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Confused About Medications in Pregnancy? Why Pharmacists Are the Essential Experts | MaternalRx · Pharmacy Podcast Network

• 0:05
  Speaker 1: You are listening to the global network of podcasters dedicated
• 0:09
  Speaker 1: to the pharmacy profession. Welcome to the Pharmacy podcast Network.
• 0:26
  Speaker 1: Welcome to the Maternal RX podcast, where we challenge the
• 0:29
  Speaker 1: status quo and pregnancy care and highlight how pharmacists can
• 0:32
  Speaker 1: play a pivotal role in improving outcomes and help reverse
• 0:35
  Speaker 1: the trajectory of preventable maternal morbidity and mortality. I'm your host,
• 0:40
  Speaker 1: doctor Daniel Plummer, pharmacist and anti Pardumdullah, and I'm so
• 0:45
  Speaker 1: excited today to speak to doctor Tarah Birch, a clinical pharmacist,
• 0:49
  Speaker 1: mom of two and founder of the Mother Baby Pharmacist,
• 0:53
  Speaker 1: helping women navigate medications during pregnancy and breastfeeding with clear,
• 0:58
  Speaker 1: evidence based guidance so they feel confident caring for themselves
• 1:02
  Speaker 1: and their babies. Today's topic is a bit broad, but
• 1:06
  Speaker 1: when I am really just beyond myself to dive deep
• 1:09
  Speaker 1: into because pharmacists are often left out in the field
• 1:12
  Speaker 1: by themselves with wealth of knowledge and are now finally
• 1:16
  Speaker 1: becoming part of collaborative care teams. So today's topic is
• 1:20
  Speaker 1: a collaborative team approach supporting moms to strength and care. Tara,
• 1:25
  Speaker 1: welcome so much to the Maternal RX podcast. I came
• 1:29
  Speaker 1: across your social media and was like, you have to
• 1:32
  Speaker 1: be on here, and I am grateful you readily accepted.
• 1:36
  Speaker 1: So first, tell me a little bit more about yourself.
• 1:39
  Speaker 1: What brought you into the space of helping moms and babies.
• 1:44
  Speaker 2: Yeah, well, thank you so much for having me. First
• 1:46
  Speaker 2: of all, I'm really looking forward to this conversation today.
• 1:48
  Speaker 2: It's something I'm very passionate about. I started my side
• 1:53
  Speaker 2: job with mom and babies, focusing on them, especially about
• 1:56
  Speaker 2: two years ago. I've always had a passion for mom
• 1:59
  Speaker 2: and babies, especially when I was in pharmacy school. But
• 2:02
  Speaker 2: when my sister actually got pregnant, a lot of questions
• 2:06
  Speaker 2: just started popping up, and she was asking me thing
• 2:08
  Speaker 2: after things.
• 2:09
  Speaker 3: I was like, oh, let me help you find this.
• 2:10
  Speaker 2: You know. It started with her prenatal what prenail do
• 2:13
  Speaker 2: I get? You know, like, okay, let's dive into that.
• 2:15
  Speaker 2: And then it just became one friend after the other
• 2:18
  Speaker 2: that got pregnant and all these questions started arising. So
• 2:21
  Speaker 2: I definitely started diving into it then. But then I
• 2:24
  Speaker 2: found myself pregnant with my first daughter, and that's when
• 2:27
  Speaker 2: it really became Okay, there's an area for this where
• 2:29
  Speaker 2: you have a lot of questions and you need to
• 2:32
  Speaker 2: get answers.
• 2:33
  Speaker 3: That really is what got my foot in the door.
• 2:35
  Speaker 2: And then it was actually my first lactation consultant during
• 2:38
  Speaker 2: my first appointment that said, Terry, you've got to do
• 2:41
  Speaker 2: something with this because you have all this information. It's
• 2:44
  Speaker 2: so valuable. I want to use you. I want to
• 2:47
  Speaker 2: use you to help my clients and the moms that
• 2:49
  Speaker 2: I see. And then I just literally started this on
• 2:52
  Speaker 2: my maternity leave and I had a really supportive husband
• 2:55
  Speaker 2: for starting a new job while taking a break from
• 2:57
  Speaker 2: my other one.
• 3:00
  Speaker 1: Incredible. Thank you so much for sharing that you brought
• 3:02
  Speaker 1: to light many topics would I have found by looking
• 3:05
  Speaker 1: at all the drug resources, they have different answers, and
• 3:09
  Speaker 1: you have to wonder which is correct. When I was
• 3:11
  Speaker 1: working in preclamsy in the diagnostics space, there was an
• 3:14
  Speaker 1: understanding that aspirin is the safest medication to prevent full
• 3:18
  Speaker 1: blown preclamsia and acclamptic seizures. However, when you look at
• 3:22
  Speaker 1: a drug resource about aspirin safety and pregnancy, or when
• 3:26
  Speaker 1: you see doctor google right, and I'm curious, now we
• 3:29
  Speaker 1: should ai this and see what responses, we get it's
• 3:32
  Speaker 1: quite scary, and yeah, moms are really afraid to take aspirin.
• 3:35
  Speaker 1: And if I was a mom who was not a
• 3:38
  Speaker 1: pharmacist being pregnant and got risk for preclamsy and my
• 3:41
  Speaker 1: doctor said, take aspro and start with lotus aspron daily
• 3:44
  Speaker 1: and I googled that, it would be quite terrifying. And
• 3:46
  Speaker 1: I have to wonder if women go to the counter
• 3:49
  Speaker 1: and ask their pharmacists my doctor said I should take
• 3:52
  Speaker 1: asproenn and pregnancy should I What would that response be?
