Herpes 1 is an infection that causes fever blisters located on or near the mouth. In the past it was less common than Herpes 2 but in recent years is now responsible for 30 to 50% of lesions found on or near the vaginal area. Herpes 2 is an infection that causes blister-type lesions in the genital area and is usually painful to touch. The first-time (or primary) infection is usually the worst and is associated with painful and burning urination, fluid-filled blisters in the genital area, fever and sometimes a headache. Any infection thereafter is called a recurrent infection which is usually milder and has fewer symptoms. Contrary to popular belief, most infections are spread from one person to another when there are NO lesions or what’s commonly called asymptomatic shedding.

A first-time infection is treated with a medicine called Acylovir taken three times a day for 7 to 14 days. If a pregnant woman has Herpes 2 and a fever, she has to be admitted to the hospital to decrease her chances of developing pneumonia. For pregnant patients with recurrent infection, it is recommended that they take acyclovir three times a day beginning at 36-weeks up until the time of birth. Valtrex medicine may also be taken twice per day if the patient can’t tolerate Acylovir.

If lesions are present during labor, a cesarean section MUST be done to avoid an infection of the newborn. One out of 3200 babies will be infected with Herpes that causes severe diseases of the eye, skin and mouth. 80% of babies will die of Herpes 1 and 2 if they are not treated.
Please inform your healthcare provider of any symptoms of active lesions or previous history of Herpes immediately to avoid preventable complications.

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

Educate yourself by purchasing my latest book The Smart Mother’s Guide To A Better Pregnancy!

The patient, who experienced the scenario just described, gave a resounding “yes!” and was extremely grateful that her 8-½ pound arrived safely albeit via a C-Section. Most obstetrical textbooks would also agree; this patient had an Arrest of Labor.

An Arrest of Labor occurs when the contractions of the uterus does not allow the baby to come down the birth canal or is not powerful enough to open (or dilate) the cervix. The labor has been “arrested” or stopped. This can happen for a number of reasons including having a large baby, inadequate contractions, abnormal pelvic bones or uterine cavity. An accurate diagnosis of an Arrest of Labor is important to avoid birth complications. The most common (and dreadful) birth complication is a Shoulder Dystocia, meaning that a baby’s head has been delivered but the rest of its body is stuck, especially at the shoulders. Several maneuvers are made in attempt to deliver the baby including pushing on the top of the uterus (aka fundal pressure), using a suction cup excessively (called a vacuum extractor) or tugging and pulling on the poor baby to no avail. ALL these maneuvers are inappropriate and could cause serious harm; and if caught off-guard there are appropriate maneuvers that can be done but a better strategy would be to avoid the issue altogether which is exactly what occurred with the patient described above. Her physician had the good sense to take the path of least resistance.

How do you know if you have an Arrest of Labor? If you dilate to a certain number of centimeters and remain at that same number for over two hours despite several interventions. Your lack of progress in labor suggests that your baby might need some help. The victory is not in having a vaginal delivery; it’s bringing home a healthy baby.

For additional information I invite you to obtain a copy of The Smart Mother’s Guide® to a Better Pregnancy. Remember, a healthy pregnancy doesn’t just happen; it takes a smart mother who knows what to do.

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 pre-ordained human experience. Please let the journey be smooth. Do not create a storm from worry, a tornado from doubt, a cloud from fear, a disaster from envy. The majority of patients who end up with emergency cesarean sections are those with “fetal distress.” What was causing the distress? Who was causing the distress? Let it not be you, its mother.

Because of the advent of 4-D ultrasound technology, we can actually observe fetal behavior in the womb. We can see babies yawning, sucking their thumbs, stretching their arms and legs, even playing with their umbilical cords. They respond to music, the rhythm of your heartbeat, a touch from your partner, the sound of your voice. You are literally filled with the miracle of life. There is no gift on Earth more precious than that.

You are smarter, stronger, and more brilliant that you can ever imagine. You have been selected, yes, selected, to be this child’s mother. That is the Divine Connection.

I wish you a healthy, joyous pregnancy and a prosperous and blessed New Year.

This excerpt is taken from The Smart Mother’s Guide® to a Better Pregnancy. All Rights Reserved.

A few months ago, a patient in her early third trimester came for a routine prenatal visit. Her vital signs were good, the baby’s heart rate was normal and as I handed her an appointment slip, I asked whether she felt her baby move during the past two hours.  She said no, she had not felt the baby move all day. Despite hearing the baby’s heartbeat, my antennas immediately went up and I referred her to the labor room to have further diagnostic tests.

