Getting Pregnant: Basic Infertility Evaluation
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You are trying to conceive a child but not having much luck. Could there be medical issues preventing you from getting pregnant? How do you know when it is time for basic infertility evaluation? What can you expect? I am Dr. Susanna Park, a Reproductive Endocrinology and Infertility with the San Diego Fertility Center and this Preggie Pals’ episode 72.
Sunny Gault: Welcome to Preggie Pals’; Broadcasting from the Birth Education Center of San Diego. Preggie Pals’ is your weekly online on-the-go-support group for expecting parents and those hopping to becoming pregnant. I am you host Sunny Gault. Have you joined our Preggie Pals Club, our members get bonus content after each new show plus special give aways and discounts. You will also get a free subscription to “The pregnancy” magazine. Visit our website www.preggiepals.com for more information. Also thanks to everyone who is listening to this episode through our awesome Preggie Pals Apps, they are available on the Apple and Android market place, Google Play Now as well as the Window’s phone. This is the best way in my personal opinion to listen on the go, like when you are out pushing your stroller with your little ones or perhaps waiting for your prenatal appointment and it is absolutely free. So download our Apps today.
We do have some amazing panelists joining us in our studio, but if you are not local to San Diego, you can still joining our conversation and Stephanie our Preggie Pals’ producer is here to tell us a little bit more about our Virtual Panelist Program.
Stephanie Saalfeld: All you have to do is like us on our Preggie Pals’ facebook page or follow us on twitter and when we record our show we are going to give you a little sneak preview questions and you can be part of our conversations from anywhere in the world.
Sunny Gault: So if you are on twitter follow “#preggiepalsVP, that stands for Virtual Panelist and we will be sure to tag everything with that. So you can follow the conversation little more easily and there is more information on our website if you want to check that out in the community sections, be a virtual panelist.
Lets meet the panelist hear that are able to join us in the studio, I guess Stephanie and I are considered panelist as well. I will tell you a little bit more about me, you guys know that I am the host of the show. I am pregnant with identical twin girls, the due date is December 16th but we are having the girls, we are C- Section and that is set for December 2nd. I am crossing my fingers, I will be 38 weeks, that is a long time to hold out for twins, but that is my goal date. I do have two little boys are home, Sayer who is 3 years-old and Urban who is 15 months.
Stephanie Saalfeld: I am Stephanie, I am 30. I am a producer for Preggie Pals’ and I have a baby girl Savanna who is about 8 months-old. Other than been a producer for Preggie Pals’, I am a stay-at-home mom.
Sunny Gault: Destiny!
Destiny Bochinski: I am Destiny, I am 34. I am a Physical Therapist and I specialize in Pelvic Floor Disfunction. I am due November 2nd with a little girl. We decided to find out this time, we didn’t find out with my son, it was a surprise and then planning urges took over this time around. So my son will be 3 in October and we planning our second home birth with a midwife.
Sunny Gault: Jessica!
Jessica Blagg: My name is Jessica. I am 29. I am a medical biller and my due date is March 8th and we have a one kiddo already. She is 8 and we are hoping for a VBac this birth.
Sunny Gault: Brigid!
Brigid Santiago: I am Brigid. I am 28. I am a nonprofit fundraiser and grant writer. My due date is December 19th with my first baby. It is a little boy and we are planning a natural birth with a midwife in a hospital.
Sunny Gault: Dr. Park I am going to throw you into the mix here because I know you have a little boy at home. So tell us little bit about him.
Dr. Susanna Park: I am the mother of a 13 month-old boy, know actually was conceived by fertility treatment and he is doing great and he is taking a nap as we speak.
Sunny Gault: You know my first was via fertility (unclear) you know from my first, anyone else had fertility go around? No? Okay! There is so many interesting conversations but first we are going to take a quick break.
Sunny Gault: Before we get started with today’s show we do have a pregnancy App to review. This is an interesting App because it could help you get pregnant or not get pregnant. It is all about tracking your fertile days and the App is called iCycleBeads. I downloaded the App the other day and what I like about it is it’s really simple. It is based on a product they have brace that basically that they have and that allows you to really easily be able to see when your cycle started and therefore be able to predict your fertile days and your non fertile days.
