June 27, 2012
Dr. Linda Burke Galloway advises pregnant women about warning signs of dangerous affairs.
August 24, 2011
What would you do if you discovered early in your pregnancy that you were pregnant with a girl when you wanted a boy? Would you terminate the pregnancy? With the advent of a new DNA test that can determine the sex of a fetus at 7 weeks gestation with a simple blood or urine test, fetal sex selection is now possible. However, before you proceed to pop the cork on your bottle of champagne, a word of precaution is warranted. The Chinese and India dilemmas present a global warning regarding the perils of fetal sex selection. Boys now outnumber girls in China and India and competition is fierce regarding finding a wife or a mate. According the Chinese Academy of Social Sciences (CASS), by the year 2020, there will be between 30 to 40 million more boys than girls in China and the statistics in India is equally as alarming. In her book, Sobs In The Night, by Xinran, she describes a scene where a baby girl is born and the father cries out, “Useless thing” and then the baby is dropped in a bucket and dies. This “son preference” is what has caused the unusually large amount of U.S. adoptions of baby Chinese girls.
Clinically, the gender of a baby is only important if you are screening for gender-related diseases such as Muscular Dystrophy or Hemophilia that has adverse effects on males. Barring those exceptions, testing for fetal sex determination is merely an exercise of curiosity and desire. One of America’s greatest poets was a delightful young man name Mattie Stepanek who had Muscular Dystrophy and lived 13 short but brilliant and magnificent years on this planet. He died 3 weeks before his 14th birthday and was eulogized by former President Jimmy Carter. His words touched the hearts of millions including Oprah Winfrey. What would have happened had his mother decided to terminate her pregnancy because Mattie was a boy who was born with a disease?
According to the Fertility Institute, clinics in Los Angeles, New York and Guadalajara, Mexico, 85% of 500 American couples chose fetal sex determination although 75% of these couples lived abroad. The question is not whether a mother has or does not have the right to terminate a pregnancy. The question is should a pregnancy be terminated because of a fetus’s gender?
Native Americans perhaps said it best: “Nature hangs in balance. It is man that creates the imbalance.” Please be careful what you ask for because you just might get it.
August 17, 2011
Twins. Oh how we adore them. They represent approximately 3.3% of all births in the U.S. and are associated with both joy and complications such as prematurity. When I saw the headlines of the August 14th edition of the Sunday New York Times, I paused to reflect. Have we gone too far?
The article, Unnatural Selection, Ruth Padawer reviews a growing trend among U.S. women who, when pregnant with twins requests that the twins be reduced to one pregnancy. We have grown accustomed to multiple births in our country based upon the increase in the use of fertility drugs. Indeed, 1% of all births and 16% of twin births are associated with the use of fertility drugs. Very few people complain when there is a request to reduce quadruplets (four babies) or quintuplets (five babies) to twins. And who doesn’t remember Nadya Suleman, the controversial “Octomom” who gave birth to 8 babies that were conceived with fertility drugs.
Padawer describes a woman who was pregnant with twins and sought a physician to reduce her pregnancy to one baby. She initially encountered difficulty because most physicians will not reduce a twin pregnancy unless they have a medical indication and feel that the mother is in jeopardy. The word “reduction” is a polite term for termination and very few physicians will terminate one-half of a twin pregnancy based solely upon maternal request. However since a termination of pregnancy is legal, some physicians will reduce a twin pregnancy to a single pregnancy based upon a mother’s request. According to Dr. Richard Berkowitz, a high-risk specialist at Columbia University Medical Center in New York City, “The overwhelming majority of women carrying twins are going to be able to deliver two healthy babies.” As a mother of two sons who are eleven months apart, I can understand the concerns one may have regarding raising twins. However, despite all of the perceived obstacles of raising two children who were born so close together, somehow my sons managed to thrive and their parents have maintained their sanity.
Should twin pregnancies be reduced to one? It’s an individual decision, so please — make it wisely.
