Last Resort: Oral Contraceptives as Emergency Contraception

OCP 2Dear Dr. Mo: What if I needed an emergency contraception and didn’t have it (couldn’t get it) – would a regular pill do the trick?

Dear reader: Even though I don’t recommend this as a contraceptive practice of choice, the answer is Yes.

Any Oral Contraceptive Pill can, in principle, be used as an Emergency Postcoital Contraception (EPC) as long as it contains a certain amount of estrogen hormone; the required amount is 200 μg of ethinyl estradiol (usually 20 – 35 μg of ethinyl estradiol per tablet but it may vary – read the composition label) – take the number of tablets to amount to 200 μg, then repeat in 12 hours. Continue reading

Baby’s first breaths and what you didn’t know about her first cries

Dear Dr. Mo: I’ve read your post on C-section and I wanted to know more about what you’ve said were risks for ‘increased respiratory problems of the newborn’ with C-section delivery. Also, why do babies always cry when they’re born?

Oxygen isn't just explosive - it burns

Oxygen isn’t just explosive – it burns

Dear reader: Your questions about newborn’s breathing at the instant of birth and crying are important and could prompt a very technical answer, which I will try to avoid here.

Let’s just imagine a baby floating in water for 9 months – this is the baby’s natural environment in the womb. The baby doesn’t breathe the way she will breathe after birth and so the water fills up her lungs. The natural act of birth is so important because the birth canal through which the baby is traveling pushes on the baby and squeezes out that fluid (almost all of it) from the lungs and compresses the lungs so much that at the instant both of baby’s shoulders are delivered, the lungs automatically and involuntarily inflate taking that first and only passive breath the baby will ever take. Every following breath, for the rest of her life will be active breathing effort.

So you see, if this natural pathway of delivery is circumvented via C-section, the baby’s lungs don’t have the assistance to expel the fluid out and the newborn may have some problems with breathing in the first few hours – this manifests itself as a very rapid breathing called tachipnea and it’s in most cases transient. Sometimes though, more serious breathing problems can occur and if this rapid breathing does not go away within 4 hours, we always have to rule out sepsis as the most dangerous complication.

Now about that crying, there’s a myth here to debunk: Continue reading

Cesarean versus vaginal delivery – which to go for and why?

Dear Dr. Mo: I’m due soon and I’ve been considering to ask for a cesarean birth – what would you medically recommend a woman should go for, normal or cesarean?

No matter how you deliver, this is your future

No matter how you deliver, this is your future

Dear reader: What you are considering is what we term a Cesarean delivery (C-section) on maternal request, in which case you would undergo a planned C-section delivery before the natural onset of labor, without you or your baby really medically needing it and in such scenarios, I tend to advise against it.

But here’s the thing:

The reality is that there’s no good evidence to facilitate a textbook counselling in this case and most of the available data comparing the two delivery routes (planned C-section versus planned vaginal delivery or what you refer to as ‘normal’) is weak and ought to be interpreted cautiously.

Things to consider:

When you desire a cesarean delivery, your doctor should consider your specific (risk) factors, such as age, body mass index (i.e. if you’ve gained a lot of pregnancy weight, any surgery is more risky), accuracy of estimated gestational age (i.e. C-section on maternal request should not be performed before a gestational age of 39 weeks which is full term), reproductive plans for the future, personal values, and cultural context. I know that sometimes, some past experiences (e.g, violence, trauma, or poor obstetric outcomes) and anxiety about the whole birth process may be what’s prompting such requests and if any of these are what concerns you, bring it up with your doctor.

If your main worry is pain during delivery, then prenatal childbirth education, emotional support in labor (i.e. your partner or someone else close to you could attend), and anesthesia for childbirth (epidural) should be offered and could eliminate this issue entirely. Continue reading

The great health benefits of spinach and why Popeye the Sailor was wrong

Popeye was wrong, well, sort of..

Popeye was wrong, well, sort of..

Dear readers: Spinach is one of those foods we should always have in mind when we’re planning a healthy meal – it’s just that good! In fact it is one of the healthiest leafy greens around – and it’s actually not so much for its iron content although that’s likely to be your first association.

Popeye the Sailor has been eating tones of it for decades but what works for him is not really what works for the rest of us, at least when iron is concerned.

Spinach has a high nutritional value and that’s beyond any doubt. It is very rich in antioxidants, it is a rich source of vitamin A (particularly high in lutein, which is very good for the eyes), vitamin C, E, K, B and magnesium.

Spinach is also a rich source of Folate, which is an essential ingredient for our cells and is especially important for pregnant women and those trying to conceive. However, boiling it can more than halve the Folate content while microwaving it doesn’t seem to have such an effect.

Folate aside, boiling spinach actually increases its nutritional value several times as it helps our body use the nutrients more effectively.

A compound in spinach called oxalate prevents iron and calcium from being absorbed into our body. In case of calcium, even though spinach has a high calcium content, its absorption is decreased by oxalate to only around 5% so don’t count on it too much.

Similar goes for iron – oxalate both reduces the absorption and flushes it out of our intestines. Boiling is a good way to get rid of some oxalate content and for this purpose you should boil it for at least 2 minutes. Another way is to eat a vitamin C rich food together with spinach to help deactivate oxalate. Continue reading

Artificial sweeteners – what are they, are there risks and what are the possible benefits?

