pregnant

Dr. Nave now works with queens through her virtual practice Hormonal Balance.
We talk this time about how a woman can prepare her body for pregnancy.  You can listen to this complete podcast episode on iTunes or SoundCloud.

Alyssa:  Hello!  Welcome to another episode of Ask the Doulas Podcast.  You have Kristin and Alyssa here today, and we are excited to be back with Dr. Nave, the naturopathic doctor at Health for Life GR.

Dr. Nave:  Thanks for having me again!

Alyssa:  Thanks for coming again!  Last time, we had an amazing conversation about a woman’s cycle, and today, we want to talk about actually preparing your body for pregnancy.  What do you want to say?

Dr. Nave:  Well, that ideally, we would start a year ahead.

Alyssa:  One year ahead?

Dr. Nave:  One year ahead.

Kristin:  Does that mean they should be off birth control one year ahead, or would you advice getting off of an IUD or birth control pills in advance of that year?  That’s my question because that’s something that is commonly asked.

Dr. Nave:  That’s a great question.  Even though ideally I say a year, if a woman wanted to, say, get pregnant in less than a year, then I would suggest, if she’s coming off of an IUD that has hormones in it or an oral contraceptive, to stop taking it at least three months before starting to try to conceive.  That’s because the oral contraceptive and the IUD with hormones is basically producing the hormones that your body should be responsible for making, and what women often find is that once they stop using those — because, basically, it’s suppressing the body’s own production of hormones.  She’ll find that she doesn’t have a period for an extended period of time, and I would also want her to detox her body and make sure that she’s pooping regularly, that her hormones are being made at an optimal level, and basically establishing what the normal and optimal cycle should look like.

Alyssa:  So if you’re preparing your body for a year, then that means you can stop at three months?  So the three months is just a part of the year?  Twelve months ahead of time of when you would ideally like to be pregnant, you’re going to talk about what to do; but then three months before, minimum, is when you should get off a hormonal birth control pill or IUD?

Dr. Nave: Yes, because it gives your body time to normalize your cycle and it prepares your body to actually hold a baby so that it can grow.

Alyssa:  So then what do we start doing at twelve months out

Dr. Nave:  It’s basically a multifactorial approach.  It’s stopping the things that interfere with your hormones, like oral contraceptives or getting the IUD removed.  Also cleaning up her environment, so skin care products, household items, household cleaning supplies, being more environmentally aware of the things that she’s using, the foods that she’s placing into her body.

Kristin:  If she’s coloring her hair and things like that?

Dr. Nave:  Right, if she’s coloring her hair, nail polish, things like that.  And then we would also want to address nutrition.  A lot of the foods that are really accessible, like going to fast food or going to a restaurant, are foods that promote inflammation.  They tend to be higher in trans fats and refined sugars, which are all shown to increase inflammatory products in the body.  We want to reduce that by making sure that the woman is eating more whole foods.  When I say whole foods, I mean from the earth; no one processed it.  If you’re getting it frozen, that’s fine too, as long as someone didn’t already make it into a meal, so that you have more control and autonomy over what is being placed into your body.

Alyssa:  What does inflammation do to affect fertility?

Dr. Nave:  With inflammation, we have more cortisol.  We have dysregulation of blood sugar.  We have greater likelihood of mental and emotional disorders.  It wreaks havoc on us.

Alyssa:  It’s a lot of what we talked about last time with the cycles; if you’re not having a regular period, your cortisol levels could be too high, and that disrupts everything else?

Dr. Nave:  Right.

Alyssa: And inflammation kind of does the same thing to your body?

