“Help! Our (Pregnant) Mommy is Trying to Kill Us!”

Pregnant mom drives car into the ocean

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.

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How to Keep a Short Cervix from Messing Up Your First Pregnancy

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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.

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How can we prevent a Teen Mom from Carrying a Dead Fetus in a Shopping Bag?

Fetus in a shopping bag

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?

What Will Prenatal Care Look Like in the Future?

In today’s tough U.S. economy, healthcare is in the forefront because of the three trillion dollars spent each year. Patients are not seeing their money’s worth and neither is the U.S. government who writes the check for a large percentage of it. The cost of women having babies too early or prematurely costs our society $26 billion dollars each year. Something has to give.

Women’s health is the topic of great political debate as you may well be aware if you listen to the news or watched both political parties’ national conventions during the past two weeks. Do women control their destinies? Do we and will we continue to have control over our bodies? These are the questions at hand. While there’s great chatter about this topic as the U.S. election nears, there’s also a quiet revolution occurring in our healthcare system that will directly affect pregnant women.

Prenatal care as we know it will begin to change, especially if you receive Medicaid or government sponsored insurance. The current trend is to visit your healthcare provider’s office individually and wait to be seen. In the future, you will be seen by your healthcare provider as a member of a group, not as an individual. This is called enhanced prenatal care with group appointments and will be the wave of the future.

Groups of 10 pregnant women will be seen at the same time for approximately 10 prenatal visits that will last approximately 90 minutes. It is anticipated that 2 healthcare providers will not only take your vital signs, listen to your baby’s heartbeat, but will also allow you to interact with the other patients in this group setting to discuss prenatal issues, receive health education information and any concerns that you may have. Believe it or not, this model of care is not new.  The concept was called Centering Pregnancy and was developed by nurse midwife Sharon Shindler-Rising in 1989.

In the future, doulas and social workers along with midwives will become more prominent in terms of prenatal care as things continue to evolve. Are you ready for group prenatal visits?

Does Fear Prolong Labor?

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.

Why Pregnant Women Need to Know About MRSA

Photo credit: Public Health Image Library (PHIL)

A few years ago, a 20-something year old pregnant woman presented to her physician with complaints of a skin bump that was red and painful. She was told it was a spider bit and given antibiotics. The patient ultimately went in labor but required an emergency cesarean which went well without any complications. Four days later she developed skin lesions and 3 months later she expired after a very stormy hospital course. What did she die of? MRSA, which stands for Methicillin Resistant Staph Aureus.

Staph Aureus (Staph) is a bacteria that can be found on the skin and doesn’t usually cause problems as long as there are no breaks or cuts in the skin. However, if there are cuts and Staph gains entry into the skin, an infection can develop that if often not serious. However, Staph has a very dangerous form that is resistant to the medications that will normally treat it. The resistant form of Staph can cause havoc if unrecognized which can lead to several complications including death. In fact, 20% of people who have (MRSA) dies from this infection because the diagnosis is made too late. One of the most common complaints patients have when there is a MRSA infection is a bump or red lesion on the skin that is misdiagnosed as a spider bite. How do you avoid the misdiagnosis? By knowing who is at risk and what to look for.

MRSA tends to be found in places where there are many people living close to each other such as nursing homes, but of late, several cases are also associated with

  • People who are either in a prison or an athletic facility.
  • Athletes who share towels or razors

People who either work in prisons or visit relatives or friends incarcerated should always wash their hands after a visit.

If you are given a diagnosis of a “spider bite,” request that it be cultured, meaning a Q-tip is used to take a sample from the bump. Sometimes people can have the infection without having any symptoms. This is known as being a “carrier.” Again, if you are given the diagnosis of having a spider bite, ask that a culture be obtained from inside of your nose to make certain you don’t have MRSA.

MRSA can be treated appropriately with the right antibiotics. Medicines that are associated with Penicillin such as Amoxicillin and cephaplosporins will not work.

Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.

