August 27, 2012
I was recently on a few pregnancy sites and was surprised at the number of times someone was confused as to whether or not they were pregnant. Finding out whether one is pregnant can provoke equal anxiety for both those who are attempting to get pregnant and for those who don’t want an unplanned pregnancy. Here are some facts:
- The most common sign of pregnancy is a missed period for women who are sexually active and have had normal periods in the past. While abnormal bleeding, back pain and breast tenderness are symptoms, they are not the most common symptoms. If you can set your clock by your monthly period and then it “disappears” for more than 2 weeks, you need a pregnancy test.
- How soon after a missed period can a pregnancy be detected?
- With a urine pregnancy test – 5 to 7 days after the last menstrual period (LMP)\
- With a blood pregnancy test – 1 to 2 days after the LMP
- Why the difference in the urine and blood test?
- The urine pregnancy test requires more pregnancy hormone (aka BHCG or beta HCG) than the blood test. The urine pregnancy tests requires 20 to 50 IU/L of beta HCG while a blood only requires 1 to 5 IU/L. Big difference isn’t it? However most clinics or healthcare providers’ offices will do a urine test first because it is less expensive than a blood test.
- Your home pregnancy test is positive. Now what should you do?
- Repeat the test at your clinic or healthcare provider’s office to make certain that your home test was not a false positive.
- Will an ultrasound confirm your pregnancy?
- Usually not until 6 weeks after your missed period or if your beta HCG level is above 1500 IU/L. If your beta HCG level is greater than 1500 IU/L, an ectopic pregnancy should be suspected and appropriately managed by your healthcare provider.
Have questions? Feel free to contact me at www.smartmothersguide.com Remember, a healthy pregnancy doesn’t just happen. It takes a smart mom who knows what to do.
August 22, 2012
- Form a “walking club.” Walking is a great way to exercise and is also a stress reducer. It’s also a good way to bond with other pregnant moms.
- Learn how to knit and crochet. As you may or may not know, baby clothes can be very expensive and knitting or crocheting your baby’s outfits are a great way to save money.
- Does your baby like music? Many of my patients state that their baby moves faster when certain types of music is played. Does the baby like Soft Rock? Smooth Jazz? Hip-Hop? Country Western? Experiment with music and see how your baby responds.
- Yoga for pregnant women. Yoga is a great way to reduce stress, stretch and keep the body limber.
- Take time progressive photos of your pregnant belly. Takes pictures of your belly every month or even a video and send it to your friends and family who might not be able to see you during your pregnancy. It’s a great way to keep them engaged and informed.
- Don’t ask about the gender when having an ultrasound. Let it be a surprise at birth. Believe it or not, this is how things were done prior to the development of ultrasounds.
- Form a “baby weight pool.” Have friends and family guess the weight of the baby and give the prize money to your favorite charity.
- Is this your first pregnancy? Be a volunteer in a hospital nursery. Many nurseries need volunteers to feed babies, especially when their parents are not available. Volunteering in a nursery will give you first-hand exposure of what your baby will experience during its first days of life.
- Join a pregnancy support group and exchange ideas (nursery decorations, food plans, etc)
- Start your own You Tube® channel. You can use it as a video journal to publish your thoughts and experiences of being pregnant.
Pregnancy is a sacred journey. Make it memorable. Make it fun. What are some things that you do to make your pregnancy more fun?
August 20, 2012
In a television interview with KTVI-TV in Missouri, Representative Atkins allegedly said:
‘It seems to me, from what I understand from doctors, that’s really rare,” Mr. Akin said of pregnancies from rape. ”If it’s a legitimate rape, the female body has ways to try to shut that whole thing down. But let’s assume that maybe that didn’t work or something: I think there should be some punishment, but the punishment ought to be of the rapist, and not attacking the child.”
What an outrage! Someone really has to draw the line. First, you mandate a diagnostic test such as ultrasonography prior to pregnancy terminations and demand that the woman view the fetus. Then you tell women they can’t have birth control on one hand and then condemn them if they have an abortion on the other. And now you have the temerity to suggest that the human body can categorize the atrocity of rape into a “true-false” mode. Are you kidding me?
So what are you saying, Representative Atkins? Do you think a rapist’s sperm is color-coded so that the ovary will put up a barrier to prevent its penetration to a woman’s egg? Will the fallopian tube sound an alarm when the process of fertilization comes from a rapist’s sperm? How will the human body be able to differentiate the sperm of a rapist from the sperm of a consenting adult? Will a woman’s body produce shock waves to the rapist upon his unlawful entry? How will a woman’s body be able to “shut that whole thing down?”
