TRANSCRIPT EPISODE 60 – All About Pregnancy & Birth With Dr. Nicole C. Rankins

Transcript episode #60: Sleeping, Caffeine, Deli Meats, Sex: Answers To Common Questions About Pregnancy

Transcript

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(00:00):

This episode answers some common questions that often come up during pregnancy. But quick warning, there is a little bit of adult content discussed.

(00:14):

Welcome to the All About Pregnancy & Birth podcast. I'm Dr. Nicole Calloway Rankins, a practicing board certified Ob Gyn who's had the privilege of helping hundreds of moms bring their babies into this world. I'm here to help you be knowledgeable, prepared, confident, and empowered to have your best pregnancy and birth. Quick note, this podcast is for educational purposes only and it's not a substitute for medical advice. Check out the full disclaimer at www.ncrcoaching.com/disclaimer. Now let's get to it.

(00:54):

Hello, welcome to another episode of the podcast. This is episode number 60. I so appreciate you being here with me today. So on today's episode of the podcast, I am covering some common concerns and questions that come up, but none of them are really big enough to warrant an entire episode by themselves. So what I did was kind of put them all together to make one big episode. So on today's episode you are going to learn is it okay to sleep on your back? What is the deal with lunch meats and certain cheeses during pregnancy? Is it okay to have caffeine during pregnancy? Why in the world shouldn't you change your kitty litter if you have a cat and then is sex okay in pregnancy and then I have two special guests who are answering the concern about fatigue in pregnancy.

(01:58):

As I was preparing for this episode, I had some notes open on my computer and the two human beings that I gave birth to decided to record their own advice after I walked away from the computer for a few minutes so you will get to hear a little piece of advice from my two daughters. All right, now before we get into the episode, let me do a listener shout out. This is to C-Scotton, and the review says awesome podcast. "It was exactly what I was looking for. As I progress through my current pregnancy. Dr. Rankins is so knowledgeable and her show is truly engaging. The bonus is that she is a practicing OB which makes the information provided more credible. So happy to have come across this show. Take a listen and thank me later." Thank you so much for those kind words, C-Scotton I am so glad that you came across this podcast and that you find the show helpful, engaging and credible.

(03:03):

Now I think another thing that folks will enjoy and then be thankful for later is my online childbirth education class, The Birth Preparation Course. This course is entirely online so you can do it from the comfort of your own home and it covers everything from how to get in the right mindset for your birth. That is so, so, so, so, so important. The course starts out with that. As a matter of fact, you'll learn what to expect in labor, how to be in control of pain during labor, how to push your baby out and not tear your body up in the process you learn the truth about interventions like Pitocin, how to make birth wishes that doctors actually pay attention to and then how to get off to a great start postpartum.

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And there is much, much, much, much, much, much more. And you also get lifetime access to the course and there's a 30 day money back guarantee so you really have nothing to lose by checking it out. And you also get more personal access to me than hearing my voice through the podcast. You can interact with me through the course private Facebook groups. So check out all the details of the course at www.ncrcoaching.com/enroll.

(04:14):

All right, let's get into the episode. So let's start off with, is it okay to sleep on your back? All right, so the reason that we get concerned about pregnant women sleeping on their back is that when your uterus gets big enough, roughly about 20 weeks size or so, it can compress something called the inferior vena cava. The inferior vena cava is a very large vein that runs kind of in the middle of our bodies and that vessel brings all of the blood from the lower part of the body back to the heart.

(04:58):

And we worry that if the uterus is compressing the vena cava, then there's less blood that's coming back to your heart, less blood that's available for your heart to pump out blood back to your baby. Now there have been some small studies that have suggested that sleeping on your back increases your risk of stillbirth and we believe it's because perhaps that compression of the inferior vena cava, but we're not entirely sure. Again, those studies are very, very small and also very, very limited. So as a result of that, we recommend that if possible, you sleep on your side. Now when I say sleep on your side, I mean start sleeping on your side, because none of us have any control about how we move during the night. And if you wake up and you happen to be on your back, please, please do not panic. You have not killed your baby.