When Doctors Won’t Listen (Part 2)

ImageIn Part 1 of Monday’s blog, we learned about Angela Burgin Login, a first-time pregnant mom who was developing pre-eclampsia but the signs were ignored by her physician.  Angela almost lost her life because the recognition of her diagnosis was delayed.  While most pregnancies are uneventful, a “normal” pregnancy will not always mean a “normal” birth. Things can change quickly, especially in the labor room. In order to have a favorable outcome at the end of a pregnancy, the healthcare provider and the patient must be in total agreement regarding expectations and treatment. Sometimes that may not happen. The most important task of a pregnant mother is to select the right provider and Chapter 1 of The Smart Mother’s Guide to a Better Pregnancy addresses this issue in detail. What then should a patient do if her physician is not responsive to her concerns? Here are a few strategies:

  1. Ask that your concerns be documented in your chart and then ask to receive a copy of the chart. If your concerns are still present and not addressed to your satisfaction, call your insurance company, explain the situation and request approval to change providers.
  2. If for some reason, you are not able to change physicians or providers, contact your insurance company, explain yours concerns and dissatisfaction, then ask for approval to obtain a consultation with a high-risk specialist (aka maternal fetal medicine) so that he or she can evaluate your condition to make certain that it’s not high-risk
  3. If you are in labor and are not satisfied with your progress, have a family member or your support person request to speak to the nursing supervisor. When he or she arrives, inform them of your concerns and that you want it documented in your chart. Ask her who is the on-call or consulting maternal fetal medicine specialist and then request an in-house consultation. Simultaneously contact your insurance company, explain your concerns and ask for approval for the consultation advising them that if anything happens to you or your baby, they have been duly notified in advance. Also ask to speak to the hospital’s risk management office as well.

By implementing these strategies, you improve your chances of having a favorable outcome because you are formally documenting your concerns and holding people accountable for your patient care. Your proactive role will protect both you and your child.

Most physicians are compassionate, competent and caring. On rare occasion, you might unfortunately encounter one who needs to be “brought back down to Earth.” If that happens, you now know what to do.

Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.

http://youtu.be/rySO6jqj0ik

Should a U.S. Birth Certificate Equal Automatic Citizenship?

ImageNebraska has recently been on the radar screen for their controversy regarding public funding of “illegal” pregnant immigrants. Although Nebraska’s governor vetoed the bill that allowed funding for prenatal care, the Nebraska legislatures had the good sense to switch the benefits to a state-funded program for children which would include the unborn babies. Should the unborn be penalized because of their mothers’ immigration status?

When the general public hears the word “illegal” associated with the word immigrant, they immediately think of people who are born south of the border. But if the truth be told, there are pregnant women who enter the U.S. as tourists every day, have their babies and then return to their country. Eighteen years from now, these “babies” will be U.S. citizens although their parents never paid taxes or contributed to Social Security.  Is that “illegal?”

Money is usually the deciding factor regarding political policies and these policies affect the unborn. When I worked in public health in the pre-9/11 days, there was a wealthy couple from the Middle East who sought prenatal care.  The wife was very advanced in her pregnancy and her jewelry was worth more than my month’s salary.  My initial impression was “How on earth did an airline allow her to board a plane and travel half-way around the world?” The administrator spoke with me personally to make certain that I would “take care of the patient.”His concern had less to do with the well-being of her baby and more to do with the cash that her husband pulled out of his pocket to pay for her care. He peeled off $2500.00 in one-hundred dollar bills as if they were one-dollar denominations. He then asked how soon could they return to their country after the birth of their child and also mentioned that they were staying at the Ritz Carlton Hotel.

So, which is worse?   A baby born to an “undocumented” immigrant whose husband is under the radar screen and working for minimum wage or a wealthy medical tourist who has a baby that will return 18 years later to claim their rights and privileges as an American citizen? I’ll let you be the judge.

