What To Tell Your Teenagers About Plan B "Emergency" Contraceptive

Screen Shot 2013-07-01 at 2.55.50 PM


The politics around women’s healthcare and reproductive choices have been interesting as of late to say the least. We have seen Planned Parenthood vilified, and concurrently, we have seen gains in women’s access to Preventive Exams as well as the expansion of birth control coverage. Recently, the FDA approved Plan B for sale to minors over-the-counter. Although Plan B is not associated with long term medical risks, use of Plan B is not guaranteed to prevent pregnancy, and incidental birth control does not address a multitude of other unintended consequences, particularly in young men and women.

I am a mother of two young girls who at this lovely age still think that boys are gross and annoying. I know that in short order this will all change. I have given much thought as to how I will educate my daughters about their sexuality and their safety. Too often young people falsely believe that  ”I won’t get pregnant from one time,” or “I won’t get herpes,” or “I’ve had the Gardisil vaccine so I won’t get HPV”. While I applaud the many changes in women’s healthcare, over-the-counter availability of Plan B to minors gives me pause about young women’s emotional and physical well-being as it relates to unplanned sexual encounters. The easy access of a simple pill can give the false illusion of being able to erase actions from the night before.

woman-in-pharmacy-selecting-medicationsAs a woman’s healthcare provider, I am an advocate for access and education, but I admit that I am concerned that Plan B may give young people a false sense of security regarding pregnancy prevention without acknowledging unintended consequences such as the emotional risks of unplanned and unprotected intercourse and the risks of STD’s. Unlike condoms, which are used at the time of sexual activity, Plan B does not offer any protection from STD’s, nor does it require forethought to action. Unfortunately, I have recently met with two teenagers who had been pressured to have unprotected intercourse and then take Plan B. Each of these young women, broke down in tears of fear and shame that saddened me greatly for them.

Now, more than ever, our daughters need to be educated on what it means to choose to be sexually active or to choose to be abstinent. More importantly, they need to be taught that they have a choice to say “No thank you” and mean it. Our daughters also need to be educated about unsafe situations, how to recognize them, and how to avoid them. A young woman who desires to be sexually active should be made to feel comfortable coming to an Ob/Gyn so that she can choose a reliable method of birth control and receive complete medical care and advice, something she won’t get from an over-the-counter package.

So what do you tell your teenagers about Plan B? First, have the discussion and discuss your value system and why that set of values is important. Second, educate them on all birth control options that are available and what they do and do not protect against. Third, encourage them to ask questions from trusted adults, to think about their choices, and to seek medical advice when it is needed.

Our team is committed to the well-being of each woman that walks through our door.  To learn more about our practice visit www.capobgyn.com or call us at 512-836-2536 if you have any questions or to schedule your next appointment.

An Option for Severe Morning Sickness?

OB JEN recently contributed to an article in Daily Rx regarding the use of Diclectin as an option for reducing severe morning sickness.  You can read the full article below. © Copyright 2010 CorbisCorporation

Diclectin given at pregnancy start may reduce risk of very severe morning sickness.

The nausea of morning sickness can strike at any time of day. For some women, it can be particularly bad, such as for Duchess Catherine of Cambridge, the wife of Prince William.

Her morning sickness was a very severe kind called hyperemesis gravidarum (HG). It can can cause dehydration bad enough to send those women suffering from it to the hospital.

About 2 percent of all pregnant women will experience HG. In addition, about 75 to 85 percent of women who had HG during their first pregnancy will have it in their next one.

But a recent small, unpublished study may offer a way for these women to reduce their risk of having it again. Taking a medication called Diclectin at the start of pregnancy may help women avoid severe morning sickness or HG if they have had it in the past.

About twice as many women in this study who took Diclectin at the start of their pregnancy did not experience HG, compared to those who only took Diclectin when they started feeling nauseous.

“Talk to your OB about severe morning sickness.”

The study, led by Gideon Koren, MD, of The Hospital for Sick Children in Toronto, ran a trial to see whether it was possible to lower the incidence of HG among women who have already had it by giving them medication at the start of their pregnancies.

The study included 59 women who had experienced severe nausea and vomiting or had been diagnosed with HG in a previous pregnancy.

Half the women were given a medication called Diclectin as soon as they found out they were pregnant. The other 29 women were only given Diclectin at the first sign of nausea.

Diclectin contains 10 mg of vitamin B6 (pyridoxine) and 10 mg of doxylamine, an antihistamine. Diclectin is the Canadian brand name for the medication.

The US brand name was Bendectin until it was voluntarily removed from use in 1983 because of concerns about possible birth defects. Studies have since shown that it does not cause birth defects.