• 3:55
  Speaker 1: And now with the change in guidelines as of twenty fifteen,
• 3:58
  Speaker 1: the FDA gives a much broader response. If medications are
• 4:02
  Speaker 1: grandfathered in, they're going to come into the guidelines at
• 4:06
  Speaker 1: the time. But now we have to really use our
• 4:09
  Speaker 1: clinical knowledge to say is this medication safe or not?
• 4:12
  Speaker 1: And that is where you come right in supplay.
• 4:15
  Speaker 3: Yeah, and you're one hundred percent right.
• 4:17
  Speaker 2: The answers that the moms are getting, they're getting conflicting
• 4:19
  Speaker 2: advice and that's the problem, and moms are told different
• 4:22
  Speaker 2: things by different providers from doctor Google, which is very
• 4:26
  Speaker 2: popular right now, and especially with AI, it's creating an
• 4:29
  Speaker 2: entire new environment of confusion for moms during some of
• 4:32
  Speaker 2: the most vulnerable times for them, as they're going through
• 4:35
  Speaker 2: all these hormonal changes, stressful times, going through postpardon depression, anxiety.
• 4:41
  Speaker 2: Their whole world is changing, and there's not consistent information.
• 4:44
  Speaker 2: I actually just yesterday had a mom reach out to
• 4:46
  Speaker 2: me because her dermatologist said that she could take a
• 4:49
  Speaker 2: medication and then the pediutrician said it wasn't okay to take.
• 4:53
  Speaker 2: So here she's battling two different providers telling her one
• 4:56
  Speaker 2: thing and the other one saying something else. And now
• 4:59
  Speaker 2: the mom's do I treat myself or do I stop breastfeeding?
• 5:03
  Speaker 2: What do I do here? In a situation? So that's
• 5:06
  Speaker 2: where you really have to have that third party team
• 5:09
  Speaker 2: that is the medication expert involving themselves to help them
• 5:12
  Speaker 2: give the correct information or at least figure out a
• 5:15
  Speaker 2: game plan that suits both mom and baby, because we
• 5:18
  Speaker 2: have to care.
• 5:18
  Speaker 3: About both mom and baby in the situation.
• 5:20
  Speaker 1: Yeah, I can just imagine how that mom felt having
• 5:23
  Speaker 1: this conflicting information from two specialists. It's very scary. Everybody
• 5:28
  Speaker 1: knows what you ingest while you're pregnant or while your
• 5:30
  Speaker 1: nurse and can have long term effects on that baby.
• 5:33
  Speaker 1: So have that determination, and you are the perfect person
• 5:36
  Speaker 1: to turn to to get those answers. I want to
• 5:39
  Speaker 1: circle back to something you said when your sister became
• 5:41
  Speaker 1: pregnant and was looking at the plutthroat of prenatal vitamins
• 5:44
  Speaker 1: out there, like, how do you begin? I once wrote
• 5:47
  Speaker 1: a blog on prenatal vitamins. It's interesting, with my specialty
• 5:51
  Speaker 1: being extreme nausea and vomiting and pregnancy, you can't even
• 5:55
  Speaker 1: keep prenatals down, So then you have that fear of
• 5:58
  Speaker 1: what if I'm not getting my nutrients? So it's a
• 6:01
  Speaker 1: legitimate fear because if you're not getting the nutrients you
• 6:03
  Speaker 1: need during pregnancy, what happens long term for mom and baby? Right?
• 6:07
  Speaker 1: I try to find vitamins that might have some other
• 6:10
  Speaker 1: effects to decrease nausea and are vomiting. There's no evidence
• 6:14
  Speaker 1: based medicine showing any have that claim. We know claims
• 6:17
  Speaker 1: and over the counterproducts are not held to the same
• 6:20
  Speaker 1: standard as prescription medications. But I also advise on what
• 6:25
  Speaker 1: other dietary needs do you have? Are you kosher? Are
• 6:28
  Speaker 1: you vegan? Are you gluten free? Finding medications a less
• 6:32
  Speaker 1: filler if you have an mpt r G mutation. Are
• 6:35
  Speaker 1: you looking for a methylated vitamin which did not exist
• 6:39
  Speaker 1: in my pregnancies? They are available now. There's a lot
• 6:43
  Speaker 1: of conflicts or debate about that as well. If you
• 6:46
  Speaker 1: don't convert mthfr, do you end up with too much
• 6:49
  Speaker 1: HomeOS Systein? What did you tell your sister when she
• 6:52
  Speaker 1: was choosing a prenatal vitamin.
• 6:55
  Speaker 2: Yes, Actually it's funny because I'm working on a prenatal
• 6:58
  Speaker 2: guide right now to have patients use.
• 7:01
  Speaker 3: It's complicated.
• 7:02
  Speaker 2: There is not a one size fits all prenatal vitamin.
• 7:06
  Speaker 2: It is very patient specific and you don't really think
• 7:08
  Speaker 2: that when you go into the store there's so many options. Oh,
• 7:10
  Speaker 2: I'm just going to grab anything. But when you turn
• 7:13
  Speaker 2: that over and you look at the label, there's varying
• 7:15
  Speaker 2: amounts of each ingredient, and some vitamins don't have all
• 7:19
  Speaker 2: the necessary nutrients that you need, they don't have the
• 7:22
  Speaker 2: necessary minerals, or certain amounts are.
