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.
The Washington Post recently published a story about mammoth retailer Wal-mart’s new policy that allows pregnant women more options so that they can continue to work even late into their pregnancy. While this change of policy is a moral and economic victory for pregnant Wal-mart employees, it did not come without a fight.
In 2011, the Equal Employment Opportunity Commission received 5,797 pregnancy-related complaints from women who represented all walks of life from a cashier to corporate executives who felt that they were discriminated against by their employers solely on the grounds of being pregnant. According to the National Women’s Law Center, almost 9 out of 10 women worked into their last two months of pregnancy which carries an increased risk of complications. Rather than allow the pregnant employees to change positions, work less hours or sit in a chair, many find themselves terminated or asked to take a temporary leave of absence that often times becomes permanent. Many are forced to use their Family Medical Leave time before having the baby and must rush back because they’ve run out of time.
Tiffany Beroid’s blood pressure started to rise as her pregnancy advanced. Her doctor gave her a light duty note but Wal-Mart told her they didn’t have light duty work, forcing her to take her pregnancy leave sooner than anticipated. Through social media efforts, pregnant employees of Wal-Mart with problems similar to Beroid’s began networking and an organization called Our Wal-Mart that is a labor union supported group began to advocate on Beroid’s behalf. She was also assisted by a work advocacy group called A Better Balance as well as the National Women’s Law Center.
March 5, 2014 became a day of victory for the thousands of pregnant employees of Wal-Mart when the company issued a new policy that allows its pregnant employees to perform less demanding work if they’re having difficulty fulfilling their duties.
All pregnant women are encouraged to become familiar with The Pregnancy Discrimination Act of 1978 in order to protect their rights. The policy changes of Wal-Mart are to be commended. Let’s hope other industries will follow suit.
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.
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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.
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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, firstname.lastname@example.org
The contradictions of life can be maddening. On one hand, we have the case of Jahi McMath, a 13-yearold girl who is brain dead on a mechanical ventilator that her family fought to maintain and on the other hand, there is Marlise Munoz, a 33 year-old mother of a 15 month old son, who collapsed on her kitchen floor from what appeared to be a blood clot to the lungs back in November. Munoz, according to her husband and family, never wanted to be on life support but the state of Texas ordered it when they discovered that she was 14-weeks pregnant. Should state law override the wishes of a patient because of her pregnancy?
The family of Munoz is concerned and angry about the state of Texas’s decision for a number of reasons. Munoz was without oxygen for over an hour before her husband found her on the floor which meant that the fetus was without oxygen as well. Medical experts believe this could cause serious problems for the unborn baby. Munoz’s father describes his daughter has having “rubbery arms that feel like a mannequin” which makes it difficult for him to visit her in the hospital. Munoz was very early in her second trimester (14 weeks), remote from delivering a baby, yet forced to be, as her father states, “a host for the fetus.” Who will have the ultimate responsibility of raising the child once the physicians intervene and deliver it via C. Section?
When John Peter Smith Hospital was confronted regarding their decision, they emphatically state that they are merely following the rule of law; however some medical ethics experts disagree and state that the hospital is misinterpreting the law. According to the New York Times, at least 31 states have adopted restrictive laws prohibiting physicians for ending life support for “terminally-ill pregnant women regardless of the patient’s wishes or her family’s.”
Should a brain dead pregnant woman lose her rights under the United States Constitution in order for the benefit of her unborn baby? I’d love to know what you think.
I will never forget the patient or the day it happened. Assigned to my residency team, we had watched her vigilantly because she was 39 years old and pregnant with her first baby. Although she spoke no English the love that she had for the miracle growing inside of her could be understood in any language.
She had begun to have premature contractions at 33 weeks and we were trying to prolong her pregnancy for just a little bit longer to allow the lungs to develop. For approximately one week, we monitored her blood, her temperature and fetal movement. One of her tests ultimately indicated that she was developing an infection so we decided to induce her. We would then transfer the baby to the special care nursery where, under the watchful eyes of the neonatologists, he would continue to grow. My team was not on call that night although, in retrospect, I wished the heck that we were. We signed out the patient to the on-call team before we left. We gave them explicit instructions on how often to monitor the patient and discussed her complicated history. She was having, what we, in obstetrics called, a “precious baby” meaning that an older woman was having her first child. When we went home that evening, the baby was alive. When we returned the next morning, it was dead.
“What happened?” I asked as a volcano of anger started to mount. I received a litany of excuses, none of which made sense. Essentially, they missed an opportunity to intervene at the proper time and perform an emergency cesarean. By the time they got their act together, the baby was dead. There was a heated exchange of words between the male chief resident and myself. Another resident had to jump in between the two of us because at that moment, I was ready to swing.
Later that afternoon, the patient demanded to see her baby. We retrieved his body from the morgue in the basement, dressed him in a beautiful blanket and the social worker attempted to console her in her native language. I knew that I could never bring her baby back alive but from that moment on, I vowed to never allow a tragedy of that magnitude happen again.
In today’s tough U.S. economy, healthcare is in the forefront because of the three trillion dollars spent each year. Patients are not seeing their money’s worth and neither is the U.S. government who writes the check for a large percentage of it. The cost of women having babies too early or prematurely costs our society $26 billion dollars each year. Something has to give.
Women’s health is the topic of great political debate as you may well be aware if you listen to the news or watched both political parties’ national conventions during the past two weeks. Do women control their destinies? Do we and will we continue to have control over our bodies? These are the questions at hand. While there’s great chatter about this topic as the U.S. election nears, there’s also a quiet revolution occurring in our healthcare system that will directly affect pregnant women.
Prenatal care as we know it will begin to change, especially if you receive Medicaid or government sponsored insurance. The current trend is to visit your healthcare provider’s office individually and wait to be seen. In the future, you will be seen by your healthcare provider as a member of a group, not as an individual. This is called enhanced prenatal care with group appointments and will be the wave of the future.
Groups of 10 pregnant women will be seen at the same time for approximately 10 prenatal visits that will last approximately 90 minutes. It is anticipated that 2 healthcare providers will not only take your vital signs, listen to your baby’s heartbeat, but will also allow you to interact with the other patients in this group setting to discuss prenatal issues, receive health education information and any concerns that you may have. Believe it or not, this model of care is not new. The concept was called Centering Pregnancy and was developed by nurse midwife Sharon Shindler-Rising in 1989.
In the future, doulas and social workers along with midwives will become more prominent in terms of prenatal care as things continue to evolve. Are you ready for group prenatal visits?