Diclectin is classified as a Risk Factor A drug in Canada, a designation which is equivalent to a Category A drug at the FDA. This classification means it is in the safest category to take during pregnancy.

During this study, researchers interviewed the women through phone calls an average of eight times during the women’s pregnancies to find out their symptoms.

Among the women who took the Diclectin right away, 43.3 percent did not experience HG. Among those who did not take it until they felt nauseous, only 20.6 percent avoided HG.

In addition, only 15.4 percent of the women who took Diclectin right away experienced moderately severe cases of nausea and vomiting during the first three weeks of the study. Among those who waited, 39.1 percent experienced moderately severe morning sickness.

Among the women who began taking Diclectin right away, 78 percent stopped having nausea and vomiting before delivery, compared to 50 percent among those who waited to take the medication.

The researchers concluded that taken Diclectin pre-emptively appeared to reduce the amount of severe morning sickness or HG that women experience.

Jen Mushtaler, MD, an obstetrician in Austin, Texas, and a dailyRx expert, said her patients sometimes take the two active ingredients in Diclectin/Bendectin on their own to address morning sickness symptoms.

“The data has been very reassuring in terms of safety,” Dr. Mushtaler said about Diclectin/Bendectin. “Many of my patients get relief from the combination of vitamin B complex and half a Unisom, whose active ingredient is doxylamine.”

Despite the findings, this study has not yet been published in a peer-reviewed journal, so its results should be regarded as preliminary and still require review by researchers in the field. It is also a very small study with results that should be confirmed with larger studies.

The most common side effect of Diclectin is drowsiness. Other possible side effects include diarrhea, difficulty sleeping, dizziness, headache, irritability or nervousness.

Very rare but possible serious side effects that have been reported include seizures, pounding heartbeat, stomach pain and difficulty urinating.

The study was presented February 14 at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting, in San Francisco. Information was unavailable regarding funding and conflicts of interest.

To schedule an appointment with any Capital Ob/Gyn physicians, call 512.836.2536 or visit www.capobgyn.com.  We look forward to seeing you soon at Capital Ob/Gyn!

Having a Baby After Bariatric Surgery

OB JEN recently contributed to an article in Daily Rx regarding having a baby after Bariatric surgery.  You can read the full article below.

Pregnancy after bariatric surgery involved some risks but less so than obesity.  Pregnancy can involve more risks for women who are obese. As obesity rates rise, so does the number of women seeking bariatric surgery to treat their obesity.  A recent study considered what recommendations might be important for women who want to become pregnant after they have had bariatric surgery to treat obesity.

The authors concluded that women should wait at least a year, preferably 18 months, before becoming pregnant after the surgery. They may need additional nutrient supplements, and they should limit their pregnancy weight gain.  The authors also recommended that women discuss their options related to obesity, pregnancy and bariatric surgery with their doctors to make informed decisions.  “Ask your doctor about pregnancy after surgery.”  The study, led by Rahat Khan, MBBS, MRCOG, an OB/GYN at Princess Alexandra Hospital in Harlow in the United Kingdom, reviewed the current research related to pregnancy and bariatric surgery for obesity.

Obese women are more likely to have complications during pregnancy as well, so the researchers wanted to better understand possible pregnancy outcomes after a woman undergoes an increasingly used obesity treatment.  The National Institute for Health and Clinical Excellence in the UK recommends that morbidly obese women who have been unable to lose weight through lifestyle changes or medication could consider bariatric surgery.

The question is how long a woman should wait after she has bariatric surgery before she tries to get pregnant. The research on this question is sparse and sometimes contradictory.  Some studies found a higher risk of preterm (early) birth among women who got pregnant within a year of their surgeries.  Another study found a higher miscarriage rate (31 percent) among women who became pregnant within 18 months of their surgeries, compared to the miscarriage rate (18 percent) among women who waited at least 18 months after their surgery to become pregnant.

However, most studies did not find a higher risk of miscarriage, high blood pressure or gestational diabetes among pregnant women who had had bariatric surgery, regardless of how long they waited until after the surgery before becoming pregnant.  The research also found no differences so far in children’s birth weight, fetal growth restriction or cesarean section rates among women who conceived within a year of their surgery versus more than a year post-surgery.

Yet, since the evidence in this area is still thin and there are some studies to support the recommendation, the authors said that women should be advised to wait 12 to 18 months after their bariatric surgery before trying to become pregnant.

