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.
June 20, 2012
Imagine giving birth in an MRI machine? Well that’s exactly what a German woman did as a volunteer for a scientific study according to the American Journal of Obstetrics and Gynecology (AJOG).
In November 2010, a 24-year-old woman who had 2 previous children was admitted to a German hospital with regular contractions. She received an epidural for pain management and was allowed to labor in a magnetic resonance imaging (MRI) suite. She delivered a 2585 gram boy whose Apgar scores were 9 after one minute and 9 after 5 minutes. Both baby and mother did well and were discharged home after 2 days in excellent condition.
Most physicians and midwives were taught about the birth process through books and clinical exams. We’re taught that the labor process has three stages:
- The first stage involves active labor that begins at approximately 4 centimeters and continues until the mother is 10 centimeters, also known as fully dilated. During this first stage, the baby has to make certain movements through the birth canal called the cardinal movements. These movements are called engagement, descent, flexion, internal rotation, extension, external rotation and expulsion. So, just like mom is working during the labor process, the baby is working as well.
- The second stage involves pushing once the mother has reached 10 centimeters. This process usually takes 2 hours and slightly more if it’s the mother’s first baby. However, after 2 hours, the labor process needs to be evaluated. Is the baby too big? Or is the pelvis too small for a vaginal delivery? It is at this point that a decision needs to be made whether the mother should have a cesarean section.
- The third and final stage involves the expulsion of the placenta that should occur within 30 minutes after the baby is born.
Now, this entire process has been recorded on a video and has revealed a real-time version of labor that provides a tremendous amount of information regarding the mother’s pelvic anatomy as well as the baby’s. What we learned is that the baby has to navigate a 90-degree turn within the birth canal, extends and then rotates its head before coming out of the womb.
Why is this information important? Because it can allow us to determine who will require a cesarean depending on what we see. It will also allow us to provide a more individualized approach to the labor process. Although MRI observation in the labor room may not happen tomorrow, it certainly has a potential role for the birth process in the future.
May 7, 2012
The subject of paternity has always been a source of controversy and brings to mind an old adage my late aunt used to say: “Mama’s baby. Daddy’s maybe.” Because 50 percent of pregnancies in the U.S. are unplanned, paternity becomes a huge issue when there are multiple partners involved.
What haven’t I seen as an obstetrician? There was the patient who wanted me to change her due date and induce her 2 months early to correspond with her male partner of choice, rather than the baby’s biological father. Of course, the answer was no. It’s also difficult to explain how two parents of one race can produce a baby of another. And then there’s always the pregnant teen whose boyfriend’s mother is demanding a paternity test.
In 2009, an article in the Sunday New York Times Magazine published a story that nearly brought me to tears. Ruth Padawer wrote a story about fathers who had been “duped” regarding their children’s paternity. Who Knew I was Not the Father, is a cautionary tale of men who raised children, paid child support only to discover that they are not the biological father. It was disheartening to read about the profound betrayal these men felt upon discovering the truth.
Traditionally, mothers and fathers would have to wait until after the birth of the baby to determine paternity or have an invasive procedure called an amniocentesis that took a sample of fluid around the baby and tested it against the father’s DNA. Now, things have changed, thanks to modern genetics and Ravinder Dhallan, MD, PhD, who discovered the test through his research. Although fetal cells are present in a mother’s blood, it was difficult to isolate them based on technical difficulties. Dhallan discovered that if he mixed the mother’s blood with a fixative, the fetal blood cells could be obtained. Therefore, rather than have an invasive test that runs the risk of causing a miscarriage or waiting until after the baby is born, the paternity of a baby can be established as early as 8 weeks gestation.
This new DNA tests is a game-changer. It allows women to make informed choices and empowers men to prove or disprove paternity much earlier in the pregnancy. Would you use this test if it were available? Please share your thoughts.
April 30, 2012
We recently celebrated the arrival of a new addition in our family and it was a delivery made in Heaven. Our relative’s membranes ruptured, contractions started and she delivered a healthy baby 45 minutes after her arrival to the hospital. The doctor came 10 minutes before the baby was born and all she had to do was basically “catch the baby.”
Sadly, everyone is not as fortunate. Each month I review medical malpractice cases and shake my head in frustration because many of them could have been avoided if only someone had listened to the patient or paid attention in the labor room. Last week, the listeners of a popular morning radio show listened in horror to Angela Burgin Logan’s interview about her missed diagnosis of pre-eclampsia that almost killed both her and her unborn daughter. Fortunately she lived to tell the story which is now a movie entitled Breathe. Although Angela and her daughter are well, other women have not been as lucky.
