Blood clots are sneaky, deadly and unfortunately occur more frequently in pregnant women – especially after they have had a baby. In a non-pregnant woman, blood clots are good because they keep us from bleeding to death after we cut our finger or scrape our knees. However during pregnancy, the body produces many blood clots (a condition known as hypercoaguability) which increase the risk of having a stroke, blood clots in the leg (deep venous thrombosis, aka DVT) which could travel to the lungs and cause death. Pregnant women are five times more likely to develop a blood clot than a non-pregnant woman and there is a greater chance that this will occur after the baby is born as opposed to before.
Who is at risk for developing blood clots during pregnancy?
• Women who are born with genetic disorders that increase the risk of blood clots (known as thrombophilia)
• Women who have had greater than 5 children
• Women who have c/sections
• Women who smoke
• Women who are obese
• Women who have had a previous blood clot
• Women who have had injuries that require them to wear a cast while pregnant
• Women who have cancer
• Women who are greater than age 30
A recent article in The New England Journal of Medicine had shed new light on this problem. It was known that pregnant women have an increased chance of having a blood clot for approximately six weeks after delivering a baby. However, a medical study of over 1.6 million women demonstrated that an increased risk of developing a blood clot can occur up to 12 weeks after the baby is born rather than six weeks. The greater risk for developing a blood clot occurs at approximately 3 weeks after having a baby but that risk might continue up until 12 weeks.
Based on this new knowledge, post partum patients at risk for blood clots must wear compression stockings and take blood thinners for approximately 12 weeks as opposed to 6 weeks. Although you healthcare provider is aware of these new changes, you should too.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
Thank God for common sense. For once, the state of Florida has done something right and kept Ebony Wilkerson, (the 32 year old pregnant mom who drove her kids into the ocean) into a hospital where she rightfully belongs. Wilkerson is 7 months pregnant and certainly doesn’t need to be in a jail where the chances of her having a healthy baby are greatly diminished. Had it not been for good Samaritans who ran into the Atlantic Ocean and rescued Wilkerson, three innocent children and an unborn baby would have met an untimely demise.
What is it about our country that prevents us from recognizing mental illness when it smacks us dead in the face? The fact that Wilkerson was interviewed and released by law enforcement agents three hours before she drove into the ocean is troubling. Mental illness is a public health disease and yet it’s treated as an afterthought in a “too-busy-society” that focuses more on entertainers’ wardrobes and scandals as opposed to its citizens that need immediate attention and intervention.
Pregnancy can bring out the best in women but it can also provoke anxiety, depression, social isolation, rejection, substance abuse and changes in economic status. Pregnant women who have mental illness might be reluctant to take their medications, which only makes their illness worse. Or, they might become victims of domestic violence because of their partners’ lack of desire to have children.
Thank goodness we can learn from our mistakes. Unless law enforcement officers have mental health training, they need to bring patients to an Emergency Department for further evaluation whether they appear to be “normal” or not. Psychiatrists should be alerted before a patient signs out against medical advice (as in the case of Wilkerson) to determine whether the patient needs medication and a possible court ordered stay.
It’s tragic that no one (with the exception of her sister) believed Wilkerson had a mental health problem until she drove her car into the ocean. How many more families will suffer before we finally get it right?
Most women look forward to having a baby but no one wants to feel pain. In recent years, having a baby in a pool of water has become a popular trend because it allegedly reduces the need for pain meds and anesthesia however not so fast, says both obstetricians and pediatricians. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) have issued a formal opinion (Committee Opinion #594 April 2014) that does not support “immersion” (aka underwater) births because of its associated complications while a mother is pushing to deliver her baby. The “pushing” part of childbirth is also known as “second stage labor.”
Why is this important? Because there are presently 143 birthing centers in the U.S. that offer underwater births to pregnant women. In fact, 1% of all births in the United Kingdom are immersion. While some research claims that these births are safe, experts think otherwise and state that the number of women studied was too small to detect rare but potentially harmful outcomes.
