Prenatal Care (Part 2)

In this episode, we are continuing to discuss a topic from Season 1, which is  to bring awareness to the importance of prenatal care for mothers/birthing people and babies across the Navajo Nation. We invited  Dr. Katherine Glaser with Tuba City Regional Health Care Corporation to discuss what happens during pregnancy for the birth person and the baby and why it’s important to attend prenatal care appointments.

Check out our social media pages!

Facebook: @Navajo Maternal and Child Health Project at Diné College

Instagram: @navajomch

Please email us if you have any questions, comments, or suggestions: navajomchproject@dinecollege.edu

This podcast was sponsored by the Arizona Department of Health Services through federal funding from the Health Resources & Services Administration, with support from the Navajo Native American Research Centers for Health (NARCH) Partnership between Diné College and Northern Arizona University through federal funding from the National Institute of Health’s National Institute of General Medical Sciences, award number S06GM142121. The views expressed are the sole responsibility of the program staff and do not necessarily reflect the views of the Arizona Department of Health Services or the United States Government.

Transcript

Intro Ya’ateeh. Welcome to the Maternal and Child Health Podcast, where we discuss maternal and child health topics and provide strategies for improving the health of Navajo families. Amá dóó áłchíní ats’íís baa áháyá baa yadelti. (Translation, we will be talking about the health of mothers and children).

Amber-Rose I'm your host, Amber Rose Begay. Hashk’ąąhadzohi nishli, Táchii’nii bashichiin, Tábąąhá dashichei, Naakai Dine’é dashinali. Nataani Nez denashaa. I'm originally from Shiprock, New Mexico, where I live and work at Diné college as a project coordinator of the Navajo Maternal and Child Health Project. I am a Navajo woman and mother of two. 

Stacey  Yá’átééh! Im your co-host, Stacey Litson. Tódích’íí’nii nishłį. Tábaahá báshischíín Áshiihíí dashicheii Kinyaa'áanii dashinalí. I'm originally from Tsaile, Arizona, but I currently live and work at Northern Arizona University in Flagstaff, Arizona. I'm so happy to be a part of this podcast to better help our native families and listeners. 

Amber-Rose On this episode, we'll be discussing prenatal care as part of our work with the Navajo Maternal and Child Health Project. We are implementing a prenatal care campaign, and the goal is to do our part in improving maternal health, which involves sharing information and resources on where to obtain prenatal care and birthing services, as well as the importance of this. We'll be working with Navajo area clinics and hospitals in order to provide them audio and printed information on the importance of prenatal care. 

Stacey Today we are going to talk with special guest Dr. Katherine Glaser with Tuba City Regional Health Care Corporation to discuss what happens in pregnancy for the birth person and the baby and why it's important to attend prenatal care appointments. Dr. Glaser, thank you for joining us. Can you please introduce yourself?   

Dr. Katherine Glaser Thank you so much for inviting me to talk with you today. I am an obstetrician-gynecologist and I work at the hospital Tuba City- Tuba City Regional Health Care Corporation. And I've worked there for the last ten years taking care of pregnant people and women also desiring to become pregnant.  

 Amber-Rose Okay, next question. What happens at a regular prenatal care visit, and why is this important?  

Dr. Katherine Glaser As a person enrolls in prenatal care and moves through those visits. There is a series of things that happen for them. Early in the pregnancy, during the first visit, the clinician who sees that person, so whether that's an obstetrician or a midwife, will take a careful history of all the prior medical problems that might be there, as well as any surgeries that may have happened in the past and also any other pregnancies that that person has had those. Knowing those things can help to guide the entire pregnancy and make sure that things are as safe as they possibly can be. Also, on the first visit, we will often check laboratory tests to look for immunity to certain infections and to look for signs of other infections, some of which are not that common but can definitely impact a pregnancy. Things like syphilis or HIV. And we will often, if not done at the first visit, will soon after doing an ultrasound which establishes the dating for the pregnancy so that we know exactly how far along in the pregnancy that person is. As we move forward through the pregnancy, there will be different things done at each of the visits, and some visits have things that are very important. So around the 18th to 20th week of the pregnancy, we often do an ultrasound to make sure that the anatomy of the growing baby is normal. Often around that time, we can also talk about optional tests that can look for certain genetic abnormalities in the pregnancy. And then, as the pregnancy moves along. So after the end of the second trimester. So around the 24th to 28th week, we offer vaccinations mostly against pertussis or whooping cough, which can cause serious illness in a child after they’re born. And we also recheck for things like anemia or low red blood cells, which often impact pregnancy. And we check to make sure there isn't any sign of gestational diabetes in the pregnant person because that can impact the growth of the growing baby and make the delivery more difficult. And it can be controlled with often with some education and changes in diet or lifestyle, at the very end of the pregnancy. We check again for infections, especially an infection called Group B Strep, or GBS, which can make the infant very sick when he or she is born. So we want to make sure that if that infection is present, we treat for that. So, each time in the pregnancy has important aspects to the prenatal care that allow us to take care of any existing health problems and also anticipate any health problems that might be there once the baby is born and offer some guidance in those areas.  

