Melissa Drake OB GYN

Preeclampsia is part of a constellation of high blood pressure conditions in pregnancy that includes chronic hypertension, HELLP syndrome, and gestational hypertension. These diseases are not stable or static, and can rapidly progress to more severe forms, sometimes even within hours. Generally, the earlier in pregnancy that preeclampsia is diagnosed, the more rapid the progression. If untreated, it is associated with severe complications for mother and baby, including seizu...re, stroke, and death for both. Preeclampsia can occur from 20 weeks of pregnancy until 6 weeks after birth. It is associated with certain symptoms (headache, blurry vision) as well as signs (protein in the urine, impaired liver function). High blood pressure before 20 weeks of pregnancy is considered chronic hypertension, a pre-existing health condition that can evolve into a superimposed preeclampsia. Preeclampsia is treated with DELIVERY, but it is not a reason, on its own, to do a c-section. A vaginal birth is less stressful on the body than surgery. Delivery should be hastened, which can mean induction of labor or augmentation if labor has already begun. Sometimes, an epidural may be recommended to bring the blood pressure down. The presence of ANY of the following symptoms earns you a prompt evaluation. Call the office or go to Labor and Delivery if you have: Nausea or vomiting that is new or different Headache Blurry or impaired vision Chest pain or shortness of breath Decreased urination Baby not moving as much as before Any questions? Hit me up in the comments. Don’t include personal info, obviously! #preeclampsia #delivery #obstetrics

Braxton Hicks contractions - aka the uterine charley horse. Just about as much fun as it sounds! In addition to all the other wonderful and weird body stuff that goes on in pregnancy, Braxton Hicks contractions are a common source of frantic 2 am Googling. Braxton Hicks contractions are a labor FAKE-OUT. They can hurt (don’t listen to those who say they can’t! Again, charley horse!) but they DO NOT tend to build into a rhythm where they increase in intensity or frequency. Th...ey also tend to be focal - coming from only one spot, typically on the front of the abdomen. They may start because of an over-full bladder, exhaustion, dehydration, or orgasm (!), and they can often be resolved if the person is able to pee, hydrate, and rest with feet up. If the pain is in the back, wraps around to the front, radiates down the legs, or is accompanied by bleeding/spotting, mucous discharge, or water leaking down the legs, this is more likely to be true labor. Call the office or head on in to Labor and Delivery if this happens! #braxtonhicks #laboranddelivery #empoweredbirth

- attributed to the World Health Organization, by way of bellybelly.com.au A good birth is actually one where women are placed at the center of their care.

Ask Dr. Drake -- When should I announce my pregnancy? Another way this question is often asked is: when is it safe to announce my pregnancy? The answer is: it depends on you and who you’re telling. Your partner and your family will most likely know before your friends and your workplace. Many people will wait until 12 or 13 weeks, when the risk of miscarriage is lower (1-5%). At this point, some people will have their genetic testing back as well, which may give them more ...confidence when announcing a pregnancy. There are some good reasons to announce earlier than 12 weeks -- 1) Difficulty conceiving or previous miscarriage - if you’ve had a previous loss or been through the roller coaster of fertility care, it makes sense to tell your loved ones about the latest developments. It also helps build your support network. 2) Extreme morning sickness that is affecting your life and/or making you miss work or other obligations. Some choose to wait until mid-2nd trimester. At 18-22 weeks, an anatomy ultrasound is often performed to rule out birth defects or other anomalies. This may give parents more reassurance and confidence when announcing a pregnancy. Some people choose to wait until the 3rd trimester -- this is perfectly okay too. It really isn’t anyone’s business! Be aware that almost everyone’s bump will show by 20 weeks, so if you want to keep things under wraps after that point, some strategic wardrobe choices may be in order. When did you decide to announce, and why? Sound off in the comments. You might help someone else! #birthannouncement #fertilityjourney #babyontheway #pregnancy

