September 3, 2012
A Dog and a Baby, Part 2
A few years ago, I read a miraculous story about a stray dog that had saved the life of an abandoned baby in Kenya. The event occurred in May 2005 and it left such an indelible impression on me that I decided to not only include the story in The Smart Mother’s Guide to a Better Pregnancy, but a year later, I blogged about it. I was intrigued that a mother abandoned her baby but a dog miraculously saved it. Three years later, the story has resurfaced as a result of a picture that was published on Pinterest and the interest regarding the outcome of both the baby and the dog was humbling. Many readers asked what happened to the dog and someone was kind enough to send a link that answered the question.
For those not familiar with the story, a dog found an abandoned baby in Kenya on top of a garbage heap near a race track wrapped up in an old pair of shorts. The dog had given birth to her puppies and was looking for food. The dog picked up the baby, carried it across a busy street and returned the baby to its compound along with its puppies. Some children who live near the compound heard the baby cry, saw her along with the dog and then told their parents who called the police. Unfortunately, baby abandonment was quite common because of extreme poverty.
The baby girl was 2 days old and they weren’t sure if she was going to make it. She spent 3 weeks in the NICU and was adopted quickly because of her miraculous rescue made by the dog. The biological mother was never found.
The heroic dog’s puppies died but she had a happy ending. She was given the name Mkombozi which means Savior in Swahili and adopted by the Kenyan SPCA. She now occupies a space (including her bed) in their office, functions as the “canine ambassador” and is very good with children who visit from school on field trips.
As I’ve stated before, pregnancy is a time of miracles. Somewhere in Kenya, there’s a 7-year old girl living and breathing because of the humanity of a dog. Perhaps we should all take out our notebooks and take lessons.
For more information on Mkombozi, please click on this link:
http://www.dogheirs.com/tamara/posts/533-mkombozi-the-stray-dog-saved-the-life-of-a-newborn-baby
August 13, 2012
Does Fear Prolong Labor?
Journalist Nicholas Bakalar of the New York Times wrote an article that addressed a profound issue regarding pregnancy: Does Fear Make Labor Longer?
Over 2,000 pregnant women in Norway were given a questionnaire at 32 weeks to determine if they had a fear of labor. These women were then followed to determine how long they were in labor and according to the study, there was a 47 minute difference in the length of labor of 165 women who feared childbirth compared to those who don’t. Why is this important? It’s important because fear is something that we can control.
Three of the most empowering things a pregnant woman can do are request a tour of the labor room before she has a baby, take childbirth classes and request pain meds or an epidural if she experiences pain while in labor. When a pregnant woman is calm, the unborn baby is calm but if she’s writhing in pain, the adrenaline that she’s producing affects the baby and inevitably causes fetal distress. Prolonged fetal distress means emergency c. section.
One of my most memorable deliveries was as an intern during the late ‘80’s. Recording artist Anita Baker was very popular back then. I was astounded when a very “Yuppy” expectant father, pulled out a tape cassette and played Baker’s tape while his wife was in labor. He requested dim lights and held his wife’s hand as they listened to my favorite song, Sweet Love. Although I respected their privacy, I was never far from their room. His wife ultimately had a beautiful, uncomplicated delivery that left an indelible impression.
No, everyone doesn’t have to listen to Anita Baker while they’re in labor but they should do what makes them comfortable including receiving an epidural or pain meds if necessary. You don’t have to be stoic. Here’s a quote from The Smart Mother’s Guide to a Better Pregnancy that I’d like to leave you with: “The Force that moves the air within our lungs, the blood within our veins, is the same force that has created the life within your womb. The most important key to a healthy pregnancy is the consciousness that lies within. Your child will be shaped by your thoughts, your dreams, your values, your energy. You are the ship that will carry the baby to the shores of its preordained human experience. Please let the journey be smooth.”
You are smarter, stronger and more brilliant than you could ever imagine. Childbirth should not be feared. It should be celebrated.
July 30, 2012
Should a 36-week Pregnant Woman Compete in the Olympics?
Malaysian shooter Nur Suryani Mohamed Taibi’s participation in the Olympics makes me nervous but I can understand her dilemma. It’s not every day that a woman receives the opportunity participate in such a renowned event, especially if she 35-weeks pregnant. At 36 weeks, most healthcare providers would strongly advise against traveling by air because the change in the barometric pressure has the potential of causing premature rupture of membranes, or quite simply, the “water” to break. Certainly no one wants that to happen while flying at 32,000 feet in the sky. Taibi not only has to worry about traveling safely from Malaysia to London and back, but hopefully the noise from the gun shooting during her competition will not produce any undesired effects of her unborn child such as hearing loss.
