Electronic fetal monitoring was first used at Yale University in the 1950s and is a great asset in terms of checking fetal well being. Unless a woman delivers at home, most pregnant women will have fetal monitoring during the time that they’re in labor. The fetal monitor measures both the baby’s heart rate and the mother’s uterine contractions. Why is this important? Because the vein in the baby’s umbilical cord receives oxygen which is necessary for growth and development, especially in the brain. When the uterus contracts, the blood flow to the baby is reduced, then increases once the contraction is over. The fetal monitor essentially tells us two important things: (1) whether the baby is tolerating labor and (2) whether it’s receiving enough oxygen.

Of four million babies born in the US each year, approximately 875,000 will experience birth injuries. What is a birth injury? It’s any type of injury suffered by an infant as a result of the birthing process. Most birth injuries can be avoided if someone is paying attention. Babies can’t tell us when they’re in trouble with their mouths, but they can certainly do so with their hearts. The signs of normal and abnormal fetal heart tracings are included in The Smart Mother’s Guide to a Better Pregnancy. Fetal tracings are either reassuring (meaning good) or nonreassuring (not good). If the fetal tracing is nonreassuring, then the baby needs to be delivered as quickly as possible.

Despite our current healthcare challenges, babies will continue to be born.  I therefore encourage all pregnant women, childbirth educators and doulas to take these bold new steps:

1. Become familiar with fetal tracings and the distinction between reassuring and nonreassuring traces (pages 201 and 202 of The Smart Mothers Guide®)
2. Doulas should become Labor Room Advocates who can be another set of eyes and ears that can address any issues during labor and make certain that appropriate communication of hospital staff (including the status of the fetal tracing) is known during a shift change
3. Become familiar with a high-risk specialist who can offer a second opinion in case there is a  disagreement regarding labor room management

When your baby’s fetal monitor attempts to “talk” to you, everyone should understand what it’s saying.

As a physician, I know exactly what medication costs and was incensed when I received my $13,000 hospital bill. Charges of $181.00 for a $4.00 generic drug, implausible costs for intravenous medications and “Star- Wars-type” surgical tools made me see red.  I challenged the outrageous bill but to no avail. I went through layers of billing clerks who were both rude and useless; and spoke with a hospital auditor who defended the charges. I complained vehemently to my insurance company, advising them that they were being duped but they paid their portion and never investigated my complaints. I ultimately paid my portion of the bill but felt like I had been extorted by the Mafia. In retrospect, here’s what I wish I had done:

• Requested an estimate of hospital charges BEFORE I was admitted
• Wrote a letter of complaint to my state’s Insurance Commissioner; and
• Consulted the services of a medical billing advocate

Most pregnant women will give birth either in a hospital or birthing center so it behooves you to be as pro-active as possible regarding scrutinizing your bill. Healthcare has become a business. Make sure you’re an educated consumer.

Asthma occurs when the air in the lungs are reversibly blocked because of infections, allergies, cigarette smoke, pets, cold weather and severe exercise. Its symptoms include coughing, wheezing and shortness of breath that becomes worse at night. Poorly controlled asthma can cause severe complications for both mother and unborn child and it is now recommended that all pregnant women with asthma have peak flow studies.

A peak flow meter is a small, hand-held device used to monitor a person’s ability to breathe out air. It measures the airflow through the lungs and the degree of obstruction or blockage in the airways. Peak flow readings are higher when patients are well and lower when the airways are narrowed. The meter is also color coded: Green means everything is okay. Yellow means “caution” or some of the airway is blocked and medication is required. Red indicates a medical emergency dictating immediate medication and a phone call to a physician. Readings in the yellow and red zone have been associated with prenatal complications such as preterm labor and babies weighing less than five pounds.

Pregnant women should avoid asthma triggers such as mold, dust, rodents, pollens and cigarette smoke. Certain pets might have to be avoided as well. If symptoms of asthma become worse during pregnancy, medications might have to be changed or adjusted and a consultation from a high-risk obstetrician and/or an asthma specialist is recommended. Do not increase the frequency of your medication without the supervision of a physician as some asthma medication can cause complications, including irregular heartbeats and uncontrolled diabetes if taken improperly. It is also not recommended that pregnant patients take over-the-counter antihistamines such as Loratadine or Cetirizine before 12-weeks because of its increased association with birth defects.

