August 31, 2024 • 32 mins
Dr. Jonathan Crowther discusses prenatal care and screening during trimesters two and three. The goals of prenatal care are risk assessment, health promotion and education, and therapeutic interventions. Prenatal care should ideally start in the first trimester. Providers who specialize in prenatal care include midwives, family medicine doctors, obstetrician-gynecologists, and maternal fetal medicine subspecialists. Screening tests include blood tests, ultrasounds, and invasive procedures like chorionic villus sampling and amniocentesis. Other screenings include blood type, hemoglobin, urine tests, and mental health. It's important to report any concerning symptoms to your healthcare provider, such as vaginal bleeding, decreased fetal activity, abdominal pain, and high blood pressure. Telehealth can be used to consult with your provider. Increasing protein intake and following the Brewer's diet may help with high blood pressure, but medication may be necessary. Utilizing physical therapists, chiropractors, and acupuncture can help with musculoskeletal pains during pregnancy.
CHAPTERS
00:00 Introduction and Background of Dr. Jonathan Crowther 01:30 Trimester Two: Morning Sickness and Provider Options 10:26 Screening Tests during Pregnancy 29:34 Utilizing Telehealth and Additional Support for Prenatal Care
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:05):
It's the Best Birth Podcast, wherewe interview experts that elevate
you as you prepare your heartand mind to have the best birth.
Each episode will interviewprofessionals so you are prepared
for pregnancy, birth, and postpartum.
Our experts will build your confidenceand empower you to trust your
intuition throughout your pregnancy.
This audio is takenfrom videos on YouTube.
(00:27):
Watch the entire episodes onYouTube at Birth Made Mindful.
00:05]
You're listening tothe Best Birth Podcast.
Today we have Dr.
Jonathan Crowther.
He is our resident doctor of thepodcast and he'll be talking all about
trimesters two and three, what toexpect and when to see your provider.
Dr.
Crowther is a husbandfather of two little girls.
(00:49):
And in his spare time, he is inhis final year as an internal
medicine resident physician.
He lives in Castle Rock, Colorado andpractices medicine out of three hospitals
and a primary care clinic in Denver.
While he has resorted to specializingin internal medicine, he has a passion
for supporting and encouraging womenwho are currently navigating through
pregnancy, birth and postpartum.
(01:11):
He had the great pleasure of deliveringmultiple babies during medical school,
but of course his favorite experienceswere helping to deliver his own two baby
girls, Kinsley, now age three, and RaeLynn, now age one, whose birth stories
were both unique and life -changing.
Welcome Dr.
Crowther.
Jonathan Crowther [01:01]
Yes, thank you.
I'm glad to be on again.
(01:31):
The Best Birth [01:05]
We're excited to talk all abouttrimester two and trimester three.
And I would just like to note thattrimester two is my favorite trimester.
I was one of the lucky ones who didnot feel morning sickness during my
second trimester, but I know many do.
So please be gracious with yourself.
If you're still feeling nauseous.
I mean, many of my friends, they werein their ninth month and they were
(01:53):
still praising that porcelain goddess.
Jonathan Crowther [01:30]
Yes, yeah, I can imagine.
I cannot speak from experience,although I think I maybe had
empathy morning sickness one day.
The Best Birth [01:43]
Did you ever hold her hair?
Jonathan Crowther [01:46]
(02:14):
I will say yes.
But
right.
Yeah.
I usually, I wasn't, it was kindof interesting because Carly would
have morning sickness more at night,which is, which is very common
for people, you know, they don'treally have the morning sickness.
It's, it's the evening sickness, but.
(02:35):
The Best Birth [01:50]
We'll take it.
You get the gold star.
Jonathan Crowther [02:10]
Yeah, so today just wanted to talk alittle bit about, our prenatal care
and, and, you know, a lot is going tobe the first or the, second and third
trimester, but you know, there's somethings that we kind of, went unanswered
with the first trimester as well.
So I might add a couple of things there.
but yeah, prenatal care, basically,you know, the three big goals of it.
(03:01):
when you're, when you're, when you'relooking for someone to get help, navigate,
through pregnancy.
You know, you and your providerare they're going to be looking
at you know risk assessment.
Are you a going to be a high riskpregnancy, a low risk pregnancy?
Provide health promotion andeducation because it's like drinking
(03:24):
out of a fire hose sometimeswith getting the information.
And therapeutic interventions.
Are there any things that need tobe done so that both mom and baby
can be as healthy as they can be?
And there's a good quote that Ihave here just saying, high quality
prenatal care can prevent or leadto timely recognition and treatment
(03:45):
of maternal and fetal complications.
Complications of pregnancy and childbirthare the leading cause of morbidity and
mortality and female ofreproductive age globally.
So the main goal is to help ensurethe birth of healthy newborn
while minimizing maternal risk.
So if you think of itthat way that really...
(04:07):
the health of the baby, you know, I'mgoing to these doctor's appointments,
it's for the health of the baby, butit also help for mom because it is
the leading cause of passing awayand mortality for pregnant age women
globally, which is kind of interesting.
(04:29):
So in general, you know, thequestion is when do we first
start doing prenatal care and,
you know, ideally it should beinitiated in the first trimester, some
usually by age 10 weeks of gestation.
When you are meeting with aprovider, it's kind of a little
bit of your choice on who you see.
(04:52):
But I will kind of lay out theproviders that will see patients of this
specialty, the special pregnant patients.
You
have midwives and family medicines,which usually see patients who have,
(05:15):
where major complications or high riskpresidencies are usually not anticipated.
OB -GYN or obstetrician gynecologistsare also those who can see uncomplicated
and some complicated pregnancies.
And then you also havematernal fetal medicine.
(05:35):
subspecialists who are obstetricianswho actually go through more training
with expertise in managing highrisk and complicated pregnancies.
So when you're talking with yourprovider, with all the information
that they'll get from you with thesescreening exams, they can let you know,
are you high risk, medium risk, low risk?
(05:56):
And are there any anticipatedcomplications with your birth?
And then the other one that we can'tforget with our birthing partners
is going to be, prenatal doulas andprenatal educators, which you guys
are part of that community who provideboth the education and support.
(06:21):
And a lot of times, you know, workingone -on -one with a patient, they serve
as a coach, they serve as an advocate,they serve as somebody to rely on.
