I’d like to share a video someone sent me about 5-year- old whose name is Pretty Boy Bam Bam. Because of his pony tail and boxing skills, he was mistakenly identified as the granddaughter of Muhammed Ali.  The video shows Pretty Boy sparring with his boxing coach and it is obvious that he is a boxing prodigy.   His father, who was previously incarcerated for dog fighting admits he doesn’t know where his son’s gift comes from and is chagrined that he was previously in jail. His son’s gift is the motivating factor that now keeps him on the straight and narrow path.

You might not know what gift your unborn child has but reassured they have one. A well-renowned minister, Joel Osteen states that none of us were born to simply occupy space.  Anthropology, genetics and quantum physics has proven that despite our human quest for individuality, we are all inextricably linked.  The birth of each baby changes the configuration of our planet. We desperately need their gifts. My passion regarding pregnant women stems from my excitement regarding their unborn baby’s gift? Is it the next Einstein? Edison? Mother Theresa?

As we celebrate the birth of our nation, let’s also celebrate the births of children who have yet to come. America’s greatest gift is the promise of its future and that future lies in the wombs of pregnant women.

Today’s economy has proven that no one is exempt from losing a job; a home; a spouse or their dignity. If the truth be told, we are all just one paycheck away from getting the dreaded pink slip. Medicaid insurance is the government’s safety net for the working poor and has traditionally been shunned by physicians but now hospitals are following suit.

I remember when the only cancer specialists in a small Louisiana town wouldn’t provide cancer patients with chemotherapy if they had Medicaid so the patients either sought care in another town or died from benign neglect.  Perhaps it’s the memory of those cancer  patients who were denied access to care that makes me fight so hard for my patients to be delivered at a quality hospital despite the hospital’s alleged resistance. In New York City, it’s a well-known fact that a renowned teaching hospital places Medicaid pregnant patients on separate floors but at least they accept them for obstetrical care.

Complicating my dilemma is another community hospital that has had quality care issues in the past and would “love” to have my patients because their patient census is shrinking. Most of the physicians in the community no longer deliver at their institution opting to take their patients to a new competitor hospital that recently opened its doors for business.

Although I have been involved in a recent arm-wrestling match with powers-that-be to “steer” my patients in a certain direction, I ultimately leave the decision up to the patients regarding their hospital of choice. If a hospital accepts Medicaid insurance, then they have to accept Medicaid patients.

The “heart” of medicine has flat-lined. Could someone PLEASE perform CPR? STAT!

According to Macones, there are no scientific models that can predict who will succeed and who will fail a trial of labor after cesarean section but he did offer these helpful insights:

1. A VBAC candidate who has had a previous vaginal delivery has an 89% success rate for a VBAC and fewer complications as opposed to a woman who has never had a vaginal delivery.
2. Women who have spontaneous labors have more successful VBACs than women who are induced in labor.
3. Doses of oxytocin or Pitocin greater than 20 mu/min increase the risk of uterine rupture
4. Intrauterine pressure catheters do NOT accurately predict uterine rupture and should not be used for that purpose.
5. VBAC candidates who need more than one medication to induce labor are at an increased risk of uterine rupture
6. If a VBAC candidate has an epidural and still feels significant pain or needs frequent doses of the epidural anesthetic, there is a high probably that there might be a uterine rupture.

Performing repeat c. sections in women who have had previous vaginal deliveries is morally wrong. Patient safety should always take precedence over physician convenience.

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!

Appendicitis is sometimes difficult to diagnose during pregnancy however the location of pain is helpful regarding making the diagnosis. Patients with appendicitis sometimes have fever and abnormal lab results but this is not always the case. Although the appendix is usually on the lower right side of the abdomen during pregnancy is shifts towards the middle. Therefore, when attempting to make the diagnosis, a physician will examine the patient lying down and also tilted to her left side. If the pain shifts to the left side, the pain is probably from the uterus and not the appendix.

The safest time for a pregnant woman to have surgery is during the second trimester. An epidural or spinal anesthesia is safer than general anesthesia for many reasons.  It is more difficult to place a breathing tube down a pregnant woman’s throat because hormone’s make the throat smaller. The patient also has an increased risk of aspirating or having food or liquid in her windpipe as opposed to her stomach.

There should always be an obstetrician and pediatrician consultant on hand prior to and during the surgical procedure, especially if the patient is in her third trimester. According to the latest medical literature, there are no anesthetic medications that cause birth defects to the unborn fetus, provided the surgery is not done during the first trimester. The heart tone of the fetus should always be monitored during surgery. Because a pregnant woman has an increased risk of developing blood clots, it is strongly advisable to wear “compression” stockings during a procedures. These stockings are available in the hospital and compress or squeeze the blood vessels in the legs to promote better circulation.

Following these suggestions will greatly improve your chances of having a surgical procedure that will not adversely affect your pregnancy. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.

During the case review, the healthcare provider used the Enron excuse and blamed the nursing staff for the poor outcome, alleging that he was never informed there was a problem with the fetal tracing. He was also responsible for several other deliveries that had occurred during the same night. While that may be true, the patient was still under HIS professional care. Most hospitals have central fetal monitoring systems where the tracing can be visualized in several places including the nurses’ lounge and the providers’ on-call room. I have said this in the past and will continue to emphasize the importance of the fetal heart tracing. It is equally important for your healthcare provider to know exactly what is going on with your labor. So, here are a few tips to improve your chances of delivering a healthy baby:

1. Ask whether your provider will be in the hospital while you are in labor. If not, could she or her representative give you and your family an hourly update on the status of your fetal tracing.
2. When you are admitted to the labor room, ask how many other patients of your provider are admitted as well. If more than three, ask whether there is someone else that could be consulted regarding such as a hospitalist or your provider’s partner in the event he is busy.
3. According to the new standards of fetal monitoring established by the National Institute of Child Health and Development (NICHD), if your fetal tracing isn’t “reassuring,” then someone needs to give you a report about the tracing every 15 minutes. If the tracing suggests repeated problems then your baby needs to be delivered as soon as possible.