A few weeks later, my assistant said, “Dr. Galloway, you’ve done it again.” I asked what was she talking about and she explained that our patient was seen in a follow-up clinic for the removal of her staples. The same day I sent her to the hospital, she had an emergency C-Section because her tests were extremely abnormal. Her baby was in trouble. When the on-call obstetrician delivered the baby, he noted an umbilical cord wrapped around its neck five times and once around its body. However, the baby did well and was eventually sent home in stable condition.

My most gratifying moment occurred when I saw the baby for the first time. “She’s my miracle, Dr. Galloway” said the patient, and of course, I agreed. “She was channeling me the night before I came to see you.” “What do you mean?” I asked. “The night before I had her, I dreamt that she had died but because you sent me to the hospital, she’s alive. She’s my miracle.” Tears swelled in my eyes as I struggled to maintain my composure.  The miracle of life never ceases to amaze me.

I witnessed the side effects of obesity through the eyes of my late mother. Social isolation, discrimination and low self-esteem were an everyday occurrence. Behind every obese woman is often an untold story.

According to medical statistics, 66% of Americans are either “overweight” or obese. This includes ten to thirty-six percent of pregnant women. Obesity is discussed using the Basal Metabolic Index (or BMI) and is calculated based upon a patient’s weight and height. A BMI of thirty (200 pounds) or greater is reason for concern.

Ideally, obese pregnant women should seek the professional care of a high-risk obstetrician who is also known as a maternal fetal medicine specialist. Obese women are at an increased risk of gestational diabetes, high blood pressure, cesarean delivery, increased post-operative complications and stillbirths. There is also an increased risk of birth defects but it is not known why. Because obese women have a greater chance of having twins, an early ultrasound should be obtained.

How much weight should an obese woman gain during her pregnancy? No more than 11 to 20 pounds according to the Institute of Medicine. And pregnancy is not the ideal time to lose weight. The body requires a daily minimum of 300 additional calories. And it’s the quality of the food that’s important. Not the quantity.

Obese women should seek the services of a clinical nutritionist during their pregnancy and maintain a daily food diary. Every state offers the WIC (Women, Infants & Children) program that has a nutritionist or dietician on staff. I strongly encourage pregnant women to take advantage of their services.

Although obesity poses additional challenges, with proper support and guidance, the outcomes for most women are safe deliveries and healthy babies.

http://www.fns.usda.gov/wic/

http://www.smartmothersguide.com

In recognition of September as the National Infant Mortality Awareness Month, I’d like to share some SMART tips to pregnant women:

S = Seek prenatal care early.  Problems in pregnancy cannot be fixed at the last minute. Tests for genetic problems can only be detected in the early first and second trimesters.  A first trimester ultrasound is also the MOST accurate in terms of a due date. 

M = Mention all high-risk factors such as family history of diabetes, high blood pressure or bleeding. Do not omit information such as smoking or “recreational” drugs.  It will come back to haunt you.

A= Ask to have your cervix measured during your ultrasound if there is a previous history of premature contractions or delivery.  A cervical length of 2.5 centimeters or less is a risk factor for preterm labor. 

R= Research your hospital and prospective physician or midwife carefully.  Is the physician or midwife skilled in managing high-risk conditions?  Will they continue to see you even if you lose your insurance?  Has the hospital had any recent outbreaks of antibiotic-resistant – infections in the newborn nursery?  Is there 24-hour anesthesia? 

T= Test for potential problems such as Gestational Diabetes, Sickle Cell Trait or sexually transmitted infections.

The U.S. is one of the most industrialized countries in the world, yet we rank below Cuba and Taiwan, with respect to our national infant mortality rate.  The health of a nation is judged by its national infant mortality rate. We can do better.  We must do better.  The health of our future generation is depending on it.

Like most Americans, I admired the Kennedy family from afar and  their compassion had far-reaching effects.  President John Kennedy sent troops to the Deep South and protected the civil rights of my relatives.  Senator Robert Kennedy transformed my beloved Bedford Stuyvesant Brooklyn community into a successful economic empowerment zone that created jobs and stability.  We always looked forward to the annual ice skating party that was organized by Mrs. Ethel Kennedy even after that horrendous assassination.  Because of Kennedy’s vision, the price of a Bed Stuy brownstone in today’s market begins at one-half-million dollars. 

My introduction to the magic of Senator Edward Kennedy began in medical school during the early eighties when my former Assistant Dean, Dr. Van Dunn, resigned from BU to become the senator’s Senior Policy Advisor.  Senator Kennedy was full engaged and committed to healthcare reform and Dr. Dunn had the privilege of helping him.  Kennedy’s name re-emerged during the early nineties when I was working in a small southwest Louisiana community.   Towns were buzzing for miles around about the marriage of Kennedy and a Cajun woman named Victoria Reggie.