 Stacey Thank you so much, Dr. Glaser, for mentioning all the well, that information that goes on within the early visits in the pregnancy and after the pregnancy. I just think these prenatal care steps are very important to the mother and the child in regard to their health. For those who are pregnant, what should they do to take care of themselves?  

 Dr. Katherine Glaser In a very basic sense, being as healthy as you can be is important. So sometimes that could include some changes to a person's diet, to eliminate things that maybe are not as good for you. Certainly, we would discourage anyone who is pregnant from drinking any alcohol at all. Even a little bit can be related to what we call fetal alcohol effects or fetal alcohol syndrome. So it's very important to avoid alcohol. We would also encourage anyone who is pregnant to not smoke. And then people might sometimes have certain exposures that would occur through their occupation. So if someone has an occupation that would expose them to something like metals, like lead is an example, they might want to rethink or make their job safer. Certainly, there can be exposures, for example, of someone who works in a hospital that they might want to protect themselves against, and then sometimes it can be something simple. Like if a person has cats in their household, they would want to avoid taking care of that litter box in the household because the cats can carry a parasite that is not normally harmful to anyone who's healthy and adult. But again, make the baby when it's still inside the uterus. Very sick. There are a few other things about foods that we usually advise people about. One specific thing that comes up is the risk of infection when a person eats deli meat. So we often advise that people who might be eating that kind of food heat it up to make it safe for themselves. But generally, just trying to take the best care of yourself as you can is the most important thing. And I might add that if you are currently exercising, you can usually continue to do that at the same level if you haven't been exercising. You can probably add a little bit of exercise, but you would want to be a little bit cautious about adding anything too strenuous.  

Amber-Rose Thank you, Dr. Glaser. I'm glad that you pointed out some of these things that birthing people can do to be healthier during their pregnancy, especially the one about the cats. I remember when my sister was planning to become pregnant, she for she got rid of two of her cats, and they had been whatever a while. So I was kind of like bummed that, you know, she was doing that. But then, as I learned later on, you know, it is bad for the, in this case, mom to clean the litter. So and they were big cats. So they were huge. And then also the other one about the deli meat, that's one that I have not heard of. So thank you for pointing that out. The next question, what can the partner do to take care of themselves? The partner being the partner of the birthing person or mother?  

 Dr. Katherine Glaser So yeah with the partner can do is if the partner does engage in any of those activities that I mentioned that could, you know, impact the environment in the home, they would want to try to cut down on that like especially smoking or they could do that activity outside, but know that some degree of secondhand smoke is still harmful and might be harmful to the baby after the baby's born as well. Otherwise, just generally trying to be supportive, especially if there's going to be things like dietary changes in the home or reducing or eliminating things like drugs or alcohol. You know, being supportive about those changes is always helpful. And then just being honest with themselves too, about anything that they might need as, especially if it's their first baby as this huge transition begins to take place. So I think an honest assessment of where the person is at mentally as far as preparing can be really helpful so that both people can be in the best place possible as they look forward to welcoming this new person into their lives.  

 Stacey Thank you, Dr. Glaser, for stating those. Some recommendations on cutting down secondhand smoking and just having the partner be supportive with the changes and preparing their mental health because I feel like that would just help the baby even more be stronger and the mother have a healthy mindset as going forward into this new life change. What changes are taking place for the birthing person's body?  