And it's a really special experience.
special kind of relationship thatyou can have between the two of you.
Yeah, go.
The Best Birth [06:12]
Myself and Sarah both delivered allthree babies at different places.
(06:44):
So that's always interesting as well.
Changing providers.
I delivered my first baby in Idaho.
That's where my husbandwas going to school.
My second baby was at a hospitaland my third baby, I did
have a high risk pregnancy.
So I was transferred to aspecialist at a university.
Jonathan Crowther [06:20]
Mm -hmm.
Yeah, kind of similar with our experience,my wife and I, we had our first in
(07:08):
a hospital, and then our second onewas gonna be at birthing center and
didn't make it to the birthing centerin time, and so baby was born at home.
And of course, Carly did allthe work, all I did was catch,
but kind of a special thing.
The Best Birth [07:00]
Those babies are so sneaky.
They come when they want to come.
(07:29):
Jonathan Crowther [07:03]
Yeah, I will tell you afunny story just about...
Kind of my perspective of our first child.
So this is this is when I was naive andnot a parent and My the nurse at the
hospital was like, okay, you know Thisis your last sleep before having a baby
because we were doing servidel, whichis a type of You know induction form,
(07:54):
but it's a very relaxed kind of way Itdoesn't kind of it's not like pitocin.
It doesn't just hit you right into labor.
They're like, yeah, it'llprobably take about 24 hours
hours for it to kind of kick in, kindof allow for the cervical ripening
and allow for contractions to thenhopefully start naturally after that.
and so tonight's going to beyour last night of good sleep.
(08:17):
And so I was like, okay, I'mgoing to take a sleeping pill.
So I took one and then two hourslater, Carly goes into full, labor
and this entire time I am fightingsleep during the, during the labor
of my wife and our firstborn child.
(08:38):
And so I was just praying to God.
I was just praying like, Lord,
Please don't have me fall asleepwhile my wife is laboring.
Number one, it's rude and Idon't want to get in trouble.
And then my prayer just changedto like, Lord, if I do fall
asleep, just don't let her notice.
(09:03):
The Best Birth [08:35]
And were your prayers answered?
Jonathan Crowther [08:38]
They were, yes, very much so.
The Best Birth [08:40]
My first was born in a hospitaland second in a birth center.
My third little boy was born at home.
So I have a lot of differentproviders that I worked with and
I'm grateful for all of them and thesupport that gave they gave to me.
I did allow my husband to sleepwhen we had our home birth.
(09:23):
I told myself, I, I don't wantanybody to, have to be up in the
night if they don't have to be.
So I forced myself to sleep.
and I let him sleep for aboutfive hours while I was laboring.
So I even went to a different bedbecause I am that kind of woman.
Jonathan Crowther [09:13]
Wow, that's dedication there.
The Best Birth [09:17]
(09:43):
Well, we were, we were lucky enough tohave a guest bed that I could go and,
and kind of wiggle and writhe while Iwas having those early contractions.
But lucky for him, when the midwife came,a couple hours, at 10 in the morning,
I had progressed to eight centimeters.
So then my husband had the, the crazyjob of trying to get everything ready,
fill the birth tub, call the birthingphotographer, make me my smoothie.
(10:08):
So it was, it was kind of awhirlwind, even though it was not.
a quick delivery of your wife.
Jonathan Crowther [09:47]
Yeah.
Well, thank you for sharing.
Well,
I guess I'll just jump in.
So
I won't be too specific on,you know, timing of things.
(10:30):
I'll give a little bit of timing hereand there, but essentially you're going
to come in, you're not going to reallyknow what everything happens, but
there's a lot of things thatwill happen within your first,
second and third trimester.
And a lot of it has to do with screening.
and so screening has to do bothwith using ultrasound, evaluating
(10:54):
the baby as well as blood tests.
And even, as far as doing, chorionicvillus sampling or even amniocentesis.
so just a little bit about thosecause a lot of, you know, people don't
really know too much about those.
But the chorionic villus biopsyor the amniocentesis, these
(11:15):
are invasive procedures thatare done by an obstetrician.
And basically what you're doing isyou're checking to see if there's any,
you can actually check and see the sexof the baby during that time, but you're
looking for DNA sampling of the baby.
(11:37):
And...
You know, my kind of take on it ismaybe different from others, but
in general, what they're screeningfor is chromosomal abnormalities.
These are patients with trisomyor Down's syndrome, Edward's
syndrome, Patow's syndrome.
(11:58):
And the question then becomes if they arepositive for that, what do you do then?
Do you choose for elective?
abortion or not.
So if that isn't your plan, then alot of the times these can be foregone
and you can actually go ahead and do,but if you're still kind of curious,
(12:22):
you can even do serum testing andyou can do DNA testing of the mother
serum and you're actually looking forDNA of these chromosomes within the
serum if you want to know that wayinstead of having to do the invasive.
procedure.
Other screenings that we do iswe check blood type and that's
(12:45):
important for looking for people whoare row positive or row negative.
And you guys know plentyabout that I'm sure.
But essentially for those who maynot know it's basically the row
is a immunoglobulin that can be
(13:07):
antibodies against this markeron your bloodstream and it
can make your baby at risk.
If you are a row negative parent, it makesyou at risk for developing antibodies
against a row positive baby's blood type.
it's not really much of a problem forbaby number one, but the problem comes
(13:28):
on with baby number two or number three.
If they then again have a positiverow on their blood and you are still
row negative, then you can developauto antibodies and you can actually
cause a type of a hemolytic anemia onthe child and it can be devastating
(13:51):
and it can be fatal for the baby.
So it's a simple test that they check forthat and then they look for any sort of
aloe antibodies that are beingmade and then you can get an
immunization shot which preventsyou from making those antibodies.
(14:13):
Other things that you're going to bescreening for is you're going to be
looking for the hemoglobin hematocrit.
Remember in our last episodewe kind of talked a little bit
about that physiological changeof anemia but there can be actual
actual anemia that happensfor those who are pregnant.
And so, you know, looking at that,looking at your main corporeal
(14:36):
volume could indicate whether ornot, we need to check iron levels.
If your iron levels are low, then maybeit'd be good to get on a iron supplement
and then have that contribute to yourconstipation that you're already having
from those normal physiological findings.
So it's.
The Best Birth [14:28]
So then what do you taketo combat the constipation?
(14:57):
Jonathan Crowther [14:32]
Yeah.
