Reproductive Health Center, Tucson, Arizona

Hutchison’s Huddle: Managing Stress

It is a stressful time for everyone. You’re worried about getting stick. You’re concerned about family members. You’re bombarded with media stories daily. Working from home, homeschooling your kids, the list goes on. It’s ok to feel overwhelmed and stressed about it all. But being able to manage that stress is important, especially if you are pregnant or trying to conceive.

On this special Hutchison’s Huddle, Dr. Scot Hutchison was joined by Dr. Carmel Bellacose, an OB/GYN Generalist at Banner UMC. They offer tips to help you manage stress during the COVID-19 pandemic, as well as general tips to help patients reduce their stress when pregnant or preparing for fertility treatments.

Watch the full video below or on Facebook. 

Hi this is Dr. Scott Hutchison here in Tucson, Arizona for another Hutchison’s Huddle. And with us tonight is a great OB/GYN generalist at Banner UMC named Dr. Carmel Bellacose. And so she does general practice OB/GYN and takes care of pregnant people. I thought it would be very nice to hear her perspectives on a lot of our topic here tonight which is managing stress and stress and fertility treatment during COVID-19. So, let me welcome Dr. Bellacose.

Thank you for having me.

Yeah, it’s so nice to not be wearing a mask all day. Isn’t it?

So nice. 

Yeah, we’ve been all masked up all day and, you know, your face gets pretty wet under those things. But anyway, um, so we have a few questions that people have asked, who have sent in and then, but I figured–you know, Carmel, why don’t you talk about some of the things that you’ve heard from patients that are worries of theirs once they are pregnant? What have you heard about this whole COVID thing? Like what are they worried about?

So I think one of the things is just there’s so much unknown and it’s really hard for them to kind of plan out pregnancy with things that might occur because we just don’t know some of the things that might happen. But I think just because they get pregnant, there’s that thought of what if I get sick, what will happen to me, what about the baby? And then things just look different as well during prenatal care to the office visits are different. Baby Shower might not be the same. Delivery is definitely different. We have it limited now to just one one person that is allowed at the hospital with them while they’re laboring. And then I think afterwards too, there’s all these firsts that people have planned with their babies and those things don’t look the same either: introducing their baby to grandparents or whatever. It’s all different and unknown and it’s hard to plan.

Yeah. And you know, the stressors I think are real. It’s a weird disease. It may not be as bad as  we were thinking a month or two ago, but still a lot of our friends and family, we will lose and that’s always going to be a worry. People have lost a lot of jobs and lost income. And so there’s a lot of–I hear from my patients, you know, am I going to be able to afford to have a baby? Because on the other end of it, having a baby, it’s pretty expensive. So, I sure hope we go to kind of national childcare relatively soon, I hope that maybe this spurs that along, because that certainly would help a lot of people with their planning for being able to have family. 

But yeah, you know, let’s talk about some of these questions. One person says, Does stress have an impact on fertility? And the answer to that actually is, yes, it does, but we can’t really quantify how much. I think you’ve heard me talk about Mind-Body programs and the patients who complete Mind-Body programs tend to have about a 50% improvement in pregnancy rate with IVF which is really pretty cool. Carmel, do you see? And by the way this Dr. Bellacose, here it just says Carmel Bellacose, but she’s got her MD. But what do you see? Do you think stress during pregnancy makes management of the pregnancy harder–management of blood sugars or anything like that? Do we have any data on that?

So there have been some studies that have shown some of these diseases during pregnancy can be related to some of these other things, possibly stress, things like preeclampsia, and gestational diabetes, and some of these other things. Obviously, it’s all very multifactorial, so we can’t say it’s only stress, but it’s kind of a piece of the whole puzzle of being well.

