July 2, 2012
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.
May 28, 2012
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.
January 30, 2012
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.
December 28, 2011
It’s an obstetrician’s worst nightmare and it continues to happen on a daily basis. The story of Michal Lura Friedman brings tears to my eyes. After 7 years of trying, the 44 year old songwriter finally became pregnant –with twins. Her husband, Jay Snyder, a free-lance voice-over artist, describes the 9 months of Friedman’s pregnancy as pure bliss. However towards the end, her blood pressure became elevated so she was scheduled to have a C. Section the day after Thanksgiving.
Snyder accompanied his wife to the hospital and witnessed the birth of his babies. Then Friedman began to bleed. And bleed. And bleed. At 9:30 p.m., she became yet another U.S. maternal mortality statistic.
At least 2 women die from complications of childbirth in the US daily. Some celebrities such as Christy Turlington Burns have become a Maternal Health Advocate as a result of first-hand experience. She had a near-miss childbirth experience but lived to tell the story. Many women, including Friedman, don’t. The American Congress and College of Obstetrician-Gynecologists (ACOG), will have both Burns and Tonya Lewis Lee, the wife of renowned director, Spike Lee as spokeswomen on the topic of maternal mortality at the 2012 Annual Conference in San Diego. However, we need much more. There are obstetricians who have worked on the front-lines managing high-risk patients for years who can’t get a seat on ACOG’s policy committees and it is frustrating. Here are a few questions that should be asked at the hospital where Friedman expired:
- She had a short stature with a uterus stretched to the max with two babies. Was the possibility of hemorrhage considered?
- When her blood pressure became elevated, was it controlled prior to doing the C. Section knowing the risk of possible HELPP Syndrome that is associated with pre-eclampsia?
- Was there an OB Rapid Response Team?
- Was a Bakri balloon used once the bleeding couldn’t be controlled with uterine massage or meds?
- Was the prospect of a problem anticipated BEFORE it occurred or was there chaos trying to find appropriate meds and equipment as the tragedy unfolded?
Pregnancy is not a benign act contrary to what most people believe. Things can and do happen, most often when the hospital staff is unprepared and ill-equipped to handle an emergency. My heart bleeds for Jay Snyder. He is 41 years old, a new father and now a widow who must take care of two beautiful children, who will never know their mother. With all due respect ACOG, talk is cheap. More action must be taken to stop this.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do…
November 14, 2011
OMG, Michelle Duggar is pregnant again. Is she competing with the wife of Feodor Vassilyev? Vassilyev was pregnant 27 times between 1725 and 1765 and gave birth to 16 pairs of twins, 7 sets of triplets and four sets of quadruplets. 67 children survived infancy making her the woman who had the most documented number of children in the world. Vassilyev had a history of multiple births. What’s Duggar’s excuse?
I’ve written about Duggar before out of genuine concern and received over 2,000 comments on the Basil and Spice website. Many were unkind. People like Duggar because of her affable personality but want to ignore the facts: with each subsequent pregnancy, her life becomes fraught with danger. Her last pregnancy was extremely high-risk, complicated by pre-eclampsia and the emergency premature delivery of her daughter who only weighed 1.3 pounds at birth. It was a very close call. According to Answers.com, the Duggar family gets paid an estimated $25,000 to $75,000 per episode on the reality television show on Channel TLC. So, is it perhaps the show’s ratings that have prompted this 45 year old mother of 19 children to have yet another child? Is it the Baby-Doll syndrome where women have multiple children because they like the baby doll effect of having a newborn? I’m still scratching my head. However, I would be remiss if I did not, as an obstetrician offer some advice (albeit unsolicited) regarding the dangers of extreme parity (aka a great number of pregnancies). It was the same advice I offered almost 2 years ago.
- Mrs. Duggar, you are 45 years old and have what’s known in obstetrics as Advanced Maternal Age. This condition predisposes you to several high-risk conditions including pre-eclampsia, preterm labor and a host of other issues.
- You’ve carried 19 children in your uterus and its muscles are stretched to the max. Post-partum hemorrhage lies high on the list as a future complication and is the most common cause of maternal death in the industrialized world.
- You’ve also had a cesarean section and now have the potential to have a placental abruption (early placenta separation from the uterus) as well as a placenta accreta (the placenta sticks to the uterine incision and is extremely difficult to remove).
The Bible says to go forth and multiply and you’ve followed directions well. Now pat yourself on the back and give your body a well deserved rest. You escaped serious harm because of Divine Intervention and a skilled medical staff. Please, do not push the envelope.
