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Pregnancy Cravings…on the Wild Side

While not a common side effect of pregnancy, cravings for non-food items are neither unheard of nor surprising. The desire to eat ice, chalk, dirt, ashes, starch, soap – even matches – is called pica. 

If this happens to you, don’t panic. We see patients many times who are too embarrassed or afraid to admit they have these cravings. It’s a real concern, and it’s important to discuss your symptoms and the specific items you’re craving with your physician or provider.  Together, we’ll work to stop this eating disorder as soon as possible so you don’t wind up with a serious health issue.

Risks associated with pica include intestinal blockage, malnutrition, toxicity, and weight gain. When eaten, earth, clay or other non-digestible substances can collect in your bowels and make it difficult or even impossible to expel. If your cravings are for bulkier items, ruptured intestines are a possibility. The items you ingest may contain parasites, chemicals or toxins that could harm the fetus as well as your own body. And, these substances, or what’s in them, can interfere with your body’s ability to absorb the nutrients in the healthy foods you’re eating. Depending on what you’re consuming (corn starch is full of empty calories), you could even gain weight.

Your doctor will check your iron level to ensure you don’t have an iron deficiency. He or she may prescribe an iron pill or potentially iron infusion to get you back on track. It may also be suggested that you increase the protein or iron-enriched foods you are eating each day. Adding a vitamin C supplement in between meals might help as well. If there is a deficiency in your diet, your doctor will recommend you eat plenty of low-fat protein, complex carbohydrates, and fresh fruits and vegetables daily. He or she may even prescribe some counseling sessions from a therapist or dietitian.

While there is no definitive reason for the cause of pica, it’s suspected that it could be physical, psychological, cultural, and even a learned behavior. If you have unusual cravings, don’t justify them by saying your baby is hungry for what you are craving. Talk to your doctor, and he or she will help you decide what to do next.

Ginny Wolf is a registered dietitian with the WakeMed Diabetes Program.

New WakeMed Women’s Hospital Opening May 2015
We’re counting down the weeks until the May 2015 grand opening of Wake County’s fifth full-service hospital, WakeMed North Family Health & Women’s Hospital. WakeMed North Healthplex at 10000 Falls of Neuse Road in Raleigh is currently being transformed into a 248,800-sq. ft., full-service women’s hospital designed with the unique needs of women in mind. It will feature a tranquil environment as well as amenities tailored to our patients’ needs. This includes spacious and comfortable labor and delivery rooms. Learn more.

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Happy, Happy Baby Story

We are pleased to share that WakeMed has become the first hospital in the U.S. to successfully correct esophageal atresia – a rare condition in which a baby is born without part of his or her esophagus – without surgery. Traditionally, this condition is corrected by a difficult surgery, requiring lengthy hospitalization and an extensive recovery process. This non-invasive, breakthrough procedure was performed at Raleigh Campus last week on a seven-week-old baby girl who has been a patient in the NICU since birth.

Led by pediatric surgeon David Hoover, MD, a team of WakeMed’s interventional radiologists, neonatologists and others were able to use magnets placed by a catheter to repair the patient’s esophagus. The procedure, which was developed at the University of Chicago Medicine, was a complete success and thanks to the exceptional work of the WakeMed team, this baby girl who had been unable to swallow for the first seven weeks of her life is now eating normally and almost ready to go home.

Watch the story on WRAL.

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Pregnant Women Beware of a Different Kind of Labor Pain

As a midwife, I understand the labor pains pregnant women face nowadays. Hormones are raging, they are not getting enough sleep, and their bodies are changing.  It’s normal to experience sensory overload, but sometimes pregnant women feel pain and discomfort that has nothing to do with the actual baby. They might be hurt by comments made by those closest to them or even by strangers.

It’s a funny thing, when people see a pregnant woman…their verbal filters and personal barriers magically disappear. Everyone becomes an expert – or a comedian.  So, here is what I tell my pregnant patients to be aware of when it comes to facing the world:

1. The Baby Babble: Don’t be surprised if people ask you some inappropriate questions such as “Do you know who the daddy is?” or “Are you carrying twins in there?”  or “I can’t believe you’re still here at work. You’re huge!”  And don’t read too much into a well-intentioned compliment about how small you look. It doesn’t mean something is wrong with your baby. When you’re pregnant, people often wind up babbling and putting a foot in their mouth. They will share their childbirth experience with you whether it was wonderful or difficult. They will offer you opinions on whether you should have a natural birth or C-section.  This is your experience, and you know what’s best for you. If you have questions, talk with your healthcare provider.

