Who ever invented the term ‘pregnancy glow’ has obviously never been pregnant.  Unless by ‘glow’ they mean oily skin, acne and stretch marks. While pregnancy can be a wonderful and joyful experience, it does tend to reek havoc on your skin. Here are a list of the top annoying skin changes of pregnancy, and what you can safely do to treat them.

5. You Get Hairy

Most women will develop coarse hair on their abdomen and inner thighs that progressively worsens throughout pregnancy. For some, this is minor and a little extra shaving is all that’s necessary. For others it becomes a little more Chewbacca-esque.  The extra hair usually decreases after pregnancy. It is OK to shave during pregnancy. Laser hair removal, chemical hair removal and waxing are not harmful to the baby, but they may cause increased irritation because your skin is much more sensitive during pregnancy.

4. Acne

Though you would never know it by looking at all the porcelain skinned models on the cover of those pregnancy magazines, acne is extremely common during pregnancy. The hormonal changes of gestating can really do a number on your face and back.  Your skin usually goes back to normal shortly after delivery. Microdermabrasion and facials are safe, however your skin is more sensitive in pregnancy so notify your aesthetician as she may need to use milder settings.

Safe: benzoyl peroxide, salicylic acid, resorcinol, adapalene, topical antibiotics (clindamycin and erythromycin), Vaniqa

Not recommended: RetinA, tazarotene, Avita, Oral antibiotics (especially tetracycline), Isotretinoin

3. Stretch Marks

The dreaded stretch marks. The amount of stretch marks you get are merely a function of your skin’s elasticity and how much weight you gain. Your elasticity is genetic, so that’s out of your control. All women are encouraged to stay active and maintain a healthy weight during pregnancy. There is no ‘magic cream’ that prevents stretch marks, so don’t waste your money on expensive anti-stretch mark creams. Use a good lotion and stay hydrated, but in most women stretch marks are a fact of life.

2. Increased Pigment

What’s this weird line on my belly? I often get asked by women as they begin to notice a brown stripe running down the middle of their belly. In addition to the belly stripe, which is technically called the linea alba, women of darker skin tones may notice darkening of the skin of their nipples, arm pits, groin and neck. This darkening is thought to be estrogen related and begins to fade slowly postpartum.

Melasma {see image above}, some times called ‘the pregnancy mask’ refers to the darkening skin on the face. It can occur in up to 70% of pregnancies. Reduce sun exposure and wear sunscreen to reduce its effects. Up to 30% of women will experience persistent melasma after delivery. It can be treated by a dermatologist with lightening creams and laser therapy.

1. Veins

Both spider veins and varicose veins can make their appearance during pregnancy. The text book I consulted for writing this article recommended to “avoid prolonged standing” to relieve discomfort. For those of us with jobs and kids, that’s not very practical advice. Support stocking and lower salt intake can reduce swelling and symptoms of varicose veins, but only delivery will reduce their size.

Hemorrhoids are varicose veins of the rectum. Stool softeners, high fiber diet and adequate hydration can help relieve the discomfort of hemorrhoids.

Varicose veins can also be present on the vulva during pregnancy. While they can cause significant pain and swelling, they does not interfere with delivery and resolve quickly postpartum. Support garments are available on for vulvar varicose veins (try saying that 5 times), but in general my patients have not found them helpful.

What skin issues are you struggling with during pregnancy?

{Photo Credit}

{Photo Credit}

Long has the stereotype of the arrogant, self righteous doctor permeated society.  Some doctors have even been accused of having a ‘god complex’.

Is it because they constantly balance life and death? Does shocking heart rhythms back in sync, bringing new life into this world and cracking skulls to remove deadly brain tumors cause their own craniums to arrogantly expand?

Some might suggest such obvious reasons, but I think the true source of their supernatural pride comes from a more mundane source: the power of their pen.

I postulate that it is the power of the the almighty ‘doctor’s note’ that can lead to the ‘God complex’. At exactly what point in history did the doctor’s note achieve such a powerful status? I have no clue, but over the years I have been requested to attach my magical signature to some very interesting requests.