(06:04):

You have not done anything wrong. All you did was wake up on your back. So if you happen to wake up on your back, then just turn on your side, take a deep breath and go back to sleep. Okay? Now we do say, as far as side, you can go either side left or right, whichever is more comfortable for you. The inferior vena cava, the IVC is on the right side. So that's why we often say sleep on the left side. But really either side is fine, but again, don't stress about this. There are other things that can refer a much higher risk of stillbirth, like uncontrolled blood pressure in pregnancy, uncontrolled diabetes. So don't obsess about your sleep position and if you're affecting or hurting your baby. So just start on your side. If you end up on your back, don't panic. Just turn back on your side.

(06:54):

You can also use some pillows to help make you comfortable. If you have trouble sleeping on your side, they make all kinds of fancy smancy pillows. And maybe ask in the Facebook group. You know I have a free Facebook group All About Pregnancy & Birth, where there's lovely pregnant women in the group, lovely women in the group who are very supportive and helpful of each other. So I'll ask them, do a post in the group about people's favorite pregnancy body pillow. So you can get some recommendations there. So definitely come join the group if you're not, and you only need like a slight tilt to be off your back. So you only need to be off your back like 20 to 30 degrees, which is not very much. So a couple of pillows can make a difference. And again, like I said, there are tons and tons of fancy body pillows that you can try out and we'll post about that in the group. So join the group if you're not already a part of it.

(07:47):

All right, next up is deli meats and cheeses and deli meats can refer to the ones that you get behind the butcher counter. You know, they slice it for you, the meats that are pre-packaged, both of those, all that stuff counts as deli meats or lunch meats. And the problem with those lunch meats or deli meats, hotdogs to fall into this category. And then also some cheeses, specifically unpasteurized cheese is something called listeria. Now, listeria is a kind of bacteria. It's found in soil water. It's found in some animals including cattle and poultry. And what happens is when you eat listeria, it can cause a foodborne illness called listeriosis. It's actually a fairly serious type of food poisoning. So when a mom gets listeriosis, it can cause you to have like flu like symptoms, like fevers, chills, muscle diarrhea, upset stomach, the diarrhea can cause you to get dehydration.

(09:02):

And some other things that may occur when it's more severe are stiff neck and headaches and confusion or even loss of balance. And the crazy thing about listeriosis is that the symptoms can appear as late as two months after you have eaten something with listeria. So it can be way later that you actually realize that you have the symptoms from some type of infection. You know, you may not necessarily make that connection. And in all practicality, many pregnant women do not have symptoms when they get listeria. So it's not necessarily that if you get it, that you automatically will have symptoms. It's just that sometimes it can be severe symptoms. Now here's the thing about it. Even if you don't feel sick, you can still pass the infection on to your baby through something called vertical transmission where the bacteria crosses through the placenta and then infects your baby.

(10:00):

And listeria can have some pretty serious consequences when babies are born with listeriosis. So it can cause miscarriage, it can cause preterm labor and can cause stillbirth. And then babies who are born with it may also have very serious infections of the blood or brain. And even lifelong health problems like intellectual disability, paralysis, seizure blindness, problems with the brain, kidneys, heart, even death. So listeriosis is very, very serious. It does not occur very commonly. Knock on wood, I have never actually seen it in a pregnant woman. And that's with me being in practice for nearly 15 years. So it's not common at all, but it can be quite devastating when a pregnant woman gets it and the effects that it has on her baby. So to help prevent listeriosis, what you have to do is avoid eating the following foods while pregnant. So unpasteurized milk and foods like soft cheeses.

(11:09):

It's not very common that you're going to find unpasteurized milk. Pretty much all milk is pasteurized and that's a process where it's heated to a certain temperature before it's packaged, all that stuff. So most milk will be pasteurize and most cheese is pasteurized. If you're not sure, then you can look on the label. It should say if it's unpasteurized and most cheeses like hard cheeses are fine. Like cheddar, swiss, those kinds of things. It's more soft cheeses that you have to be worried about. So look on the label, look very carefully, see if it's unpasteurized and if it's not pasteurized or doesn't clearly say that it is then don't eat it. Okay.

(11:52):

The other thing is you don't want to eat hot dogs luncheon meat, cold cuts, any deli meat unless it's been heated to an internal temperature of 165 degrees or it's steaming hot just before serving. Now, first off, I don't know why anybody would want to eat hotdogs. I find hotdogs completely disgusting. But if you happen to like hot dogs and make sure you keep them super duper hot. Now you will hear stories of people saying that they ate lunch meat and it was perfectly fine and most likely, honestly it probably will be fine. But the recommendation is that you don't eat it or if you do so do it via very hot. So you can do like a hot sandwich. You know, it's just you can't do like a cold sandwich, but you could do like a hot grilled sandwich where the meat gets nice and hot and steamy.

