Welcoming a new baby is one of the most exciting times in a woman’s life. Upon meeting that special tiny person, your life will never be the same. Although you know life will be different, you may not be sure exactly how things will change. Here are some ways you may have to adjust, along with some tips for enjoying your first moments and days with a newborn.

Long labors are tiring, but nothing will re-energize you more than the feeling of finally having your newborn in your arms! So that you can give those first moments with your little one your undivided attention there are a few immediate postpartum decisions that should be made ahead of time. These include:

• Feeding method. Are you planning to breastfeed or bottle feed? It’s important to figure this out beforehand, especially if you feel strongly about nursing your baby. Babies are ready to nurse almost as soon as they are born, so knowing what you prefer is important.
• Cord blood banking. If you are planning to bank your baby’s cord blood, it needs to before before your baby’s birth. Cord blood banking is where the umbilical cord blood is collected after birth and stored for your family – to provide the unique benefit of being available as a potential medical resource, should the need arise in the future.
• Routine newborn procedures. Most hospitals routinely give babies routine tests and screenings as well as both erythromycin eye drops and a Vitamin K injection shortly after birth. Be sure to research these procedures and tests to be sure that you feel comfortable with them before you go into labor.

After you’ve gotten through the initial postpartum phase at the hospital, it’s time to take your baby home and adjust to caring of your baby without the help of ever-present nurses and doctors. Although every newborn is different, there are some common factors that tend to surprise most new parents. For instance, you may have heard that you lose a lot of sleep when you have a newborn. This is true, but it may shock you how much your baby sleeps during the first few days at home. Newborns need a high quantity of sleep, but do not always have quality sleep, as they have to eat and be diapered frequently.

So how do you best adjust to these changes? Sleep when baby sleeps, accept help from loved ones, and do not forget to eat! You should try to already have some healthy and quick meal options on hand. That way, you can feed yourself while you keep up with the frequent feeding needs of your sweet baby. Care for yourself during this special time!

Her husband, Mohamed Farrouq was an interstate truck driver who was away from home at various times. The Farrouqs, like many New York City dwellers, lived in an apartment but owned a vacation home in the Poconos. Two weeks after his wife was missing, he brings their four children to their vacation home and discovers the bodies of his missing wife and unborn baby. I have many, many questions for both the husband and police department. Where was Mr. Farrouq during his wife’s 2-week absence and why did he not report her missing sooner or go to their vacation home when she went missing? Who took care of her four children during her absence and did anyone in her family not get suspicious that something was array?

Although the state police investigator doesn’t believe “there’s been foul play,” I am reminded of a folklore legend we heard during our residency training about a physician (more specifically, an anesthesiologist) who killed his wife using the paralyzing poison, Curare. He almost “got away with murder” but didn’t based on a toxicology report that the nurses insisted be done because of his alleged infidelity.

From 1990 to 2004, there were 1,367 pregnant women murdered. Studies show that physical abuse occurs in 7 to 20 percent of pregnant women, sometimes leading to death from homicide. Women with an unplanned pregnancy have a 3-fold higher risk of physical abuse than planned pregnancies. The toxicology reports on Farrouq are pending. A DNA test of mom, dad and stillborn might not be a bad idea either. This case certainly has more questions than answers.

In 2009, an article in the Sunday New York Times Magazine published a story that nearly brought me to tears. Ruth Padawer wrote a story about fathers who had been “duped” regarding their children’s paternity. Who Knew I was Not the Father, is a cautionary tale of men who raised children, paid child support only to discover that they are not the biological father. It was disheartening to read about the profound betrayal these men felt upon discovering the truth.

Traditionally, mothers and fathers would have to wait until after the birth of the baby to determine paternity or have an invasive procedure called an amniocentesis that took a sample of fluid around the baby and tested it against the father’s DNA. Now, things have changed, thanks to modern genetics and Ravinder Dhallan, MD, PhD, who discovered the test through his research. Although fetal cells are present in a mother’s blood, it was difficult to isolate them based on technical difficulties. Dhallan discovered that if he mixed the mother’s blood with a fixative, the fetal blood cells could be obtained. Therefore, rather than have an invasive test that runs the risk of causing a miscarriage or waiting until after the baby is born, the paternity of a baby can be established as early as 8 weeks gestation.

This new DNA tests is a game-changer. It allows women to make informed choices and empowers men to prove or disprove paternity much earlier in the pregnancy. Would you use this test if it were available? Please share your thoughts.