Change the law

Husbands racing to the hospitals with their pregnant wives will often request notes to get out of speeding tickets they got on the way. I’m unsure why my signature is necessary to prove the large screaming pregnant woman in the seat beside them is in labor. Evidently my unintelligible squiggle is sometimes more convincing than common sense.

Very commonly I get a requested to write for handicap parking stickers for my pregnant patients. But sorry ladies, pregnancy is not a disability.

Get out of EVERYTHING

From school to jury duty, I have been asked to write notes to excuse people from nearly every responsibility in life. No, I will not write you off school/work for:

• Yeast infection (neither will I give you Percocet–but that’s an entirely different post)
• Pregnancy (sorry, miserable pregnancy alone isn’t enough, you must have a complication)
• You got your period (women have been going to work on their period for years)

Sex

Some of the oddest requests for doctors notes have concerned sex. I have been asked to write a note saying that a pregnant woman was OK to have sex. Evidently her husband was afraid to hurt the baby and wanted an ‘official’ doctor approval.  On the other end of the spectrum, several women whose libido was negatively effected by pregnancy have asked me to write them ‘off sex.’

I’ve also been asked to write note to get husband off work while his wife was ovulating so that they might procreate.

Change of religion

My all time strangest request involved Beef. A pregnant woman requested I write note to her priest saying that it was OK for her to eat meat. Her religion normally did not allow her to eat meat, but since she was pregnant and had anemia, her priest said he would approve it if she had a note from me.

I never determined her exact faith, but with the stroke of my pen I essentially changed her religion.

And that, my friends, that is why doctors can easily have “God Complex.”

All kidding aside, it’s truly amazing the crazy things I’ve been asked to put in a doctors note. Luckily, I have many people in my life to keep my pride in check.

What would YOU like a doctors note to get out of?

I’ve been doing this mom thing for a mere 5 years now {as of next Tuesday}. I don’t know much, but I do know there are a lot of things people should tell you before you become a mom that they just don’t. It seems like prenatal advice is either all good or all bad. You have your grandma telling you how blissful motherhood is {what with it being 50+ years since she brought a baby home} and the woman behind you in line at the grocery store sharing how life will never be the same and you should get some sleep now.

Motherhood is quite a dichotomy of truth. The wonderful thing is, these dual truths can balance themselves out if you let them. One of the most important pieces of wisdom you can walk with into motherhood is to keep your eyes and mind wide open. Not to all of the voices clamoring around you but to the beauty and the pain of motherhood. . .to the bliss and the stress. . .to the overwhelming confusion and sure clarity. Let grace be the bridge between these extremes and you will walk through motherhood with honest peace.

As I thought about this dichotomy of truth, I was reminded of these 10 things no one tells you before you become a mom:

1. You may feel numb, even paralyzed by fear as you adjust to your new role.

2. You will feel more deeply than you’ve ever felt before after opening your heart to your child.

3. If you weren’t a control freak before, you just might become one now.

4. You will need to let a lot of things go – if only to survive the day – and it’s more than OK to do so.

5. You will always feel like you aren’t giving enough.

6. If you walk in the Spirit, what you are giving is not only enough, it’s exactly what your child needs.

7. You will feel like you’ve lost yourself.

8. In reality you may just find out what you are made of.

9. You will compare yourself to every mom you come in contact with and your baby to every other little one around you.

10. There are a million ways to do most things in motherhood and you’ll likely try many of them before finding what works for you and your baby. What works for some may not work for others – do what works for YOU.

What is the most honest advice you received before becoming a mom?

{Photo Credit}

{Image Credit}

Breast is best. We all know that.

If we all agree that breastfeeding is so great, then why are only 44% of American women still breastfeeding at 6 months? The most common reason women give for stopping breastfeeding is “low milk supply.” These women do not feel like they are making enough milk for their babies. I was not at all surprised at this statistic. One of the most common breastfeeding questions I get from my patients at their postpartum visit is “How can I increase my milk supply?”

What I found as I researched this topic is that the keys to good supply are also the keys to successful nursing in general.

Frequent Feedings

Establishing a good milk supply is kick started by frequent feedings during the first few weeks of life. A newborn should nurse 8-12 times a day for the first week. By the time he reaches one month old he should be down to 7-9 feedings a day. That first week is extremely challenging, but commitment to regular feedings early on is truly helpful for establishing a plentiful supply.

