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Practice is moving from Oakland to San Diego!.

My practice has moved!

My private practice seeing individuals, couples, and facilitating support groups has moved to San Marcos/Carlsbad. I look forward to supporting clients in this area going through this journey.  Please contact me for further information. amoreena@gmail.com

When you’re coping with infertility, certain comments and experiences can bring that pain to the forefront. Well-meaning remarks, family-focused events and sometimes even being around friends with babies can be painful when you’re longing to have a little one of your own.

Friends and family who have not experienced infertility have good intentions, but often don’t understand how sensitive the situation may be. Truthfully, navigating the waters can be incredibly difficult for aspiring couples, as well as their friends and family. Here are 12 tips to help all parties build strong, supportive relationships.

6 Tips for Couples Coping with Infertility:

  1. Anticipate when you might see children at events. If it’s too painful to be around youngsters, consider arriving just in time for the main event and not earlier.
  2. Consider social invitations carefully.  You have no obligation to go to parties and events heavily attended by children or pregnant women, especially if it’s too difficult emotionally. When in doubt, decline.
  3. Be prepared. Plan an answer ahead of time should someone inquire about your intentions to have children. While relatives and close friends will understand, couples are under no obligation to discuss personal details about their infertility experiences.
  4. To hold, or not to hold? Holding a baby for some can bring hope, while for others it can be incredibly painful. Everyone may want to share in the joy of a baby as do you, but you must always listen to your personal needs first.
  5. Focus on your relationship with your partner and spending quality time together without discussing family planning. It could be a ski trip or a romantic getaway, or a simple date night.
  6. Concentrate on friendships with couples who don’t have children. Surrounding yourself with couples who aren’t child-centric can ease the pressure of what you are facing personally. Plan to spend time with couples or friends who don’t have children should child-filled gatherings become too much to bear.

6 “Infertility Etiquette” Tips for Friends & Family:

  1. Show support. A helpful hug and encouraging statement can make a world of difference. Spend quality time together and make plans without children as the main focus.
  2. Don’t complain about your own past or present pregnancy. Couples dealing with infertility hope for the day they can worry about pregnancy woes.
  3. Avoid minimizing the problem by discussing parenting struggles or saying “there are worse things that could happen.” Until you are in a couple’s shoes, you are unable to understand how difficult infertility can be.
  4. Stay away from offering advice or tips for a couple looking to conceive. Topics such as exercise, food and lifestyle are off limits. If they are seeing a physician, they are already aware of your suggestions. Couples coping with infertility also often cope with the unjust blame they place upon themselves. No need to increase the burden.
  5. Never say: “Just Relax.” Everyone has heard it before – just relax, if it is meant to be, it will happen. But looking at a couple’s situation and reducing it to a simple statement is insensitive and careless. If couples have tried unsuccessfully for more than a year to conceive, doctors consider couples infertile. While stress often appears to be a contributor, the human reproductive system is complex and affected by a number of biological and physical factors.

Don’t push adoption. Each couple has their own approach to family building, and are well aware of their options. This is a tough topic to navigate, and pushing your opinion may not help them make a decision.

Infertility is one of the leading causes of marital troubles and more than seven million couples are affected by it. Many people are waiting until their mid 30s to start a family these days only to find out that they aren’t getting pregnant right away.

One of the most common problems we see is advanced maternal age. We’re seeing a lot of difficulties with women 35 or over and sometimes even younger than 35, who are starting to have diminished egg quality. We call that diminished ovarian reserve. So at 35, their eggs and ovaries might be acting like they’re 42 or 45 and that can be a difficult problem to get through because the essence of the embryo and the infrastructure of the embryo is the egg so you must start off with a good quality egg. The best way to eliminate that is with early detection and treatment as with most disorders.

Many couples are opting to have children later and it’s understandable that they want to be financially stable with a successful job and career, but unfortunately Mother Nature doesn’t wait for that. To some degree, I do want to get out the message to couples to not wait too long. If we can start testing women when they’re younger around the age of 30, with simple blood tests which can give a woman an idea of the quality of her eggs, that would help. One of the things we can do now is take the eggs of a young woman, freeze them and then use them later in life when they’re ready to have children, although that is not a guarantee and it can be quite expensive.

