June 4, 2012
Thirteen Thousand Addicted Newborns
A New York Times and an American Med News article gave me reason to pause. Each year approximately 13,500 newborns are born addicted to prescription opiates.
Neonatal abstinence syndrome (NAS) occurs when babies who are born to opiate-addicted mothers who more than likely received their meds from a prescription. The number of pregnant women using opiate drugs has increased five-fold from 2000 to 2009.
The problem had become so rampant in Florida that state legislators finally took action after it became a national embarrassment. To the chagrin of the Florida governor, 1 in 7 people died from prescription drug overdoses and the state held the title as the pill-mill capital of the nation.
Now a law that requiring each opiate prescription be filed in a data base by the prescribing physician. There’s nothing like good old fashion documentation to put physicians in check.
During the 1980’s crack-cocaine addiction was rampant. Despite the socioeconomic stigma, addicted pregnant women willingly came forward requesting treatment in order to save their babies. Addiction was treated as a disease and the mothers received rehabilitation that included medically supervised withdrawal and psychiatric counseling.
Those days appear to be over. In Alabama and other states, pregnant women’s addictions are now criminalized making it extremely difficult for them to divulge their addiction or receive treatment. The consequences are severe. 31% of newborns born addicted to opiates have breathing problems, 18% have feeding problems and 2% have seizures.
Denial is a terrible disease. Despite significant problems, my medical colleagues are reluctant to address the issue and in some instances, they’re part of the problem. Doing a urine toxicology test takes time, especially if it’s positive. No one wants to call social service. Why? Because it’s a time-consuming and frustrating process that some physicians would rather avoid. And what are the consequences? 13,500 addicted newborns.
Unfortunately, the problem of NAS will continue until healthcare providers and policy leaders take a pro-active stance. Addiction is not a crime. It’s a disease. Throwing pregnant women in jail is not going to solve the problem and I blogged about that issue recently. How can we improve this problem?
- Provide mandatory universal urine toxicology tests for all pregnant mothers, whether in a public or private setting.
- Perform an immediate referral to social service if the urine toxicology test is returned positive
- Physicians should not prescribe a 30-day supply of pills for a 4-day problem. This is what causes unintended addictions
Should doctors who prescribe painkillers to pregnant women be liable if the mother becomes addicted? Please, weigh in.
May 30, 2012
Why is Preeclampsia Misdiagnosed?
Preeclampsia is a pregnancy condition that involves high blood pressure, swelling and protein in the urine. Risk factors for developing preeclampsia include:
- 1st Pregnancy
- Age; young teens and women over 35 are at greater risk
- Obesity
- History of diabetes
- History of hypertension
- Family history (mother, sister, aunt) of preeclampsia
The typical preeclamptic patient has a blood pressure of 140/90 or greater with protein in the urine and swollen ankles in the late 3rd trimester. She may often complain about a headache. This patient is fairly straightforward, but what happens if these symptoms present in a patient who is only 31 weeks? Or 27 weeks? Some healthcare providers will try to “buy time” and “treat the patient with bed rest or blood pressure meds” and she ends up having a seizure or a stroke. The only treatment for preeclampsia is delivery of the baby because it is the placenta that’s causing the problem. There’s something in the placenta that causes the blood vessels to squeeze and increase the blood pressure. Once the placenta is delivered, the blood pressure usually comes down but a woman can have preeclampsia and the risk of having a seizure for 96 hours after birth.
A patient may have a blood pressure of 120/80 with a measurement of 3+ protein in the urine. Her normal blood pressure is usually 90/60 and she has gained 5 pounds in one week. Yet her physician or midwife thinks this is normal. It’s not. They have been lulled into a false sense of security because her blood pressure is 120/80 and not 140/90. This patient should have her blood pressure repeated 2 more times within a 6 hour period and if it remains high, the diagnosis of preeclampsia is made. She should also have her urine collected for 24 hours to determine if there’s significant protein.
Why is preeclampsia often misdiagnosed? Because healthcare providers view the abnormal signs of pregnancy as “normal” variants. They’re not. A headache that doesn’t go away, a sudden increase in weight gain, swollen feet or ankles needs further evaluation as well as significant protein in the urine. If you think you have preeclampsia but your healthcare provider disagrees, by all means, call your insurance company and request a second opinion.
Remember, a healthy pregnancy doesn’t just happen it takes a smart mother who knows what to do.
May 28, 2012
Remembering my Soror Dawn: A Preeclampsia Victim
As a young girl growing up in a small Long Island town called Amityville, Memorial Day was a huge holiday filled with parades and barbeques. I would inevitably end up at my friend Diane’s backyard eating a hotdog along with the rest of the kids on our block. It was also a day when we made our annual trip to the cemetery to place American flags on the graves of veterans and flowers on the graves of the deceased. Well, today, in honor of both Memorial Day and Preeclampsia Awareness Week, I’d like to take time to remember all mothers and their babies who died during childbirth, especially from preeclampsia.