Monitor Latch

A poor latch can lead to nipple injury, pain, swelling and poor supply. Most nipples are sensitive to breastfeeding initially. Normal breast pain usually lasts for 1-2 minutes as the baby latches then slowly resolves. This pain is usually only noted for the first week postpartum. Nipple pain that is outside this range should prompt a visit with a lactation consultant to help prevent nipple injury. Proper latch techniques are illustrated here.

Know Risk Factors for Late Let-Down

Most women’s milk will come in by day 2 or 3 postpartum, however certain medical conditions can effect the hormonal shifts that cause milk let down. This can lead to delayed milk production for a few days. In these instances you should continue to nurse, but supplementing may be necessary while you wait for your milk to fully come in.

Common conditions that can delay your milk coming in include:

• PCOS
• Pre-eclampsia
• Obesity

Complete Emptying of Breasts

Some babies like to feed frequently enough, they just want to fall asleep in the middle of the feeding, not fully emptying the breast. Encourage your baby to finish each feeding. Common strategies for keeping a baby awake for a full feeding include taking off his clothes or gently rubbing his cheek with a wet cloth. If these strategies don’t work, pump the rest of your milk to fully empty your breast. If you continually have incomplete feedings,  your breasts ‘will learn’ to not produce as much milk.

Breast pumps are now required to be covered by your health insurance under the Affordable Care Act. Contact your insurance company to find out how to obtain one.

Stay Hydrated

Breastfeeding can literally suck every bit of moisture out of your system. Drinking lots of water is crucial. Instead of aiming for a specific amount of water to drink (because you really don’t need another thing to keep up with in your exhausted postpartum state), drink enough so that your urine stays pale yellow.

Eat

A lot of postpartum moms are very concerned with weight loss. While some calorie restriction can be tolerated, an extremely low calorie diet can lead to decreased milk supply. Your body needs 500 calories a day just for breastfeeding. Dropping calorie intake below 1500 will often interfere with supply.

Medications

There is ongoing controversy as to the safety and effectiveness of medications and herbal supplements given to improve milk supply. A trial of supplements should only be used after all other options have been pursued. These are the common supplements given and what we know about them:

Reglan (metoclopramide) is a drug originally prescribed for nausea that has been shown to increase milk supply by up to 15% in some studies, however other studies have shown no effect. Reglan does pass into the milk but the long term effects of the drug on the baby have not been studied. Maternal side effects can include headaches, mood swings and diarrhea.

Motilium (domperidone) is a drug originally used for nausea that has been shown to increase milk supply in some studies but not others. The FDA issued a warning against the use of the drug in 2004, after the IV form was found to be associated with heart attacks. The oral form was also found to cause EKG changes in the baby.

Fenugreek is an herbal supplement that is very widely used despite the lack of any studies to measure its safety or effectiveness. In the US, there is no quality control or regulation of herbal supplements. There is no way to be certain of the exact dose of the supplement you are receiving. Many patients and lactation consultants swear by the effectiveness of this herb, often taken in the form of tea.

Additionally, there are medications that have been associated with decreased milk supply:

• birth control pills containing estrogen
• diuretics
• antihistamines (bendryl, claritin, ect.)
• pseudoephedrine

My heart for writing this post is not only to guide women to breastfeeding success, but also to alleviate the fears of those whose breast milk did not flow as freely as they had hoped. I’ve talked to a lot of women who are desperately searching for a magic potion to improve their supply and help them succeed in breastfeeding. Most of them will eventually try all these strategies and many more. If you have tried these strategies and you are still not able to nurse, then you can rest assured that you have genuinely done all that you can do.

Have you struggled with inadequate milk supply? If so, what did you find helpful?

I don’t consider myself an advocate for infertility per se. More of a silent contender for those whose stories read a lot like my own. I’m not storming the hill like other amazing women but I am storming the gates of heaven begging God {much like I did for myself} to have mercy on women who are simply longing for what He creates – life.

I navigated through my journey of infertility with my faith as my guide. And now, I help lead this community of women, hoping to encourage those who are in the waiting, those who are just setting out on their path or those who have traveled so long they’ve lost sight of the destination. One of my greatest life passions is to share my story so that others know they are not alone and so that those who can, will make provisions for the millions of women who struggle to conceive.

