What Every Pregnant Woman Needs to Know About Blood Clots

Image from WebMD

Image from WebMD

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.

What Pregnant Women Need to Know About 5,797 Work-Related Complaints

Walmart pregnancy case

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.

Is Underwater Childbirth Safe? Some Doctors Say No.

Compliments of Health Day News

Compliments of Health Day News

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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Pregnant Moms: Is a 1st Trimester Prenatal Screening Test Right for You?

DNA 2

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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Is It Safe to Take Acetaminophen During Pregnancy?

pills

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, yourobgyn@twitter.com

How to Keep a Short Cervix from Messing Up Your First Pregnancy

Image

It’s your first pregnancy and very exciting. While doing your first ultrasound, the technician frowns as she scans your cervix with a vaginal probe. You ask what’s wrong and she mutters something about the cervix being too short but that your provider will explain more. What’s going on? You could possibly have a short cervix which means you’re at risk for having the baby too soon.

One out of eight babies born in the United States is premature which accounts for over one-half million babies each year. Premature birth is the leading cause of infant death, brain damage, blindness and other complications that costs $26 billion dollars a year in health care.  

Women who have had a previous premature baby are at significant risk for having another one and should be seen immediately by a maternal fetal medicine specialist (a high risk pregnancy specialist).  Does this also apply to women who are pregnant for the first time? The answer is yes. All pregnant women should receive an ultrasound for dating and documenting normal fetal anatomy no later than the middle of the second trimester and if the cervical length is less than 2.5 centimeters, the mother is at risk for a premature birth even if she is not complaining of cramping or bleeding. If the cervix is less than 25 mm or 2.5 cm,

·         A repeat ultrasound should be done ASAP to document the short cervix

·         Vaginal progesterone tablets should be prescribed as soon as possible and before 24 weeks. Why? Because they reduce premature births by 44%

This information is especially important for first-time pregnant women who have no documented history of previous preterm births. Several years ago, first-time pregnant moms with a short cervix were not treated but recent medical studies have proven that these women should be treated. Therefore, a short cervix should not be ignored.

Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother or knows what to do.

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The Shocking Truth: 10 Reasons Why You Are Not Getting Pregnant

The Shocking Truth: 10 Reasons Why You Are Not Getting Pregnant 3rd

Image courtesy of imagerymajestic / FreeDigitalPhotos.net

Getting pregnant is easier said than done for at least 10% percent of women in the U.S.  About 90% of women will conceive after one year of trying. If you’ve been trying to get pregnant without success, consider these reasons and possible solutions.

  1. You’re not having sex at the right time. The only way a woman can get pregnant is if the egg is fertilized by sperm but if there’s no egg, there’s no baby. If you don’t get your period every month, there’s a strong possibility that you’re not ovulating. What can you do? Buy an over-the-counter ovulation kit (many are sold at the dollar store) to determine if you’re ovulating.
  2. You might have scar tissue in your tubes or in your uterus.  If you’ve had a history of a sexually transmitted infection or pelvic inflammatory disease (PID), your tubes might be blocked. A procedure called a hysterosalpingogram (HSG) inserts dye into the uterus and tubes to see if they’re open or closed.
  3. Your partner’s sperm count might be low. Male infertility accounts for 23% of reasons why women can’t get pregnant. If you’ve been trying unsuccessfully to get pregnant after a year, please see your healthcare provider.
  4. There might be something wrong with your uterus.  “Congenital anomalies” means something was wrong with your uterus from birth.  An HSG will make the diagnosis.
  5. You could have endometriosis which is tissue from the uterus on places such as the ovaries, rectum, abdomen or other unlikely places. Severe pain during the times of your period gives a clue about this possible condition.
  6. Your eggs might be too old. Your age plays a significant role in your ability to conceive. If you’re over 30 and can’t get pregnant, please see your health care provider. IVF (in vitro fertilization) is very successful for women in their 30’s.
  7. You’re having a lot of miscarriages. Two or more miscarriages could signify an autoimmune disorder and a good reason to see a infertility specialist.
  8. There might be something wrong with either your genes or your partner’s. Another reason to see an infertility specialist.
  9. You’re trying too hard.  There have been studies that have proven that meditation and hypnosis has helped women get pregnant.  You might be one of those success stories when all else has failed.
  10. You’re overweight.  If you’re overweight and not getting your period, you’re not ovulating. I had a patient who had been trying to conceive unsuccessfully for years. She lost 10 pounds, became pregnant and the mother of a beautiful baby girl. Losing weight can help.

If you’ve been trying to get pregnant unsuccessfully for over a year, it’s time to move your feet and find out why.

Should Pregnant Smokers Take Vitamin C?

Are you pregnant and smoke cigarettes? Then please consider taking take Vitamin C.

