August 20, 2012
Is He Serious: “Legitimate Rape Rarely Causes Pregnancy”
Really? Since when did GOP Representative Todd Atkin complete a residency program in obstetrics and gynecology? Or for that matter, attend medical school?
In a television interview with KTVI-TV in Missouri, Representative Atkins allegedly said:
‘It seems to me, from what I understand from doctors, that’s really rare,” Mr. Akin said of pregnancies from rape. ”If it’s a legitimate rape, the female body has ways to try to shut that whole thing down. But let’s assume that maybe that didn’t work or something: I think there should be some punishment, but the punishment ought to be of the rapist, and not attacking the child.”
What an outrage! Someone really has to draw the line. First, you mandate a diagnostic test such as ultrasonography prior to pregnancy terminations and demand that the woman view the fetus. Then you tell women they can’t have birth control on one hand and then condemn them if they have an abortion on the other. And now you have the temerity to suggest that the human body can categorize the atrocity of rape into a “true-false” mode. Are you kidding me?
So what are you saying, Representative Atkins? Do you think a rapist’s sperm is color-coded so that the ovary will put up a barrier to prevent its penetration to a woman’s egg? Will the fallopian tube sound an alarm when the process of fertilization comes from a rapist’s sperm? How will the human body be able to differentiate the sperm of a rapist from the sperm of a consenting adult? Will a woman’s body produce shock waves to the rapist upon his unlawful entry? How will a woman’s body be able to “shut that whole thing down?”
Do these candidates get screened for intelligence? Atkin’s statements are both reckless and unequivocally false.
“A lie unchallenged becomes the truth.” Please do not allow this lie to prevail.
August 15, 2012
My Baby is Still Breech and I’m 37 Weeks. Help!
You’re 37 weeks pregnant with your first baby and your doctor or midwife tells you more than likely the baby is not going to turn. What should be done?
This is a dilemma that pregnant women face on a daily basis. Up until 36 weeks, the position of the baby can vary from feet first (breech), buttocks first (frank breech), head first (cephalic) or transverse lie (the baby is lying in a horizontal position). However, after 36 weeks, the position of the baby normally doesn’t change because there is not enough room for the maneuver.
This becomes a significant challenge for first-time moms who have what we call, an “untried pelvis” meaning there’s never been a birth so it’s not certain whether the pelvis could accommodate a breech presentation. Delivering a breech baby takes a tremendous amount of skill because the baby’s head is the last part of the delivery and could theoretically get “stuck,” something we want to avoid. This is why most first-time pregnant moms have c-sections if their baby is in a breech position.
Some physicians will attempt to do an external cephalic version, commonly known as an “external version” if they think they can manually turn the baby from a breech to a head down position. This is usually done by an obstetrician or family practice physician in rare instances. The procedure is successful in 65% of cases but here are a few things one should be aware of in order to make an informed decision.
- An ultrasound should be done prior to the procedure to make sure they are no fetal anomalies
- There should be enough fluid around the baby but not over 20 centimeters
- The baby should weigh at least 4.5 pounds but not more than 8.5 pounds
- The baby should be in a “back up” position, meaning it’s back is facing the front of the abdomen
- RhoGham should be given if the patient is Rh negative
- The procedure should be done in a hospital in the event of complications
- The procedures should be done preferably by a high-risk specialist (maternal fetal medicine specialist) or someone who has done at least 30 procedures hopefully with a success rate
- The baby should not be in a footling breech position because the umbilical cord could become injured during the procedure
- No more than 3 attempts should be made
- The procedure should be done under ultrasound guidance
- Terbutaline is usually given to relax the uterine muscles before the procedures starts
- The baby should be monitored for 30 minutes after the procedure is finished
Should your provider suggest an external version, you now have the facts. If the procedure is not successful, do not worry. Better safe than sorry. A c-section does not mean failure. It means all options were taken and it is the safest way to have a healthy baby.
July 16, 2012
Cooling Procedure Saved Pregnant Heart Attack Victim; What Happened to the Baby?
A 33-year-old pregnant woman at 20 weeks collapses while attending a church function and a physician at the scene began receives CPR (cardiopulmonary resuscitation). According to a recent article in the Annals of Emergency Medicine, emergency workers arrive and shock her heart out of a life-threatening irregular heart rhythm and 25 minutes later, it beats in a normal pattern. The patient however, appears to be in a coma which occurs when the brain doesn’t receive enough oxygen. The hospital physicians enter unchartered water and perform a procedure that has rarely been done in pregnant women. They cooled her body temperature to 90 degrees, a procedure known as hypothermia for an hour in an attempt to improve her condition and then slowly rewarmed her body back to its normal temperature in order to save her life. It worked and during the procedure an ultrasound showed the fetus shivering.