August 15, 2011
You know the basics of good oral hygiene: Brush after every meal, avoid sugary snacks and drinks, floss daily, etc. However, what you may not know is that some of the best dental care you can give your children starts long before their first visit to the dentist, or even before those first baby teeth appear.
Believe it or not, good dental health begins in the womb, and making a few important changes to your lifestyle can go a long way toward protecting you and your unborn baby.
Step up your routine dental care.
If you can, try to see your dentist before you become pregnant, and be sure to attend all of your regular checkups as well. That way, your teeth can be professionally cleaned and examined to identify potential dental problems that may impact your baby. Pregnancy causes changes in estrogen and progesterone levels that increase your risk of developing dental health problems such as tooth sensitivity, plaque formation, cavities and gum disease. Plus, mothers with poor dental health have a much higher risk of delivering preterm babies and passing cavity-causing bacteria to their children, so it is especially critical that you take advantage of preventive care during this time.
Eat a well-balanced, teeth-friendly diet.
Nutrition is another important part of good prenatal dental care. Tooth development begins between the sixth and eighth weeks of pregnancy and continues throughout, while hardening of the baby teeth begins at four months. Set your baby up for success by eating plenty of dairy products and other foods rich in calcium and vitamin D, which help with your child’s teeth, gum and bone development.
Minimize the effects of morning sickness.
If you struggle with morning sickness or frequent vomiting, ask your dentist to recommend a bland-tasting toothpaste that you can use throughout your pregnancy. Also, be sure to rinse your mouth out with water or a mouth rinse in order to neutralize the acid caused by vomiting that leads to tooth erosion. If you can, clean your teeth using a paste made of baking soda and water as well.
Become a regular gum chewer.
Make it a habit to chew gum containing xylitol for at least five minutes after every meal. Xylitol has been proven to slow down the growth of bacteria in the mouth, neutralizing plaque acids to fight cavities and restrengthen tooth enamel.
Visit your dentist at the first sign of dental trouble.
If you notice any negative changes in your teeth and gums, such as pain, bleeding, inflammation or infection, schedule an appointment to see your dentist right away. Dental emergencies can be treated during any trimester, and the longer you wait to get treatment, the higher the risk of complications down the road.
Check medications and vitamins with your doctor.
Discolored teeth can result from certain medications and supplemental vitamins that contain iron. Bring your meds and vitamins with you to your doctor appointment so that you can both review whether or not it’s safe for your unborn child. Also be aware of tetracycline, an antibiotic used to treat conditions like urinary tract infections and acne. This drug is known to cause permanent tooth discoloration and affect your child’s growth later in life.
Research shows that following all of these tips can significantly improve your child’s dental development before and after birth.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
July 27, 2011
No one likes pain, least of all pregnant women. Although obstetricians do a great job providing prenatal care and childbirth deliveries, there is always room for improvement regarding patient education.
The management of labor pain is usually delegated to the Anesthesia Department within a hospital or an ambulatory center. The goal of anesthesia is to eliminate physical pain and any suffering that might be a result of pain. However pain and suffering may not always be about cause and effect. To quote the literature, “Although pain and suffering often occur together, one may suffer without pain or have pain without suffering.” Some women want to eliminate pain and others view it as a normal process. However, to the well initiated, it is well known that women who are in pain and “suffering” do not progress as quickly in labor as those who are pain free. For those pregnant moms who would prefer not to have “drugs” here are some options however, please keep in mind that information regarding the safety and effectiveness of these methods is “scientifically” limited, meaning the subjects involved in medical studies to prove whether these methods work or not are small. Having said that, listed below are some of the most popular ways to reduce pain without drugs, however, please consult your physician or healthcare provider prior to using them.
1. Be in an environment that simulates home such as a birthing room. Although home deliveries are increasing, the American Congress of Obstetricians and Gynecologists does not support this method.