Real easy to set up the App, you just download it to your phone, you select your cycle date and then it gives you a nice little visual, there are a couple of options at the bottom, you can look at your calendar or get a visual of what they called cyclebeads and it literally kind of looks like it has got a circle on it, it has got different little circles within that and you know if you are in a brown area that means that you are not likely to get pregnant and if you are in a white area, then you are more likely to get pregnant.
Of course everything is according to date. So I am picturing myself you know out and about and thinking “Okay, is this a good day or not a good day” and it is just a nice visual because what I have done in the past is like put little “X” on my calendar at home and then tried to follow it that way. But for me this is a much more organized way been able to view my fertility but I wanted to get your lady’s feedback.
I know not all of you had a personal opportunity to test the App but we did pass around some phones here in the studio so that you guys could check it out a little bit.
Destiny! Let’s start with you, what do you think?
Destiny Bochinski: I like the visual, actually prefer the calendar look than the actual cyclebeads visual to it. The cyclebeads kid of looks like, it almost looks like what I have seen Birth Control Pills Pack. It doesn’t have dates on it; well it does tell you which day here on but…
Sunny Gault: It is harder to read I think without a calendar…
Destiny Bochinski: I like the calendar aspect that you can just look on there and see where you are at in your cycles. Also to track, I mean if you are not really particularly caring about getting pregnant. I like to track my cycle just so that I know what to expect and everything.
Sunny Gault: Mood swing!
Destiny Bochinski: Yes, and I can plan accordingly. So I think it is a lot easier than you said like clean access on calendar or trying to keep track of it in your regular calendar App.
Sunny Gault: Okay! Thumps Up/ Thumps Down, would you recommend it to another parent?
Destiny Bochinski: Sure! Thumps Up!
Sunny Gault: What you other ladies think?
Jessica Blagg: Thumps UP!
Sunny Gault: You like it, you think you could use it?
Jessica Blagg: It is nice, easy, simple tool!
Sunny Gault: Brigid!
Brigid Santiago: I have used several fertility Apps, I tried about 14 months to get pregnant and I like the visual interface in this, it is really simple. I will give it a “Thumps Up”. But for me I wanted something…when I am actually trying to get pregnant, I want something a little bit more comprehensive. So something that has a place to put your basal body temperature, your other symptoms and everything. But in general I think for most people that this will be a good App.
Sunny Gault: Stephanie, what do you think?
Stephanie Saalfeld: I have also used other types of fertility Apps and I say “Thumps Up”, I mean it works, I tracks what it needs to track and yeah it could be more comprehensive. I mean that can be a good suggestion to them but I think it is good overall.
Sunny Gault: Overall, I would give it a “Thumps Up” as well. A nice easy way again I like that it is on my phone and I don’t have to track down the calendar system. I think it is only like $299 in the Apps store. So it is not really expensive, it is something you can obviously use over and over again and the nice thing is a lot of people like that it tracks your cycles and keeps that information. So if you want to go back and look at a previous cycle, sometimes if you are really trying to get pregnant, if you are not completely, like “I am always 29 day, I am always 30 days” or whatever, it is nice to go back and see what you where the previous month. So I do like that feature as well.
So, it sounds like we are giving it a Preggie Pals’ “Thumps Up”. Okay! Thanks Ladies!
Sunny Gault: Today we are continuing our ongoing series focused on getting pregnant. Sometimes you try and try to conceive a child and nothing happens and that could be a result of a medical issue. Here to tell us more about that is our expert Dr. Susanna Park. She is a fertility specialist with San Diego Fertility Center and she is one of the featured experts on our shows. So welcome back to Preggie Pals’ Dr Park.
Dr. Susanna Park: Thank you Sunny, great to be here again.
Sunny Gault: What should couples do prior to seeking help with infertility, like what should we be doing on our own before we say “Okay, we probably need to see somebody”.
Dr. Susanna Park: So there are actually a lot of things couples could do before they come to see us. Because the more information they give me, the better I can help them. Speaking of Apps that we were just talking about, that is a great sag way. Often time’s patients would come to be and I don’t have a history as to what there periods are like. So it is helpful when they wipe out their phone and say “Hey look here is an App and this is what my cycles have been like for the past 5 to 6 months”.