Please be empowered. Please be pro-active. A healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.

Katy did not have health insurance, nor did her husband, Al. Four days later, Katy was rushed to the hospital because of increased excruciating pain and almost died shortly thereafter. She experienced massive organ failure, and then lapsed into a coma.  Katy had Group A streptococcal disease which causes strep throat or mild soft tissue disease. However if this bacteria gains access into the blood stream its effects can be devastating. It causes necrotizing fasciitis or the “flesh eating bacteria.” It is also responsible for Streptococcal Toxic Shock Syndrome, commonly referred to as either “Toxic Shock Syndrome” or TTSS. This infection has been on the rise in the U.S. since the 1980’s with 8 to 10 thousand cases occurring annually and 30% of people affected still die each year.

Katy’s husband faced a major dilemma. The physicians informed him that the only way to save Katy’s life was to remove the source of the infection which was her uterus. In addition, all four of her legs and arms had to be surgically removed as well in addition to her ovaries, stomach and part of her intestines. And there was still the possibility that she might die. Al made the heart-wrenching decision for Katy to have the surgery. 

Katy regained consciousness on March 12^th and is on a slow but steady road to recovery. She will have to be fitted for prosthesis of her arms and legs and her greatest desire is to hold her baby and return to her family. Her friends and family are conducting fund raisers to pay for her hospital bills.

Some schools of thought will argue that Katy should have never had a home birth. Others will defend her right to do so. I hope Katy did not opt to deliver at home because she lacked healthcare insurance. That would be a moral tragedy. I wish I could turn back the hands of time because here’s what Katy should have known:

1. Older women (those over 35) have an increased risk of birth complications. Katy was 41.
2. There are federally funded community health centers to take care of the uninsured.
3. A fever after childbirth needs PROMPT attention. Katy had a fever for four days before she was taken to the hospital.

Let’s all pray for Katy’s continued recovery and a swift return home to her baby.

Join the FB group created for her http://www.facebook.com/group.php?gid=343063085090

Some Ob physicians have stopped delivering babies, others have retired from private practice and many have become hospital employees called hospitalists. Hospitalists will take care of you in the hospital while your ob provider sees patients in the office; in some cases, a LOT more patients, but more on that in a minute.

Contrary to popular belief, the days of milk and honey for most physicians are gone. Money previously spent on vacation homes, boats, luxury cars and exotic vacations is now used to pay for billing code specialists, and triple the number of their original office staff in order to fulfill insurance demands. False denials of payments by insurance companies mean additional paperwork and manpower. Delay of payments is the order of the day and higher patient co-pays certainly don’t help. Many physicians can’t provide health insurance for their office staff because of prohibitive costs.

It’s not a coincidence that gyn-“spas” are on the rise and your gynecologist is now doing liposuction, facials and selling vitamins. Some obstetricians opt to see more patients as a way to compensate for their losses and that becomes a dilemma. As the number of patients increases, the quality of their care decreases.

There is also the danger of monopolies forming when hospital systems purchase physician practices which could drive up the cost of healthcare even more and limit your physician’s autonomy.  So, what is a patient to do? Empower yourself with information. Ask how many patients your physician sees per day before making an appointment. If your insurance company is delaying payment for your procedure, file an official complaint with your State Commissioner of Insurance or to the Center for Medicare and Medicaid if it’s a self-insured plan. If your OB is honest enough to admit their concerns, ask how you can help.

Small changes CAN make big differences.

                Anyone who is remotely familiar with obstetrics knows that the APGAR score is a useful tool for determining the newborn’s status shortly after it is born. APGAR scores were developed by Dr. Virginia Apgar, a Columbia University trained anesthesiologist and evaluates the baby’s heart rate, muscle tone, respiratory rate, reflex response and color at one and five minutes of life. Each criterion is given either 0, 1 or 2 points. An APGAR score of 0 to 3 after five minutes is suspicious for a birth brain injury.

                When the baby does not receive enough oxygen in the womb, its brain cells becomes damaged causing permanent injury. However, that dismal prognosis has begun to change, thanks to hypothermia (cooling) therapy. According to a large medical study called Cochrane, “. . . parents should expect that cooling will decrease their baby’s chance of dying, and that if their baby survives, cooling will decrease his/her chance of major disability.” What a MAJOR breakthrough in medical science and a reason to celebrate for expectant parents.

                One of the first institutions to use this method was the University of California at San Francisco. I contacted the nurse in charge of the program and she was kind enough to share their protocol. In order for the cooling method to work, it must be used within the first six hours of life. Here’s how it works:

1. Your baby must be 36 weeks or greater
2. Must have an APGAR score of less than 5 at 10 minutes
3. Must have received chest compressions  and/or intubated or received a mask helping it to breathe at 10 minutes of life
4. Have a low blood gas within the first 60 minutes of life
5. Have signs suggesting HIE which include having a seizure, poor muscle tone, poor feeding or be in a coma.

                Although the cooling method is expected to become the standard of care in the future, there are hospitals that are already using it. Does your hospital use hypothermia? The answer could save your baby’s life.