Top 4 Ways Pregnant Women Can Avoid Food Poisoning

ImageThe U.S. Department of Agriculture (USDA) and Food Drug Administration (FDA) are on a mission. One in six Americans become sick each year from food poisoning (aka foodborne illness) and pregnant women are quite susceptible of becoming victims. Why? Because the immune system of pregnant women is lowered thereby making them at risk for developing infections. Specifically, they are at risk for developing illnesses that are associated with Listeria Monocytogenes and Toxoplasma gondii.

Listeria causes a form of food illness called Listeriosis that can cause a miscarriage, premature deliveries, serious illness or death of a newborn. Each year, 2,500 Americans become ill from listeriosis and one out of five cases result in death. Unfortunately one-third of listeriosis occurs during pregnancy. Foods associated with listeriosis can grow slowly at refrigerator temperatures. Such foods include: improperly cooked hot dogs, luncheon meats, cold cuts, fermented or dry sausages and other deli-style meat and poultry.  Raw (unpasteurized) milk and soft cheeses made with unpasteurized milk are also culprits as well as smoked seafood and salads made in the store such as ham, chicken or seafood salads as well as raw vegetables. Symptoms of listeriosis include fever, chills, headache, backache, occasional upset stomach, abdominal pain and diarrhea. It may take up to 2 months to become ill.

Toxoplasmosis is a parasite found in raw or undercooked meat as well as cat litter boxes and other areas where cat feces can be found. It can cause hearing loss, mental retardation and blindness in babies. It can also cause miscarriages and birth defects. Its symptoms include flu-like symptoms that usually appear 10 to 13 days after eating and may last for months.

How can pregnant women avoid getting these foodborne illnesses? By following the four basic steps to food safety: clean, separate, cook and chill food during and after preparation. Wash hands and surfaces often. Use paper towels to clean kitchen surfaces. Rinse fruits and vegetables. Clean lids before opening cans. Separate raw meat, poultry, seafood and eggs from other foods in your grocery shopping cart, grocery bags and in your refrigerator. Never place cooked food on a plate that previously held raw meat. Use a food thermometer when cooking meat and refrigerate or freeze meat, poultry, eggs seafood and other perishables within 2 hours of cooking or purchasing. Refrigerate within 1 hour if the temperature outside ifs above 90°F.

For further information, please contact AskKaren.gov that is a virtual assistant funded by the FDA. www.fda.gov/Food/ResourcesForYou/HealthEducators/ucm081785.htm is another great resource regarding food safety for pregnant moms.

Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.

http://youtu.be/rySO6jqj0ik

What Pregnant Women Can Learn From a Cabbage

ImageIn the Native Americans culture it is said: “If you want to learn the lessons of life, please observe Nature.”

My oldest son brought home a cabbage seedling from school to enter in a contest.  If his plant grew the largest, he would win a $1,000.00 scholarship. For the first 2 weeks he faithfully nurtured the plant but then his attention span decreased as basketball and track gained more prominence on his radar screen. His father felt sorry for the abandoned plant and sat it on top of soil in a larger pot so that it could receive some sunlight. The larger pot represented a burial ground of a deceased plant that had met its untimely demise due to unintended neglect.

A few weeks passed. We assumed the plant was dead. On a lazy Sunday afternoon a hint of spring was in the air as flowers blossomed. The sun shone brightly and my spouse stepped into the backyard to get some fresh air. A few minutes later, he beckoned my son to come outside in a voiced filled with excitement. The cabbage plant was miraculously resurrected. Although still confined to its original container it had somehow dug its way into the soil of the larger pot and was now firmly attached. It was thriving with large, thick green leaves and had a significant growth spurt. What a teachable moment. Ignoring the confines of its container, the cabbage plant sensed a window of opportunity in the form of fertile soil and literally – dug in. We cut away its first container to allow it to thrive even more.

Pregnant moms, a tree is known by the fruit that it bears. The seed within you has the potential to blossom into infinite possibilities if given the proper nourishment. When the challenges of life attempt to intimidate or discourage you be like the cabbage plant and ignore the external barriers. Deflect negativity. It cannot do you harm if you ignore it. Focus instead, on the potential within.

What can we learn from the cabbage plant? We learn that the will to live is far greater than any external challenge.