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.
March 19, 2012
Is it wrong to be born? That question was asked in front of an Oregon jury who responded in a resounding yes with a guilty verdict of 12 to 0 against Legacy Center for Maternal Fetal Medicine and the Legacy Lab. The jury awarded nearly 3 million dollars to Ariel and Deborah Levy for the wrongful birth of their daughter, Kalanit who was born with Down syndrome although the prenatal tests said that she was normal. Levy was 34 years old at the time of her pregnancy with Kalanit and requested genetic tests. She had two previous deliveries of healthy boys and thought she had completed childbearing. Her pregnancy with Kalanit was a total surprise and she wanted to make sure the baby was normal. A chorionic villus sampling (CVS) was done at 13 weeks and the results were good. Levy breathed a sigh of relief, but not for long.
Although the CVS result was normal, Levy’s two ultrasounds weren’t. They were suspicious for Down syndrome but her physician assured her that she had a normal baby and did not bother to do an amniocentesis. When Kalanit was born, a hospital worker informed Levy that she appeared to have Down syndrome. One week later, the diagnosis was confirmed. Levy and her husband were devastated. How could this happen? Kalanit has a rare form of Down syndrome called Mosaic Down syndrome meaning some of her cells do not have abnormal chromosomes.
The Levys initiated a lawsuit in 2007 for a wrongful birth. They contend that although they love their daughter, had they known she had Down syndrome, they would have terminated the pregnancy. The trial languished for 10 days. The Levys received death threats. The Pro-Life and the Pro-Choice supporters squared off in predictable fashion and I shake my head in frustration. The ultrasound didn’t lie. An amniocentesis was warranted. The Levys did not make an informed decision regarding the birth of their daughter because they were not given the correct data.
Physicians don’t walk on water. On some regretful occasions, we will make mistakes. If for any reason you’re not comfortable with your physician or the diagnosis given, please get a second opinion; or even a third. And above all, trust your instincts.
Was it wrong for Kalanit Levy to be born? I’ll let you be the judge.
February 23, 2012
A lie unchallenged becomes the truth. While I admire GOP candidate Rick Santorum’s decision to raise a special needs child, I certainly wish he would keep his political agendas out of my exam room. Yes, it takes love and courage to raise a child with Trisomy 18, a genetic disorder that’s associated with severe physical and mental challenges. However, this does not make Santorum an expert on prenatal tests and to say anything to the contrary, is both reckless and immoral.
Prenatal tests, especially those that tests for chromosomal abnormalities, are optional. A woman can decline the tests if she chooses to do so and I’ve had patients who have exercised that perogative in the past. But first, let me tell you why these genetic tests are so important. If a woman discovers that she has a baby with Trisomy 21, commonly known as Down’s syndrome, both she and her pediatrician will have time to prepare for possible complications. Many genetic disorders are associated with heart conditions and require immediate surgery after birth. There are instances where the baby is born with a pediatric cardiologist in the delivery room who then whisks the baby away to have a life-saving cardiac procedure. This cannot happen if you don’t have the prenatal test.
In my 25-year career as a physician, I’ve only had 2 confirmed cases of Trisomy 21 and both mothers decided to keep their pregnancies. However, please be aware that there are some genetic disorders that are incompatible with life and the baby expires shortly birth. Most mothers do not want to experience that type of emotional trauma.
Mr. Santorum, please stop using Women’s Health as a stepping stone to gain entrance into the White House. If you can’t campaign for President based on truth and merit, then perhaps you’re not cut out for the job.
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…
December 5, 2011
The umbilical cord of the fetus is the lifeline to its mother. Not only does it carry nutrients from the mother, but it also removes waste products from the fetus. The cord, as it is referred to, plays a very important role in obstetrics. At birth, a sample of blood from the cord is obtained and tested to identify its blood type and make certain the baby has enough oxygen. Traditionally, the cord is clamped immediately after birth or within the first 15 seconds of life to reduce the incidence of jaundice. However, this no longer holds true. A recent article in the New York Times discussed a Swedish medical study that demonstrated waiting 3 minutes or more before clamping the cord reduced the chances of getting iron deficiency in the newborn four months later. The blood of a newborn is unique because it is in its most primitive state and has stem cells. Stem cells are important because they have the potential to grow into many different cells in the body. When clamping of the cord is delayed, the baby essentially receives a blood transfusion of its own blood.
