HEALTH

Pregnancy is already a long journey, and the emergence of COVID-19 has brought along physical and mental burdens to mothers and mothers-to-be. Pregnant people are at a higher risk of contracting COVID-19 or experiencing more severe effects of lung and cardiovascular strain.  Worries about their health also affect pregnant peoples’  mental states and can further contribute to ill health. This stress is compounded by isolation as many people have had to deliver babies without loved ones around them due to current no visitor policies in hospitals. 

The Physical Impact of COVID-19 on Pregnancy

Although research on pregnancy is still far from complete, some trends have been observed.. Firstly, data suggests that pregnancy causes women’s bodies to be more susceptible to severe COVID-19. This is partially due to the coronavirus’ main points of attack being the respiratory and cardiovascular systems, both of which are already under additional stress during pregnancy. As the uterus expands, it presses against the lungs and therefore affects pulmonary function. The higher vulnerability to COVID-19 also stems from pregnancy altering the immune system. According to Dr. Akiko Iwasaki, an immunologist who studies at the Yale School of Medicine, a pregnant woman’s entire immune system is geared towards not creating any sort of anti-fetal immune response, so “the mother has to compromise her own immune defense in order to preserve the baby’s health.” 

In September of 2020, the Centers for Disease Control and Prevention (CDC) conducted a study on the birth outcomes of 598 pregnant women confirmed to have COVID-19. They found that pregnant women with COVID-19 were more likely (6 times more likely according to the Public Health Agency of Sweden) to be hospitalized and admitted to the Intensive Care Unit as opposed to their non-pregnant counterparts. Moreover, there was a slight increase in preterm deliveries. Another study found that pregnant women were 70% more likely to need ventilators. 

The Mental Effects of the Pandemic on Pregnant Women

In addition to the physical strain of pregnancy, there are several mental stressors on pregnant women during this pandemic. From worrying about their baby’s health  to their own wellbeing, people are spread thin juggling the physical and emotional labor of pregnancy.

Working as a medical assistant at a gynecologist’s office over this past year has given me personal insight to the perspectives of pregnant individuals during the COVID-19 pandemic. I heard many admissions of distress and anxiety, and the OB-GYN I worked under shared her fair share of saddening stories of what it is like in the operating room. Many hospitals have a limitation of one visitor per patient- meaning that some expecting mothers’ partners must be home to take care of their other children and that there is an absence of the usual flood of friends and family who would shower love upon the new mother and child. As a result of this policy, there are patients who must deliver on their own or with their loved ones through a phone screen. Additionally, the one visitor policy can lead to conflict of who the expecting mother would like as her companion during the delivery. This could be between their partner, a parent/parental figure, a doula (a trained professional who provides the mother with emotional, physical, and mental support before, throughout, and shortly following childbirth), a best friend, etc. Although this rule is extremely useful in the prevention of COVID-19 spread within the hospital, the loneliness and lack of support in labor and delivery are not insignificant issues. These problems and prolonged isolation from quarantining in general most definitely have a negative impact on the mental health of these mothers. Bringing life into this world is usually an event that is filled with lots of joy and loved ones, but the pandemic has transformed it to being a lonely and stressful experience. Studies have proven that after only 50 days of quarantine, pregnant people showed a pronounced “increase in depression, anxiety and negative affect” compared to the non-pregnant people. With a normal pregnancy lasting about 9 months, these emotions are further prolonged and amplified. 

During these trying times, it is important to do what we can in order to take care of ourselves but also to help the others around us, especially those at high risk. While this does include the elderly and those that are immunocompromised, a more subtle population that is still at high risk during this pandemic is pregnant people. It is extremely important that pregnant people take care of their bodies, as they are working to provide for themselves as well as another being. In order to stay physically healthy during the pandemic, pregnant people can follow the typical guidelines for pregnancy such as: eating nutritious meals, exercising regularly (staying at home or socially distanced is best), and getting plenty of rest and sleep. To maintain mental and emotional health during these times, it is essential for pregnant people to keep loved ones close (physically or virtually), as they can aid in the navigation of any anxiety, stress, or depression. Also, speaking to a provider about their mental health can be helpful for pregnant people. There are often support groups offered by hospitals, such as Chester County’s Hospital’s Mommy Wellness Network program. 