• 7:24
  Speaker 3: Too much too little. It's definitely a complicated process.
• 7:28
  Speaker 2: So looking back to what I did with my sister,
• 7:30
  Speaker 2: I actually pulled up the guidelines, started exactly where I
• 7:33
  Speaker 2: needed to be and what is the recommended amount for
• 7:36
  Speaker 2: a pregnant woman, which is different than a woman who
• 7:39
  Speaker 2: is not currently pregnant, and it's different than when you're lactating.
• 7:42
  Speaker 2: Nutriment needs are variable for both of those. We started
• 7:44
  Speaker 2: there and then we went through different stages as she
• 7:47
  Speaker 2: went through different stages of for pregnancy. When her nausea
• 7:49
  Speaker 2: and morning sickness kicked in, she was no longer able
• 7:52
  Speaker 2: to take the one that we found was best for
• 7:54
  Speaker 2: her needs, you know. And then, I mean to be
• 7:56
  Speaker 2: honest with myself, when I was going through my pregnancy,
• 7:58
  Speaker 2: when my constant patient got worse with some of those hormones,
• 8:02
  Speaker 2: iron wasn't an option for me anymore, and I had
• 8:04
  Speaker 2: to find other ways and change my prenatal So it
• 8:07
  Speaker 2: is complicated something you have to break down. You have
• 8:10
  Speaker 2: to find what works for the patient to get the
• 8:13
  Speaker 2: most that they can at where they are in their
• 8:15
  Speaker 2: stage of pregnancy.
• 8:17
  Speaker 1: Well said, it's interesting how you talked about going to
• 8:22
  Speaker 1: the store and seeing all the options on the shelf
• 8:24
  Speaker 1: of prenatal vitamins. I work with a lot of functional
• 8:27
  Speaker 1: medicine pharmacists who have their own we come online dispensaries,
• 8:31
  Speaker 1: but nothing to do with marijuana at all. Right, where
• 8:34
  Speaker 1: you can talk to your pharmacists like yourself, Terra, I'm
• 8:37
  Speaker 1: sure you have. One of the options is called full script,
• 8:40
  Speaker 1: an account where they've vetted all the prenatal vitamins and
• 8:44
  Speaker 1: other supplements of that are available, made sure there's not
• 8:47
  Speaker 1: filler ingredients though, carcinogens that are in there. And when
• 8:52
  Speaker 1: you talked about looking at the guidelines for recommended daily
• 8:55
  Speaker 1: allowance of nutrients, those are not always accurate either. They're
• 8:59
  Speaker 1: very outdated. And I want to use thiamin as an example.
• 9:03
  Speaker 1: If a woman is getting a full healthy diet, diamon
• 9:07
  Speaker 1: is like three point two I think it's milligrams, but
• 9:10
  Speaker 1: if somebody is not eating in the case of hypermesis,
• 9:13
  Speaker 1: you need fifty to one hundred. But if anyone saw
• 9:16
  Speaker 1: numbers and didn't understand that, that would just seem like poisonous.
• 9:21
  Speaker 1: I mean, that would be my guest about having studied this. Again,
• 9:24
  Speaker 1: thank you for what you do for vetting the actual
• 9:26
  Speaker 1: what are the actual numbers would you need? And bringing
• 9:29
  Speaker 1: to the point it changes prenatal throughout your pregnancy and postpartum,
• 9:34
  Speaker 1: and particularly when you are breastfeeding.
• 9:38
  Speaker 2: Yeah, yeah, of course, yeah, it definitely changes as your
• 9:41
  Speaker 2: body's changing with you, you're growing a human and then
• 9:44
  Speaker 2: once you give birth to that human, you're nourishing them
• 9:47
  Speaker 2: from your body if you choose to breastfeed, So you
• 9:49
  Speaker 2: actually need more nutrients while you're breastfeeding than you do
• 9:52
  Speaker 2: while you're pregnant, which a lot of people don't realize.
• 9:54
  Speaker 3: They think, oh, you.
• 9:55
  Speaker 2: Know, when the baby's in me, that's when they need
• 9:56
  Speaker 2: the most, But actually many things are actually higher at postpart.
• 10:01
  Speaker 1: Tara, you brought to light a very important point and
• 10:03
  Speaker 1: I'm going to repeat what you just said that most
• 10:06
  Speaker 1: people think it's while you're pregnant and nourishing this baby
• 10:10
  Speaker 1: that's growing in use the most important time to optimize
• 10:13
  Speaker 1: your nutrients. However, you said that postpartum is a time
• 10:19
  Speaker 1: when you need to optimize nutrients as well. What nutrients
• 10:23
  Speaker 1: are we considering during the postpartum time period.
• 10:26
  Speaker 2: Yeah, so there's actually a few that you need an
• 10:28
  Speaker 2: increased amount of postpartum. One of them is being vitamin A.
• 10:33
  Speaker 2: This is a common wondering pregnancy that you also need,
• 10:36
  Speaker 2: but we watch how much we have during pregnancy because
• 10:38
  Speaker 2: of the effects on the fetus growing inside of us,
• 10:41
  Speaker 2: So postpartum you.
• 10:42
  Speaker 3: Do need an increased amount.
• 10:43
  Speaker 2: There's also vitamin E which the dietaria recommendation does go
• 10:48
  Speaker 2: up postpartum as well. So those are a few of them,
• 10:51
  Speaker 2: but things we look out for.