The practice of delayed clamping of the cord is not new but it is usually done after premature births to reduce complications. Delayed clamping of the cord of preemies by 30 to 120 seconds reduced the need for blood transfusions and reduced brain hemorrhages. These benefits were seen immediately. However, in the Swedish study, the benefits of delayed cord clamping were seen at a much later time interval of 4 months. This is was very significant and paves the way for further studies to determine if this benefit will still prevail months or even years later. Should all babies have delayed cord clamping? No not all. Newborns who had fetal distress during labor should not have delayed clamping because there is a greater transfer of blood from the placenta to the baby during this type of crisis. Also, babies who were growth restricted during pregnancy and babies of diabetic moms should not have delayed cord clamping as well.
Delayed cord clamping might play a significant role in the prevention of newborn and infant anemia. It certainly deserves a discussion with your healthcare provider at your next prenatal appointment.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
November 30, 2011
On a recent Sunday in the bathroom of the Baltimore-Washington International Thurgood Marshall Airport, a baby boy made his entrance to life. His mother was approximately 28 weeks and delivered prematurely, however both baby and mother were healthy according to the media. Although the details of the delivery are sketchy, anyone involved in obstetrics can predict what occurred.
The mother might have had a previous history of a urinary tract infection, or complained of back pain. Did her ultrasound reveal a short cervix? Or perhaps she had a history of a previous early delivery. If it was her first pregnancy, did she complain of mild abdominal pressure? Premature labor is one of the most common reasons for birth defects and has a price tag of approximately 26 billion dollars per year. The signs and symptoms of preterm labor often go unnoticed or diagnosed because healthcare providers aren’t paying attention. A urine analysis report showing bacteria in the urine will not be addressed. No inquiry will be made as to whether the patient made frequent trips to the bathroom or whether she drank soda. Soda predisposes patients to urinary tract infections because of the carbonation or bubbly component of the drink irritates the bladder. Untreated urinary tract infections can cause premature labor. A complaint of lower abdominal pressure will be attributed it to “round ligament pain” even though the patient is well beyond 20 weeks when it is most likely to occur. A complaint of back pain will be blamed on the changing shape of the uterus rather than sending the patient to the hospital for further evaluation. In essence, some healthcare professionals keep missing the diagnosis or intervening too late.
According to the American College of Obstetrician/Gynecologists (ACOG) pregnant women can travel up to 32 weeks by air provided they don’t have any complications or high risk conditions. The change in altitude can sometimes cause the “water to break” or the placenta to separate too soon. All pregnant women who plan to travel (especially by air) should consult with the OB provider for advice and instructions. For pregnant women who plan to travel, here are some suggestions:
- Obtain a copy of your prenatal record prior to traveling in the event of an emergency
- Find out the name of the nearest Level 3 hospital where you will be staying
- Do not sit for more than 2 hours without standing for a few minutes to stretch your legs to prevent blood clots.
- If you are complaining of back or abdominal pain before traveling, contact your provider immediately
Fortunately the baby born in the airport bathroom appears to be fine. However not all unexpected births have a happy ending. Pregnant moms, if you have to travel, please don’t push the envelope.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
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.
November 7, 2011
A recent article about the shameful infant mortality rate in the U.S. caught my attention. Certainly the statistics quoted are nothing new but still remains alarming. However, the Op Ed by CNN contributor Deborah Klein Walker gave the subject matter a new spin. Walker wrote “This is one of the greatest injustices in our country: that a baby’s chance of having a healthy life is largely dependent on where he or she is born. States and local communities vary widely in what care their leaders choose to provide to women and children.” If Dr. Walker were present, I’d give her a great big hug for her courage to say what no one else dared. A baby can die based on a hospital zip code.
Every pregnant mother needs to take a mini course in hospital politics because they are directly affected. A hospital is no longer a place of healing. It is a business and at times, ruthless. I have witnessed a colleague forced out of business because she said no when a hospital wanted to buy her practice so they withdrew her admitting privileges instead. I recall bitter battles with my former employer because I would not encourage my patients to deliver at a hospital that was notorious for being under staffed, overworked and a haven for medical errors, simply because of a business relationship that my employer had with thatehospital.