Pregnant women need to start thinking in terms of “outcomes” regarding their pregnancy. As the healthcare “industry” moves deeper into the 21st century, healthcare providers and hospitals will be measured and paid according to the outcomes of the patient. You will hear terms such as “pay for performance” and “performance measures” used more frequently. A “normal” pregnancy does not necessarily mean a “normal” outcome at birth (aka healthy baby) if someone misses a sign or a signal of a potential life-threatening problem. Why does this happen? For reasons too numerous to count but the main culprit is lack of communication. A lab report with important results was not reviewed or signed. High-volume practices leave little time to provide quality care for patients and then of course, there is arrogance.
Two of the most empowering things a pregnant woman can do in order to improve her chances of having a healthy baby is to (1) select the right healthcare provider and (2) have strategies at hand in the event that she encounters administrative or clinical complications. In Part 2 of this discussion, I will provide some of those strategies in the event that you have a healthcare provider who will not listen to your concerns. Until then, remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
April 9, 2012
Introducing Guest Blogger Melis Ann: What Pregnant Moms Need to Know About Neonatal Intensive Care Units
Today I’d like to introduce our guest blogger, Melis Ann, who has written a thought-provoking and highly informative article about Neonatal Intensive Care Units and the importance of selecting the right hospital. Melis Ann is a mom and a social scientist who loves to do research to find out the how and why. Her website is http://melisann.hubpages.com
During pregnancy, there are many decisions to make. The most important decision is where to have your baby. Hospitals have different levels of qualifications to deal with life-threatening circumstances that newborn babies may face. Many infants are born premature and need help to survive in a Neonatal Intensive Care Unit (NICU). Many other babies, including full-term babies, are unexpectedly affected by breathing difficulties, heart defects and other birth defects and need emergency care. Understanding what to look for in a hospital, the neonatal nurses, and the NICU will give expectant parents the ability to make an informed decision. See the article at the following link.
February 29, 2012
The State of Wisconsin is being challenged on their policy of requiring unmarried pregnant women to identify the father of the baby in order to receive Medicaid benefits. Once the alleged fathers are identified, the State of Wisconsin requires them to pay for the birth costs. But here’s the controversy: Wisconsin collected $19 million dollars in 2010 which is the most money earned among the 10 states that use this policy.
ABC for Health, a nonprofit Wisconsin law firm is challenging that policy stating that the longstanding practice could contribute to the state’s high black infant mortality rate. Why? Because, according to ABC, having to identify the father “may discourage unmarried pregnant mothers from getting timely prenatal care services.” The State of Wisconsin encourages collection agencies to be aggressive because it keeps 15 percent of the money.
While the altruism of ABC is admirable, its logic is completely off-base. Based on my 25 years of clinical experience working with Medicaid patients, I can assure you that late prenatal care is not based on fear of repercussions for identifying paternity. A delay in obtaining prenatal care for most women involves waiting for their insurance benefits to begin. Or not wanting to take time off from work to keep prenatal appointments. Or using poor judgment and waiting until the last possible minute to show up for prenatal care because they didn’t have any significant problems with their previous pregnancy. Please do not use infant mortality as an excuse to keep fathers for assuming their financial responsibilities. It’s like comparing apples with oranges. While it’s unfortunate that the State of Wisconsin receives what could only be described as a “commission” for obtaining payments from expectant dads, those payments provide necessary funds to a cash-strapped state funded program. Conversely, the State of Wisconsin should not abuse the system by committing extortion.
If a woman is reluctant to divulge the name of the father of her baby, please don’t eliminate her Medicaid benefit. Dig deeper and find out why.
February 13, 2012
There are moments in life that break your heart and the untimely death of Whitney Houston is one of them. Although most people remember Whitney as a celebrity, I remember her as a daughter and cousin of a very talented musical family. Her mother, Cissy Houston sang background for Elvis Presley, Aretha Franklin and Bette Midler. Her cousins Dee Dee Warwick and Grammy Award winning Dionne Warwick were famous in their own right. Growing up in New York City gave one a clear advantage regarding seeing talented singers before they became outright stars. Such was the case of Whitney.
