Pole has 2 masters’ degrees, one in economics and the other in statistics and has developed predictive models to determine whether a woman is pregnant.  Why is that important? Are they going to pay your medical bills? Or send you a bouquet of flowers at the time of birth? Give you a year’s free supply of disposable diapers? None of the above. They’re going to try to convince you to buy additional purchases through enticements and “behavioral psychology.”

Why is Target so interested in pregnant women? According to the article, new parents are a retailer’s “holy grail.” Right around a child’s birth, shopping patterns change. Birth records are public so by the time a baby is born, a retailer has lost its advantage, so the key is to reach consumers, particularly pregnant women earlier, preferably in the second trimester. Why the second trimester? Because that’s when pregnant women begin buying things for their babies. Target has established a system and an identifier called the Guest ID that allows them to track and record everything you buy and then keep a record of it. It can buy information regarding your ethnicity, neighborhood, marital status and educational status. Now, I understand why cashiers are always asking for my zip code.

Allegedly, when a woman buys more unscented lotion, vitamin supplements such as magnesium and calcium, there is a significant possibility that she might be pregnant. Purchases of lots of scent-free soap, an extra large bag of cotton balls, cocoa butter and large bags (future diaper bags) signals a close due date. There is even mention of “habit specialists” who are trained to figure out how people think. A  Duke University study estimates that 45 percent of our decisions are based on habit. As a result of spying, Target revenues grew from 44 billion to 67 billion dollars between 2002 and 2010.

How can one prevent this intrusion of privacy? By spending cash instead of using credit cards when shopping.  Pregnant moms, do you think that Target has crossed the line or are you okay with their policy. Please, weigh in.

In 1952, Dr. Virginia Apgar, an anesthesiologist, developed a system to evaluate the baby’s response to its new external environment outside of the uterus and revolutionized newborn care. The Apgar score can determine whether the newborn will need more intensive care and is used world-wide.  It evaluates the baby’s condition after the 1st and 5th minute of life by looking at it heart rate, respirations (or breathing), muscle tone, reflexes and skin color. Each of these five conditions is assigned a score of 0, 1 or 2. Ideally, the perfect baby is one that has a heart rate above 100 beats per minute, a good cry, active motion, coughing, sneezing or crying and completely pink. The ideal score is 10 after 5 minutes. If the five-minute score is less than 7, additional scores are obtained every five minutes for a total of 20 minutes. About 90 percent of newborns will have a score between 7 and 10 and need no further intervention. But what happens if the baby’s Apgar score is less than 7? Approximately 10 percent of newborns will require intervention and 1 percent will need serious intervention or help at birth.

An article in the August 2011 edition of The Journal of Obstetrics and Gynecology addressed the question of whether Apgar scores less than 7 have long-term effects on the baby’s future academic performance in school. It is well known that low Apgar scores increase the risk of neurological problems however very few studies evaluated children’s school performance at age sixteen until recently. A Swedish study reviewed over 800,000 with available Apgar scores and determined that babies with APGAR scores of less than 7 will have lower academic achievements at the age of 16. So, what’s a mother to do if she has a baby with an APGAR less than 7? Request a neurological examination of your newborn and look for future delays in speech patterns or walking. The earlier a problem is identified, the better the chances for improvement. According to the medical study, “Apgar score at birth is a powerful marker of neonatal health and effect on future academic achievements.”

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

Any pain associated with bleeding and cramping warrants an immediate phone call or visit to your healthcare provider. This combination of symptoms may indicate a significant problem, including pregnancy loss. Your provider will examine you to determine the following:

• The baby is alive. This will be checked with an ultrasound and measurement of the hormonal levels of the pregnancy.
• The pregnancy is in the right place, inside your uterus, and not inside the fallopian tube (known as an ectopic pregnancy). An ectopic pregnancy, although rare, is a medical emergency because the baby is in an abnormal place. As the baby grows, the fallopian tube could rupture, causing severe bleeding and shock, among other problems.

Any pain associated with a temperature of 100°F or higher needs to be evaluated further to make certain that you don’t have an appendicitis or an infection in the kidneys (aka pyelonephritis).

The signs of appendicitis are

• Dull pain near the navel or the upper portion of the abdomen that becomes sharp as it moves to the lower right portion of the abdomen
• Loss of appetite
• Nausea or vomiting or both soon after abdominal pian begins
• Inability to pass gass
• Temperature of 99°F to 102°F

The signs of pyelonephritis are

• Back, side, and groin pain with a fever of greater than 101°F
• Frequent urination that is painful and/or burning urination, especially at night
• Blood and/or pus in the urine

Should you experience any of the signs or symptoms discussed above, please contact your provider immediately or go to the hospital for further evaluation. These are potentially life-threatening conditions that require immediate attention.

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

Excerpt from The Smart Mother’s Guide to a Better Pregnancy.