So number one is track your cycles and it doesn’t have to be an App but something in writing. Remember when we say the first day of your cycle; we consider that the first day of full flow and not spotting. So sometime’s some patient’s come to me. I look at their history and they are counting spot but they spot for three days and then they menstrual. So it looks like their cycles are so long but they really not. So one is to track your period. Track when you ovulate and sometimes you can tell when you are ovulating but if can’t you buy an ovulation kit. Please don’t confuse it with the pregnancy kit. They are always sold side by side…
Sunny Gault: They are right!
Dr. Susanna Park: I don’t know why but they are and you had mentioned a basal body temperature, you can track that as well, right on the calendar when guys have sex, because that is also important. Another thing couples can do is look at your medical history, if you’re not medically healthy, make sure you go to your doctor, let him/her know that you are trying to get pregnant and get yourself medically healthy-optimally and another thing is get yourself in some kind of prenatal vitamin. The truth is you really don’t need a prenatal vitamin if you have a very healthy diet. But not everybody does, so what you really need is actually folic acid and the minimal requirements 400micro grams which is 0.4mg of folic. But most prenatal vitamins have about 800 to about 1000 micro grams. So it is really a good idea to get on a prenatal vitamin.
Sunny Gault: How long should we be trying to conceive before we…you hear the one year mark, I mean is that pretty standard?
Dr. Susanna Park: It depends of your age. So the standard is under the age of 35, one year of volatile intercourse. Above the age of 35, 6 months, but having said that it is really hard I think, let’s say you are 28 and you have been trying for 10 months and you are not getting pregnant and you really start to get anxious. So one of the tests you can ask your doctor for is a blood test to see “Hey, do I have enough eggs. There is a blood test called Anti-Mullerian Hormone, it is a simple blood test you can do any day of your cycle and it gives you an idea “that you know what, you are okay, you have got enough eggs, there is no need to panic yet”. But of course the world known FSH that you do on day 3 of your cycle which you should measure, FSH along with Estrogen. So these are two other hormones you can do and that will then a lay your fears that “Oh my goodness, I am running out of time”.
Sunny Gault: But nobody had to do this in here, right? No one had to wait and the seek fertility help.
Brigid Santiago: I didn’t end up seeking fertility help, I had six months trying, I mentioned to my doctor that I wasn’t successful in getting pregnant yet and I was 27 at that time and she did a blood test to check my Estrogen level and they were normal. But we then discovered actually (I don’t want to invade by husband’s privacy) it was on his end, he never went for fertility treatments and then we were…but he talked to his doctor and took Sudafed, actually my husband is a diabetic and so there was a complication related to his diabetes and that’s what eventually ended up working. So we would have eventually but we pretty sure it was him and not me. So that is why I never went in.
Sunny Gault: So Dr. Park, this kind of leads into the next question. What are some non-medical factors that could contribute to a couple’s infertility?
Dr. Susanna Park: So interestingly, when I see a lot of these histories that patients bring in, sometimes couples have sex way too often. The first month it is funny right, “Oh great, great”. Four months later, it is not funny anymore and they are tired of having sex. So take home messages “You cannot be having sex everyday because if you do, by the time you are ovulating there is no more sperm”.
But the other extreme is people just work and they are tired when they come home. Especially if you and your husband work two different shift, you are switching off because you already have kids at home and you honestly don’t have sex enough and that is really why you are not getting pregnant.
Then another factor which I mention but I mentioned it lightly is sometimes you so badly want to have that child that you it worked in your head that you are so anxious and so focused on it. That you are almost like shooting yourself in foot and I don’t like telling my patient’s that “Look you really need to calm down” because it is implying that their stress is causing it. But I do believe that your mental state really affects your physical state and sometimes you just have to be more natural about and just sort of have fun.
Sunny Gault: Which is hard to do if you have been trying for a long time. You feel like there is a lot of pressure especially if other people know that you are trying. It is just like every month it is like so…you know; it is like once you pass your due date they are like “So where is that baby”. So you know is just kind of the same thing…
So an average, what would you say percentage wise of couples having actual medical issue once they have been diagnosed and once they have gone through this evaluation. I suppose it is just a timing issue, because with my husband and I it is kind of an interesting story; we tried for over a year, we could not get pregnant and we started to seek the help of a fertility specialist and we did overall three rounds of chromed but it was two rounds and we had to take a break for just a month and then the third round is when we actually…we got pregnant. Subsequently with other pregnancies, they were pretty much not “Oops” babies because we wanted to have more kids but it was like “Oh my God, we did this on our own” like when we got pregnant with our second we were trying and we gave ourself “Hi Fives” you know we were like “Oh we can do this on our own”.