I was entertaining an out of town friend and decided to see Cissy Houston in concert at a club in Greenwich Village called The Bottom Line back in the early 80’s. As always, Houston gave a stellar performance and then announced that her daughter, Whitney, would sing a solo. The pride on Cissy’s face was priceless but she was also quite annoyed. The pianist played the wrong tempo as Whitney was singing. Whitney was barely 17, thin, statuesque and had a voice that left the audience spellbound. I was not surprised to hear years later of Whitney’s 40 million dollar contract with a record company. She had a gift that ultimately made her a star but of course, there was also tragedy. Her troubled marriage to Bobby Brown ultimately ended in divorce but out of that marital union emerged the birth of her daughter Bobbie-Kristina who is now 18 years old.
One of Whitney’s last projects was producing an old remake of the movie Sparkle which is scheduled to be released in August 2012. In the movie, she plays a mother to three daughters who are aspiring to be professional singers. In an interview about the movie, Whitney stated that she was able to play the role of a mother based on her real-life role as a single mother, which she described as one of her greatest achievements.
The untimely death of Whitney Houston is a strong reminder that life is fragile. That our days are numbered. That we should live our lives fully; completely; but also responsibly. How do you say goodbye to an icon? With tremendous difficulty.
Goodbye, Whitney. Thank you for your musical legacy. May your family be comforted during these moments of grief.
January 18, 2012
Although most women will spontaneously develop labor by their due date, there are exceptions to the rule. Some women may have to be delivered earlier because of complications such as high blood pressure, pre-eclampsia, diabetes, poor fetal growth or low amniotic fluid. Other women may have to be induced because they have exceeded their due date by one to two weeks. Why are inductions of labor necessary? When the conditions within the uterus or a medical condition pose a threat to either the baby or the mother, the baby must be delivered. While most labor inductions are successful, there are some questions that pregnant moms need to ask in order to increase their chances of having favorable outcomes.
- Is my cervix favorable? The softer the cervix, the greater the chances are of having a successful vaginal delivery. If the cervix is not “favorable” or soft, medicine will be necessary to make the cervix softer, usually in the form of suppositories.
- How long will the induction take? This is a legitimate question because the longer the induction takes to occur, the greater the risk of developing complications such as infections. Most inductions of labor and delivery occur within 48 hours of admission. First-time moms dilate 1.2 centimeters per hour while moms who have had previous children dilate at 1.5 centimeters per hour. It can take up to 20 for a 1st time mom and 14 hours for a mom with previous children to develop active labor (meaning she is dilated 4 centimeters) but thereafter she should deliver within the next 12 hours. A 3-day induction of labor is a red flag that there might be potential problems that could compromise the health of the unborn baby or mom.
- If you are being induced, break your water but are not having contractions, ask your provider whether he or she will give you antibiotics to prevent infections. The longer your membranes are ruptured, the greater the risk of developing an infection.
- A multiple-day induction of labor involves many providers and nurses who will be changing shifts. Sometimes things or information gets lost in the transition. Ask who the lead person or team leader is regarding your care and make sure everyone is on the same page regarding your information. Try to obtain this information, BEFORE you are admitted to the hospital.
- Trust your instincts. If things appear complicated during your labor, ask for a maternal fetal medicine consult. These are high risk OB doctors who specialize in managing complications.
Most of the medical malpractice cases that I have reviewed as an expert have involved the issues discussed above. To be forewarned is to be forearmed.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what do to.
December 21, 2011
When I think about Christmas, I instinctively think about the miracle of birth. Four million miracles (aka births) happen in our country each year and many more occur globally. On a hot summer night in the urban community of Harlem almost 30 years ago, I witnessed my first miracle as a volunteer and was never the same again. The mother was a young teen who had been pushing for approximately forty-five minutes. She suddenly let out a piercing scream and out popped the hairy head of baby who started to wail. The mother sat straight up and peered down at the baby whose body had yet to be delivered. The delivery nurse admonished her to lie back down so that the baby could be delivered properly. Oh what a humorous and miraculous sight. I was in complete awe.
The events leading up to the birth of a baby are amazing. It begins with fertilization. The male sperm cannot fertilize an egg until it undergoes specific changes. It has the task of finding the egg which lies outside of the uterus. Does it turn left or right to enter the fallopian tube? Only Nature knows for sure. In order to fertilize the sacred egg, the sperm must change its shape so that it can penetrate the egg’s protective barrier. Once fertilized, the egg must travel from the fallopian tube back into the uterus and implant into the uterine lining to begin its miraculous journey towards the human experience.
All paths to greatness begin with a journey. Sometimes that journey is simple. At other times it might be complex. Let us remember the journey of the three wise men that followed a star that led them to a special baby in Bethlehem. And may we also remember that each of our lives began in a most miraculous way.
I wish all of my readers a very Merry Christmas and happy holiday.