I truly believe that if we are open, we can grow through whatever we go through. But the truth is, the journey to “the other side” is often long and always hard. Knowing your body doesn’t do what it’s supposed to do – can’t create or hold or grow life as it was meant to  – is one of the most confusing, maddening, heart-breaking realizations. It’s just plan unfair.

We will never fully overcome the injustice of infertility because it will never go away. But together, we can rise up as a community of family fighters that will not rest until others begin to understand what it’s like to feel broken and incomplete. We must not rest until we find a way to communicate our stories in ways that others understand – enough to do something about it.

This is why, although I’m “on the other side” of infertility, I will reach back across the fence and grasp the hands of my sisters – to steady them, comfort them and fight with them – until they can join me in seeing their dream come true.

No matter what the other side looks like for you, you WILL be better for having crossed over. . .for having endured years of hoping, waiting, and fighting for your family. And when you find yourself standing within the fulfillment of your deepest longing, I pray you’ll also reach back for those who need you to continue to fight.

Infertility has given me strength.

Infertility has given me gratitude.

Infertility has given me compassion.

Infertility has given me perspective.

I am a better woman for having endured and overcome my battle of infertility. I fought for my family and I pray strength and grace and provision for others in the midst of their battle.

Will you join me in the movement to bring awareness to those fighting for family?

{Photo Credit}

Friends, it’s infertility awareness week. I have been reflecting my journey and praying for those that find themselves longing for a child. Will you join us in praying and believing for LIFE to come to the over 10% of women who are struggling to conceive? Please share this message with others in your sphere and let’s storm the gates of heaven with prayers of healing and miracle life.

If you are struggling to conceive, please get in touch with us so we can be praying for you specifically.

He sees and he hears your cry. Trust him as you journey. Your story is being written and it’s not finished yet.

{Photo Credit}

UPDATE: We had some technical difficulties with the printables but they are ready and we are now offering them FREE to everyone! Click here to download your printables!!

Buy the book and get these adorable printables free! Use our schedule tracker and prayer cards to help navigate baby’s first year in style. Email grace4moms@gmail.com for access to these exclusive gifts!

Young Dr. Rupe, Circa 1998

“You must have the grossest job in the world. Why on earth would anyone want to be a Gynecologist?” my twenty something patient asked, as I was examining her ‘nether regions’.

“Well, I do enjoy helping people” I lamely replied. I was doubtful she heard me, as she had already returned back to texting at this point.

I smiled as I left the room, remembering my surprisingly similar thoughts at her age.

I wanted to be doctor for as long as I could remember. But when I started medical school, the two specialties I knew I didn’t want anything to do with were OB/GYN and Pediatrics.

There was little doubt in my mind that Family Practice was my chosen path.  I chose Oklahoma State University because of its focus on primary care. I had shadowed several FPs and truly enjoyed the continuity of care and relationships that occurred in Family Practice.

When I started my rotations as a third year student, I excitedly picked FP as my first month. The practitioner I worked with was amazingly kind and knowledgeable.  He also had a passion for teaching and I was appreciative of the time he spent instructing me. Though we saw some interesting patients, there was also a lot of mundane colds and earaches. After about 3 weeks, I started to have doubts whether this was really what I wanted to do for the rest of my life. I was a little concerned, but knew I had a few (our school required 6 months of Family Practice) more months to decide.

The next month, I did an away rotation in internal medicine with a wise internist who had been in practice for 30 years. While I didn’t love internal medicine, I did love the doctor. I soaked up every bit of wisdom about life and medicine he sent my way. He inspired me to THINK and not just memorize facts. On my last day of the rotation he sat me down and said essentially that I had done well on the rotation, but he thought my personality was the most suited for OB/GYN.

I smiled on the outside, but internally I rolled my eyes.

My first thought was, “What a sexist!” I was sure he was saying that merely because I was a woman. OB was becoming a female dominated field, and it had been commonly suggested for me to consider it. However, the last thing I could possibly be interested in was doing PAP smears all day. Yuck. Child bearing had no interest to me whatsoever. It was WAY too messy.