2. The Grocery Store Grab: Strangers grab your stomach to feel the baby kick – “Um, hello? You’re touching ME, not my baby!”  Don’t be afraid to back up, turn away or respond with a comment such as, “I’m sorry, but please don’t touch. The baby’s ticklish.”

For those people around a pregnant woman, the best advice I can give: support her in any way you can with positive encouragement and help.  You know she can’t bend over, so help with some chores around the house. If she’s a stranger at a store, ask her if you can help her with her bags or get something off a shelf.  If she is past the morning sickness, deliver a healthy meal for her family. But most importantly be kind and remember, there is really only ONE thing to say to a pregnant woman… “YOU LOOK FABULOUS!”

Julie Stembridge, RN, MSN, CNM, is a certified nurse midwife with WakeMed Physician Practices – Women’s Center.

New WakeMed Women’s Hospital Opening May 2015
We’re counting down the weeks until the May 2015 grand opening of Wake County’s fifth full-service hospital, WakeMed North Family Health & Women’s Hospital. WakeMed North Healthplex at 10000 Falls of Neuse Road in Raleigh is currently being transformed into a 248,800-sq. ft., full-service women’s hospital designed with the unique needs of women in mind. It will feature a tranquil environment as well as amenities tailored to our patients’ needs. This includes spacious and comfortable labor and delivery rooms. Learn more.

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Pregnancy & Heart Trouble

When a typically healthy pregnant woman is asked about her heart, she is probably only thinking about it being full of love for her unborn baby.  However, pregnancy can cause cardiac problems for some women, and Dr. Sahar Amery of WakeMed Physician Practices – Raleigh Cardiology helps us learn more.  Dr. Amery is skilled in evaluating and treating women who experience heart trouble during pregnancy.

What Causes Heart Trouble during Pregnancy?
During pregnancy, the heart is impacted by the excess weight and fluid carried by a woman’s body as well as hormonal changes.  All of these factors are potential precursors to certain cardiac issues.

Know the Symptoms
Symptoms of discomfort that may be part of the normal pregnancy can also be related to potential cardiac conditions, including:

  • Easy fatigability
  • Shortness of breath
  • Chest pain
  • Rapid heart beat
  • Overly swollen feet and ankles

Most of the time, these symptoms are benign, however, talk to your OB/GYN openly about what you are feeling.  If there are concerns, he or she will refer you to a cardiologist for further evaluation. 

Common Cardiac Issues for Pregnant Women
The most common cardiac-related problems faced by pregnant women include:

  • Heart palpitations: Racing heart
  • Shortness of breath: Sometimes an underlying cause of heart failure
  • High blood pressure: Blood pressure reaches greater than 140/90 mm Hg
  • Peripartum or Postpartum cardiomyopathy: The heart weakens and cannot pump enough blood to support the body (occurs during pregnancy or right after delivery)
  • Supraventricular Tachycardia (SVT): Abnormally fast heart beat

The prognosis is good for most of these conditions.  However, medication, follow-up, a healthy diet, exercise and the avoidance of caffeine are often indicated. 

What to Expect from the Cardiologist Appointment
If you are referred to a cardiologist as a pregnant woman, you can expect a physical exam and a comprehensive review of your health history and symptoms.  In some cases, you may undergo additional diagnostic testing to identify potential cardiac problems that could be causing your discomfort. This testing will help the cardiologist determine if you have a heart condition and what treatment plan is needed.

Who’s at Risk?
While women with obesity are at a greater risk for heart complications during pregnancy, any healthy pregnant woman could develop symptoms.  Therefore, being aware of your heart health and open communication with your doctor will help ensure the delivery of a happy, healthy baby. 

Dr. Amery sees patients at WPP-Raleigh Cardiology on the WakeMed Raleigh Campus and at the WakeMed North Campus, where the WakeMed North Family Health & Women’s Hospital will open in May 2015.