Yeah, absolutely. So, another patient writes in, can stress have an impact on my cycle regularity, truth or myth? Well, that’s true. You know, the most stark example of that is hypothalamic dysfunction, which commonly was called stress related amenorrhea or athletes amenorrhea. And, certainly just, you know, you put enough stress into the picture and especially coupled with starvation, and you can certainly alter someone’s ability to make pituitary gland hormones that will allow them to ovulate. On the other end of it if you stress somebody so badly that they’re eating improperly–and I’ve talked about this on these Huddles with my own inability to self regulate with regard to junk food–but, you know, if people are then going big into a lot of junk food, a lot of sugars, and then they gain a lot of weight, they may drift into polycystic ovary syndrome, which is sort of the other end of it, of not ovulating. So again, another whooping dose of badness from stress. 

So, another patient writes in, I’m stressing even more now that my fertility treatments are on pause, what can I do to improve fertility while I wait for my treatments to start back up? So, I think you know, we’ve talked about this. Certainly,here in Tucson, we have decided to let people pursue fertility treatment as they wish as long as they know the potential risks of the COVID virus for them and the baby and potentially for the chaos in the hospital that may follow even with delivery. But if you’re in a place where they’re not letting you try to do fertility treatment for right now, I would recommend that you take as good care of yourself. Get ready to get pregnant right now. So we’ve talked about it, like eating a Mediterranean diet; getting a lot of sleep; getting some moderate exercise, or even vigorous exercise if you have polycystic ovary syndrome; taking the Coenzyme Q10, 100 milligrams, twice a day; taking the vitamin D 2000 a day, and your prenatals. You want to definitely keep taking prenatals and you don’t want to drink alcohol, smoke pot, use CBD oil, any of these things that potentially could be toxins for eggs or sperm. And that applies to the guys as well. So there’s a question, Dr. Bellacose. What are some ways to mitigate stress? What do you tell patients about that?

So I think finding an activity that you enjoy and doing that regularly some kind of exercise every day moving your body, whether it’s yoga or going for walks or a hike or just something–being outside is a great stress reliever for me. And I think I feel better when I eat well, that is a huge thing as well. So the Mediterranean diet, just staying away from the sugars and starches, obviously is a big part of that too. And I think too, this is a weird, weird time but you get a little more time with your family. I think that it can be a little bit of a blessing to having more time with some of the people that at least live in your house is a really nice thing.

Yeah, I agree. Yeah, Dr. Bellacose and I were talking earlier you know that in a lot of places, people’s commutes are super long here in Tucson. They typically are–what would you say the average commute here in Tucson is?

Still probably can be 20 or 30 minutes!

Yeah, that’s what I would say. Yeah, my feeling with that is if you’re stuck working from home, and again, maybe we shouldn’t call it being stuck, but just you know, If you’re able to work from home, then I would consider those commute minutes that you have, those are yours. Those are not your employers. So if you have a 30 minute commute or if you’re back, and you’re in LA or something, and you have an hour commute each way, and you’ve got two hours a day to yourself. And I would recommend that you learn some new thing like Dr. Bellacose is saying here. You know, for me, I decided I’m going to learn a lot about Native American history from here in this part of the country because I feel like I was sorely deficient in my education. So I’ve been doing that. And yeah, so kind of look at the bright side of it and make use of that. Yeah, so there’s a question on here, do you have suggested yoga practices that help mitigate stress? Dr. Bellacose, do you do yoga at all?

I do and I don’t know that there’s like particular yoga poses that are better for stress. I think it’s just kind of that time that you’re spending on yourself and moving your body and just kind of focusing on what you’re doing rather than focusing on whatever else was going on throughout the day. That is probably better for stress than any particular moves–although the corpse pose is great for stress relief!

That’s where you’re just lying flat, right?