2. Continuous labor support such as a doula
3. Immerse in warm water to cover the abdomen and reduce labor pain
4. Sterile water injections in the lower back to decrease back pain
5. Walk around the hospital during the early 1st stage of labor provided your vital signs are stable
6. Touch and massage therapy
7. Acupuncture and Aromatherapy
9. Transcutaneous Electrical Nerve Stimulation (TENS)
10. Obtain childbirth education
Listing these options does not constitute a personal endorsement of any of the methods but is provided to increase a pregnant woman’s options regarding enhancing her birth experience and having a greater sense of control regarding the process.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
July 20, 2011
When we think of skin changes in pregnancy, what immediately comes to mind are stretch marks or Striae Gravidarum . Stretch marks occur because of a breakdown of collagen, a substance that holds the skin together and is responsible for its stretching. Teen pregnant patients are more at risk for having stretch marks. Why is that important? Because, according to medical literature, stretch marks can increase the risk of having lacerations (or tears) during birth.
Another fairly common skin condition during pregnant is called Pruritus gravidarum or generalized itching during pregnant without the presence of a rash. Approximately 14% of pregnant women are affected by this condition and it is associated with twin pregnancies, fertility treatments and diabetes. As stated in my previous blog, itching during pregnancy should not be ignored, especially in the third trimester because it could signify a condition called Cholestasis of Pregnancy that involves an increase in bile or liver enzymes. This condition is also associated with preterm labor.
Hormonal changes of pregnancy that involve estrogen or progesterone can produce skin lesions called spider angiomatas. Although spider angiomatas are associated with pregnancy, they can also be seen in men who are alcoholics.
If you are a pregnant woman who has palms that are red, especially at the fingertips than you have a condition called Palma Erythema. Palma Erythema occurs because of an increase in blood flow in the body and is a way of eliminating heat that comes from the fetus and disappears after the baby is born.
The most common rash that is associated with pregnancy is called PUPPPs (Pruritic Urticarial Papules and Plaques of Pregnancy). It usually develops in the third trimester and has a distinct look. It usually begins in the abdomen, involving the stretch marks and then spreads to the legs, buttocks and thighs. It is extremely itchy and is usually treated with topical steroids. Fortunately, it does not have a negative effect on the fetus.
The most serious skin disorder in pregnancy is called Pemphigoid Gestationis which is a rare, autoimmune disease. The rash begins around the belly button and then spreads to the trunk, buttocks and extremities. It is intensely itchy, can occur at any time of the pregnancy including the post partum period. It is often associated with premature labor, small babies and can recur in women who take birth control pills. It is usually treated with steroids.
Skin rashes during pregnancy should not be ignored or self-treated. At least three skin disorders that are associated with pregnancy can have an adverse effect on the fetus. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
June 15, 2011
Some of the most endearing moments I have witnessed as an obstetrician involved observing men in the labor room. There was the hip Jewish dad from Brooklyn who brought his Anita Baker tape and played it while his wife was in labor. Because she was one of my favorite artists, I was constantly in their room under the guise of watching the fetal monitor, just so that I could listen to the music. Another memorable moment was the dad who cried tears of joy when his wife was returned back to her room after having a c. section. The love and admiration that beamed in his eyes almost tempted me to ask him if he had a friend (this was of course, when I was single). The point is, expectant dads can play a significant role in helping their wives or girlfriends have a healthy baby. Here’s how:
1. Remind the baby’s mother to make certain she feels the baby move at least 4 or more times in one hour.
2. Make sure she knows what her blood pressure is at each prenatal visit
3. Make sure she keeps all of her prenatal appointments
4. Make certain her hospital bag is packed and she has all her important papers in one specific location
5. Ask permission to be in the labor room with her so that you can witness the birth of your child. It is a scene you will never forget and will bring you closer together as a couple.
6. Please don’t cheat on her while she’s pregnant. You could give her an unwanted sexually transmitted infection
7. Encourage her to push when it’s time
8. Rub her back in between contractions
9. Take notes when she’s in labor. If there’s a change of shift, make sure that the new shift knows what went on during the previous shift; particularly if she’s having complications such as high blood pressure or fetal distress on the monitor. One of the greatest risk of OB medical malpractice is miscommunication or a lack of communication during shifts changes. The proverbial left hand doesn’t always know what the right hand is doing.
