11 May | 2013

When Mother’s Day Becomes a Day of Mourning

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Mother's day

I will never forget her face; the laboring patient in Room 4. Although it happened almost 20 years ago, her memory is forever etched in my mind.

She was older, perhaps in her 30’s and about to deliver her first child. We disconnected the fetal monitor from her abdomen, gathered her IV but the moment we sat her up as we unlocked her bed, she lost consciousness. Although it took less than a minute to transport her from the labor room into the delivery room, she lapsed into a coma. The OR nurse tore open the instrument tray as the chief and senior residents scrubbed and gowned. A code called to the delivery room needed no further explanation. They zapped her body several times with electrical paddles but there was still no pulse. While the Code Team did CPR on the other side of the drape, the chief and senior residents did the C. Section at reckless speed. When they pulled the baby out of his mother’s womb, he barely cried while I on the other hand, sobbed uncontrollably. I couldn’t believe that we had just lost a mother.

The baby lived but the autopsy revealed that his mother had an amniotic fluid embolism, which meant that either fluid or fetal cells entered her blood stream and essentially caused a heart attack. I will never, ever forget the look on her husband’s face, when we informed him that she had died. It was my first exposure to a maternal death as an obstetrician and thankfully my last.

For most families, Mother’s Day is a holiday but for others it’s a day of mourning. Each day thousands of women enter U.S. hospitals to give birth and two of those women will end up dead. One-third of all births end with complications and 92 women will have nearly missed death. This is totally unacceptable however, the seriousness of this condition has finally reached center-stage.

Several organizations, including Unexpected.com and Lucina Maternity have launched a campaign called “Save a Mother’s Life” to raise public awareness about preventable maternal deaths and start programs in an effort to reduce bad outcomes. The American College of Obstetricians and Gynecologists (The College) and the Society for Maternal-Fetal Medicine (SMFM) have also jumped in with an independent program. It is now time for all of us to roll up our sleeves and become actively involved.

This blog is In memory of all the mothers who entered a hospital to have a baby but never returned safely back home.

 

 

 

Filed Under: childbirth death, Dr. Linda Burke-Galloway, Family, High-Risk Pregnancy, Ob-Gyn, Parenthood, Physician Care, Pregnancy, pregnant women Tagged With: , , , , , ,
10 May | 2013

Pregnancy and Dental Problems, Part 2

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As previously discussed in Part 1, dental problems and pregnancy has been a long-standing problem based on limited access of pregnant women to dental services. This is especially true for pregnant women who have Medicaid coverage. However, your obstetrician should be your advocate and assist the dentist in treating your dental problems safely. Here is an excerpt from the Smart Mother’s Guide to a Better Pregnancy that will hopefully help pregnant moms work around this dilemma:

  1. Try to avoid having procedures before twelve weeks if possible
  2. Obtain a letter from your obstetrician advising the dentist what type of treatments you can have and what you can’t have while you are pregnant
  3. Make sure that your dentist always covers you with a lead apron if you require x-rays
  4. Avoid extractions and invasive procedures until after delivery, if possible
  5. Do not use tetracycline antibiotics because they will stain the fetus’s teeth
  6. Make sure you have antibiotics after tooth extractions. (I managed a patient during my residency training many years ago who died from infections after having an extraction because she didn’t receive antibiotics.)
  7. Consult your healthcare provider before using ibuprofen (Motrin, Advil) or naproxen (Aleve) for pain because these medications can potentially reduce the fluid around the baby.
  8. If you are having challenges trying to find a dentist who will see you, try to find a federally qualified community health center that might have a dentist on staff. You should also contact your health insurance plan to see if they can refer you to a dentist who is on their provider panel.
  9. If you are experiencing dental pain and are having challenges finding a dentist who will see you because of your Medicaid insurance, contact your Congressman’s office. They have staff assistants who are paid to help their constituents.
  10. If you live in a community that has a dental school, see if they will see you as a patient. Yes, you will have student dentists taking care of you but they will be under the supervision of a licensed, practicing dentist.

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

 

 

 

Filed Under: Dr. Linda Burke-Galloway, High-Risk Pregnancy, The Smart MOther's Guide to a Better Pregnancy Tagged With: , ,
7 May | 2013

Dental Problems and Pregnancy, Part 1

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Are you pregnant, poor and need to see a dentist? Well, God help you according to a recent article in the New York Times by Catherine Saint Louis.

