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.
March 5, 2012
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.
November 16, 2011
A recent medical study by Dr. Ira J. Chasnoff of the Children’s Research Triangle asserts that Hispanic women who have assimilated to American culture have a greater risk of having children born with fetal alcohol syndrome. According to Chasnoff , pregnant Hispanic women in San Antonio had the second highest drinking rate of 29 cities in the states that were studied. I find that rather hard to believe based on my twenty-one year history of taking care of Hispanic pregnant women. I have seen first, second and third generation Hispanic women and never encountered alcoholism among any of them. However, Chasnoff brings up an interesting point about alcohol and pregnancy. There are two schools of thought. According to Good Morning America, there are physicians such as Dr. Jacques Moritz, who think an occasional glass of wine is okay to consume during pregnancy however the U.S. Surgeon General and the American College of Obstetrician-Gynecologists advocate strict abstinence from alcohol while pregnancy.
According to medical literature, more than one-half of women of childbearing age report drinking alcohol and 1 out of 8 women report binge drinking. Alcohol appears to have negative effects throughout the entire pregnancy, not just during the first-trimester. At present, it is not known how many drinks consumed would affect the fetus, therefore strict abstinence is recommended before conception and during the pregnancy.
What happens if a pregnant woman is alcohol dependent? She will need close monitoring because of the adverse effect on the fetus including support from a multidisciplinary team of healthcare and social work providers. Women who consume three or more drinks per day are encouraged to enter an alcohol treatment program. Women who drink less than 3 drinks per day are encouraged to receive counseling. The pediatrician should be present at the birth of a woman who is alcohol dependent in the event the baby has alcohol withdrawal. Women who continue to drink should be discouraged from breastfeeding.
Dr. Chasnoff is to be commended for studying substance abuse and pregnant women but please don’t stereotype ethnic groups in the process. Pregnant women should abstain from drinking alcohol if at all possible. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
April 13, 2011
Twin pregnancies have always kept me in wonder and awe, especially at the time of a delivery. At present, they represent 33% of all live births and their numbers are rising thanks to the increase in older women who are successfully conceiving through In Vitro Fertilization (IVF). Fertility drugs account for a 70% increase in multiple births. Are you at risk for having a twin pregnancy? You are if you have:
- Advanced maternal age
- Are African or African American
- 3 or more children
- A tall height or are obese
Unfortunately twin pregnancies can be complicated and everyone must be appropriately prepared.
Twins can be divided into 3 categories: monozygotic (identical); dizygotic (fraternal) and conjoined. In a monozygotic (MZ) pregnancy, only one egg was fertilized but “split” and then divided. MZ pregnancies represent the greatest risk for complications because the babies share the same placenta and circulatory system. One baby can have too much fluid and the other baby not enough. This is called a twin-twin transfusion or TTS. Dizygotic twins involve the fertilization of two eggs and have two separate placentas. It is more common, representing 69% of all pregnancies. Conjoined twins result when a single, fertilized egg only partially splits and the babies share a delay or a partial split from when there is a delay in the division of the fertilized egg and the babies share are physically connected. This is sometimes referred to as Siamese twins and represents a very poor prognosis in terms of survival. ALL twin pregnancies are at risk for preterm contractions and delivery and therefore are high risk. I am therefore perplexed when patients with twin pregnancies are not referred to a high risk specialist for a consultation.
At minimum, patients with twin pregnancies should have
- Monthly ultrasounds to document appropriate fetal growth. The number of ultrasounds might increase as you get closer to the due date
- Nonstress tests beginning at 32 weeks to document fetal well being
- A well thought out delivery plan in a level 3 hospital with a pediatrician waiting in the delivery room
Twins are a joy but remember their pregnancies are high risk. If you are pregnant with twins and no one has recommended you to see a high-risk specialist, make some noise . . . loudly. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
Check out my informational pregnancy video!
April 6, 2011
In the wee hours of the morning, Patricia Garcia took her last breath and made her transition. Her death was not a total surprise, she had almost died before. Garcia was 39 years old and the mother of an 11-month old son name Josiah who had made his entrance three months earlier than expected because he had stopped growing in his mother’s womb. During her pregnancy, Garcia was concerned that she might die before Josiah was born because of her complications of having a stroke, obesity and failing kidneys. At barely 5 feet, Garcia weighed 261 pounds and was decidedly obese with a basal metabolic index (BMI) of over 40.
Obese pregnant women are plagued with almost every type of complication imaginable from miscarriages, higher rates of cesarean deliveries, birth defects, pre-eclampsia and sometimes death. Garcia received general anesthesia during the cesarean birth of Josiah. It would have been technically challenging to attempt to give her an epidural or spinal anesthesia. Because she was put to sleep, the surgical team had to move quickly to remove the baby so that it would not receive excessive amounts of the anesthetic. Garcia’s procedure was unfortunately prolonged by several minutes, again due to technical difficulties.
Obesity is a national epidemic with 26.7% of our population affected. Garcia was considered the smallest person in her family because her brother weighed 700 pounds prior to receiving a gastric bypass. Obese patients often face discrimination and humiliation from within the medical community. Diagnostic procedures have been cancelled when it is determined that the patient is over a certain BMI for fear that their equipment would not sustain the additional weight. Patient safety experts propose that “obesity centers” for pregnant women be established to provide nutritional counseling, emergency cesareans as necessary and neonatal intensive care units.