• 10:52
  Speaker 1: Would you recommend buying separate supplements for them? Or a
• 10:56
  Speaker 1: lot of women will stay on their prenatal vitamins postpartum.
• 10:59
  Speaker 1: Is that something you recommend or is there a different
• 11:02
  Speaker 1: vitamin you take postpartum?
• 11:04
  Speaker 2: So generally I always just recommend keeping your prenatal through postpartum.
• 11:09
  Speaker 2: They do sell post natals, but to me, mainly it's
• 11:11
  Speaker 2: always looking at the back of the bottle on what
• 11:13
  Speaker 2: is actually in the bottle because we go into that
• 11:15
  Speaker 2: whole world of no vitamins are regulated or approved by
• 11:19
  Speaker 2: the FDA, so the exact amounts are never great. But
• 11:24
  Speaker 2: a lot of this can also come from your diet
• 11:25
  Speaker 2: as well, so we have to adjust for those factors too.
• 11:29
  Speaker 2: But typically all lactating women need to be taking a
• 11:32
  Speaker 2: prenatal daily, whether it's a pre nail or post natal,
• 11:35
  Speaker 2: you need some sort of supplemental nutrient.
• 11:38
  Speaker 1: The old line of thinking was that water soluble, well,
• 11:41
  Speaker 1: you can't get too much of it, you'll just pee
• 11:43
  Speaker 1: it out right. Well, we now know that's not necessarily
• 11:46
  Speaker 1: the case, and on the flip side. You want to
• 11:48
  Speaker 1: be very careful with your fat soluble, your ad E
• 11:52
  Speaker 1: and K. You're mentioning A and E. Is there a
• 11:55
  Speaker 1: risk of getting too much or do you just stick
• 11:58
  Speaker 1: with that recommended daily allowance.
• 12:01
  Speaker 2: I always recommend going with the daily allowance because there
• 12:05
  Speaker 2: are risks when there's too much. And like you said,
• 12:07
  Speaker 2: like the water, solibil, epomout and everything, you don't pee
• 12:10
  Speaker 2: those ones out. Anything in a large amount is not
• 12:13
  Speaker 2: healthy for you, even with water. If you drink too
• 12:15
  Speaker 2: much water, it can cause damage. So I always recommend
• 12:18
  Speaker 2: staying within the limit.
• 12:20
  Speaker 1: Let's circle back now to the original topic. We We're
• 12:22
  Speaker 1: going to talk about collaborative team approach supporting moms to
• 12:26
  Speaker 1: strength and care. So collaborative teamwork in a hospital is
• 12:30
  Speaker 1: the best where I've seen pharmacist involvement. You are also
• 12:35
  Speaker 1: a clinical pharmacist, a hospital pharmacist. Tell me about your
• 12:39
  Speaker 1: experiences there and how this can be continued out patient
• 12:43
  Speaker 1: as well.
• 12:45
  Speaker 3: Yeah, so exactly what you said. I totally agree.
• 12:47
  Speaker 2: Our hospital system in most places is already built for
• 12:51
  Speaker 2: the collaborative care process. So I work a lot sometimes
• 12:54
  Speaker 2: in the ER or the ICU and there, especially in
• 12:58
  Speaker 2: the ICU. We do patient rounds in the morning, so
• 13:00
  Speaker 2: you have your clinical pharmacists, you have your dietitian, you
• 13:04
  Speaker 2: have your intensivists, the hospital position in the er, you
• 13:09
  Speaker 2: have the nurse practitioner in the ICU, you have social work.
• 13:15
  Speaker 2: You have everyone there on the team, rounding on each
• 13:17
  Speaker 2: patient one at a time to make sure that.
• 13:19
  Speaker 3: Everyone is on the same page so.
• 13:22
  Speaker 2: That they get the best care for their safety and
• 13:25
  Speaker 2: for the hospital. So that has been really eye opening
• 13:29
  Speaker 2: for me.
• 13:29
  Speaker 3: But where I feel that.
• 13:30
  Speaker 2: We need more is in the outpatient setting. Once you're
• 13:34
  Speaker 2: out of the hospital, how do we have that team environment,
• 13:37
  Speaker 2: Because like I said earlier, that mom that had to
• 13:40
  Speaker 2: go to the dermatologists, there was no connection between the
• 13:44
  Speaker 2: multiple providers. There's gap and we need to fill those
• 13:48
  Speaker 2: gaps where there is that team collaboration. And that's a
• 13:51
  Speaker 2: difficult thing because there's different EHRs, there's different providers and
• 13:57
  Speaker 2: sometimes different states involved in this because some people use
• 14:00
  Speaker 2: online pharmacies right.
• 14:02
  Speaker 3: Now too, so it's a whole.
• 14:04
  Speaker 2: World of things outpatient that we're dealing with. But if
• 14:08
  Speaker 2: those can unite, it would be easier for everyone and
• 14:12
  Speaker 2: instead of one person holding the weight of everything, it
• 14:16
  Speaker 2: would make the workload a lot easier. Instead of the
• 14:19
  Speaker 2: dermatologists having to search on the computer for hours looking
• 14:23
  Speaker 2: up some crazy medication question, he knows he can reach
• 14:27
  Speaker 2: out to this person, find the answer and then they
• 14:30
  Speaker 2: can rely it to the patient and give them the
• 14:32
  Speaker 2: best recommendations.
