smart mother's blog

It Honestly Never Occurred to me that Pregnancy Could be Dangerous

These words are a direct quotation from a pregnant woman who almost died.


I want to personally thank Steph Montgomery for writing one of the most honest articles about the dangers of pregnancy, something that very few of my OB colleagues have been willing to do.

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DC Pregnant Women are the Victims but Who is the Real Culprit?

Women in one of the poorest communities in the District of Columbia will no longer be able to deliver babies at their community hospital, United Medical Center. Why? Please keep reading.


I will not address the absence of clinical standards performed by the staff that led to a newborn baby being infected with HIV and an obese preeclamptic patient with a severe breathing disorder being harmed. Go deeper into the root cause analysis and you will find politics and money as the culprits.


The present CEO of the hospital, Luis Hernandez, was the former CEO of Interfaith Medical Center, a hospital located in my hometown of Bedford Stuyvesant, an African American community in Brooklyn, NY. The hospital went bankrupt and set the community into a tailspin of doom and gloom.

The "health consultant", Corbett Price, hired by DC"s mayor previously worked for HCA, in institution riveted with fraud and corruption. Price subsequently became an owner of a "private equity firm called Veritas." Nowhere have you read that neither of these individuals have any medical training or expertise. Yes, they might have reduced business costs with their previous endeavors but in both cases, hospitals closed, hundreds of workers lost jobs and NOW, innocent patients have been harmed. This is what happens when "business" people make decisions about "healthcare" issues. Healthcare is NOT a business.

 

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Mission Statement for Life by Dr. Amber Robins, MD

 

Re-posted with permission from:

http://www.empowernowmovement.com/Mission-Statement-for-Life

 

 

I took part in a leadership workshop where I was asked to write a mission statement for my life. This was the FIRST time anyone has asked me to do this. It was a great exercise that I would suggest others to take part in. Have you ever tried this? Well, this is what happened when I wrote my mission statement.

Here's MY MISSION STATEMENT FOR LIFE:

"My mission is to spread the love of God through my career, family, friends, and acquaintances. To reach the level of purpose that my creator has set for me. To be fearless in my thinking and unlimited in what I can do. Always yearning to bring peace, positivity, and happiness to myself and others. To be a loving daughter, sister, friend, doctor, companion, and future mother as I honor my ancestors for the sacrifices that were made. My mission is to be an ever evolving being whose inner light illuminates this often gloomy, dark world. But to always keep in mind that I must preserve my health and well-being to reach my mission and goal in life."

 
What is your mission statement for life? How will your mission help bridge you to the next level?


Here are 4 Questions to ask yourself  when writing your Mission Statement

  1. What is most important to you?
  2. What or who do you use as your internal guide? What are the rules you play by?
  3. Where do you see yourself in the next 10 to 20 years?
  4. What roles do you want to take on from your past to bring in your future?

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Dr. Amber Robins is a Family Medicine resident physician and graduate of the University of Rochester School of Medicine and Dentistry. Dr. Robins is also an international best-selling author of “The Write Prescription: Finding the ‘Right’ Spiritual Dosage to Overcome Any Obstacle.” Throughout her journey, Dr. Robins’ goal is to motivate others to achieve their own personal success which she does as a personal life coach. You can find more articles at www.empowernowmovement.com and www.DrAmberRobins.com.

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The Carter Twins Have Arrived: Well Done Beyoncé & Jay!

Congratulations are in order.

 

The Carter twins have arrived and we can all breathe a sigh of relief.

Although twins represent “two unique souls united by one birth,” their prenatal course and birth at times are not without risks. Twins come earlier than expected. Their umbilical cords may become entangled if they are identical.  Their placentas can prematurely separate too soon and there are other risks that I won’t even bother to mention. From what we know thus far, these complications have eluded the Carter pregnancy.

According to the media, Beyoncé delivered a week ago, but the babies remain in the hospital for “minor reasons.” This is not unusual.


It’s possible that the twins were born a bit early and the babies might be slightly underweight. Other reasons their delayed hospital discharge include the following: increase risk of yellow jaundice, breathing problems, poor feeding or an irregular heartbeat. Whatever the problem is, I’m sure it will be resolved quickly under the watchful eyes of the neonatal nurses as well as the Carter and Knowles families.


Beyoncé’s twin pregnancy will be remembered for many reasons.  Not everyone can rock a pair of heels during her 7th or 8th month of pregnancy and sing upside down as she did at the 2017 Grammy Awards nor am I recommending that pregnant women try that. And my fellow Marcy Housing Alumnus Jay-Z, is to be commended as well. Rather than attend the Songwriter’s Hall of Fame ceremony for which he was an inductee, he opted to remain by Beyoncé’s side at the hospital.

Singer, song writer, 22-time Grammy Award winner, actress, visual artist extraordinaire, wife, formerly mother of one and now mother of twins. A phenomenal woman you are, indeed.

All the best with the twins, Mr. and Mrs. Carter. Your devoted fans can’t wait to meet them.

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Judge Glenda Hatchett's Daughter-in-law Shouldn't Have Died in Childbirth

The tragic death of Judge Glenda Hatchett’s daughter-in-law is yet another reason why people shouldn’t think of pregnancy as a condition without risks.

 

Hatchett’s daughter-in-law, Kyira Dixon Johnson was 39 years old and pregnant with her second child. She had a repeat cesarean section that had been scheduled in advance at the prestigious Cedar Sinai Hospital in Los Angeles, California. The cesarean procedure went smoothly and took approximately 30 minutes. Johnson gave birth to a baby boy and was taken to the recovery room in stable condition. Three hours later, an astute nurse noticed that Johnson had blood in her Foley catheter (a tube that drains the urinary bladder) and allegedly informed the physician. A CT scan was ordered but not done.

 

Hours later, Johnson was taken back to the operating room where three liters of blood was found when they surgically opened her abdomen. Although they made a valiant effort to save her life, she died. Johnson’s husband and mother-in-law have sued the physicians and hospital.  The autopsy report stated excessive blood loss was the cause of death.


Stories such as Johnson’s make me angry.   Women who enter a hospital to give birth shouldn’t end up dead.  Johnson did not have her baby in a remote village whose name is difficult to pronounce.  She died in one of the most prestigious hospitals in the U.S. and the question is why?


When the nurse reported blood in her urine, there should have been immediate lab work drawn to determine if her blood count was dropping. When the CT scan was ordered but not done within 30 to 60 minutes, an alert should have been sent to the radiology department, her physician and nursing staff. Her blood pressure should have been checked frequently to see if it was low. And until proven otherwise, the diagnosis of post-partum hemorrhage should have been high on the list of possibilities as a reason for having blood in her urine.
Kyira Dixon Johnson shouldn’t have died last April and neither should the other 700 women who die each year as well. These deaths are totally unnecessary – and they really need to stop.

 

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Dr. Linda Discusses Downton Abbey and Preeclampsia

Dr. Linda Burke-Galloway, author of the Smart Mother's Guide to a Better Pregnancy discusses the interview she had with Hollywoodlife.com about the hit series, Downton Abbey and the eclamsia episode where Sybil Crawley dies in childbirth.


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Vivien Thomas is Smiling Down from Heaven at Jimmy Kimmel’s Son

I have incredible respect for Jimmy Kimmel for baring his soul in front of millions of people and crying unabashedly at the thought of losing his infant son. Kimmel’s son was born with a congenital anomaly called Tetralogy of Fallot which causes a lack of oxygen to reach the lungs. The story had a happy ending because the problem was corrected with a surgical procedure.

