Spokane OBGYN
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Mark Schemmel, M.D. interviewed by local news companies about COVID vaccination in Pregnancy

Mark T. Schemmel, M.D.


Mom-to-be and pediatrician stresses importance of expecting moms getting the vaccine

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The Spokeman Review

With growing numbers of critically ill pregnant COVID-19 patients, doctors urge expectant parents to get vaccine

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Spokane Public Radio

Doctors Say They’re Seeing More Expectant Moms With Covid

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Is there a natural way to treat a vaginal infection?

By Amery Baker, PA-C

The best answer to this question is: not really.

Natural remedies for treatment of vaginal infection have theoretic science behind them and limited evidence supporting use.  When compared to available medications (including over the counter treatments) for vaginal infections, however, they do not help enough for doctor recommendation. Some remedies are even harmful. Here are the most notable natural/ alternative therapies and little about their use:

Vaginal yogurt with honey. Yogurt contains live bacteria and is thought to help restore good bacteria and decrease yeast overgrowth. While the bacteria in yogurt (lactobacilli) is similar to vaginal bacteria, it is not the same.  Honey is a natural antibiotic/ antifungal.  Small studies show that when yogurt with honey is inserted vaginally it can help a yeast infection in some patients, but is far inferior to antifungal treatments available over the counter. Also, there is a concern that using yogurt vaginally can promote resistant strains of vaginal bacteria.

Probiotics: Probiotics are thought to restore healthy balance of vaginal bacteria. Oral probiotics are generally thought to be safe and are reasonable to try.  Using probiotics in the treatment of bacterial vaginosis is showing promise in overseas studies, but they are still inconclusive. Probiotics are not shown to be helpful for a yeast infection.

Garlic. Garlic has natural antifungal properties.  Studies show when taken orally, it has no effect on a vaginal infection. There are no studies on the use of garlic vaginally.

Boric Acid:  While not natural, this is probably the most used alternative treatment for vaginal infections. The boric acid is thought to restore the natural pH of the vagina, thus promoting the growth of good bacteria. It can be used to treat a vaginal infection if used vaginally. It is better for treatment of yeast than bacterial vaginosis and doesn’t work as well as antibiotics or antifungals. It is a poison if ingested orally and very dangerous if not handled correctly. It is recommended to discuss this option with your doctor before using.

pH douches: Vaginal douching destroys the normal vaginal bacteria. It is not a treatment for a vaginal infection, and is often harmful. It can cause a vaginal infection or worsen an already existing infection.

With little effective natural options, what can you do?

First, practice good vaginal hygiene. Anything that can cause irritation, decrease beneficial bacteria or change the pH in the vagina can make an infection worse. Here are a few things to do to help your body heal.

  • Use water only to clean the genitals. Using too much soap, even if it is hypoallergenic, fragrance-free, or for sensitive skin clears the good bacteria and causes irritation on the vaginal mucosa. Bubble baths are also not advised.
  • Keep the vaginal area dry. Change out of work out clothing or swim suits as soon as possible. Don’t use minipads or, if you do, change them often.

Second, you can determine what kind of vaginal infection you most likely have.  There are common signs that help differentiate between the two most common causes of vaginal infections:

Yeast infections:

  • Main symptom is vaginal itching and irritation
  • Discharge is either white and thick or there can be an increase in vaginal dryness (especially with intercourse).
  • Yeast infections are more common after the use of an antibiotic

Bacterial Vaginosis (BV):

  • Main symptom is vaginal odor. The smell is almost always described as “fishy”. This odor is worse after intercourse.
  • Discharge is almost always increased and yellow, thin.
  • This infection can be associated with mild pelvic cramping.

If you think you have a yeast infection, over the counter treatments are very effective. These include Monistat and Gynelotrimin.  If you think you have bacterial vaginosis (BV), there are no over the counter options and a prescription antibiotic is needed.  If neither or both seem likely, an exam by your OBGYN is the most beneficial.

Signs that something more severe could be going on:

  • Fever
  • Irregular vaginal bleeding
  • Severe vaginal or pelvic pain
  • Recent intercourse with a new partner

Do I have to have an exam?

Most OBGYN doctors encourage an appointment for a vaginal infection due to the many potential causes of vaginitis. While most vaginal infections are related to overgrowth of normal organisms in the vagina, some can be very serious and lead to significant problems. These include chlamydia, herpes, trichomoniasis and other sexually transmitted infections.  Getting the right diagnosis decreases healing time and ensures that nothing more serious is the cause. Also, if you are or could be pregnant, you should always check with your doctor before diagnosing or treating a vaginal infection.

