctor would have guessed. And so we try our very best not… And people will ask like, “Do you recommend bad rests?” I’m like, “Pretty much never.”

It’s a very unusual circumstance that we’re going to recommend it. And usually, it’s a form of like, all right, maybe lay low, whatever. There’s some art to this to figure out for each person what might be the right way to go, but it’s very unusual that we would recommend any form of strict bedrest, again, except in exceptional circumstances.

Dr. Melka: Yeah. I’m asked about it sometimes when we have somebody who’s pregnant with certain complications like a bleeding previa, or the cervix is dilated but they’re not actively in labor, and will recommend they stay in the hospital. And they don’t wanna stay in the hospital because they wanna go home. And it’s not that we’re doing any… Most of the time, you’re in the hospital just to be physically close to the labor floor because things can worsen quickly, and that’s often when I’ll get asked this, like, “Well, why can’t I do what I’m doing here at home?” It’s like, you’re doing the same thing, but at home, you’re a half an hour away from the operating room. Here, you’re six minutes away, two minutes away.

Dr. Fox: Right. Which is why for people in this circumstance who are hospitalized, we try to get them to mimic sort of their activities of… It’s obviously not as easy in the hospital, but know you don’t have to be in bed all day.

Dr. Melka: You can walk, take a shower, you can sit in the lounge.

Dr. Fox: Yeah. Have visitors, like, those types of things. So, again, it doesn’t feel the way, and it’s not… I say there’s no magic to the hospital. It’s not like being in the hospital is gonna keep you from bleeding or keep you pregnant if you bleed or if you go into labor. Like you said, we are close to the people and the services that are needed for you. So it’s not that. Another one that comes up a lot is, people get diagnosed with a short cervix, which is a risk for preterm birth, but it’s not preterm labor. Do you need to be on bed rest? And there’s a lot of the data does not demonstrate any benefit to telling them to go on bed rest. And so, it’s a conversation.

On the one hand, probably not a great idea to train for an Iron Man, but on the other hand, not a great idea to get in bed for the next two months. And so, where in the middle is that supposed to be? Nobody knows, and it’s probably different for every person. So, again, that’s why it’s an art and you have, you know, your doctor just try to tailor it to you, but complete bedrest should probably be questioned. That’s what I’d say. All right. We’re rolling along here. Next myth. We are gonna go back to the gynecology world. All right. Here’s the myth, Melka. I’m having my period. That’s a myth. All right. I’m having my period, I therefore need to call and cancel my doctor’s appointments with a gynecologist

Dr. Melka: Myth.

Dr. Fox: All right. So, talk about that. Is this something that happens a lot?

Dr. Melka: Yes.

Dr. Fox: Okay. So, explain.

Dr. Melka: Many women don’t want a pelvic exam when they’re bleeding, which is okay. But many women feel that we will be grossed out by it, we will be put off by it, or that they’re “not allowed to come in if they’re menstruating.”Not true.

Dr. Fox: Not true. Yeah. It’s just not true.

Dr. Melka: Many years ago, I think the pap smear technology, I think it was either one of the old automated ones or the actual smear, you weren’t supposed to do when someone was bleeding because it would affect the results. Again, this was years ago, but that’s not the case now. And look, if you’re more comfortable rescheduling, that’s fine. We don’t want anyone to do anything they’re uncomfortable with. That’s challenging. A lot of our patients, they’re working full-time, they have kids, or they’re working full-time and they have kids. And they don’t have that much time. It’s not that easy to reschedule.

Dr. Fox: Or they’re trying to see Bender.

Dr. Melka: Or we reschedule four months from now.

Dr. Fox: We could see you again next year.

Dr. Melka: Many women have irregular cycles. And especially if you’re coming in to discuss abnormal bleeding, there’s no need to put it off.

Dr. Fox: So, just to be clear, so if someone is due for pap smear, you can do it during their period?

Dr. Melka: Yes.

Dr. Fox: If someone needs STD screening or any sort of cultures, you can do it when they’re getting their period?

Dr. Melka: Correct.

Dr. Fox: Someone needs a pelvic exam, you can do it when they’re having their period. That’s it. What else? You know, everything else should be okay. So, it’s really, again, if it makes you uncomfortable to go to the doctor getting your period, okay, you know, God bless. If that makes you uncomfortable, you can reschedule. It’s no problem. But on our side, everything we need to do, we can do, and we absolutely see people who have bleeding, whether it’s from menstruating or otherwise, all the time. I mean, again, it’s part of what we do, and it’s not gonna gross us out. That’s for sure. Absolutely not. All right.

Dr. Melka: And please don’t feel bad about it.