As I listened to Kimmel’s ultimate triumph, I thought back to an HBO show I saw years ago called “Something the Lord Made.


It tells the story about the quintessential “odd couple”: a Caucasian surgeon (Dr. Alan Blalock) and an African American carpenter (Vivien Thomas) who would eventually develop the Blalock-Thomas-Trussig shunt that saved the lives of babies who were known back then as “Blue Babies.”

 

Thomas wanted to attend medical school but never had the opportunity. However, he would eventually become a surgical technician at Johns Hopkins School of Medicine and train young surgical resident physicians in training.  I’m certain both Blalock and Thomas are smiling down from Heaven knowing that their procedure saved the life of the son of one of American’s most beloved comedians and humanitarians.  Kimmel’s stock rose exponentially in the accounting system of human integrity when he advocated for the continuance of the Affordable Care Act, citing his newborn son as an example of a child with a pre-existing condition.

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May is Pre-Eclampsia Awareness Month

 

The month of May has always been special; it is the month that I officially became a physician exactly 30 years ago; it is the month that we celebrate Mother’s Day but unfortunately it is also a month that makes us aware that some mothers are no longer with us because of a pregnancy related condition called pre-eclampsia.


Pre-eclampsia affects 5 to 10% of pregnant women on a global scale and 3 to 5% in the U.S. It causes high blood pressure after 20 weeks, protein in the urine, headaches that are unrelieved with acetaminophen, swelling of hands, legs and feet and blurry vision. It is caused by abnormal blood vessels in the placenta and mother and the cure is to deliver the baby. Pre-eclampsia can also occur after the baby is born and requires aggressive treatment to quickly lower the blood pressure in order to avoid a stroke. In addition to strokes, it is sometimes associated with seizures and is then called eclampsia.

 

Pre-eclampsia can be devastating. Each year it claims the lives of approximately 800 women. Joan Donnelly was one of those women and this is her story told by those she left behind and who obviously loved her deeply.

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What Beyoncé and Serena Need to Know About Their Pregnancies

As a fan of both Beyoncé and Serena, I am overflowing with excitement for their pregnancy  as they embark on the mystical and magical journey called pregnancy for the first and second time in their lives. However, as an obstetrician, I’d like to share a few pearls of wisdom to ensure that the pressure gift that they carry, arrives safely.

Serena and Beyoncé are both 35 years old which is considered advanced age in pregnancy. While age 35 is a great time to have a baby because of presumed maturity, it is also a time to exercise precaution. Queen B, you are blessed to be carrying twins, but please be aware that twins can come earlier than expected. Preterm labor is sometimes sneaky and rears its ugly head as back pain. Therefore, if you are experiencing back pain for greater than one hour, please call your pregnancy provider immediately who should advise you to go to the labor and delivery to be checked.

 

Goddess. Serena, while you are in phenomenal physical shape, you must be aware that you are at risk for developing pre-eclampsia because this is your first pregnancy and are 35 years old. Pre-eclampsia is also sneaky and doesn’t make a grand announcement. Some of the symptoms include, having a headache that doesn’t go away even after taking acetaminophen, blurry vision, rapid weight gain in one week (because of increased fluid) and having high blood pressure after 20 weeks.


The Queen and Goddess are both African American, therefore the risk of having a pre-term delivery is greater.

While pregnancy is a beautiful thing, it’s not always peaches and cream. It’s more like an airplane ride that can encounter some rough air and bumps. The purpose of writing this blog is to help you navigate your pregnancy to a safe and healthy delivery.

Wishing you peace, joy and love and hope you remember that “A healthy pregnancy doesn’t just happen, it takes a smart mother who knows what do to.”

 

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Spring Has Returned and So Has Dr. Linda

 

“To everything there is a season” and I am happy to report that my season of discontent, health challenges and yes, even dissolution of a 25-year marriage is over and I am REALLY back this time.

I have missed you, my faithful readers, pregnant moms and followers who continued to come to my website even though it had been unattended to for months . . . no . . . actually a few years. I hadn’t planned on staying away for so long but like John Lennon once said, “Life is what happens while you’re busy making other plans.”  In 2014, I had a vision problem that prevented me from seeing things at a  distance and I had stopped driving for a year. I was visually disabled and scared. During this crisis, there were people who ran TO me in my time of need and those who ran FROM me.  One day, I will delve deeper into this topic but I’m so grateful to report that my vision has improved and so has my life.

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Is Underwater Childbirth Safe? Some Doctors Say No.

Most women look forward to having a baby but no one wants to feel pain. In recent years, having a baby in a pool of water has become a popular trend because it allegedly reduces the need for pain meds and anesthesia however not so fast, says both obstetricians and pediatricians. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) have issued a formal opinion (Committee Opinion #594 April 2014) that does not support “immersion” (aka underwater) births because of its associated complications while a mother is pushing to deliver her baby. The “pushing” part of childbirth is also known as “second stage labor.”

 

Why is this important? Because there are presently 143 birthing centers in the U.S. that offer underwater births to pregnant women. In fact, 1% of all births in the United Kingdom are immersion. While some research claims that these births are safe, experts think otherwise and state that the number of women studied was too small to detect rare but potentially harmful outcomes.


While some women may experience a feeling of well being and control, decreased stress and less vaginal tears during an immersion birth, according to the Committee Opinion, there is no scientific evidence that an underwater or immersion birth helps the baby. In fact, there is evidence of increased complications such as

  • increased infections to both the mother and newborn, especially after the membranes are ruptured (aka “water broke”)
  • difficulty in regulated the newborn’s temperature
  • increased risk of the umbilical cord tearing from the placenta
  • infant drowning and near drowning
  • infant seizures and suffocation
  • severe infant breathing problems

Should women give up immersion births completely? Probably not. The experts think that a woman may stay in these tubs during labor but should NOT push or deliver the baby underwater. They also recommend stricter protocols, patient selection and infection control.

 

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Pregnant Mother Who Drove into the Ocean Will Remain in Hospital

Thank God for common sense. For once, the state of Florida has done something right and kept Ebony Wilkerson, (the 32 year old pregnant mom who drove her kids into the ocean) into a hospital where she rightfully belongs. Wilkerson is 7 months pregnant and certainly doesn’t need to be in a jail where the chances of her having a healthy baby are greatly diminished. Had it not been for good Samaritans who ran into the Atlantic Ocean and rescued Wilkerson, three innocent children and an unborn baby would have met an untimely demise.

What is it about our country that prevents us from recognizing mental illness when it smacks us dead in the face? The fact that Wilkerson was interviewed and released by law enforcement agents three hours before she drove into the ocean is troubling. Mental illness is a public health disease and yet it’s treated as an afterthought in a “too-busy-society” that focuses more on entertainers’ wardrobes and scandals as opposed to its citizens that need immediate attention and intervention.

 

Pregnancy can bring out the best in women but it can also provoke anxiety, depression, social isolation, rejection, substance abuse and changes in economic status. Pregnant women who have mental illness might be reluctant to take their medications, which only makes their illness worse. Or, they might become victims of domestic violence because of their partners’ lack of desire to have children.

Thank goodness we can learn from our mistakes. Unless law enforcement officers have mental health training, they need to bring patients to an Emergency Department for further evaluation whether they appear to be “normal” or not. Psychiatrists should be alerted before a patient signs out against medical advice (as in the case of Wilkerson) to determine whether the patient needs medication and a possible court ordered stay.

It’s tragic that no one (with the exception of her sister) believed Wilkerson had a mental health problem until she drove her car into the ocean. How many more families will suffer before we finally get it right?