New WakeMed Women’s Hospital Opening May 2015
We’re counting down the weeks until the May 2015 grand opening of Wake County’s fifth full-service hospital, WakeMed North Family Health & Women’s Hospital. WakeMed North Healthplex at 10000 Falls of Neuse Road in Raleigh is currently being transformed into a 248,800-sq. ft., full-service women’s hospital designed with the unique needs of women in mind. It will feature a tranquil environment as well as amenities tailored to our patients’ needs. This includes spacious and comfortable labor and delivery rooms. Learn more.

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Are Women Athletes More Likely to Tear their ACL?

It is true that we see an increasing number of knee injuries in female athletes, especially in those who participate in basketball, soccer and volleyball. The ACL is one of the four major ligaments of the knee and acts as a stabilizer between the thigh (femur) and the shin (tibia), restraining forward motion of the shin.

Females who perform jumping, cutting and pivoting sports are 3 to 8 times more likely to tear the ACL than their male counterparts. The majority of ACL injuries occur without contact or a direct blow. Athletes often report landing awkwardly and the sensation of the knee giving out with an associated “pop”. When there is significant knee pain and swelling after this type of sports injury, there is a 75% chance the ACL has been torn. 

Females have multiple unique factors that increase their risk for ACL tears. Women have weaker hamstrings relative to their quadriceps muscles, which may affect the knee stability and the stress on the ACL. Other theories include differences in anatomy and hormones. Some studies have indicated that a female’s body mechanics move differently than males. For instance females jump and land with the hip and knee less flexed than males. Research has shown that specialized training programs in female athletes that focus on these factors will significantly reduce the risk of ACL tears. Conditioning and training are the keys to preventing ACL injuries. In general, all athletes should:

  • Always warm up correctly before playing sports or working out – especially stretching the hamstrings, quadriceps, calves and hip flexors.
  • Strengthen leg and core muscles with correct techniques.
  • Add speed and flexibility training to your program.
  • Learn proper landing, pivoting and jumping techniques.
  • Cross-train between sports and allow time for rest to avoid overuse injuries.
  • Contact an Orthopaedic Sports Medicine Doctor or Physical Therapist for further assistance.

Dr. Mark Wood is an orthopedist at Wake Orthopaedics who specializes in sports medicine.

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New Ronald McDonald House Opening on Raleigh Campus

Since the opening of the Children’s Hospital in 2010, we have been working with the Ronald McDonald House of Durham to provide a Family Room for Children’s Hospital families.  This room has been a respite for hundreds of families over the past five years, offering a private, relaxing space to help them endure stressful situations. 

The room is staffed with volunteers and is open from 9 am to 9 pm every day.  Household amenities like  a microwave, TV, computer and  washer/dryer have benefited our families who often stay in the hospital 24 hours a day, 7 days a week supporting a sick child or infant. 

Now, we are pleased to announce an expanded collaboration with the Ronald McDonald House of Durham.  Beginning April 15, families of the Children’s Hospital and the Neonatal Intensive Care Nursery patients will have access to five bedrooms located on the third floor of the Heart Center. 

“We care for thousands of babies and children each year at our Children’s Hospital, and as the only pediatric inpatient care provider and level IV Neonatal Intensive Care unit in Wake County, we are committed to providing the highest level of care for our young patients as well as much-needed support and resources for our families,” said Mark Piehl, MD, medical director of the WakeMed Children’s Hospital. “Our collaboration with the Ronald McDonald House of Durham is an amazing support system for our patients and their families, and this new house program is a great next step in our expanded partnership.”

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Seven Tips to Deal with Baby Backache

Probably the biggest symptom my pregnant patients complain about is the achy back, otherwise known as “baby backache.”  And it’s certainly understandable why.  Your body is gaining weight, mostly in the front, and preparing for childbirth. Those pesky hormones, estrogen and progesterone, are relaxing your joints and softening muscles. 

Just because a backache is normal, it’s important to discuss your symptoms with your healthcare provider. The first thing we’ll do is rule out a bladder infection, preterm labor, muscle injury and other problems. If need be, we can prescribe Tylenol. But there are other things that will help.
 
#1 – Stay hydrated. Your body is made up of about 60 percent water, so drinking water is especially important while you’re going through these changes. About six to eight glasses are all you need.  If you are retaining water and have swelling in your feet and hands, don’t stop drinking water. Talk with your provider.
 