So for those, you dothat high fibrous diet.
I would add on like thingslike metamucil is very good.
It's, you know, a fiber or.
Yeah, that'll work.
even, even a Sena coat could,could, could be helpful.
in those situations.
The Best Birth [14:41]
(15:17):
That'll definitely work.
And all of these tests are performedwith the blood draw that is performed at
most of our visits, our prenatal visits.
Jonathan Crowther [14:57]
Yep.
And it kind of depends on whenyou start your initiation of these
prenatal visits, when you'll get it.
There are some specific blood draws,but I'll kind of just go through a
slew of other things that they'll do.
(15:39):
They'll check a urine, they'lllook for urine in your protein.
That will tell them later on ifyou develop any sort of signs of a
preeclampsia or eclampsia later on, ifyou already had protein in your urine.
They'll do a urine culture and justmake sure that you don't have any
infection that needs to be treated.
And they also look for GroupB strep in that urine culture.
(16:01):
The Best Birth [15:35]
And the tricky thing about thoseurine tests is it's a fine line
between having enough in yourbladder and not having enough.
I remember just going into thedoctor because I'm not sure if
they want a urine test or not.
we'll get it out of the way.
So you can be more comfortable,cause you need to pee a lot.
It seems that I was required togive a urine sample every time.
So I just started planning on it.
(16:22):
Jonathan Crowther [15:49]
Yeah, exactly.
So, you kind of.
Yeah, that's a good advice just remindyourself when you're drinking that
water, just, just wait on having topee until you get to the doctor's
office and in one of their cups.
these are new moms, they've usuallyvery healthy and coming and seeing
a doctor for the first time.
The Best Birth [16:02]
If you can.
Jonathan Crowther [16:13]
This is an opportunity for us to get otherhealthcare things that are going to be
(16:46):
better for the mother in the long term.
So cervical cancer screening issomething that also may occur.
Either they may wait or they doit kind of early on in pregnancy
and they just do a pap smear.
They'll check you for things like STDs.
(17:06):
bloodborne diseases, HIV, syphilis,hepatitis B, hepatitis C, chlamydia.
Now the question, big question thatpeople will have, well, I'm monogamous, I
don't necessarily have a second partner.
I don't trust my patients asfar as I could throw them, but
also with these conditions,
(17:30):
it's better just to know for sure thatyou're negative for these because having
blindness of your child because you didn'tget screened for chlamydia or gonorrhea
or something like that is somethingthat's gonna be helpful in the end.
The Best Birth [17:20]
Will the provider typically recommend a C-section if you show a positive response?
(17:52):
Jonathan Crowther [17:28]
So there's a couple of things that theywould recommend you having a C -section.
The chlamydia if it's untreated.
So if it gets treated,then you should be fine.
And then they can just treat thebaby's eyes once they get out.
(18:13):
For things like herpes simplex,if there are active lesions
within the genital area,
then that is an indication for acesarean section, just because there
isn't a way to protect the child otherthan by doing a cesarean section.
(18:35):
Other kind of not verycommon ones for our country.
that we don't have to worry about as muchare things like measles, tuberculosis,
taxoplasmosis.
But essentially, we get thatbecause we get vaccinated.
(18:55):
So make sure that all of yourvaccines are current, and they'll
make sure that that happens as well.
One of them for sure being the Tdap.
they could also screen you for Zika orjust make sure that, you know, we don't
live in an area that's for that, butthey'll recommend you not go to endemic
areas where Zika is just because of thebirth defects that can occur from Zika.
(19:21):
and then another thing that,is, generally screened with
these, visits is mental health.
you know, checking to look for depression.
anxiety.
It's very important because numberone, you're going through a lot and
(19:42):
as it is, and especially for thosewho may not have as much support, it's
important to be screened for that becausethere's easy treatments for that, both
medication -based but also cognitivebehavioral therapy that can be very
helpful in supporting mothers who are
(20:02):
New Time Moms.
The Best Birth [19:39]
And then towards the end ofthe third trimester is when you
start to go weekly if you're ina hospital for those checkups.
Yeah, is that justbecause birth is imminent?
Is it there's more riskfactors towards the end?
Jonathan Crowther [19:46]
Yes.
Yeah, exactly.
So, the reason for it being, you know,in general, the, the second first and
(20:28):
second trimesters, they may say everyfour weeks and then in your third
trimester, they might say every two weeks.
And then when you're in the last fourweeks, they'll have you go every week.
and two things they're checkingfor mom and they're, we're checking
on baby, you know, making surethat there's good fetal movements.
(20:50):
going on.
and there's also the very, fungroup B strep that has to happen.
as well as your checking for your, yourdiabetes, pregnancy associated diabetes.
so they'll do those kinds of screeningtests because, later on in the pregnancy,
(21:15):
that's where you could have, things where,
If you had diabetes and it wasunchecked during pregnancy, then
baby could actually become too largeand then be a problem for just a
normal, uncomplicated vaginal birth.
(21:35):
And so that's why we kindof check for those things.
The Best Birth [21:14]
It's amazing to me how much data andhow much information is gathered from
these appointments just by, simple bloodextraction and urine and physical exam.
Jonathan Crowther [21:25]
Mm -hmm.
Yeah, there's you you don't think aboutkind of everything that happens behind
(21:57):
the scenes but there's just a whole lotthat kind of goes on behind the scenes and
And then you pair it with the you know,the intermittent kind of ultrasounds If
there's more concerned about a baby Youknow, maybe not showing as much movement
then doing a non -stress test on the babyis a is another way of being able to see
(22:21):
How is baby doing?
How's the baby's growth?
Is there any growth restriction?
Is there too much growth?
There's a lot to kind of takeinto consideration there.
The Best Birth [22:10]
I had ultrasounds a lot more frequentlywith my third because I had placenta
(22:41):
previa and they were checking myscar area to see if the placenta was
trying to burrow into those scars.
Jonathan Crowther [22:23]
Right.
Yeah.
Yeah.
That's a, that's an example.
cause they want to see if, if, if babywill be able to be vaginal or not.
and then, you know, the big hopethat you're having in those kind
(23:04):
of later weeks and like, 36 weeksto 41 weeks, is going to be,
if baby is cephalic or not, meaning isbaby's head down or is baby's head up?
because offering an external cephalicversion or being able to actually
manipulate the baby could be somethingthat providers can offer as well.