 

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Why a Water Birth May Not Be a Good Idea

The next time you see one of those You Tube® videos singing the praises about water births, Amy Stenton wants you to think again. She had one and now wants them stopped. She sued The Legacy Healthcare system for 35 million dollars as a result of the injuries incurred by her son who now has significant disabilities including cerebral palsy and hearing problems. He will need life-long care. We often hear about patients suing for damages but when patients demand that the hospital program be shut down because it’s dangerous, it gives us reason to pause.

 

Stenton and her spouse, Matthew Marino, read the hospital’s website and assumed water births were safe. Allegedly the website read: “European studies have shown a lower use of pain medication, decreased need for medicines to stimulate labor, decreased perception of pain, and high patient satisfaction, among other benefits, ­during labor and delivery in a birth tub."

 

What the website omitted was the expert opinion of both The American Congress of Obstetricians and Gynecologist (ACOG) and the American Academy of Pediatricians who do not think water births are safe. If you are considering water births, here are the facts:

  • Laboring in water is okay. Delivering in water is not. The safety of having a baby in water has not been established
  • The baby’s umbilical cord could snap off or rupture
  • The baby could drown
  • Potential infections from the tubs
  • Patients need to be low-risk before entering the tub during early labor
  • Difficulty in checking the baby’s temperature
  • Breathing problems for the baby

Unfortunately there were no physicians available during Stenton’s birth which aggravated the situation. Based on a survey in 2005, there are approximately 143 birth centers in the U.S. that allows water births however, as a result of Stenton’s lawsuit, those numbers might change.

 

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Sherry Shepherd’s Surrogate Mom Forced to Pay Child Support? Another Surrogate Mess

Sometimes a woman marries the wrong man. And then things become more complicated because there are children involved. This man that you should have never married is now looking for a big pay day. However, please do not allow innocent children and babies to suffer because of a highly contentious divorce and certainly do no drag the surrogate mother into your mess.

 

Surrogate parenting (aka Gestational Carriers) is tricky. A woman is hired to have a baby for a couple with the expectation that the couple will pay her and take responsibility for their child. She is screened very carefully to make sure that she’s healthy enough to carry a pregnancy and that there is mutual agreement with the intended parents. It is a gift not to be abused. It seems that is not the case regarding Sherri Shepherd, former co-host of the popular show, The View.

 

Shepherd’s estranged husband, Larry Sally, is seeking child support from Shepherd and rejected her original offer of $150,000. He has full custody of their son, who was born on August 5, and applied for Medicaid in California. The State of California is now seeking child support from the surrogate mother whose name is listed on the birth certificate. Shepherd has allegedly not seen the baby since his birth.

 

In surrogate arrangements, both intended parents and surrogate mom are supposed to have psychological testing prior to the arrangement. It's uncertain whether this has occurred in the Shepherd-Sally case. Based on what has occurred, it would be prudent for the California Child Protective Services Department to intervene in this case. Someone at needs to protect the rights of the baby. Someone also needs to have an adult conversation with both Shepherd and Sally about parental responsibility. The surrogate mother SHOULD not be dragged into the middle of this dispute.

 

Agree or disagree? Please share your thoughts.

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The Circle of Life

The holiday season is a time of both joy and sorrow. Tomorrow a childhood friend will be laid to rest; one of my favorite artists, Teena Marie, died unexpectedly two days ago and at least six other people have made their transitions as well.  My own father died unexpectedly on Christmas Eve in 1981 leaving a great void in our family life. Why do people leave us during the holiday season? It has been said because they want to be remembered.

While I lamented about all the transitions that occurred in the past two weeks, one of my best friends announced that she had a new granddaughter that was born on Christmas Day. She stated that this was part of the “Life Cycle or Circle of Life.” Her comments gave me reason to pause and reflect.

 

We recently had severe cold weather in Florida and my beautiful purple Morning Glory flowers immediately died. They were special because they were a gift from a friend with whom I no longer see and the only other place I saw them was in West Africa.  Last year during a very cold freeze, I thought that I had lost them. Their purple flowers and stems had completely disappeared. But in early March, a green leaf appeared out of nowhere; followed by tiny white buds that culminated into purple blossoms. My Morning Glories were back, as if resurrected from the grave.

When a loved one departs, miraculously a family member becomes pregnant and a new loved one appears.  This baby brings gifts that enhance our human experience. When my mother left us in 2002, I was childless and told that I couldn’t bear children. On Christmas in 2005, I felt a pang of loneliness that was palpable. I began to look at adoption websites and three years later, we brought home our glorious sons. Everything has a season.

As we bid farewell to 2010, let’s reflect on our roles as men and women. Life begins with us and within us. We each play an integral role in the circle of life; therefore, “in the time of your life — live.”

Happy New Year.

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Patient’s Miscarriage Gets Hospital in Trouble

It’s a sad commentary when human beings have to be reminded how to act like human beings, especially when they’re in the helping profession.  Loni Hildebrandt was a 29 year old certified nursing assistant who was pregnant with her first baby. Make that two babies because she was pregnant with twins. Hildebrandt considered her pregnancy miraculous because she had infertility and was a diabetic since the age of one. Together, she and her boyfriend saved their money and obtained fertility treatments. Her mother, Jo Novtny, a nurse of 30 years was ecstatic when she saw the ultrasound of her two grandbabies but her happiness was short-lived. One day after the procedure, Hildebrandt began to bleed so they went to Sarasota Memorial Hospital in Florida.

 

Sarasota Memorial Hospital has an excellent maternal fetal medicine (aka high-risk obstetrics) department but Hildebrandt never made it there. She got as far as the hospital’s emergency room where she was attended to by one of its physicians. Despite repeated requests to have her blood sugar checked, Hidebrandt had to wait six hours before it was done. An ultrasound at the hospital revealed a blood clot that was causing the contractions and the ER doctor told her that he could probably save one by “suctioning the clot so the labor would stop.”  According to The Herald Tribune, the physician suctioned the clot and one of the twins as well. Hildebrandt allegedly began bleeding more, passing bright red blood clots. They called for help but no one came. According to the newspaper report, a nurse put the afterbirth in a bedpan and left it near Hildebrandt’s head where she was lying. Her mother moved it and placed it under her daughter’s bed. Novtny ultimately delivered the second twin because no one else was around.  The ER doctor returned to the room saw the fetus in Novotny’s hand took it from her and put it in a bucket.

Novtny states her daughter did not receive proper treatment until her personal physician arrived and remained in a pool of blood for over 10 hours. Hildebrandt’s iron count was dangerously low because of the bleeding. Her mother’s request to speak with the hospital administrator was met with no response so she wrote a letter to the governor instead.  An investigation was done, gross negligence was found, the ER doctor resigned and Hildenbrandt’s nurse was cited for “lack of critical thinking skills.” The hospital will now have unannounced federal inspections in order to keep their Medicare payments. The hospital administrator issued a public apology.

Perhaps one day hospitals will do the right thing, even when no one is watching.  Hopefully, Hildebrandt will become pregnant again and have a better outcome.

 

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Is Using Your Mother’s Uterus an Option?