Helpful and links to resources that can be shared by non-pregnant people to aid the expecting mothers in their lives:

• FAQ about nutrition during pregnancy: https://www.acog.org/womens-health/faqs/nutrition-during-pregnancy
• FAQ about exercise during pregnancy: https://www.acog.org/womens-health/faqs/exercise-during-pregnancy

Featured Image: The Little Poster Shop

Whether you’ve done a deep dive into birth control options or not, you’ve probably heard at least something about IUDs. Intrauterine devices, more commonly referred to as IUDs, have been on the market in the US in some form since the 1960s, but their popularity has fluctuated over the years, largely due to an IUD called the Dalkon Shield (taken off of the market in 1974) which led to more than 300,000 lawsuits by women who had developed infections and eventually became infertile because of this defective device (1). IUD design and safety has changed significantly since then and the number of women using them in the US have increased in recent years (2). Barbara Blizzard, a nurse practitioner at the UT Women’s Health Clinic, attributes the increase in IUD popularity among college-aged people in recent years to two things: 

• Increased research shows that IUDs are safe for people who have never given birth
• The Affordable Care Act, which mandates that all insurance plans cover all forms of birth control, including IUDs, which can cost up to $1000 without insurance. 

If you are one of the many people who have considered getting an IUD in recent years, you may have some questions about them. Here’s a guide to help you decide whether or not an IUD could be right for you!

How do IUDs work?

The method by which IUDs work depends on the type of IUD (more on that later). Hormonal IUDs work the same way that other hormonal forms of birth control do: they slowly release progestins (the same hormone present in several types of birth control, such as the mini-pill, the birth control shot, and Nexplanon, the birth control implant) into your body to stop ovulation and thicken the cervical mucus, both of which reduce the chance of pregnancy. Non-hormonal IUDs don’t prevent ovulation; instead, they work by releasing a small amount of copper ions, which create a hostile environment for sperm (3). It is important to note that no IUD protects against STIs; always use a condom to protect against STIs (3). There are two main types of IUDs: hormonal and non-hormonal. In the US, there are four different hormonal IUDs available: Mirena and Liletta, which are effective for six years, Kyleena, which is effective for five years, and Skyla, which is effective for three years (4,5,6,7). Mirena and Liletta both have the highest hormone levels, and Skyla has the lowest amount of hormone. There is one non-hormonal IUD, the ParaGard, which lasts for ten years. All IUDs available in the US are flexible and shaped like a T; they sit completely in the uterus, with strings that go through the cervix to allow for removal2. 

Why might you consider an IUD?

IUDs are incredibly effective; both hormonal and non-hormonal versions are over 99% effective at preventing pregnancy (3). They are also essentially no-maintenance. Once they are placed, all you have to do is check the strings on the IUD every once in a while by feeling for the strings around your cervix. Since you don’t need to remember to take a pill at the same time every day, the risk of user error is very low. Several of the hormonal IUDs will decrease bleeding and pain during your period, and the copper IUD is a great option for people who don’t want hormonal forms of birth control. 

What are some drawbacks of an IUD?

IUD insertion is not a painless procedure. Insertion “is brief but intense,” Blizzard said, explaining that the uterus is a “formidable muscle” that naturally resists the process of IUD insertion. Both types of IUDs have side effects; the copper IUD can lead to heavier and more painful periods, and the side effects possible with other types of hormonal birth control still apply to hormonal IUDs, such as impacts on mood. Some side effects, such as spotting or irregular bleeding, go away after a few months, but can persist longer in some people. There are also a few risks associated with IUDs, just as with any other form of birth control; there is a small chance that your body may expel the IUD, usually within the first few months of having it, and there is a smaller chance that one of the arms of the IUD could become embedded in your uterine wall (3). Additionally, with IUDs, your choice of menstrual products is slightly more limited. Many people are advised not to use menstrual cups if they have an IUD because the suction might pull it out, and a recent study found that women who use menstrual cups had higher than usual rates of IUD expulsion (8). 

Who might not benefit from an IUD?

If you’ve responded poorly to hormones in the past, hormonal IUDs might not be your first choice. Additionally, non-hormonal IUDs can increase bleeding and pain during periods. “For someone who already has heavy periods or significant cramping, [they] might not choose to try the copper IUD, because that may enhance that,” Blizzard said. Another factor that can influence your ability to get an IUD is something you may not be aware of: if you have a small or irregularly shaped uterus, you may not be able to get T-shaped IUDs, which are the only option available in the US. Several pre-existing conditions may also factor into your decision and your healthcare provider will be able to advise you best on your contraceptive options. Without insurance, IUDs can be a tough financial choice. While they last for many years, the up-front cost can be very high without insurance. 