Dr. Fox: You don’t have to…”I’m sorry I’m getting my period.” Okay. Like, you don’t have to be sorry about that. I’d be like, “I’m sorry.” Absolutely not. Okay, great. Next one. Let’s see. All right. Here’s another good one. Sex or exercise is going to do anything to you when you’re pregnant like cause you to miscarry or cause you to go into labor.

Dr. Melka: No.

Dr. Fox: All right. So, is this a big one?

Dr. Melka: The miscarriage one is big because, again, as a gynecologist, I often see women where they’re diagnosed with a miscarriage and we’re having the conversation, and you can always see the look on someone’s face when they start to ask, I exercised last week, I forgot my prenatal vitamin, I got in a fight with my partner, I was stressed at work, I accidentally took two prenatal vitamins because I forgot I took one that morning. People will look back and link almost anything they did to losing a pregnancy, and it’s not the case.

Dr. Fox: It’s really interesting because in the early part of pregnancy, it’s usually people saying, “Oh, I need to avoid these things because they’re gonna cause something bad. I shouldn’t exercise in the first trimester. I should take it easy because if I do too much, I’ll somehow dislodge the pregnancy and miscarry. Or if I have sex, it’s somehow gonna do something terrible to the uterus or to the baby, or to the cervix and I’m gonna miscarry.” And those are absolutely false. Like, it’s just not true. You could not exercise a baby out. You cannot have sex to… I mean, if that were the case, we would have no issues with abortion in this country, because anyone, if they wanted to end a pregnancy, is, “Oh, I’m just gonna go exercise.” It doesn’t work like that.

Thank God our bodies are built in a way that’s a little more secure for holding in a pregnancy and it will not cause a miscarriage. If people are bleeding, I will tell them sometimes not that sex or exercise will cause you to miscarry, but it is possible that they will cause you to bleed a little bit more, which will worry them. And I’ll say if sex or exercise early in pregnancy causes you to bleed and that causes you anxiety, fine, back off, you know, for a couple of weeks or whatever. But it absolutely will not cause you to miscarry if you’re not bleeding, it won’t cause you to miscarry if you are bleeding. If you’re gonna miscarry, you’re gonna miscarry, unfortunately. And if you’re not, you’re not. And having sex will not change that one way or other, or exercise.

Dr. Melka: And I’ll also tell people emotionally, if you’re going to exercise and then you have a miscarriage and you’re going to feel like you cause it, then don’t do it.

Dr. Fox: Right. You have to know yourself and your sort of emotions about these things. But on our end, like, we don’t tell people, “Oh, because, whatever, because you’re pregnant, because you’re early pregnant, because you’re early pregnant with twins, because it was, whatever. We do no poor research. Now, sometimes there are exceptions where the fertility doctors want people to avoid certain activities early in pregnancy. Some of it is because they’re just much more conservative in these regards. But other times it’s because they just stimulated your ovaries. And the ovaries are very large and swollen, and they’re worried that these activities might cause them to twist or cause pain. So they want you to wait until those ovaries sort of back down to size.

I don’t know the data on that, whether that’s a true thing or just sort of how they counsel people, but it’s slightly different when coming from IVF than it would be from a spontaneous pregnancy. So, I will recognize that difference. And I don’t judge my REI colleagues when they tell people that. Whereas at the end of pregnancy, it’s the opposite. It’s people like, “I’m gonna try to do things so I can go into labor. All right, you know, my due date’s next week, let’s get this baby outta here. I’m gonna go for a long walk. I’m gonna do some squats. We’re gonna have sex.” Does not work. It does not work. I mean, God bless. I mean, do it, but it does not put someone into labor.

Dr. Melka: Physiologically, with having sex, nipple stimulation., orgasm will release oxytocin from the brain. Semen has prostaglandin in it. All of those things can make people a little bit crampy. Some women when they’re having sex, even when they’re not pregnant may notice they have menstrual cramps afterwards, and it’s sort of that physiologic effect.Some people will find at term they’ll have sex a lot and they’ll go into labor. I tend to think they were likely to go into labor anyway. Or it’s like you’re rolling a ball up the hill and it’s right about to crest the hill and it’s maybe that tiny little push you need. But if these things worked, we wouldn’t need to schedule inductions. I could just tell someone, “Oh, you wanna deliver on Thursday? Great. Have sex at six o’clock that morning. I’ll see you at 10:00.” It would make our job a lot easier.

Dr. Fox: It’s just not that simple. There’ve been pretty good studies in this where they’d tell people, “All right, you guys go home and have sex or you guys don’t. You know, you guys have sex every other day and you guys don’t,” and the rates of going into labor on your own are the same.

Dr. Melka: The other thing people ask about at term is castor oil or enemas, basically things to stimulate a large bowel movement, which again, might make someone a little bit crampy. They might not get you into labor, but they will keep you on the toilet all night.