Infertility or the inability to have a baby can be devastating and affects approximately 10 percent of the female population. There are many conditions that prevent women from having children including and Mayer Rokitansky Kuster Hauser Syndrome (or MKHS). MKHS is a rare disorder that affects a woman’s ability to conceive. At present, for every 10,000 women, only 1 to 2 will be affected. Both Sara Ottoson of Sweden and Melina Arnold of Australia have this condition. MKHS is characterized by the absence of a vagina and part of the cervix. Patients with this condition have normal breast development and functioning ovaries. Genetically, they also have female or double X-chromosomes and look like normal women. The problem comes to light during adolescence when a teen fails to have a period. The condition is also known as Vaginal Agenesis because they are born without a true vagina, a problem that can be corrected through surgical and non-surgical procedures. Unfortunately, they are unable to have children and usually adopt or use a surrogate mother. Those options, however, might soon change.

 

Both Ottoson and Arnold plan to have biological children using those mothers’ transplanted wombs next year.  The wombs that these women resided in prior to their birth will potentially be used to nurture their unborn babies.  Ottoson and Arnold will be making history in the same manner as Louise Brown did in 1978 when she became the first successful “test tube” or In Vitro Fertilization (IVF) baby. Has a womb transplant been attempted before? Yes, about 10 years ago in Saudi Arabia but it was an unsuccessful procedure. After four months, the 25-year-old patient’s body rejected the transplanted uterus of a 46-year old woman. Ottoson will receive the uterus of her 56 year old mother but will not be able to conceive through IVF until she has waited a full year to make certain that her body will not reject the donated organ.

If womb transplant becomes successful, it will also be a powder keg regarding ethical and legal issues.  It would also provide an option to women who are cancer survivors and desire fertility. All eyes will be on Ottoson and Arnold next year. It will be history in the making.

 

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Mother Becomes Pregnant With the Wrong Baby! The Ultimate Nightmare

The MSNBC story, Wrong-Embryo Baby’s Parents Laud Guardian brings to mind a line from Tina Fey’s movie, Baby Mama: “Life is messy.” Fey plays the character of a thirty-seven year old woman who was informed that she only has a million-in-one chance of conceiving because of an abnormal uterus. She hires a surrogate who unknowingly is not pregnant with Fey’s child but her own. When the surrogate discovers the error, she must break the news to Frey who is of course, devastated. Art imitates life.

Carolyn Savage was a 40 y.o. woman who received in Vitro-Fertilization and on the third attempt, successfully conceived a baby. Unfortunately, it was the wrong baby; a nightmare no one should ever experience. Savage was carrying a baby who belonged to the Morrell family who had frozen embryos at the same infertility clinic.

 

As tragic as this may appear, all parties involved rose to the highest level of integrity regarding correcting this unfortunate error. The clinic informed Savage immediately upon discovering their mistake. As a physician who has witnessed my share of ethically-challenged administrators and colleagues in the medical profession, it took a tremendous amount of courage to claim ownership to an error of that magnitude. Savage was given the option of terminating the pregnancy or giving the baby to its biological parent. The Morrells had not planned to have a baby anytime soon but were informed that another woman was carrying theirs. What a moral dilemma.

As a former infertility patient and physician who became a mother after age 50 through the miracle of adoption, I truly felt their pain. Last week Savage delivered a healthy baby boy and gave it to the Morrells. There are no words that can articulate Savage’s valiant act.

To err is human but the effects are still shattering. May this level of incompetence never be allowed to recur again.

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What Every Woman Should Know About Dollar Store Ovulation Kits!

So here we go again! First a dollar pregnancy test and now an ovulation test for the same great price ($1.00)

Three cheers for SCI International, the manufacturer of these super products.

After the tremendous positive response to my earlier post regarding the $1.00 pregnancy test, I received a phone call from SCI’s Vice President, Mr. Abedi. He was delighted that the blog was well received and I in turn was delighted with his product. He explained that the company’s only makes a few cents above its production cost but that they deal in volume. It was so refreshing to hear about a company that wasn’t going to bankrupt its customers in order to make a profit. Abedi continued to describe the company’s array of products including an ovulation kit for $1.00. You can only imagine how far my jaw dropped. As a former infertility patient, I am well-versed with ovulation kits and could not believe they were being sold for . . . a dollar? Abedi quickly added that the ovulation kits were only available at the Dollar Tree store. So, off I went to my local Dollar Tree store to see for myself.

 

Upon my arrival and to my utter delight, both pregnancy and ovulation tests were readily available. The pregnancy tests were behind the counter while the ovulation kits were displayed up front. The cashier must have read my mind and offered the following explanation: The pregnancy tests are a popular item among teens who attempt to steal them. And the ovulation kits are displayed in front of the cash register because “teens are not trying to get pregnant.” It made perfect sense. And just like their pregnancy test counterpart, the ovulation tests are 99% accurate.

Quality and at affordable prices. Who would want to pay more?

 

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Does Fear Prolong Labor?

Journalist Nicholas Bakalar of the New York Times wrote an article that addressed a profound issue regarding pregnancy: Does Fear Make Labor Longer?

Over 2,000 pregnant women in Norway were given a questionnaire at 32 weeks to determine if they had a fear of labor. These women were then followed to determine how long they were in labor and according to the study, there was a 47 minute difference in the length of labor of 165 women who feared childbirth compared to those who don’t. Why is this important? It’s important because fear is something that we can control.


Three of the most empowering things a pregnant woman can do are request a tour of the labor room before she has a baby, take childbirth classes and request pain meds or an epidural if she experiences pain while in labor. When a pregnant woman is calm, the unborn baby is calm but if she’s writhing in pain, the adrenaline that she’s producing affects the baby and inevitably causes fetal distress. Prolonged fetal distress means emergency c. section.

One of my most memorable deliveries was as an intern during the late ‘80’s. Recording artist Anita Baker was very popular back then. I was astounded when a very “Yuppy” expectant father, pulled out a tape cassette and played Baker’s tape while his wife was in labor. He requested dim lights and held his wife’s hand as they listened to my favorite song, Sweet Love. Although I respected their privacy, I was never far from their room. His wife ultimately had a beautiful, uncomplicated delivery that left an indelible impression.

No, everyone doesn’t have to listen to Anita Baker while they’re in labor but they should do what makes them comfortable including receiving an epidural or pain meds if necessary.  You don’t have to be stoic. Here’s a quote from The Smart Mother’s Guide to a Better Pregnancy that I’d like to leave you with: “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 preordained human experience. Please let the journey be smooth.”

You are smarter, stronger and more brilliant than you could ever imagine. Childbirth should not be feared. It should be celebrated.

 

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New Guidelines say Give First-Time Pregnant Women More Time in Labor

The American College of Obstetricians and Gynecologists and The Society for Maternal Fetal Medicine (aka high-risk obstetricians) have issued a new recommendation that is a game-changer in the manner that obstetrics is practiced: allow low-risk first-time pregnant moms more time in labor. This is assuming that the fetal tracing is normal and the mother does not have a fever, high blood pressure or a condition that could compromise her life or the life of her unborn baby. This recommendation is based on new evidence that demonstrates contradicts the old school Friedman Curve theory that active labor begins at 4 centimeters. It actually begins at 6 centimeters. This would be especially helpful to first-time teenage moms who might be forced to have future cesarean sections based on hospital rules and physician opinions if their first delivery was a cesarean section. The “once a C-section, always a C-Section” culture hits this particular group the hardest.

According to the new recommendations:

  • Women should be allowed to push for at least two hours if they’ve given birth before, three hours if they are first-time mothers, and even longer in certain cases, such as when an epidural is used for pain relief.
  • Vaginal delivery is the preferred option whenever possible and doctors should use techniques — forceps, for example — to assist with natural birth.
  • Women should be advised to avoid excessive weight gain during pregnancy.

