Are you having back pain with any of the following?
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
We offer many resources to help you and your partner prepare for your baby. Learn about what to expect during and after pregnancy including labor and delivery, breastfeeding, and when to call us.
The period of time before pregnancy is important for all women of reproductive age as a time when you can maximize your own health. It's important to take good care of your health. When and if you do become pregnant, you will have a good chance of having a healthy baby and minimizing the risks of miscarriage and birth defects.
We want to help make sure that your body is ready to welcome a new baby. We will help you focus on specific issues that could affect your pregnancy, even before you know you are pregnant. We can discuss:
While you may not be planning to become pregnant, it's still important to protect and improve your health. About 40 to 50 percent of pregnancies are unplanned. Most women do not have a prenatal visit until after they know they are pregnant. The time between conception and when a woman knows that she is pregnant is especially important – where good health practices can make a real difference. In light of this, we hope that you follow these guidelines even if you are not planning to become pregnant.
Here are some important things to consider – and act upon – before you become pregnant. Make changes to become as healthy as possible before you start trying to conceive.
If you are of childbearing age, take 400 micrograms (400 mcg or 0.4 mg) of folic acid every day, even if you are not planning to become pregnant. Since many pregnancies are unplanned, this is good advice for all women between 18 and 45. The easiest way to do this is by taking a standard multivitamin daily.
Studies show that folic acid plays an important role in lowering the risk for certain birth defects (called neural tube defects), if it is taken before conception and through the first 3 months of pregnancy.
You can also get your folic acid in:
It is important to try to reach or maintain a healthy weight before you conceive (get pregnant). Underweight women may have a harder time getting pregnant and are more likely to have smaller babies who may have problems during labor and after birth. Women who are overweight may experience high blood pressure or diabetes during pregnancy. Babies born to overweight women may also have a higher risk of certain birth defects. Reaching and maintaining a healthy weight before pregnancy can reduce these risks.
If you are not already physically active on a regular basis now, this is a good time to start. You will feel better overall, have more energy, less stress, and sleep better. Try to develop a regular, moderate exercise program that you can continue during pregnancy. It is important to begin slowly and build up gradually. A 5 or 10-minute walk is a good start. Try to set a goal of exercising at least 30 minutes per day on most days. If you have a health condition, please check with us before you begin any exercise program.
If you smoke, one of the most important things you can do to improve your health is to quit now. Smoking may make it harder for you to get pregnant. And women who smoke are more likely to have problems in pregnancy and childbirth, like premature babies. Once your baby is born, studies show that there is also an increased risk for SIDS (crib death) for babies exposed to secondhand smoke.
Using alcohol or drugs like cocaine or crack during pregnancy can harm your baby. These drugs can cause your new baby to cry a lot or have problems eating, sleeping, or breathing. Later, your baby might have trouble learning. These drugs can also cause serious problems like birth defects or brain damage. They can even cause you to have a miscarriage.
If you are around certain chemicals that are found in the home or workplace, it could make it more difficult to become pregnant and may harm your developing baby. To decrease contact with chemicals, make sure you wear rubber gloves and work in a well-ventilated area. You can also try to:
We recommend that women have regular Pap tests, pelvic exams, and breast exams. All sexually active women 24 and younger should also be screened every year for chlamydia (a sexually transmitted disease). If you have any unusual bleeding, pain, sores, or bumps near your vagina, please let us know. It is better to identify any health problems right away when they may be easier to treat.
Diseases that are transmitted through sexual contact not only affect your ability to get pregnant, but they also can infect and harm your baby. Some examples of sexually transmitted diseases (STDs) are chlamydia, gonorrhea, genital herpes, HIV (the virus that causes AIDS), hepatitis B and C viruses, and syphilis.
You can have an STD even if you don’t have symptoms. STD symptoms can include sores, bumps, or blisters near your vagina, rectum, or mouth and burning or pain when you urinate. If you have any of these symptoms, you should avoid having sex until you can see us for evaluation and treatment.
Some infections can be prevented by immunization. Before you plan to get pregnant, ask us whether you should be immunized against rubella (German measles), chickenpox (varicella), or hepatitis. If you are not immune, you may want to receive the vaccinations before you get pregnant. Being exposed to these infections during early pregnancy could harm your baby. We recommend that you wait at least one month after being vaccinated before trying to get pregnant.
If you are not sure if you or your family members have been vaccinated against rubella or chickenpox, you can find out by viewing your Preventive Services online through my home page or by contacting my office.
Whooping cough (also called pertussis) is a contagious disease that can spread easily from person to person through coughing. When babies get whooping cough, it can be life-threatening. You can protect your baby by getting a Tdap (tetanus, diphtheria, pertussis) vaccine before you are pregnant, during pregnancy, or after giving birth. Partners and families can be vaccinated at any time, but preferably before the birth of the baby so they don't infect their newborn. It is safe for mothers to get the Tdap vaccine while breastfeeding.