Yeah, I don’t know. I have a very intelligent and moderately-to-severely competitive spouse and so she loves doing yoga and trying to do it like as good as the instructor and all that kind of stuff and the bar on that is way too high for me. So I don’t even bother trying to do that. But I definitely would confirm that I think that the exercise is very important. Humans are really meant to move a lot. And recently it’s come out that even sedentary behavior itself is a big risk factor for Alzheimer’s disease and probably a lot of that is because humans, we’re originally were living in these tribal, nomadic bands and you had to get remember things and a lot of it kind of coupled with motion and geography, supposedly. So we may be really tuned to exercise to have the best mental function as possible. And certainly, I think that most people who will tell you who have been in some kind of academic program will tell you, you really will do better if you’re exercising along the way. What do you think about meditation? There’s a question about meditation. I mean, that kind of fits into the yoga doesn’t it to a degree?

I love it. I have a hard time with it. I have a hard time focusing. I think there’s a couple great apps I have been using recently like Headspace, Calm, apps like that kind of guide you through meditation. And I find that a little bit easier. Because I’m pretty scattered. It’s hard for me to just clear my mind and be quiet.

Yeah, me too. I can’t. I don’t try very much. I do think it’s really important to immerse yourself in something that takes your mind off of it. And I think that the fancy word for that, that the psychologists have is called limerence. And, you know, it’s one of the reasons I like fly fishing. Because you can’t do anything else. You can’t think about anything else while you’re doing it. It’s fairly taxing mentally to do that, mentally and a little bit physically. So yeah, so you said the apps are Calm–

And then there’s another one called headspace. I’ve really only been using them for the last couple of months, but I really enjoy them. There’s one for sleeping–so there’s a few that are kind of guided sleeping meditations. So you can do them right before bed. If you’re having a hard time getting to sleep. They pretty much put me right out. So I think but yeah, I highly recommend those.

Cool, you know, picking up on that–on the sleep. I think all of us have had some trouble with sleep at some point, or most people, one of the big bugaboos and certainly it was true for me personally is sleep hygiene I think is really, really important. So I would strongly recommend that you not have any screen time for a couple hours before bed, that you set your phone to that yellowish tinge or whatever it is the, no TV in bed, no reading in bed–that got me into trouble because what you’re doing is you’re training yourself to be awake and alert in this place that should that you should just be programmed to just get into and fall right asleep and so I’m big fan of that. So people should just sleep and be intimate in bed and that’s just it. That there’s no other work or anything else. And what do you think about social media, Dr. Bellacose? Like, I think a lot of toxicity with it, personally, like I don’t do any of that stuff. Stuff like Facebook because it, like, hurts my feelings reading some of these posts, like what do you think?

Well I have a little bit of an addiction to Instagram, but yeah it is. I feel like it’s kind of one of those things where if you’re noticing that you are not feeling good when you’re on certain websites, it’s probably time to cut some of those websites out and see how you feel. Just take a little break from those. They are a big time suck, too. That’s the other thing!

Oh yeah! So if you’re trying to, in this slack time, where you might be able to learn how to make kimchi or sauerkraut or if you’re trying–if you say I’m going to have this lofty goal where I’m going to learn how to make sourdough bread or learn to cook Beef Wellington or something like that, then it’s gonna sitting there just scrolling through an endless feed is not going to be your friend. I also think that for our you know, that like with Instagram, like nobody posts like, bad stuff, right? Like, they’re curating everything, right? And then people who get pregnant post all these beautiful pictures of themselves when they’re pregnant on there and if you’re trying to get pregnant, I think that’s kind of very hurtful. I don’t know. I would be kind of careful with social media, personally. 

Somebody asked what tips do you have for reducing stress during fertility treatments? And I think all of the above, again, the good eating, exercise, good sleep. Another thing that I always tell people is, and we heard this recently from a patient of ours who’s a counselor, and she has some really good advice for her patients, which is just get through today. You know, if you can get through today, then you can get on tomorrow, but just get through today, because a lot of these things are up in the air. And when you’re going through a fertility treatment cycle, you know, you don’t have a lot of control over it. We have some control over it, but not a phenomenal amount. I mean, there’s still a lot that we don’t understand and that that we can’t control and so I think that what I would encourage people to do is just say, you know, I’m just going to try to do the best that I can. And what do you think about that Dr. Bellacose?

