The Four Trimesters Blog

Pregnancy through Postpartum

COVID-19 and Pregnancy

Very little is know about COVID-19 and its effect on pregnant women. Based on a small number of cases, it is believed pregnant women may be at higher risk of severe illness (compared to the general population). Again, this is based on a small number of cases.

How is it spread? Mainly from person-to-person (within six feet) through respiratory droplets. When an infected person coughs or sneezes, the droplets can land in the mouths or noses or nearby people or possibly inhaled. Preliminary studies found the virus can remain viable on surfaces from 3-24 hours, depending on the surface material. For example, the handles of a shopping you want to wash or disinfect your hands as soon as possible and do not touch your face.

Everybody should be following the CDC (Center for Disease Control and Prevention) guidelines for prevention and readiness. The single best thing you can do is wash your hands!

The best way to prevent the illness is to avoid being exposed to...

Continue Reading...

Placenta Previa

Placenta previa happens when the placenta implants low and covers the cervix. If you have placenta previa you'll need to have a cesearean delivery.

There are three types of previa (depicted in the photo above).


Normally, the placenta will implant far away from the cervix. Most often it implants on the back wall of the uterus (normal placenta in the photo) or at the top of the uterus (called the "fundus"). Less often, it implants on the front wall ("anterior placenta") - this is not a worry for delivery, but it may mean that it is harder to feel your baby move.

Placentas that implant near or over the cervix are problematic. If it partially or totally covers the cervix (see photo above) a cesearean section will be the only delivery option.

The cervix is the the outlet through which the baby exits the womb. If the placenta covers the cervix completely, a cesearean section is the only mode of delivery possible.

A partial placenta previa may or may not require an operative...

Continue Reading...

A Cure for the Postpartum Chills

Intense shivering after the baby is born?

It's the postpartum chills.

You shiver like you're naked at the north pole. Your teeth chatter. But you're not cold. Warm blankets and hot tea don't help.

Why does it happen? It isn't fully understood, but theories include fluid loss, heat loss, hormonal changes.

It's the most annoying thing, and you can't stop it. Or can you?

Generally, it is self-limiting and you can just ride it out. Duration varies from a few minutes to a half an hour. But if you can't stand it....

Stick out your tongue! 

As long as your tongue is out, the shivers stop. Put it back in your mouth, and they resume until the episode is over.

Continue Reading...

Why Babies Don't Shiver When Cold

Did you know that newborns don't shiver when they're cold? 

Shivering is a way for us to generate heat. The rapid expansion and contraction of muscles (shivering) creates heat to warm us. 

So then why don't newborns shiver when they're cold? They don't have to!

Babies are born something called brown fat. Newborns burn "brown fat" to generate heat instead of shivering until they are about 6 months old.

What is this brown fat, and is it different than regular fat? 

Well, have you ever seen chicken fat? That glob of yellow stuff? That's regular fat as we think of it. Commonly called "white fat".

Sparing you the chemistry lesson, suffice it to say that white fat is stored excess calories. Brown fat burns calories to produce heat. 

Infants are born with brown fat around their necks, backs, chests, and buttocks. It like they're wearing a comfy sweater to keep them warm. 

Babies lose most of their brown fat in the first couple of years. By...

Continue Reading...

Dysphoric Milk Ejection Reflex

breastfeeding Jan 02, 2020

Breastfeeding? You need to know about this!

Dysphoric Milk Ejection Reflex (D-MER) is a condition affecting lactating women that is characterized by an abrupt dysphoria, or negative emotions, that occur just before milk release and continuing not more than a few minutes.

Dysphoria is defined as an unpleasant or uncomfortable mood, such as sadness, depressed mood, anxiety, irritability, or restlessness. Etymologically, it is the opposite of euphoria. D-MER is like a reflex. It is controlled by hormones and cannot be controlled by the mother. You can't talk yourself out of the dysphoria.

If you get a momentary feeling of sadness when you breastfeed you are not alone. You are not crazy! It's actually a thing!

Continue Reading...

50% Complete

Two Step

Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua.