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.
July 9, 2012
Amber Scott is a very lucky woman. She was 38 weeks pregnant and had complained about a headache all day which was mistakenly thought to be a migraine. It wasn’t. More than likely it was pre-eclampsia and somehow the diagnosis was missed. Amber’s husband told her to lie down and presumably left the house. He attempted to contact her throughout the day and when he arrived home, he found her unresponsive with one eye open and the other closed. She was moaning and had vomited. When she arrived at the hospital, an emergency c-section was performed and Amber’s baby was saved. It was determined that Amber had a blood clot to her brain which was removed surgically as well as part of her skull in order to avoid damaging her brain. Amber was in a semi coma with a guarded prognosis but miraculously, she had progressed enough to see her baby 6 weeks after the delivery.
Amber is able to move her right side but will require many months of rehabilitation. Some women are not so lucky. A pregnant woman that has complaints of a severe headache needs immediate attention. If she’s in her third trimester, it should be assumed that she has preeclampsia until proven otherwise, especially if the headache doesn’t go away after taking analgesics. Headaches are usually the first sign of high blood pressure in a pregnant woman and should not be ignored. Complaints of headaches associated with blurry vision, abdominal pain, swollen hands or feet and “spots” in front of their eyes needs to be addressed immediately even if it means going to the hospital first before calling your midwife or physician.
The definitive treatment for preeclampsia is the delivery of the baby because it is the placenta that is thought to contribute to the rising blood pressure. If the blood pressure becomes too high, a woman may have a seizure, also known as eclampsia and suffer a stroke that could be potentially fatal.
Headaches during pregnancy should never be ignored or assumed to be a migraine and requires an immediate blood pressure checks. Taking this precaution might inevitably save your life.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
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.
May 3, 2010
Although most pregnant women anticipate a normal, uncomplicated delivery, there are exceptions to the rules. A shoulder dystocia is one of the more frequent complications in the delivery room and unfortunately there is no sure-fire way to predict it.
A shoulder dystocia means that extra maneuvers must be done to deliver the baby’s shoulders. If not managed properly, the baby could sustain permanent injuries to its neck and arms. The most common scenario is the successful delivery of the baby’s head but the rest of its body is “stuck.”. Once this occurs, the mother’s thighs should be flexed back as much as possible towards her abdomen. This is called a McRobert’s Maneuver. Here are things that should NOT be done if there is a shoulder dystocia:
- Pulling on the baby’s head in an attempt to deliver shoulders
- Pressure on the top of the uterus (aka fundal pressure) in an attempt to deliver the baby. This only aggravates the problem more. A better approach would be supra pubic pressure meaning gentle pressure right above the bladder in order to help dislodge the baby’s shoulders
- More than three attempts to deliver the baby with a vacuum extractor
Although a shoulder dystocia cannot be predicted, there are women who will have risk factors for its occurrence and include:
- A woman who has a short stature of 4’11 or less
- A woman with Gestational or Type 2 Diabetes
- A woman who has gained more than 50 pounds during her pregnancy
- A woman who has had a previous shoulder dystocia
- A woman who has been pushing for greater than 2 hours
- A woman who had had a difficult or prolonged labor
- A woman with an estimated fetal weight of 10 pounds or greater
Contrary to popular belief, an ultrasound does not predict which babies are at risk for having a shoulder dystocia. However, if you have any of the risk factors above, it is not unreasonable to ask your OB practitioner if they’re prepared to handle a shoulder dystocia should it occur.
Although I have said this many times, it still bears repeating: A healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.