sexual health & family planning MAY/JUNE 2017
May/June 2017 ~ living well
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MAY/JUNE 2017 VOL. 41
IN THIS ISSUE SEXUAL HEALTH & FAMILY PLANNING
BIRTH CONTROL what is right for you
Page 4
ALSO IN THIS ISSUE
DO I STILL NEED
WAITING FOR THE GLOW
birth control
PREPARING for pregnancy
first tri blues
Page 6
Page 10
Page 12
HEALTHY TIPS Page 14
Also
DON’T HATE YOUR SPOUSE Page 16
SHARING NEWS OF A MISCARRIAGE
BLUEBERRIES Page 17
Page 18
May/June 2017 ~ living well
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What birth control is right for you? MAYO CLINIC NEWS NETWORK Choosing a method of birth control can be difficult. You need to know the options and how to pick the type of contraception that’s right for you and your partner. Some of the most commonly used methods are a combination of birth control pills and condoms. Sterilization can be a choice if you’re sure you don’t want to have children in the future. But there are still a number of other options to consider.
WHAT BIRTH CONTROL IS RIGHT FOR YOU?
There are many different options available to help prevent pregnancy. The most commonly known methods include condoms, birth control pills and getting your tubes tied. However, several other choices are available. Each option has differences that can make it either the right or wrong choice for you. In order to help decide what method is best for you, consider what your plans are for having children in the future, if you will remember to take a pill at the same time every day, or if you are OK with having a birth control device within your body. No decision is right or wrong. The best choice is the decision that is best for you.
BIRTH CONTROL PILLS
Birth control pills are not all the same. They come with different hormones (estrogen and progesterone or progesterone alone) and can affect your periods differently. Pills containing estrogen can increase your risk for blood clots in the legs and lungs and should not be used if you are more likely to develop these conditions. Conventional birth control pills contain both estrogen and progesterone. The NuvaRing and OrthoEvra patch also contain these hormones and work similarly to conventional birth control pills. The advantage of the NuvaRing or OrthoEvra is that you don’t need to remember to take a pill every day. If you take birth control pills, the NuvaRing, or OrthoEvra in the
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conventional manner, you will have a period every month. Alternatively, you can take birth control pills in a continuous manner. This means that you take a pill containing hormones every day. When using birth control pills continuously, you may not have any period, or may have if only four times a year.
CONTRACEPTIVE INJECTION
An injection of progesterone (Depo-Provera) can also serve as an effective method of birth control. It lasts for three months. You need to visit a nurse every three months to continue receiving the injection. After stopping the DepoProvera, it may take some time before your periods become normal and you are able to get pregnant.
LONG-ACTING REVERSIBLE NTRACEPTIVES
Long-acting reversible contraceptives (LARCs) provide you with effective birth control for several years. They are great options if you know you want to be pregnant eventually, but not anytime soon. LARCs don’t require you to take a pill every day and can easily be placed in your doctor’s office. When it is time for your LARC to be removed or you want to get pregnant, it simply can be removed in the office as well. You can get pregnant soon after removing your LARC. Intrauterine devices (IUD) (Mirena, Skyla, Kyleena, Liletta, ParaGard) are T-shaped and are inserted into the uterus. A pelvic exam is required for the placement of your IUD. The ParaGard is hormone-free and effective for 10 years. The remaining IUDs have progesterone and are effective for three to five years. The progesterone can affect your period, often resulting in lighter and less painful bleeding. A contraceptive implant (Nexplanon) also can be placed under the skin in your arm. This is effective for three years and does not require a pelvic exam. It contains progesterone and can cause your periods to become lighter.
NATURAL FAMILY PLANNING
Use of the rhythm method, checking your cervical mucus, and testing your temperature when you first wake up can be used to help predict when you ovulate. This is the time that you want to avoid unprotected sex if you don’t want to get pregnant. You can also use the withdrawal method, in which the man withdraws his penis from the vagina prior to ejaculation. Similar to barrier birth control, this method is not as effect as other methods of birth control.