I love walking through the congested WIC (Women, Infant and Children) department at work and beam with pride at the sight of beautiful, healthy babies and children.   They are truly Kennedy’s legacy.  If you’ve ever received a Medicare benefit, a WIC check, SHIP benefits, a Family Medical Leave, the right to vote or a COBRA benefit, you can thank Senator Ted Kennedy.  He served “the least among us” nobly.

I hope more legislators and physicians will do the same.

Get the Facts!

I don’t care how many times you repeat the same refrain some patients still don’t get it.  A significant number of pregnant women begin prenatal care at the eleventh hour because they’re waiting for insurance approval but others simply procrastinate without rhyme or reason.  As a public health physician, I can’t reject difficult patients like my counterparts in private practice.  I am obligated to see them for better or for worse.  Obstetricians usually steer clear of women who begin prenatal care late and for good reason:  they usually present with a host of problems.  Quite often I can foresee these problems but on rare occasion, I get duped.

A patient came to see me in her early third trimester and there was nothing unusual about her medical history.  She appeared pleasant, cooperative and all of her labs had returned normal, including her fetal ultrasound.  Two weeks later, during a routine visit I was unable to hear her baby’s heartbeat. When she stated that the baby had not moved for over a week, my heart sank. 

Exhaling a sigh of frustration, I wrote the order for an emergency ultrasound and warned her that things did not look good.  Two hours later, a stillbirth was confirmed.

The on-call physician who had delivered the baby gave me an update the next day.  The baby had multiple abnormalities and the patient’s lab tests were positive for cocaine. And of course, she initially denied taking it.  Her previous ultrasound was allegedly “normal” and although I’m far from being naïve, I would have never suspected the possibility of drugs.  

She subsequently refused consent for an autopsy so the official cause of death remains unknown.  Earlier prenatal care and a level of honesty might have changed the outcome of this pregnancy. Do  I now have to resort to performing drug screens on ALL late prenatal registrants? 

What do you think?

Judy Dominguez Trunnell was a 33-yeard old special education teacher from Cameron County, Texas that lies on the US/Mexico border. CDC reports that she was admitted to the hospital at approximately thirty-three weeks because of respiratory problems. Her pregnancy was complicated by asthma, rheumatoid arthritis and psoriasis. She remained in the hospital for two weeks then succumbed to a coma. Although an emergency cesarean section delivered a baby girl, mom died on May 7th leaving behind two daughters and a husband.

Tunnell had a weak immune system making it difficult to fight off infections. Rheumatoid arthritis and psoriasis are autoimmune diseases that attack its own body. Living near the Mexico border and teaching special needs children probably increased her risk of exposure to the H1N1 virus as well. Some necessary precautions are in order:

• Most symptoms of seasonal flu involve fever (90 percent); cough (84 percent) and a sore throat (61 percent). However only one in four people complain of vomiting or diarrhea. Symptoms of vomiting or diarrhea along with fever, sore throat or a cough, requires a trip to a healthcare provider for further investigation that includes obtaining a special swab from your nose.

• CDC reports that the virus spreads not only through the air but also through feces-contaminated hands. Wash your hands; wash your hands; wash your hands; PLEASE – and preferably with an alcohol based gel.

To be forewarned is to be forearmed. I will continue to report updates as they emerge.

In celebration of Mother’s Day, I’d like to share a few pearls from my book, The Smart Mother’s Guide® to a Better Pregnancy.   Those who orbit my universe know how impassioned I am about babies.  Crazy would probably be a better term.   I cringe when a newborn is admitted to the NICU because someone wasn’t paying attention.

The  path to a successful delivery becomes much straighter when everyone marches in the same direction.  Knowing how to sidestep some of the imperfections of our hospital systems will greatly improve your chances of having a successful delivery. 

Please take my Smart Mother’s Guide Quiz© and see how you do:

You are thirty-five weeks pregnant and were admitted to the hospital by your physician for suspected pre-eclampsia or high blood pressure.  You were also evaluated by the maternal-fetal medicine specialist, who recommends inducing your labor in the morning after he has obtained your lab results.  The next morning your physician’s partner is on call.  He examines you and states that he is going to discharge you home because your blood pressure has improved.  Is the physician correct?

Answer:  No.

The maternal-fetal medicine specialist had ordered lab tests and had recommended an induction of labor.  You should request that the on-call physician discuss your case with the maternal-fetal medicine specialist before discharging you since there is a difference of opinion regarding your care.  The specialist wanted to induce you for a reason.  Sending you home would place both you and your baby in harm’s way.

For more helpful tips regarding pregnancy and delivery, please pick up a copy of the Smart Mother’s Guide® to a Better Pregnancy available at all book stores and Amazon.com.

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