The three children (ages 3, 9 and 10) and the unborn baby of Ebony Wilkerson are lucky to be alive, despite the fact that she drove her van into the frigid Atlantic Ocean. Two hours prior to this horrific event, the Daytona Police interviewed her, deemed that she was sane and left. The day before, a local hospital kept her overnight for mental health observation for 24 hours and then sent her home. If I were the sister of Ebony Wilkerson, I’d speed-dial liability attorneys and then immediately request Wilkerson’s medical records because obviously someone dropped the proverbial ball.
Wilkerson’s sister knew something wasn’t right because Wilkerson exhibited paranoia and kept discussing Jesus and demons that she felt were controlling her. She had fled South Carolina because she believed that her ex-husband was attempting to kill her. Eerily, Wilkerson is from the same state where Susan Smith drove her children into the ocean 20 years ago and blamed the crime on an unknown man. Unlike Smith, whose children died; Wilkerson and her three children were gratefully rescued by a heroic group of men who selflessly plunged into the water to save them.
Kudos goes to Wilkerson’s sister who had the wisdom to call law enforcement and report her sister’s bizarre behavior and hide her car keys. Unfortunately Wilkerson had another set of keys. What’s troubling about this case is how Wilkerson was able to sign herself out of the hospital and how she fooled the police to thinking that she was sane which meant that didn’t have to “Baker Act” her or commit her to the hospital . I find it hard to believe that Wilkerson could walk out of a hospital after seeing a psychiatrist which leads me to speculate that perhaps the hospital didn’t have a psychiatrist on duty at the time.
Law enforcement officers are not trained mental health specialists. In the future, when they are called for a suspected mental health issue, a better approach might be to take the individual to the hospital, despite the appearance of a person’s “calm demeanor” and let the experts make or rule out the diagnosis of mental illness.
Mental illness is not a joke, America. It claims innocent lives every day.
If you start prenatal care early enough (in the 1st trimester), you will inevitably have to decide on whether you want to be tested for potential genetic problem such as Down syndrome (aka Trisomy 21) or other life-threatening genetic conditions. Terms such as non-invasive prenatal tests (aka NIPS), Integrative Screens and Alpha-Maternal Serum Testing will be hurled at you along with very specific time tables for getting these tests done. Ideally, you should receive extensive counseling so that you may make an informed decision but quite often this is not the case.
Knowing the difference between screening and diagnostic tests is a great way to begin your decision-making process. A screening test identifies potential problems and requires additional testing. A diagnostic test provides a definite answer. Diagnostic tests in the first trimester include chorionic villi sampling (aka CVS) and amniocentesis is usually done in the second trimester. Both of these tests are invasive and carry a small risk for miscarriages. Risk factors such as advanced maternal age (meaning greater than 35) also affect a pregnant woman’s decision because the risk for Down syndrome increases with age. The risk of having any type of genetic disorder is 1 in 190 for women age 35 and 1 in 65 for women age 40.
NIPS have gained in popularity over the past decade because they have a less than 2% false positive rate for detecting Down syndrome by the 10th week of pregnancy but this rate increases slightly for other lethal genetic problems such as trisomy 13 and 18. They work by measuring the amount of fetal DNA found in the mothers’ blood stream. This test does NOT test for open neural tube defects such as Spina Bifida.
The integrative screening test is also done in the first trimester by measuring four pregnancy hormones in the mother’s blood and requires an early ultrasound to measure the baby’s neck (aka “nuchal test”) to rule out Down syndrome and has a false positive rate of approximately 5%. It also requires a second trimester Maternal Serum Alpha Fetal Protein test to rule out open neural tube defects.
The NIPS tests are not cheap, require insurance coverage and costs between $800 to $2700. They also cannot determine future heart problems, whether you’re having twins or other fetal abnormalities. But again, they are the most accurate test regarding screening for Down syndrome.
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Acetaminophen (the generic brand of Tylenol) is one of the most prescribed drugs for pregnant women around the globe to treat fevers and mild pain. It was thought to be safe but now researchers in Denmark have just disrupted the obstetrical community by suggesting that there is an association between taking acetaminophen during pregnancy and hyperactive children who are diagnosed with attention-deficit/hyperactivity disorder.
This is a profound disappointment to most prenatal care providers whose options are limited in what they can prescribe to pregnant women, especially for a fever. It appears that acetaminophen breaks up hormones and according to the researchers, “abnormal hormonal exposures in pregnancy may influence fetal brain development.”
Although the study reports investigating over 62,000 children, a word of caution must be exercised before making the assumption that acetaminophen is not safe for pregnant women. Remember that in this study:
• There was a stronger association between ADHD and acetaminophen if the mother took it for more than one trimester
• The researchers do not know exactly how many pills the pregnant mothers took
• The risks were greater for pregnant women who took large amounts of acetaminophen throughout their pregnancy
• They do not know if pain is associated with an increased risk of developing ADHD
According to the director of the Maternal-Fetal Medicine program at the Cleveland Clinic, it is important to remember that an association of acetaminophen and ADHD is not the same thing as saying acetaminophen causes ADHD and for that reason, he will continue to provide acetaminophen to his pregnant patients advising them to take it in the manner in which it is prescribed.
The take-home message is that most physicians are not going to change their prescribing patterns based on this study. Please consult with your physician or midwife before taking acetaminophen and only take them as prescribed.
Remember, a healthy pregnancy doesn’t just happen; it takes a smart mother who knows what to do. If you like what you read, please like me on Facebook at https://www.facebook.com/SmartMothersGuide or Twitter, email@example.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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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.
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?
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
There might be something wrong with either your genes or your partner’s. Another reason to see an infertility specialist.
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.
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.
Are you pregnant and smoke cigarettes? Then please consider taking take Vitamin C.
Years ago, Vitamin C was frequently in the spotlight because of the scientist, Linus Pauling who made the bold assumption that it was the cure for the common cold. While that topic is still subject to debate, it appears that Vitamin C has been proven to help pregnant mothers who smoke.
The dangers of smoking during pregnancy are well known. Not only does it increase the risk of developing lung cancer, it can also increase the chances of having a small baby, the placenta separates too soon before the birth of the baby (also known as a placenta abruption) and preterm labor. There is also an increase in Sudden Infant Death (SIDS) and pre-eclampsia.
At a recent international medical conference, the Oregon Health and Science University presented a medical study that looked at pregnant smokers who were aged 15 and older and gave them 5400 mg tables of Vitamin C. They compared these women with those who smoked but did not take Vitamin C. Of course, both groups of women were counseled to stop smoking but continued during the course of their pregnancy. At birth, the infants of both groups were given lung tests and the Vitamin C group had better results. These results are significant because babies of smokers can also have breathing problems and death before the age of 28 days.
The researchers plan to test the babies again at age 12 months to see if there are any differences between babies of the same age who have wheezing problems.
Does this study give pregnant women who smoke the green light to continue? Of course not, but if they can’t stop smoking then taking Vitamin C might help reduce some of the harmful effects smoking has on their newborn.
Until next time, remember – a healthy pregnancy doesn’t just happen, it takes a smart mother who knows what to do.