1. Ask that your concerns be documented in your chart and then ask to receive a copy of the chart. If your concerns are still present and not addressed to your satisfaction, call your insurance company, explain the situation and request approval to change providers.
2. If for some reason, you are not able to change physicians or providers, contact your insurance company, explain yours concerns and dissatisfaction, then ask for approval to obtain a consultation with a high-risk specialist (aka maternal fetal medicine) so that he or she can evaluate your condition to make certain that it’s not high-risk
3. If you are in labor and are not satisfied with your progress, have a family member or your support person request to speak to the nursing supervisor. When he or she arrives, inform them of your concerns and that you want it documented in your chart. Ask her who is the on-call or consulting maternal fetal medicine specialist and then request an in-house consultation. Simultaneously contact your insurance company, explain your concerns and ask for approval for the consultation advising them that if anything happens to you or your baby, they have been duly notified in advance. Also ask to speak to the hospital’s risk management office as well.

By implementing these strategies, you improve your chances of having a favorable outcome because you are formally documenting your concerns and holding people accountable for your patient care. Your proactive role will protect both you and your child.

Most physicians are compassionate, competent and caring. On rare occasion, you might unfortunately encounter one who needs to be “brought back down to Earth.” If that happens, you now know what to do.

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

Sadly, everyone is not as fortunate. Each month I review medical malpractice cases and shake my head in frustration because many of them could have been avoided if only someone had listened to the patient or paid attention in the labor room. Last week, the listeners of a popular morning radio show listened in horror to Angela Burgin Logan’s interview about her missed diagnosis of pre-eclampsia that almost killed both her and her unborn daughter. Fortunately she lived to tell the story which is now a movie entitled Breathe. Although Angela and her daughter are well, other women have not been as lucky.

Pregnant women need to start thinking in terms of “outcomes” regarding their pregnancy. As the healthcare “industry” moves deeper into the 21^st century, healthcare providers and hospitals will be measured and paid according to the outcomes of the patient. You will hear terms such as “pay for performance” and “performance measures” used more frequently. A “normal” pregnancy does not necessarily mean a “normal” outcome at birth (aka healthy baby) if someone misses a sign or a signal of a potential life-threatening problem. Why does this happen? For reasons too numerous to count but the main culprit is lack of communication. A lab report with important results was not reviewed or signed. High-volume practices leave little time to provide quality care for patients and then of course, there is arrogance.

Two of the most empowering things a pregnant woman can do in order to improve her chances of having a healthy baby is to (1) select the right healthcare provider and (2) have strategies at hand in the event that she encounters administrative or clinical complications. In Part 2 of this discussion, I will provide some of those strategies in the event that you have a healthcare provider who will not listen to your concerns. Until then, remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.

When the general public hears the word “illegal” associated with the word immigrant, they immediately think of people who are born south of the border. But if the truth be told, there are pregnant women who enter the U.S. as tourists every day, have their babies and then return to their country. Eighteen years from now, these “babies” will be U.S. citizens although their parents never paid taxes or contributed to Social Security.  Is that “illegal?”

Money is usually the deciding factor regarding political policies and these policies affect the unborn. When I worked in public health in the pre-9/11 days, there was a wealthy couple from the Middle East who sought prenatal care.  The wife was very advanced in her pregnancy and her jewelry was worth more than my month’s salary.  My initial impression was “How on earth did an airline allow her to board a plane and travel half-way around the world?” The administrator spoke with me personally to make certain that I would “take care of the patient.”His concern had less to do with the well-being of her baby and more to do with the cash that her husband pulled out of his pocket to pay for her care. He peeled off $2500.00 in one-hundred dollar bills as if they were one-dollar denominations. He then asked how soon could they return to their country after the birth of their child and also mentioned that they were staying at the Ritz Carlton Hotel.

So, which is worse?   A baby born to an “undocumented” immigrant whose husband is under the radar screen and working for minimum wage or a wealthy medical tourist who has a baby that will return 18 years later to claim their rights and privileges as an American citizen? I’ll let you be the judge.

Listeria causes a form of food illness called Listeriosis that can cause a miscarriage, premature deliveries, serious illness or death of a newborn. Each year, 2,500 Americans become ill from listeriosis and one out of five cases result in death. Unfortunately one-third of listeriosis occurs during pregnancy. Foods associated with listeriosis can grow slowly at refrigerator temperatures. Such foods include: improperly cooked hot dogs, luncheon meats, cold cuts, fermented or dry sausages and other deli-style meat and poultry.  Raw (unpasteurized) milk and soft cheeses made with unpasteurized milk are also culprits as well as smoked seafood and salads made in the store such as ham, chicken or seafood salads as well as raw vegetables. Symptoms of listeriosis include fever, chills, headache, backache, occasional upset stomach, abdominal pain and diarrhea. It may take up to 2 months to become ill.