Dr. Nave:  Right, and things that can influence inflammation is not just the food that you eat, but being in a constant high stress environment and not managing that effectively or not having tools to really take care of yourself and having self-care.  Self-care is not selfish the way that people typically think of it as being, but more so, it’s nurturing.  Nurturing of yourself.  Think of the year leading up to pregnancy as rediscovering yourself, as reconnecting to who you are, and getting in the mode of, “I am ready to carry a baby to full term.  I am ready to add a new life to my life.”  It’s getting connected to that.  Also processing your past traumas.  Mental and emotional health is absolutely important with regards to getting ready to conceive.  Ideally, I wouldn’t want someone to be seeing conception as a solution to a relational issue because it probably won’t be, and it will probably exacerbate a lot of those things.  So during that year leading up, it’s dealing with your past traumas, whether they be related to a miscarriage previously; processing what happened and how it affected you, not just trucking along to get pregnant again, but really fully processing it.  Not necessarily living in it, but not pushing your emotions aside because they are valid.  Whatever you haven’t dealt with — and this is not guilt any woman by any means — but whatever we haven’t dealt with, that influences the baby.  That influences the baby’s risk for depression and anxiety.  It influences the genes and their susceptibility to different types of conditions.  In that year, by you taking care of yourself, you’re taking care of that baby in advance, as well.

Alyssa:  The baby you haven’t even had yet?

Dr. Nave:  The baby you haven’t even had yet; you haven’t even conceived yet.

Kristin:  So what if a woman is a constant dieter?  How do you handle women who are, say, on a fad diet, if they are wanting to conceive?

Dr. Nave:  I really like the book Intuitive Eating.  It’s written by two dieticians, and before mindfulness eating was a thing, these two dieticians came together, and they were like, diets don’t work.  Diets are a lie, and I completely agree with that.  If you think that, oh, I don’t have enough will power — you’re not the one failing.  The diet is failing you, because they weren’t built to work.  They’re not sustainable, at least the diets that people often purport.  Now, I would like to reclaim the term diet, because diet just means eating.

Alyssa:  What you’re eating, right?

Dr. Nave:  Right, right.  And so if you view your diet, if you view your food, as nourishing yourself, as honoring yourself, you fully immerse yourself in the experience of eating, like smelling the food.  You eat with your eyes first, so viewing it; it’s appetizing.  You smell it; you taste it.  You savor the textures that are in your mouth and the flavors that are bursting on your tongue and really immerse yourself in that and sit in that and be mindful.  Then you have a greater connection to yourself.  You are then more apt to tell when something isn’t going well.  If a woman is a fad dieter or is using food as a coping mechanism, we would then assess what is food giving you that you are not at this time receiving.  And so talking about that, having her read the Intuitive Eating book, because it goes through what type of eater are you, and reconnecting yourself to that intuitive eater, because as children — have you ever watched children eat?  They do not sit.  They get up, they eat what they want, and then they go back around and play.  At some point, we lose that ability to tell when we’re hungry or when we’re craving something and really honoring that, and intuitive eating is all about getting back to that.  SO I would definitely work with her and address, when did this first start?  What is it giving you?  What is it not giving you?  What is your motivation for doing things in this way?   Because what is encouraged by the media as what a healthy weight looks like is very cookie cutter, and I’m all about individualized care.  If you look at someone’s bone frame and they’re really thin and they have big bones and they look sick or they don’t feel well, that’s not good.

Kristin:  And then fitness is obviously a big question many of my birth doulas clients have.  What should they do in preparation?  If I was with them for the first delivery and then they want to conceive again, what would be an acceptable form of fitness as you’re trying to conceive?  What should you do to get your body ready for birth and postpartum time?

Dr. Nave:  If you’re already exercising, just maintain it.  Don’t go overboard.  Don’t become sedentary.  Moving your body at least ten minutes per day — ideally, thirty minutes, but that thirty minutes doesn’t have to be in one chunk.  Being consistent is more important than doing things really hard and really intense in a short period of time, so if she’s already exercising, just keep doing it.  You’re doing great, Mom.  Now, if she’s excessively exercising, that could be another thing that’s causing amenorrhea.

Alyssa:  Yeah, I’ve had friends who have been extreme athletes who just don’t get their period.