A word of caution should be offered about these recommendations: forceps deliveries are becoming a lost art and can cause more damage than good in the hands of an inexperienced provider and the “avoid excessive weight gain during pregnancy” is easier said than done for most women.


That being said, these new recommendations gives first-time pregnant women the right to step on the proverbial brakes, the next time someone wants to rush their delivery via a C-section.

 

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You’re Pregnant and Your Local Hospital Closed. Now What?

Today will be a day of mourning for pregnant women who are uninsured and receiving Medicaid in Houma, Louisiana. Their local hospital closed its maternity and neonatal units because of a $2.9 million dollar budget cut. Over 100 employees will lose their jobs, many whom have held their positions for over 20 years.  This closing will have a ripple effect and is an increasing phenomenon that has besieged many hospitals across our nation. Over thirteen hospitals in Philadelphia closed their labor and delivery departments and in my own backyard, South Seminole Hospital in Florida did the same. What’s going on? Hospitals claim they’re losing money and government insured and non-insured pregnant women are feeling the aftermath. These are some very scary times.

The options for Houma’s uninsured pregnant women or women who receive Medicaid are quite limited. A few years ago, they could have gone to Lafayette Hospital in Lafayette; or Earl K. Long in Baton Rouge or Charity Hospital in New Orleans. Sadly, all of those hospitals have closed their labor and delivery department. I know those hospitals well, having worked and lived in Louisiana for almost four years as a community health physician.

Although Houma is a small, close-knit community, its hospital provided hundreds of prenatal visits for pregnant women in nearby parishes. They interacted like family. The nurses at Leonard J. Chabert Medical Center are devastated and apprehensive about the future of the pregnant women knowing that most cannot afford to go to private physicians and many have high risk problems. Consequently, many of these patients will be forced to travel over 300 miles on a 5-hour trip to Shreveport, Louisiana to receive prenatal care at its charity hospital.

I strongly encourage the State of Louisiana to brace itself for an increase in infant and perhaps even maternal deaths. Many high risk patients are simply not going to be able to make that 300-mile trek to Shreveport without adverse consequences. Any perceived benefit from that $2.5 million dollar budget cut will quickly dissipate based on the spike of NICU admissions that are sure to come.

The women and their unborn babies deserve better. Shame on the State of Louisiana.

 

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An OB Nightmare: Mom Dies after Giving Birth to Twins

It’s an obstetrician’s worst nightmare and it continues to happen on a daily basis. The story of Michal Lura Friedman brings tears to my eyes. After 7 years of trying, the 44 year old songwriter finally became pregnant –with twins. Her husband, Jay Snyder, a free-lance voice-over artist, describes the 9 months of Friedman’s pregnancy as pure bliss. However towards the end, her blood pressure became elevated so she was scheduled to have a C. Section the day after Thanksgiving.

Snyder accompanied his wife to the hospital and witnessed the birth of his babies. Then Friedman began to bleed. And bleed. And bleed. At 9:30 p.m., she became yet another U.S. maternal mortality statistic.

At least 2 women die from complications of childbirth in the US daily. Some celebrities such as Christy Turlington Burns have become a Maternal Health Advocate as a result of first-hand experience. She had a near-miss childbirth experience but lived to tell the story.  Many women, including Friedman, don’t.  The American Congress and College of Obstetrician-Gynecologists (ACOG), will have both Burns and Tonya Lewis Lee, the wife of renowned director, Spike Lee as spokeswomen on the topic of maternal mortality at the 2012 Annual Conference in San Diego. However, we need much more. There are obstetricians who have worked on the front-lines managing high-risk patients for years who can’t get a seat on ACOG’s policy committees and it is frustrating. Here are a few questions that should be asked at the hospital where Friedman expired:

  1. She had a short stature with a uterus stretched to the max with two babies. Was the possibility of hemorrhage considered?
  2. When her blood pressure became elevated, was it controlled prior to doing the C. Section knowing the risk of possible HELPP Syndrome that is associated with pre-eclampsia?
  3. Was there an OB Rapid Response Team?
  4. Was a Bakri balloon used once the bleeding couldn’t be controlled with uterine massage or meds?
  5. Was the prospect of a problem anticipated BEFORE it occurred or was there chaos trying to find appropriate meds and equipment as the tragedy unfolded?

Pregnancy is not a benign act contrary to what most people believe. Things can and do happen, most often when the hospital staff is unprepared and ill-equipped to handle an emergency. My heart bleeds for Jay Snyder. He is 41 years old, a new father and now a widow who must take care of two beautiful children, who will never know their mother. With all due respect ACOG, talk is cheap. More action must be taken to stop this.

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

 

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What Every Woman Ought to Know About Dollar Store Pregnancy Tests!

I love my local dollar stores. It’s one of my favorite places to shop when I want to reward my sons inexpensively and have fun in the process. My husband often calls me the “queen of the deals” because saving money always gives me an adrenaline rush. So imagine the rush I felt when I discovered that dollar stores now sell pregnancy tests and are giving name-brand competitors a run for their money.

According to the August issue of Ob.Gyn. News (Volume 44, Issue 10, page 10), Dr. Sunaina Sehwani and associates at St. Luke’s Hospital in Bethlehem, PA. tested twenty-seven dollar-store pregnancy tests and compared the results with the early-response name brands that are commonly used in physician and clinic offices. The article states that the dollar store brand was 100% accurate. Can you imagine? These pregnancy tests were also evaluated to determine if they could be easily interpreted and passed with flying colors.

 

Who makes these kits, you ask? They’re marketed under the names of New Choice, U-Check, and MD Quality all made by a company in Frederick, MD, called SCI International Inc.

Score two points for healthcare reform. When I traveled to Mexico a few years ago, I was amazed that I could purchase a tube of Retin-A for $10.00 (U.S.) and pay close to $100.00 back here in the States. A colleague paid $20.00 for an IUD in Egypt while the U.S. average cost is approximately $300.00. Kudos to SCI International Inc. for having corporate integrity. Essential personal items such as disposable diapers, infant formula, feminine hygiene products, medications (including birth control methods) and pregnancy tests should not bankrupt our bank accounts. Competitive pricing with a reputable product is a win-win experience for everyone.

So, the next time you miss a period, save your money and hit the friendly dollar store and if you see me shopping, don’t forget to wave or say hello.

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“Convenience” in not a Reason to do an “Early” Induction or C/Section

In Native American culture there is a premise that Nature thrives on order but it is man who creates the disorder. That thought came to mind last month when I presented yet another malpractice case for review with a panel of colleagues. A patient wanted to be induced at 39 weeks and inevitably had significant complications with a poor birth outcome. In my expert opinion, I suggested that the physician should have waited until the patient was 41 weeks before she attempted an induction and one of my colleagues thought that I was vehemently wrong. “She was full-term and entitled to an induction” he practically shouted in my ear. “That’s not the point,” I countered. There was no reason to do the induction except for physician and maternal convenience. I reminded him that most high-risks specialists will start fetal monitoring and nonstress tests (NSTs) at 40 weeks to document fetal well being and then induce labor at 41 weeks if it has not started spontaneously.


At 39 weeks, the cervix is usually thick which means it has to be softened with medication before Pitocin (the medicine that starts contractions) can be given. Anytime an induction goes beyond 48 hours, there is a strong possibility that it will end in a C-section. At 41 weeks, the cervix is usually soft and if an induction must be started, it has a much greater success rate for a vaginal delivery.