 Dr. Katherine Glaser In order to have the pregnancy, there are several changes that take place- there is an increase in hormones, notably estrogen, and progesterone, which are hormones that women always have in their bodies before they go through menopause but are not present at such high levels. So one of the things that pregnant people often notice is that they might have trouble eating their meals, they might sometimes feel a little bit sick to your stomach, and they might have trouble with passing their bowel movements and some constipation. All of that's related to the hormones. I think pregnant people find ways to deal with those symptoms by sometimes eating crackers or drinking a fizzy drink, or sometimes taking Tums. But I think it can be helpful to know that those changes are normal, even though they can be uncomfortable. Other changes that take place are an increase in the volume of blood that circulating through your body, a great deal of which is necessary to take care of the growing placenta and the growing baby in the uterus. That volume of blood can sometimes lead people to become mildly anemic or have fewer red blood cells, especially for anyone living in northern Arizona or northern New Mexico. We all live at a little bit of altitude, so sometimes that can make people feel a little bit more fatigued, and that can be common. Of course, the other thing that happens is as the uterus grows the diaphragm, so the kind of division between the heart and lungs and everything in the abdomen gets pushed up a little bit. So that can make people feel a little bit short of breath as well. And also, that growing uterus can sometimes make it a little bit harder for all the blood that goes to the bottom half of the body to get back to the heart. And people experience that sometimes as a little bit of swelling in the feet. So all of those things at a small level can be common. But certainly, if somebody had, you know, a lot of swelling or they had trouble breathing to where they couldn't catch their breath, that can be signs of emergencies, and there's something that is always worth talking about, the clinician taking care of you during your pregnancy.  

Amber-Rose Thank you, Dr. Glaser. Yeah, those are subtle things that we might notice, but not really think that there might be a problem. So thank you for pointing out that if there is, like, swelling in the feet, or trouble breathing, that they should let their doctors or providers know. Next question, can you describe the development process of a fetus?  

 Dr. Katherine Glaser Yeah, so after fertilization occurs, when the sperm fertilizes the egg. The first thing that happens pretty rapid division of that new cell. So the cells keep dividing and dividing. And then, about three days after that, implantation into the uterus will occur. And from there, the placenta starts to grow. It takes a little while. And then, as the embryo develops, it will eventually become a fetus. And what is kind of interesting and very special about that is that by the time the fetus has reached about 12 weeks along in the pregnancy, all of the organs are formed as well as the hands and feet with fingers and toes. All of that occurs quite early. So as an example of that, even the spine, which builds itself from the neural tube, was formed very early in the pregnancy. And that's one of the reasons you will often hear clinicians say that you want to start a prenatal vitamin even before you become pregnant to help with the formation of that spine, which forms in the first, really, two months of the pregnancy. So after the fetus has formed all of its organs, the next months of the pregnancy are really spent growing and developing those organs. So that process really takes until the last few weeks of pregnancy for the lungs to be fully developed and for the intestines and the brain to be fully developed and ready to meet the world, so to speak, which is one of the reasons that we worry about early deliveries and have a few things that we can offer to people who have experienced those is because that fetus isn't really quite yet ready to be born, especially late in the in the end of the second trimester or early in the third trimester, because everything hasn't finished growing and developing.  

 Stacey Thank you for that, Dr. Lee. Sir, I never really thought about the process of a fetus growing and how early it starts; like you said, the spine grows in the first two months, and then the first 12 weeks, organs are formed as well as the hands and feet and how it is very important to take vitamins to help the baby. And I feel like you putting it in the sense of a like a video, like a movie, and a step-by-step process; I feel like was very interesting to hear. And I hope our listeners can take this information with them as they go forward in their lives. How can we encourage those who may be hesitant because they are substance users to receive prenatal care?  