Imagine! Being able to screen yourself for HPV! At home! I'm well aware that coming to the gynecologist is not generally something that people really look forward to! On the list of awesome, cool, fun things to do, a gynecology exam ranks...pretty low. So that's why it's pretty exciting to hear that the NIH is studying a protocol to have people self-sample for HPV, the virus that is the most common cause for cervical cancer. The idea is essentially that you would have ...to self-insert a little tiny brush, swirl it around a couple of times, put it into a little preservative container, and mail it away. Another potential self-administered test that is being investigated is urine-based -- pee into a cup and mail that. There you have it, guys. Mailing our bodily fluids. It's the future. Also, please support the U.S. Postal Service. Buy some stamps. Their funding is in serious jeopardy and in addition to potentially having to handle our fluids, postal carriers have to deal with the threat of COVID every day. http://ow.ly/WlfZ50AwgFY

Act accordingly.

Hoo boy, here it is. This has the potential to be an absolutely massive post, but I’m going to try to keep it as brief as possible. While post-traumatic stress disorder is most frequently associated with soldiers and firefighters, there is good evidence that childbirth can provoke it with a shocking frequency. It makes logical sense. For those who are skating on the edges of life and death, trauma lingers nearby. Both mothers and soldiers in war zones may experience feeling h...orror, helplessness, or extreme fear, getting hurt, seeing another person hurt, and having little or no social support after the event. How common is it? Estimates range widely from 1% to 17%, with some studies suggesting that 25% of women exhibit at least some symptoms of PTSD following a birth. Symptoms include: - Being easily startled, tense, or on edge - Difficulty sleeping - Reliving the event, having flashbacks that may be triggered by seemingly unrelated events - Numbness, emotional blunting Significant research into birth-related PTSD only started in 2006. That’s a YEAR AFTER Youtube came online! It is clear, however, that there are several things that can be done to reduce the risk of PTSD related to birth: - Education about pregnancy, birth, and the postpartum period - Support from a provider who takes the time to listen to you and answer your questions in a way that you can understand (i.e. not jargon-heavy) - Continuous birth support from a doula - Continuous presence and support from a loved one who can advocate for you Treatments are similar to PTSD treatment for veterans: therapy (including EMDR), support groups, medication, writing/art/dance therapy. Early intervention helps - talking through a birth with your loved ones and your provider goes a long way towards preventing PTSD and fortifying your brain. Finally, PTSD affects not only mothers but also partners. Don’t hesitate to seek help early for each other.

It's time for another round of Ask Dr. Drake! Today's question: How much should I be showing? This is a question that I get a lot. I hear from patients, People keep telling me how tiny I look as well as the ever unhelpful Tee hee, are ya sure you’re not having twins?!... Eeeeeevvvvvverrrry one seems to have an opinion about pregnant women’s bodies. Good lord. Here’s the deal -- the way your bump looks depends on a number of factors: your height and torso length, your starting weight, your body shape (apple, pear, etc), your ab strength (shoutout to several patients with abs of steel, holding that uterus up real high and tight, you know who you are! :-)...as well as your gestational age, your baby’s size, and how much amniotic fluid your baby is making. The image I used here is of Australian HIIT coach Chontel Duncan and her friend Natalie Smith. This image went viral in 2015. In it, Chontel and Natalie are only 4 weeks apart. Chontel is also a foot taller than Natalie and in her first pregnancy (and also, extremely fit), while Natalie is in her 3rd. Guess who got criticized for their body size and shape? Spoiler alert: it was both! Yay being a woman on the internet! FINALLY...a public service announcement... It is not helpful to say to women that they look so tiny or not even pregnant. That scares people. Don’t do that. Additionally, kindly shut up if you think she looks "big". You don’t know what’s going on with her and frankly it's none of your beeswax. Love you all! #pregnantandperfect #pregnantbelly