Dr. Fox: The castor oils is interesting. Many of the midwives swear by it.

Dr. Melka: I think there’s mixed data on it.

Dr. Fox: It’s not dangerous, you know. I mean, the castor oil makes people pretty crampy. And again, exercise isn’t dangerous, sex isn’t dangerous. So, again, if someone wants to be active in a pregnancy, they wanna have sex in a pregnancy, absolutely, positively, it’s fine. It’s safe. It doesn’t matter if the cervix is dilated or not, like, it’s not unsafe, it’s totally fine. But don’t do it specifically because I’m only doing because I wanna be put into labor, because it’s not gonna work. And another myth that comes up a lot at the end of pregnancy is, I can’t go swimming, I can’t go in a pool

Dr. Melka: Because If my water breaks, I won’t know it. That was the best explanation I had.

Dr. Fox: Yeah. That’s where it came from. Again, your water’s no more likely to break if you go swimming, and if it breaks in the pool, probably no one will know. I guess the only one who’ll really care is the one who cleans pool It’s salt water, basically, everything comes out, so it probably wouldn’t even get noticed in a pool. But you would notice.

Dr. Melka: And you’ll notice.

Dr. Fox: You’ll notice when you’re done swimming, you will notice you’re still leaking. The water breaking is something continuous. All right. So, that’s another myth. All right. We got two more myths coming up. The next one was one you wanted to bring up. Which one was that?

Dr. Melka: You cannot let your heart rate go over 140 when you’re exercising.

Dr. Fox: Yeah. So, I honestly have no idea where that came from originally, why 140 or what the concern was. I think the concern was if your heart rate’s that fast, that somehow you’re diverting too much blood away from the uterus and towards your muscles, and somehow that’s dangerous for the baby, I’m guessing. That’s sort of a guess of where that may have come from. But I don’t know, unless you know any other reason.

Dr. Melka: I’ve never been able to find it.

Dr. Fox: I think that it’s possible… 140 is sometimes around the heart rate for an average sort of young to middle-aged person of where their metabolism switches from aerobic to anaerobic maybe. I don’t know. I have no clue why that is, but it’s not a thing ultimately.

Dr. Melka: Earlier today when we were talking, my heart rate went up to 120. I’m looking at my Garmin data.You could be running for the bus walking up and down the subway stairs, especially in the summer, in the 98-degree heat and humidity, and your heart rate can get to 140 just normal day-to-day stuff.

Dr. Fox: Yeah. Yeah. So, that’s definitely a myth. Again, exercise, we’ve got a whole podcast on exercise and pregnancy. And ultimately, what is or isn’t safe is usually just dependent on things that where you could get injured. So that’s something you wanna avoid. But in terms of actual exercise, it really depends who you are, what your fitness is, and generally, whatever exercise you can tolerate physically when you’re not pregnant, you generally can early in pregnancy. And as you get more pregnant, it’s just harder to do those things, but it’s not dangerous to do them.

You modify them because it’s just more difficult, you’re carrying more weight, your center gravity is different, your joints are different. So, there’s some thought that goes into it, but it’s not really that your heart rate’s in danger, that’s not a concern. So, that’s cool.

Dr. Melka: I get a lot of patients that see me that are runners, they know me from the running community. They come in and they’re like, “How am I supposed to run if I can’t get my heart rate over 140?” It’s like, you can, you don’t have to push yourself crazy hard doing a workout every single time, but you can continue exercising and you feel like it’s a workout.

Dr. Fox: Last myth we’re gonna talk about is the myth related to nausea and vomiting in early pregnancy. And the myth is that it is morning sickness.

Dr. Melka: Neither morning nor sickness almost, discuss.

Dr. Fox: Over two. So, do you even know how it became called morning sickness?

Dr. Melka: I think it’s on average, more often than not, women that are early in pregnant will be nauseous in the morning as opposed to having zero symptoms or being nauseous at night. And I think that’s just what’s most commonly known. Do you know anything different?

Dr. Fox: I don’t. I have no idea. Maybe also it’s just based on, again, this is something that would’ve been hundreds of years old, and maybe it’s just related to when people ate, like what time of day, what time they woke up, what sleep patterns were… I have no idea. But in my experience, people who are nauseous in pregnancy, it’s all day or parts of the day, random parts of the day, before they eat, after they eat, while they eat, morning, afternoon, night, you know, wakes them up from sleep, doesn’t wake them up from sleep. It’s all over the place. And the most important part is that it’s all normal based on how you define the word normal, but it’s all very common. None of it implies anything bad about the pregnancy or anything, and the treatments are the same.