Dear Dr. Mo: What exactly are the artificial sweeteners and what are their pros and cons? 

Jellies often contain artificial sweeteners

Jellies often contain artificial sweeteners

Dear reader: Artificial sweeteners are sugar substitutes, usually synthetic , but may also come from naturally occurring substances like herbs or sugar itself (like sucralose, which is derived from sugar).

These sweeteners are many times sweeter than table sugar and this is why they are intense sweeteners. Continue reading

Herbal infusions during pregnancy – are they safe?

Dear Dr. Mo: What is the deal with other teas – not relating to caffeine? I’ve heard pregnant women shouldn’t drink chamomile tea…? I thought ‘herbs’ were generally healthy and a desirable component.

Dear reader: During pregnancy, many women choose herbal infusions instead of caffeinated drinks. Most of these choices are perfectly fine.
I would always advise to stay away from herbs and supplements of any sort during the first trimester, while the fetus is particularly vulnerable; but even during this sensitive period, one or two cups of herbal teas now and then (even daily) are so moderate an amount that any harm is virtually impossible.

Herbal infusions are generally safe during pregnancy

I would generally stay away from herbal infusions, which contain some additional supplements (such as Ginseng) as these are of unknown action on the fetus and are not undergoing sanction and approval by regulatory bodies. Choose pure herbal teas with nothing added.

The talk about herbs that may concern you is that some may help induce a certain level of uterine contraction so I’d stay away from herbs such as black or blue cohosh. Also avoid herbal infusions with known pharmacological actions that are intense and aggressive on your body and generally unhealthy like Sena leaves.

Chamomile infusion is fine and safe to drink in moderation – stay within a few cups a day but not liters of it. Continue reading

Green tea and breast feeding

Dear Dr. Mo: Is green tea safe during breast-feeding?

Dear reader: While drinking green tea is generally considered safe and beneficial to health, due to its polyphenol content, it is important to note that it also contains 2 – 4% of caffeine, which could affect some people more than others.

What this means is that 2 cups of green tea provide about 200 mg of caffeine.

Green tea is generally safe and healthy

In some people caffeine can cause side effects that may range from mild to severe and include restlessness and nervousness, headache, sleep problems, irregular heartbeat, heartburn, tremor, dizziness, confusion and so on. These side effects in most people would be possible if too much green tea is taken each day – more than 5 cups – but even this is very individual and responses vary.
If other sources of caffeine are consumed as well (coffee, energy drinks, some sodas, weight loss supplements etc.) the effects compound and could aggravate the symptoms of caffeine overdose.
Alcohol consumption can decrease how quickly the body breaks down caffeine and increase its presence in the blood, adding to its (side)effects. Continue reading

How to recover from a Caesarean (C) section?

Dear Dr. Mo: How to recover from a Cesarean section?

Dear reader: It is important to know that, after any surgery, the recovery is done in stages, it is gradual and it takes some time and effort but in the end, all was worth it.

After an intensive care unit (ICU) in which you are taken immediately after surgery to wear off the anesthetic and to wake up (length of time spent there varies, depending on the type of anesthesia, its intended duration and complexity of your surgery) while being closely monitored for vital signs and for uterus firmness and possible bleeding from the uterus (it should contract down – this could be painful), you are moved to your room – usually after a couple of hours. In it you spend the rest of the hospital recovery and there you usually have your first contact with the baby.


Recovery may be painful but it will happen

The best word of advice I can give to anyone recovering from a Caesarian section (C section) is to begin to move as soon as possible. This movement you can start while still in ICU with breathing – as simple as it may sound, it is not – taking deep breaths could be difficult and this little exercise should be undertaken as early on as possible and as frequently as possible.

Once in your room, you may still be hooked up to some equipment like the I.V. drip, blood pressure monitor, you may still have your catheter inserted although it is removed early in the recovery process.
Your intestines need to start working again and until that happens, the I.V. line will likely remain. You will know when they re-start – you will hear and feel the sounds of deep rumble and should start passing gas (this may cause some pain as the gas build up stretches the intestines). All this is good development and albeit somewhat painful, it is an important event and most of us are relieved when it occurs.
Avoid cold, hot and carbonated drinks as they could worsen the gas issue. Continue reading

Constipation during pregnancy – what happens and what to do?

Dear Dr. Mo: What to do for constipation during pregnancy?

Fresh fruits and vegetables are among the best remedies for constipation.
I took this photo on an Adriatic island of Vis last summer

Dear reader: Constipation (infrequent bowel movements or having difficulty in passing stools – waste  products of digestion), is a common gastrointestinal problem and also a common complaint in pregnancy, usually affecting women during the first and/or last trimester of the pregnancy.

Normally, food is passing through intestines via muscle contractions, which slowly push it in the forward direction. In the colon (the large intestine), most of the water and salt content from digested material is reabsorbed into the body and this process is essential for keeping our bodily functions balanced and normal.

First of all, what’s considered ‘normal’ frequency for passing stools varies widely. You’ve probably heard that ‘only every day is good enough’ and this would be an ideal case but in general, let me tell you that one is probably experiencing constipation if one passes fewer than three stools a week, and these stools are hard and dry. This can happen for any number of reasons, most commonly when there is not enough fluid or fiber-rich food in a diet or the colon muscle contractions are slow and/or uncoordinated.
Continue reading