So in my head, they did all the testing and stuffs which we are going to talk about after the break and nothing came up, they couldn’t even find anything. So for us, I really think it was a timing issue, we were blaming it on some sort of other thing but you know, really how many people just can’t time it right. Because it is a very…we talked about this in our last episode by getting pregnant, it is a pretty narrow window of time. So of the couples trying to get pregnant, 15% of couples would find that they have a fertility issues. Of that 15 % of couples, 85% would have non-medical problem diagnosed. So the vast majority will.
Dr. Susanna Park: It is only a small set, that it is just a timing issue.
Sunny Gault: Interesting! We are going to explore this lot more when we come back. We are going to talk about what to expect during a basic infertility evaluation. So we will be right back.
Sunny Gault: Welcome back, today we are discussing “Basic Infertility Evaluations” and Dr. Susanna Park from the San Diego Fertility Center is our expert. She is also our feature expert on our show. So Dr. Park, let’s talk about these appointments? First time appointments and maybe a little nerve racking because we already kind of feel that something might be wrong with us. It is a topic that is hard to talk about because it is related to sex and that is always kind of weird and complicated. So what should couples expect at their first appointment?
Dr. Susanna Park: So ideally it would be great if both parties are present at the appointment, but you don’t have to be. But if you come without your spouse then try to get medical history on the spouse. So the first appointment what you want to get, as a physician, I want to know are there any medical problems contributing to the infertility? So medical history, surgical history, medications, social history- do you smoke, do you drink, are you currently using drugs, what is your occupation. You may have a hazard at work that is actually contributing to your infertility.
For women of course your obstetric and gynecologic history, how old where you when you first got your period? Do you get your period every month? Do you have a re-painful period? Have you had cyst? Have you had sexually transmitted infections? Have you had abnormal pap smear? So all those questions are very important, so really coming in armoured with this much of your medical information’s as possible would be helpful. Once that is done, I sit down and I basically go over basic reproduction, which may sound so simplistic but it is amazing how many of us have not been educated on basic female and male anatomy. So I go over that and I go over how fertilization actually happens and then I do an ultrasound to make sure there are no cysts on the ovaries and that the uterus has no fibroids.
Then I sit down and talk about just basic options and it is just an information gathering session. That is all it is. Then patient schedule a follow up visit just to go over test results.
Sunny Gault: So that kind of leads us to the next point which is, the testing that takes place. So we go to our first appointment, we talk with you, we talk about our history and then from there test are ordered. It is obviously different from men and women. So let us take this down a little bit.
For women what are some of the general test? What do you do?
Dr. Susanna Park: So for women, you want to focus on three organs; eggs, fallopian tubes and the uterus. So the eggs which I mention a bit in the past is blood test. So you want to do the Anti- Mullerian Hormone, you want to do on the third day of your cycle Follicle-Stimulating Hormone, which is FSH and you also want to do on that same test J3 Estradiol Estrogen. You also would like and we do this in our practice and I don’t know if it is done at every other practice, we do an ultrasound because we measure something called Antral Follicles which is the number of little Follicles you can see on your ovary for that month.
So you use all those two blood test and the ultrasounds to get an idea what that woman’s egg count is like. So these are only tests of egg quantity quality.
Then to look at the Fallopian Tubes; you do a test called Hysterosal pingography which some people know as the Dye Test. It has a bad warp because many patient’s complained “Oh my goodness, it was so painful” and it is for some women but it is not for all women.
Sunny Gault: I personally experienced a little bit of cramping but they told me when it was going to happen and it was nothing – I have menstrual cramps that are much worse though.
Dr. Susanna Park: Then the third test is to look at the Endometrial Cavity which is the inside of the uterus to make sure it is normal and that can also be achieved by the same Hysterosalpingography test. So the Hysterosalpingography looks at both your Fallopian Tubes and your uterus at the same time.
Sunny Gault: Now how quickly can this test be done? Are we trying to time this at certain times of our cycle right?
Dr. Susanna Park: Right! So the Hysterosalpingography has to be done usually around between days 7 to 10 of your menstrual cycle, counting day 1 as the first day of full flow. Your hormone test and the FSH and the Estrogen should be done around day 3 of your cycle.