Garcia promised her physician that she’d lose weight after she was discharged home. She didn’t. Although Josiah is now more than a diminutive 1-pound-11 ounce baby, he is still very small and was recently diagnosed as having dwarfism. He will be raised by his sixty-something year old grandmother who is also taking care of Garcia’s mentally disabled brother. Obesity is not a benign disorder. Until Americans make better lifestyle choices, tragedies like Patricia Garcia’s will continue.
January 11, 2010
Just when I think that I’ve seen and heard it all, I read yet another bizarre story that proves me wrong. Last month CNN reported a story about a woman who had attempted to end her rival’s pregnancy Woman Tried to End Rival’s Pregnancy, Prosecutor Say in a most deceptive way.
Kisha Jones was arrested for allegedly tricking Monique Hunter, her husband’s pregnant lover into taking an abortion-inducing drug. Jones allegedly forged a physician’s prescription and prescribed a medication that would induce early labor. She told the pharmacist that the medicine was for “a procedure.” She then called Hunter and convinced her that her physician had prescribed an important medication and she should pick it up and take immediately. Hunter complied. Shortly thereafter, she was soon rushed to the hospital and delivered a premature baby boy two months early.
While Hunter’s baby was still in the intensive care unit, an unknown man brought what he claimed to be breast milk for the baby and it was later determined to be poison. The hospital staff called the police and Jones was arrested on a host of charges including criminal impersonation. The facts of this case suggest that either Jones was familiar with labor inducing medications or knew someone who was. The “abortion-inducing drug” referred to by CNN was probably Mifepristone.
Mifepristone is a medication that’s used for early first-trimester abortions and to induce labor with fetal demises. Since its inception back in the late ‘80’s, I have disagreed with it being prescribed as an outpatient medication. Any medicine that causes bleeding and the evacuation of the uterus should be done in a controlled environment under the supervision of medical staff to avoid complications. Unfortunately, the FDA has reported several deaths of women who had taken this medication at home.
While this story has all of the makings of daytime drama, the bigger tragedy is that an innocent newborn was almost killed. I think the FDA should reexamine its policy regarding Mifepristone. People like Kisha Jones should never be allowed to strike again.
December 9, 2009
The tragedy of Roshunda Abney, (Las Vegas Review, Woman Says She Was Ignored in ER, Paul Harasim ) occurs much too often. She went home after a six-hour hospital wait, and returned with a dead baby.
Abney was a part-time customer service rep in Las Vegas who lived with her high school sweetheart. They had relocated from Mississippi for a better life.
Abney had irregular menstrual periods, so she didn’t know that she was pregnant. For the past two days she had experienced menstrual-type cramping that wouldn’t go away despite taking over-the-counter painkillers. When the pain became unbearable, Abney went to a hospital-affiliated urgent care center. A nurse requested a urine sample but Abney was not able to supply one. Thirty minutes later a decision was made to transfer Abney to the hospital ER because she needed “higher care.” She was also uninsured.
Abney’s vital signs were taken upon her arrival to the hospital ER and then she proceeded to wait. And wait. And wait. Her pain became worse and she unsuccessfully attempted to receive medical attention. When she told a certified nursing assistant that her pain was getting worse, he told her that if she endured it for two days, “another 45-minutes wouldn’t make a difference.”
Sympathetic patients who were present in the waiting room offered to allow Abney to go ahead of them. They were subsequently informed to “mind their business or they would never see a doctor.” After a six-hour wait without being seen, she went to another hospital where she was also not seen and went home thinking she had gallstones. Twenty minutes after she reached home, her membranes ruptured and the feet of a baby was emerging. Paramedics were called and subsequently delivered a 24-week breech baby girl who was lifeless.
Abney’s case illustrates why hospitals and physicians get sued. She had to contend with layers of arrogance and calloused gatekeepers.
I strongly encourage all pregnant women to read The Smart Mother’s Guide to a Better Pregnancy. If you think the story of Roshunda Abney is an isolated incidence. Please, think again.
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.
November 2, 2009
Every day we look in the mirror, see our reflections but are not astute enough to recognize that we are viewing a miracle. However, Sade Davis knows otherwise because she is pregnant and was technically dead. (See Paramedics Bring Drowned Pregnant Woman Back to Life, NBC News, Keith Garvin and Matthew Stabley).
Davis is a 23-year-old pregnant mom from Prince George County, Maryland whose car veered off the road and ended up in a nearby creek. Miraculously someone saw what happened and moved into quick action. People from Fire Station 825 were on their way to another call when the eye-witness jumped in the middle of the road and flagged them down for help. Firefighter David Wilson and Lieutenant Dale Giampetroni pulled Davis out of the car and found her breathless and without a pulse. They performed CPR and brought Davis back to life. Both mom and unborn baby are alive and awaiting the baby’s delivery. Someone told Davis that it was obvious her baby was meant to be here which brings me to my next point.
There are no accidents, coincidences or “chance occurrences” in the human experience. And there certainly are no “accidents of birth.” Millions of sperm are given the assignment of fertilizing an egg that resides outside of the uterine cavity in the ovary. The uterine cavity is a hostile environment to the well-meaning sperm and yet it somehow overcomes the adversity of the uterus, travels inside the fallopian tube where it drills through the protective covering of the egg in order to gain entrance for fertilization. That’s not an easy task my friends, just ask any infertility patient.
Our presence on this planet is nothing short of a miracle. We are ALL supposed to be here to share our special gifts during the human experience.
The story of Sade Davis inspires all of us to recognize that you do not need to have a near-death experience in order to experience miracles. Just look at your reflection in the mirror, and then give your Creator some praise.