Taibi represents a new generation of women who have crossed over into unchartered waters based on their performance of untraditional roles. Auto mechanics, airplane pilots and astronauts are just a few of the many new occupational roles that women have assumed. In the case of Taibi, it was her father who put a gun in her hand and introduced her to the firing range at the age of 15. Fourteen years later at the age of 29, she has qualified for the Olympics which is a phenomenal achievement and will represent her country.
Hopefully, Taibi won’t develop preterm labor as a result of the sheer stress of Olympic competition. She is creating history and the medical community needs to do research on her for the next 10 to 20 years to determine if her late-pregnancy Olympic participation has any negative effects on her baby’s future development and health.
We know that the fetal ear develops from 8 weeks gestation to 28 weeks and the most common cause of children’s hearing loss is caused by abnormal development followed by infection and trauma. More than 10% of children aged 6 to 19 years loss suffer noise-induced hearing loss in one or both ears in the U.S. according to medical studies.
Taibi says participating in the Olympics is a chance of a lifetime. If you were 36 weeks pregnant, would you compete on a shooting range in the 2012 Olympics?
I’d love to know what you think.
July 18, 2012
“Convenience” in not a Reason to do an “Early” Induction or C/Section
In Native American culture there is a premise that Nature thrives on order but it is man who creates the disorder. That thought came to mind last month when I presented yet another malpractice case for review with a panel of colleagues. A patient wanted to be induced at 39 weeks and inevitably had significant complications with a poor birth outcome. In my expert opinion, I suggested that the physician should have waited until the patient was 41 weeks before she attempted an induction and one of my colleagues thought that I was vehemently wrong. “She was full-term and entitled to an induction” he practically shouted in my ear. “That’s not the point,” I countered. There was no reason to do the induction except for physician and maternal convenience. I reminded him that most high-risks specialists will start fetal monitoring and nonstress tests (NSTs) at 40 weeks to document fetal well being and then induce labor at 41 weeks if it has not started spontaneously.
At 39 weeks, the cervix is usually thick which means it has to be softened with medication before Pitocin (the medicine that starts contractions) can be given. Anytime an induction goes beyond 48 hours, there is a strong possibility that it will end in a C-section. At 41 weeks, the cervix is usually soft and if an induction must be started, it has a much greater success rate for a vaginal delivery.
Very few physicians will allow a patient to deliver beyond 42 weeks because the baby gets too big and the placenta becomes old. An “old” placenta, aka “grade 3” means the baby could possibly receive inadequate oxygen and inevitably there will be meconium which is an internal bowel movement that sometimes indicates fetal distress.
According to the Bloomberg News, “Aetna has renegotiated maternity payments with 10 hospitals around the country so far, bringing rates for cesareans and vaginal births closer together.” This will inevitably decrease my colleagues’ checking accounts but please do not look for sympathy from me. The standards of medical care were written for a reason. Performing inductions of labor for the sake of “convenience” is certainly not one of them.
July 2, 2012
Do You Know How to Avoid a Homebirth Disaster?
A Maryland jury made history by awarding Enso Martinez and Rebecca Fielding $55 million dollars but there are no winners in this tragedy. Enso Martinez Jr. has irreversible brain damage and Johns Hopkins Hospital will spend resources that could be used for research for direct patient care, to defend their care of Fielding.
Home birth in the U.S. has increased by 20% in part, because of Ricki Lake’s documentary, The Business of Being Born. Women want to have their babies at home despite the admonishment and warnings from the American College of Obstetricians and Gynecologists. To all pregnant moms who want to have their babies at home, I get it. I truly do. You want a comfortable intimate environment to have what you deem is a “natural event” without “unnecessary intervention.” You want to be like the celebrities who have had successful home deliveries. But here’s the problem: your home is not equipped to deal with emergencies and they DO occur. Just ask celebrity mom Christine Turlington Burns, who experienced a postpartum hemorrhage and had to be rushed to the hospital in order to save her life. Obstetrics is a specialty of the unexpected. You MUST be prepared for emergencies.
Fielding entered Johns Hopkins Hospital because the baby was “stuck.” The midwife couldn’t deliver the baby because it was either too large or she couldn’t manage a shoulder dystocia. According a blogger, Dr. Amy Tuteur, Midwife Evelyn Muhlhan’s license was suspended by the State of Maryland because of five homebirth disasters including Fielding’s delivery.
An ambulance brought Fielding to a hospital where she allegedly waits for over 2 hours for blood test results. A c. section is delayed. A baby has brain damage. Take home message?
- Know your midwife’s professional record. Does she have malpractice suits? Has she been sanctioned by the state medical board for negligence?
- Meet your midwife’s ob-gyn back-up. The Smart Mother’s Guide to a Better Pregnancy discusses this in detail. At the first sign of trouble, Muhlhan should have contacted her ob backup. If she didn’t have one, she was begging for trouble.