#2 – Improve your posture. Most of us slouch over a computer, hunch over in chairs, and don’t make a conscious effort to stand or sit straight when we aren’t pregnant. When you’re pregnant, this can easily lead to back pain. Watch your posture throughout the day – while sitting, sleeping, standing, walking and driving.
 
#3 – Exercise. We need 30 to 60 minutes of exercise most days of the week for a healthy heart.  This makes for a healthy you and a healthy pregnancy. Exercise will release endorphins, elevate your mood and alleviate signs of depression.
 
#4 – Support your back. Your provider may suggest a maternity belt for back pain or physical therapy so you can learn how to keep your muscles strong and your back huting less.
 
#5 – Watch your weight.  Your healthcare provider has given you guidelines on how much weight is appropriate for you to gain based on your body frame and overall health. Following his or her advice will lead to a healthier, happier pregnancy and reduce the risk of having a cesarean section.
 
#6 – Wear low-heeled shoes. Not only will this help improve your posture, but wearing low heeled shoes lowers your center of gravity and keeps you safer while you walk. As your body changes, you’ll have to learn to balance going down stairs and other hard-to-maneuver places.
 
#7 – Warm baths. Warm baths are a great way to relax and get comfortable. Be sure your tub is outfitted with a suitable bath mat or non-slip strips placed inside. You may even find a shower gripper bar especially useful.
 
And an added bonus… ask your partner for a massage!

New WakeMed Women’s Hospital Opening May 2015
We’re counting down the weeks until the May 2015 grand opening of Wake County’s fifth full-service hospital, WakeMed North Family Health & Women’s Hospital. WakeMed North Healthplex at 10000 Falls of Neuse Road in Raleigh is currently being transformed into a 248,800-sq. ft., full-service women’s hospital designed with the unique needs of women in mind. It will feature a tranquil environment as well as amenities tailored to our patients’ needs. This includes spacious and comfortable labor and delivery rooms. Learn more.

Sharon Varner, RN, MSN, CNM, is a certified nurse midwife with WakeMed Physician Practices – Women’s Center.

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Preparing for a Marathon

In many ways, preparing for a marathon or a half marathon is the same as preparing for a 5K or 10K.  When getting ready for any running event, the focus is always on hydration and nutrition.  The difference comes in when you start prepping and what and how much you eat.  The reasoning is simple; the longer the race the earlier you need to start preparing and adding in the right kind of calories.

What to do before a marathon:
Hydrate:
  Three to four days before a race, begin adding two to four cups more water per day than you would normally drink.  In total, men need to consume approximately 13 cups per day and women need to consume 9 cups per day when preparing for a long run. 

Being dehydrated at the start of a race can lead to poor performance, so carry that water bottle with you everywhere you go in the days leading up to the race.  It’s probably also a good idea to limit drinks that will dehydrate you like caffeinated soda, coffee and alcohol. 

About four hours before the marathon start, drink an additional one to two cups of water every hour until one hour prior to the race  and then another cup 15 minutes before the race start.

Eat: If you’re able, eat a full meal of low glycemic index carbohydrates, protein and fat (i.e, oatmeal and eggs) about 3 to 4 hours before the race start.  In the 15 to 30 minutes right before the race, eat something light like peanut butter or a piece of fruit that will give you a boost of energy and stick with you but will not weigh you down.

During the marathon:
Hydrate: Take advantage of those water stations!  During the race, be sure to hydrate every 15 to 30 minutes with water, sports drink or a carbohydrate source (at least 25 grams). 

Listen to Your Body: Spring in Raleigh means warmer temperatures and often pollen!  These two factors can put even the most fine-tuned body under additional respiratory stress.  If at any time you feel dizzy, have cramps, are nauseous or feel faint slow down to a stop and take a break.  And, never be embarrassed to try intervals of jogging and walking.

After the marathon:
Hydrate:
After the race, you’ll want to replace the fluid you sweated out during the race, so be sure to drink plenty of water. You may also want to consider drinking a sports drink like Gatorade.

Eat: Ingest a snack that has a 3 to 1 carbohydrate to protein ratio that will get into your system quickly (i.e., bagel with cream cheese, fruit and peanut butter).  Bananas and apples also help you replenish your electrolytes.  Every 1 to 2 hours after the race, you’ll want to continue eating mixed meals with a 3 to 1 or 4 to 1 carbohydrate to protein ratio to replenish your body.