Heart conditions during pregnancy are rare, affecting only 1 to 4% of patients. This particularly patient had a condition called cardiomyopathy which is an enlargement of the heart, causes heart failure and is often fatal. It is a disease that hits close to home because it killed my grandmother six months after she delivered my aunt. The heart is considered a pump that helps circulate blood throughout the body and heart failure means the “pump” is not working properly. No one knows exactly why cardiomyopathy occurs but it tends to affect
- women over 30
- African American women and
- women who have several children
Fortunately, the patient had a device implanted 8 days after her heart attack that helped her heart beat in a normal pattern. The patient was discharged home from the hospital after 10 days, returned to work in 4 weeks and then delivered a normal baby boy at 39 weeks who weighed 5 lbs. 15 oz. The baby was evaluated at 1, 2, 3, 6, 12 and 36 months of age and is completely normal.
Although hypothermia has been used as a treatment for heart attack victims since 2005, pregnant women were previously excluded. However as a result of this case, I suspect they won’t be excluded anymore.
July 9, 2012
Why Pregnant Women Shouldn’t Ignore Headaches
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.
June 27, 2012
Pregnancy Shouldn’t be a Deadly Affair: Critical Advice That Could Save Your Life
Dr. Linda Burke Galloway advises pregnant women about warning signs of dangerous affairs.
June 11, 2012
Should All Newborns With Low APGAR Scores Get the Cooling Blanket?
I had first heard about the cooling blanket a few years ago when a friend of mine told me a story that could only be defined as a miracle, at least for an obstetrician. A newborn had the lowest possible Apgar score of 1 and did not die. Not only did the baby live, but it never had a seizure and appeared to be doing well. It was a jaw-dropping moment for me because the prognosis of an infant who is born with extremely low Apgar scores is extremely poor. This infant was given a cooling blanket, something I had never heard of.
A cooling blanket is given to newborns in an attempt to lower their temperature to 93 degrees Fahrenheit for 2 to 3 days and then their temperature is eventually raised. By lowering the temperature, neurological damage is minimized or prevented entirely. Newborns with low Apgar scores have a multitude of problems including respiratory problems and seizures. These babies and their families suffer emotionally as they wade through layers of specialists in an attempt to give their children a “normal” life. There is great debate whether these children were born with special needs prior to their mothers being in labor or did their brain injuries occur as a result of negligent care in the labor room?
A recent medical study looked at children who had received the cooling blanket as infants and the results are promising. Although some of the babies eventually died, others lived and at ages 6 and 7, do not demonstrate mental retardation, blindness or physical handicaps that are associated with low Apgar scores. Doctors now want to do further research and change some of the protocols. They want to lower the infants’ temperatures even lower by 1.5 degrees, keep them on the blanket for 5 days as opposed to 3 or do a combination of both to see if they can achieve even better results.
So pregnant moms, this is one more thing you need to investigate when selecting a hospital or physician. If I were pregnant, would I want to deliver in a hospital that offered a cooling blanket? Absolutely. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
June 6, 2012
New Hope for Women Over 40 Who Are Trying to Conceive
In my 25 years of clinical experience as an ob-gyn physician, I have seen our specialty evolve, especially in the area of infertility. In Vitro Fertilization (aka IVF) has come a very long way since its first “test tube baby,” Louise Brown, back in 1978. When I was attempting to conceive (unsuccessfully), the price of IVF was exorbitant and it had a very low pregnancy success rate. 34 years later, the landscape has changed.
When women delay childbearing after age 32, they increase the risk of developing infertility and pregnancy complications significantly. It is now recommended that women over 35, who have not conceived after six months of having unprotected sex seek further evaluation as opposed to waiting a year. Women who are 40 or older and trying to conceive should be seen by a high risk specialist immediately. Women who are less than age 35 have a 41.7 % percent of conceiving as opposed to women over 42 who only have a 4.1% of conceiving.
If a woman over age 40 attempts to conceive through IVF, egg donors are her only option if the quality of her ovaries is poor or the number of eggs is reduced. However, the Center for Human Reproduction (CHR), a New York fertility center claims to have increased the pregnancy rate of women over age 44 to 10.3% through the use of a male hormone, DHEA. CHR takes pride in its reputation as being the fertility center of “last resort” and managing “aging” ovaries. According to its medical director, Norbet Gleicher, MD, the majority of their patients had failed IVF cycles somewhere else and were turned away by other fertility centers if the patients didn’t want to use donor eggs. Gleicher claims his fertility center succeeds where others have failed and allows older women to use their own eggs during the IVF cycle.