(12:44):

You also want to be sure you wash your raw produce like fruits and vegetables because sometimes it comes from the soil. And then of course avoid any raw or undercooked seafood, eggs, meat, anything like that. Okay? You shouldn't eat sushi made with raw fish. Cooked sushi is safe, but nothing that has raw ingredients. And that's because cooking and pasteurization are the only ways that we know to kill listeria. Okay. Cooking and pasteurization. So that is the deal with those deli meats and some soft cheeses. And some examples of soft cheeses are like Bri, I believe feta is considered a soft cheese, but again just look on the label to make sure that it is pasteurized.

(13:31):

Okay, so let's move on and talk about caffeine and pregnancy. Now we get concerned about caffeine because caffeine does cross the placenta and then just because of some of the physiologic effects that caffeine has on the body and the effects that it has on blood vessels in particular like vascular constriction, there has been some concern that may be it may increase the risk of miscarriage. It also may increase the risk of babies not growing as well because of affecting blood flow to the placenta. And then there also have been investigations looking into whether caffeine contributes to preterm birth. So let me first talk about miscarriage. Now the data is actually pretty mixed regarding the association between caffeine and miscarriage. A lot of the things that are out there are retrospective studies and those are challenging because of something called recall bias. So what our retrospective study is is that it asks women or asks people to look back in time about something. And see if something happened.

(14:47):

So for example, it will ask women who've had a miscarriage, how much coffee were you drinking during, you know, the first trimester of your pregnancy? And it's possible maybe even likely that if you've had a miscarriage you may be more likely to remember more specific details about how much coffee you drank than someone who drank coffee and didn't have a miscarriage. Because if they didn't have a miscarriage or anything go wrong, then they wouldn't necessarily be paying specific attention to how much coffee they drank. So those studies suffer from, again, retrospective nature and recall bias.

(15:24):

Now there have been two larger studies that have been done that were more prospective, but they had conflicting results, well at least about high amounts of caffeine. So high amounts of caffeine, one study said is associated with miscarriage. Another study said it's not. However, both studies did have the same results for lower amounts of caffeine. And I'll talk about what that amount is in just a minute. So both studies did show that lower amounts, moderate capping consumption does not appear to be a major contributing factor for miscarriage. Similarly, studies have shown that for preterm birth, lower amounts or moderate amounts of caffeine do not appear to increase the risk of preterm birth.

(16:12):

And when we look at growth restriction and whether or not caffeine affects the growth of babies, that data is not clear. There's one larger study that found a slightly increased risk and another study that showed no association. So based on all of the available evidence and research, ACOG, the American College of Obstetricians and Gynecologists, that's the organization that sets standards for obstetric practice in the United States. Their final recommendation is that 200 milligrams of caffeine a day or less is considered safe.

(16:50):

And just to give you some references for about how much caffeine is in common drinks. One eight ounce cup of coffee is about 130 milligrams of caffeine. One eight ounce cup of tea is 50 milligrams and a 12 ounce caffeinated soda is 40 milligrams. I personally was a coffee drinker during both of my pregnancies. Obviously that is not the same as research, but I drank one or two cups of coffee most every day for both of my pregnancies. So that's the final recommendation from ACOG, that at 200 milligrams of caffeine a day or less is considered safe. You can always just cut back to even less if you want to or do like caffeine, decaf mixes or switch to decaf, which still actually has a little bit of caffeine, is not completely caffeine free, if you feel uncomfortable about having any caffeine.

(17:44):

Okay, now let's talk about if you have a cat, why you shouldn't change your kitty litter. Now the risk with that is with something called toxoplasmosis. And toxoplasmosis is a parasite that is almost exclusively, actually exclusively transmitted through feline species. So cats, mountain lions, that kind of thing. And it's a disease that results from infection with that parasite toxoplasma gondii I don't know if I'm saying that right, but that's what causes toxoplasmosis. Now, most of the time infection actually occurs by eating undercooked contaminated meat, but you can also get it from infected cat feces and mothers can also transmit it to their children during pregnancy. So vertical transmission where it crosses the placenta. Mom has an infection, the parasite crosses the placenta and affects the baby.