Dr. Katherine Glaser Well, for people who are using substances. It still is, of course, very important to receive prenatal care. Though, it's not the case for every substance that someone might be using. We do have good medication-assisted treatment for people who are using opioids that we know are safe during pregnancy and also prevent some of the cravings that a person might have and probably prevent because of the stability of using this treatment, prevent some of the risky behaviors that a person might engage in to acquire opioids. So I would want everyone to know that the team in the hospital is ready to help you with that. There is always the fear between what happens with the team in the hospital and what happens legally. And I think that's something that we can always work to do better on because, as a doctor, my priority, of course, is that a person, whether they use substances or not, receive the best prenatal care so that they can have the best outcome of their pregnancy. But I know that people worry about requirements for reporting substance use, which can make that entry into care difficult. But really, we want to form the best partnership with all of our patients that we can so that we have a basis of trust and are able to care for everyone as an individual, however, they find their way to us.  

 Amber-Rose Thank you, Dr. Glaser. I know that was something that I was also thinking about when thinking about this question was what might happen if a person is using substances and wants to receive prenatal care but they're scared that they might get in trouble. But I like that you reassure them that you know that you're there to provide the best prenatal care and the best outcome for their pregnancy. So thank you for saying that. The next question is, what are birthing plans, and why are they important?  

Dr. Katherine Glaser Well, not everyone necessarily needs to have or wants to have a birthing plan. But what they can be very important to do is communicate your thoughts about your delivery before the intense moments of that delivery itself. I would say all clinicians providing prenatal care would have the goal that you have a healthy pregnancy and a healthy delivery that is safe for you and your baby. But the birth plan can help you to articulate some things that you want and help you set expectations for that time of delivery. So the things that people often think about in their birth plan can be, especially things like pain control. We all know that there is labor pain and pain with delivery. Some people know very much so that they want to try to have that delivery without any pain medication. Other people might want some pain medication through their I.V. site toward the end of the delivery. Other people might want to try alternative pain relief, such as music or meditation. And for others, we have inhaled gas- that's nitrous oxide, which can be helpful for some people. So some people are very interested in those types of modalities for pain relief, whereas other people know that they want to have their delivery be as pain-free as possible and they're interested in an epidural. So the birth plan can help you think through those options and discuss them beforehand and even write some of those things down. Often a birth plan, people will comment as to whether or not they want something like an episiotomy, which is a cut that can be done to facilitate delivery, you know, around the vaginal area. I would say we don't routinely do that. It's sometimes done in the case of an emergency, but expressing that you would not want that done unless there was an emergency is a very reasonable thing to do. And then other things that routinely happen, but you might have thoughts or opinions about would be things like after the baby is born, where do you want the baby to go right away? What we usually try to do in most deliveries, as long as it's safe, is delay the clamping of the umbilical cord for a little bit of time to allow some additional blood to flow back. And then often, while that's happening, as long again as it's safe for everyone, we can place the newborn right onto the abdomen of the other birthing person and allow that first contact to happen. And then, of course, people have thoughts about after the pregnancy and things like how they want to feed their newborn. So I would say a lot of people want to breastfeed, and expressing that desire even before the baby's born kind of helps to set up that. You will get as much support in that as you need because, for a lot of birthing people, that's a really challenging process, and we want to help you to be successful in that as well. So I think the birth plan is a really good way to communicate any specific desires with the people who will be taking care of you at the time of delivery and even afterward. Some things kind of have to happen or will happen. You'll definitely have a baby. We'll definitely try to make everything as safe as it can be. But having thought through the options that are there is really helpful.  

Stacey Thank you for expressing all those options that our listeners may need in the future for themselves and just expressing all their concerns with the health care physician of their choice, and that is provided to them could really benefit you, the birthing person, and the baby. So thank you for sharing those. Where can birthing people go to receive prenatal care on the nation?   

Dr. Katherine Glaser So there are a number of hospitals that provide both prenatal care and the services for delivery. That would include the Tuba City Regional Health Care Corporation, the hospital in Chinle, and the Northern Navajo Medical Center in Shiprock as well. There are other sites that are not; they don't have all the resources to have the delivery happen at those places where they are able to provide prenatal care. And that would include Kayenta, which provides prenatal care and then often has the birthing person have the last few visits at the place where the delivery will take place. So those are some of the options. I know that people also get care in Page and Flagstaff as well.  

Amber-Rose Okay. Well, thank you again, Dr. Glaser, for joining us today. We really appreciate your time and all of the valuable information that you provided.  