I think  that’s a perfect attitude to have. I had not heard that before, that get through today. attitude, but I do really like that because it really is all you can do.

Yeah. I mean, we all have to plan. Yeah, you do have to plan like, you know, you can’t just sit there and smoke pot all day and then go okay, I’m ready to get pregnant or whatever, but I do think especially when things are super stressful and you’re hearing about people, you know, getting sick and you’re worried about your parents or whatever that try to just say, you know what, I’m going to just get through today. I think that that’s a good plan. 

Someone writes, my partner and I respond to stress differently. Any tips on how we can help support each other? What do you think about that?

I think that’s a really common thing. It’s probably more rare for you and your partner to be perfectly in sync on all of these things. And I am by no means a marriage expert. We’ve been married now for nine years, we have ups and downs and whatever. But I think one big thing that we have found is just being very communicative about these things [including stress]. So even though my husband and I are very different with how we respond to things, if I am able to say, this is what’s going on, and this is what I’m feeling, I feel a lot more supported, because then he understands what’s going on with me rather than me just assuming or hoping that he will be able to support me. And I know it doesn’t feel quite as Hallmark movie when you have to tell your partner what you need from them and they don’t just come in and sweep you off your feet and know deep down what you wanted. But it really does make a difference.

Yeah, I totally agree with that. Yeah. We’ve been married for 31 years and coming up on 32, I guess! And you know, it’s one of those things where, over time, you pick up people’s subtle cues that they’re unhappy with you. And my spouse is fairly, very non-confrontational, but you know, so, but I’ve picked up when she’s unhappy with me. And I know now to ask more, I try to be a little bit better about getting out ahead of it, rather than letting the potential anger build up, which is not good. Yeah, it’s interesting, and then you’re stuck in the house with him all day, for example, for the people who can work from home all the time, and so like division of labor, becomes a thing where I think that needs to be kind of discussed as well. You know, historically, we’ve been pretty busy and we have this fantastic woman who helps us clean. So we felt like since we would be exposed at work and coming home, that probably it would be better for her not to come over to our house, so we just we send her a check every month, but the house has gotten dirtier and dirtier and dirtier and we were kind of like, we need to clean! It’s been like six weeks! Since the kids are out house, it’s just us, it’s sort of getting a little sketchy in the house but it’s you know, it’s not like I’m a super clean freak and then she’s just sitting around you know, eating Cheetos or something and getting them on the rug or whatever. But yeah, it’s an interesting deal. 

Oh, there’s a thing in here, somebody says I hear often, “just relax and get pregnant.” What would be a good educational response to this comment? What would you say?

That’s a hard one! I feel like anytime people give you this kind of unwelcome advice, it’s a hard thing. It’s obviously coming from a place of support. But obviously, it’s something that does not understand and hasn’t gone through what you’re going through. And I am also not very confrontational. So for me, I don’t have a good response. I will probably just smile and nod like I do in those situations. I don’t have a good response for that.

Yeah, I don’t know that I do either. All I know is that like, I don’t think I try to not ever say the word relax, even to patients, because I know that when people say relax to me, like if I’m having some procedure, it makes me feel like I’m gonna get hurt. Yeah, it’s just is not a good word at all. Except in the confines of your when you get home and you’re going to unwind, but I think telling somebody relax, that–yeah, like you’re saying, they’re coming from a good place. And you have to remember that there’s so many people out there who, they got pregnant when they didn’t want to get pregnant and they didn’t have any fertility problems and so that, you know, for them, it took them unawares. And so, yeah, I remember when we were having trouble getting pregnant people saying that to us, and I just would look at them and think, you know, what are you? Are you out of your mind? It has nothing to do with the biology of this. Except, I guess if you’re overly stressed, it’s one thing but, you know, then they’ll also say, Oh, you know, you should relax by going and really getting drunk, because that’s how I got pregnant. Again, it’s a big difference! 