Years ago, Vitamin C was frequently in the spotlight because of the scientist, Linus Pauling who made the bold assumption that it was the cure for the common cold. While that topic is still subject to debate, it appears that Vitamin C has been proven to help pregnant mothers who smoke.

The dangers of smoking during pregnancy are well known. Not only does it increase the risk of developing lung cancer, it can also increase the chances of having a small baby, the placenta separates too soon before the birth of the baby (also known as a placenta abruption) and preterm labor. There is also an increase in Sudden Infant Death (SIDS) and pre-eclampsia.

At a recent international medical conference, the Oregon Health and Science University presented a medical study that looked at pregnant smokers who were aged 15 and older and gave them 5400 mg tables of Vitamin C. They compared these women with those who smoked but did not take Vitamin C.  Of course, both groups of women were counseled to stop smoking but continued during the course of their pregnancy. At birth, the infants of both groups were given lung tests and the Vitamin C group had better results. These results are significant because babies of smokers can also have breathing problems and death before the age of 28 days.

The researchers plan to test the babies again at age 12 months to see if there are any differences between babies of the same age who have wheezing problems.

Does this study give pregnant women who smoke the green light to continue? Of course not, but if they can’t stop smoking then taking Vitamin C might help reduce some of the harmful effects smoking has on their newborn.

Until next time, remember – a healthy pregnancy doesn’t just happen, it takes a smart mother who knows what to do.

10 Reasons to Have an Ultrasound

Technology has made fascinating advances in medical practice and ultrasounds are no exception. However, contrary to popular belief, they are not a tool developed so that women can find out the sex of their baby. While that is a great benefit to expectant parents who “just have to know,” the true purpose of having an ultrasound is to make certain that your baby is doing well, to measure its growth and to help a healthcare provider make a decision if he or she suspects there is a problem. So when and why should you have an ultrasound? Here are 10 good reasons that can be found in The Smart Mother’s Guide to a Better Pregnancy:

  1. To determine the age of the pregnancy
  2. To document that the baby is alive
  3. To determine the position of the baby
  4. To determine “normal” anatomical organs, usually after 18 weeks
  5. To determine the position of the placenta
  6. To determine the cause of bleeding
  7. To determine whether you are having more than one baby
  8. To document that the baby is in the uterus and not a fallopian tube
  9. To measure amniotic fluid late in the pregnancy
  10. To periodically watch the baby if you have a high-risk condition

There will be temptation for pregnant moms to get “keepsake” ultrasounds done in the mall for entertainment purposes. Not only are those ultrasounds not approved by the FDA but they could potentially miss an important diagnosis if they are not read or interpreted by a physician. The conditions listed above will give you legitimate reasons for requesting an ultrasound that can be done by a professional under the supervision of a doctor.

Remember, a healthy pregnancy doesn’t just happen. It takes a smart mom who knows what to do.

Could You Pass This Pregnancy Quiz?

Pregnant moms, are you ready to take a Smart Mother’s quiz? Here’s one that taken from The Smart Mothers Guide to a Better Pregnancy. All rights reserved.

You have been which might be considered fluid for the past two days. You call your provider, who advises you to go to the hospital for further evaluation. Upon your arrival at the hospital, the nurse does something called a nitrogen test.  Nitrogen is a substance that turns blue when exposed to amniotic fluid, mucus or blood. Your nitrogen test proves negative. Should you be discharged home? Yes or No.

The answer is no, you should not be discharged home. You first need to have an ultrasound to make certain you have adequate fluid. You could have legitimately been leaking fluid for several days and now have no fluid. Without fluid, an infection called chorioamnionitis could easily develop. Or if your fluid is extremely low (also known as oligohydramnios), you might need to be delivered.

Did you learn something? Well here’s another quiz also taken from the book:

You have had a dull headache all day. For the past two weeks you have received nonstress tests because you complained of decreased fetal movement. You had a two-hour wait before a bed became available in the triage unit. The nurse takes your vital signs, and your blood pressure is 140/90. After twenty-five minutes, your nonstress test is reactive, the triage unit is becoming busy, and the nurse calls your physician with a report of your NST results but omits your blood pressure result and complaint of a headache. However, she does advise your physician that the labor is busy and they need your bed. Your physician’s midwife is on call and sends you home. Is this correct?

No. Although the nurse was correct to report a reactive nonstress test, she did not mention your elevated blood pressure or your complaint of a headache. In this clinical situation, other tests would be necessary to make certain that you are not developing pre-eclampsia.

In pregnancy, the unexpected things, if not managed properly could get you in trouble. Sadly, many healthcare providers do not discuss potential problems with patients until they are smack in the midst of a crisis.

Want to be prepared? Then order a copy of The Smart Mother’s Guide at www.smartmothersguide.com. Remember a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.