Either way all of this stress and pressure and lead to marital tension.  I encourage all couples to seek help in the beginning of this journey to help process these feelings.

Amoreena Berg, MFT

Most people don’t know this but, you can breastfeed your adopted baby!

It is not only possible, it is fairly easy and the chances are you will produce a significant amount of milk. It is not complicated, but it is different than breastfeeding a baby with whom you have been pregnant for 9 months.

Breastfeeding and Breastmilk

There are really two objectives involved in nursing an adopted baby. One is getting your baby to breastfeed. The other is producing breastmilk. It is important to set your expectations at a reasonable level. Since there is more to breastfeeding than breastmilk, many mothers are happy to be able to breastfeed without expecting to produce all the milk the baby will need. It is the special relationship, the special closeness, the biological attachment of breastfeeding that many mothers are looking for. As one adopting mother said, “I want to breastfeed. If the baby also gets breastmilk, that’s great”.

Getting the baby to take the breast

Although many people do not believe that the early introduction of bottles may interfere with breastfeeding, the early introduction of artificial nipples can indeed interfere. The sooner you can get the baby to the breast after he is born, the better. However, babies need flow from the breast in order to stay latched on and continue sucking, especially if they have gotten used to get flow from a bottle or another method of feeding (cup, finger feeding). So, what can you do?

  • Speak with the staff at the hospital where the baby will be born and let the head nurse and lactation consultant know your plan to breastfeed the baby. They should be willing to accommodate your desire to have the baby fed by cup or finger feeding, if you cannot have the baby to feed immediately after his birth. In fact, more and more frequently, arrangements have been made where the adopting mother is present at the birth of the baby and takes the baby immediately to nurse. The earlier you start, the better.
  • Some biological mothers are willing to nurse the baby for the first few days. There is some concern expressed amongst social workers and others that this will result in the biological mothers’ changing her mind. This is possible, and you may not wish to take that risk. However, this has been done, and it allows the baby to breastfeed, get colostrum, and not receive artificial feedings at first.
  • Latching on well is even more important when the mother does not have a full milk supply, as when she does. A good latch means painless feedings. A good latch means the baby will get more of your milk, whether your milk supply is abundant or minimal.
  • If the baby does need to be supplemented, this should be done with a lactation aid with the supplement being given while the baby is breastfeeding. Babies learn to breastfeed by breastfeeding, not cup feeding or finger feeding or bottle feeding. Of course, you can use your previously expressed milk to supplement. And if you can manage to get it, banked breastmilk is the second best supplement after your own milk.
  • If you are having trouble getting the baby to take the breast, come to the clinic as soon as possible for help.

Producing Breastmilk

As soon as a baby is in sight, contact a specialized lactation clinic and start getting your milk supply ready. Please understand, you may never produce a full supply for your baby, though it may happen. You should not be discouraged by what you may be pumping before the baby is born, because a pump is never as good at extracting milk as a baby who is sucking well and well latched. The main purpose of pumping before the baby is born is to start the changes in your breast so that you will produce milk, not to build up a reserve of milk before the baby is born, though this is good if you can do it.

If you know far enough in advance, say 6 or 7 months, treatment with a combination of estrogen and progesterone (as in the birth control pill, but without a break) plus domperidone will simulate pregnancy somewhat, and may allow you to produce more milk.

a. Pumping. If you can manage it, rent an electric pump with a double setup. Pumping both breasts at the same time takes half the time, obviously, but also results in better milk production. Start pumping as soon as the baby is in sight, even if this means you will be pumping for 4 months. You do not have to pump frequently on a schedule. Do what is possible. If twice a day is possible at first, do it twice a day. If once a day during the week, but 6 times during the weekend can be done, fine. Partners can help with nipple stimulation as well.
b. Domperidone. This drug can help you produce more milk. It is not necessary for you to use in order to breastfeed an adopted baby, but it will help you develop a more abundant milk supply faster. There is no such thing as a 100% safe drug. If you do decide to take it, the dose is 20 mg four times a day. Check the handout for more information. Ask at the clinic. Using pumping and domperidone, most adopting mothers have started to produce drops of milk after two to four weeks.