(18:50):

Now most of the time if women are infected with toxoplasmosis, they're actually asymptomatic or they have very mild symptoms and actually babies who have congenital toxoplasmosis, most babies are asymptomatic. However, there can be some very serious complications like neurologic difficulties, some other challenges. So we do want to be mindful of it and help prevent it if possible. Now actually owning a cat is a very weak association for infection, a very weak risk. And the reason is because the parasite lives in cats eggs and cats only excrete the, something called oocyst for just three weeks of their life. So a very short period of time that they actually can actively transmit infection. So you're just as likely to get exposed from somebody else's cat outdoors.

(19:55):

So the risk of you getting infected from your own cat is actually very low. However, we feel like it's pretty sensible to say, hey, just to be on the safe side, have someone else change the litter box daily if possible. It doesn't come from fresh feces. Actually, it has to be like older feces and of course if you do have to change the litter box because you're the only one or you live by yourself or whatever, then just be careful and normal hand hygiene techniques and you should be fine.

(20:28):

All right, now let's talk about sex during pregnancy and obviously here's the point in the podcast where we have a bit more adult content. Now, the short answer about sex during pregnancy is that sex is perfectly fine for an uncomplicated pregnancy. It is a normal and natural thing that happens. Now, some women will actually experience an increase in sex drive during pregnancy.

(20:59):

Some women experience a huge increase actually in sex drive during pregnancy and it's thought to relate to the pregnancy hormones. So if you fall into that category and you feel like you need to have more frequent sex, as long as your pregnancy isn't complicated, then go for it. Now as far as sex harming your baby, penetration in your vagina will not harm your baby, your baby is in a protected environment in your uterus. So the uterus itself, obviously that muscle layer is a layer of protection. The baby is in amniotic fluid, which provides another layer of cushion and then there's cervical mucus that kind of blocks the cervix. That's what comes out with the mucus plug and that also protects the baby. So you are not going to harm your baby with penetration during sex.

(21:49):

Now as far as having sex, you may have some physical changes in your body that impact the type of sex that you have or how you experience sex. So one thing you may feel is you may feel like a little wetter. Sometimes the pregnancy hormones can cause an increase in physiologic vaginal discharge. That's not harmful. It's not doing anything. It's just more like wetness there. Even to the point of wearing a pantyliner. So you may feel more wet, your vaginal area may feel more sensitive as a result of the blood flow changes to the vagina. Another thing that may be different is that your breasts may be quite sensitive. You may not want them to be touched at all. Your nipples can be even painful sometimes when touched. And then finally, some positions may feel not as comfortable. As far as positions go, you can do whatever you feel comfortable with. There's nothing that's, you know, off limits or anything.

(22:44):

Now, towards the end of your pregnancy, being on your back is not ideal because of that compression of the vena cava, like I talked about earlier. So you may want to try more positions like being on top or sex from behind or being on your side. Those may work best, but really there's nothing that's off limits. So I suggest that you have conversations about, Hey, this is what feels good, what doesn't feel good? Because things may change during pregnancy.

(23:12):

Now, some other things that you may notice is that you may experience contractions during orgasm. That's totally normal. They're usually mild and they subside quickly and you also may have very light spotting after sex because the cervix is more sensitive and when something hits up against it, it may bleed a little bit. That should be very mild and subside quickly. You can always call your doctor if you have any questions or concerns. One of the most common questions we'll ask if someone has vaginal bleeding is have you had sex in the last 24 hours or so? Because that's often what it's from.

(23:47):

Now as far as sex later in pregnancy, stimulating labor, data's pretty mixed. Some studies say it does. A lot of studies say it doesn't, so it's not going to hurt in terms of advice on how to start labor. Oh, and I'll let you know what, let me say that was mostly talking about vaginal penetration. I will also say that oral sex is fine. Anal sex is fine as well. You can continue to do those things in pregnancy as long as your pregnancy is going along normal and your doctor hasn't given you any specific restrictions. Now there are some circumstances where you absolutely should not have sex. So if you are at risk for miscarriage and you have a history, a lot of miscarriages, then we often say like delay until you get out of the first trimester. So we know things are a little more stable and we're not messing with anything.

