December 28, 2011
It’s an obstetrician’s worst nightmare and it continues to happen on a daily basis. The story of Michal Lura Friedman brings tears to my eyes. After 7 years of trying, the 44 year old songwriter finally became pregnant –with twins. Her husband, Jay Snyder, a free-lance voice-over artist, describes the 9 months of Friedman’s pregnancy as pure bliss. However towards the end, her blood pressure became elevated so she was scheduled to have a C. Section the day after Thanksgiving.
Snyder accompanied his wife to the hospital and witnessed the birth of his babies. Then Friedman began to bleed. And bleed. And bleed. At 9:30 p.m., she became yet another U.S. maternal mortality statistic.
At least 2 women die from complications of childbirth in the US daily. Some celebrities such as Christy Turlington Burns have become a Maternal Health Advocate as a result of first-hand experience. She had a near-miss childbirth experience but lived to tell the story. Many women, including Friedman, don’t. The American Congress and College of Obstetrician-Gynecologists (ACOG), will have both Burns and Tonya Lewis Lee, the wife of renowned director, Spike Lee as spokeswomen on the topic of maternal mortality at the 2012 Annual Conference in San Diego. However, we need much more. There are obstetricians who have worked on the front-lines managing high-risk patients for years who can’t get a seat on ACOG’s policy committees and it is frustrating. Here are a few questions that should be asked at the hospital where Friedman expired:
- She had a short stature with a uterus stretched to the max with two babies. Was the possibility of hemorrhage considered?
- When her blood pressure became elevated, was it controlled prior to doing the C. Section knowing the risk of possible HELPP Syndrome that is associated with pre-eclampsia?
- Was there an OB Rapid Response Team?
- Was a Bakri balloon used once the bleeding couldn’t be controlled with uterine massage or meds?
- Was the prospect of a problem anticipated BEFORE it occurred or was there chaos trying to find appropriate meds and equipment as the tragedy unfolded?
Pregnancy is not a benign act contrary to what most people believe. Things can and do happen, most often when the hospital staff is unprepared and ill-equipped to handle an emergency. My heart bleeds for Jay Snyder. He is 41 years old, a new father and now a widow who must take care of two beautiful children, who will never know their mother. With all due respect ACOG, talk is cheap. More action must be taken to stop this.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do…
October 17, 2011
It is said that when one wants to learn the mysteries of life, observe Nature. To everything there is a season, but what are the chances that twin sisters would give birth on the same day? Alicia Teepler and Ari Ostler are identical twins . Their own births were miraculous when you consider that there was one fertilized egg that split into two during their conception. They shared one amniotic sac, one placental connection with their mother and one common birth date. Now, their children do as well. Ostler gave birth to a baby boy on October 7th and 43 minutes later Teepler gave birth to a baby girl. Both sisters had exceeded their due dates and were induced. Ostler requested an epidural for pain management while Teepler opted for natural childbirth. Both moms’ deliveries had an abnormal amount of amniotic fluid and their babies had nuchal cords, meaning the umbilical cord was wrapped around their necks but they were easily removed at birth. Surprisingly, both labors progressed at the same pace.
Sometimes miracles are in plain view and we discount them as mere coincidences. I recall the time when I had a patient who was in labor and ultimately delivered a baby girl on her daughter’s birthday. She now had two daughters born on the same day. Or the patient who had a miscarriage with a twin pregnancy after she had relocated to another state. She returned pregnant again and an ultrasound was ordered to confirm her dates. When I initially reviewed the ultrasound report, I thought there had been a mistake. The ultrasound report’s findings indicated twins. However, I quickly discovered there had not been a mistake. The patient was pregnant with twins – again. She went on to have a successful delivery. Then there was the patient who had lost her daughter to undiagnosed heart failure at the age of four and was understandably anxious when she became pregnant again. She ultimately delivered a baby girl on her deceased daughter’s birthday. As an obstetrician, these experiences have made me both happy humbled.
“Life is not measured by the number of breaths we take, but by the moments that take our breath away.” The births of these twin sisters, Teepler and Ostler’s babies can certainly be counted as one of them.
September 19, 2011
In 2007, Melanie Jaggard went to the hospital for a punctured ear drum and was given the shock of her life. She had cancer; a very rare form that was located at the base of her brain.
Adenoid cystic carcinoma (ACC) is the second most common cause of salivary gland cancer but can affect other areas of the body. Melanie is one of only 20 to 25 people in the United Kingdom to have ACC and had a 2-inch tumor was removed from her head following a delicate 10-hour operation. She was single at the time, cancer free and one year later met the love of her life, Charlie Jaggard, on an online dating site. Charlie proposed three months after their first date and life was good, until she received the news that the cancer had returned, this time metastasizing to her lungs. Surgery was not an option because the tumors were too numerous and radiation was too risky to the lungs. However the couple was not discouraged. They married in January 2009 and Melanie decided to be a victor rather than a victim. Although 89 % of people with ACC survive after 5 years only 40% survive after 15. Melanie has a life-span of 15 years and she and Charlie have both decided to look at the glass as half full rather than half empty. After careful consideration regarding Melanie’s condition and prognosis, they decided to start a family.