(23:32):
So there are a couple, you know, things,signs and symptoms that you should be
reporting to your healthcare provider.
One is going to be vaginal bleeding.
Okay.
Vaginal bleeding is something that can
occur in any of the trimesters.
If it's kind of earlier in thetrimesters, it could just be
(23:55):
from implantation bleeding.
It could be from asubchorionic hemorrhage.
It could be from threatened miscarriage.
It could be a sign of miscarriage.
So those should be checked out.
If there is associated pelvic pain,
that should also be somethingthat is, evaluated as well.
(24:18):
And a lot of times they'll do transvaginal ultrasound earlier in, the
pregnancy course in order to, make surethat there's not any sort of ectopic
pregnancy or even twin pregnancies,maybe one that's inside the uterus
and other one that's ectopic.
They're looking for a lot of things,or ruling out a lot of things.
(24:40):
And hopefully it's just,
normal laxity from themusculoskeletal system.
That's what they're hoping for.
if you're noticing any sort of, ofmembranes where you're having more clear
fluid, that could be something that you'llwant to talk with the provider because
you may be in a preterm or pre -labor.
kind of situation.
Any sort of decreased fetal activity,you know, you feel them moving around
(25:04):
and then it's not as much, you know,that's something to be checked out.
If you're having abdominal pain,especially abdominal pain that
is sharp and severe in nature andunrelenting, meaning that it continues
because that could be an emergencythat may need to be addressed.
(25:27):
The Best Birth [25:01]
And for most of these situations,would you recommend that we call the
office that we're seeing and justsee if they can get us in or would
we ever need to, head over to the ER?
Jonathan Crowther [25:11]
Yeah, it depends.
if you're having, sharp abdominalpain, and then you're starting to
feel, nauseous, you're vomiting,you're feeling dizzy or feeling
(25:49):
like you're going to pass out andthat situation, you're just going
straight to the ER, to get evaluated.
and hopefully it's nothing but, itis something to take in, in mind,
especially for those who have.
you know, had prior c -sections, theyare at more risk for uterine rupture.
(26:11):
it's a little less of a risk than kindof what previously it had been thought
to be, with cesarean sections, andthose who are trying to do feedback,
but, but it still is an, and a riskto, and a higher, high risk pregnancy.
(26:31):
The Best Birth [26:05]
Are there any other situations thatwe'll want to notify our provider?
Jonathan Crowther [26:09]
Yeah, definitely.
big things that people don't reallythink about are, you know, headaches
that aren't relieved by having adose of acetaminophen or if you're
having any sort of visual changes.
(26:53):
and if you're noticing, youknow, your blood pressure is
spiking, you check it at home.
Those are all signs of preeclampsia.
and preeclampsia is.
the lesser evil of eclampsia,which is essentially headaches,
high blood pressure, that thenresults in seizures for the mom.
(27:16):
And so that's where, you know, beingevaluated and making sure that your
blood pressure is under control.
And a lot of the times, you know,depending on how many weeks that
you're, you've been in, could resultin earlier induction of labor.
to treat that preeclampsia.
(27:36):
So that way you don't have thecomplications of eclampsia.
I like to tell, you know, anybody who'skind of questioning what, you know,
when in doubt about your symptoms, it'salways better just, you know, a phone
call to your provider is appropriate ifit's not something that you feel like
(27:57):
is, you know, severe in nature, but.
Don't just try to do this on yourown, create your health care team and
whether that is, your team consistsof your doula and a midwife or
your family medicine doctor or whateverit might be, just know that they are
(28:19):
there to support you during this time.
The Best Birth [27:55]
And oftentimes a provider canuse telehealth, text messaging,
calling to kind of find out more.
You might not have to immediately dropwhat you're doing and, and head somewhere,
but you can get the assistance needed.
Jonathan Crowther [28:07]
Yeah, exactly.
The Best Birth [28:09]
I remember having to leave a coupleof voicemails for mine and then
they would always answer within theday, but that's a good reminder.
(28:43):
We'll just share our momsquad secret for the day.
This one's from Megan and she says,if you are experiencing high blood
pressure, increase your proteinand look into the brewer's diet.
Cod liver pills may alsodecrease your blood pressure.
Have you found that would help your bloodpressure is increasing your protein?
What does that do to it?
(29:04):
Jonathan Crowther [28:38]
you know, blood pressure in this case,there's, there's a lot of things that can
just help your blood pressure normally.
cause you think of essential hypertensionas, essentially separate from a pregnancy
type of hypertension, which actuallyoccurs at the spiral arteries with,
(29:27):
the connection between your placenta,moms and babies, blood right there.
So
once you have preeclampsia, youknow, the treatment will be,
you know, more medication based.
Now taking supplements that haveknown to have a, you know, a good
(29:50):
effect on blood pressure can't hurt.
But it may not do everything to help.
So
if you truly have, you know,
high blood pressure in pregnancy, itshould be something that is managed
with blood pressure medicationsbecause that will make you at
more risk for having preeclampsia.
(30:11):
The Best Birth [29:47]
This has been a wonderful conversation.
Is there anything else you'd like toadd for our second and third trimester?
Jonathan Crowther [29:53]
this is the time to kind of utilize,help with physical therapists,
with chiropractor, maybe evenacupuncture, has been known to help
(30:31):
if you're kind of suffering in pain.
the musculoskeletal pains that justhappens from that laxity and everything
else can be addressed through those forms.
Regardless of who you chooseas your provider, what you want
(30:53):
is somebody who's going to bedoing evidence -based medicine.
So for example, me being a physician,
I know maybe too much to bedangerous or whatever, but we felt
completely comfortable with oursecond baby being seen and managed
by a midwife because of Carly's firstpregnancy was largely uncomplicated.
(31:19):
And so it was the second one.
And so
it's something to keep in mind, but stillit's important that whoever is giving
that care isn't overlooking things like,
these important screening tests suchas the group B strap, the checking
your blood pressure, screening fordiabetes and that and the like.
(31:45):
The Best Birth [31:20]
And if your intuition is promptingyou to, inform your provider of
something that you feel inside, that'salways something to follow as well.
Jonathan Crowther [31:29]
Mm -hmm.
Yeah, very much so.
The Best Birth [31:32]
Very well said.
Well, thank you so much for being here.