(24:38):

If you have had preterm cervical dilation where your cervix has dilated early before 37 weeks or you have been treated for preterm labor, then you need to avoid sex during that time. If you have vaginal bleeding and we don't know what the cause is, then you need to abstain from sex. Once your water is broken, you know you have preterm rupture of membranes, then no sex. And then finally there are some issues with your placenta where you shouldn't have sex. The placenta is very vascular, it's a ton of blood goes through it every single minute. It's what does all the work between you and your baby and the transfer of oxygen and nutrients and getting rid of waste.

(25:26):

And if the placenta is close to the opening of the cervix, something called a low lying placenta, which is where it's near the opening of the cervix or a placenta previa where it's over the opening of the cervix, then sex can irritate the placenta and cause significant bleeding that can be threatening for your baby. So in that instance you should not have sex. And then again, if there are any other circumstances where your doctor says that it's not appropriate, but withstanding those things, if your pregnancy is normal, healthy, your doctor hasn't given any restrictions, then vaginal, oral, anal sex are all perfectly fine and normal.

(26:06):

All right. The last thing I want to leave you with, and maybe it feels a little bit weird to transition from talking about sex to some advice from my two daughters. As I said in the beginning, as I had up notes for the episode, I had some stuff on my computer and I walked away from my computer and them being the technological wizards that they are know how to record stuff and they recorded like six, eight minutes of stuff. But I took a little snippet of it out and this is their advice on what to do if you feel tired during pregnancy.

(26:44):

Okay. Our next question, well, it's not really a question this time, it's more of a statement. So it says, I'm so tired I can't do anything. Don't worry. When I first started out, I was so tired. I couldn't even do my work without getting so distracted and almost falling asleep. Well, the only thing to solve this problem is to sleep. Yeah. That she just put it straight out there. You just have to start sleeping more.

(27:20):

All right. All right. All right. I hope you found that clip useful. So we are at the end of this week's episode, and just to recap, if you can avoid sleeping on your back, do so, but do not stress about it. If you find that you end up on your back during your sleep, just turn over to your side and go back to sleep. You want to avoid deli meats, hot dogs, cold cuts, all of that stuff, unless it's heated to where it's steaming. And you also want to avoid unpasteurized cheese to avoid listeriosis. A cup of coffee a day is okay during pregnancy, it does not appear to increase the risk of miscarriage or preterm birth. If you can get someone else to change the kitty litter, then do so, but the risk is low. So if you have to do it, just take appropriate hygienic precautions. Sex during pregnancy is perfectly safe as long as your pregnancy is going along normal. And if you are tired, the advice from my daughters is just get yourself some sleep. And when in doubt there's also this one last piece of advice from my two little cohosts today and that is basically the main thing to take from this is to just talk to your doctor. Okay.

(28:34):

All right, so that is it for this episode of the podcast. Be sure to subscribe to the podcast in Apple podcasts or Spotify or wherever you listen to podcasts. And please do me a favor and leave me a review in Apple podcast. Number one, of course, I love, love, love, love, love to hear what you have to say about the show. And it also helps this show to really grow and helps more women to find the show when you leave reviews. And I love to leave shout outs and give shout outs on the podcast, so leave me that review in Apple podcast. I would be most, most, most appreciative.

(29:10):

Also, don't forget to check out The Birth Preparation Course. The Birth Preparation Course will ensure you are knowledgeable, prepared, confident and empowered for your birth. Remember there's a 30 day money back guarantee, so if you're not happy with it, you can get a full refund within 30 days. You can go to www.ncrcoaching.com/enroll to check out all the details of all the great stuff you'll learn in the course. It's all online. You can go through it at your own pace on your own time. So definitely check that out. Next week on the episode we have a birth story episode, so do come on back next week and until then I wish you a healthy and happy pregnancy and birth.

(29:54):

Thanks so much for listening to this episode of the All About Pregnancy & Birth podcast. Head to my website at www.ncrcoaching.com to get even more great info, including free downloadable resources on how to manage pain in labor and warning signs to look out for after birth. You'll also find information on my free online class on how to make a birth plan, as well as everything you need to know about The Birth Preparation Course. Again, that's www.ncrcoaching.com and I will see you next week.

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