• 14:34
  Speaker 1: Well said, you know, my dream is to have a
• 14:37
  Speaker 1: pharmacist involved with every obgyn clinic. It just like we
• 14:41
  Speaker 1: have the same dream, right, Just like we see pharmacists
• 14:44
  Speaker 1: are now being involved with primary care clinics as well.
• 14:47
  Speaker 1: It's new state guidelines vary. There's a lot of legislation
• 14:52
  Speaker 1: now allowing pharmacists to be part of that collaborative teamwork,
• 14:57
  Speaker 1: to be billing insurances for their consultation and stepping away
• 15:01
  Speaker 1: from that role of a dispensing pharmacist. And not only
• 15:04
  Speaker 1: is that important for our topic today in medication safety
• 15:07
  Speaker 1: for mom and baby, but also the shopping habits of
• 15:11
  Speaker 1: the American public. And I'm going to guess it's international
• 15:15
  Speaker 1: as well. Nobody has time now to go to your
• 15:18
  Speaker 1: corner pharmacy, stand in line and wait to speak to
• 15:21
  Speaker 1: your pharmacist. So I do love the fact there are
• 15:23
  Speaker 1: remote consultations when you create a disconnect from where the
• 15:26
  Speaker 1: pharmacist is to these other clinicians. You lose an opportunity
• 15:31
  Speaker 1: that is right there at your fingertips, and that's that
• 15:34
  Speaker 1: knowledge of a doctor of pharmacy to incorporate medication safety
• 15:39
  Speaker 1: into the whole care curriculum.
• 15:42
  Speaker 2: Yeah, exactly what I'm saying, because we lose sort of
• 15:45
  Speaker 2: like that checks and balance when we have the dispensing
• 15:49
  Speaker 2: pharmacy not associated with anything else. So you get this
• 15:52
  Speaker 2: prescription from Amazon pharmacy, this one from here, there's not
• 15:56
  Speaker 2: the checking for drug interactions, and we miss an entire
• 16:00
  Speaker 2: your safety net for the patient. And that's really where
• 16:03
  Speaker 2: we need to get all on board to make sure
• 16:05
  Speaker 2: all medications are accounted for every patient, not even just
• 16:08
  Speaker 2: mom and baby, that patients have a complete review when
• 16:13
  Speaker 2: they are seen by any provider, whether you're a pharmacist,
• 16:17
  Speaker 2: a physical therapist, dentist.
• 16:19
  Speaker 3: We need to look at the patient as a whole.
• 16:22
  Speaker 1: There's a specialty of a pelvic floor physical therapist which
• 16:26
  Speaker 1: can help with UTIs, which can help all the women
• 16:30
  Speaker 1: who end up being when they cough or they jump.
• 16:33
  Speaker 1: You always see the mom so that the kids are
• 16:35
  Speaker 1: on the trampoline and the mom's like, mom, come jump
• 16:37
  Speaker 1: on the trampoline and like Mom's like, I don't want
• 16:39
  Speaker 1: to jump on the trampoline. You don't really know why,
• 16:42
  Speaker 1: but we know why, right, there's a specialty to help
• 16:46
  Speaker 1: with that muscle support, get the strength back, get the
• 16:50
  Speaker 1: alignment in. If you can get that physical therapy, then
• 16:54
  Speaker 1: there's a potential to get off some of these medications.
• 16:57
  Speaker 1: And I know this is focused on younger women, but
• 17:00
  Speaker 1: I see it in my mom's generation as well. So
• 17:03
  Speaker 1: when you have women going in their seventies, eighties, nineties
• 17:06
  Speaker 1: living in their hundreds now, we lose a lot of
• 17:08
  Speaker 1: that strength. Women are being put on medications to help
• 17:11
  Speaker 1: with urinarian continence. We know what there's opportunities out there
• 17:15
  Speaker 1: to get off those medications. I always say everything we ingest,
• 17:19
  Speaker 1: whether it's a medication or not, could be a supplement,
• 17:22
  Speaker 1: could be food. There's always a risk involved, and we
• 17:24
  Speaker 1: want to make sure the safest things, the healthiest things
• 17:28
  Speaker 1: are going into our bodies, including pharums. Into this care
• 17:31
  Speaker 1: team is one of the ways to allow this to happen.
• 17:35
  Speaker 1: Tera you created such an amazing business connecting those missing
• 17:40
  Speaker 1: pieces together. In pregnancy, it's very common not to see
• 17:44
  Speaker 1: your obstetrician until you are ten weeks so long? Looking
• 17:48
  Speaker 1: back to how do you choose a prenatal vitamin right?
• 17:51
  Speaker 1: Look at other screenings we should have ahead of time?
• 17:53
  Speaker 1: Am I at risk for preclampsia? Am I at risk
• 17:56
  Speaker 1: for prenatal diabetes? Do I even have diabetes? Hypertension? Things
• 18:00
  Speaker 1: that young women would not often be screened for early
• 18:05
  Speaker 1: that might affect a pregnancy. Looking at someone like you
• 18:08
  Speaker 1: working part of a care team if we can, like
• 18:10
  Speaker 1: I said, CM in primary care offices, in obgyn clinics,
• 18:16
  Speaker 1: pharmacists need to be part of that care team.
• 18:19
  Speaker 2: Yes, and exactly what you've said that this is not
• 18:21
  Speaker 2: a cultural norm to be seen before pregnancy, and it
• 18:25
  Speaker 2: needs to be to be honest, because we know as
• 18:27
  Speaker 2: pharmacists and the obis know it too, that the most
• 18:30
  Speaker 2: damage from potential medications or outside factors like smoking, nicotine,
• 18:35
  Speaker 2: things like that, it happens in the first trimester.