Dr. Katherine Glaser You are welcome. Thank you so much for taking the time to talk with me about something that is very, very important to individual birthing people, to their partners, to the entire family, and really overall, to the future of the Navajo Nation.  

Stacey Hello, listeners. We are now moving onto a new segment of this podcast where Ambrose and Stacy discuss what they learned or what they found interesting from the interview with our special guest. 

Amber-Rose Stacey, what are some key points that you want to talk about from our interview with Dr. Glaser?  

 Stacey Yeah, I thought the interview was very informative, informative, and I learned a lot, especially about the development of the baby in the early stages, like how quickly and fast the spine develops and the organs develop. I feel like I never really knew somebody. I never heard somebody talk about like that in a sense, like a step-by-step process and how babies are formed is very amazing in general, and you never actually see it. But there's something going inside the belly that is just amazing, and it’s just nice to hear from her point of view and her knowledge. And then the next thing is the vaccinations and testing options that she also included and how it better help to reduce infection and disease of the birthing person in the baby, which I thought was very informative to our listeners who can gain this information and help them when it's their time to go to the physician or the provider. Then the next thing was the different innovative ways the birthing plan can take place and how it can look like. 

Amber-Rose Yes, really, I agree. I think we don't always think about or I know there's those apps where you can track like your baby's growth, like what's developing. And so I think that's also helpful. But not everyone has access to cell phones and then let alone data. It's great to hear again, like that step-by-step process of a developing baby. And I think as far as the vaccinations, that's very important now, given COVID. I know pregnant women can get vaccinated and I believe children six months and older now. So that's very important. And then for the birthing plan, you know, I've been hearing that a lot with our previous interviews with Doulas, and I like how they talk about birthing plans, you know, what's going to happen, what decisions you want to make, who do you want to be involved, you know, that's very important. And I think this really gives more power and more choice to the birthing person and their partner and their families, really. I think it's a time to sit down and say, hey, you know, because this is a very big event happening, like a health event happening. You know, you're going to give birth to a person. 

Stacey Yeah, it's a big life change.

Amber-Rose Yeah, I think those are really great points. Some points for me that I just want to take away because I am a mom. And so I've been through two pregnancies. One is occupational exposure. She did talk about metals being exposed to metals such as lead. And then, if you work at the hospitals, you know, we have been through a pandemic. So I think that's very important to keep yourself safe and vaccinated if you do work in those areas and even just letting your boss know like, Hey, I'm pregnant, you know, I can't do anything strenuous, I want this to be a healthy pregnancy. And if they're not, you know, considering or considerate or supporting, you know, that can also be a toxic environment as well. So make sure you take care of yourself. The other thing was the increase in hormones and gestational changes. I didn't really think about that when I was pregnant, so I was kind of like, okay, I'm pregnant, you know, let's just make sure this baby is growing and is healthy. And, you know, I did my best to be healthy and change my diet and eat more nutritious foods. But I guess I just really never thought of really what's going on in your body, like the hormone changes. I feel like that, you know, with the higher blood volume and the swelling in your legs, like, I'm like, wow, you know, I never really thought of that. And two, I was younger when I was pregnant, so my body was a little bit more healthier than it is now. Read into what's happening with your body. If you see swelling in your feet, make sure you don't let that go unreported to your doctor. I believe that leads to like pre-eclampsia, which, you know, in the past has been fatal. But if you catch it, you know, it can be treated. And then the medications, medication-assisted treatment for opioids, that was one of the major things that I wanted to know is, you know, what happens if a birth person comes in is pregnant and, you know, is maybe a substance user, you know, what happens to them in the hospital? Will they be supportive? Will providers give you treatment? And yes, they will. That's, you know, very important, especially if you're pregnant, to get that treatment. And if you can, you know, stick with that treatment. And I like how she said that you know, it's important for them to make sure that you have the best possible pregnancy and birth outcome. I'm really thankful that we have this podcast, and I hope that you know, for anybody who is listening, you know, we're here for you, we support you, reach out to us, know if you need any additional resources, information, whatever it might be. We're here.

Stacey Yes, we're here. 

Outro Ahe’hee. Thanks for listening to the MCH podcast. For more information about the Navajo MCH project, please visit us on Facebook at the Navajo Maternal and Child Health Project at Diné College.