Pregnant women with well-controlled asthma should anticipate a favorable outcome. When mom can breathe, the baby can breathe as well. What a wonderful sigh of relief.

So, this is my one-hundredth blog-post, a feat I never thought I would accomplish. I didn’t think I’d have the time to sit at my computer and churn out bi-weekly posts however the imperfections and celebrations of life beckoned me to do so.

I’m extremely grateful to the progressive websites and magazines who have given me a venue for expression: LifeScript.com, Basil & Spice, Medpedia, e-Health Forum, Not Ur Mamas News, Favor Magazine, Alive Magazine and WordPress.com, thank you so much. An expression of gratitude is also in order for Sharon Goldinger, Mary Ellen Gross, Nettie Hartsock, Michelle Roberts and the incredible, buoyant Zanade Mann, who introduced me to a magical world called social media and guided me to new horizons.

Last but not least, I am indebted to my readers for your support. As a small token of my appreciation, I have launched a contest that will allow me to hear from you. I would love to know which Dr Linda Galloway blog was your favorite and what are your greatest fears and concerns if you are a pregnant woman.  The first prize is a $100.00 Visa card, and the 2d and 3d prizes are signed copies of my book, The Smart Mothers Guide to a Better Pregnancy. Please click on http://www.smartmothersguide.com/one-year-anniversary-contest for details.

Thank you for this amazing journey and may you all continue to enjoy the ride.

Patients do not come in neat little packages with straight forward pregnancies nor are their complications obvious. Some pregnancies are complicated not only by health issues but social issues as well. Take Karen* for example. She was considered mentally “slow”. Her parents gave her up at the age of eight and she subsequently grew up in group homes.

Karen had an innocence that made everyone want to protect her and I was at the top of the list. She had a friend name Shirley* who was also pregnant and they eventually became roommates. I was not Shirley’s physician, but I wish I had been. Both Karen and Shirley made plans for the birth of their babies and assumed they would grow up together.

Two weeks before Shirley’s due date, she began bleeding bright red blood but was hesitant to go to the hospital. When she finally arrived, her baby was dead from a premature separation of the placenta; a condition known as placental abruption. Shirley most likely had pre-eclampsia, a disease that sometimes goes unrecognized.

The day before Karen’s due date, her blood pressure became elevated, there was protein in her urine and her feet were swollen. I referred her to the hospital with a diagnosis of pre-eclampsia. Karen brought home a healthy baby. Shirley left the hospital with empty arms.

                Here are three important things every pregnant mom needs to know about pre-eclampsia:

1. If you are over 20 weeks pregnant and your feet are swollen someone needs to check your blood pressure
2. If your blood pressure is “normal” but you have protein in the urine, the urine needs to be sent for a 24-hour specimen AND you need to be given the results
3. If there is more than 300 gram of protein in the urine, you may have pre-eclampsia and a decision needs to be made whether your baby should be delivered

Sometimes the diagnosis of pre-eclampsia is missed because a patient doesn’t have the usual presentation of extremely high blood pressure. Karen was Caucasian; Shirley was African American. Both had the same illness that ended with very different outcomes.

If Shirley ever becomes pregnant again, I’d be honored to be her physician. Every pregnancy deserves to have a happy ending.

*Names have been changed

I met my first “Precious” at the age of fifteen, in a housing project in the Bronx. My life was ruined when my family was uprooted from Brooklyn to the Bronx in order to be closer to my uncle’s job. We were greeted with suspicion and ridicule by our neighbors and not exactly given a “welcome mat.”  I was grateful when I discovered there was a girl who was my age living on the second floor. However, we were not exactly peers. She had recently brought home a newborn that looked exactly like her middle-aged stepfather. The uncanny resemblance of the newborn to his grandmother’s husband made me want to cry.  I looked at the teen’s mother (who appeared embarrassed) and silently screamed “Why didn’t you protect her? “