We really appreciate you sharingyour expertise and continuing
to be our resident doctor.
(32:05):
Jonathan Crowther [31:39]
Yeah, yeah, very much so.
I'm glad to be here.
Thanks for joining us on today's episode.
We hope you've been elevated andinspired by this week's expert.
Subscribe today so you never missan episode and please share our
podcast or post on your socialmedia so that other moms and dads
to be can also have the best birth.
(32:27):
Please note that the informationprovided is based on the expert's
insights and personal experience.
It is not intended as medical guidance.
Please seek the advice of yourmedical provider as it applies
to your specific condition.
It's the Best Birth Podcast, wherewe interview experts that elevate
you as you prepare your heartand mind to have the best birth.
Each episode will interviewprofessionals so you are prepared
for pregnancy, birth, and postpartum.
Our experts will build your confidenceand empower you to trust your
intuition throughout your pregnancy.
This audio is takenfrom videos on YouTube.
(00:27):
Watch the entire episodes onYouTube at Birth Made Mindful.
00:05]
You're listening tothe Best Birth Podcast.
Today we have Dr.
Jonathan Crowther.
He is our resident doctor of thepodcast and he'll be talking all about
trimesters two and three, what toexpect and when to see your provider.
Dr.
Crowther is a husbandfather of two little girls.
(00:49):
And in his spare time, he is inhis final year as an internal
medicine resident physician.
He lives in Castle Rock, Colorado andpractices medicine out of three hospitals
and a primary care clinic in Denver.
While he has resorted to specializingin internal medicine, he has a passion
for supporting and encouraging womenwho are currently navigating through
pregnancy, birth and postpartum.
(01:11):
He had the great pleasure of deliveringmultiple babies during medical school,
but of course his favorite experienceswere helping to deliver his own two baby
girls, Kinsley, now age three, and RaeLynn, now age one, whose birth stories
were both unique and life -changing.
Welcome Dr.
Crowther.
Jonathan Crowther [01:01]
Yes, thank you.
I'm glad to be on again.
(01:31):
The Best Birth [01:05]
We're excited to talk all abouttrimester two and trimester three.
And I would just like to note thattrimester two is my favorite trimester.
I was one of the lucky ones who didnot feel morning sickness during my
second trimester, but I know many do.
So please be gracious with yourself.
If you're still feeling nauseous.
I mean, many of my friends, they werein their ninth month and they were
(01:53):
still praising that porcelain goddess.
Jonathan Crowther [01:30]
Yes, yeah, I can imagine.
I cannot speak from experience,although I think I maybe had
empathy morning sickness one day.
The Best Birth [01:43]
Did you ever hold her hair?
Jonathan Crowther [01:46]
(02:14):
I will say yes.
But
right.
Yeah.
I usually, I wasn't, it was kindof interesting because Carly would
have morning sickness more at night,which is, which is very common
for people, you know, they don'treally have the morning sickness.
It's, it's the evening sickness, but.
(02:35):
The Best Birth [01:50]
We'll take it.
You get the gold star.
Jonathan Crowther [02:10]
Yeah, so today just wanted to talk alittle bit about, our prenatal care
and, and, you know, a lot is going tobe the first or the, second and third
trimester, but you know, there's somethings that we kind of, went unanswered
with the first trimester as well.
So I might add a couple of things there.
but yeah, prenatal care, basically,you know, the three big goals of it.
(03:01):
when you're, when you're, when you'relooking for someone to get help, navigate,
through pregnancy.
You know, you and your providerare they're going to be looking
at you know risk assessment.
Are you a going to be a high riskpregnancy, a low risk pregnancy?
Provide health promotion andeducation because it's like drinking
(03:24):
out of a fire hose sometimeswith getting the information.
And therapeutic interventions.
Are there any things that need tobe done so that both mom and baby
can be as healthy as they can be?
And there's a good quote that Ihave here just saying, high quality
prenatal care can prevent or leadto timely recognition and treatment
(03:45):
of maternal and fetal complications.
Complications of pregnancy and childbirthare the leading cause of morbidity and
mortality and female ofreproductive age globally.
So the main goal is to help ensurethe birth of healthy newborn
while minimizing maternal risk.
So if you think of itthat way that really...
(04:07):
the health of the baby, you know, I'mgoing to these doctor's appointments,
it's for the health of the baby, butit also help for mom because it is
the leading cause of passing awayand mortality for pregnant age women
globally, which is kind of interesting.
(04:29):
So in general, you know, thequestion is when do we first
start doing prenatal care and,
you know, ideally it should beinitiated in the first trimester, some
usually by age 10 weeks of gestation.
When you are meeting with aprovider, it's kind of a little
bit of your choice on who you see.
(04:52):
But I will kind of lay out theproviders that will see patients of this
specialty, the special pregnant patients.
You
have midwives and family medicines,which usually see patients who have,
(05:15):
where major complications or high riskpresidencies are usually not anticipated.
OB -GYN or obstetrician gynecologistsare also those who can see uncomplicated
and some complicated pregnancies.
And then you also havematernal fetal medicine.
(05:35):
subspecialists who are obstetricianswho actually go through more training
with expertise in managing highrisk and complicated pregnancies.
So when you're talking with yourprovider, with all the information
that they'll get from you with thesescreening exams, they can let you know,
are you high risk, medium risk, low risk?
(05:56):
And are there any anticipatedcomplications with your birth?
And then the other one that we can'tforget with our birthing partners
is going to be, prenatal doulas andprenatal educators, which you guys
are part of that community who provideboth the education and support.
(06:21):
And a lot of times, you know, workingone -on -one with a patient, they serve
as a coach, they serve as an advocate,they serve as somebody to rely on.
And it's a really special experience.
special kind of relationship thatyou can have between the two of you.
Yeah, go.
The Best Birth [06:12]
Myself and Sarah both delivered allthree babies at different places.
(06:44):
So that's always interesting as well.
Changing providers.
I delivered my first baby in Idaho.
That's where my husbandwas going to school.
My second baby was at a hospitaland my third baby, I did
have a high risk pregnancy.
So I was transferred to aspecialist at a university.
Jonathan Crowther [06:20]
Mm -hmm.
Yeah, kind of similar with our experience,my wife and I, we had our first in
(07:08):
a hospital, and then our second onewas gonna be at birthing center and
didn't make it to the birthing centerin time, and so baby was born at home.