STERILIZATION
When you know you don’t want the any possibility of pregnancy in the future, sterilization can be considered. For both women and men, a small surgery is required. For women, this can be performed by tubal ligation (tubes tied) or removal of the fallopian tubes (salpingectomy). A device can also be placed through the uterus into the fallopian tubes causing the fallopian tubes to be blocked (Essure). This procedure does not require any abdominal incisions, but does require a test in radiology and alternative birth control for three months after the procedure. For men, vasectomy is the only option for sterilization. During this procedure, the tubes that carry sperm into the semen are cut and sealed. A follow-up test is required after the procedure to make sure sperm are no longer in the semen.
BARRIER BIRTH CONTROL
Birth control that forms a barrier between the sperm and the uterus can also be used. These include male and female condoms and female diaphragms. These methods also help reduce the risk of getting a sexually transmitted infection. Barrier methods of birth control are less effective at preventing pregnancy than other methods and need to be used every time you have sex.
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Do I still need birth control?
MARK APLET, Dreamstime/TNS 6
living well ~ May/June 2017
MAYO CLINIC NEWS NETWORK Birth control is often something women, perhaps in their 40s or early 50s, stop worrying about a little too soon. “We find that in most of the research, by the time a woman reaches the age of 55, she is 95 percent likely to have gone through menopause,” says Mayo Clinic gynecologist Dr. Petra Casey. “Menopause is defined as one year of no periods. If you reach 11 1/2 months of no periods, then have a period, the clock starts all over again and you’re still not in menopause.”
DO I STILL NEED BIRTH CONTROL?
Wondering when you’re menopausal and can safely stop birth control? What birth control is best for women over age 35 or 40? Can you still get pregnant in your 40s and 50s? These are common questions women ask of their gynecologists, women’s health physicians and other health care providers. Overall, almost half of all pregnancies and 75 percent of pregnancies in women over 40 years of age are unplanned. Also, some pregnancy complications and risk of miscarriage go up with age. So, if you don’t want to become pregnant, using effective birth control until you are truly menopausal is very important. Depending on your medical history, your health care provider will talk with you about the best options for you. If you are at a healthy weight, don’t smoke, don’t have high blood pressure or history of blood clots, you can probably continue the oral contraceptive pill, patch or ring well into your 50s. Other great options which don’t contain the hormone estrogen include IUDs, implants, shots and minipills. Some IUDs contain the hormone levonorgestrel, a kind of progestin, which helps decrease or even eliminate heavy menstrual bleeding, a common problem for women in their 40s. These types of IUDs last three to five years. Another kind of IUD is made of copper, does not contain hormones and can last up to 10 years. Both types of IUD and the contraceptive implant, a small flexible rod which is inserted under the skin of your arm for three years of birth control, are collectively called long-acting reversible contraception (LARC). They are more effective than pills, patch or ring, don’t contain the hormone estrogen (so women
who cannot use estrogen can use these), and can protect you against pregnancy for several years. Just in case you had unprotected sex and you don’t wish to become pregnant, there are also several kinds of emergency contraception, previously known as the morning after pill. There are pills called Plan B One-Step which you can get at your local pharmacy without a prescription. They contain the hormone levonorgestrel and delay ovulation or release of an egg. They do not interfere with an established pregnancy or cause a miscarriage. Plan B should be taken as soon as possible after unprotected sex but must be taken within 72 hours. Another option that is more effective, especially if you are heavier, is Ella. Ella is effective in decreasing the risk of pregnancy up to five days after unprotected sex but requires a prescription. A copper IUD inserted within five days of unprotected sex is the most effective option for emergency contraception but requires an appointment with a health care provider. The advantage of the IUD is that you can keep it for birth control for up to 10 years (and about 80 percent of women do). Once you have missed your period for a year, you are considered menopausal and may safely stop birth control. About 9095 percent of women will be menopausal by age 55 and may stop birth control then. Sometimes lab tests are also performed to confirm menopause, but most women don’t need them. Even before the final period, many women experience menopausal symptoms such as hot flashes and trouble sleeping. You can start on menopausal hormone therapy using an estrogen patch to help manage symptoms and use one of the progestin-only birth control options for contraception and to protect the uterine lining from growing too much with the estrogen. The progestincontaining IUD, implant, shot or minipill all work well for this. If you have had a hysterectomy, you can take estrogen alone. If you would like to avoid hormones as you transition into menopause, you can use the copper IUD, barrier methods like condoms, cervical cap, diaphragm or sponge, or have a minor surgical procedure to tie or block your fallopian tubes. Your health care provider can help guide you in choosing the best birth control option for you during the menopausal transition. May/June 2017 ~ living well