• 18:38
  Speaker 3: And if you're not being seen un till ten.
• 18:39
  Speaker 2: Weeks, well, you don't have very many weeks left of
• 18:42
  Speaker 2: your first trimester at that point. And it needs to happen,
• 18:45
  Speaker 2: and it needs to be a cultural change now for
• 18:47
  Speaker 2: all of our moms and babies. And I really feel
• 18:50
  Speaker 2: like both of our specialties that we can help promote
• 18:52
  Speaker 2: that and get the safety and push for those prenatal appointments,
• 18:56
  Speaker 2: even preconception appointments, because that's when you.
• 18:58
  Speaker 3: Really should start thinking about things.
• 19:00
  Speaker 2: And for anyone listening that any women of a woman
• 19:03
  Speaker 2: of a child bearing age should be taking a prenatal
• 19:06
  Speaker 2: vitamin just in case, because most pregnancies are not planned,
• 19:09
  Speaker 2: and so it's really important that we think about that,
• 19:11
  Speaker 2: especially if you are at the family planning stage and.
• 19:15
  Speaker 1: If a one has a question first trimester, they're often
• 19:18
  Speaker 1: going to an urgent care or an er, and those physicians,
• 19:22
  Speaker 1: while they're brilliant or the advanced practice providers, that's not
• 19:26
  Speaker 1: their focus, their specialty, their education. They are focused on
• 19:30
  Speaker 1: let's treat your acute need and discharge you and get
• 19:34
  Speaker 1: you out. Yeah, huge opportunity here for pharmacists involvement.
• 19:39
  Speaker 3: Yeah exactly.
• 19:40
  Speaker 2: I think that's another area too where we can come
• 19:42
  Speaker 2: in and jump in because there's a lot of women
• 19:45
  Speaker 2: that go there to get seen because the ob providers
• 19:48
  Speaker 2: won't see you till that ten week mark and you're
• 19:51
  Speaker 2: experiencing symptoms at six seven weeks, you get the nausea,
• 19:55
  Speaker 2: you get the constipation, vomiting and you do go there
• 19:58
  Speaker 2: and you get prescribed stuff, and like you said, they
• 20:01
  Speaker 2: are not the specialists in that area.
• 20:03
  Speaker 3: So that just definitely gives a lot.
• 20:04
  Speaker 2: Of opportunity where pharmacists could help with the most optimal
• 20:07
  Speaker 2: medication choices for those patients.
• 20:11
  Speaker 1: You mentioned preconception counseling. Who would someone go to do this?
• 20:15
  Speaker 1: Are you talking to the pharmacist or is there another provider?
• 20:19
  Speaker 2: So I know there are some providers that offer that.
• 20:21
  Speaker 2: I know a lot of lactation consultants I work with
• 20:24
  Speaker 2: offer this to try to help prep patients for the
• 20:27
  Speaker 2: breastfeeding journey because it is a big journey. Pharmacy wise,
• 20:31
  Speaker 2: I like to offer that to try to get a
• 20:32
  Speaker 2: comprehensive medication.
• 20:34
  Speaker 3: Review before your family planning.
• 20:36
  Speaker 2: Just because if there are medications that need to be addressed,
• 20:38
  Speaker 2: we get some time for your body to get it
• 20:40
  Speaker 2: out of your system before the pregnancy could occur. But
• 20:43
  Speaker 2: I'm hoping more areas start doing that too. Besides pharmacy
• 20:47
  Speaker 2: and lactation incredible.
• 20:50
  Speaker 1: So I did nurse all my babies and I was
• 20:53
  Speaker 1: a young military wife living overseas. Our hospital did have
• 20:57
  Speaker 1: a lactation consultant and I remember moving overseas when my
• 21:01
  Speaker 1: daughter was about to turn on, and that was when
• 21:03
  Speaker 1: the guidelines. I don't know what they are now, you'll
• 21:05
  Speaker 1: have to update us on that. One. The guidelines had
• 21:07
  Speaker 1: breastfeed for a year, and I said, I'm I've breastfed,
• 21:10
  Speaker 1: she's almost one. I want to wean her. She didn't
• 21:13
  Speaker 1: want to wean and I was so overwhelmed and lost,
• 21:16
  Speaker 1: and they referred me to a local support group of moms.
• 21:20
  Speaker 1: And now when I think back to that, there were
• 21:22
  Speaker 1: no medical professionals, licensed clinicians part of that group. Moms
• 21:28
  Speaker 1: are getting information from other moms. This was before social media.
• 21:32
  Speaker 1: Now I think, oh my goodness, what is on TikTok
• 21:35
  Speaker 1: and Instagram and the other platforms that everyone's getting their
• 21:38
  Speaker 1: medication advice today. So, Sarah, if somebody wants to reach
• 21:41
  Speaker 1: out to you for preconception consoling, how do they find you?
• 21:46
  Speaker 2: So anyone that wants to reach out to me can
• 21:48
  Speaker 2: find me on my website at the Mother Baby Pharmacist
• 21:51
  Speaker 2: dot com, or they can text or call me at
• 21:54
  Speaker 2: three two one sixty zero oh nine five four to
• 21:57
  Speaker 2: two four. Really, you can text her calling time. I
• 22:00
  Speaker 2: promise I won't answer. I'm not available but I will
• 22:02
  Speaker 2: get back to you as soon as possible, and you
• 22:04
  Speaker 2: can message me on weekends late at night. I helped
• 22:07
  Speaker 2: moms at eleven o'clock at night when OBI offices are closed,
• 22:10
  Speaker 2: and they are so thankful.