What is preeclampsia and why is it so deadly? Preeclampsia is a condition of pregnancy in which there is high blood pressure; swelling of the ankles, feet, or face; protein in the urine; and abnormal kidney function. This condition requires the delivery of the baby in order to preserve the mother’s life and prevent seizures and strokes. The old fashioned term for preeclampsia was toxemia and it affects 1 out of 12 pregnancies each year. Approximately 76,000 women die annually from this disease and most people know of at least someone that it has affected during pregnancy.
When I think about preeclampsia, a woman name Dawn Fleming comes to mind. Dawn was 31 years old, a member of my sorority, Delta Sigma Theta and a popular radio personality in Orlando. Although I did not know her personally, she was from my former hometown of Queens. She was gregarious, a community activist who died unexpectedly from a preeclampsia related stroke. She had recently married and delivered a baby girl 6 days before her untimely birth. Her daughter is now approximately 8 years old and will never know her mother. When I attended Dawn’s wake, I was both angry and sad. I suspected someone had inevitably missed the diagnosis and by the time she was given treatment, it was too late. Such is the case of the vast majority of preeclampsia victims. By the time a diagnosis is made, the damage is already done. In her book, You Have No Idea, celebrity Vanessa Williams and her mother, Helen, discusses preeclampsia as the reason for her paternal grandmother’s death.
In my next blog, I will describe the signs, symptoms and treatment for preeclampsia that is also described in The Smart Mother’s Guide to a Better Pregnancy. But in the meantime, I urge all of us to take a few moments to remember all the moms and babies who are no longer with us and pray that a cure for preeclampsia will one day be found.
May 23, 2012
Should All Pregnant Women be Tested for STDs?
While the topic of sexually transmitted diseases (STD) is not pleasant, it certainly is essential, especially for pregnant women. A recent medical study reports that only 59% of pregnant women are tested for Chlamydia and Gonorrhea. That is absurd. Both the Center for Disease Control (CDC) and the American Congress for Obstetrician/Gynecologists (ACOG) recommend that all pregnant women be screened for STDs during their first prenatal visit.
Untreated STDs can cause havoc during pregnancy. From preterm labor to newborn blindness, STDs are not a nice thing to have. But the good news is, they’re curable provided you know that you have one. One of my former patients complained about “breaking her water” although she was only 26 weeks pregnant. When I checked her, she did indeed rupture her membranes but also had an STD called Trichomonas which I ultimately treated. Had I not checked her, we would never have known about the premature rupture of membranes as well as the STD. The patient was sent to a specialty hospital where she remained for the next 11 weeks until she had her baby.
In our present healthcare climate, time equals money. The more patients a provider sees the more money he or she makes so there is the temptation to cut corners. Every pregnant woman should have an initial PAP smear at her first prenatal visit. Most PAP smears have the ability to detect cervical cancer as well as the Human Papilloma Virus (HPV) in addition to Trichomonas and Bacterial Vaginosis. Both of these infections need to be treated in order to reduce the risk of developing preterm labor and your partner needs to be treated for Trichomonas as well. If your partner is not treated and you have sex, consider yourself reinfected.
Unlike men, women rarely have symptoms so it is important to be tested for Chlamydia because if untreated, there is a risk of going blind. All pregnant women should be tested for Chlamydia and then retested after receiving treatment to make certain the infection is gone. The same principle holds true for Gonorrhea.
All foul-smelling vaginal discharges need to be checked by your provider. No exceptions. Some providers will not examine the patient but give her a prescription for a “yeast” infection. All vaginal discharges cannot be attributed to a yeast infection and needs further evaluation.
All pregnant women need to be tested for STDs, not a mere 59%. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
http://youtu.be/rySO6jqj0ik
May 21, 2012
Can You Recognize a Labor Room Dilemma?
I’ve just returned home after traveling over 1900 miles to attend my cousin’s baby shower and oh, what a joyous event. There was great food, laughter, a zillion gifts along with a spirit of generosity that revealed the power of true friendship. In the next 30 days my cousin will embark on a new journey called motherhood with all of its associated peaks and valleys. She clearly loves her baby and I want to make certain that she arrives safely.
My cousin appears to be receiving good prenatal care but I want to leave nothing to chance. When she is finally admitted in labor, I will be calling for updates and a status report. Why? Because obstetrics is a specialty that frequency involves the unexpected. I will inquire at least every two hours regarding her progress in labor. Is she dilating 1.2 centimeters every hour? And if not, are her contractions regular? If her contractions are not regular, and she’s less than 4 centimeters, will they encourage her to walk? If she’s more than 4 centimeters and having irregular contractions, will she receive Pitocin (a medicine that helps the uterus contract)? And if she receives Pitocin, is the baby tolerating it, meaning is the fetal heart rate between 120 to 160 beats per minute?