Hyperemesis gravidarum (HD) is a severe form of nausea and votiting affect 3 percent of pregnant women and is associated with severe dehydration, electrolyte imbalance and weight loss. Your provider should consider this diagnosis if

• You have lost more than 10 pounds in a two-week period and have relentless vomiting.
• Large ketones, substances the body makes when it is not receiving enough calories, are found in the urine. This can be documented with a dipstick urine test.

The treatment of HD includes hospitalization with IV fluids (with vitamins added) until the patient is against able to tolerate food.

Gallstones develop when cholesterol and other substances in the bile form crystals that become hard stones in the gallbladder. The female hormone estrogen can cause this condition during pregnancy. The symptoms of gallbladder disease in pregnancy include the following:

• Severe nausea and vomiting associated with pain in the upper right portion of the abdomen or pain that radiates to the back or shoulder blade.
• Jaundice (yellowing) of the skin and eyes, dark urine, and light-colored stools. These symptoms are associated with gallstones that have blocked the common bile duct.

A diagnosis of gallbladder disease can be made using an ultrasound. Depending upon the symptoms and the number and location of the stones, treatment can range from prescribing a bland diet to surgically removing the entire gallbladder.

A molar pregnancy is a rare condition occurring in approximately one in a thousand pregnancies. It is an abnormality of the placenta that’s very rare and occurs when a sperm fertilizes an empty egg. Sometimes it may be associated with severe nausea and vomiting. The two types of molar pregnancy are complete and partial. In a complete mole, there is no baby, just a placenta. In a partial molar pregnancy, there is a baby that has an abnormal number of chromosomes and usually dies. Sometimes this condition is also associated with cancer. You don’t need to be concerned about this condition unless you have vaginal bleeding with the passage of grapelike clots. This condition is confirmed by an ultrasound.

Between 50 to 90 percent of women have some form of nausea during pregnancy that is normal. However, should you experience any of the symptoms that are mentioned above; please see your provider immediately.

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

This is an excerpt from The Smart Mother’s Guide to a Better Pregnancy

1. Is my cervix favorable? The softer the cervix, the greater the chances are of having a successful vaginal delivery. If the cervix is not “favorable” or soft, medicine will be necessary to make the cervix softer, usually in the form of suppositories.
2. How long will the induction take? This is a legitimate question because the longer the induction takes to occur, the greater the risk of developing complications such as infections. Most inductions of labor and delivery occur within 48 hours of admission. First-time moms dilate 1.2 centimeters per hour while moms who have had previous children dilate at 1.5 centimeters per hour.  It can take up to 20 for a 1^st time mom and 14 hours for a mom with previous children to develop active labor (meaning she is dilated 4 centimeters) but thereafter she should deliver within the next 12 hours. A 3-day induction of labor is a red flag that there might be potential problems that could compromise the health of the unborn baby or mom.
3. If you are being induced, break your water but are not having contractions, ask your provider whether he or she will give you antibiotics to prevent infections. The longer your membranes are ruptured, the greater the risk of developing an infection.
4. A multiple-day induction of labor involves many providers and nurses who will be changing shifts. Sometimes things or information gets lost in the transition. Ask who the lead person or team leader is regarding your care and make sure everyone is on the same page regarding your information. Try to obtain this information, BEFORE you are admitted to the hospital.
5. Trust your instincts. If things appear complicated during your labor, ask for a maternal fetal medicine consult. These are high risk OB doctors who specialize in managing complications.

Most of the medical malpractice cases that I have reviewed as an expert have involved the issues discussed above. To be forewarned is to be forearmed.

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

Samantha submitted her research project to the national Intel science competition and made the competitive semi-finals. She is now one of 300 students nationwide who have a chance of winning the top prize of $100,000. And it gets even better. The county social service department found a home for Samantha’s family at a subsidized rent and a private corporation is donating furniture. Hopefully, she will also hear good news from Brown and Yale Universities where she has submitted her applications for freshman admission.

When Olga and Leo Garvey bought their 2 pound 14 ounce daughter into the world, they gave us a gift. Let Samantha’s resilience and determination be an inspiration to us all, especially to parents of premature babies. Somewhere on the other side of the rainbow, the angels are smiling, and we are too. Congratulations, Samantha. I’m sure we’ll hear about you again in the near future.

Photo from www.pregnancy.about.com

Okay future moms and dads, your dream is about to come true. The National Institute of Health has recently published an article that indicated the sex of a fetus might be able to be determined as early as the first trimester, even a few days after conception based on a blood test. That’s right, a blood test.  No more invasive procedures such as an amniocentesis where a needle is inserted into the abdomen to withdraw fluid from around the baby. In the future, there will be no more chorionic villus sampling where a small sample is taken from the early placenta using a needle and inserted into the abdomen or through the cervix. Both of these procedures have a small risk (1 to 2%) of causing miscarriages and are used to detect genetic disorders. The fetal sex determination is just an added benefit.