If  you would like to make an appointment with Spokane OBGYN, please complete our online form or call us.

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Once a C-section, Always a C-section?

By Mark Schemmel, M.D.

Patients often ask if having had a cesarean once means that they will always require a cesarean.  The fact is that most women who have had a single prior cesarean are candidates for what we call TOLAC, or a trial of labor after cesarean. Many of these women have a high likelihood, 60-70% or better, of succeeding in achieving a VBAC (vaginal birth after cesarean). Individual likelihood of success is variable depending on a number of factors. This can be determined through consultation with your obstetrician as part of an overall discussion of the pros and cons of TOLAC.

When discussing chances of vaginal deliver after cesarean, your doctor will consider the reasons for having had a prior cesarean as well as medical conditions and disorders, gestational diabetes, and current pregnancy complications.  There is always a risk associated in attempting a vaginal delivery after cesarean.  Risks to the mother include having another unsuccessful labor leading to repeat cesarean.  Risk to the baby (and mother) include uterine rupture.

Your obstetrician will assist you in consider all of this information and deciding whether or not TOLAC is the best choice for you.

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Dietary Supplements During Pregnancy

By Dr. Jason Reuter

It is important to maintain healthy nutrition during pregnancy.  Taking the time to meal plan and shop for healthy food is essential.  In addition to obtaining nutrition from food, some women turn to nutritional supplements to maintain good health during pregnancy.  Nutritional supplements are intended to aid in acquiring nutrients lacking from food consumption, or that are in extra demand due to the pregnancy.  However, controversy and confusion exist when it comes to the safety, type, and quantity of nutritional supplements.

In general, there are two categories of nutritional supplements: (1) elemental supplements, or vitamins; and (2) herbal or plant supplements.  Each of these categories is addressed in turn below.

Elemental Supplements found in Prenatal Vitamins

Elemental supplements, also referred to as vitamins, play an important role in the health of the mother and development of the fetus.  Elemental supplements have been well studied for decades and have undergone rigid and comprehensive safety studies to determine the quantity that is safe for a healthy pregnancy.  As a general guideline, the safest practice is for pregnant women to take only prenatal vitamins.  Vitamins such as folic acid, calcium, iron, vitamin D, potassium and many of the “B” vitamins (thiamine, niacin and riboflavin) are found in prenatal vitamins.

Herbal or Plant Supplement Safety

Herbal or plant supplements may be regarded as “safe” by the public, but there is often no scientific data to support this.  While elemental supplements are purified and the dosing range is established, the same is not true for herbal or plant supplements.  Herbal or plant supplements are sold in many different preparations by many different companies.  As a result, they are sold without prior testing and their makers have no obligation to report adverse events.  The lack of oversight of the herbal supplement market allows companies to make inaccurate and/or false claims of the reported benefits of the supplements without recourse.

Another concern for pregnant woman is many manufacturers of herbal supplements use fillers and unlisted ingredients, such as metals, to decrease their cost of production.

The lack of prior testing of herbal supplements is concerning for pregnant women, because the risks are simply unknown.  A lack of proof of harm should not lead a pregnant woman to assume herbal supplements are safe.  Due to the unknown safety of herbal or plant supplements, it is standard practice to recommend that women avoid taking herbal supplements during pregnancy.

Discuss all nutritional supplements with your medical provider

Please note this posting is not meant to be a comprehensive discussion, but rather, a starting point for further discussion with your medical provider.  In addition to the nutritional supplements discussed above, two other items to be discussed with your medical provider include caffeine and omega 3 supplements.  These items are beyond the scope of this article, but a pregnancy woman should be aware these may pose a concern during her pregnancy, should she choose to use them.

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Non Invasive Prenatal Screening or Cell free DNA Testing

Non Invasive Prenatal Screening ( N.I.P.S.) or Cell free DNA Testing

By Dr. Stovall

Introduction: Chromosomal testing with gender identification in the first trimester

New to prenatal screening is the N.I.P.S. testing. It is a chromosomal test for Down’s syndrome and other genetic disorders.  It is getting a lot of attention not only for increased sensitivity to check for Down’s syndrome, but its ability to find out the baby’s gender in the first trimester.  This blog article will go over that testing and when it is appropriate to order.