Very few physicians will allow a patient to deliver beyond 42 weeks because the baby gets too big and the placenta becomes old. An “old” placenta, aka “grade 3” means the baby could possibly receive inadequate oxygen and inevitably there will be meconium which is an internal bowel movement that sometimes indicates fetal distress.

According to the Bloomberg News, “Aetna has renegotiated maternity payments with 10 hospitals around the country so far, bringing rates for cesareans and vaginal births closer together.” This will inevitably decrease my colleagues’ checking accounts but please do not look for sympathy from me. The standards of medical care were written for a reason. Performing inductions of labor for the sake of “convenience” is certainly not one of them.

 

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Should Life Begin in an Airport Bathroom?

On a recent Sunday in the bathroom of the Baltimore-Washington International Thurgood Marshall Airport, a baby boy made his entrance to life. His mother was approximately 28 weeks and delivered prematurely, however both baby and mother were healthy according to the media. Although the details of the delivery are sketchy, anyone involved in obstetrics can predict what occurred.

The mother might have had a previous history of a urinary tract infection, or complained of back pain. Did her ultrasound reveal a short cervix? Or perhaps she had a history of a previous early delivery. If it was her first pregnancy, did she complain of mild abdominal pressure? Premature labor is one of the most common reasons for birth defects and has a price tag of approximately 26 billion dollars per year.  The signs and symptoms of preterm labor often go unnoticed or diagnosed because healthcare providers aren’t paying attention.  A urine analysis report showing bacteria in the urine will not be addressed. No inquiry will be made as to whether the patient made frequent trips to the bathroom or whether she drank soda. Soda predisposes patients to urinary tract infections because of the carbonation or bubbly component of the drink irritates the bladder. Untreated urinary tract infections can cause premature labor. A complaint of lower abdominal pressure will be attributed it to “round ligament pain” even though the patient is well beyond 20 weeks when it is most likely to occur. A complaint of back pain will be blamed on the changing shape of the uterus rather than sending the patient to the hospital for further evaluation. In essence, some healthcare professionals keep missing the diagnosis or intervening too late.

According to the American College of Obstetrician/Gynecologists (ACOG) pregnant women can travel up to 32 weeks by air provided they don’t have any complications or high risk conditions. The change in altitude can sometimes cause the “water to break” or the placenta to separate too soon. All pregnant women who plan to travel (especially by air) should consult with the OB provider for advice and instructions.  For pregnant women who plan to travel, here are some suggestions:

  1. Obtain a copy of your prenatal record prior to traveling in the event of an emergency
  2. Find out the name of the nearest Level 3 hospital where you will be staying
  3. Do not sit for more than 2 hours without standing for a few minutes to stretch your legs to prevent blood clots.
  4.  If you are complaining of back or abdominal pain before traveling, contact your provider immediately

Fortunately the baby born in the airport bathroom appears to be fine. However not all unexpected births have a happy ending. Pregnant moms, if you have to travel, please don’t push the envelope.

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

 

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“She Died Because She was Pregnant”

Those words were articulated by Lieutenant Brian Tobin, chief investigator of the death of 27 year old Jennifer Snyder. Snyder was a pregnant veterinarian technician who was murdered by the father of her baby – a married veterinarian, Dr. n on March 16, 2011.

October is Domestic Violence Awareness Month; an uncomfortable topic and certainly not one that pregnant women would rather not discuss. But you must – because homicide is the leading cause of death for pregnant women in the United States.

The tragic death of Jennifer inspired filmmaker Tracy Schott to produce a documentary called Finding Jenn’s Voice.  Fate connected Tracy and I because of a blog I had written called 7 Reasons Why Pregnancy Becomes a Deadly Affair. At the time I wrote it, I had no idea that homicide was the number one cause of maternal death. Before the production of Finding Jenn’s Voice, most of my colleagues didn’t know as well.

I had the honor and privilege of being interviewed for Schott’s documentary as an expert. Her passion regarding this project was palpable.    She interviewed 11 women who were either maimed, harmed or lost a child at the hands of their former partners but they are grateful to be alive. Laci Peterson, Jessie Davis, LaToyia Figueroa, Belinda Temple and Cherica Adams were not so lucky. They were murdered and their babies were never born.

A woman should not lose her life because she’s carrying life. Until our society does a better job of preventing these tragedies, these women and unborn babies will continue to speak to us from beyond their graves.

 

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What Are the Most Important Symptoms a Pregnant Woman Should Never Ignore?

When a woman becomes pregnant, we immediately think happy thoughts: a new addition to the family, a new grandchild, the baby shower, what colors to paint the nursery and of course, the challenging role of becoming a parent. We make the assumption that everything will be okay during the pregnancy but sometimes it’s not. Complications can occur during the pregnancy, during labor and even after the baby is born.

The human body is a fascinating creation and it speaks to us if we have the wisdom to listen. The ability to recognize the “language” of the body can save our lives, especially during pregnancy. What are the symptoms that pregnant women need to recognize?

  • A headache that occurs during the late second or third trimester and doesn’t go away with acetaminophen. This is one of the beginning signs of pre-eclampsia
  • Bleeding during pregnancy. There is no such thing as “normal” bleeding or spotting. Bleeding could signify an infection or a problem with the placenta. A pelvic exam should be done as well as an ultrasound.
  • Gaining 5 pounds or more in one week. This is not normal and could represent the beginning of pre-eclampsia
  • Back pain that that is beyond a 5/10 scale, especially if it moves to the front of your abdomen. This is a sign of preterm labor until proven otherwise. This requires an phone call to your provider and a trip to labor and delivery
  • Fever and chills could represent an infection called chorioamnionitis which could directly affect the unborn baby
  •  A headache or high blood pressure that continues AFTER the baby is born. Pre-eclampsia can last for several weeks after birth
  • Not able to have a bowel movement after a c-section. This could possibly indicate a complication called “bowel obstruction” and is a surgical emergency. You should not be discharged from the hospital until you’ve had a bowel movement

Recognizing these seven symptoms could potentially save your life. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.

 

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Erica Morales Delivers Four Babies and Then Dies: Another Pregnancy Tragedy

Erica Morales’ last Facebook message was dated January 15th and simply said, “Prayers please. 5 o’clock C Section.” Now, she speaks from Heaven.

Erica was 36 year old and wanted to become a mother after marrying her soul mate, Carols, in 2007. She worked at the University of Phoenix and was also a real estate agent. Carlos worked in manufacturing. Like millions of other couples, they desired a family but encountered stumbling blocks. Through infertility treatments, their dream came true. Erica became pregnant with four babies.

Carrying four babies at the age of 36 is a serious affair, especially if it’s a first pregnancy. One anticipates that the babies will come early and the risk of developing high blood pressure and pre-eclampsia is significant.

Pre-eclampsia is a deadly pregnancy condition that involves high blood pressure, swelling and protein in the urine. It can cause strokes and women die. The only treatment is delivering the baby because there is something in the placenta that keeps the blood pressure high until it is removed.

Although the hospital will not release the cause of death because of patient privacy issues, one can assume that Erica possibly died from either pre-eclampsia or a hemorrhage. Her blood pressure was reportedly 190/90 which caused her to be admitted to the hospital at 31 weeks. She had a cesarean section and according to her best friends, “never got a chance to hold the babies.”She delivered at a hospital that has high risk specialists so it’s assumed that she received the best care however I do have some concerns:

  • I hope the decision to deliver the babies wasn’t delayed because of their prematurity
  • I hope someone recognized the subtle signs of pre-eclampsia
  • I hope the hospital did simulations or practice drills prior to Erica’s delivery in anticipation of a potential problem

Despite all of our medical advances and sophisticated technology, women are still dying in childbirth. It’s frustrating and it hurts.