Hats off to Ms. Saint Louis for her expose of a quiet little secret that has existed for decades: pregnant women with dental problems have a very challenging time being seen and it’s shameful.

Luatany Caseres, was a 34 year old factory worker in Durham, North Carolina who had an abscess so bad that her “swollen cheek bulged as if a lollipop were stuck there.” Caseres was in her second trimester and was refused treatment three times because of her pregnant condition. Luckily, she was finally seen by a fourth-year dental student was trained at a new prenatal program at the University of North Carolina at Chapel Hill.

The article goes on to quote an alarming statistic of 77% of pregnant women in the U.S. who were denied dental care.  Hopefully these statistics will land on the desk of the U.S. Secretary of Health, Kathleen Sebellius, but I won’t hold my breath waiting. While it’s nice to quote statistics and point fingers of blame and shame, there is a larger issue that needs to be addressed which of course involves money.  Present Medicaid policy dictates that preventive care (fillings and cleanings) are only provided to patients until the age of 21 and will only pay for extractions for anyone older. Until that policy changes, the refusal of dental treatment for pregnant women will NOT go away.

Dental care in pregnant women is such an important issue that it was discussed in Chapter 5 of The Smart Mother’s Guide to a Better Pregnancy.

Yes, there are dentists who are initially uncomfortable taking care of a pregnant woman but once the obstetrician gives them additional information regarding “do’s and don’ts,” most  dentists in my experience will accommodate the patient.

Tomorrow, in Part 2, I will discuss the “do’s and don’ts” of dental care for pregnant women.  I strongly encourage all pregnant moms to read Catherine Saint Louis’s New York Times’ article. Information is power.

http://nyti.ms/10Ds9JI

 

 

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1 May | 2013

10 Things Every Pregnant Woman Needs to Know About Pre-eclampsia

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Courtesy of WebMD

Courtesy of WebMD

May is Pre-eclampsia Month, a time to empower all women about the dangers of this very deadly disease. It has claimed the lives of many women, including the grandmother of Vanessa Williams. Although it has been described as far back as the days of Hippocrates, we still don’t have a cure in the 21st century.

Pre-eclampsia is a condition that involves high blood pressure, swollen feet or ankles and protein in a pregnant woman. It can occur anytime after 20 weeks but usually develops in the third trimester and affects up to 7.5% of pregnant women worldwide. Why is it so dangerous? Because the blood pressure can reach such high levels that a woman can have a seizure or a stroke and die. It can also reoccur for up to 6 weeks after the baby is born, is frequently and regretfully often misdiagnosed.  How is it treated? By delivering the baby and therein lies the dilemma. Sometimes it occurs so early that some healthcare providers will either miss the diagnosis or are hesitant to deliver the baby because of its prematurity. The baby has to be delivered because the placenta is abnormal and must be removed.

Pre-eclampsia is sneaky and the diagnosis is not straightforward so here’s what you need to know to make certain that no one will miss the diagnosis:

  1. A severe headache that doesn’t going away with acetaminophen needs an immediate blood pressure check.
  2. Blurry vision needs an immediate blood pressure check
  3. A blood pressure of greater than 120/80 needs the attention of a doctor immediately
  4. Swollen hands, feet or a puffy face, needs the immediate attention of a doctor
  5. If you’ve developed 5 pounds in one week, see your doctor immediately
  6. If you had pre-eclampsia during childbirth, are sent home and develop blurry, vision or a headache, call your doctor immediately
  7. If you had pre-eclampsia during childbirth, are sent home and develop shortness of breath, return to the hospital immediately
  8. If you had pre-eclampsia during childbirth and are sent home, you should have a repeat blood pressure check at your doctor’s office in one week for follow-up
  9. If you had pre-eclampsia during childbirth and are sent home with a blood pressure that’s greater than 120/80, you should either have been given a prescription for medication or a return appointment to see your doctor in 2 to 3 days for follow-up
  10. If you’re blood pressure keeps going up during your pregnancy and your clinician doesn’t do anything about it, ask for a referral to see a high-risk specialist (aka maternal fetal specialist)

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

Filed Under: babies, birth complications, Blog, Celebrities, Dr. Linda Burke-Galloway, High-Risk Pregnancy Tagged With: , , , , , ,
24 Apr | 2013

An Open Letter to Hallie Berry: Pregnant at Age 46

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Courtesy of E!

