December 12, 2011
Sometimes Fate has to shout in order to be heard, especially when the voice of reason is ignored. Michelle Duggar was pregnant with her 20th child to the aghast of many including this author. We squirmed in our seats. We moaned. We groaned. We blogged. The combination of Duggar’s 19 children and her advanced maternal age of 45 is enough to make any obstetrician or midwife cry, especially when she becomes pregnant, yet again. Not surprisingly, Duggar experienced a miscarriage with pregnancy number 20. According to media reports, when the Duggars presented for their ultrasound, a fetal heart beat could not be obtained. What occurred in obstetrical vernacular was a missed abortion or an early fetal demise. Based on the Duggars’ press release, his wife probably had no symptoms prior to receiving the ultrasound. The cramping, spotting, abdominal and back pain was probably absent. An early fetal demise without symptoms or missed abortion means the baby stopped growing because there was a condition present that was incompatible with life. Did Duggar’s age increase her chances of having a miscarriage? Absolutely. 93.4% of woman who are over 45 will have a miscarriage. Or put another way, only 6% of pregnant women over age 45 will deliver a baby. 7% of all women Duggar’s age will have an ectopic (tubal) pregnancy and 8.2% will have a stillbirth. One out of 19 pregnant women who are age 45 will have a baby with Trisomy 21 or Down’s syndrome. So should we be surprised that Duggar had a miscarriage? No. And no one is gloating over her misfortune. A miscarriage for any family, even those with 19 children is lamentable. However, most pregnant women who have experienced a miscarriage will attempt to conceive again. In the case of Duggar, this would be a profound tragedy. Mrs. Duggar, you have our condolences regarding your miscarriage. Millions of people enjoy coming into your home each week and think you are delightful. However it is out of our profound concern for your well-being that prompts us to implore you. Please don’t push the envelope any further. Please give your uterus a well-deserved rest.
September 14, 2011
Every year there are approximately 4 million babies born in the U.S. and most will arrive in a hospital or a Birth Center. However, there are moments when this may not be the case. In the past 4 years the number of home births has increased by 20% and these births will hopefully be attended by a midwife or someone skilled in childbirth. But then, there are those unexpected births that no one was prepared for; the ones that occur at the most inopportune time and place, even on an airplane in flight. These are the ones that the mother never “saw” coming, although she might have experienced warning signs but didn’t take heed.
Most unexpected deliveries occur because of prematurity. What are the signs that a pregnant woman should not ignore?
- Low back pain that lasts for greater than an hour. This is typically how premature labor begins.
- Abdominal pressure that lasts for greater than an hour
- Leaking fluid from the vagina
- A sudden urge to have a bowel movement
Any of these signs requires an immediate trip to the labor and delivery suite as soon as possible.
If you are bleeding (especially passing clots), get off your feet and attempt to lie down on your left side while someone prepares to take you to the hospital. If the blood is bright red, this is a medical emergency because the placenta might be separating and the baby might be depleted of oxygen.
If your membranes rupture (water “breaks”) and there is a rope-like structure hanging from your vagina, it could be the baby’s umbilical cord. Call 911 immediately and do not allow the cord to be squeezed or manipulated. Lie down, preferably with your feet lifted on pillows with the cord undisturbed. This is ca cord prolapsed which means the baby’s in a breech position (feet first) and is an obstetrical emergency.
If you have a strong urge to have a bowel movement at home that is associated with contractions or abdominal pain, be aware that this could represent an impending delivery. Sit on a bed or floor with your knees separated to see if someone can visualize the head of the baby. If so, call 911 for guidance and further instructions. If the baby should be born unexpectedly, gently rub its back to stimulate crying and keep it warm in a blanket until the emergency technicians arrive.
Although you assume that your delivery will be “normal,” it never hurts to be prepared for the unexpected. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
March 29, 2010
At some point during her pregnancy, a patient might complain of dizziness or “fainting.” However, the challenge is to determine if this is an isolated incident or does the patient need additional tests?
True fainting (or syncope) means that there has been a temporary loss of consciousness and the patient is no longer standing. This usually occurs when there is a temporary decrease in the blood flow to the brain. The most common reason patients faint is because of low blood sugar (hypoglycemia), especially during the first trimester. However, hypoglycemia does not explain all reasons for fainting.
During pregnancy, the blood vessels are opened wide (dilated) which sometimes decreases the amount of blood flowing within the chambers of the heart. It therefore beats slower. A slow heart beat (aka bradycardia) produces symptoms of dizziness or fainting. However, there are also serious conditions that also cause fainting and it’s important to know the difference. Listed below are examples of fainting that require additional tests:
- Fainting associated with a loss consciousness that lasts for greater than 15 minutes
- Fainting associated with loss of urine
- Fainting preceded by shortness of breath, light-headedness, chest pain and a fast heartbeat
- Fainting associated with significant disorientation, weakness of limbs, numbness and abnormal movements
Items 1, 2 and 4 require a neurology consultation to rule out a seizure disorder or a space-occupying tumor. Item 3 requires a cardiologist (heart specialists) to look for heart problems or, on rare occasions, a blood clot in the lungs. These are extremely rare conditions that most pregnant women will never experience.
Most pregnant women can avoid fainting episodes by drinking lots of fluids, avoid prolonged periods of standing, get up SLOWLY if sitting down for long periods of times and wear stockings that improve circulation. Thankfully, unless fainting has been associated with a serious condition, there will be no harm to the baby.
May 4, 2009
Just when I think I’ve heard and seen it all, something pops up that proves me wrong. Both Amy Gates” article, Home birth advocate’s baby dies during free birth: Do you blame or show compassion? And Cate Nelson’s Unassisted childbirth one woman’s story, gave me reason to pause. Both journalists discuss the March 27th death of Janet Fraser’s infant daughter and the controversy regarding unassisted childbirth.
Fraser is an Australian advocate of the unassisted childbirth movement that encourages pregnant women to deliver babies alone without the benefit of a midwife, a doctor, or a hospital. She used phrases such as “birth rape” to describe a delivery assisted by a healthcare provider. Please. As a descendent of a slave midwife and an obstetrician I am highly offended. Birthing is in my genes. There is nothing more satisfying than assisting in the delivery of a healthy and crying baby be it by midwife or physician. Heck, even a cow gets a c/section when necessary.
Cate’s article described a woman who had an “orgasmic” unassisted delivery during the birth of her daughter and then made frozen smoothies out of the placenta that she ate for the next thirty days. A placenta smoothie?
A reality check is in order. Forty percent of women died in childbirth during the 19th century but less than one percent, or 520 women today; and even those deaths are preventable. Do we really want to proceed in reverse? Perhaps members of the “unassisted” crowd would like to trade places with women in Sierra Leone and Afghanistan, who have the world’s highest number of childbirth deaths.
We need our babies born healthy and alive. All of them, without exception. The adverse outcome of the Fraser’s “unassisted” delivery speaks for itself. Here’s hoping she’ll never experience it again.