Research in South Korea on more than 200 women was done during the first trimester by taking blood samples and testing them for 2 specific enzymes called DYS14 and GDPH. The ratio of both of these enzymes can predict whether a woman is having a boy or a girl. This will certainly take tremendous pressure off a healthcare provider who is usually bombarded with requests to have an ultrasound for fetal sex determination. Oh the challenges I had during my years in practice was trying to convince pregnant moms that an ultrasound for fetal sex determination was not a legitimate medical reason and most insurance companies simply would not pay for them. While it’s true that the sex of the fetus is determined at conception, the external genitalia (male and female parts) are not visible until approximately 18 weeks although sometimes it is seen earlier, depending on the position of the baby and the accuracy of the ultrasound.

According to the researchers, more research will be required before this test hits the market but it’s comforting to know that help is on the way. There will come a day when you’ll be able to take a pregnancy and then find out what you’re having the same day or shortly thereafter. Isn’t that exciting?

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

On a hot summer night in 1990, my chief resident (who was also my BFF) and I were on call at Harlem Hospital. We were informed that a “guest” was coming to interview us. Hot, sweaty and looking haggard rather than glamorous, we wanted to choke our director when Spike Lee walked through the door with film crew in tow. Lee was there to film the infamous movie, “Mo Better Blues.” We introduced him to our staff, he hung out with us all night and a patient allowed him to witness her delivery. Lee, dressed in paper scrubs, stared in awe as most people do when witness the miracle of birth. He graciously sent the patient a dozen roses the next day. I’m sure it’s not a coincidence that one of the main character’s in the movie was named Clarke, which just happened to be the name of one of our favorites nurses on duty that night. Denzel Washington was coming the next night but I was scheduled to go on vacation and someone else got the pleasure of meeting him. But here’s where the hypocrisy begins. When it came time to film the actual delivery for the movie, our residency director (who hadn’t delivered a baby in over 20 years) pulled rank and hijacked the part. To his credit, Spike Lee paid for the patient’s delivery.

On January 7, 2012, Lenox Hill Hospital in New York City, shut down its entire 4^th floor, prohibited employees from using cell phones and security cameras were taped. “Ingrid Jackson,” aka Beyonce Knowles Carter was having a baby. All hands were on deck and the hospital functioned at its highest level of proficiency. Unfortunately, the same day that Blue Ivy Carter entered the world, 2 women died of maternal complications. Many more had abruptions, premature labor, shoulder dystocias and stillbirths. $1.3 million dollars bought quality care for Beyonce, something that should really be experienced by all.

While I’m ecstatic about the arrival of Blue Ivy Carter, especially since her father and I were once residents of the humble Marcy Projects; my prayer is that Lenox Hill Hospital will take their windfall profit of $1.3 million dollars and put it to good use. How about donating ultrasounds, maternal fetal consultations and (OMG), a couple of free deliveries for uninsured pregnant women? And I’m sure they won’t boot Beyonce out of the hospital one day after her C. Section.

The birth of Blue Ivy Carter, while joyful, is yet another glaring example of separate and unequal health care treatment. Congratulations Jay and B. As you bask in the glow of your daughter’s safe arrival, please take time to remember those who may not be as fortunate.

My goal for 2012 is to encourage women to become significantly more proactive regarding their healthcare, especially if they’re pregnant. Background checks of hospitals, clinics and healthcare providers should be done on a routine basis prior to making an initial appointment. Obstetrics is a specialty of the unexpected. A “normal” pregnancy could become “abnormal”   in a matter of minutes in the labor room. Unwanted conditions such as diabetes, high blood pressure and premature labor rear their ugly heads. Can your healthcare provider handle these problems appropriately?

The untimely death of Hip Hop artist “Heavy D” aka Dwight Arrington Myers is a teachable moment in prevention. An autopsy confirmed that Myers had died from a blood clot to his lungs, also known as a pulmonary embolism. Myers had a previous history of obesity and heart problems. He was returning from England which is an extremely long flight. Sitting for greater than 2 hours increases the risk of developing blood clots in the legs. I wonder if anyone had advised him to stand every 2 hours for 15 minutes as a precaution. This advice also applies to pregnant women.

The story of Flight 1549, aka the “Miracle on the Hudson” is inspiring. The pilot, Captain Skully Sullenberger miraculously landed a plane in the Hudson River after the plane’s engine had been compromised by low-flying birds. His skill and proficiency saved 150 lives. Can your healthcare provider and hospital handle the unexpected? I certainly hope so.

The Smart Mother’s Guide to a Better Pregnancy was written to help pregnant women improve birth outcomes. There will also be future webinars to assist as well.

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