I will encourage my cousin to ask for pain medication because a pain-free mother progresses faster in labor than a woman writhing in pain. I will ask her about weight gain during the pregnancy not for embarrassment but because the answer has clinical significance. If she gained more than 40 pounds, it’s quite possible that the baby might be larger than expected, thus increasing the possibility of a shoulder dystocia. And if there is a shoulder dystocia, I hope the nursing staff will put my cousin’s knees to her chest and encourage her to push. I also hope her physician will be well versed in the maneuvers that are necessary to handle this type of emergency.
If the fetal tracing looks suspicious meaning, flat, or “U-shaped,” I hope the nurses will have the good sense to inform the physician immediately and not wait to the 11th hour. I also hope her hospital has 24-hour anesthesia coverage and a level 3 NICU. Lastly, I will emphasize to my cousin that a C. Section is not a failure. Iin the event of an emergency it could mean the difference between having a healthy baby or one who is brain damaged and physically disabled for the rest of its life.
Do you know how to handle a labor room dilemma? You will, if you read The Smart Mother’s Guide to a Better Pregnancy.A healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
May 14, 2012
Katie Moore Shares Tips on Taking Care of Newborns
In celebration of National Women’s Health Week and Pregnancy Awareness Month, we are pleased to introduce our Guest Blogger, Katie Moore. Katie Moore is an active writer within the blogging community who discusses maternity, motherhood, prenatal health, and childbirth. She loves being able to share her ideas with others, and while she enjoys writing, her real passion and full time job is being the best wife and mother she can be!
Welcoming a new baby is one of the most exciting times in a woman’s life. Upon meeting that special tiny person, your life will never be the same. Although you know life will be different, you may not be sure exactly how things will change. Here are some ways you may have to adjust, along with some tips for enjoying your first moments and days with a newborn.
Long labors are tiring, but nothing will re-energize you more than the feeling of finally having your newborn in your arms! So that you can give those first moments with your little one your undivided attention there are a few immediate postpartum decisions that should be made ahead of time. These include:
- Feeding method. Are you planning to breastfeed or bottle feed? It’s important to figure this out beforehand, especially if you feel strongly about nursing your baby. Babies are ready to nurse almost as soon as they are born, so knowing what you prefer is important.
- Cord blood banking. If you are planning to bank your baby’s cord blood, it needs to before before your baby’s birth. Cord blood banking is where the umbilical cord blood is collected after birth and stored for your family – to provide the unique benefit of being available as a potential medical resource, should the need arise in the future.
- Routine newborn procedures. Most hospitals routinely give babies routine tests and screenings as well as both erythromycin eye drops and a Vitamin K injection shortly after birth. Be sure to research these procedures and tests to be sure that you feel comfortable with them before you go into labor.
After you’ve gotten through the initial postpartum phase at the hospital, it’s time to take your baby home and adjust to caring of your baby without the help of ever-present nurses and doctors. Although every newborn is different, there are some common factors that tend to surprise most new parents. For instance, you may have heard that you lose a lot of sleep when you have a newborn. This is true, but it may shock you how much your baby sleeps during the first few days at home. Newborns need a high quantity of sleep, but do not always have quality sleep, as they have to eat and be diapered frequently.
So how do you best adjust to these changes? Sleep when baby sleeps, accept help from loved ones, and do not forget to eat! You should try to already have some healthy and quick meal options on hand. That way, you can feed yourself while you keep up with the frequent feeding needs of your sweet baby. Care for yourself during this special time!
May 9, 2012
Pregnant Woman Found Dead in a Tub with Stillborn. Was it Murder?
How can a pregnant woman be missing for more than 2 weeks and her husband not be a person of interest? Bibi Farruoq, a native of Guyana, South America and a U.S. citizen was a mother of four. She was a former real estte professional, loving soccer and stay-at-home mom according to her cousin. She was pregnant with her 5th child and was 41 years old. It’s not clear whether this was a planned pregnancy or if she had any prenatal complications. Certainly her advanced age would increase her risk factors but hopefully not to the point of death. Yet, Farrouq was found dead in her bathtub of her Pennsylvania vacation homes in the Poconos with a stillborn baby girl lying underneath her. She had been dead for at least 10 days although the exact time of death was indeterminate because of her severely decomposed body.
Her husband, Mohamed Farrouq was an interstate truck driver who was away from home at various times. The Farrouqs, like many New York City dwellers, lived in an apartment but owned a vacation home in the Poconos. Two weeks after his wife was missing, he brings their four children to their vacation home and discovers the bodies of his missing wife and unborn baby. I have many, many questions for both the husband and police department. Where was Mr. Farrouq during his wife’s 2-week absence and why did he not report her missing sooner or go to their vacation home when she went missing? Who took care of her four children during her absence and did anyone in her family not get suspicious that something was array?
