August 13, 2012
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.
August 6, 2012
New York Times writer, Anemona Horticollis has written yet another telling story. The Short Life and Lonely Death of Sabrina Seelig describes why entering a hospital could be hazardous to your health.
Sabrina Seelig was a writer, a student and came from a family of artists. Both of her parents previously taught at the University of Art in Philadelphia and then moved to an artists’ colony in Maine. Sabrina eventually moved to my hometown of Brooklyn, New York in a neighborhood that was changing. Like many New York neighborhoods, Bushwick has experienced significant transformation and revitalization, thus attracting young professionals, students and artists. Unfortunately, the neighboring hospital remained unchanged and had been cited for mismanagement, was under investigation by the Brooklyn District Attorney and didn’t carry medical malpractice insurance. Had Sabrina had known those facts; they might have saved her life.
According to The New York Times, Sabrina took Ephedra (a stimulant) to stay awake all night so that she could write her Latin paper for school. She also took an herb called Valerian. Feeling sick, she contacted the public health Poison Control Center after calling an ambulance that never came. The Poison Control Center wasn’t that helpful and basically told her to wait for the ambulance. It’s not clear how Sabrina arrived at Wyckoff Hospital but a cascade of unfortunate events sent her to the grave:
- She was given a sedative that made her sleepy although she had taken Valerian
- Her wrists were bound in restraints
- She was never given oxygen
- She lie on a small hospital cot unresponsive for over 12 hours
- She never received a breathing mask or tube
- She was never transferred to the ICU
- There were few notes written in her medical chart
- She did not have vital signs recorded for over 3 hours despite the fact that she was unconscious
- Her parents had her transferred to another hospital but by that time she was brain dead
- The nurse involved stated “writing vital signs were unnecessary because she was watching the cardiac monitor. “
- Her family had a challenging time finding an attorney who would take the case
- A jury found the hospital not guilty and made snide comments about Sabrina’s alleged drug use
As a physician and parent, I am outraged about the death of Sabrina. Wyckoff Hospital should be shut down immediately.
There are two lessons to be learned from this case. (1) Know your hospital. There is a chapter in The Smart Mother’s Guide that addresses this issue. If a hospital does not carry medical malpractice insurance, RUN in the opposite direction; and (2) to quote Sabrina’s dad, “Never enter a hospital alone.”
June 4, 2012
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.
February 20, 2012
“If we wanted to figure out if a customer is pregnant, even if she didn’t want us to know, can you do that?” This question was allegedly posed to a statistician (Andrew Pole) who worked for Target® back in 2002, according to a New York Times article written by Charles Duhigg, entitled “How Companies Learn Your Secrets.” What an eye-opener.
Pole has 2 masters’ degrees, one in economics and the other in statistics and has developed predictive models to determine whether a woman is pregnant. Why is that important? Are they going to pay your medical bills? Or send you a bouquet of flowers at the time of birth? Give you a year’s free supply of disposable diapers? None of the above. They’re going to try to convince you to buy additional purchases through enticements and “behavioral psychology.”
Why is Target so interested in pregnant women? According to the article, new parents are a retailer’s “holy grail.” Right around a child’s birth, shopping patterns change. Birth records are public so by the time a baby is born, a retailer has lost its advantage, so the key is to reach consumers, particularly pregnant women earlier, preferably in the second trimester. Why the second trimester? Because that’s when pregnant women begin buying things for their babies. Target has established a system and an identifier called the Guest ID that allows them to track and record everything you buy and then keep a record of it. It can buy information regarding your ethnicity, neighborhood, marital status and educational status. Now, I understand why cashiers are always asking for my zip code.
Allegedly, when a woman buys more unscented lotion, vitamin supplements such as magnesium and calcium, there is a significant possibility that she might be pregnant. Purchases of lots of scent-free soap, an extra large bag of cotton balls, cocoa butter and large bags (future diaper bags) signals a close due date. There is even mention of “habit specialists” who are trained to figure out how people think. A Duke University study estimates that 45 percent of our decisions are based on habit. As a result of spying, Target revenues grew from 44 billion to 67 billion dollars between 2002 and 2010.
How can one prevent this intrusion of privacy? By spending cash instead of using credit cards when shopping. Pregnant moms, do you think that Target has crossed the line or are you okay with their policy. Please, weigh in.
December 7, 2011
Like most pregnant women Lynsey Addario was cautious and conscientious. After all, this was her first pregnancy. She called the border officials in advance to make certain that she would not have to walk through an X-ray machine when she entered a country that has been besieged by war for more than 60 years. Unfortunately, Addario was wrong. Dead wrong. She was scanned, not once. Not twice. But THREE times and then made to strip down to her underwear. The soldiers laughed each time she complained. What was so funny? Her 28-week pregnant belly? Or perhaps her vulnerability.
As an American photojournalist with a Pulitzer Prize under her belt, Addario is not immune to danger. She had first-hand experience while on an assignment for The New York Times in March of 2011. At that time, she along with four other journalists went missing for four days in Libya. They were ultimately released but not before Addario was allegedly groped and humiliated by Libyan soldiers. In May 2009 she broke her collar bone in a motor vehicle accident in Pakistan where another passenger was injured and the driver was killed.