- Have a PERSONAL copy of your prenatal chart with you and your back-up hospital or birthing center should have a copy as well. This is standard prenatal procedures. Having a homebirth doesn’t change that. Your prenatal record contains all of the important information including blood type and blood count. No one, I repeat NO ONE, is going to bring you into the operating room without knowing your blood type unless you are hemorrhaging to death. Had Fielding had a copy of her prenatal record, she might not have encountered the delay.
If you’re going to have a homebirth, then please take the necessary precautions. An ounce of prevention is always worth more than a pound of cure.
June 18, 2012
Why Pregnant Women Need to Know About MRSA
Photo credit: Public Health Image Library (PHIL)
A few years ago, a 20-something year old pregnant woman presented to her physician with complaints of a skin bump that was red and painful. She was told it was a spider bit and given antibiotics. The patient ultimately went in labor but required an emergency cesarean which went well without any complications. Four days later she developed skin lesions and 3 months later she expired after a very stormy hospital course. What did she die of? MRSA, which stands for Methicillin Resistant Staph Aureus.
Staph Aureus (Staph) is a bacteria that can be found on the skin and doesn’t usually cause problems as long as there are no breaks or cuts in the skin. However, if there are cuts and Staph gains entry into the skin, an infection can develop that if often not serious. However, Staph has a very dangerous form that is resistant to the medications that will normally treat it. The resistant form of Staph can cause havoc if unrecognized which can lead to several complications including death. In fact, 20% of people who have (MRSA) dies from this infection because the diagnosis is made too late. One of the most common complaints patients have when there is a MRSA infection is a bump or red lesion on the skin that is misdiagnosed as a spider bite. How do you avoid the misdiagnosis? By knowing who is at risk and what to look for.
MRSA tends to be found in places where there are many people living close to each other such as nursing homes, but of late, several cases are also associated with
- People who are either in a prison or an athletic facility.
- Athletes who share towels or razors
People who either work in prisons or visit relatives or friends incarcerated should always wash their hands after a visit.
If you are given a diagnosis of a “spider bite,” request that it be cultured, meaning a Q-tip is used to take a sample from the bump. Sometimes people can have the infection without having any symptoms. This is known as being a “carrier.” Again, if you are given the diagnosis of having a spider bite, ask that a culture be obtained from inside of your nose to make certain you don’t have MRSA.
MRSA can be treated appropriately with the right antibiotics. Medicines that are associated with Penicillin such as Amoxicillin and cephaplosporins will not work.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
April 11, 2012
What Pregnant Women Can Learn From a Cabbage
In the Native Americans culture it is said: “If you want to learn the lessons of life, please observe Nature.”
My oldest son brought home a cabbage seedling from school to enter in a contest. If his plant grew the largest, he would win a $1,000.00 scholarship. For the first 2 weeks he faithfully nurtured the plant but then his attention span decreased as basketball and track gained more prominence on his radar screen. His father felt sorry for the abandoned plant and sat it on top of soil in a larger pot so that it could receive some sunlight. The larger pot represented a burial ground of a deceased plant that had met its untimely demise due to unintended neglect.
A few weeks passed. We assumed the plant was dead. On a lazy Sunday afternoon a hint of spring was in the air as flowers blossomed. The sun shone brightly and my spouse stepped into the backyard to get some fresh air. A few minutes later, he beckoned my son to come outside in a voiced filled with excitement. The cabbage plant was miraculously resurrected. Although still confined to its original container it had somehow dug its way into the soil of the larger pot and was now firmly attached. It was thriving with large, thick green leaves and had a significant growth spurt. What a teachable moment. Ignoring the confines of its container, the cabbage plant sensed a window of opportunity in the form of fertile soil and literally – dug in. We cut away its first container to allow it to thrive even more.
Pregnant moms, a tree is known by the fruit that it bears. The seed within you has the potential to blossom into infinite possibilities if given the proper nourishment. When the challenges of life attempt to intimidate or discourage you be like the cabbage plant and ignore the external barriers. Deflect negativity. It cannot do you harm if you ignore it. Focus instead, on the potential within.
What can we learn from the cabbage plant? We learn that the will to live is far greater than any external challenge.
March 5, 2012
You’re Pregnant and Your Local Hospital Closed. Now What?
Today will be a day of mourning for pregnant women who are uninsured and receiving Medicaid in Houma, Louisiana. Their local hospital closed its maternity and neonatal units because of a $2.9 million dollar budget cut. Over 100 employees will lose their jobs, many whom have held their positions for over 20 years. This closing will have a ripple effect and is an increasing phenomenon that has besieged many hospitals across our nation. Over thirteen hospitals in Philadelphia closed their labor and delivery departments and in my own backyard, South Seminole Hospital in Florida did the same. What’s going on? Hospitals claim they’re losing money and government insured and non-insured pregnant women are feeling the aftermath. These are some very scary times.