One thing I did want to say about the–going back to the meditation–because I’ve never liked any meditation, but I had a friend who was smoking a lot of pot every single day and was priding himself on being able to smoke a bowl and then really meditate hard and be really focused. It was really hilarious because then he got to know these other people who are really into meditation. They’re like, dude, you are so cheating! You cannot you can’t smoke a bowl and then meditate, that’s cheating. Anyway, I thought that was hilarious–really defeating the purpose of the whole thing. 

But anyway, what other little things? I was thinking one of the things that like you were talking about having a routine. I think that’s very important to have, you know, being able to–if you do have regular hours, even if you’re working from home like that you work the certain hours in a certain space and then you get out of that space, just like with the sleep hygiene where you leave your bed alone for working, I think, like Dr. Bellacose and I are lucky enough to go to work, so to speak. And then when we come home, we’re like, off-duty kind of. It’s sort of a different deal. We’re not in the office anymore, but I really think that I would encourage you if you’re working from a laptop at home, do that in one specific place. We were talking with our daughter and she’s an attorney back in DC and so she was she was saying that she created–she was a really small place–and so she created this little cubby where that’s where she does all of her work and and then when the day is done, then it’s then computer gets shut and she moves into a different part of her life. Also little things like that you do with your hands that can also be kind of occupied, I think are important. Knitting or crocheting, if you like that stuff might be good. I’m sort of on the Autism sort of spectrum, so I have taken to cleaning and manicuring my fingernails every night while I listen to my wife, while we talk about the day’s events, and for some reason, that is like very oddly soothing to me. So anyway, but any other tips or anything for that?

I don’t, I guess like, kind of off of that subject a little bit is one of the things that we had talked about earlier is how, if there are some good things that come out of this for you, take advantage of that. I think for some people that extra time with family is great, there’s maybe extra time with a partner that involves more intercourse, there are more homemade meals, there’s maybe more time to exercise like there’s– It obviously is very stressful for a lot of people, but I think just taking is taking that step back to realize that maybe there are a few extra good things that do come from this can help you kind of take it that day by day sort of attitude.

I yeah, I concur. Yeah, and I guess if you’re about ready to jump out of your skin, I think professional counseling is probably a good idea, too. I heard a thing from the stats from the VA that their numbers of Televisit or Audio Visit consults with their psychology and psychiatry patients had gone up like five times,  from like 40,000 a day to like 250,000 a day or something. I mean, it’s huge! So the psychologists and psychiatrists out there I think are very willing and able to to help you with the Televisit stuff. You know, most of the psychiatrists aren’t going to touch anyway. So I mean, heck, you might as well do that! 

Anything else you can think of? Pets are sometimes helpful!

Yeah. We’ve been signed up to foster foster animals during this time, which is fun and lets us feel like we’re doing good things. We get a little extra cuddles and get some extra walks in and that’s great for a whole family, too

Yeah, yeah. It is really interesting. Yeah, there’s many, many studies I think out there that having a pet that you like, will reduce your blood pressure just looking at them for example or giving them pats or whatever. Yeah, I know it’s kind of fun when I’m working from home on the computer and doing consults, our old dog will kind of burst into the room make me give her pats and it’s at least good for me!

Well, cool. Well, thank you all for joining us. Thank you, especially to Dr. Carmel Bellacose here who is a Generalist OB/GYN at Banner-UMC here in Tucson, Arizona. So, if you need a good generalist or a good OB, I would strongly recommend you to call there and it’s 694-6010. 

A patient says thank you, and thank you for paying attention to it as we yammer on, but feel free to check out some of our other Huddles because I think a lot of them are very informative for topics like endometriosis or polycystic ovary syndrome, hypothalamic dysfunction, you can go check that out on our Facebook page or whatever. And yeah, and then if you have questions that come up later, feel free to give us a call or post them on here and we will answer those for you on another Huddle. Thank you all! Thank you all for joining and Dr. Bellacose, see you tomorrow!

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