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Pregnancy for Sale

Being told that your body will never be able to reproduce is beyond painful – I’ve been there. But should procreation become a business at any cost?


In a recent New York Times article, we are introduced to a gay couple from Portugal who became parents through surrogacy because it was illegal in their country. According to the article, the United States is one of the few countries that allow paid surrogacy.

While parenthood through surrogacy has become increasingly popular, especially among celebrities, it is not without risk. Contrary to what people believe, there are a greater percentage of intended parents who abandon and reject the babies or pregnancies than there are surrogate mothers who refuse to relinquish their maternal rights after the baby is born. It seems that everyone wants a “perfect” baby which is totally unrealistic.

 

The thought of “paying” more money for eggs and sperm of models and Ivy League grads is sickening. What do you do if the child doesn’t get into Harvard? Ask for a refund? The article discusses a case where a couple wanted a surrogate mother to terminate the pregnancy at 21 weeks because the fetus appeared to have a cleft palate which later proved to be wrong.

Babies who are born in the U.S. and brought back to foreign countries by their international parents face a myriad of problems. Is the baby a U.S. citizen or a citizen of the parents’ country? For gay international couples, some countries will not provide a birth certificate unless there is a mother and father identified, not two fathers or two mothers.

The cost of surrogacy is not cheap and amounts as high as $150,000 has been quoted. These fees include the cost of the surrogate mother, the donor eggs and the agencies involved. At present, this “industry” remains unregulated, partly because it comes under the jurisdiction of state law. Therefore, there is no protection for the surrogate mother, the intended parents or the baby.

Since the Supreme Court has such a profound interest in a woman’s body regarding who pays for her birth control, they might also be interested in what happens to babies born on U.S. soil who are taken abroad.

Does the United States really want to be viewed by the world as a breeding ground for hire? Please share your thoughts.

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What Every Pregnant Woman Needs to Know About Blood Clots

Blood clots are sneaky, deadly and unfortunately occur more frequently in pregnant women – especially after they have had a baby. In a non-pregnant woman, blood clots are good because they keep us from bleeding to death after we cut our finger or scrape our knees. However during pregnancy, the body produces many blood clots (a condition known as hypercoaguability) which increase the risk of having a stroke, blood clots in the leg (deep venous thrombosis, aka DVT) which could travel to the lungs and cause death. Pregnant women are five times more likely to develop a blood clot than a non-pregnant woman and there is a greater chance that this will occur after the baby is born as opposed to before.

Who is at risk for developing blood clots during pregnancy?

  • Women who are born with genetic disorders that increase the risk of blood clots (known as thrombophilia)
  • Women who have had greater than 5 children
  • Women who have c/sections
  • Women who smoke
  • Women who are obese
  • Women who have had a previous blood clot
  • Women who have had injuries that require them to wear a cast while pregnant
  • Women who have cancer
  • Women who are greater than age 30

A recent article in The New England Journal of Medicine had shed new light on this problem. It was known that pregnant women have an increased chance of having a blood clot for approximately six weeks after delivering a baby. However, a medical study of over 1.6 million women demonstrated that an increased risk of developing a blood clot can occur up to 12 weeks after the baby is born rather than six weeks. The greater risk for developing a blood clot occurs at approximately 3 weeks after having a baby but that risk might continue up until 12 weeks.

Based on this new knowledge, post partum patients at risk for blood clots must wear compression stockings and take blood thinners for approximately 12 weeks as opposed to 6 weeks. Although you healthcare provider is aware of these new changes, you should too.

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

 

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What Pregnant Women Need to Know About 5,797 Work-Related Complaints

The Washington Post recently published a story about mammoth retailer Wal-mart’s new policy that allows pregnant women more options so that they can continue to work even late into their pregnancy. While this change of policy is a moral and economic victory for pregnant Wal-mart employees, it did not come without a fight.

In 2011, the Equal Employment Opportunity Commission received 5,797 pregnancy-related complaints from women who represented all walks of life from a cashier to corporate executives who felt that they were discriminated against by their employers solely on the grounds of being pregnant. According to the National Women’s Law Center, almost 9 out of 10 women worked into their last two months of pregnancy which carries an increased risk of complications. Rather than allow the pregnant employees to change positions, work less hours or sit in a chair, many find themselves terminated or asked to take a temporary leave of absence that often times becomes permanent. Many are forced to use their Family Medical Leave time before having the baby and must rush back because they’ve run out of time.

Tiffany Beroid’s blood pressure started to rise as her pregnancy advanced. Her doctor gave her a light duty note but Wal-Mart told her they didn’t have light duty work, forcing her to take her pregnancy leave sooner than anticipated. Through social media efforts, pregnant employees of Wal-Mart with problems similar to Beroid’s began networking and an organization called Our Wal-Mart that is a labor union supported group began to advocate on Beroid’s behalf. She was also assisted by a work advocacy group called A Better Balance as well as the National Women’s Law Center.

March 5, 2014 became a day of victory for the thousands of pregnant employees of Wal-Mart when the company issued a new policy that allows its pregnant employees to perform less demanding work if they’re having difficulty fulfilling their duties.

All pregnant women are encouraged to become familiar with The Pregnancy Discrimination Act of 1978 in order to protect their rights. The policy changes of Wal-Mart are to be commended. Let’s hope other industries will follow suit.

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Is Underwater Childbirth Safe? Some Doctors Say No.

Most women look forward to having a baby but no one wants to feel pain. In recent years, having a baby in a pool of water has become a popular trend because it allegedly reduces the need for pain meds and anesthesia however not so fast, says both obstetricians and pediatricians. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) have issued a formal opinion (Committee Opinion #594 April 2014) that does not support “immersion” (aka underwater) births because of its associated complications while a mother is pushing to deliver her baby. The “pushing” part of childbirth is also known as “second stage labor.”
Why is this important? Because there are presently 143 birthing centers in the U.S. that offer underwater births to pregnant women. In fact, 1% of all births in the United Kingdom are immersion. While some research claims that these births are safe, experts think otherwise and state that the number of women studied was too small to detect rare but potentially harmful outcomes.

While some women may experience a feeling of well being and control, decreased stress and less vaginal tears during an immersion birth, according to the Committee Opinion, there is no scientific evidence that an underwater or immersion birth helps the baby. In fact, there is evidence of increased complications such as

  • increased infections to both the mother and newborn, especially after the membranes are ruptured (aka “water broke”)
  • difficulty in regulated the newborn’s temperature
  • increased risk of the umbilical cord tearing from the placenta
  • infant drowning and near drowning
  • infant seizures and suffocation
  • severe infant breathing problems

Should women give up immersion births completely? Probably not. The experts think that a woman may stay in these tubs during labor but should NOT push or deliver the baby underwater. They also recommend stricter protocols, patient selection and infection control.


If you like what you’ve read, please subscribe to the blog, like me on Facebook, or follow me on Twitter.

 

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Brain Dead and Pregnant: A Moral Dilemma

The contradictions of life can be maddening. On one hand, we have the case of Jahi McMath, a 13-yearold girl who is brain dead on a mechanical ventilator that her family fought to maintain and on the other hand, there is Marlise Munoz, a 33 year-old mother of a 15 month old son, who collapsed on her kitchen floor from what appeared to be a blood clot to the lungs back in November. Munoz, according to her husband and family, never wanted to be on life support but the state of Texas ordered it when they discovered that she was 14-weeks pregnant. Should state law override the wishes of a patient because of her pregnancy?