Dr. Nave:  Right, because all the hormones are being turned into something else as opposed to getting turned into progesterone and having adequate levels of estrogen so that you can bleed.  And I know some women are, like, oh, I didn’t bleed for a really long time and I’m so happy, but…

Alyssa:  Our bodies do this for a reason, right?  It needs to happen.

Dr. Nave:  Right, it needs to happen.  When you shed the old — think of it as shedding the old.  It’s a new month; I’m shedding the old from last month.

Alyssa:  It’s like a natural cleaning, almost.  It’s like a detoxifying — yeah, just — it seems like anything else that stores up in your body that needs to be shed can create toxic levels of something.

Dr. Nave:  Right, absolutely.  It can create adverse symptoms.  Having too much estrogen is not the best thing in the world.  Last time, we talked about estrogen dominance and how that can influence having more PMS symptoms like bloating, for instance, and being more weepy on your period.  If you’re not having your period, then you’re basically reabsorbing the estrogen and that could by your PMS looks that way.  But I digress.

Alyssa:  I have one question before we move on to whatever you want to talk about next.  Even with, like, what we’re putting on our body and our environment — so there are things that are called hormone disruptors, things that will disrupt your hormones, right, like in the products that we’re putting in and on our body?

Dr. Nave:  Yes.

Alyssa:  What do you know about that?

Dr. Nave:  Those are parabens or phthalates.  They’re actually made from crude oil, which is refined and you can get parabens and phthalates.  You get mineral oil from it; you get the gas that you put in your car from it.  All of these things come from this product.  Why parabens and phthalates are an issue is that, basically, they act like estrogens.  Then that can be part of the estrogen dominance.  It can also affect increased risk for breast cancer.  It can affect mental and emotional health because remember I said that estrogen can increase weepiness or having a lower mood on your period.  Ovarian cancer; you have an increased risk for that because it’s an exogenous estrogen.  It acts like estrogen; technically it’s not estrogen, but our bodies respond to it in that way, which can also lead to extra weight.  On the topic of weight, if you want to lose weight before getting pregnant, you would want to do that in a year before trying to conceive because with exposures to things like parabens or phthalates, which — technically, they’re solvents, so you would usually pee them out; however, if you have higher levels of them or if you’re being continuously exposed to it, our bodies store it as fat.  Then, when you’re trying to lose the weight, you’re releasing it back into your bloodstream, which can create symptoms like headaches or feeling really lethargic when trying to work out.  It’s not necessarily because you’re working too hard, but it could because your body is working on detoxifying or biotransforming these things so that they’re no longer toxic to you so you can pee it out and poop it out.

Alyssa:  So if you need to lose weight, that needs to happen before this twelve-month timeframe of detoxing before you get pregnant?

Dr. Nave:  It can happen in that twelve months.  You can start it before that because then you don’t have as much to do during the twelve months.

Alyssa:  But it should be one of the things that you’re thinking about a year ahead of time?

Dr. Nave:  Yes, because there are so many things that we use on a daily basis that, if we really thought about them, I think most of us would be scared to leave our homes, but we have to live, you know.  We need things in order to live efficiently and not work as slow, I guess.

Alyssa:  Well, if you think about the chairs we’re sitting on.  These are as eco-friendly as we could find, but the majority of them — there’s sprays on everything.  I looked at the new pajamas I got my daughter, and it said the flame retardant — it said that I can’t wash it in soap because the flame retardant will come off.  I was like, no.  I’m washing it.  I’m washing all the flame retardant off, actually.  But you don’t think about that.  My daughter needs a new nightgown.  You buy her a nightgown, and it’s covered in a chemical so that it doesn’t go into flames.