Although the state police investigator doesn’t believe “there’s been foul play,” I am reminded of a folklore legend we heard during our residency training about a physician (more specifically, an anesthesiologist) who killed his wife using the paralyzing poison, Curare. He almost “got away with murder” but didn’t based on a toxicology report that the nurses insisted be done because of his alleged infidelity.
From 1990 to 2004, there were 1,367 pregnant women murdered. Studies show that physical abuse occurs in 7 to 20 percent of pregnant women, sometimes leading to death from homicide. Women with an unplanned pregnancy have a 3-fold higher risk of physical abuse than planned pregnancies. The toxicology reports on Farrouq are pending. A DNA test of mom, dad and stillborn might not be a bad idea either. This case certainly has more questions than answers.
May 7, 2012
Is He the Daddy? Now you’ll know at Eight Weeks
The subject of paternity has always been a source of controversy and brings to mind an old adage my late aunt used to say: “Mama’s baby. Daddy’s maybe.” Because 50 percent of pregnancies in the U.S. are unplanned, paternity becomes a huge issue when there are multiple partners involved.
What haven’t I seen as an obstetrician? There was the patient who wanted me to change her due date and induce her 2 months early to correspond with her male partner of choice, rather than the baby’s biological father. Of course, the answer was no. It’s also difficult to explain how two parents of one race can produce a baby of another. And then there’s always the pregnant teen whose boyfriend’s mother is demanding a paternity test.
In 2009, an article in the Sunday New York Times Magazine published a story that nearly brought me to tears. Ruth Padawer wrote a story about fathers who had been “duped” regarding their children’s paternity. Who Knew I was Not the Father, is a cautionary tale of men who raised children, paid child support only to discover that they are not the biological father. It was disheartening to read about the profound betrayal these men felt upon discovering the truth.
Traditionally, mothers and fathers would have to wait until after the birth of the baby to determine paternity or have an invasive procedure called an amniocentesis that took a sample of fluid around the baby and tested it against the father’s DNA. Now, things have changed, thanks to modern genetics and Ravinder Dhallan, MD, PhD, who discovered the test through his research. Although fetal cells are present in a mother’s blood, it was difficult to isolate them based on technical difficulties. Dhallan discovered that if he mixed the mother’s blood with a fixative, the fetal blood cells could be obtained. Therefore, rather than have an invasive test that runs the risk of causing a miscarriage or waiting until after the baby is born, the paternity of a baby can be established as early as 8 weeks gestation.
This new DNA tests is a game-changer. It allows women to make informed choices and empowers men to prove or disprove paternity much earlier in the pregnancy. Would you use this test if it were available? Please share your thoughts.
May 2, 2012
When Doctors Won’t Listen (Part 2)
In Part 1 of Monday’s blog, we learned about Angela Burgin Login, a first-time pregnant mom who was developing pre-eclampsia but the signs were ignored by her physician. Angela almost lost her life because the recognition of her diagnosis was delayed. While most pregnancies are uneventful, a “normal” pregnancy will not always mean a “normal” birth. Things can change quickly, especially in the labor room. In order to have a favorable outcome at the end of a pregnancy, the healthcare provider and the patient must be in total agreement regarding expectations and treatment. Sometimes that may not happen. The most important task of a pregnant mother is to select the right provider and Chapter 1 of The Smart Mother’s Guide to a Better Pregnancy addresses this issue in detail. What then should a patient do if her physician is not responsive to her concerns? Here are a few strategies:
- Ask that your concerns be documented in your chart and then ask to receive a copy of the chart. If your concerns are still present and not addressed to your satisfaction, call your insurance company, explain the situation and request approval to change providers.
- If for some reason, you are not able to change physicians or providers, contact your insurance company, explain yours concerns and dissatisfaction, then ask for approval to obtain a consultation with a high-risk specialist (aka maternal fetal medicine) so that he or she can evaluate your condition to make certain that it’s not high-risk
- If you are in labor and are not satisfied with your progress, have a family member or your support person request to speak to the nursing supervisor. When he or she arrives, inform them of your concerns and that you want it documented in your chart. Ask her who is the on-call or consulting maternal fetal medicine specialist and then request an in-house consultation. Simultaneously contact your insurance company, explain your concerns and ask for approval for the consultation advising them that if anything happens to you or your baby, they have been duly notified in advance. Also ask to speak to the hospital’s risk management office as well.
By implementing these strategies, you improve your chances of having a favorable outcome because you are formally documenting your concerns and holding people accountable for your patient care. Your proactive role will protect both you and your child.
Most physicians are compassionate, competent and caring. On rare occasion, you might unfortunately encounter one who needs to be “brought back down to Earth.” If that happens, you now know what to do.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
http://youtu.be/rySO6jqj0ik