I composed my initial thoughts and replied, with a simple, “I don’t think so.”

“When’s your OB/GYN rotation?” he asked.

“The last one of the year.” I replied, having postponed it to the end.

“You should seriously consider moving it up earlier” he encouraged me.

I thanked him for his advice as a courtesy. Then thanked him profusely for the other things he had taught me.

On the drive home I was still fuming about his remark. However, my thoughts began to wander. His wife and all 3 of his daughters were doctors, but none OB/GYNs. There were no other sexist things he had said or done the whole month.  I respected him greatly and had trusted all the other advice he had given me. Perhaps, I should listen and at least move my rotation up to earlier in the year. After all, I wasn’t loving FP nearly as much as I thought I would.

After several frantic phone calls, I managed to set up a rotation with a local private practice doctor, in desperate need of some CME’s.  I ‘did’ very little during this month, but what I observed was life changing.  I observed his daily practice: his rapport with his patients, interesting procedures and complex diseases.  He was able to practice preventative medicine in a real way (one of my passions) and also do fascinating surgeries.  I witnessed babies born then later the same day the removal of a giant ovary full of teeth and hair from another patient. It was thrilling. On my last day of the month, I broke down in tears on the way home. I couldn’t believe my month was over. I didn’t want it to end. I had fallen in love with the crazy life of being an OB/GYN.

Then began the soul searching and prayer. How could I have a family and be an OB/GYN? As much as I loved my month of OB, the hours were harsh, and I wasn’t sure I could hack it. Was being an OB really God’s plan for me or just a selfish whim? After months of pro’s and con lists and long discussions with my husband, I finally felt a peace from God that this was the path I should take.

Finishing my last 6 months of family practice rotation only confirmed my decision.

This life is NOT easy. The hours do get crazy. Yes, there are days when I do get tired of looking a vaginas all day long. But the longer I do this job the more I love it. So here I am, 8 years into private practice reflecting on how my life is nothing like I expected it to be when I began this crazy adventure in medicine. I realize that it is amazingly better.

Thank you Dr. Bruns for telling me I should be an OB/GYN. You were right.

Sometimes our lives take a path much different than we expected. Have you ended up on in a different role or calling than you once anticipated? How did you get there? What would you say to encourage others seeking answers about their life calling?

I was thrilled to see the latest campaign from Similac entitled, Strong Moms Empower. Reading further I learned that they are on the trail to send a message of unity and support amongst moms. They don’t actually use the word, but over here, we call that GRACE. . .and it’s what we are all about in this community and with The Baby Companion book. Naturally, I stood up at my computer and shouted, “YES!” when I received their email inviting me to be a part of this campaign. Unfortunately, I came a bit late to the party what with the book launch, child illness and now my own sickness holding me back. But the wee one is sleeping so I thought I would take this opportunity to share about the campaign because it lights a fire in my heart to think of a movement of moms who have moved beyond comparison and judgement to a place of support and acceptance.

It’s perfect timing friends. Perfect timing for me to share this Strong Mom Manifesto with you. Something I am prompted to write because of this campaign but that was the motivation behind the writing of this book over 2 years ago. It’s so funny how things work together in life. Just proves that when we are on the right track with our message, it will show up place after place after place.

{The Baby Companion Strong Mom Manifesto}

I have been chosen to be the mother of my child

therefore I have everything I need to help him {her} thrive

I will operate in confidence knowing that

with God’s help, we will experience peace and joy everyday

I will seek out other moms to support and grow with

but I will not impose my point of view

or make them feel less-than for choosing

a path that is different than our own

I will encourage and build up other moms in my sphere

While remaining confident in our own convictions and methods

As I go throughout my days and lay my head down at night

being confident that I did my best

And my best is not only good enough, it’s perfect for my family

I am a strong mom and I will empower myself with truth

I am a strong mom and I will empower others with grace

Knowing that each path of motherhood is as unique

as the wonderful mom and beautiful children making the journey

Friends, go in confidence that you are empowered and you have the grace to empower other moms you meet every day. Give grace, get grace and you will surely thrive!

{Go now to take the pledge to support moms!}

I am participating in a blog campaign with One2One Network. I have not received any payment. All opinions are my own