Do these candidates get screened for intelligence? Atkin’s statements are both reckless and unequivocally false.
“A lie unchallenged becomes the truth.” Please do not allow this lie to prevail.
August 15, 2012
This is a dilemma that pregnant women face on a daily basis. Up until 36 weeks, the position of the baby can vary from feet first (breech), buttocks first (frank breech), head first (cephalic) or transverse lie (the baby is lying in a horizontal position). However, after 36 weeks, the position of the baby normally doesn’t change because there is not enough room for the maneuver.
This becomes a significant challenge for first-time moms who have what we call, an “untried pelvis” meaning there’s never been a birth so it’s not certain whether the pelvis could accommodate a breech presentation. Delivering a breech baby takes a tremendous amount of skill because the baby’s head is the last part of the delivery and could theoretically get “stuck,” something we want to avoid. This is why most first-time pregnant moms have c-sections if their baby is in a breech position.
Some physicians will attempt to do an external cephalic version, commonly known as an “external version” if they think they can manually turn the baby from a breech to a head down position. This is usually done by an obstetrician or family practice physician in rare instances. The procedure is successful in 65% of cases but here are a few things one should be aware of in order to make an informed decision.
- An ultrasound should be done prior to the procedure to make sure they are no fetal anomalies
- There should be enough fluid around the baby but not over 20 centimeters
- The baby should weigh at least 4.5 pounds but not more than 8.5 pounds
- The baby should be in a “back up” position, meaning it’s back is facing the front of the abdomen
- RhoGham should be given if the patient is Rh negative
- The procedure should be done in a hospital in the event of complications
- The procedures should be done preferably by a high-risk specialist (maternal fetal medicine specialist) or someone who has done at least 30 procedures hopefully with a success rate
- The baby should not be in a footling breech position because the umbilical cord could become injured during the procedure
- No more than 3 attempts should be made
- The procedure should be done under ultrasound guidance
- Terbutaline is usually given to relax the uterine muscles before the procedures starts
- The baby should be monitored for 30 minutes after the procedure is finished
Should your provider suggest an external version, you now have the facts. If the procedure is not successful, do not worry. Better safe than sorry. A c-section does not mean failure. It means all options were taken and it is the safest way to have a healthy baby.
August 13, 2012
Journalist Nicholas Bakalar of the New York Times wrote an article that addressed a profound issue regarding pregnancy: Does Fear Make Labor Longer?
Over 2,000 pregnant women in Norway were given a questionnaire at 32 weeks to determine if they had a fear of labor. These women were then followed to determine how long they were in labor and according to the study, there was a 47 minute difference in the length of labor of 165 women who feared childbirth compared to those who don’t. Why is this important? It’s important because fear is something that we can control.
Three of the most empowering things a pregnant woman can do are request a tour of the labor room before she has a baby, take childbirth classes and request pain meds or an epidural if she experiences pain while in labor. When a pregnant woman is calm, the unborn baby is calm but if she’s writhing in pain, the adrenaline that she’s producing affects the baby and inevitably causes fetal distress. Prolonged fetal distress means emergency c. section.
One of my most memorable deliveries was as an intern during the late ‘80’s. Recording artist Anita Baker was very popular back then. I was astounded when a very “Yuppy” expectant father, pulled out a tape cassette and played Baker’s tape while his wife was in labor. He requested dim lights and held his wife’s hand as they listened to my favorite song, Sweet Love. Although I respected their privacy, I was never far from their room. His wife ultimately had a beautiful, uncomplicated delivery that left an indelible impression.
No, everyone doesn’t have to listen to Anita Baker while they’re in labor but they should do what makes them comfortable including receiving an epidural or pain meds if necessary. You don’t have to be stoic. Here’s a quote from The Smart Mother’s Guide to a Better Pregnancy that I’d like to leave you with: “The Force that moves the air within our lungs, the blood within our veins, is the same force that has created the life within your womb. The most important key to a healthy pregnancy is the consciousness that lies within. Your child will be shaped by your thoughts, your dreams, your values, your energy. You are the ship that will carry the baby to the shores of its preordained human experience. Please let the journey be smooth.”
You are smarter, stronger and more brilliant than you could ever imagine. Childbirth should not be feared. It should be celebrated.
August 8, 2012
The 4th Amendment of the U.S. Constitution guarantees the privacy of its citizens and states that the government cannot interfere in their personal affairs. Someone forgot to tell the Delhi Charter School in Delhi, Louisiana who required students to take a pregnancy test if it is rumored that they’re pregnant. If the students refuse to take the test, they are essentially kicked out of school. If the pregnancy test is positive, they are forced to leave and become home-schooled.