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First trimester down,
still waiting for that pregnancy glow LAUREN CHVAL Tribune News Service Pop culture representations and mythic understandings of pregnancy had misled me. Of course I’d heard of morning sickness, but apart from that pesky aside, I was under the impression that pregnancy was an amazing time in a woman’s life. “Magical” seems to be the word most often used. You have “a glow” about you. You’re a goddess of fertility. Your body is doing what it is meant to do (they say almost threateningly). Let me assure you that I do not have a glow. Lest you think I’m being self-deprecating, I’ll offer some proof: I went to see my longtime masseur last week and revealed that I was expecting. “Usually I can tell when women are pregnant because they have a glow,” he said. “But you have more of an … exhaustion.” He’s not wrong. The only media portrayal of pregnancy that accurately captures how I feel is that bit from “Twilight” when Kristen Stewart’s character is carrying a half-vampire child that’s physically draining the life from her. The most shocking betrayal of my naive conception of pregnancy was the first ultrasound. TV shows had led me to believe that cold goo is squirted onto your stomach and then the doctor moves the wand around your skin to reveal the baby on the screen. Not so! When the fetus is that small, the
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living well ~ May/June 2017
wand is inserted into the vagina to capture the image. It is no more pleasant than it sounds. In that moment, I couldn’t help but feel a kernel of resentment toward my husband as he sat opposite me, staring at the screen with the faintest hint of tears in his eyes. He was seeing our baby for the first time as a wholly positive experience, unburdened by the discomfort of having a machine thrust inside his body. For him, this was magical. For me, less so. I’ve heard prostate exams are a bummer, but at least men don’t have to undergo them to catch a glimpse of their unborn child.
That mental barrier between my husband and me persisted throughout the first trimester. I was plagued by nausea and headaches that made me cry. I woke up to pee every single night. Worst of all was the crushing exhaustion. I had considered the reality that motherhood would change my identity once the baby arrived, but I had no idea pregnancy would rob me of my capable nature before I even held the kid in my arms. As we shared the news with friends and family, everyone was through the roof with excitement. I wanted to join them. But
how to be wholly joyful about something that is making you sick? There were two of us inhabiting my body now, but I felt isolated. It wasn’t the experience I’d been promised. When we announced the pregnancy via social media, wave after wave of congratulations flooded in. In particular, a former colleague of mine who is a few months further along than I am commented that “pregnancy is the best … I’ve loved it so much.” I had gathered as much from her beautifully curated lifestyle blog, full of tasteful, professional bump pictures and posts on her skin care regimen and how to fashionably dress a pregnant body. She makes the glow look real, I thought, as I – a prickly, haggard gargoyle not so much perched on as embedded in my couch – scrolled through her blog. She was blown-out, dewy and in heels, for God’s sake. Why I feel the urge to be competitive with other women even in pregnancy is beyond me. But as she gushed about pregnancy being the best, I struggled to digest my feeling that pregnancy has been the worst, and the pressure to embrace it as magical made that only harder. We don’t talk about our pregnancies in the first trimester because there’s still a high risk something will go wrong, but that silence feels suffocating when you’re living it. I recently asked my father if he remembered my mom struggling with her first trimester. He shrugged. “Your mom doesn’t really complain.” It’s a trait she failed to pass on to me, but maybe we should complain! There’s honesty in complaining. I don’t mean to suggest I’m not grateful for the life I’m lucky to be growing, but is sugarcoating the difficulties the payment I have to make for that blessing? I’m about to enter my second trimester, which everyone assures me is full of new energy and restored appetite. I hope they’re right, but I’m not counting on it. I already fell for the pregnancy myth once.