September 7, 2011
Although Kathryn Stockett’s novel, The Help, had been a New York Times bestseller for months, somehow it had escaped me. However after hearing all the buzz about the movie, I was determined to see it even if I had to go by myself which ultimately happened.
Set in rural Mississippi during the turbulent sixties, on the surface, the movie appears to be about race relations between African American housekeepers and their Caucasian female employers, but as the lens sharpens, it becomes evident that the deeper meaning of The Help addresses issues regarding motherhood, fear, courage and trust. The characters are memorable such as Aibileen, an African American maid who has raised seventeen Caucasian children during the course of her domestic career. She becomes disturbed when the 2 year old that she cares for is emotionally neglected by her mother who is buckling under peer pressure from Hilly, the alpha woman who organizes the annual charity ball and spreads her unique brand of ignorance in the form of fear and intimidation. Hilly convinces her female counterparts that they all need to build outside toilets specifically for “the help” in order to avoid contracting mythical diseases. The discussion of Jim Crow segregation laws is nothing new in America. But what was unique about The Help is that we meet Skeeter, a young Caucasian college graduate who was raised by an African American maid whom she credits for giving her confidence. Skeeter looks beyond the occupation of the maids and seeks to discover their humanity. She asked Aibileen the very poignant question: “How does it feel to raise someone else’s children when yours are often left alone?” Aibileen diplomatically asks Skeeter to ask another question perhaps because it conjured up too much pain.
There are thousands of children left in the care of extended relatives or friends each year while their mothers work as domestic housekeepers taking care of someone else’s children. Some even leave their own country. I have met these women. I have been their physician. Their hopes and dreams for the future of their children are just as strong and vivid as mine. And if the truth be told, many housekeepers become an integral part of the family. What The Help demonstrates is that it is not easy to identify “them” versus “us.” The lines of those relationships are often blurred.
What we learn from the movie is that when women come together as a collective force, expect nothing short of triumph. The bond that unites us is far greater than the distractions that keep us apart.
August 11, 2010
According to Dr. Holcomb, approximately 1 in 1500 pregnancies is affected by cancer. However as women delay childbearing to ages 30 and 40, there is an increased incidence because the peak age of cancer occurs at age 40. Cervical cancer is the most common cancer found during pregnancy and usually presents as vaginal bleeding. A Pap smear done during the first prenatal visit will reveal the diagnosis. A colposcopy procedure done during pregnancy is extremely important to detect invasive disease which would then require aggressive treatment. In my own clinical practice, I had a patient who had a low grade abnormal PAP during a previous pregnancy but unfortunately the disease has now progressed to a high-grade Pap smear three years later with her current pregnancy. She is being watched very closely with repeated colposcopy procedures and has been encouraged to stop smoking which is a risk factor for cervical cancer.
If microinvasive cervical cancer is detected, the pregnancy may continue to term and a c. section is only necessary for obstetrical reasons. A post-partum hysterectomy is not necessary if the patient desires to have more children. If invasive cervical cancer is detected before 24-weeks, radiation therapy will cause a miscarriage 35 days after treatment in the first trimester and 45 days after treatment in the second trimester. If invasive cervical cancer is detected after 24-weeks, delivery is done by a cesarean section at term, and the patient then receives radiation therapy. The lower the stage of cervical cancer detected during pregnancy, the higher the survival rate. PAP smears save lives.
Breast cancer is the second most common malignancy detected during pregnancy and affects 1 in 3,000 women. Twenty percent of women will have breast cancer before age 35 and 1-2 percent are pregnant at the time of diagnosis. The later the diagnosis, the worse the prognosis. A modified radical mastectomy is well tolerated during pregnancy. If the patient has a lumpectomy, therapeutic abortions do not improve the prognosis. Chemotherapy is used in advanced cases after the first trimester. If future children are desired, a 2-3 year waiting period is recommended. Actress Christine Applegate is an example of a breast cancer survivor who is now pregnant with her first child.
Melanoma is the third most common cancer diagnosed during pregnancy and ovarian cancer is the fourth. Ovarian cancer presents more danger to the mother than the fetus. An ovarian cyst greater than 5 centimeters detected during pregnancy requires surgery to rule out cancer, preferably done at 18 weeks. Most ovarian cancers found during pregnancy are stage 1 which has a good prognosis.