If you are not sure if you and your family members have been properly vaccinated against whooping cough, you can find out by viewing your Preventive Services online through my home page or by contacting my office.
If you think you're being abused or may be abusing someone else, you can get help by talking to us or:
If someone has hurt you before, it may happen again. Sometimes abuse can start when you become pregnant. Abuse during pregnancy can cause health problems for you and your baby.
If you, the father of your baby, or any close family members (children, parents, sisters/brothers, aunts/uncles) have a history of birth defects or inherited conditions, you may have a higher chance of having a baby with such a condition. A genetic counselor can give you more information about the specific risks to your baby and possible tests you may choose to have. Getting your test results before you get pregnant will give you time to consider your options.
If you have a chronic medical condition, it is important to discuss this with us before getting pregnant. We want to help you successfully manage conditions such as:
It is best to have these chronic conditions under control before conceiving. If you take any prescription, over-the-counter medications, or herbal remedies on a regular basis, discuss this with us.
Teratogenic medications are medications that increase the risk for birth defects if used during pregnancy. Many of these medications are commonly prescribed:
|Medication Use||Teratogenic Medicine|
|Diabetes||Certain types of insulin|
|Depression and bipolar disorders||Lithium|
|High blood pressure||ACE inhibitors or ARBs|
|High cholesterol||Certain statins|
|Epilepsy||Certain anticonvulsants such as Dilantin (phenytoin)|
|Mild sedation||Valium and Ativan|
|Cancer||Certain cancer drugs and chemotherapy treatments|
The list of medications above isn’t comprehensive, but it contains some good examples of medications to avoid if you think you might become pregnant.
Some medications can be changed before pregnancy, while others should still be used because the potential benefits outweigh the risk. If you are of childbearing age and think you may be taking a teratogenic medication, please discuss this with us. Please do not stop any medications without talking with us first.
For the best chance of success, it’s important to observe and understand your menstrual cycle.
The menstrual cycle is measured in days, starting with Day One as the first day of the menstrual period. Ovulation (releasing an egg) usually occurs at approximately 14 days before you expect your next period. This may not be Day 14 if your cycles are longer than 28 days. If the released egg is not fertilized, then you get your period. Normal cycle lengths can vary from 21 days to 42 days.
The easiest time to get pregnant is around the time of ovulation. Besides counting the days of your cycle, you can also try to predict ovulation using a basal body temperature chart or an ovulation predictor kit. For additional help with predicting your fertile days, try the fertility calculator.
The basal body temperature (BBT) indicates your body’s temperature while at rest. Hormone changes during your menstrual cycle affect your body temperature. A woman’s basal body temperature increases during ovulation.
To use this chart:
Ovulation prediction kits help determine when you are about to ovulate. They are sold over the counter at pharmacies. About 12 to 14 days before a menstrual period, the brain releases luteinizing hormone (LH). This is called the “LH surge” and can be detected in your urine. The LH surge happens about 1 to 1½ days before an egg is released. Here are some tips for using the kit successfully:
Do you think you may be pregnant? Some women can tell almost immediately because of certain changes in their body. The most common symptom is a skipped period. Some other early pregnancy symptoms include:
If you have any of these symptoms and you have not yet done a pregnancy test, please do one soon. You can stop by our lab for a pregnancy test. No appointment or lab order is needed.
Sometimes getting pregnancy takes time. It may not happen as quickly as you would like. This may depend on many factors, including your age.
Couples under the age of 35 are considered to be infertile if they have not been able to conceive after 12 months of having sexual intercourse at least 2 to 3 times a week without using any form of birth control.
Couples 35 or older that have not conceived after 6 months of having sexual intercourse at least 2 to 3 times a week without using any form of birth control may have a fertility problem.
Infertility in men can be caused by problems with:
Infertility in women can be caused by problems with:
Egg quality refers to both the ability of an egg to become successfully fertilized and also the ability of that fertilized egg to develop into a healthy baby. Egg quality is most closely associated with age.
Baby girls are born with a certain number of eggs. As a woman ages, the number of eggs, as well as the quality of the eggs, declines. As a result, a woman over 35 years old has a lower chance of getting pregnant and a higher chance of having a miscarriage or a baby with congenital problems (such as Down syndrome) than a younger woman does.
Both hormone functioning and reproductive anatomy must be within a healthy range for fertilization and fetal growth to occur.
An infertility workup may consist of:
Treatments for infertility could include:
If you’re thinking of getting pregnant:
If you think you might be pregnant:
If you’re having trouble getting pregnant, you may have a fertility problem if you are:
If you are having difficulty getting pregnant, contact me by e-mail or call to discuss whether you should be referred to one of my colleagues who specializes in infertility.
You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.
Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.
Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.
We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.
If refills are needed in the future, you can:
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.
My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.
As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test. We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.
As your personal physician, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.