Dr. Nave:  Yeah.  Another of the things that the woman can do to help get herself ready before even consulting with a physician is that, with regards to environment medicine, opting to eat the dirty dozen — you can look at www.ewg.com, so that’s the Environmental Working Group.  The release the dirty dozen each year, and these are the fruits and vegetables that are the most heavily sprayed.  Opting to eat those things in season and organic, as opposed to nonorganic, and what that will do for you is — pesticides have solvents, which parabens and phthalates are a type of solvent, so they have some of those components to them.  By opting for organic fruits and vegetables that are on that dirty dozen, you don’t have to do all your fruits and vegetables organic.  Preferably, if they’re thin-skinned, like if you eat the skin of it, like tomatoes and strawberries and berries, you would want to opt for organic, but if not, at least the dirty dozen.  Make sure those fruits and vegetables are organic because those pesticides have the endocrine disruptors.  They’re things that affect your estrogen and your progesterone, and it’s not just those things it affects but your overall well-being.

Alyssa:  So because it’s disrupting hormones, it can affect your ability to get pregnant, but let’s say even while doing all this, you get pregnant.  It’s essentially affecting, again, your growing baby?

Dr. Nave:  Yes.

Alyssa:  Because you’re disrupting the hormones that the baby is using to grow?

Dr. Nave:  Yes.  So if you’re already pregnant, don’t freak out.  Don’t try to lose weight.  That’s one, because you’re pregnant, so your body is trying to use all the energy to make baby, as well as the fact that we don’t want to release any of the stored toxins in your fat to the baby.  What you can do is, if you’re going to eat fish, make sure it’s not one that’s high in mercury.  Avoiding things like swordfish, and if you’re going to eat tuna, make sure that — I think it’s albacore tuna, but don’t quote me on that — you can look at the Environmental Working Group, and there are other resources as well that list out the fish that are lowest in mercury.  Looking at your skin care products and, as much as you can and as much as is possible, avoiding shampoos and skin care products that have parabens or phthalates or sulfates in them.  It’s also because sulfates rub down your skin and it’s not as moisturizing.  We want you to look glowing and magnificent!  You can avoid those things in your skin care products and your household items and the food that you eat.

Kristin:  So cleaning products, obviously, as well?

Dr. Nave:  Yes, cleaning products.  And if anything has any fumes and you have to spray it, make sure that you have all the windows and doors open so it can air out.  If you get your clothes dry-cleaned and you have a garage, leaving them in the garage to off-gas before taking them into your house.  If you don’t have a garage, if you have them in a room where you can remove the plastic and open the door and let them air out so that you’re not exposing yourself to those fumes.  Just do that.  And then after the fact, then we can address those things then.

Kristin:  And then they would meet with you for a consultation preconception to try to get their body as healthy as possible?

Dr. Nave:  Yeah, and even if she is already pregnant, what can we do to maintain the pregnancy while also minimizing her exposure to these environmental toxins.  And her addressing her mental health during that time, if she hasn’t already started that process.  Is she eating adequate amount of calories?  Since we’re on the topic of nutrition, prenatal vitamins — you would start that at a year out.  A year ahead of time.

Kristin:  And, obviously, food-based versus the generic that you get at the normal doctor’s office?

Alyssa:  Yeah, you know, you get free prenatals at the pharmacy but they’re basically junk.

Dr. Nave:  We have very good-quality ones as naturopathic doctors, and I think DOs also have really high-quality ones, as well.

Alyssa:  So for somebody who can’t afford it, what are those over-the-counter free prenatals doing?  Are they doing any good?

Dr. Nave:  Yes, because they have folate and they have an adequate number of B vitamins.  It’s like a multi that’s specifically geared towards not only the mother’s health but also making sure that the baby can develop well.  Folate is the one that I’m most thinking about at this present time because folate is important for neural development, like the spinal cord.  What happens if there is insufficient or no folate is that the neural tube doesn’t close, and then that can cause spina bifida, which is a preventable condition if the mom is getting adequate vitamins.  Folate is B9.

Alyssa:  Oh, folate is a B vitamin?

Dr. Nave:  Yeah, it’s a B vitamin, so it’s a water-soluble vitamin that’s very important for the neural tube development.