The American Civil Liberties Union (ACLU) and the Louisiana State Board of Education had to intervene. According to the ACLU, the school’s policy violates federal law, specifically Title IX of the Educational Amendments of 1972 that states: “No person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance.”
According to Wikipedia, New Delhi is a town of approximately 3,000 people where the average yearly income is $25,000 for men and $12,000 for women. Those statistics are glaring. Clearly both girls and boys desperately need an education if they are going to change their destiny. It would be interesting to know whether the fathers of the alleged pregnant girls at the charter school are forced to leave as well. Is sex education is part of the educational curriculum? Do they have or offer family planning services? Do they realize that forcing someone to take a pregnancy test is a violation of their privacy according to HIPAA rules?
Fortunately, the Louisiana Department of Education and the ACLU put a stop to the school’s unlawful practice. A society that does not respect its women does not respect its future. The school officials at the Delhi Charter School should hang their heads in shame.
August 6, 2012
New York Times writer, Anemona Horticollis has written yet another telling story. The Short Life and Lonely Death of Sabrina Seelig describes why entering a hospital could be hazardous to your health.
Sabrina Seelig was a writer, a student and came from a family of artists. Both of her parents previously taught at the University of Art in Philadelphia and then moved to an artists’ colony in Maine. Sabrina eventually moved to my hometown of Brooklyn, New York in a neighborhood that was changing. Like many New York neighborhoods, Bushwick has experienced significant transformation and revitalization, thus attracting young professionals, students and artists. Unfortunately, the neighboring hospital remained unchanged and had been cited for mismanagement, was under investigation by the Brooklyn District Attorney and didn’t carry medical malpractice insurance. Had Sabrina had known those facts; they might have saved her life.
According to The New York Times, Sabrina took Ephedra (a stimulant) to stay awake all night so that she could write her Latin paper for school. She also took an herb called Valerian. Feeling sick, she contacted the public health Poison Control Center after calling an ambulance that never came. The Poison Control Center wasn’t that helpful and basically told her to wait for the ambulance. It’s not clear how Sabrina arrived at Wyckoff Hospital but a cascade of unfortunate events sent her to the grave:
- She was given a sedative that made her sleepy although she had taken Valerian
- Her wrists were bound in restraints
- She was never given oxygen
- She lie on a small hospital cot unresponsive for over 12 hours
- She never received a breathing mask or tube
- She was never transferred to the ICU
- There were few notes written in her medical chart
- She did not have vital signs recorded for over 3 hours despite the fact that she was unconscious
- Her parents had her transferred to another hospital but by that time she was brain dead
- The nurse involved stated “writing vital signs were unnecessary because she was watching the cardiac monitor. “
- Her family had a challenging time finding an attorney who would take the case
- A jury found the hospital not guilty and made snide comments about Sabrina’s alleged drug use
As a physician and parent, I am outraged about the death of Sabrina. Wyckoff Hospital should be shut down immediately.
There are two lessons to be learned from this case. (1) Know your hospital. There is a chapter in The Smart Mother’s Guide that addresses this issue. If a hospital does not carry medical malpractice insurance, RUN in the opposite direction; and (2) to quote Sabrina’s dad, “Never enter a hospital alone.”
August 1, 2012
JoNel Allecia’s NBC News article, Burned Out Nurses Linked to More Infections , addresses an important issue that is often overlooked and ignored. Let’s be brutally honest, without an appropriate nursing workforce, our entire healthcare system would collapse. As our healthcare system continues to shift to a business and profit model, both nurse and physician burnout will only increase.
Decisions to “cut corners” by not providing adequate nursing staff are made on a daily basis to our detriment. There was a time when additional nurses would be brought in based on the patient census for the day or evening shift but those days are gone forever.
According to a recent medical study, for every extra patient added to a nurse’s workload, there is one hospital acquired infection for every 1,000 patients. While this may not sound significant to the uninitiated, a hospital acquired infection can wreck havoc because it is usually caused by antibiotic-resistant bacteria that are difficult to treat and Methicillin-Resistant Staph Aureus (aka flesh-eating bacteria) or MRSA is a perfect example.
The study goes on to report that when an additional patient is added to 5.7 patients per nurse, 1,351 additional hospital infections occur that are preventable. The statistics are alarming.
A few months ago I reviewed a medical ob-gyn case where the labor room nurses were short-staffed and the patient unfortunately died of complications. The physician had patients in labor but chose to finish his office hours rather than attend to a sick patient so the short-staffed labor room nurses were essentially managing his high-risk patients.