Jennifer Mushtaler, MD, an obstetrician in Austin, Texas and a dailyRx expert, said waiting after surgery to conceive also allows a woman to achieve a more consistent body weight.  “The greatest weight loss occurs in the first year after surgery, so many surgeons and obstetricians advise waiting at least one year after surgery before attempting pregnancy to allow weight to stabilize,” Dr. Mushtaler said.

The researchers also noted, however, that women tend to have improved fertility after bariatric surgery compared to morbidly obese women who do not undergo the surgery or otherwise lose weight.  The researchers noted that women who become pregnant after having bariatric surgery may experience nutritional deficiencies, especially with folate and vitamin B12. Therefore they should work with their doctors to ensure they are getting all the nutrients they and their developing babies need.  “Women will require additional levels of iron, calcium, folate, vitamin B12, protein and fat-soluble vitamins alongside diagnosis and treatment of other nutritional deficiencies,” the authors wrote.

In terms of weight gain during pregnancy, the authors said that the ideal amount for these women is between 15 and 24 pounds.  The authors also reviewed some of the complications that are possible among pregnant women who have had bariatric surgery. For those who receive gastric-banding, it is possible for the band to move or cause leaking in about 24 percent of cases. Only 4 percent of patients needed the band removed.

Overall, however, there were fewer complications among pregnant women who had bariatric surgery compared to morbidly obese pregnant women.  For example, one study found that 0 percent of pregnant women who had had bariatric surgery developed gestational diabetes, compared to 22 percent of obese pregnant women.  Similarly, the rate of pre-eclampsia in pregnant women who had had bariatric surgery was 0 percent, compared to 3.1 percent in obese pregnant women. Pre-eclampsia is a condition involving high blood pressure and protein in a woman’s urine. The only treatment is to deliver the baby.

Dr. Mushtaler said her experiences in treating women who became pregnant after having had bariatric surgery match up with what the researchers found in their review.

My experiences are consistent with the data in that fertility is improved and rates of complications are less,” Dr. Mushtaler said. “We do watch the infants for risks of growth restriction and we advise patients to take nutritional and vitamin supplements but limit caloric intake.”

In comparing women who had bariatric surgery to healthy weight women who have not had the surgery, there may be additional risks for miscarriage for two particular bariatric procedures: biliopancreatic diversion (BPD) and Roux-en-Y gastric bypass (RYGB).  One study found a miscarriage rate of 34.7 percent among women who had RYGB and 4 percent among women who had BPD. There was not evidence to show a higher miscarriage rate among women getting laparoscopic adjustable gastric banding (LAGB).

The authors concluded that women who have had bariatric surgery or are considering it should consult with their doctors, especially if they plan to have children.  “Both obstetricians and surgeons should consider post-bariatric surgery pregnant women as high risk,” the authors wrote. “Optimal education should be encouraged in these individuals so that they can make well-informed decisions about planning pregnancy after weight loss surgery.”

The study was published January 11 in the journal The Obstetrician and Gynaecologist. The research paper did not note any sources of funding. The authors declared no conflict of interest.

To schedule an appointment with any Capital Ob/Gyn physicians, call 512.836.2536 or visit www.capobgyn.com.  We look forward to seeing you soon at Capital Ob/Gyn!

Free Educational Event for Expecting Parents – Saturday, February 23rd

image001Join Capital Ob/Gyn this Saturday, February 23rd from 9:30 a.m. – 3:00 p.m. for a FREE educational seminar for expecting parents.  BabyEarth is bringing
together experts to provide you with informative sessions and interactive Q&As covering important birth and parenting topics.  Dr. Catherine Browne will be representing the Capital Ob/Gyn team on the Birthing Options Panel, so come see us and benefit from this unique event!

Getting Ready for Baby
Saturday, February 23rd

9:30 a.m. – 3:00 p.m.
Baby Earth – 106 E. Old Settlers Blvd. Round Rock, TX 78664
RSVP at www.babyearthbabyu.eventbrite.com

10:00AM-10:45AM- Infant Safety– We will review issues such as safe sleep, car seat safety, baby proofing, etc.

11:00AM- 11:30AM- Car Seat Installation– We will teach you how to properly install a car seat.

11:45- 12:30- Non-toxic Home and Baby– Toxic chemicals are poorly regulated and are found in everything from cleaning products to body lotion. You will learn how to be proactive in keeping your family and your home free of these harmful substances.

1:00-1:30- Creating a Birthing Plan– Having a plan relieves some of the stress of child birth. During this session you will learn the important things to consider when creating a birthing plan.