Courtesy of E!

Dear Hallie:

You don’t know me but 6 years ago, I sent you a copy of my prenatal book, The Smart Mother’s Guide to a Better Pregnancy and your agent sent it back with a rude note attached. No worries. I don’t hold grudges.

Congratulations on your pregnancy at the blessed age of 46 but with your advanced age, I’m sure you’re aware of the potential risks. I would have sent this message via video but my 11 and 12 year old camera men (aka my sons) are still in school.

Women with advanced maternal age have to be extremely careful for a multitude of reasons and you, especially because you are a Class C Diabetic, meaning you have been a diabetic for over 20 years. In fact, you might want to read a blog I wrote entitled Pregnancy After Age 45 is a High-Risk Dilemma when you have a moment. Unfortunately you’ve joined a very unpopular sisterhood of celebrity women who had pregnancy complications that almost cost them their life. Don’t believe me?

  • Salma Hayek had Gestational Diabetes
  • Mariah Carey had pre-eclampsia and Gestational Diabetes with twins
  • Tori Spelling had a Complete Placenta Previa that required her to be hospitalized for 10 weeks
  • Jane Seymour had pre-eclampsia and an emergency cesarean section
  • Brook Shields had post-partum depression

Hopefully, you are under the care of a maternal-medicine fetal specialist (high risk pregnancy doctor) who will closely monitor your diabetes. In fact, it might not be a bad idea to seek out an endocrinologist as well. Because of your age and high risk condition, you should:

  • Have a 1st trimester blood test for possible genetic disorders including Down syndrome and Spina Bifida
  • Have monthly ultrasounds to document fetal growth because of your diabetes
  • Have weekly Nonstress tests beginning at 32 weeks
  • Not fly in a plane (even a private one) after 32 weeks to reduce your chances of breaking your water based on the difference in barometric pressure at 32,000 feet above land
  • Pay attention to fetal movement because of the increased risk of stillbirth with older women and especially those who have diabetes
  • Plan on being delivered by 38 weeks because of your diabetes

I wish you a healthy and wonderful pregnancy but remember: a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.

 

Filed Under: babies, birth complications, Celebrities, Dr. Linda Burke-Galloway, Family, Mothers, The Smart MOther's Guide to a Better Pregnancy Tagged With: , , , , , , , , , , ,
22 Apr | 2013

The Boston Bombing: A Teachable Moment in Parenting

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Alleged shoplifter and mother of Dzokhar Tsarnaev and Tamerlan Tsarnaev

Zubeidat Tsarnaev, alleged shoplifter and mother of Dzokhar Tsarnaev and Tamerlan Tsarnaev

Pregnant moms, please indulge me as I veer off-topic today in the aftermath of the Boston Marathon.

As I deboarded a plane yesterday, I observed a young woman sporting a bright green baseball cap with the letters, BOSTON emblazoned on the front. Obviously, she was making a statement perhaps as a sigh of relief that the 19-year-old bombing suspect, Dzokhar Tsarnaev was captured and his 26 year-old-brother, Tamerlan Tsarnaev, was dead.

I’m not surprised that the Tsarnaev family ended up in Boston seeking political asylum because the city has a long-standing history of preserving freedom and helping the oppressed. The Revolutionary War and the Underground Railroad are just brief examples of that admirable commitment.

I can’t begin to explain why the Tsarnaev Brothers committed such a vile act but I do want to discuss their mother, Zubeidat Tsarnaeva. Allegedly, she purports that her sons were “set up” and is in denial of their actions. I wish I had a dollar for every parent whom I’ve met that, like an ostrich, stick their heads in the proverbial sand rather than admitting that their beloved children can inevitably “mess up” and in some instances, “mess up” royally.  The fact that we, as parents can raise our children to do the right thing only to find out that they didn’t listen to us is shocking and painful. Oh, don’t I know it.

This past Friday, while I’m hundreds of miles away attending a conference, I received a message from my children’s principal and my heart sank. A phone call from the principal is never a good thing. I discovered that one of my beloved children did something completely out of character that made me tearfully apologize. I could have gone into the denial mode but it would not have helped my son in the long-run. I’ve met mothers who never said “no” to their children, never disciplined them, always covered up for them and those children ultimately grew up to be adult misfits. That is not the future that I want for my sons.

No one ever said that parenting would be easy. We can only lead by good example and hope that our children will have the ability to follow.

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