What can a patient do? Plenty.
- Ask what the patient to nurse ratio on the day of your hospital admission and if the nursing staff pattern is inappropriate, ask your insurance company if you are eligible for a private duty nurse based on the increased hazards associated with inadequate nursing staffs.
- Ask your physician to come to the hospital to closely oversee your care or make sure there’s a hospitalist on duty
- File a formal complaint with the hospital administrators, State Board of Nursing and the Joint Hospital Commission for jeopardizing your patient safety based on inadequate staffing patterns
When nurses are overloaded with work, an entire community suffers.
July 30, 2012
Malaysian shooter Nur Suryani Mohamed Taibi’s participation in the Olympics makes me nervous but I can understand her dilemma. It’s not every day that a woman receives the opportunity participate in such a renowned event, especially if she 35-weeks pregnant. At 36 weeks, most healthcare providers would strongly advise against traveling by air because the change in the barometric pressure has the potential of causing premature rupture of membranes, or quite simply, the “water” to break. Certainly no one wants that to happen while flying at 32,000 feet in the sky. Taibi not only has to worry about traveling safely from Malaysia to London and back, but hopefully the noise from the gun shooting during her competition will not produce any undesired effects of her unborn child such as hearing loss.
Taibi represents a new generation of women who have crossed over into unchartered waters based on their performance of untraditional roles. Auto mechanics, airplane pilots and astronauts are just a few of the many new occupational roles that women have assumed. In the case of Taibi, it was her father who put a gun in her hand and introduced her to the firing range at the age of 15. Fourteen years later at the age of 29, she has qualified for the Olympics which is a phenomenal achievement and will represent her country.
Hopefully, Taibi won’t develop preterm labor as a result of the sheer stress of Olympic competition. She is creating history and the medical community needs to do research on her for the next 10 to 20 years to determine if her late-pregnancy Olympic participation has any negative effects on her baby’s future development and health.
We know that the fetal ear develops from 8 weeks gestation to 28 weeks and the most common cause of children’s hearing loss is caused by abnormal development followed by infection and trauma. More than 10% of children aged 6 to 19 years loss suffer noise-induced hearing loss in one or both ears in the U.S. according to medical studies.
Taibi says participating in the Olympics is a chance of a lifetime. If you were 36 weeks pregnant, would you compete on a shooting range in the 2012 Olympics?
I’d love to know what you think.
July 25, 2012
With a swipe of your credit card at the cost of $3.00, a machine in a Minnesota bar will dispense a pregnancy test in the ladies room to help you determine if you’re pregnant and if you are, you might want to rethink about having that drink.
The Center for Disease Control and Prevention (CDC) recently published a study that is sobering: 1 out of every 13 pregnant women drinks alcohol and of those who drink, 1 in 5 will consume 4 or more drinks per day. These statistics are both alarming and sad. According to CDC, 50.9% of adults 18 and over have had at least 12 drinks per year. But let’s return to the subject of pregnant women.
I get highly annoyed when my colleagues advise pregnant women that it’s “okay” to have a glass of wine a day while pregnant. It is not “okay” because we don’t have all the facts. Our U.S. Surgeon General of the United States and the Secretary of Health and Human Services recommend abstinence from alcohol for women planning pregnancy, at conception, and during pregnancy because “a safe level of prenatal alcohol consumption has not been determined.” I repeat: “a safe level of prenatal alcohol consumption has not been determined.”Canada, New Zealand, France and England recommend the same advice.
As yet, science has not established whether it’s safe to drink 1, 2, or 3 drinks during pregnancy or not. We know with certainty that drinking 4 or more drinks a day can cause problems. Perhaps there is confusion because some of the larger medical studies ruled out preterm labor and small babies if a pregnant woman has no more than 10 grams of pure alcohol per day which is equivalent to one drink. However, what they didn’t rule out or even test was whether there is an association between consuming 1 drink per day and alcohol related birth defects and fetal alcohol syndrome. It has been proven that alcohol consumption can have the following effect on children:
- Attention deficit hyperactivity disorder
- Inability to foresee consequences
- Inappropriate or immature behavior
- Lack of organization
- Learning difficulties
- Poor abstract thinking
- Poor adaptability
- Speech, language and other communication problems
According to Uptodate.com, “definitive information about the risks associated with light to moderate prenatal alcohol use remains unknown.” Ladies, why take the risk?
Should bars dispense pregnancy tests in their bathrooms? I say a resounding yes. A healthy pregnancy doesn’t just happen; it takes a smart mother who knows what to do.