1:45-3:00- Birthing Options Panel– Join us with a team of experts to review your options for birth. A home water birth? A medicated birth in a hospital? Something in between? This birthing panel will talk about your options and answer your questions, so come prepared! The panel will include; Dr. Catherine Brown from Capital Ob/gyn; Chan McDermott child birth instructor; Leticia Moran a birth and postpartum Doula and we are awaiting confirmation on several others!

To schedule an appointment with any Capital Ob/Gyn physicians, call 512.836.2536 or visit www.capobgyn.com.  We look forward to seeing you soon at Capital Ob/Gyn!

The Vitamin D Deficiency Pandemic – Not so Fast!

Some researchers have warned that vitamin D deficiency is akin to a silent epidemic. However, recent data from the Institute of Medicine reveals that the majority of people are getting enough vitamin D and calcium. Although quite plausible, there is not enough data to support claims that vitamin D can help
protect against cancer, heart disease, diabetes, MS or pre-eclampsia of pregnancy to name a few.

What are the recommendations for vitamin D and calcium intake?

It is recommended that young women ages 9-18 consume 1300 mg/day of calcium and 600 IU/day of vitamin D. Healthy women ages 19-51 including those who are pregnant or lactating should consume 1000 mg/day of calcium and 600 IU/day of vitamin D. Women ages 51-70 should consume 1200 mg/
day of calcium and 600 IU/day of vitamin D. Women older than 70 years should increase their vitamin D consumption to 800 IU/day in addition to 1200 mg/day of calcium.

Should I take a calcium and/or vitamin D supplement?

Most individuals can achieve the recommended amounts through proper diet and nutrition, and it only takes 10-15 minutes of sun exposure to generate your daily vitamin D requirements. Research shows that most people get 600-900 mg of calcium daily from diet alone. There is also a recommended upper safe limit of 2000 mg/day of calcium and 4000 IU/day of vitamin D. Excess calcium and vitamin D has been associated with calcifications in blood vessels, kidney stones, cardiovascular risk and surprisingly falls and fractures. Some natural food sources of vitamin D include cod liver oil, salmon, mackerel, and fortified milk. If you are going to supplement your diet, check for USP verification on the label.

Should I have my vitamin D level checked?

Only those persons at risk for vitamin D deficiency need to have their levels screened. At risk persons include pregnant and nursing women, obese individuals, darker skinned individuals, persons who have undergone prior bariatric surgery, persons with Crohn’s disease, and persons with osteoporosis.
There are several other serious medical conditions in which vitamin D testing is also recommended so speak with your doctor first.

Don’t have one? Come see OB JEN at Capital Ob/Gyn Associates of Texas.

What should I do for back pain relief during pregnancy?

As pregnancy progresses, your center of gravity shifts forward which can cause strain and discomfort in your lower back. Here are some tips from Dr. Jennifer Mushtaler to help you enjoy your pregnancy free from back pain!

1. Practice good posture by standing and sitting tall with your shoulders back and your knees slightly bent. When sitting, place your feet on a low stool.

2. Squat and lift from your legs instead of bending at the waist to pick something up.
3. Try sleeping on your side with a pillow between the knees.
4. Alternate warm and cool packs to the lower back.
5. Gently stretch your lower back muscles by resting on your hands and knees with your head in line with your back, then round your back slightly and hold for ten seconds.
6. Consider complimentary therapies such as massage, chiropractic reatment, acupuncture or a maternity belt.
7. Keep up with regular physical activity.

To schedule an appointment or consultation with Dr. Jennifer Mushtaler, please visit www.capobgyn.com or call 512-83.OBJEN.  We look forward to seeing you at Capital Ob/Gyn Associates of Texas.

KXAN News – Dangers of Heat in Pregnancy

Dr. Jen Mushtaler (a.k.a. OB JEN) was featured on KXAN Health Watch this past Saturday to discuss the Dangers of Heat During Pregnancy.  Here’s a recap in case you missed it!


Video Replay: http://www.kxan.com/dpp/health/how-heat-affects-pregnant-women

AUSTIN (KXAN) – “OB Jen” Dr. Jennifer Mushtaler shares important information about how the heat affects pregnant women.

Tips to keep cool if you’re pregnant:
1.Drink six to eight glasses of water daily
2.Avoid caffeine and salt
3.Apply sunscreen daily and reapply hourly if you’re in the sun
4.Exercise indoors during cool times
5.Carry a spritz bottle

The most common complication for late-term pregnant women is preterm labor.

The baby’s temperature is a degree or two higher than the mother’s temperature, and they don’t have a way to cool off.

Consult with your physician when deciding to exercise.

To schedule an appointment with OB JEN, visit Capital Ob/Gyn Associates of Texas www.capobgyn.com.