And of course, Carly did allthe work, all I did was catch,
but kind of a special thing.
The Best Birth [07:00]
Those babies are so sneaky.
They come when they want to come.
(07:29):
Jonathan Crowther [07:03]
Yeah, I will tell you afunny story just about...
Kind of my perspective of our first child.
So this is this is when I was naive andnot a parent and My the nurse at the
hospital was like, okay, you know Thisis your last sleep before having a baby
because we were doing servidel, whichis a type of You know induction form,
(07:54):
but it's a very relaxed kind of way Itdoesn't kind of it's not like pitocin.
It doesn't just hit you right into labor.
They're like, yeah, it'llprobably take about 24 hours
hours for it to kind of kick in, kindof allow for the cervical ripening
and allow for contractions to thenhopefully start naturally after that.
and so tonight's going to beyour last night of good sleep.
(08:17):
And so I was like, okay, I'mgoing to take a sleeping pill.
So I took one and then two hourslater, Carly goes into full, labor
and this entire time I am fightingsleep during the, during the labor
of my wife and our firstborn child.
(08:38):
And so I was just praying to God.
I was just praying like, Lord,
Please don't have me fall asleepwhile my wife is laboring.
Number one, it's rude and Idon't want to get in trouble.
And then my prayer just changedto like, Lord, if I do fall
asleep, just don't let her notice.
(09:03):
The Best Birth [08:35]
And were your prayers answered?
Jonathan Crowther [08:38]
They were, yes, very much so.
The Best Birth [08:40]
My first was born in a hospitaland second in a birth center.
My third little boy was born at home.
So I have a lot of differentproviders that I worked with and
I'm grateful for all of them and thesupport that gave they gave to me.
I did allow my husband to sleepwhen we had our home birth.
(09:23):
I told myself, I, I don't wantanybody to, have to be up in the
night if they don't have to be.
So I forced myself to sleep.
and I let him sleep for aboutfive hours while I was laboring.
So I even went to a different bedbecause I am that kind of woman.
Jonathan Crowther [09:13]
Wow, that's dedication there.
The Best Birth [09:17]
(09:43):
Well, we were, we were lucky enough tohave a guest bed that I could go and,
and kind of wiggle and writhe while Iwas having those early contractions.
But lucky for him, when the midwife came,a couple hours, at 10 in the morning,
I had progressed to eight centimeters.
So then my husband had the, the crazyjob of trying to get everything ready,
fill the birth tub, call the birthingphotographer, make me my smoothie.
(10:08):
So it was, it was kind of awhirlwind, even though it was not.
a quick delivery of your wife.
Jonathan Crowther [09:47]
Yeah.
Well, thank you for sharing.
Well,
I guess I'll just jump in.
So
I won't be too specific on,you know, timing of things.
(10:30):
I'll give a little bit of timing hereand there, but essentially you're going
to come in, you're not going to reallyknow what everything happens, but
there's a lot of things thatwill happen within your first,
second and third trimester.
And a lot of it has to do with screening.
and so screening has to do bothwith using ultrasound, evaluating
(10:54):
the baby as well as blood tests.
And even, as far as doing, chorionicvillus sampling or even amniocentesis.
so just a little bit about thosecause a lot of, you know, people don't
really know too much about those.
But the chorionic villus biopsyor the amniocentesis, these
(11:15):
are invasive procedures thatare done by an obstetrician.
And basically what you're doing isyou're checking to see if there's any,
you can actually check and see the sexof the baby during that time, but you're
looking for DNA sampling of the baby.
(11:37):
And...
You know, my kind of take on it ismaybe different from others, but
in general, what they're screeningfor is chromosomal abnormalities.
These are patients with trisomyor Down's syndrome, Edward's
syndrome, Patow's syndrome.
(11:58):
And the question then becomes if they arepositive for that, what do you do then?
Do you choose for elective?
abortion or not.
So if that isn't your plan, then alot of the times these can be foregone
and you can actually go ahead and do,but if you're still kind of curious,
(12:22):
you can even do serum testing andyou can do DNA testing of the mother
serum and you're actually looking forDNA of these chromosomes within the
serum if you want to know that wayinstead of having to do the invasive.
procedure.
Other screenings that we do iswe check blood type and that's
(12:45):
important for looking for people whoare row positive or row negative.
And you guys know plentyabout that I'm sure.
But essentially for those who maynot know it's basically the row
is a immunoglobulin that can be
(13:07):
antibodies against this markeron your bloodstream and it
can make your baby at risk.
If you are a row negative parent, it makesyou at risk for developing antibodies
against a row positive baby's blood type.
it's not really much of a problem forbaby number one, but the problem comes
(13:28):
on with baby number two or number three.
If they then again have a positiverow on their blood and you are still
row negative, then you can developauto antibodies and you can actually
cause a type of a hemolytic anemia onthe child and it can be devastating
(13:51):
and it can be fatal for the baby.
So it's a simple test that they check forthat and then they look for any sort of
aloe antibodies that are beingmade and then you can get an
immunization shot which preventsyou from making those antibodies.
(14:13):
Other things that you're going to bescreening for is you're going to be
looking for the hemoglobin hematocrit.
Remember in our last episodewe kind of talked a little bit
about that physiological changeof anemia but there can be actual
actual anemia that happensfor those who are pregnant.
And so, you know, looking at that,looking at your main corporeal
(14:36):
volume could indicate whether ornot, we need to check iron levels.
If your iron levels are low, then maybeit'd be good to get on a iron supplement
and then have that contribute to yourconstipation that you're already having
from those normal physiological findings.
So it's.
The Best Birth [14:28]
So then what do you taketo combat the constipation?
(14:57):
Jonathan Crowther [14:32]
Yeah.
So for those, you dothat high fibrous diet.
I would add on like thingslike metamucil is very good.
It's, you know, a fiber or.
Yeah, that'll work.
even, even a Sena coat could,could, could be helpful.
in those situations.
The Best Birth [14:41]
(15:17):
That'll definitely work.
And all of these tests are performedwith the blood draw that is performed at
most of our visits, our prenatal visits.
Jonathan Crowther [14:57]
Yep.
And it kind of depends on whenyou start your initiation of these
prenatal visits, when you'll get it.
There are some specific blood draws,but I'll kind of just go through a
slew of other things that they'll do.