Alyssa:  So my best friend found out she has this, and what’s the name — your body can’t absorb folate.

Dr. Nave:  Oh, right.  I know what you’re talking about.

Alyssa:  So she actually had a really hard time getting pregnant because she was taking too much folic acid.  But if you don’t know you have this, then…

Dr. Nave:  If you don’t know you have it, if possible, choosing a supplement that has methylated B vitamins, so methyl folate as opposed to hydroxylated folate is better.  What Alyssa was talking about is call MTHFR.  It’s methylenetetrahydrofolate reductase, so that’s an enzyme that basically, when you take in folate, for most people, they can then attach a methyl group to it, which makes it bioactive. There’s this cycle that you need methylation to occur in order to make the B vitamins active, which is important for making your red bloods cells, which is important for energy production, which is important for getting energy from your food.  B vitamins — I think of them as, like, the power house side kick.  Almost every enzyme in the body requires B vitamins.  I have this lovely chart right here that shows the citric acid pathway, basically the utilizing our food to make energy pathway, and almost every single step in here requires two or three different types of B vitamins.  There are even B vitamins that are enzymes themselves and carry things along.

Alyssa:  You love B vitamins!

Kristin:  So the free prenatals are helpful, just not…

Alyssa:  It’s better than nothing?

Dr. Nave:  Yes, it’s better than nothing, but if possible, there are different brands that we use as naturopathic doctors that you can probably try to get on Amazon, like Ortho Molecular or Integrative Therapeutic Initiative, I think is the name of it, ITI.  SO I know those are pharmaceutical-grade, and when I say that, I mean that they have enough of the vitamin.  It’s beyond the recommended dose, like what the government says this is minimally what you need, and it’s of good therapeutic value, so we know that it will do what it says it’s going to do.  They tend to have more of the methylated form, so whether the mother has a different time methylating her B vitamins, or if she doesn’t, it takes out more work for the body to do so then it can go right to where it needs to go.

Alyssa:  That’s fascinating!  Is there anything we didn’t touch on?

Dr. Nave:  I don’t think so.  We talked about environment medicine and reducing your exposure.  We talked about nutrition and making sure you’re getting enough calories.  Oh — fish oil, vitamin D3, specifically, vitamin D3, because that’s the active form, and prenatal vitamins with regard to eating whole foods.

Kristin:  We don’t get enough vitamin D in Michigan anyway, and I know that — and, again, I don’t have a medical background, but I know a lot of research on preeclampsia shows a lack of vitamin D3.

Dr. Nave:  Yes.  Another thing about preeclampsia is calcium and magnesium.  If a woman starts to experience preeclampsia, making sure that — sometimes, it’s due to an electrolyte imbalance and not getting enough protein, so we would want to look at how much protein is she getting.  The ratio that we usually look for is at least 0.8 to 1 gram of protein per kilogram of weight, so however many pounds you weight, divide your weight by 2.2, and that tells you how many kilograms, and then it’s 0.8 to 1 gram per that number that she should be getting.  If she’s getting adequate protein and has enough calcium and magnesium, then she shouldn’t get preeclampsia.  If she has a history of hypertension, making sure we’re managing that, whether naturally or if she’s taking medication, as long as it’s not one that would interfere with conception, would help to prevent it from happening.  But even if a woman experiences preeclampsia, it doesn’t automatically mean that she will get eclampsia because we can still, at that point in time, address what’s going on.

Alyssa:  Right.  Well, thank you so much.  I just feel like we could keep going and going.  You probably have 80 other topics we could talk about.  We’ll just have you back once a week!

Dr. Nave:  Oh, I’d be down for that!

Alyssa:  We’ll set up a couple more!  Well, tell our listeners where to find you if they want to reach out.

Dr. Nave:  You can find me at our website, and you can find me on Instagram, @drgaynelnavend, and I’m also on Facebook at the same handle.

Alyssa:  Great!  Thanks again!