I commend our federal government for initiating programs such as Healthy Start and the new home visiting program, but dependence on government assistance alone cannot guarantee a healthy baby. A pregnant mom must do her due diligence. She must investigate the credentials of the provider and hospital where she intends to give birth. What should a pregnant mom do if she lives in a community or state that has a high infant mortality rate? Give birth at a teaching hospital that’s affiliated with a university or medical school. Most of these institutions receive federal and state financial support and are obligated to provide care to patients.
Can a baby die based on the zip code where it’s born? Unfortunately, yes unless the mother is willing to do her homework and take the necessary precautions to avoid that from happening. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
October 24, 2011
Infertility or the inability to have a baby can be devastating and affects approximately 10 percent of the female population. There are many conditions that prevent women from having children including and Mayer Rokitansky Kuster Hauser syndrome (or MKHS). MKHS is a rare disorder that affects a woman’s ability to conceive. At present, for every 10,000 women, only 1 to 2 will be affected. Both Sara Ottoson of Sweden and Melina Arnold of Australia have this condition. MKHS is characterized by the absence of a vagina and part of the cervix. Patients with this condition have normal breast development and functioning ovaries. Genetically, they also have female or double X-chromosomes and look like normal women. The problem comes to light during adolescence when a teen fails to have a period. The condition is also known as Vaginal Agenesis because they are born without a true vagina, a problem that can be corrected through surgical and non-surgical procedures. Unfortunately, they are unable to have children and usually adopt or use a surrogate mother. Those options, however, might soon change.
Both Ottoson and Arnold plan to have biological children using those mothers’ transplanted wombs next year. The wombs that these women resided in prior to their birth will potentially be used to nurture their unborn babies. Ottoson and Arnold will be making history in the same manner as Louise Brown did in 1978 when she became the first successful “test tube” or In Vitro Fertilization (IVF) baby. Has a womb transplant been attempted before? Yes, about 10 years ago in Saudi Arabia but it was an unsuccessful procedure. After four months, the 25-year-old patient’s body rejected the transplanted uterus of a 46-year old woman. Ottoson will receive the uterus of her 56 year old mother but will not be able to conceive through IVF until she has waited a full year to make certain that her body will not reject the donated organ.
If womb transplant becomes successful, it will also be a powder keg regarding ethical and legal issues. It would also provide an option to women who are cancer survivors and desire fertility. All eyes will be on Ottoson and Arnold next year. It will be history in the making.
October 12, 2011
The fact that Amber Miller did not fall or faint or develop complications while running in the Chicago Marathon is nothing short of a miracle. An ounce of prevention is worth a pound of cure. What on earth was her physician thinking when she was given the green light to half-run half-walk a 26.2 mile marathon? Miller was not your usual runner; she was approximately 39 weeks pregnant.
Although pregnant women are encouraged to maintain an active, healthy lifestyle that includes aerobic exercise, moderation is the order of the day. A woman’s body changes when she becomes pregnant. She has more fluid circulating in her body; hormones from the pregnancy make her ligaments more relaxed, thus she waddles. As the baby enlarges, the diaphragm (aka muscle of respiration) gets pushed up making it difficult for pregnant women to breathe. The heart rate increases and the center of gravity changes as the uterus becomes larger thus, increasing her risk of falling.
Miller participated in 8 previous marathons including one when she was pregnant with her first child. At that time she was 18 weeks. She says that she’s “crazy about running.” As the mother of two sons who were Junior Olympic Track and Field participants, I can relate. However, where is the voice of reason? Prolonged exercise means an increase in heat production which may or may not affect the fetus. Years ago, pregnant women were discouraged from running or performing any exercise that would increase their core temperature for fear it would adversely affect the fetus. Unborn babies cannot regulate temperature because their brains are not fully developed and it is a special part of the brain that controls temperature. In recent years, this rule has been relaxed because the medical studies are inconclusive. However, it is not recommended that pregnant women perform more than 45 minutes of continuous exercise and it should be in a temperature controlled environment. This was not the case with Miller. Although she ate frequently and drank water, she ran and walked for over 6 hours, developed contractions and subsequently went into labor. If her physician gave her permission to run at 39 weeks, then perhaps he or she should have accompanied MIller to monitor the process.
26.2 miles at 39 weeks is not a benign act and I certainly hope this will not become a trend among pregnant women. Can you imagine delivering a baby in the middle of a marathon? It would not be a pretty sight.