The things we do are not different whether it’s morning, afternoon, or night. And there’s nothing again, better or worse about your pregnancy if it’s morning after night or not at all. If you’re the lucky one who doesn’t have any, God bless, you know, that’s great. It doesn’t mean you have a bad pregnancy. It means you’re fortunate, and just the less of these symptoms. And similarly, if your symptoms are much worse, we don’t really have a great sense of why some people have much worse nausea and vomiting than others. We don’t have a great sense of why the same person might have different levels or different manifestations of it in different pregnancies, which is really wild. Like in one pregnancy, they’re very nauseous, in one pregnancy, they’re no.

Some people say it’s boy versus girl. Not true. There we go, another myth. We just don’t know exactly why it is. There’s a lot we don’t understand about it, but we do understand it can happen all day, any part of the day and it’s not morning sickness. Beautiful. All right. Malcolm Myth Busters.

Dr. Melka: Boy and girl is another good one.

Dr. Fox: Oh, you know.

Dr. Melka: I always laugh about this with patients because when you ask patients this, there’s so much crap that people say that’s like so wildly offensive. When I was pregnant, we didn’t know what we were having. On the same day, one person said to me, “Oh, you’re carrying big, you must be having a boy.” And I was like, “Oh, thank you.” And then somebody looks at my face and they go, “You must be having a girl because girls steal your beauty.”

Dr. Fox: Oh my God.

Dr. Melka: I’m by far not the only person that’s been…

Dr. Fox: Wait. Basically in the same day, you were told you’re big and ugly?

Dr. Melka: Yes.

Dr. Fox: Oh, that’s nice.

Dr. Melka: One was boy and one was girl.

Dr. Fox: I find in my experience that those kind of statements are right about 50% of the time.

Dr. Melka: And a boy or a girl.

Dr. Fox: These things though.

Dr. Melka: Where like some people you’re carrying out as opposed to carrying upwards. Some women look further along in their pregnancy or some women look like they’re earlier in their pregnancy. And the comments they get, like, some people come in and are truly worried by it. Or they come in, “My mom said I’m not carrying big enough and something must be wrong.” And they’re fine, it’s just the way their body is.

Dr. Fox: You know, word of advice to people out there who are gonna comment on someone’s body, number one, don’t.

Dr. Melka: Or comment in a positive way.

Dr. Fox: If she’s pregnant and you know she’s pregnant, it is out there, I think the only comment is, “You look terrific. How do you feel?” Saying to someone, “You’re carrying big,” not good, “You’re carrying small.” Not good. “You’re carrying low, you’re carrying high.” How about just, “You look terrific. How do you feel?” And if you don’t know if she’s pregnant…

Dr. Melka: Just don’t say it. Don’t say it.

Dr. Fox: Just, “How you doing? Looks good.” There’s nothing to be gained by guessing on that one. It’s not good.” Listen, this is my career. I see pregnant women all day every day. I will never tell someone that I do not know 100% before I see them anything about them being pregnant, even if they’re literally…until they’re like in stripes and pushing because it is just, “What if I’m wrong? What if they gave birth two weeks ago?” You can only hurt people’s feelings. You cannot say anything pleasant in that situation.

Dr. Melka: I always get a good laugh at that because again, you’re saying things to someone and you’re not letting on that they’re pregnant and they’ll say, “Well, can’t you tell? Isn’t this what you do?” And I’m like, “Ah, but what I do is to never assume.” And then they go, “Oh, okay.”

Dr. Fox: I’m gonna end this with a great story. So, a friend of mine, I haven’t seen in a long time, but he’s telling me he graduated, he went to med school, said he spoke at his med school graduation and he told a story about what he was doing, his OB-GYN rotation as a third-year med student. He did not go into OB-GYN but he was saying he was told to go in and take a full history and physical, which is what med students are frequently told to do on this woman. So, he comes in and she’s pregnant woman, she’s lying in bed, and he’s doing a whole… And for med students, it’s an hour. They do the whole history, their medical history, their sexual history…

Dr. Melka: Where were you born?

Dr. Fox: Everything. They go through, “Do have to walk upstairs? Does your cousin have diabetes?” The whole thing, talks about her pregnancy and everything about, “How’s the pregnancy going? This, this, this.” He didn’t do an internal exam, but listen to the belly, listen to the heart, this, this, this. And when he stopped, he said after an hour, the poor woman didn’t have the heart, and she finally told him, “You know I delivered like four hours ago.” She’s like, “I’m not pregnant anymore.” He said it was very humbling, you know. But he said she was very kind, that she didn’t burst his bubble until he was completely done with this full evaluation. But yes, sometimes you just don’t know if someone’s still pregnant or not. Very good. Melka, thank you for coming by. This is a great one. We’ll do it again.

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@healthfulwoman.com. Have a great day.

The information discussed in “Healthful Woman” is intended for educational uses only, 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 to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.