From Jia Tolentino ("Trick Mirror"), Interview Magazine, "Ask a Sane Person." "It’s a choiceit can’t be a matter of fluctuating affect, whatever viral news story or TikTok gave you hope in people or took it away. In general, I try to expect nothing and hope that everything is possible. I want the courage to need very little and demand a lot." Take it easy this evening, friends. Thinking of you all, Dr. Drake ... #fridayvibes #mindset See more

HOSPITAL UPDATE 7.10.20 We are still doing symptom questions and temperature checks at the front entrance. Masks are required for entry. Partners are still welcome for birth support. Because birthing patients are getting swabbed for COVID upon admission, they are not required to keep a mask on in the birth room. Birthing patients are now permitted to walk in the hallways with a mask on! Woot woot! ... Partners need to remain in the room. Sorry, partners.

Like a muscle, sometimes our "no" needs to be exercised. Whether at home, at school, at work...as a mom, as a patient...women and girls are too often socialized to say "yes" endlessly. "No" is okay. "No" is necessary. "No" to unwarranted advice. "No" to that scary birth story someone feels the urge to tell you as you approach your own birth. "No" to that totally unhelpful opinion about how big or how small you look. "No" to that visit from your mother-in-law. ... It's a complete sentence.

Gaze upon this gorgeous butterfly. Have a great weekend. May we all glow with such radiance. "Walk as if you are kissing the Earth with your feet." ... --Thich Nhat Hanh See more

It's time for another round of Ask Dr. Drake! The question: is it safe to paint my house? The answer is yes...most likely. There has been very little research into the effects of paint fumes on unborn babies. The studies that have been conducted are retrospective (obviously, who is signing up for the paint fume-huffing pregnant lady study??) and suffer from recall bias. So, the risk is likely quite low, but it’s impossible to know exactly how low. This is because it’s very ...difficult to measure the substances and chemicals your body absorbs during activities such as painting. Any small risk to your baby is greatest during your first trimester when your baby’s organs start to develop, so any harmful fumes or chemicals at this stage could affect your baby more severely. As a precaution it’s best to avoid painting and decorating until at least the 14th week of your pregnancy. More importantly, renovating houses can increase your exposure to lead. If your house was built before 1978 (when lead-based paint was still available), get advice before doing anything that disturbs the paint. Disturbing lead-based paint can spread lead dust into the air and around the house. Obviously, it’s important that pregnant women and children aren’t around during renovations that disturb lead-based paint.

They were loving partners, parents, family members, friends and community members. Black trans women are being murdered at an alarming rate, impacted by the intersections of racism, sexism, homophobia, biphobia and transphobia, according to a report from Human Rights Campaign. Say their names. ... Rem’mie Fells Riah Milton Neulisa Luciano Ruiz Yampi Mendez Arocho Monika Diamond Lexi Johanna Metzger Serena Angelique Velasquez Ramos Layla Perez Sanchez Penelope Diaz Ramirez Nina Pop Helle Jae O’Regan #SayTheirNames #BlackTransLivesMatter

Happy Pride Month! Did you know that it's against federal and state laws for health insurance plans to discriminate against LGBTQ+ people? Trans people in particular often face serious barriers to care, not only because they are more likely to face job losses and lack of insurance coverage, but also more significantly in emergency situations or rural environments where a provider may refuse to treat a person who is transgender. Additionally, this is a gentle reminder that re...gardless of gender, we all have organs that need care. Trans men may need screenings to check for breast cancer, and they may also be at risk for cancer of the cervix, uterus, or ovaries. Taking testosterone doesn’t change these risks. Testosterone might make pregnancy less likely, but shouldn't be used as a form of contraception. The National Center for Transgender Equality is an excellent resource, working with federal/state/local agencies to ensure that transgender people have access to quality health care. https://transequality.org/know-your-rights/health-care #pridemonth #transhealth #pride #gay #lgbtq #loveislove #equality