Sunny Gault: What if a woman comes in and is very unclear on her cycle and hasn’t been tracking it for a while, so there is lot of question marks. How do you handle that?
Dr. Susanna Park: Very easy, because these tests just have to be done before she ovulates. Most women who don’t know where they are in their cycle are usually women who don’t get regular period, meaning their periods usually come every month and a half and so for them the timing doesn’t change. It is the woman who says “I get my period every 2 to 3 weeks” that is the woman whom you have to change the timing a little bit. But woman like that know where they are on the cycle because they are constantly menstruating.
Sunny Gault: Now how accurate are these test? Are these like a 100% or it just gives you a guideline.
Dr. Susanna Park: It is a guideline. The egg tests are pretty good but they Hysterosalpingography has a 15% falls positive and falls negative rate, meaning the test can come back positive and you still don’t get pregnant and then I decide “Let’s do this other test, just to make sure things are fine” and of course limbo hold, your Hysterosalpingography was wrong. So that does happen about 15% of the time.
Sunny Gault: So those were the test for women?
Dr. Susanna Park: Yes!
Sunny Gault: So let’s talk about what the men go through?
Dr. Susanna Park: Much simpler! The men have to give their sperm sample. So but here is the issue, the sperm sample, there is a timing factor related to it. So the men should have ejaculated 2 to 5 days prior to the date of the sperm sample. That is always very confusing, in order words we don’t want the man to have ejaculated the day before his sperm sample because the sperm concentration will be lower. We don’t want it to have been a week since he ejaculated because the sperm will be slower.
So he should have ejaculated 2 to 5 days before the given date of his sperm sample. He should go to a reputable lab and what I mean by reputable is a lot of men understandably if their insurance covers it, they go to usually a Quest or Lab Core and that is fine as a preliminary semen analysis. But these labs are not…the people are not trained to do semen analysis and so if after that initial semen analysis things are not going well he should really go to a real fertility lab and get a real thorough semen analysis. Because what you look for is the volume of the ejaculate? The concentration of the sperm, that is how many millions sperm are there in 1 cc of the ejaculate? What % of the sperm is moving? And the most important factor is there is a straight Morphology criteria called Cruegers, where you look at the shape of the sperm.
So what % of man’s sperm is normally shaped, because normally shape sperm is what fertilizes an egg?
Sunny Gault: Why does it have to be a certain shape or whatever? Can you explain? I know we talked about this a little bit in our last episode we did but why would a misshape in for like of a better term sperm not be able to meet the egg.
Dr. Susanna Park: Because in order for the sperm to fertilize an egg, it has to be bind to what is called a Receptor on the egg. So it is like a key and a lock. So if the key is not the right shape key, it won’t fit into the lock and unlock the door. Believe it or not, majority of sperm in a man’s ejaculate is not normally shaped. So you want at least 14% or greater and the most optimal condition of normally shape sperm and most men have perhaps 4% or 8 %, beneath that majority of the sperm is not normally shaped.
Sunny Gault: That is really interesting!
Dr. Susanna Park: Is that not interesting! So among infertile couples, very often we will see in the semen analysis that it is a sperm shape issue.
Sunny Gault: So it is less than what, 4% is that what you said?
Dr. Susanna Park: Ideally you want it above 14% normally shaped. But many men are less than 14%.
Sunny Gault: WOW! That amazes me. So it doesn’t mean that we can’t get pregnant? It is a game of odds. That is why it takes you longer and longer and longer. But this is among an infertile population. But also what also leads to survival of the fittest. We talked about this before like those sperm won’t work but we are trying to get the best of the best, which everyone can pat themselves on the show right now, “we are the best of the best”. We made it here.
Jessica Blagg: I know it is funny like listening to all of these statistic and listening to all things that have to go right… it is an incredible anyone ever gets ...(overlapping) How did this happen? And how does it happen naturally?
Sunny Gault: I know! So we do these test, the test come back to somebody like you’re fertility specialist who analysis this and then it is what? What do you do with these results? How do you piece everything together then?
Dr. Susanna Park: It depends, so if all the tests come back normal, it is a blessing because you can say “you are all fine” but it is also frustrating right because then you sit there and you look at me and you say “So what is wrong” what are we doing wrong? We are timing it right, we are doing everything… why am I not getting pregnant? So you fall into a category called unspecified meaning, we honestly have no idea, we don’t know…
Sunny Gault: See that is what they did with us, they said we are unspecified and it is a large % …what is the % they get put into that category?