Celebrate: Running a marathon or a half marathon is no small feat.  Make sure to take some time to celebrate your accomplishments!

Hailee Wingfield, MA, CISSN, ACSM EP-C, GFI, AHC, is a Fitness Specialist with WakeMed Healthworks.

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“Baby Maybe?” Seminar Helps Curious Couples Learn More

Thinking about having a baby?  Starting or expanding your family is a big decision. There are so many things to consider. So, where do you start?

During this FREE health seminar, hear from our expert physicians in the field of pregnancy and child birth, and learn more about preconception planning, prenatal health, fertility, diet and fitness, what to expect during pregnancy and child birth, and more. They will answer your questions and help prepare you mentally and physically for this important decision.

Tuesday, April 21
6 to 7:30 pm – Dinner Discussion
North Ridge Country Club
6612 Falls of Neuse Road, Raleigh

Our physician experts will include:


Karen Bash, MD
OB/GYN, WakeMed Physician Practices

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Amantia Kennedy, MD
OB/GYN, WakeMed Physician Practices

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Avick Mitra, MD
Maternal-Fetal Medicine Specialist, WakeMed Physician Practices 

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Registration is required. Learn more.

This seminar is brought to you by the women’s hospital at WakeMed North, opening May 2015. Learn more and follow our progress.

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Healthy Weight Gain in Pregnancy

A patient once asked me if she could eat a piece of chocolate every day while she was pregnant. At about 75 calories each for a Lindt chocolate truffle, well, technically she could.

The key to a healthy pregnancy is exercise and nutritious eating… there’s no surprise there. But there is also a third factor to consider – metabolism – over which you really have no control.

Women of all shapes and sizes have different experiences when they are pregnant. On average, a pregnant woman only needs about 300 extra calories a day.

A balanced diet includes about 5 to 6 ounces of protein, 6 to 8 servings of whole grains (1/3 c to ½ cup); 2 to 3 servings of fruits, 2 to 3 servings of vegetables and 2 to 3 cups of milk. While too much fat can cause heart disease and other health problems, it’s essential to your intestinal function. Olive oil – no more than 2 tablespoons each day – is the best option.

Pregnant women need fiber – about 25 to 35 grams each day – to stay regular and reduce the chance of hemorrhoids. Good sources of fiber include whole grains, beans, fruits and vegetables. Add calcium every day with low-fat dairy products such as 1% milk, yogurt and low-fat cheeses. Keep in mind that intestinal gas and bloating are also common with pregnancy, so you may want to find less gassy foods to reduce discomfort.

Dark, leafy green vegetables are a good choice because they have natural vitamins such as A, B, C, K and folic acid. Salmon is also a great source of omega-3 fatty acids. And if you must have that chocolate truffle, buy the darkest chocolate with the least amount of sugar for antioxidant benefits.

Overall weight gain depends on your frame and size before pregnancy. Healthcare providers generally recommend a person who is underweight should gain between 28 to 40 pounds; a person at average weight, 25 to 35 pounds; and overweight, only 15 to 25 pounds throughout the pregnancy. Managing the weight gain is especially important to minimize risks of gestational diabetes or cesarean section, for example. Guidelines we use for weight gain are as follows:

  • Underweight: 20 to 40 pounds
  • Normal weight: 25-35 pounds
  • Overweight: 15-25 pounds
  • Obese: 11-20 pounds

Everyone is different, and there is no magic number. The most sound advice is to stay as balanced as possible and talk with your healthcare provider when you have specific questions.

New WakeMed Women’s Hospital Opening May 2015
We’re counting down the weeks until the May 2015 grand opening of Wake County’s fifth full-service hospital, WakeMed North Family Health & Women’s Hospital. WakeMed North Healthplex at 10000 Falls of Neuse Road in Raleigh is currently being transformed into a 248,800-sq. ft., full-service women’s hospital designed with the unique needs of women in mind. It will feature a tranquil environment as well as amenities tailored to our patients’ needs. This includes spacious and comfortable labor and delivery rooms. Learn more.

Ginny Wolf is a registered dietitian with the WakeMed Diabetes Program.

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