President Obama’s oldest daughter, Malia is 11 years old, and to fathom her being pregnant and requiring a C. Section would be totally absurd. Yet this is exactly what happened to an 11 year old child in Texas.   (See Man Accused of Fathering a Child With an 11 Year Old) The girl had allegedly been sexually assaulted by her stepfather since the age of six and was now living in protective custody. The stepfather was mandated by the court to supply a DNA sample that confirmed he is the biological father of the child.  You can’t tell me that this child was abused for five years and her mother knew nothing about it. And had she not become pregnant, her alleged abuse would probably have continued.  Thank God I wasn’t the obstetrician who had to bring her into the operating room to perform a C. Section, because I’d probably need therapy for life.

As a society, we’ve failed this child miserably.  I’m sick of women who feign denial and ignorance regarding atrocities committed against their children. Please take off your blinders and have the courage to protect your children.

What Every Pregnant Woman Needs to Know About Seatbelts and Airbags

Posted in Mothers, Ob-Gyn, pregnant women tagged ACOG, airbags, National Highway Traffice and Safety Administration, pregnant women, seatbelts at 11:34 am by drlindagalloway

One of the most gratifying benefits of living in the U.S. is that it is a country ruled by laws. Despite our gaping differences of opinions, we are ALL protected by the Constitution. The First Amendment protects our freedom of speech, a gift for which I am eternally grateful. Therefore, as a physician, author and US citizen, I WILL render my professional opinion regarding the life-threatening risk factors of a grand multipara such as Duggar.

The facts do not cease to exist because one chooses to ignore them.  There are approximately 4 million babies born in the U.S. each year and almost one-quarter or 875,000 of those births will have complications. In worse case scenarios, 13 out of every 100,000 pregnant women will die. Unfortunately many of those complications occur because of either inexperience or neglect and I have devoted my entire medical career trying to prevent them.

The Guinness Book of Records reports that the greatest number of children born to one woman was a Russian born in 1707. Mrs. Fyodor Vassilet gave birth to 16 sets of twins, seven sets of triplets and four sets of quadruplets, for a total of 69 children.  So, there’s still hope for Duggar if she wants to continue to procreate.

Yes, I am a physician but no, I’m not God. I’m a mother who knows that children need their mommies.   It is not my intent to bash or humiliate Duggar in anyway. However, when someone appears to be sinking, you’re obligated to offer them a life jacket. Then it’s their decision whether to accept it or drown.

Burton was a 26 y.o. mother of two who was pregnant with her third child at 25 weeks and had less than desirable habits. She was a smoker, had two toddlers and was at risk for premature labor.

Burton was under the professional care of Jana M. Bures-Forsthoefel, M.D., a board certified ob-gyn physician with over 27 years of experience. She completed her residency training at Emory University which is one of the best in the country.  However, there was an obvious disconnect of professional judgment when Bures-Forsthoefel and Tahhassee Memorial Hospital obtained a court order to have Burton confined to the hospital involuntarily against her will. Burton was allegedly informed she’d have to remain in the hospital for three months and refused. But the Circuit Court of Leon County forced her to stay in the hospital and three days later, Burton delivered a dead baby by a cesarean section.  So, what was the point?

Let’s rewind the tape, and then hit replay so we can see what SHOULD have happened.

The patient is at risk for preterm labor at 25-weeks gestation so obtain a high-risk consultation from the Maternal Fetal Medicine specialists who also practiced at Tallahassee Memorial Hospital. They are the specialists, let them manage the patient

If the patient refused treatment, contact risk management, have the patient sign informed refusal of treatment consent, list every possible complication that she could encountered, including the possibility of death, then DOCUMENT everything

When she goes home, give her a list of explicit instructions with emergency phone numbers to call

No hospital or physician is exempt from getting a patient who’s a royal pain in the neck.  There will always one who will not follow medical advice. However, the days of paternalism are over. Burton was within her right to refuse the hospital admission but would have also been responsible for whatever consequences occurred. Confining her against her only exacerbated the problem by increasing her adrenaline and elevating her stress.

“Pride goeth before a fall”. Physicians don’t walk on water. When arrogance takes precedence over common sense, count on triggering a disaster.