Although rare, cancer can occur during pregnancy. Early detection can save lives. A healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
January 25, 2010
Former U.S. Senator John Edwards’ admission of paternity regarding a child not conceived by his wife brings to mind Ruth Padawer’s New York Times Magazine article, Who Knew I was NOT the Father, published a few months back. Padawer described the dilemma of Mike L. whose DNA proved he was not the biological father of a girl that he had raised from birth. Mike was extremely conflicted because he still loved his daughter deeply. However, upon learning that his former wife was about to marry the alleged biological father of their child, he asked the courts to relinquish his child support payments. Surprisingly, they refused. Mike continues to pay child support to his former wife and his daughter’s biological dad and he is not happy.
DNA tests have proven that 40% of children are born outside of marriage and the number of paternity tests has increased by 60% in the past decade. With a swab from the cheek, life can change dramatically. Most states require an unmarried couple to complete an Acknowledgement of Paternity (AOP) before the baby’s birth certificate is signed. However, there is a growing movement to have mandatory paternity tests done, even for married couples.
Life is indeed, messy. Most state-appointed judges will NOT let non-biological fathers to stop paying child support in the “best interest of the child.” According to the courts, if a man acknowledges paternity and a bond has been established with the child, it would be disruptive for that relationship to disappear. It is now recommended that a presumed father, biological mother or biological father challenge paternity before the child turns 2. This would allow for any discrepancies to be resolved before deep parental bonds have formed. However, there are men who dispute this proposal stating a man may not discover he is not the child’s biological father until years later.
As an obstetrician, I have witnessed the heart break on both sides of the fence. Sex is not a benign act. It can and DOES bring forth creation. It is therefore prudent that everyone act responsibly and HONESTLY. Children shouldn’t suffer because of misguided adults.
December 7, 2009
When Padma Lakshmi, the celebrity host of the cooking show, Top Chef, declined to reveal the gender of her unborn baby on a talk show, she represented an exception to the rule among pregnant women: most want to know what they’re having and share the news with the rest of the world.
Women under age 30 still have a difficult time believing that pregnant women once had children without knowing the gender of their baby until birth. In the age of 4-D ultrasounds performed in strip malls, and genetic home DNA testing, such a thought appears to be obsolete. Baby showers and baby room preparations are the most common reasons for ultrasound requests by patients although these reasons are not FDA approved. However, most non-medical ultrasound companies have convenient amnesia when it comes to adhering to this rule.
Well now the “home gender DNA test” has made things even more confusing for vulnerable expectant families. These tests assert to have the ability to predict the sex of the unborn child as early as ten weeks gestation and within ten minutes of taking the test. The companies claim that the test has a special secret formula (aka proprietary mix of chemicals) that turns the urine green if it’s a boy and orange if it’s a girl. The accuracy alleged from various companies is between 80 to 90 percent but most recommend obtaining an ultrasound for final confirmation.
Karen Kaplan of the Los Angeles Times wrote an informative article Old Wives ’Tale Redux regarding the challenges and effects home gender DNA tests had on expectant mothers including the class action suits that ensued because of incorrect results. The tests are expensive with a wide margin for error and exploitation.
So, what’s a mother to do? The use of the colors yellow, white or mint green still works well. Learning whether you’re having a boy or girl should not be nearly as important as safeguarding the health of your unborn child.
December 2, 2009
However, what Woods and I DO have in common is our public visibility. As a public health employee, my life is an open book.
A few years ago I had to report a former boss for inappropriate behavior based on several patients’ complaints. The case “blew up” because of his notoriety as both an elected official and a physician and I ended up with the media on my doorstep. The reporter, camera crew and satellite truck remained parked in front of my home for almost three hours, reported the 11:00 o’clock news and then finally left. Although I didn’t speak with them that night, I knew that I would have to do so the next day. “Never say ‘no comment’” was the advice that I had been given from a law enforcement agent who was investigating the case.
When I reported to work, a public information officer suggested that I participate in an elaborate scheme to avoid the media. And when I flatly refused, she told me that “I was on my own.”
The maintenance man and a secretary accompanied me as I walked out the door and faced the paparazzi. It was one of the most difficult days of my life. However, I was polite, non-judgmental and advised them that I was leaving the matter in the hands of the courts. My former boss lost his medical license and was removed from political office by the Governor. He faced criminal charges and the case dragged on for years.
In the court of public opinion Tiger, a lie unchallenged becomes the truth. The media is NOT going to go away.