Toxoplasmosis is a parasite found in raw or undercooked meat as well as cat litter boxes and other areas where cat feces can be found. It can cause hearing loss, mental retardation and blindness in babies. It can also cause miscarriages and birth defects. Its symptoms include flu-like symptoms that usually appear 10 to 13 days after eating and may last for months.

How can pregnant women avoid getting these foodborne illnesses? By following the four basic steps to food safety: clean, separate, cook and chill food during and after preparation. Wash hands and surfaces often. Use paper towels to clean kitchen surfaces. Rinse fruits and vegetables. Clean lids before opening cans. Separate raw meat, poultry, seafood and eggs from other foods in your grocery shopping cart, grocery bags and in your refrigerator. Never place cooked food on a plate that previously held raw meat. Use a food thermometer when cooking meat and refrigerate or freeze meat, poultry, eggs seafood and other perishables within 2 hours of cooking or purchasing. Refrigerate within 1 hour if the temperature outside ifs above 90°F.

For further information, please contact AskKaren.gov that is a virtual assistant funded by the FDA. www.fda.gov/Food/ResourcesForYou/HealthEducators/ucm081785.htm is another great resource regarding food safety for pregnant moms.

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

Samford was a popular volleyball coach and science teacher at Christian Academy for approximately three years. When she was originally hired, she signed a contract stating that she would exhibit “good Christian behavior.” However, when it was discovered that Samford, who has two children was pregnant with her third and unmarried, she was summarily fired from her job. Samford asserted that she was in a committed relationship and she had planned to get married before the end of the summer but “a series of events” had delayed the event. Both she and her fiancé stated that they would change their plans to get married sooner in an attempt to avoid Samford’s termination but to no avail. The school stated it didn’t matter. They weren’t going to change their decision because “It doesn’t change that her behavior was out of wedlock.” Samford was in shock. When she lost her job, she also lost her medical benefits and is rightfully concerned about her future and the future of her children. She is presently living off her tax refund. She hired an attorney and has filed a discrimination suit against the school. The school asserts that they were within their right to terminate Samford because they are a private school.

If Jesus the Christ were the headmaster of Heritage Christian Academy, do you think he would fire Samford? Probably not. Maybe the school administrators should put down their stones.

Imagine that you delivered a premature baby at 26 weeks, was informed that it was a stillbirth and then 12 hours later, you discover that it is alive. That is exactly what happened to Bouter, after delivering a baby girl via a C. Section. Bouter’s daughter was pronounced dead at the time of birth and quickly whisked away to the morgue where it remained in a refrigerated room. Twelve hours later, Bouter and her husband visited the morgue to say a final farewell and take pictures to be sent to the funeral home. Bouter’s husband attempted to open the coffin with great difficulty and once opened, he stepped aside so that Bouter could see the baby. She moved the coverings aside, touched the baby’s hand and then uncovered her face.  She then heard a cry and at first thought she was imaging things. As she stepped back, the baby woke up and let out a weak cry. Bouter fell to her knees crying and laughing simultaneously. The baby was quickly taken to the neonatal intensive care unit and is presently on a ventilator.  A news conference was held and five healthcare workers were suspended pending an investigation. Bouter plans to sue.

How could this possibly be, one might ask? There are a few possibilities. Perhaps the baby had a weak heartbeat that went undetected or it was the cold temperature that kept it alive. Almost 2 years ago to the exact date, I wrote a blog about hypothermia, (see 5 “Cool” Ways to Save a Newborn’s Life), an innovative way to keep critically ill newborns alive. This process was initiated at the University of California in San Francisco, had specific protocols that were used on babies greater than 36 weeks and must be implemented within the newborn’s first 6 hours of life. Bouter’s baby was only 26 weeks but the process still worked.

In 2005, there was a case of tourist Dan O’Rielly who drowned in Mexico and was airlifted to Houston where he was given a cooling blanket with a temperature of 90 and the man came back to life 12 hours later. He went without oxygen for 45 minutes before he was intubated. There IS something to this freezing stuff and I hope medical science will research the matter further. In the meantime, may the story of Luz Milagros (Little Miracle) continue to inspire us all. Obviously she was meant to be here.