What if I don’t want my IUD anymore? 

IUDs must be removed by a healthcare professional, but this is a very simple procedure that is typically significantly less painful than the insertion process. IUDs can be removed at any time, and your fertility can return immediately, or you can switch to another form of birth control2. 

So, is an IUD right for me? 

It might be! It also might not be. “You have to look at yourself, and [look] at what gives you the most concern, and what seems to add the most benefit,” Blizzard advised. IUDs, like any other form of birth control, have both pros and cons, and no two people will have the same experience. 

When I started looking at birth control options, I was drawn to the ParaGard copper IUD, because I had never used hormonal birth control before and didn’t know how it would affect me. I had it for a year, but it caused extremely painful cramps that I had never previously experienced, and so I eventually chose to get it removed and switched to birth control pills. I am open to getting a different IUD in the future, but for the time being, I like having a completely predictable period. This is simply my personal experience, though, and every body is different, so you may have a completely different experience with an IUD, no matter which one you choose.

It has been over half a year since many countries first started taking public health measures to control the spread of COVID-19 and implementing new policies to manage the mass congregation of people, especially in public spaces. Excluding essential work, almost every aspect of life has been moved onto virtual platforms — education, business, social events, and even medicine. Still, doesn’t it seem a little ironic that we’re being discouraged to visit our healthcare providers in person? During a public health crisis? To alleviate some of the confusion, here’s a brief FAQ about telehealth. 

Virtual health appointments?! How does that even work?

Telemedicine, also known as distance medicine, is an emerging platform that makes healthcare accessible to patients through the use of technology. Appointments typically take place over a phone or video call with your provider. Some may even allow you to type in a live chat. You’ll also be able to meet with your primary care physician as well as clinical specialists such as counselors, physical therapists, dermatologists, urologists, etc.  Not all communities have access to these services in-person. While urban areas are concentrated with medical facilities and specialty clinics, people that live outside of the city may have to drive over an hour to see their specialist. Virtual meetings can fill the geographical gaps in healthcare distribution between regions of the country and beyond international boundaries. In the context of global health, it is always be possible for doctors to cross borders and treat communities in different countries, especially given the current travel restrictions in place due to the COVID-19 pandemic. Technological advances allow for instant communication between physicians and local health workers in these communities.

While the benefits of telehealth are undeniable, this system is not without its faults. One major caveat is the accessibility of technology itself. While telehealth sounds convenient for people with smartphones and computers, not everyone has a compatible electronic device or a stable connection to the internet. As of 2019, the Pew Research Center found that 90% of U.S. adults use the internet, but only about 73% of adults have high-speed broadband service at home. 17% of adults rely on smartphones as their primary means of online access but they do not have traditional home broadband service. On average, vulnerable populations are hit the hardest by these disparities. For families with annual household incomes below $30,000, the internet usage is closer to 82%. In rural areas, internet usage is about 85%. Fortunately, there has been a rising trend in internet accessibility for all populations over the past 20 years. According to the Agency for Healthcare Research and Quality (AHRQ), telehealth improves healthcare quality, particularly in rural settings.   

Seeing a healthcare provider in person may put you at a greater risk for contracting COVID-19. If telehealth isn’t an option for you, the Centers for Disease Control and Prevention offers safety guidelines for in-person visits. 

Despite any current disparities in the availability of technology, telehealth remains a frontrunner pandemic response. The goal of this new approach is to minimize the amount of people in clinics, diagnostic centers, and hospitals. After all, even though electronic devices can get viruses, at least it’s not COVID-19!

What makes telehealth so beneficial? 

Scheduling and time management

Waiting rooms simply don’t make sense! For in-person visits, you are expected to arrive for an appointment 15 minutes early but then you’re stuck in the waiting room for half an hour! Telehealth eliminates these unnecessary delays. Just like regular appointments, there are time slots you sign up for. However, healthcare providers are able to cut down on logistical but time consuming processes such as cleaning up examination rooms after every patient. You can expect to actually meet with your physician at the time you signed up for. 

One problem that healthcare providers face are patients that are “no-shows” for their in-person visits. There are many reasons that a patient may not be able to show up for their scheduled appointment due unavoidable conflicts. Telehealth alleviates many challenges posed by these circumstances. Canceling appointments is made a lot easier as well as the scheduling process for virtual appointments allows you more flexibility and compatibility with your lifestyle.