10. If the nurses become concerned about the baby’s fetal tracing, ask that the doctor or midwife come to the hospital immediately.
The active participation of an expectant father is priceless. In the words of an old R&B classic by the Winstons, “. . . color him father; color him love.” Happy Father’s Day.
May 25, 2011
Less than three miles from the community of my youth, a maintenance worker from the Walt Whitman Projects in Brooklyn, New York heard the sound of a baby crying from a trash compactor and ultimately saved its life. When I was growing up, the trash compactor was referred to as the Incinerator Room because trash thrown down the chute would eventually be burned. Thank God those days are over because Laquasia Wright’s newborn would have died in a blazing inferno.
Neighbors said 18 year old Wright had recently looked worried, as if she bore the weight of the world on her shoulders. A relative described her as looking “lost.” Because she was “heavy-set” as described by neighbors, she was able to conceal her pregnancy until the time of her baby’s birth. They also described her as being sweet. Unfortunately this sweet, heavy-set 18 year old woman who lived with her family in the Whitman Houses is now charged with murder. Every obstetrician, physician, midwife and nurse who doesn’t discuss the state law called the Abandoned Infant Protection Act shares the blame.
As healthcare providers we have failed miserably to inform patients that they can leave a newborn in a hospital, police precinct, firehouse or other safe locations for up to thirty days without fear of penalty or prosecution. As long as the baby has not been harmed, this can be done anonymously. Clearly, this issue needs to be addressed by the American College of Obstetrician-Gynecologists but securing a place on a committee that should address these issues is synonymous with seeking congressional office.
Sure, it would be easy to point fingers at Wright with condemnation but there’s a bigger issue. Information regarding the Abandoned Infant Protection Act should be discussed in high schools, middle schools, plastered on the walls of every public ladies room and discussed from the pulpit. Radio stations and MTV should be sponsoring public service announcements to address this issue. Are there any celebrities in the house? Where are the ACOG leaders? The Office of Women’s Health? How long are we going to have read about babies being dumped in trash cans?
Wright’s baby lived because it landed on a large pile of trash. The next baby might not be so lucky.
May 16, 2011
“But for the grace of God go I.” My late aunt drilled that value into my six-year old head and it has never left. An article regarding a New York politician recently caught my attention. When New York State enacted a bill to ban the shackling of pregnant prisoners, a New York State Assemblywoman objected. The article goes on to discuss the case of Jeanna M. Graves, who, in 2002 was arrested on a drug charge and began a three year sentence. Graves was pregnant with twins and while in labor, was handcuffed during her entire C. Section. How utterly ridiculous.
Before a C. Section begins, a patient is usually given either an epidural or spinal anesthesia. On rare occasions, she is put to sleep with general anesthesia if the baby must be delivered emergently. On all accounts, the patient’s legs will either be numb from anesthesia or she will be sleeping. Why then does she need shackles? She’s certainly not in a position to run. Although I addressed this issue last August, it needs to be revisited again.
Women’s health and pregnancy should not be political agendas. I recently tweeted about another controversial article that blamed the reduced workforce in Memphis on teen pregnancy. Yes, it’s true that 49% of teen pregnancies are unplanned and unwanted but somehow the teens eventually mature and become productive human beings for the sake of their children. Our workforce problems stems from the outsourcing of U.S. jobs overseas, not teenage pregnancy.
Jeanna Graves was not perfect but neither did she commit a heinous crime. She used drugs and had a self-inflicted disease. In the course of my professional career, I have witnessed the most egregious acts corruption, fraud, deception and medical negligence, all under the rouse of helping the poor yet not one administrator ever left the building in shackles or seen the inside of a county jail.
Here’s a question for New Yorkers: Would you really elect someone who approves of shackles on pregnant to be your congressional representative?