The scanning of pregnant Addario evoked an international apology from the country at fault after it received a letter of complaint from The New York Times. There are those who feel the country was justified to radiate and strip search Addario because of its constant assault from suicidal terrorists. There are those who will even cite examples of pregnant women who have carried bombs in places like Ireland and the Middle East. There are those who will place fault squarely on Addario, stating that as a pregnant woman, she has no right to work in a war zone that places both she and her unborn baby in harm’s way. All of these points are quite debatable. Addario’s work focuses on conflicts and human rights issues for which she earned a Mac Arthur genius award of $500,000. My focus is on pregnant women and unborn babies. In November of 2010, I published a blog post on the potential ill-effects of airport body scans and pregnant women. Addario wasn’t carrying explosives. She was carrying a baby. An apology was definitely in order. http://nymag.com/daily/intel/2011/11/israel-sorry-for-searching-pregnant-journalist.html
December 5, 2011
The umbilical cord of the fetus is the lifeline to its mother. Not only does it carry nutrients from the mother, but it also removes waste products from the fetus. The cord, as it is referred to, plays a very important role in obstetrics. At birth, a sample of blood from the cord is obtained and tested to identify its blood type and make certain the baby has enough oxygen. Traditionally, the cord is clamped immediately after birth or within the first 15 seconds of life to reduce the incidence of jaundice. However, this no longer holds true. A recent article in the New York Times discussed a Swedish medical study that demonstrated waiting 3 minutes or more before clamping the cord reduced the chances of getting iron deficiency in the newborn four months later. The blood of a newborn is unique because it is in its most primitive state and has stem cells. Stem cells are important because they have the potential to grow into many different cells in the body. When clamping of the cord is delayed, the baby essentially receives a blood transfusion of its own blood.
The practice of delayed clamping of the cord is not new but it is usually done after premature births to reduce complications. Delayed clamping of the cord of preemies by 30 to 120 seconds reduced the need for blood transfusions and reduced brain hemorrhages. These benefits were seen immediately. However, in the Swedish study, the benefits of delayed cord clamping were seen at a much later time interval of 4 months. This is was very significant and paves the way for further studies to determine if this benefit will still prevail months or even years later. Should all babies have delayed cord clamping? No not all. Newborns who had fetal distress during labor should not have delayed clamping because there is a greater transfer of blood from the placenta to the baby during this type of crisis. Also, babies who were growth restricted during pregnancy and babies of diabetic moms should not have delayed cord clamping as well.
Delayed cord clamping might play a significant role in the prevention of newborn and infant anemia. It certainly deserves a discussion with your healthcare provider at your next prenatal appointment.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
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.
May 30, 2011
“Thank you for taking the time to write and send packages to soldiers. The items provided to me were more than any one soldier could ask for. Words cannot express the way a soldier feels, when they know that their fellow Americans support the effort put in to keeping this world and our country safe. Again, thank you for keeping us in your thoughts and prayers, and thank you for appreciating our efforts.” SPC Garcia
Those words were written by Specialist T. Garcia in response to a Christmas package that I sent her in 2006. I “adopted” Garcia that year along with three other female soldiers who were stationed in Iraq and had made special requests for things that we, in the States normally take for granted.
Women make up 14% of our armed forces and there are approximately 1.5 million female veterans. According to a New York Times article by Lizette Alvarez, more than 100,000 female soldiers who have served in wars are mothers who are primary care givers and a third are single parents. It is not easy serving your country while your children are half-way around the world being cared for by extended families and in some cases, friends and strangers. Such was the case of Willa Townes who was a single mom in the Army Reserve. Her sister had originally agreed to care for her son but then reneged two weeks before Towns was to deploy to Iraq. A former daycare provider who was a non-relative assumed the responsibility which allowed Towns to continue her 15 year military career.
Being a mother and a soldier has its own unique challenges. Long periods away from children can pose many problems upon one’s return. Was there permissiveness during the mother’s absence when there should have been discipline? Have the children’s grades suffered? Is the mother a victim of post-traumatic stress disorder? Nearly 2 million children have seen their parents go to war and some mothers have not returned. The Iraqi and Afghanistan conflict have claimed the lives of 25 mothers out of 121 female casualties. The divorce rate for women in the military is also 2 to 3 times greater than their male counterparts in every branch of the armed forces according to a Huffington Post article by Laura Stampler.
So, while we remember our departed heroes on this Memorial Day, let’s also remember our female soldiers who make individual sacrifices so that we may receive the global rewards. Thank you, my sisters for all that you do.
December 15, 2010
When a pregnant woman goes to work and ends up with a dead baby, something is terribly wrong. Lissedia Batista was a 27 year old Spanish teacher who taught at Exploration Academy in the Bronx and was sixteen weeks pregnant. Given today’s economy, I’m certain that Batista was grateful to have a job with the New York City Board of Education. As a native New Yorker I am keenly aware of how competitive it is to land such a position. Working for the Board of Education traditionally meant job security; a pension and a strong union that took care of its members.
Like many young teachers, Batista had compassion. She attempted to stop a fight between two male students, was pushed out of the way and subsequently fell to the floor. She was taken by ambulance to the hospital but unfortunately experienced a miscarriage. She refused to press charges against the students for fear that they would become incarcerated. Batista’s union, the United Federation of Teachers has called for an investigation; the Deputy Mayor offered condolences and condemnation but it still doesn’t change the facts – Batista’s baby is dead.
At some point in the future, Batista will draw the line and set limits as I did as a resident ob-gyn physician. I was on call one hot summer night and summoned to the Emergency Room at an ungodly hour of the morning. When I arrived, I encountered a woman who alleged she couldn’t remove a feminine hygiene product. Upon examination, I discovered that the product was already gone. The nurse had stepped out of the exam room leaving me alone with the patient. When I told the patient that her condition wasn’t exactly an emergency, she spat on me and attempted to provoke me into a physical altercation. One misguided action could have ended my career and possibly my life. The nurse returned to the exam room not a moment too soon. I had escaped bodily harm this time. The next time I might not be so lucky. I filed a formal complaint with my union and program director and refused to work in the emergency room again.
It was not Batista’s job to stop a student fight. Where was Security? Did teachers have a panic button? Our place of employment should not be hazardous to our health. Perhaps a legal consult is in order.