History of testing for genetic disorders

Amniocentesis was the first testing for genetic conditions such as Down’s syndrome.  This was not a popular test as it is invasive and carries a risk of harm to the baby.  Now we have many non-invasive options for screening that can give information about the genetics of the baby without the potential harm of an amniocentesis.  Amniocentesis is the only chromosomal study to give absolute assurance that the baby does not have a genetic disorder, but the new screening tests are getting better.

Current screening options for genetic disorders

Current tests used to screen for genetic conditions are serum (or blood) tests on the mother with or without an ultrasound. Here are a few of the most popular:

  • Quad screening

Blood draw from the mother at about 15-20 weeks of pregnancy. Four proteins, including the alpha fetoprotein that come from the placenta are evaluated by calculating the amount in the mother’s blood.

  • 1st Trimester screen

An ultrasound down in the first trimester to look at the back of the baby’s neck and to measure the nuchal translucency.  This is combined with a blood test at the time of the ultrasound measuring different proteins and hormones from the placenta.

  • Integrated screening

Combines the Quad screen and the first trimester screen.

These tests, except amniocentesis, are considered screening tests. They separate out the high risk pregnancies from the low risk pregnancies.  If any of these tests showed that the baby was at increased risk for Down’s syndrome or other genetic disorders, then we would offer to do a targeted ultrasound and amniocentesis to obtain fluid from the sac around the baby to do chromosome studies.

NIPS: the newest genetic screening test

The newest genetic screening is the N.I.P’s or cell free DNA testing.  DNA from the placenta that is in the mother’s blood is tested for chromosomal problems.  (such as Down’s syndrome, trisomy 18, and sex chromosome problems). Because this is a chromosomal test, it can give results about the gender of the baby.  It does not, however, test for all possible genetic disorders. For example, if the mother or the father has an inherited condition like cystic fibrosis, that is tested with a separate genetic test.  The advantage to this test is that it is a chromosomal test without the risk of an amniocentesis.

N.I.P’s testing is done when the integrated screening or other genetic testing shows an increased risk for Down’s syndrome.  If the NIPS test is negative, then we can be 99% sure the baby does not have Down’s syndrome, but it does not mean that the baby does not have another genetic disorder or syndrome. In this way the NIPS testing decreases the amount of invasive testing (or amniocentesis) done for positive screening.

Problems with the NIPS testing

NIPS sounds great with its ability to find out the gender of the baby in the first trimester and the high sensitivity for Down’s syndrome, but it comes with a down side as well.  The first is the cost.  It is more expensive than the other screening tests and it is not covered by all insurance carriers without a positive integrated screen or advanced maternal age (age over 35.)  The NIPS only screens for about 60% of possible genetic disorders.  Also, NIPS testing does not test for birth defects such as spina bifida or anacephaly, both of which are tested with current screening recommendations.


In the near future, as the cost to do DNA testing goes down, we will probably switch to NIPS testing with the first trimester screen as a standard to test for genetic disorders and birth defects.  For now, we are recommending using NIPS in high risk patients or patients with a positive integrated screen.


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Eating for Two

Nutrition is such an important part of pregnancy. Nikkie Strong is a registered dietician and personal trainer in Spokane. She has written an informative segment below on nutrition and has offered her contact information for anyone interested. Please take the time to read and ask one of us if you have questions, or contact her directly.

Dominique Grant M.D.

Eating for Two

Eating healthy transcends through all life cycles.  What is needed to be healthy when you are trying to get pregnant, when you are trying to lose weight, when you are a child, and when you are aging all have the same foundations with unique properties to thrive.  Pregnancy in particular, has some key changes to keep you and your baby safe.  Your nutrition during this time not only affects you, but inadequate nutritional status during development can also have consequences for the child later in life, increasing his or her risk for cardiovascular disease, hypertension, and Type II diabetes.  Listed below are the key factors to healthy nutrition during pregnancy.

Weight Gain

You’re building a person (maybe a few!) and this means that your calories and nutrient needs increase as well, resulting in weight gain.  How much weight should you gain?  If you start out at a normal weight, expect to gain 1-1 1/2 pounds each month during your first trimester, during your second trimester you should gain 1/2-3/4 pound each week, and during your third trimester you should about 1 pound each week.

Pre Pregnancy

Not sure what category you are in?  Use this link and enter your pregnancy starting weight: Learn More Here.

Weight Gain Break Down


Pregnancy Weight Gain

How many Calories do I need?

