New Guidelines say Give First-Time Pregnant Women More Time in Labor

Courtesy of Virginiawomen'sbirthcenter.com

Courtesy of Virginiawomen’sbirthcenter.com

The American College of Obstetricians and Gynecologists and The Society for Maternal Fetal Medicine (aka high-risk obstetricians) have issued a new recommendation that is a game-changer in the manner that obstetrics is practiced: allow low-risk first-time pregnant moms more time in labor. This is assuming that the fetal tracing is normal and the mother does not have a fever, high blood pressure or a condition that could compromise her life or the life of her unborn baby. This recommendation is based on new evidence that demonstrates contradicts the old school Friedman Curve theory that active labor begins at 4 centimeters. It actually begins at 6 centimeters. This would be especially helpful to first-time teenage moms who might be forced to have future cesarean sections based on hospital rules and physician opinions if their first delivery was a cesarean section. The “once a C-section, always a C-Section” culture hits this particular group the hardest.
According to the new recommendations:
• Women should be allowed to push for at least two hours if they’ve given birth before, three hours if they are first-time mothers, and even longer in certain cases, such as when an epidural is used for pain relief.
• Vaginal delivery is the preferred option whenever possible and doctors should use techniques — forceps, for example — to assist with natural birth.
• Women should be advised to avoid excessive weight gain during pregnancy.
A word of caution should be offered about these recommendations: forceps deliveries are becoming a lost art and can cause more damage than good in the hands of an inexperienced provider and the “avoid excessive weight gain during pregnancy” is easier said than done for most women.
That being said, these new recommendations gives first-time pregnant women the right to step on the proverbial brakes, the next time someone wants to rush their delivery via a C-section.
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How to Keep a Short Cervix from Messing Up Your First Pregnancy

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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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Brain Dead and Pregnant: A Moral Dilemma

Courtesy of politix.topix.com

Courtesy of politix.topix.com

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.

How can we prevent a Teen Mom from Carrying a Dead Fetus in a Shopping Bag?

Fetus in a shopping bag

Tiona Rodriguez, a 17 year old teen mom was arrested in a New York City Victoria Secrets store on suspicion of shoplifting and accompanied by 17 year-old Francis Estevez, who was also arrested. The security guard looked in the shopping bag and found a foul-smelling dead fetus wrapped in a black plastic bag along with underwear and clothes. Rodriguez informed him that she was 6 months pregnant, had a miscarriage and didn’t know what to do with the baby. She was then taken to Bellevue Hospital, most likely for a psychiatric evaluation. The dead baby was taken to the morgue where it was reported that he weighed 8 ½ pounds and died from suffocation. It is alleged that Rodriguez gave birth at Estevez’s house and from a recent picture on Facebook® where she is wearing camouflage pants and a tee-shirt; it is quite possible that she was concealing the pregnancy. She was allegedly excited about an upcoming interview at a popular restaurant.

There will be those who despise Rodriguez and others who will sympathize with her. Could this tragedy have been prevented? Absolutely and here’s how:

• Rodriguez should have received a long-acting birth control method before leaving the hospital after having her first baby 2 years ago

• All pregnant teens should have at least one home visit during their pregnancy by The Healthy Start Program or the Pregnant Home Visit Program

• Messages about the Safe Haven Infant Protection Law should be plastered in doctors’ offices, prenatal clinics, billboards, text-messages, buses, subways and even on MTV to let families know that they can anonymously leave their baby at a hospital, fire and police departments for three days without getting in trouble

• Adoption IS an option. There are loving parents desperately waiting to adopt newborns and give them a decent home.

A newborn baby took his first breath and then ended up dead in a shopping bag. Who ever thought we’d see this in the 21st century?

A Painful Memory: National Pregnancy and Infant Loss Remembrance Day

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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.

Peeping Toms, Breast Pumps and Obamacare

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While political extremists continue to have a meltdown and hold our country hostage, there is a recent court decision that illustrates just how far a woman’s rights are protected under the Affordable Care Act, aka “Obamacare.”

On March 23, 2010, breastfeeding mothers were given the privilege of receiving time to express breast milk at work, “other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public.” On October 8, 2013, Kent Gordon, a 45 year-old technologist specialist in Portland, Oregon, received a jail sentence of 10 days for secretly using a surveillance camera in the form of a pen, to video tape a co-worker pumping breast milk behind closed doors in the privacy of her office.

 The co-worker was about to resign from her position to become a stay-at-home mom so Gordon entered her office under the guise of collecting information regarding software licensure. After he left, the co-worker discovered the pen on her desk that was attached to a USB drive and alerted her managers via email. According to an article in the Seattle Times “Gordon went back to the woman’s office that evening but realized the pen was not there. He sent an email to the woman and two other female co-workers whose offices he had entered that day, asking if they had seen his pen in hopes that someone had just picked it up.” The next day, he discovered that the email had been forwarded to his managers. When confronted by his superiors, he resigned from his position but was arrested a few days later.

Gordon alleged that he was trying to his company’s intellectual property by the presiding judge didn’t believe him. In addition to spending 10 days in jail, Gordon must dedicate 160 hours of community service and undergo psychiatric counseling.

In the midst of all of the political hoopla and hysteria, we forget that the name of the health law passed in 2010 included the words “Patient Protection.” A nursing mother has a right to expect that she can pump milk for her baby and not have her privacy invaded by a peeping Tom. Did the court go far enough in Gordon’s sentence to prevent him from future offenses? You tell me.

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.