The options for Houma’s uninsured pregnant women or women who receive Medicaid are quite limited. A few years ago, they could have gone to Lafayette Hospital in Lafayette; or Earl K. Long in Baton Rouge or Charity Hospital in New Orleans. Sadly, all of those hospitals have closed their labor and delivery department. I know those hospitals well, having worked and lived in Louisiana for almost four years as a community health physician.
Although Houma is a small, close-knit community, its hospital provided hundreds of prenatal visits for pregnant women in nearby parishes. They interacted like family. The nurses at Leonard J. Chabert Medical Center are devastated and apprehensive about the future of the pregnant women knowing that most cannot afford to go to private physicians and many have high risk problems. Consequently, many of these patients will be forced to travel over 300 miles on a 5-hour trip to Shreveport, Louisiana to receive prenatal care at its charity hospital.
I strongly encourage the State of Louisiana to brace itself for an increase in infant and perhaps even maternal deaths. Many high risk patients are simply not going to be able to make that 300-mile trek to Shreveport without adverse consequences. Any perceived benefit from that $2.5 million dollar budget cut will quickly dissipate based on the spike of NICU admissions that are sure to come.
The women and their unborn babies deserve better. Shame on the State of Louisiana.
February 23, 2012
Rick Santorum: Stop Using Pregnant Women as a Stepping Stone to the White House
A lie unchallenged becomes the truth. While I admire GOP candidate Rick Santorum’s decision to raise a special needs child, I certainly wish he would keep his political agendas out of my exam room. Yes, it takes love and courage to raise a child with Trisomy 18, a genetic disorder that’s associated with severe physical and mental challenges. However, this does not make Santorum an expert on prenatal tests and to say anything to the contrary, is both reckless and immoral.
Prenatal tests, especially those that tests for chromosomal abnormalities, are optional. A woman can decline the tests if she chooses to do so and I’ve had patients who have exercised that perogative in the past. But first, let me tell you why these genetic tests are so important. If a woman discovers that she has a baby with Trisomy 21, commonly known as Down’s syndrome, both she and her pediatrician will have time to prepare for possible complications. Many genetic disorders are associated with heart conditions and require immediate surgery after birth. There are instances where the baby is born with a pediatric cardiologist in the delivery room who then whisks the baby away to have a life-saving cardiac procedure. This cannot happen if you don’t have the prenatal test.
In my 25-year career as a physician, I’ve only had 2 confirmed cases of Trisomy 21 and both mothers decided to keep their pregnancies. However, please be aware that there are some genetic disorders that are incompatible with life and the baby expires shortly birth. Most mothers do not want to experience that type of emotional trauma.
Mr. Santorum, please stop using Women’s Health as a stepping stone to gain entrance into the White House. If you can’t campaign for President based on truth and merit, then perhaps you’re not cut out for the job.
January 30, 2012
What Every Pregnant Woman Should Know About Genetics
The story regarding Republican presidential candidate Rick Santorum’s daughter, brings the subject of genetics into the forefront. Santorum’s 3-year-old daughter, Bella, has Trisomy 18, which is an abnormal disorder where some cells do not contain 2 complete sets of 23 chromosomes. It is almost always fatal and most affected babies die at birth or shortly thereafter. Bella, by some schools of thought, might be considered a miracle.
The diagnosis of a genetic disorder such as Trisomy 18, usually begins with either a screening blood test such as quad screen, or a routine ultrasound after 17 to 18 weeks. The technician or physician might note a fetus that has a clenched fist or unusual feet called Rockerbottom feet. These signs are called the Edward’s syndrome. Other ultrasound findings that suggest genetic abnormalities include polyhydramnios or excessive amniotic fluid, a “double-bubble” sign indicating a condition called duodenal atresia that is associated with Down syndrome as well as heart problems. Also, most fetuses with Down syndrome also have congenital heart problems.
If a suspicious finding is detected on an ultrasound, the technician should report it to your physician immediately for further evaluation and consultation. These consultations should include a referral to a geneticist. The geneticist will take a complete family history from both you and the father of your baby and might suggest obtaining an amniocentesis procedure to obtain fetal cells for confirmation of the disorder. All amniocentesis procedures require written consent because there is a 1 percent risk of rupturing the membranes during the procedure. There are 2 schools of thought regarding genetic screening: one school says why bother? There’s nothing that can be done. The other says it is good to know in advance so that the mother can make critical decisions regarding the continuation of the pregnancy.
Genetic counselors can identify other potential problems such as hemophilia and color blindness which are called x-linked disorders. These conditions are carried on the genes of females but only expressed or affected by males.
Genetics is an evolving field that continues to play an important role in obstetrics and pediatrics. All pregnant women should be encouraged to fully utilize their services as needed.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