(15:39):
They'll check a urine, they'lllook for urine in your protein.
That will tell them later on ifyou develop any sort of signs of a
preeclampsia or eclampsia later on, ifyou already had protein in your urine.
They'll do a urine culture and justmake sure that you don't have any
infection that needs to be treated.
And they also look for GroupB strep in that urine culture.
(16:01):
The Best Birth [15:35]
And the tricky thing about thoseurine tests is it's a fine line
between having enough in yourbladder and not having enough.
I remember just going into thedoctor because I'm not sure if
they want a urine test or not.
we'll get it out of the way.
So you can be more comfortable,cause you need to pee a lot.
It seems that I was required togive a urine sample every time.
So I just started planning on it.
(16:22):
Jonathan Crowther [15:49]
Yeah, exactly.
So, you kind of.
Yeah, that's a good advice just remindyourself when you're drinking that
water, just, just wait on having topee until you get to the doctor's
office and in one of their cups.
these are new moms, they've usuallyvery healthy and coming and seeing
a doctor for the first time.
The Best Birth [16:02]
If you can.
Jonathan Crowther [16:13]
This is an opportunity for us to get otherhealthcare things that are going to be
(16:46):
better for the mother in the long term.
So cervical cancer screening issomething that also may occur.
Either they may wait or they doit kind of early on in pregnancy
and they just do a pap smear.
They'll check you for things like STDs.
(17:06):
bloodborne diseases, HIV, syphilis,hepatitis B, hepatitis C, chlamydia.
Now the question, big question thatpeople will have, well, I'm monogamous, I
don't necessarily have a second partner.
I don't trust my patients asfar as I could throw them, but
also with these conditions,
(17:30):
it's better just to know for sure thatyou're negative for these because having
blindness of your child because you didn'tget screened for chlamydia or gonorrhea
or something like that is somethingthat's gonna be helpful in the end.
The Best Birth [17:20]
Will the provider typically recommend a C-section if you show a positive response?
(17:52):
Jonathan Crowther [17:28]
So there's a couple of things that theywould recommend you having a C -section.
The chlamydia if it's untreated.
So if it gets treated,then you should be fine.
And then they can just treat thebaby's eyes once they get out.
(18:13):
For things like herpes simplex,if there are active lesions
within the genital area,
then that is an indication for acesarean section, just because there
isn't a way to protect the child otherthan by doing a cesarean section.
(18:35):
Other kind of not verycommon ones for our country.
that we don't have to worry about as muchare things like measles, tuberculosis,
taxoplasmosis.
But essentially, we get thatbecause we get vaccinated.
(18:55):
So make sure that all of yourvaccines are current, and they'll
make sure that that happens as well.
One of them for sure being the Tdap.
they could also screen you for Zika orjust make sure that, you know, we don't
live in an area that's for that, butthey'll recommend you not go to endemic
areas where Zika is just because of thebirth defects that can occur from Zika.
(19:21):
and then another thing that,is, generally screened with
these, visits is mental health.
you know, checking to look for depression.
anxiety.
It's very important because numberone, you're going through a lot and
(19:42):
as it is, and especially for thosewho may not have as much support, it's
important to be screened for that becausethere's easy treatments for that, both
medication -based but also cognitivebehavioral therapy that can be very
helpful in supporting mothers who are
(20:02):
New Time Moms.
The Best Birth [19:39]
And then towards the end ofthe third trimester is when you
start to go weekly if you're ina hospital for those checkups.
Yeah, is that justbecause birth is imminent?
Is it there's more riskfactors towards the end?
Jonathan Crowther [19:46]
Yes.
Yeah, exactly.
So, the reason for it being, you know,in general, the, the second first and
(20:28):
second trimesters, they may say everyfour weeks and then in your third
trimester, they might say every two weeks.
And then when you're in the last fourweeks, they'll have you go every week.
and two things they're checkingfor mom and they're, we're checking
on baby, you know, making surethat there's good fetal movements.
(20:50):
going on.
and there's also the very, fungroup B strep that has to happen.
as well as your checking for your, yourdiabetes, pregnancy associated diabetes.
so they'll do those kinds of screeningtests because, later on in the pregnancy,
(21:15):
that's where you could have, things where,
If you had diabetes and it wasunchecked during pregnancy, then
baby could actually become too largeand then be a problem for just a
normal, uncomplicated vaginal birth.
(21:35):
And so that's why we kindof check for those things.
The Best Birth [21:14]
It's amazing to me how much data andhow much information is gathered from
these appointments just by, simple bloodextraction and urine and physical exam.
Jonathan Crowther [21:25]
Mm -hmm.
Yeah, there's you you don't think aboutkind of everything that happens behind
(21:57):
the scenes but there's just a whole lotthat kind of goes on behind the scenes and
And then you pair it with the you know,the intermittent kind of ultrasounds If
there's more concerned about a baby Youknow, maybe not showing as much movement
then doing a non -stress test on the babyis a is another way of being able to see
(22:21):
How is baby doing?
How's the baby's growth?
Is there any growth restriction?
Is there too much growth?
There's a lot to kind of takeinto consideration there.
The Best Birth [22:10]
I had ultrasounds a lot more frequentlywith my third because I had placenta
(22:41):
previa and they were checking myscar area to see if the placenta was
trying to burrow into those scars.
Jonathan Crowther [22:23]
Right.
Yeah.
Yeah.
That's a, that's an example.
cause they want to see if, if, if babywill be able to be vaginal or not.
and then, you know, the big hopethat you're having in those kind
(23:04):
of later weeks and like, 36 weeksto 41 weeks, is going to be,
if baby is cephalic or not, meaning isbaby's head down or is baby's head up?
because offering an external cephalicversion or being able to actually
manipulate the baby could be somethingthat providers can offer as well.
(23:32):
So there are a couple, you know, things,signs and symptoms that you should be
reporting to your healthcare provider.
One is going to be vaginal bleeding.
Okay.
Vaginal bleeding is something that can
occur in any of the trimesters.
If it's kind of earlier in thetrimesters, it could just be
(23:55):
from implantation bleeding.
It could be from asubchorionic hemorrhage.
It could be from threatened miscarriage.
It could be a sign of miscarriage.
So those should be checked out.
If there is associated pelvic pain,
that should also be somethingthat is, evaluated as well.
