Spokane OBGYN
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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.

Latest News

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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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