May/June 2017 ~ living well
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Preparing for fertility and pregnancy for women and for men KAY JENNINGS Sponsored Advertising Content Couples often wonder what diet and lifestyle approaches are recommended for becoming pregnant and for maintaining a healthy pregnancy. Let me offer a few.
Choose good nutrition before and during pregnancy
Start with the diet by eliminating vegetable oils, gluten, grain, soy, sugar and all processed refined foods. Shop the perimeter of the store and emphasize whole foods like meat, eggs, vegetables, fruit, nuts and seeds. It is important not to restrict calories during this period but to eat to satisfaction each meal. Now is not the time to try to lose weight. If you are obese or morbidly obese, you should take precautions to avoid pregnancy until you are at a healthier weight.
It is also important to avoid very-low-carb or low-fat diets.
Carbohydrates obtained mostly from vegetables and good fats are important in promoting fertility. Keep to around 20 percent of calories for fat and 20 percent for carbohydrates. Consider increasing carbohydrates if struggling with fertility issues. Fatty fish are mandatory to obtain the benefit of Omega-3 fats. One pound per week should be eaten. The DHA and EPA found in the fat of fish is essential for the baby’s optimal brain development. Fish such as sardines, salmon, tuna, trout, mackerel, herring, whitefish and sturgeon are good choices. Limit tuna to one or two times a week.
Get your ZZZZs
Sleep is essential in all of our lives but even more so when you are trying to conceive. Great light exposure during the day and darkness at night helps keep your hormones more normalized. Sleep helps the brain detoxify so aim for seven to nine hours per night of high-quality sleep.
Benefits of moderate exercise
Exercise in moderation helps with fertility and also reduces the risk of gestational diabetes during pregnancy. A mix of cardio and resistance exercises should be done three to five days per week. Avoid over-exercising, which is a source of stress and can cause hormonal imbalances and infertility.
Supplement your diet with vitamin-rich foods
Vitamins are always recommended but consider getting most from foods rich in vitamin A, D and K2. Vitamin A rich 12
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foods include liver, egg yolks, cod liver oil and grass fed dairy. Vitamin D is best obtained from the sun (while avoiding sun burn) or through cod liver oil supplement. Vitamin K2 rich foods include poultry, liver, grass-fed dairy and fermented soybeans (natto). Ask your health care provider for a prenatal multivitamin with 400 micrograms of folate (not folic acid) and take it with food to avoid nausea.
Manage your stress
Stress can impact one’s ability to become pregnant and to maintain a healthy pregnancy. Try to enjoy daily stress management practices such as meditation, deep breathing, yoga, journaling, etc. There are many online programs to help you with this aspect of your life.
Men’s health matters, too
Men, all of the information offered above will help you, too. In addition, you should add coconut or olive oil daily to your diet as well as 5 milligrams Zinc picolinate twice a day, .25 micrograms Manganese, 500 milligrams Magnesium, and 3 milligrams Boron daily. In my practice, I have come up with a Testosterone Rx to help you contribute to this experience. And remember, once you become pregnant, continue on this lifestyle approach to living a long, happy and healthy life with your new family. Kay Jennings, BSN, MSHSA, MSN, APRN-PMH, owns and operates Aleph p.c. and New Health in Missoula Montana. She has post graduate training in Integrative Functional Medicine, Obesity Medicine and Psychiatry and specializes in insomnia, mood, weight loss, fatigue and life style medicine. Jennings has compounded an allnatural sleep formula “New Sleep” that is now available for retail sale through wellnessmt. com, and is currently at work compounding an oxidative stress formula (to be released for retail sale in the near future). She is also a Certified HeartMath Practitioner. To learn more, call 406721-2537.