(24:18):
And a lot of times they'll do transvaginal ultrasound earlier in, the
pregnancy course in order to, make surethat there's not any sort of ectopic
pregnancy or even twin pregnancies,maybe one that's inside the uterus
and other one that's ectopic.
They're looking for a lot of things,or ruling out a lot of things.
(24:40):
And hopefully it's just,
normal laxity from themusculoskeletal system.
That's what they're hoping for.
if you're noticing any sort of, ofmembranes where you're having more clear
fluid, that could be something that you'llwant to talk with the provider because
you may be in a preterm or pre -labor.
kind of situation.
Any sort of decreased fetal activity,you know, you feel them moving around
(25:04):
and then it's not as much, you know,that's something to be checked out.
If you're having abdominal pain,especially abdominal pain that
is sharp and severe in nature andunrelenting, meaning that it continues
because that could be an emergencythat may need to be addressed.
(25:27):
The Best Birth [25:01]
And for most of these situations,would you recommend that we call the
office that we're seeing and justsee if they can get us in or would
we ever need to, head over to the ER?
Jonathan Crowther [25:11]
Yeah, it depends.
if you're having, sharp abdominalpain, and then you're starting to
feel, nauseous, you're vomiting,you're feeling dizzy or feeling
(25:49):
like you're going to pass out andthat situation, you're just going
straight to the ER, to get evaluated.
and hopefully it's nothing but, itis something to take in, in mind,
especially for those who have.
you know, had prior c -sections, theyare at more risk for uterine rupture.
(26:11):
it's a little less of a risk than kindof what previously it had been thought
to be, with cesarean sections, andthose who are trying to do feedback,
but, but it still is an, and a riskto, and a higher, high risk pregnancy.
(26:31):
The Best Birth [26:05]
Are there any other situations thatwe'll want to notify our provider?
Jonathan Crowther [26:09]
Yeah, definitely.
big things that people don't reallythink about are, you know, headaches
that aren't relieved by having adose of acetaminophen or if you're
having any sort of visual changes.
(26:53):
and if you're noticing, youknow, your blood pressure is
spiking, you check it at home.
Those are all signs of preeclampsia.
and preeclampsia is.
the lesser evil of eclampsia,which is essentially headaches,
high blood pressure, that thenresults in seizures for the mom.
(27:16):
And so that's where, you know, beingevaluated and making sure that your
blood pressure is under control.
And a lot of the times, you know,depending on how many weeks that
you're, you've been in, could resultin earlier induction of labor.
to treat that preeclampsia.
(27:36):
So that way you don't have thecomplications of eclampsia.
I like to tell, you know, anybody who'skind of questioning what, you know,
when in doubt about your symptoms, it'salways better just, you know, a phone
call to your provider is appropriate ifit's not something that you feel like
(27:57):
is, you know, severe in nature, but.
Don't just try to do this on yourown, create your health care team and
whether that is, your team consistsof your doula and a midwife or
your family medicine doctor or whateverit might be, just know that they are
(28:19):
there to support you during this time.
The Best Birth [27:55]
And oftentimes a provider canuse telehealth, text messaging,
calling to kind of find out more.
You might not have to immediately dropwhat you're doing and, and head somewhere,
but you can get the assistance needed.
Jonathan Crowther [28:07]
Yeah, exactly.
The Best Birth [28:09]
I remember having to leave a coupleof voicemails for mine and then
they would always answer within theday, but that's a good reminder.
(28:43):
We'll just share our momsquad secret for the day.
This one's from Megan and she says,if you are experiencing high blood
pressure, increase your proteinand look into the brewer's diet.
Cod liver pills may alsodecrease your blood pressure.
Have you found that would help your bloodpressure is increasing your protein?
What does that do to it?
(29:04):
Jonathan Crowther [28:38]
you know, blood pressure in this case,there's, there's a lot of things that can
just help your blood pressure normally.
cause you think of essential hypertensionas, essentially separate from a pregnancy
type of hypertension, which actuallyoccurs at the spiral arteries with,
(29:27):
the connection between your placenta,moms and babies, blood right there.
So
once you have preeclampsia, youknow, the treatment will be,
you know, more medication based.
Now taking supplements that haveknown to have a, you know, a good
(29:50):
effect on blood pressure can't hurt.
But it may not do everything to help.
So
if you truly have, you know,
high blood pressure in pregnancy, itshould be something that is managed
with blood pressure medicationsbecause that will make you at
more risk for having preeclampsia.
(30:11):
The Best Birth [29:47]
This has been a wonderful conversation.
Is there anything else you'd like toadd for our second and third trimester?
Jonathan Crowther [29:53]
this is the time to kind of utilize,help with physical therapists,
with chiropractor, maybe evenacupuncture, has been known to help
(30:31):
if you're kind of suffering in pain.
the musculoskeletal pains that justhappens from that laxity and everything
else can be addressed through those forms.
Regardless of who you chooseas your provider, what you want
(30:53):
is somebody who's going to bedoing evidence -based medicine.
So for example, me being a physician,
I know maybe too much to bedangerous or whatever, but we felt
completely comfortable with oursecond baby being seen and managed
by a midwife because of Carly's firstpregnancy was largely uncomplicated.
(31:19):
And so it was the second one.
And so
it's something to keep in mind, but stillit's important that whoever is giving
that care isn't overlooking things like,
these important screening tests suchas the group B strap, the checking
your blood pressure, screening fordiabetes and that and the like.
(31:45):
The Best Birth [31:20]
And if your intuition is promptingyou to, inform your provider of
something that you feel inside, that'salways something to follow as well.
Jonathan Crowther [31:29]
Mm -hmm.
Yeah, very much so.
The Best Birth [31:32]
Very well said.
Well, thank you so much for being here.
We really appreciate you sharingyour expertise and continuing
to be our resident doctor.
(32:05):
Jonathan Crowther [31:39]
Yeah, yeah, very much so.
I'm glad to be here.
Thanks for joining us on today's episode.
We hope you've been elevated andinspired by this week's expert.
Subscribe today so you never missan episode and please share our
podcast or post on your socialmedia so that other moms and dads
to be can also have the best birth.
(32:27):
Please note that the informationprovided is based on the expert's
insights and personal experience.
It is not intended as medical guidance.
Please seek the advice of yourmedical provider as it applies
to your specific condition.
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Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
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The latest news in 4 minutes updated every hour, every day.