While some women may experience a feeling of well being and control, decreased stress and less vaginal tears during an immersion birth, according to the Committee Opinion, there is no scientific evidence that an underwater or immersion birth helps the baby. In fact, there is evidence of increased complications such as
• increased infections to both the mother and newborn, especially after the membranes are ruptured (aka “water broke”)
• difficulty in regulated the newborn’s temperature
• increased risk of the umbilical cord tearing from the placenta
• infant drowning and near drowning
• infant seizures and suffocation
• severe infant breathing problems
Should women give up immersion births completely? Probably not. The experts think that a woman may stay in these tubs during labor but should NOT push or deliver the baby underwater. They also recommend stricter protocols, patient selection and infection control.
If you like what you’ve read, please subscribe to the blog, like me on Facebook, or follow me on Twitter Yourobgyn@twitter.com.
The three children (ages 3, 9 and 10) and the unborn baby of Ebony Wilkerson are lucky to be alive, despite the fact that she drove her van into the frigid Atlantic Ocean. Two hours prior to this horrific event, the Daytona Police interviewed her, deemed that she was sane and left. The day before, a local hospital kept her overnight for mental health observation for 24 hours and then sent her home. If I were the sister of Ebony Wilkerson, I’d speed-dial liability attorneys and then immediately request Wilkerson’s medical records because obviously someone dropped the proverbial ball.
Wilkerson’s sister knew something wasn’t right because Wilkerson exhibited paranoia and kept discussing Jesus and demons that she felt were controlling her. She had fled South Carolina because she believed that her ex-husband was attempting to kill her. Eerily, Wilkerson is from the same state where Susan Smith drove her children into the ocean 20 years ago and blamed the crime on an unknown man. Unlike Smith, whose children died; Wilkerson and her three children were gratefully rescued by a heroic group of men who selflessly plunged into the water to save them.
Kudos goes to Wilkerson’s sister who had the wisdom to call law enforcement and report her sister’s bizarre behavior and hide her car keys. Unfortunately Wilkerson had another set of keys. What’s troubling about this case is how Wilkerson was able to sign herself out of the hospital and how she fooled the police to thinking that she was sane which meant that didn’t have to “Baker Act” her or commit her to the hospital . I find it hard to believe that Wilkerson could walk out of a hospital after seeing a psychiatrist which leads me to speculate that perhaps the hospital didn’t have a psychiatrist on duty at the time.
Law enforcement officers are not trained mental health specialists. In the future, when they are called for a suspected mental health issue, a better approach might be to take the individual to the hospital, despite the appearance of a person’s “calm demeanor” and let the experts make or rule out the diagnosis of mental illness.
Mental illness is not a joke, America. It claims innocent lives every day.
If you start prenatal care early enough (in the 1st trimester), you will inevitably have to decide on whether you want to be tested for potential genetic problem such as Down syndrome (aka Trisomy 21) or other life-threatening genetic conditions. Terms such as non-invasive prenatal tests (aka NIPS), Integrative Screens and Alpha-Maternal Serum Testing will be hurled at you along with very specific time tables for getting these tests done. Ideally, you should receive extensive counseling so that you may make an informed decision but quite often this is not the case.
Knowing the difference between screening and diagnostic tests is a great way to begin your decision-making process. A screening test identifies potential problems and requires additional testing. A diagnostic test provides a definite answer. Diagnostic tests in the first trimester include chorionic villi sampling (aka CVS) and amniocentesis is usually done in the second trimester. Both of these tests are invasive and carry a small risk for miscarriages. Risk factors such as advanced maternal age (meaning greater than 35) also affect a pregnant woman’s decision because the risk for Down syndrome increases with age. The risk of having any type of genetic disorder is 1 in 190 for women age 35 and 1 in 65 for women age 40.
NIPS have gained in popularity over the past decade because they have a less than 2% false positive rate for detecting Down syndrome by the 10th week of pregnancy but this rate increases slightly for other lethal genetic problems such as trisomy 13 and 18. They work by measuring the amount of fetal DNA found in the mothers’ blood stream. This test does NOT test for open neural tube defects such as Spina Bifida.