Access

It is important to stay informed of your health conditions and treatments. Sometimes your symptoms may worsen or your treatment may seem to be effective. You may forget how to perform the treatment regimen or the amount of medications you’re supposed to take are certain times of the day. Just listening to your healthcare provider talk about your treatment or reading a pamphlet about it is often not helpful. Telehealth allows you to access instructions for your treatment or information about your health condition. There are already existing hotlines that can connect you to healthcare professionals 24/7 if you have any concerns. Say goodbye to the alarming search results of WebMD!  

Cost 

Researchers are currently departing the true cost effectiveness of telehealth. Upfront costs are usually less expensive for virtual visits, averaging about $40-$80, compared to in-person visits, which cost over $100 more on average.  One investment for patients is an electronic device and a means of stable internet connection. However, there are other factors of telehealth that reduce costs for things like gas for transportation to a hospital or clinic and loss of productivity and income from missing work due to check-ups and treatments. Finally, a brief virtual consultation can save thousands of dollars by curtailing unnecessary in-person visits to an emergency department at the hospital.

What is the role of telehealth for women’s health and reproductive health? 

Just as any other consultation with a primary care physician or specialist, you can meet with an OB-GYN. Since women’s health is sometimes regarded more sensitively, telehealth in sexual reproductive care can be alarming to some people. These visits, however, are just as accommodating and vital as any other medical visit. 

These are health issues that can be diagnosed and treated online 

• Sexually transmitted diseases (STDs), sexually transmitted infections (STIs), urinary tract infections (UTIs), and other vaginal infections
  • This may come as a surprise, but initial screenings for STDs/STIs and UTIs can actually be done virtually. If more than one infection is suspected, your healthcare provider may prescribe you with several medications to treat all/any at once. This is common practice even with in-person visits. 
  • Your healthcare provider will determine if you need to visit a laboratory for follow-up sampling to confirm a diagnosis 
  • There are already commercially available at-home tests for STDs/STIs, and your healthcare provider may be able to order laboratory-grade at-home sampling kits for other infections
• Abnormal cervical mucus
• Rashes, bumps, and other uncomfortable issues
  • It is always at your discretion whether or not to share pictures or videos of your condition. 
• Abnormal bleeding
  • Spotting and irregular menstrual cycles can usually be treated without laboratory testing, even when you visit your healthcare provider in person
• Hormone therapy
• Birth control 

Here are several websites that offer online birth control (most don’t even require insurance!)

• Simple health
• Nurx
• The Pill Club
• GoodRx

These health issues have recognizable signs and symptoms; descriptions of your condition may be enough for a diagnosis. Your healthcare provider may even recommend treatment with just over-the-counter drugs, which is more affordable than lab testing and prescribed medication. 

According to the American College of Obstetricians and Gynecologists (ACOG), these are health issues that usually require in-person visits

• Fever (unrelated to COVID-19)
• Vaginal infection (unrelated to COVID-19) 
• Severe vaginal bleeding 
• Symptoms of an ectopic pregnancy 
  • Pelvic pain
  • Abdominal pain 
  • Lower back pain 
• Health issues due to a recent surgery or other invasive procedure 

Although telehealth offers flexible scheduling, you need to be seen by a healthcare provider right away for urgent issues. Seek care as soon as possible so that you can prevent worsening your symptoms.

How will screenings, preventative interventions, and maintenance of birth control be affected?  

Due dates for health maintenance procedures such as mammograms may not be seen as “essential” in-person health services, but it’s important to keep up with annual screenings. Still, waiting a few extra months is unlikely to be harmful. Similarly, contraceptives such as intrauterine devices (IUDs) may have a prescribed “expiration date.” However, there’s a grace period of up to about 6 months, so it may not be detrimental to your health if you have to wait a little longer than usual. Your healthcare provider will be able to provide you with the appropriate recommendations based on personal health factors such as age, pre-existing conditions, and health history.  

What about protection of privacy?

Although laying under the covers in the comfort of your own bed isn’t quite on par with a clinic, a virtual appointment is just like any experience that you have with your healthcare provider in person. Protection of your privacy is no different.

Bodily Autonomy?

I would like to preface this with some reassurance: you’re never going to be required to show any part of your body through photos or a video call against your will. There may already be policies put in place by clinics that prohibit sharing images of more private areas of your body. You’ll need to make an appointment to meet in person if a diagnosis cannot be made based on your description.