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Healthy tips for mommy-to-be:
A nutritional guide to prenatal health AUTUMN GAYLOR Living Well Contributor One of the most common misconceptions about food consumption during pregnancy is that you are eating for two. While this statement is true, you are eating for you and your child, it is the quality of what you consume not the quantity that is most important. Following simple guidelines can help both you and your baby get the maximum benefit from your diet. It can enhance chances that you have a healthier pregnancy and maintain a healthy weight, and your child will be provided with nutrients that will assist in their growth and development.
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No matter how much time is left on your baby countdown calendar, it is never too late to kick-start a healthy lifestyle. Your eating habits during pregnancy directly affect all aspects of your child’s development. Healthy habits practiced by you today will be the foundation for your child’s nutritional future. Proper nutrition not only helps shape the way a child develops starting at pre-birth, but it can be a key building block to how your child will feel, grow, heal, and maintain adequate strength and energy throughout life. Studies show that proper nutrition can help decrease the risk of gestational diabetes. According to the International Diabetes Federation, gestational diabetes affects one in seven births. Gestational diabetes puts children at risk for high
birth weight (increasing the chance of having a C-section), low blood sugar, pre-term birth and increased risk of diabetes later in life. Genetic and environmental factors do play a role in gestational diabetes, but there are ways in which a mother can manage sugar levels and promote the healthy development of their child through proper nutrition. Being aware of proper caloric intake, making time for regular exercise and eating nutritional foods can all help to stimulate the healthy development of your baby. Mothers-tobe should make the following steps part of their pregnancy lifestyle: • Maintain a normal caloric intake for the first trimester. During the second and third trimester, increase the caloric intake by 300-350 more calories than were consumed pre-pregnancy. • Engage in 30 minutes of light to moderate exercise a day in the form of walking or light weight training. This will assist in maintaining a healthy weight throughout pregnancy. (Consult with your physician
•
about exercise concerns and safe exercise practices). Consume nutrition-dense foods in the form of whole grains, dairy, lean protein, fruits and vegetables, including the top 10 super foods for pregnant women: almonds, kale, sweet potato, eggs, yogurt, avocado, lentils, lean beef, red peppers and salmon in moderation.
Eat. Move.Grow. LLC employee Autumn Gaylor, OTR, is dedicated to using evidence-based interventions to improve the quality of life for children in the home, the school and the community. She believes that educating families and the community is vital to promoting the success and growth of children and to fostering the acceptance of all individuals regardless of any limitations. Gaylor has a master’s degree in occupational therapy from the University of WisconsinMilwaukee and is skilled in the evaluation and treatment of developmental, physical and sensory-based disabilities.