• 22:12
  Speaker 3: So pretty much, whenever you want to reach out, I'm
• 22:14
  Speaker 3: here for you.
• 22:15
  Speaker 1: Incredible, And I want to add one more topic to
• 22:18
  Speaker 1: this in line with what we've been discussing, because there's
• 22:22
  Speaker 1: a big change in guidelines now for postpartum care. It's
• 22:26
  Speaker 1: quite terrifying. I think generations from now, our children's children
• 22:31
  Speaker 1: children are going to look back and say, what just
• 22:32
  Speaker 1: like we are doing now to how delivery labor delivery
• 22:36
  Speaker 1: was done in the nineteen forties, fifties, sixties. My mom
• 22:40
  Speaker 1: said when she went to deliver my sister, they gave
• 22:44
  Speaker 1: you medications that like knocked you out and you wake
• 22:47
  Speaker 1: up and you have this baby in your arms. Now,
• 22:49
  Speaker 1: by the time I came around a few years later,
• 22:51
  Speaker 1: that had already changed. I'm just horrified at hearing that story,
• 22:55
  Speaker 1: or when I've learned why are women laying on their
• 22:57
  Speaker 1: back for delivery when that goes against guidelines. It's because
• 23:01
  Speaker 1: of the obs from the nineteen what fifties and sixties
• 23:05
  Speaker 1: made that as standard, but it's not how women are
• 23:07
  Speaker 1: built to deliver babies. So when we think about postpartum care,
• 23:11
  Speaker 1: there's a standard that you have this baby in a hospital.
• 23:15
  Speaker 1: That's changing as well. There's a lot of more home birds,
• 23:19
  Speaker 1: i want to say, freestanding birthing centers. Midwives are having
• 23:23
  Speaker 1: a resurgence now in the United States, and I'm really excited.
• 23:26
  Speaker 1: I think they're more open to partnering with pharmacists then
• 23:30
  Speaker 1: maybe obstetricians are at the moment, and there's many reasons
• 23:34
  Speaker 1: that's the case. But like I said, the future, I'm
• 23:36
  Speaker 1: sure is going to be the standard of collaborative teamwork.
• 23:40
  Speaker 1: Once that woman was discharged from the hospital, mom goes
• 23:43
  Speaker 1: home with new baby. C Section rates are still very
• 23:46
  Speaker 1: high in the United States, which again there's a time
• 23:49
  Speaker 1: and a place for the right patients, but not for
• 23:52
  Speaker 1: the percentages that we are still seeing. I didn't know
• 23:56
  Speaker 1: until recently that you can't carry your baby up the
• 23:59
  Speaker 1: stairs after you've had a C section like that, there's
• 24:02
  Speaker 1: a set time. And then the standard that really is
• 24:05
  Speaker 1: changing that Acock has come on board with is that
• 24:09
  Speaker 1: six week postpartum checkup. So this mom just had nine
• 24:13
  Speaker 1: months of her body changing. Like you said, hormonal imbalances
• 24:17
  Speaker 1: delivers this baby goes home and is on our own
• 24:21
  Speaker 1: and hopefully has a good support team with a significant
• 24:23
  Speaker 1: other or other loved ones to help. However, seeing that
• 24:27
  Speaker 1: specialists till six weeks you mentioned constipation, I'm so grateful
• 24:31
  Speaker 1: women are talking about this now. Happens to almost everyone
• 24:35
  Speaker 1: through their pregnancy. At some point postpartum is you go
• 24:39
  Speaker 1: home with a new baby and you are just severely
• 24:42
  Speaker 1: backed up. We have a very simple option, doctor say
• 24:46
  Speaker 1: right to help with that, but no one mentioned it
• 24:49
  Speaker 1: to me. So grateful to have someone like you here
• 24:52
  Speaker 1: talking about this. What should women know postpartum? As far
• 24:55
  Speaker 1: as you said changes and medications, any clinical prols you'd
• 24:59
  Speaker 1: like to share.
• 25:00
  Speaker 2: Well, I feel like I have many, because postpartum is hard.
• 25:03
  Speaker 2: It is one of the most difficult time those first
• 25:05
  Speaker 2: few days you're overwhelmed with the joy of having a
• 25:08
  Speaker 2: new baby, or sometimes you are in a harder situation
• 25:11
  Speaker 2: where you just gave birth, but your baby's in the
• 25:14
  Speaker 2: NICU and it's a mess and you have to also
• 25:17
  Speaker 2: take care of yourself at the same time. So clinical
• 25:19
  Speaker 2: pearl wise, honestly, make sure you're drinking water. It's a
• 25:23
  Speaker 2: lot and it seems simple, but you need water to
• 25:26
  Speaker 2: stay hydrated. Your body is going through a lot of
• 25:28
  Speaker 2: hormonal shifts. Most people lose a lot of blood and
• 25:31
  Speaker 2: some people more than they should. So water is a
• 25:34
  Speaker 2: big thing for me. Trying to get movement in as
• 25:36
  Speaker 2: possible is one thing that I always try to recommend
• 25:39
  Speaker 2: to help with the constipation, because that constipation.
• 25:42
  Speaker 3: Does hit almost every postpartum mom.