During your second and third trimester you will need an additional 300 calories/day.  If you exercise regularly, you may need an extra 500 calories/day.  Adjust your calorie intake as needed to meet your weight gain recommendations.

Foods To Avoid/Limit During Pregnancy

  • Raw or undercooked animal foods such as meat, seafood, and eggs
  • Shark, swordfish, king mackerel, tilefish (cooked or raw)*
  • Soft cheeses (mold-ripened, blue-veined, unpasteurized)
  • Tobacco
  • Alcohol
  • Caffeine
  • Cured/deli meats
  • Artificial sweeteners (limit as much as possible)
  • High sugar intake
  • Using cravings to justify poor food choice

* The FDA recommends eating 8 to 12 ounces of fish low in mercury per week. That amounts to about 2 to 3 servings of fish per week, which can be eaten in place of other types of protein. Make sure to choose a variety of fish lower in mercury, such as salmon, tilapia, shrimp, tuna (canned light), cod, and catfish.

Nutrients to include to meet your growing demands:


Your body is in a state of building and your protein needs are increasing.  During pregnancy you need to eat 1 gram of protein per pound of body weight.  (For example, if you weight 150 lbs, you will need 150 grams of protein).  Good sources of protein include lean meats, greek yogurts, and cottage cheese.


Omega-3’s are important for central nervous system development, particularly nerves and eyes.  Studies have shown that higher levels of maternal omega-3 consumption are related to better visual acuity and mental and psychomotor skills at 6 months and 11 months.  Good sources of omega-3’s include flax, walnuts, chia, algae or fish oil supplements (non liver), and seaweed.

Vitamin D

Vitamin D supports immune function, healthy cell division and bone health for both the mother and the baby.  Vitamin D is necessary for the absorption and metabolism of calcium and phosphorus.  Good sources of vitamin D include 20-30 min sun exposure 2-3 days per week, and Vitamin D-fortified foods.


Zinc is known to be important for many biological functions including protein synthesis, cellular division and nucleic acid metabolism.  Good sources of zinc include legumes, nuts, whole grains, and animal foods.


Folic acid before and during pregnancy can help prevent birth defects of your baby’s brain and spinal cord.  Good sources include dark, leafy veggies, legumes, and folate-fortified foods.


Calcium is needed to build strong bones and teeth.  Calcium also allows the blood to clot normally, nerves to function properly, and the heart to beat normally.  Good sources include dark, leafy veggies, bok choy, tofu, legumes, figs, nuts, seeds, fortified milks, fortified cereals, and grains.

Vitamin B-12

Vitamin B-12 helps to maintain your nervous system.  Good sources of Vitamin B-12 include animal products, particularly milk, poultry, and fish.


Your body uses iron to make extra blood for both you and your baby during pregnancy, as well as move oxygen from your lungs to the rest rest of your body, including your placenta.  Iron deficiency anemia is common during pregnancy, a condition that will make you feel even more tired.  Good sources of iron include dark, leafy veggies, dried fruits, whole grains, nuts, seeds, and animal foods.


Staying hydrated is especially important during pregnancy.  Your water needs increase during pregnancy because your blood volume is rapidly increasing. Complications from dehydration include headaches and migraines, nausea, cramps, swelling, achy joints, and dizziness. Use the link below to calculate your hydration needs:


SupplementationResearch has shown that vitamin supplementation can improve pregnancy outcomes while even reducing nausea.  Things to consider when adding a supplement:

Most prenatal vitamins meet these requirements.  Ideally you should start taking a prenatal vitamin once you start trying to conceive.  But what if your prenatal vitamin is making you sick???

  •  Try taking it with food
  • Try taking it at a different time of day, such as before bed.

Have more questions?  Talk with your doctor at Spokane OB/GYN or contact Nikki Strong, Registered Dietitian at:

email: nikkistrongfitness@gmail.com

phone: 509-389-1122

website: healthyandstrongnutrition.com

Facebook: facebook.com/healthyandstrongnutrition


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Why Do I Feel This Way? Baby Blues and Postpartum Depression

By Shelley L. Northern, ARNP

You survived 9 long months of pregnancy, hours of labor and the birth, and now you are home and settling into your new life with your newborn baby.  Although this is typically a very special time in your life, it can also be emotionally challenging.  Approximately 70% of all new moms will experience symptoms of the baby blues in the first two weeks postpartum and 1 out of every 7 women will experience postpartum depression.