Melanie is now pregnant with twins and is very optimistic about her future. While there may be people who will criticize her for starting a family, the Jaggards are convinced that 10 to 15 years will give them time to raise money for a cure or at least discover medicines that can shrink the tumor. Approximately 1 in 1500 pregnancies is affected by cancer. Melanie holds the distinction of being the only pregnant woman to have ACC in the medical annals thus far. She is treading in unchartered water but optimism will be her guide.
Lucius Annaeus Seneca once said: “Sometimes even to live is an act of courage.” Hopefully one day her twins will thank her.
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.
April 13, 2011
Twin pregnancies have always kept me in wonder and awe, especially at the time of a delivery. At present, they represent 33% of all live births and their numbers are rising thanks to the increase in older women who are successfully conceiving through In Vitro Fertilization (IVF). Fertility drugs account for a 70% increase in multiple births. Are you at risk for having a twin pregnancy? You are if you have:
- Advanced maternal age
- Are African or African American
- 3 or more children
- A tall height or are obese
Unfortunately twin pregnancies can be complicated and everyone must be appropriately prepared.
Twins can be divided into 3 categories: monozygotic (identical); dizygotic (fraternal) and conjoined. In a monozygotic (MZ) pregnancy, only one egg was fertilized but “split” and then divided. MZ pregnancies represent the greatest risk for complications because the babies share the same placenta and circulatory system. One baby can have too much fluid and the other baby not enough. This is called a twin-twin transfusion or TTS. Dizygotic twins involve the fertilization of two eggs and have two separate placentas. It is more common, representing 69% of all pregnancies. Conjoined twins result when a single, fertilized egg only partially splits and the babies share a delay or a partial split from when there is a delay in the division of the fertilized egg and the babies share are physically connected. This is sometimes referred to as Siamese twins and represents a very poor prognosis in terms of survival. ALL twin pregnancies are at risk for preterm contractions and delivery and therefore are high risk. I am therefore perplexed when patients with twin pregnancies are not referred to a high risk specialist for a consultation.
At minimum, patients with twin pregnancies should have
- Monthly ultrasounds to document appropriate fetal growth. The number of ultrasounds might increase as you get closer to the due date
- Nonstress tests beginning at 32 weeks to document fetal well being
- A well thought out delivery plan in a level 3 hospital with a pediatrician waiting in the delivery room
Twins are a joy but remember their pregnancies are high risk. If you are pregnant with twins and no one has recommended you to see a high-risk specialist, make some noise . . . loudly. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
Check out my informational pregnancy video!
April 11, 2011
Olympic winner and motivational speaker, Jim Stovall once said “Integrity is doing the right thing, even when no one is looking.” In September 2009, I wrote about a blog about Carolyn Savage, a 40 year old woman with a poor obstetrical history. Savage married her college sweetheart and had an uncomplicated first pregnancy. However, her second child was born prematurely. She had 4 subsequent miscarriages and ten years later she became pregnant through in-vitro fertilization (IVF). Because the Savages wanted a large family, they tried IVF again. Unfortunately, Savage was impregnated with the wrong embryo. To their credit, everyone rose to the highest level of integrity. The infertility clinic informed the Savage family as soon as the mistake was discovered and then gave them the option of terminating the pregnancy or continuing it. The Savage family then had to inform the rightful parents of the embryo that were not expecting to have a baby any time soon but was now faced with that dilemma. Savage ultimately delivered the baby and then handed it over to its rightful parent, the Morrell family.
When bad things happen to good people, we are perplexed and often wonder why. I remember feeling despondent as I wrote the blog. A woman had delivered a healthy baby but was leaving the hospital with empty arms. A blatant systems error had reared its ugly again reminding physicians that we are all fallible, despite our years of strenuous training and hard-earned credentials. Yet, the book of wisdom reminds us that everything works for our highest good despite the tragedies that are seen through the lens of our human experience.
Fast-forward 2 years later: the Savages hired a surrogate mother (aka gestational carrier) who was pregnant with their baby but subsequently had a miscarriage. However the Savages didn’t give up and they are now pregnant again, through their gestational carrier with . . . . twins. When Carolyn Savage leaves the labor and delivery suite this time, her arms will be filled with not just one baby, but two. Who says life can’t have a happy ending? We wish the Savage family the very best as they prepare for their joyous occasion.