• 25:44
  Speaker 2: And that's why when we talk about it now that
• 25:46
  Speaker 2: they check that when you're at the hospital, have you
• 25:48
  Speaker 2: pooped yet since you've given birth, because it is a
• 25:51
  Speaker 2: known thing. So water doc you sate. And then I
• 25:54
  Speaker 2: think the other thing that they all just need to
• 25:56
  Speaker 2: know is that that fourth trimester that you're now entering,
• 25:59
  Speaker 2: that there are resources, and it's just making sure that
• 26:02
  Speaker 2: you can find the resource that you need, whether it's
• 26:05
  Speaker 2: for postpart anxiety depression, whether it's for pelvic floor therapy,
• 26:09
  Speaker 2: which is definitely growing right now, whether it's for lactation
• 26:13
  Speaker 2: support or medication support too. Just not to be afraid
• 26:16
  Speaker 2: to reach out for the help that you need.
• 26:19
  Speaker 1: And for moms that want to breastfeed, they're discharged from
• 26:22
  Speaker 1: the hospital, they're struggling, Sarah, how do they find support?
• 26:26
  Speaker 3: So there's a few options. The lactation consultants.
• 26:29
  Speaker 2: Normally at hospitals, they'll give you a paper of ones
• 26:32
  Speaker 2: that are associated with the hospital and you can make
• 26:34
  Speaker 2: an appointment with them after. At the hospitals around mind,
• 26:37
  Speaker 2: you actually get my information now on discharge, which I'm
• 26:40
  Speaker 2: super excited about because medications questions will come up quickly.
• 26:44
  Speaker 2: But you can always google for lactation consultants online. I
• 26:48
  Speaker 2: definitely recommend looking for ones that have all the certifications
• 26:53
  Speaker 2: and positive reviews, just because it is such a vulnerable
• 26:56
  Speaker 2: thing that takes a lot of practice, and if you're
• 26:58
  Speaker 2: putting money into something, you want to get the most
• 27:01
  Speaker 2: out of it. And I've worked with some really great
• 27:03
  Speaker 2: ones here in the Brevard County area that I'm just
• 27:06
  Speaker 2: so grateful for because they've changed my breastfeeding journey. I'm
• 27:09
  Speaker 2: actually going almost two and a half years strong on it,
• 27:12
  Speaker 2: and so I couldn't do that without the support of
• 27:15
  Speaker 2: them from the early on times, especially since I had
• 27:18
  Speaker 2: a nick you baby with my second daughter. And it's
• 27:21
  Speaker 2: really the collaborati team approaches, which is what I said
• 27:24
  Speaker 2: and why I focus on this so much because it
• 27:26
  Speaker 2: is what helps us be successful in motherhood and in
• 27:31
  Speaker 2: the healthcare field.
• 27:33
  Speaker 1: There's an old saying it takes a village, and we're
• 27:36
  Speaker 1: going back to that. With pharmacists leading the forefront of
• 27:38
  Speaker 1: that village. We are that centerpiece that everything else is
• 27:43
  Speaker 1: circling around. I've yet to meet anybody today that doesn't
• 27:47
  Speaker 1: take any vitamin or supplement or prescription medication.
• 27:51
  Speaker 3: Right, you are exactly.
• 27:53
  Speaker 1: You have connected this piece beautifully, and congratulations on all
• 27:58
  Speaker 1: these achievements you just talked about, well as far as
• 28:00
  Speaker 1: nursing your child being part of that discharge information. And
• 28:06
  Speaker 1: it's not always easy. And when we're in a society
• 28:08
  Speaker 1: where you have to have two incomes today, it's really
• 28:10
  Speaker 1: hard to get by on one income. So moms are
• 28:13
  Speaker 1: in a position now trying to do everything. You seem
• 28:16
  Speaker 1: to have made it very easy. So whatever we can
• 28:20
  Speaker 1: do to support you, we are happy to do so. Tara,
• 28:22
  Speaker 1: thank you so so much, and once again i'd like
• 28:25
  Speaker 1: you to repeat. If anyone would like to reach out
• 28:27
  Speaker 1: to you, go ahead and tell us where to find you.
• 28:30
  Speaker 2: Yeah, you can find me at my website, Themotherbaby Pharmacist
• 28:33
  Speaker 2: dot com, or you can call or text me anytime
• 28:36
  Speaker 2: at three two, one, six, zero nine five four two four.
• 28:40
  Speaker 1: And is there anything else we've missed that you'd like
• 28:42
  Speaker 1: to share.
• 28:43
  Speaker 2: I think just the takeaway from today is just if
• 28:46
  Speaker 2: we can improve how we all work together as providers,
• 28:49
  Speaker 2: we can completely change how supported moms feel during one
• 28:52
  Speaker 2: of the most hormal times of their life.
• 28:55
  Speaker 1: Absolutely well said, and we know pharmacists are on this
• 28:59
  Speaker 1: forefront medication safety, prenatal, through the pregnancy, postpartum, whether you're
• 29:06
  Speaker 1: breastfeeding or bottle feeding, we are your source of support.
• 29:10
  Speaker 1: So thank you everyone for listening, and if you enjoyed
• 29:13
  Speaker 1: this today, please do share with your network of pharmacists
• 29:16
  Speaker 1: and if you'd like to be a guest, reach out
• 29:18
  Speaker 1: to me anytime and we'll have all this information in
• 29:20
  Speaker 1: the show notes as well. Thank you everyone,