Dr. Susanna Park: It is about 15 to 20%. But here is the beauty of it though, in a couple and whom everything is normal, conservative treatment is the way to go, like Chromed, right. Start of just small things, stay with the sex theme, just a little here and there…
Sunny Gault: “The sex theme” I love that…I suppose the Petri Dish theme…
Dr. Susanna Park: That is right! But as the tests come back abnormal then I know alright the sex theme isn’t going to work for these reasons. So now we need to talk about more aggressive treatment such as insemination or IVF. But if the tests do come back normal and you have got enough time because your test is great, there is no reason why you need super aggressive treatment.
Sunny Gault: So if one of your test and maybe it depends on the test but do you have to get like a 100% on these tests in order to kind of fall into the category of you can still do this on your own or you know if you flunk one then we really need to look at some outside treatment?
Dr. Susanna Park: No! It depends on the test. So let’s say she is 28 years-old and he is sperm is not the best but it is not horrible but honestly it is not the best but she is 28. I will say to her listen “Let’s just try some conservative stuff” three months and if that doesn’t work then let’s revisit this and then we will do something more aggressive to really address the sperm. But let’s say she is 39 and his sperm is not so great, my tune is different, right, because now she is running out of time and at that point I am going to say look “we really need to address the problem here which is really the sperm but you are also running out of time” so now we need to talk about aggressive treatment because if I don’t do this now, you may not have a chance in a year.
So you have to look at all of the factors to decide how aggressive you should or should not be.
Sunny Gault: I know this naturally goes into a conversation about what your options are and stuff, but we need to hold off on that, we got a whole other episode that we are planning to talk more specifically about Chromed, about IVF, I think we can do a whole episode on IVF. It is fascinating to me. But thank you Dr. Park for sharing all these information’s on our show today, it is always a pleasure to have you on Preggie Pals’, we love it.
Dr. Susanna Park: Likewise! Thank you for inviting me!
Sunny Gault: For more information about our expert and panelists you can visit the episode page on our website and this conversation continues for members of your Preggie Pals’s Club. After the show Dr. Park will shed some light on why some couples may initially have some trouble getting pregnant and then no problems conceiving future children which was exactly what I personally experience.
So for more information on our club, visit our website at www.preggiepals.com
Sunny Gault: Before we wrap today’s show, here in Janet Maccaulay with some of the best online pregnancy resources.
Janet Maccaulay: Hello Preggie Pals’, I am Janet Maccaulay of (unclear), we at (unclear) believe that you as a mother will make the right decisions for your pregnancy and birth when you have access to evidence based information and a strong support system. That is why I am here to share with you real immediate tools to find the information that is right for you.
Today, I am going to talk about a serious topic that it deserves our attention, most of us have heard of post-partum depression. But what we are learning is that mothers can be affected with a mood disorder at anytime during child bearing. They can include not just depression but also OCD anxiety and in very rare cases (unclear). About 15 to 20% of one another and mothers to be experience some type of perinatal mood or anxiety disorder. If you or someone you know is struggling beyond the normal ups and downs of pregnancy or child after birth, the website www.postpartumprogress.com is a rock solid peer to peer resource.
The site was created by mom Katherine Stone after her own struggle with postpartum OCD. Here you will find information written in what she call “plain mommy English” meaning no medical names is spoken here. There is a comprehensive list of symptoms including warning signs when you need to seek immediate help. You will also find information on treatment option including those that are compatible with breastfeeding.
Dads and partners, if you are listening, there is a section here just for you to. Most importantly when you are reading you feel like you are hearing someone who just gets it. Remember this is a peer to peer resource and not a substitute for medical attention. You can find this site at www.postpartumprogress.com you can also find Katherine Stone on twitter, follow the link from her website.
Thanks for listening today’s tool for finding the information that is right for you and be sure to listen to Preggie Pals’ for more great pregnancy tips in the future.
Sunny Gault: That wraps up our show for today; we appreciate you listening to Preggie Pals’. Don’t forget to check out our sister show Parent Savers’ for Parents with New Born, Infants and Toddlers and our show The Boob Group for Mom’s who Breastfeed their Babies. Next week we are talking about Pesiodamize Tearing and Perineal Massage.
This is Preggie Pals’; “Your Pregnancy Your Way!”
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
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