It would be helpful to see more medical studies done to prove whether adding a male hormone such as DHEA does in fact, increase pregnancy rates of women over 44. If these findings are true, it would take the treatment of older infertility patients to an entirely new level.
My hope is that all infertility patients will one day experience the joys of motherhood whether by IVF, or in my case, through the miracle of adoption.
June 4, 2012
Thirteen Thousand Addicted Newborns
A New York Times and an American Med News article gave me reason to pause. Each year approximately 13,500 newborns are born addicted to prescription opiates.
Neonatal abstinence syndrome (NAS) occurs when babies who are born to opiate-addicted mothers who more than likely received their meds from a prescription. The number of pregnant women using opiate drugs has increased five-fold from 2000 to 2009.
The problem had become so rampant in Florida that state legislators finally took action after it became a national embarrassment. To the chagrin of the Florida governor, 1 in 7 people died from prescription drug overdoses and the state held the title as the pill-mill capital of the nation.
Now a law that requiring each opiate prescription be filed in a data base by the prescribing physician. There’s nothing like good old fashion documentation to put physicians in check.
During the 1980’s crack-cocaine addiction was rampant. Despite the socioeconomic stigma, addicted pregnant women willingly came forward requesting treatment in order to save their babies. Addiction was treated as a disease and the mothers received rehabilitation that included medically supervised withdrawal and psychiatric counseling.
Those days appear to be over. In Alabama and other states, pregnant women’s addictions are now criminalized making it extremely difficult for them to divulge their addiction or receive treatment. The consequences are severe. 31% of newborns born addicted to opiates have breathing problems, 18% have feeding problems and 2% have seizures.
Denial is a terrible disease. Despite significant problems, my medical colleagues are reluctant to address the issue and in some instances, they’re part of the problem. Doing a urine toxicology test takes time, especially if it’s positive. No one wants to call social service. Why? Because it’s a time-consuming and frustrating process that some physicians would rather avoid. And what are the consequences? 13,500 addicted newborns.
Unfortunately, the problem of NAS will continue until healthcare providers and policy leaders take a pro-active stance. Addiction is not a crime. It’s a disease. Throwing pregnant women in jail is not going to solve the problem and I blogged about that issue recently. How can we improve this problem?
- Provide mandatory universal urine toxicology tests for all pregnant mothers, whether in a public or private setting.
- Perform an immediate referral to social service if the urine toxicology test is returned positive
- Physicians should not prescribe a 30-day supply of pills for a 4-day problem. This is what causes unintended addictions
Should doctors who prescribe painkillers to pregnant women be liable if the mother becomes addicted? Please, weigh in.
May 30, 2012
Why is Preeclampsia Misdiagnosed?
Preeclampsia is a pregnancy condition that involves high blood pressure, swelling and protein in the urine. Risk factors for developing preeclampsia include:
- 1st Pregnancy
- Age; young teens and women over 35 are at greater risk
- Obesity
- History of diabetes
- History of hypertension
- Family history (mother, sister, aunt) of preeclampsia
The typical preeclamptic patient has a blood pressure of 140/90 or greater with protein in the urine and swollen ankles in the late 3rd trimester. She may often complain about a headache. This patient is fairly straightforward, but what happens if these symptoms present in a patient who is only 31 weeks? Or 27 weeks? Some healthcare providers will try to “buy time” and “treat the patient with bed rest or blood pressure meds” and she ends up having a seizure or a stroke. The only treatment for preeclampsia is delivery of the baby because it is the placenta that’s causing the problem. There’s something in the placenta that causes the blood vessels to squeeze and increase the blood pressure. Once the placenta is delivered, the blood pressure usually comes down but a woman can have preeclampsia and the risk of having a seizure for 96 hours after birth.
A patient may have a blood pressure of 120/80 with a measurement of 3+ protein in the urine. Her normal blood pressure is usually 90/60 and she has gained 5 pounds in one week. Yet her physician or midwife thinks this is normal. It’s not. They have been lulled into a false sense of security because her blood pressure is 120/80 and not 140/90. This patient should have her blood pressure repeated 2 more times within a 6 hour period and if it remains high, the diagnosis of preeclampsia is made. She should also have her urine collected for 24 hours to determine if there’s significant protein.
Why is preeclampsia often misdiagnosed? Because healthcare providers view the abnormal signs of pregnancy as “normal” variants. They’re not. A headache that doesn’t go away, a sudden increase in weight gain, swollen feet or ankles needs further evaluation as well as significant protein in the urine. If you think you have preeclampsia but your healthcare provider disagrees, by all means, call your insurance company and request a second opinion.
Remember, a healthy pregnancy doesn’t just happen it takes a smart mother who knows what to do.