Health information

Doctor-patient confidentiality still applies. There are federal laws that protect your healthcare information, most notably the Health Insurance Portability and Accountability Act (HIPAA). By law, you will always be provided with a document that lists these policies and a waiver that you must sign before you can even be seen by your healthcare provider. Your health information is also digitally encrypted for your protection.

Personal information

Telehealth appointments offer patients a new sense of discretion when seeking treatment for women’s health and reproductive health services. For many people it may be intimidating or embarrassing to seek treatment from an OB-GYN or healthcare professionals that work in the field of gynecology and sexual health. There are many valid reasons that you may want to keep your consultations and treatments private. 

Women’s health is often stigmatized when treatment is sought for any reason other than pregnancy. For example, one’s culture may not be accepting of reproductive health treatment because sexual practices are considered taboo.This discretion also protects transgender men and other members of the LGBTQ+ community from being outed if they choose not to do so themselves. Telehealth allows people to connect with healthcare providers that share the same background as them as well as offering them comfort and non-discriminatory treatment.

What are the implications of telehealth for the future? 

There’s really no telling how things will turn out after our lives gain more stability. Everything going on right now is unprecedented and nothing, even healthcare, will ever be the same. Technology is playing an increasingly important role in our lives, as it has been since the last major mass pandemic in 1918, over a century ago. Perhaps in the future, we’ll be offered more of an option between seeing our healthcare providers in person or online rather than being required to do the latter for the sake of our wellbeing. For now, I just hope everyone finds the means to stay safe and healthy.

Featured Image: The Isotope by Craig Pinto

Have you felt tired or restless a few days before your period? Have you been noticing that sleep is evasive no matter how tired you are? Well, rest assured, you are not alone. According to the Sleep Health Foundation, up to 7 in 10 women say that their sleep changes just before their period (3 to 6 days before the period starts). Sleeping is a time when your body finally gets a chance to refuel for the next day. Disrupted sleep for 3 to 6 days at a time becomes a significant problem that may begin to affect other aspects of your life. However, by understanding the effect your cycle has on your sleep patterns, you may be able to anticipate and address these problems.

Disturbed sleep can be associated with premenstrual syndrome (PMS). While sleep and PMS symptoms vary greatly between individuals, there is a basic set of guidelines to keep in mind as you learn about your unique sleep and menstrual cycles.

As with most things, sleep and your cycle are unique to you and your body.. The best way to understand your body is to keep track of your mood, sleep cycle, and other symptoms. Tracking allows you to find what works for you and what doesn’t. It also makes it easier to notice any abnormalities early and you will have a record if  you visit your doctor.

How does premenstrual syndrome (PMS) affect your sleep?

• Hormone changes (significant drops in Progesterone levels)
• Reduced REM sleep
• Harder to fall asleep and stay asleep
• Increased anxiety and stress
• Restless on the days leading up to your period

How to track your sleep and your cycle:

Tracking tools can help you identify the changes your body goes through in a full cycle by recording your holistic health data. There are multiple ways to track your period, and you should pick one that works best for you.

Use an app on your personal device. Pictured below is the Flo Period tracker app which — after comparing multiple options — I found to be the best free option to keep track of everything related to your menstrual cycle. You’re able to pick from a variety of default options to describe your mood, symptoms, and more. These could all be factors that play a role in your menstrual cycle and ones that consequently affect your sleep. The tracker also has an added bonus of predicting the start of your next cycle so you won’t be caught off-guard!

Note: If you want a simpler tracker, your phone’s built in health app will likely also contain a way to record your period.

Use a bullet journal or chart. If you don’t feel like using technology to keep track of your period, you can always go old school and put pen to paper. Below is a list of some questions you should ask yourself each day. It’s important to be as honest as possible with yourself. This list is not extensive, so feel free to modify it to your needs.

• How do I feel today? 
• How much exercise have I gotten?
• How much sleep did I get last night? Do I feel well-rested or tired?
• When did my period start and end?
• How heavy is my period and are there any abnormalities? 

You could also further customize your list to include medications, birth control, productivity levels, stress levels, caffeine/alcohol intake, etc.

How can you combat these changes in your cycle?

Consuming caffeine just before and during your period can cause vasoconstriction (the narrowing of blood vessels) which can worsen period symptoms. Try and cut down on caffeine during your period to avoid sleep disruptions as a result of generalized discomfort.

Regular alcohol consumption during periods can cause large fluctuations in your hormones (especially estrogen, progesterone, and testosterone). Cutting out alcohol during your period also increases your risk for PMS and reduces your chance of dehydration!

Featured Image by middlehouse