But will I produce all the milk the baby needs?

Maybe, but don’t count on it. But if you do not, breastfeed your baby anyhow, and allow yourself and him to enjoy the special relationship that it brings. In any case, some breastmilk is better than none.

Revised January 2000
Written by Jack Newman, MD, FRCPC
Used with permission.

PCOS, Stress and Hypnosis

Chronic stress is invisible. You can’t see it, taste it, or smell it. You may not even be aware of it. Yet it can be devastating if not brought under control.

There is a link between chronic stress and problems associated with PCOS, including weight gain, belly fat, eating disorders, reduced fertility, miscarriage, premature or lower weight births, chronic inflammation, and ovarian cysts.

Hypnosis is a great tool, if you haven’t tried it, I encourage it with all my clients.

Hypnosis helps you improve your ability to handle stress. It’s very easy to do, simply by listening to a CD or see a hypnosis therapist. The Lolo Center in Oakland has a hypnotherapist on staff.  Sometimes it just takes a few sessions to work these issues out and move on to a healthier happier you.

Amoreena Berg, MFT

I am re-posting this article I came across because I find it important to be aware of when it comes to minorities. We tent to think they aren’t having as many difficulties with infertility and that just isn’t true.  They just don’t have access to the services.

ATLANTA, April 2, 2012 /PRNewswire via COMTEX/ — Infertility affects one in eight couples or 7.3 million people in the U.S. 12% of women of reproductive age experience difficulty having a baby and black women have twice the odds of infertility compared to white women. 11.5% of black women report infertility compared to 7% of white women but yet studies indicate that black women use infertility services less often. Why? “In the past, there was a lack of attention toward the problem of infertility in minority women, and most marketing campaigns of infertility awareness and treatment were not directed towards us. This resulted in a lack of awareness about infertility as a disease and about avenues for seeking evaluation and treatment,” says Dr. Desiree McCarthy-Keith, the newest reproductive endocrinologist to join Georgia Reproductive Specialists. “Cost of infertility services can be prohibitive to couples from all ethnic backgrounds and cost may be a factor for some black women as well,” she continues. “I believe lack of access to infertility care and limited awareness about evaluation and treatment options can also be substantial obstacles that keep many women from receiving the care that they need.”

A leading cause of infertility among black women is uterine fibroids. Black women develop uterine fibroids at a younger age than white women and the incidence of fibroids is higher in black women at every age, compared to white women. By the end of the reproductive years, the incidence of uterine fibroids in black women is 80%. As a result, black women have hysterectomies for treatments of fibroids more often than women from any other ethnic group. Dr. McCarthy-Keith, whose medical research focuses on the molecular mechanisms of uterine fibroid regulation, states that “black women are disproportionately affected by uterine fibroids and uterine fibroids are a common diagnosis among black women undergoing infertility treatment.”

Dr. McCarthy-Keith looks forward to educating and promoting infertility awareness within the black community. The low incidence of public awareness in some minority communities is something Dr. McCarthy-Keith hopes to improve. “I am very passionate about increasing awareness of causes of infertility, its evaluation and available treatment options in these underserved areas,” she says. “My goal is to empower women with information which will allow them to seek infertility care when necessary and to take advantage of the infertility services that we have to offer,” she adds.

Dr. McCarthy-Keith earned her medical degree from the University of North Carolina at Chapel Hill and also a Master of Public Health in maternal and child health from the University of North Carolina. She completed her obstetrics and gynecology residency training at Duke University Medical Center and a fellowship in reproductive endocrinology and infertility at the National Institutes of Health in Bethesda, Maryland. She has special interests in fertility evaluation, uterine fibroids and reproductive health disparities. Dr. McCarthy-Keith was a lieutenant commander in the United States Public Health Service Commissioned Corps and held the position of assistant professor of Obstetrics and Gynecology at the Uniformed Services University of the Health Sciences. She is board certified in obstetrics and gynecology.

“This is an exciting time to practice reproductive medicine and nothing makes me happier than to help couples reach their goal of building a family,” says Dr. McCarthy-Keith.

SOURCE Georgia Reproductive Specialists