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book review: ‘How Not To Hate Your Spouse After Kids’ HEIDI STEVENS Tribune News Service The unfortunate thing about Jancee Dunn’s new provocatively named manual, “How Not To Hate Your Husband After Kids” (Little, Brown), is that husbands are unlikely to read it. “How Not To Hate Your Spouse After Kids” would have been just as accurate and might have gotten the book’s extremely helpful (and often quite funny) message to more couples, rather than just wives. Dunn’s own habits come in for as much criticism as her husband’s, and the fact that their marriage seems remarkably healthier and happier by the end of the book is a byproduct of both halves of the couple calibrating their expectations, participation and, most of all, communication style. Dunn and her husband, Tom Vanderbilt, are New Yorkbased writers who both work mostly from home. Before their daughter, Sylvie, was born, they divided and conquered domestic responsibilities – laundry, cooking, grocery shopping. When the baby arrived, Dunn took time off work to care for her, and adopted the bulk of the household chores as well. Now, Sylvie is 6, and Dunn has been back to work for years. But Vanderbilt takes on a comically small share of the household chores, politely declining when Dunn asks him to do more and frequently forgetting when he’s agreed to do something outside his usual share – like pick up their daughter from school when Dunn is at a meeting with her editor. “I wish his 10 percent effort was enough, but it isn’t,” Dunn writes. “I feel like he’s a guest at the hotel I’m running.” Dunn, meanwhile, has adopted a passive-aggressive response to her husband’s slackery – silently seething with resentment until she can no longer hold it in, then letting loose with a toxic mix of sarcasm, rage and name-calling. In short: No one’s happy. Dunn consults reams of research and a team of experts – psychologists, sociologists, a hostage negotiator – for insight on why the division of labor is so central to a healthy union and what to do when your division is lopsided. “We will test every strategy we can find to restore harmony to our marriage,” she writes, “and, by extension, our family life.” A pivotal moment occurs when the couple visits Bostonbased family therapist Terry Real, known for his celebrity clients and blunt advice. Real calls Vanderbilt to the carpet for taking on so little at home. “When your work is done for the day, why wouldn’t 16
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you split everything 50-50? It’s not fair. You know that. Tonight you cook; tomorrow she cooks. Tonight you put Sylvie to bed; tomorrow she puts Sylvie to bed. Show up and participate.” And to Dunn, Real has this to say: “You’re verbally abusive.” “You can say, ‘I’m angry.’ But you don’t say, ‘You’re an (expletive),’ ” he tells her. “You don’t yell and scream. You don’t humiliate or demean. They’re off the table.” Sylvie, Real points out, is the one suffering most from their dynamic. Once a couple has a child, New York psychologist Guy Winch tells Dunn, everything has to be up for renegotiation. “You both are managers of the household and should have regular discussions, every two weeks minimum, about how things are going, and brainstorm about what needs to be done, and track and tweak accordingly,” Winch says. “There is no organic way these things are supposed to develop. Couples should negotiate all the time, and it requires communication and coordination.” By the end of the book, Dunn and Vanderbilt have adopted much of the guidance gleaned during the year of research, including weekly meetings to plan and negotiate the family’s needs for the days ahead. (Vanderbilt compares the meetings to preventive medicine, reasoning, that “It’s a lot easier to take a five-minute flu shot than lie in bed for a week.”) Peace is largely restored, and Dunn sums up the bulk of her learnings in the book’s final chapter: “He can’t read your mind. He’s not even close to reading your mind.” “Stop complaining and ask clearly for what you want.” “Say ‘thank you,’ and say it often.” “Know that no matter what you and your spouse tell yourselves, your child is affected by your arguing. Period.” And one of my favorites: “Don’t pee on the gift,” meaning don’t tell your spouse you’re OK with something he or she wants to do (a weekend getaway, an hours-long bike ride, an afternoon nap) and then fume about it after the fact. “It’s embarrassing to admit that I started this project because I was worried about the effect our fighting had on our daughter, whereas it was barely a concern that my relationship with my husband was deteriorating,” Dunn writes. “Instead, Tom has become the ally I didn’t know I had.” I suspect most couples will recognize their own marriage in at least one or two (or a dozen) moments of Dunn’s book. Ideally, that recognition inspires us to take a closer look at ourselves, rather than turn away out of defense or shame.
Can blueberries beat the ‘baby blues?’ LISA GUTIERREZ Tribune News Service Could the super-food we know as blueberries be any more super? Maybe. A new study by researchers in Toronto finds that a dietary supplement regimen of the powerful antioxidants blueberry juice and blueberry extract can help ward off the “baby blues.” The temporary mood swings and sadness experienced by many new moms can sometimes lead to more serious postpartum depression. In the study of 41 pregnant women in their late 20s and early 30s, women given the blueberry supplements for three days suffered no drop in mood on the fifth day after giving birth, when the so-called “baby blues” are said to peak. The women were also given the amino acids tryptophan and tyrosine to counteract the loss of so-called “feel-good” hormones in a woman’s brain after she gives birth. The 20 mothers who did not take the supplements tested higher for depression after their babies were born. “We believe this is the first study to show such a strong, beneficial effect of an intervention in reducing the baby blues at a time when postpartum sadness peaks,” lead author Jeffrey Meyer, head of the neuroimaging program in mood and anxiety at the Centre for Addiction and Mental Health in
Toronto, told the Daily Mail. Meyer is also a psychiatry professor at the University of Toronto and co-creator of the supplements. The study was published in the Proceedings of the National Academy of Sciences journal. According to the Mayo Clinic, many new moms after childbirth experience the “baby blues,” which manifest in anxiety, mood swings, crying jags and difficulty sleeping. They usually begin within the first two to three days after delivery and can last up to two weeks. Postpartum depression has more severe symptoms – including withdrawal from family and friends, loss of appetite and intense anger and irritability – and lasts longer, according to the Mayo Clinic. “Women who take the supplement don’t get sad” in those first few days of motherhood, Meyer said. “We also see this as a promising way to try to prevent postpartum depression.” He explained the fruit-based treatment was designed to “address specific changes that temporarily occur in the brain,” referencing a surge in a brain protein in some new moms that might contribute to the blues. The study’s findings are preliminary, he said, and cautioned that women should wait until the supplement regimen is approved for public use instead of trying it on themselves.
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Dreamstime
How to share news of a miscarriage ANDREEA CIULAC Tribune News Service Question: How do you share news of a miscarriage with family, friends and co-workers? Answer: Acknowledge the awkwardness of the situation. If you want to talk about it, let friends or family know. If you want to be left alone, it is OK to ask for that as well. Share the information on your timetable, and tell those closest to you in person. Over the phone is the next best thing. Don’t beat around the bush or prolong it more than you have to. Say something along the lines of, “While there is no easy way to say this, I need to tell you something. We lost the baby.” Then, be silent, and give the person a moment to process. Let him or her know that there is no right or wrong reaction, and explain the best way to support you. Can a friend do a couple of loads of laundry or make dinner? The more specific the better. At work, share the news with your manager as soon as you feel comfortable. This will help alleviate some of the pressure at work. For co-workers, try to tell everyone at 18
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once. While difficult, it will stop the spread of rumors and innuendo. – Anne Grady, speaker and author of “Strong Enough: Choosing Courage, Resilience, and Triumph” Answer: Tell people about your miscarriage as soon as you can and in whatever way is easiest for you. While some may say that this isn’t the sort of thing you email, that’s not true – particularly, if you only told a few people of your pregnancy. A quick: “We were so excited to be welcoming our baby, but it wasn’t meant to be this time.” You can add exact details of what you want their response to be, as well. Examples might be: “We need some time and space” and “We’d love some meals.” If you used social media to announce your pregnancy, this might also be the place to tastefully announce your loss as well. Similar to the wording above, you can make a quick tweet or Facebook post. – Dr. Robin Elise Weiss, Lamaze childbirth educator, doula and parenting author
GET FIT
step by step
Mallwalkers Fitness Program Be a part of Missoula’s longest running free health program. Join us in Southgate Mall’s Community Room at 9 a.m. Mondays, Wednesdays and Fridays.
COME SEE WHAT’S
in store
SHOPSOUTHGATE.COM
May/June 2017 ~ living well
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YOUR DAY TO BE BRAVE. OUR EXPERTISE.
With every challenge you face, we’ll face it with you. Whether it’s you or a loved one, a cancer diagnosis is a scary proposition. We’re here to help you strike back. Community Medical Center’s team of board-certified oncologists, surgeons, hematologists, and radiation oncologists are supported by breakthrough technology and an extensive support staff that combine to provide the most comprehensive and comfortable care available. No matter what today brings, you don’t have to go it alone. Fight back. Discover why Community Cancer Care is the right choice. Visit communitymed.org.
Community Cancer Care communitymed.org 20
living well ~ May/June 2017