The integrative screening test is also done in the first trimester by measuring four pregnancy hormones in the mother’s blood and requires an early ultrasound to measure the baby’s neck (aka “nuchal test”) to rule out Down syndrome and has a false positive rate of approximately 5%. It also requires a second trimester Maternal Serum Alpha Fetal Protein test to rule out open neural tube defects.
The NIPS tests are not cheap, require insurance coverage and costs between $800 to $2700. They also cannot determine future heart problems, whether you’re having twins or other fetal abnormalities. But again, they are the most accurate test regarding screening for Down syndrome.
Questions, comments or suggestions? Please contact me at http://www.smartmothersguide.com, like me at https://www.facebook.com/SmartMothersGuide, or follow me on Twitter Yourobgyn@Twitter.com
Acetaminophen (the generic brand of Tylenol) is one of the most prescribed drugs for pregnant women around the globe to treat fevers and mild pain. It was thought to be safe but now researchers in Denmark have just disrupted the obstetrical community by suggesting that there is an association between taking acetaminophen during pregnancy and hyperactive children who are diagnosed with attention-deficit/hyperactivity disorder.
This is a profound disappointment to most prenatal care providers whose options are limited in what they can prescribe to pregnant women, especially for a fever. It appears that acetaminophen breaks up hormones and according to the researchers, “abnormal hormonal exposures in pregnancy may influence fetal brain development.”
Although the study reports investigating over 62,000 children, a word of caution must be exercised before making the assumption that acetaminophen is not safe for pregnant women. Remember that in this study:
• There was a stronger association between ADHD and acetaminophen if the mother took it for more than one trimester
• The researchers do not know exactly how many pills the pregnant mothers took
• The risks were greater for pregnant women who took large amounts of acetaminophen throughout their pregnancy
• They do not know if pain is associated with an increased risk of developing ADHD
According to the director of the Maternal-Fetal Medicine program at the Cleveland Clinic, it is important to remember that an association of acetaminophen and ADHD is not the same thing as saying acetaminophen causes ADHD and for that reason, he will continue to provide acetaminophen to his pregnant patients advising them to take it in the manner in which it is prescribed.
The take-home message is that most physicians are not going to change their prescribing patterns based on this study. Please consult with your physician or midwife before taking acetaminophen and only take them as prescribed.
Remember, a healthy pregnancy doesn’t just happen; it takes a smart mother who knows what to do. If you like what you read, please like me on Facebook at https://www.facebook.com/SmartMothersGuide or Twitter, email@example.com
The American College of Obstetricians and Gynecologists and The Society for Maternal Fetal Medicine (aka high-risk obstetricians) have issued a new recommendation that is a game-changer in the manner that obstetrics is practiced: allow low-risk first-time pregnant moms more time in labor. This is assuming that the fetal tracing is normal and the mother does not have a fever, high blood pressure or a condition that could compromise her life or the life of her unborn baby. This recommendation is based on new evidence that demonstrates contradicts the old school Friedman Curve theory that active labor begins at 4 centimeters. It actually begins at 6 centimeters. This would be especially helpful to first-time teenage moms who might be forced to have future cesarean sections based on hospital rules and physician opinions if their first delivery was a cesarean section. The “once a C-section, always a C-Section” culture hits this particular group the hardest.
According to the new recommendations:
• Women should be allowed to push for at least two hours if they’ve given birth before, three hours if they are first-time mothers, and even longer in certain cases, such as when an epidural is used for pain relief.
• Vaginal delivery is the preferred option whenever possible and doctors should use techniques — forceps, for example — to assist with natural birth.
• Women should be advised to avoid excessive weight gain during pregnancy.
A word of caution should be offered about these recommendations: forceps deliveries are becoming a lost art and can cause more damage than good in the hands of an inexperienced provider and the “avoid excessive weight gain during pregnancy” is easier said than done for most women.
That being said, these new recommendations gives first-time pregnant women the right to step on the proverbial brakes, the next time someone wants to rush their delivery via a C-section.
If you like what you’re reading, please let me know via Twitter (Yourobgyn@Twitter.com) or Facebook (Smartmothersguide@facebook.com)