Baby blues is very common.  The symptoms are generally mild and typically come and go.  A woman with baby blues may feel tearful, insecure, vulnerable and moody.  Baby blues will resolve after a few weeks as your hormones level out and you begin to adjust to your new life with your baby.  Although it is no fun to feel this way, it is important to keep in mind that you have just been through a profound life experience both physically and emotionally.  If you are experiencing baby blues it is helpful to rest as much as you can, stay hydrated and nourished, and spend some time going for short walks outside with your partner or a friend.

Postpartum depression is different than the baby blues.  The symptoms of postpartum depression may start any point during the first year after the baby’s birth and last for several months if left untreated.  Women who have postpartum depression may feel sad, disconnected from their family and their baby, have difficulty concentrating, have a disrupted sleep routine and a change in their appetite as well.  In more severe cases, a woman may have thoughts of hurting herself or her baby.

Postpartum depression is a serious condition and requires medical help.  If you think that you could be struggling with postpartum depression, please make an appointment to talk with your care provider so that they can help you to start to feel better. Spokane OB GYN is here to listen and to help you get the care that you need to feel better soon.  Just call either the down town clinic at 838-4211 or 928-2866 at our Valley location.  We want to help.

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Welcome Eric M. Tyler, MD!

Dr. Tyler is from a small town in northern Arizona. He graduated from Arizona State University. He then went on to complete both his medical school and residency at the University of Iowa. He is making his home in Spokane with his wife and 5 year old daughter, with one more Tyler girl on the way soon. He is a member of the Army National Guard. He enjoys spending time with his family, as well as participating in various sports and recreational activities.

Dr. Tyler has a broad range of interests including minimally invasive surgery, high risk obstetrics, and office procedures. He is very invested in medical student and resident education. He is looking forward to laying down roots in the Spokane community and having the opportunity to care for the wonderful families that are a part of it.

Spokane OBGYN is excited to welcome Eric to our team!

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Frequently Asked Questions about Zika and Pregnancy

Author: Dr. Reuter

What is Zika virus and how do you catch it?

Zika virus is a mosquito transmitted virus that usually causes a mild illness.

Zika virus is transmitted primarily through the bite of mosquitos; specifically by the species Aedes aegypti mosquitoes.  Theses mosquitos are aggressive daytime bitters that are found in many parts of the world in warm climates.  These mosquitos have not been found in the Pacific Northwest.  The only recorded infections in a climate that is similar to the Northwest has only been identified in return travelers.

Other routes of transmission include perinatal (passing the disease from mother to baby) and sexual transmission.  However, it is unknown at this time if either a male or female that is asymptomatic can transmit the virus to their partner(s).

What affect does Zika virus have on a pregnancy?

In April of 2016, the CDC reported that the virus can have significant affects to an unborn fetus.  Most notably these affects include microcephaly (small head), absent or poorly developed brain structures, defects of the eye and impaired/abnormal growth.  Pregnant women can be infected with Zika virus in any trimester, but there is no evidence to suggest that pregnant women are more susceptible or likely to get the virus.

How can I protect myself from getting the Zika virus?

Because there is neither a vaccine nor preventive medications available to prevent Zika virus infection, the CDC recommends that all pregnant women (or those planning to become pregnant) consider postponing travel to areas where the Zika virus transmission is ongoing.

Can Zika virus be treated?

No specific antiviral treatment is available for the Zika virus disease.  Treatment is generally supportive and should include rest, fluids, and use of pain and fever reducing medications (Tylenol).

What should I do if I think I have Zika virus and I am pregnant?

Most people, greater than 80% of persons affected by the virus, are asymptomatic.  The symptoms are usually mild and characterized by acute onset of fever, bumpy skin rash, arthralgia and myalgia (sore joints and muscles), conjunctivitis (itchy and inflamed eyes).  Symptoms usually last from several days to one week.  Several other viruses and illnesses can present in a similar fashion so these symptoms are not conclusive for Zika.

If you think you have Zika virus infection you should talk with your doctor and consider being tested.

For symptomatic patients, testing is recommended within 2-12 weeks of travel and is prioritized to travelers returning from affected areas.  There is no commercial or over-the-counter testing available for the Zika virus.  The only test available is through the Centers for Disease Control (CDC).  But, local physicians can order and arrange for the testing if appropriate.

Can you screen for Zika virus in pregnancy?

At this time, it is not recommended to screen  for Zika virus in asymptomatic pregnant women in the setting of a healthy pregnancy.

Additional information and updates can be found online at: http://wwwnc.cdc.gov/travel/notices/