The family of Munoz is concerned and angry about the state of Texas’s decision for a number of reasons. Munoz was without oxygen for over an hour before her husband found her on the floor which meant that the fetus was without oxygen as well. Medical experts believe this could cause serious problems for the unborn baby. Munoz’s father describes his daughter has having “rubbery arms that feel like a mannequin” which makes it difficult for him to visit her in the hospital. Munoz was very early in her second trimester (14 weeks), remote from delivering a baby, yet forced to be, as her father states, “a host for the fetus.” Who will have the ultimate responsibility of raising the child once the physicians intervene and deliver it via C. Section?

When John Peter Smith Hospital was confronted regarding their decision, they emphatically state that they are merely following the rule of law; however some medical ethics experts disagree and state that the hospital is misinterpreting the law. According to the New York Times, at least 31 states have adopted restrictive laws prohibiting physicians for ending life support for “terminally-ill pregnant women regardless of the patient’s wishes or her family’s.”

Should a brain dead pregnant woman lose her rights under the United States Constitution in order for the benefit of her unborn baby? I’d love to know what you think.

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A Painful Memory: National Pregnancy and Infant Loss Remembrance Day

I will never forget the patient or the day it happened. Assigned to my residency team, we had watched her vigilantly because she was 39 years old and pregnant with her first baby. Although she spoke no English the love that she had for the miracle growing inside of her could be understood in any language.

 

She had begun to have premature contractions at 33 weeks and we were trying to prolong her pregnancy for just a little bit longer to allow the lungs to develop. For approximately one week, we monitored her blood, her temperature and fetal movement. One of her tests ultimately indicated that she was developing an infection so we decided to induce her. We would then transfer the baby to the special care nursery where, under the watchful eyes of the neonatologists, he would continue to grow. My team was not on call that night although, in retrospect, I wished the heck that we were. We signed out the patient to the on-call team before we left. We gave them explicit instructions on how often to monitor the patient and discussed her complicated history. She was having, what we, in obstetrics called, a “precious baby” meaning that an older woman was having her first child. When we went home that evening, the baby was alive. When we returned the next morning, it was dead.

“What happened?” I asked as a volcano of anger started to mount. I received a litany of excuses, none of which made sense. Essentially, they missed an opportunity to intervene at the proper time and perform an emergency cesarean. By the time they got their act together, the baby was dead. There was a heated exchange of words between the male chief resident and myself. Another resident had to jump in between the two of us because at that moment, I was ready to swing.

Later that afternoon, the patient demanded to see her baby. We retrieved his body from the morgue in the basement, dressed him in a beautiful blanket and the social worker attempted to console her in her native language. I knew that I could never bring her baby back alive but from that moment on, I vowed to never allow a tragedy of that magnitude  happen again.

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Do You Know How to Avoid a Homebirth Disaster?

A Maryland jury made history by awarding Enso Martinez and Rebecca Fielding $55 million dollars but there are no winners in this tragedy. Enso Martinez Jr. has irreversible brain damage and Johns Hopkins Hospital will spend resources that could be used for research for direct patient care, to defend their care of Fielding.

 

Home birth in the U.S. has increased by 20% in part, because of Ricki Lake’s documentary, The Business of Being Born. Women want to have their babies at home despite the admonishment and warnings from the American College of Obstetricians and Gynecologists.

 

To all pregnant moms who want to have their babies at home, I get it. I truly do. You want a comfortable intimate environment to have what you deem is a “natural event” without “unnecessary intervention.” You want to be like the celebrities who have had successful home deliveries. But here’s the problem: your home is not equipped to deal with emergencies and they DO occur. Just ask celebrity mom Christine Turlington Burns, who experienced a postpartum hemorrhage and had to be rushed to the hospital in order to save her life. Obstetrics is a specialty of the unexpected. You MUST be prepared for emergencies.

Fielding entered Johns Hopkins Hospital because the baby was “stuck.” The midwife couldn’t deliver the baby because it was either too large or she couldn’t manage a shoulder dystocia. According a blogger, Dr. Amy Tuteur, Midwife Evelyn Muhlhan’s license was suspended by the State of Maryland because of five homebirth disasters including Fielding’s delivery.

An ambulance brought Fielding to a hospital where she allegedly waits for over 2 hours for blood test results. A c. section is delayed. A baby has brain damage. Take home message?

  1. Know your midwife’s professional record. Does she have malpractice suits? Has she been sanctioned by the state medical board for negligence?
  2. Meet your midwife’s ob-gyn back-up. The Smart Mother’s Guide to a Better Pregnancy discusses this in detail. At the first sign of trouble, Muhlhan should have contacted her ob backup. If she didn’t have one, she was begging for trouble.
  3. Have a PERSONAL copy of your prenatal chart with you and your back-up hospital or birthing center should have a copy as well. This is standard prenatal procedures. Having a homebirth doesn’t change that. Your prenatal record contains all of the important information including blood type and blood count. No one, I repeat NO ONE, is going to bring you into the operating room without knowing your blood type unless you are hemorrhaging to death. Had Fielding had a copy of her prenatal record, she might not have encountered the delay.

If you’re going to have a homebirth, then please take the necessary precautions. An ounce of prevention is always worth more than a pound of cure.

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The KangaGroove

Team GroovaRoo and  GroovaRoo.com Presents...

KangaGroove: Moms Adorably Dance to Sugar Ray's 'Fly' While Wearing Their Babies.

 

The world of obstetrics and reproductive health is rapidly changing with topics such as the Zika Virus, gene editing and  pregnancy and exercise taking center stage in the print and visual media.


While I do plan to blog about them in the every near future, right now, I want us all to do something fun like . . . . . dance! I’ve come across this very cool video called the KangaGroove where moms are dancing with their babies.  So everyone fall in line and step to the beat. Not only is this an opportunity to do some fun exercise, but an amazing way to bond with your baby. So, are you ready? Okay, let’s go!!

 

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Plan Your Pregnancy

Congratulations! You’ve reached a defining moment in your life. You’ve decided to have a baby. Although not yet pregnant, there’s a lot of work that has to be done in order to achieve your goal of having a healthy baby. Unlike the 2 million women who have unplanned pregnancies in the United States each year, yours will be different because it involves strategic planning, so let’s get busy.

 

The old saying “fail to plan means plan to fail” holds true, especially if you have decided to have a baby. The decisions you make will not just involve what color to paint your baby’s nursery or who to invite to a baby shower. You will have to decide whether to see a midwife, a family practice doctor or an obstetrician for prenatal care. Each one of those providers has a different level of training and education.

 

You must determine whether you are healthy enough to have a baby or what to do if you have pre-existing conditions such as diabetes, high blood pressure, sickle cell disease, cystic fibrosis or an autoimmune disease such as Lupus that could affect the outcome of your pregnancy or even your own health. So, let’s talk about your health for a moment. If you have any of the pre-existing conditions mentioned, you should plan to see a maternal fetal medicine specialist who is a high risk pregnancy doctor. Although you’re not pregnant at the moment, he or she will be able to counsel you regarding what tests you might need, medications or necessary treatment before you become pregnant.

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Research Your Hospital

One of the most important decisions you will make as a pregnant woman is where to have your baby. Most women will select a hospital although other options for birth include delivering at a birth center or for others, to deliver at home. Should you decide to give birth at a hospital, it is important for you to select the right one because they are not all made equal. Some look very pretty on the outside but have some patient safety concerns on the inside. Others might not look attractive externally, but you’ll receive the best care possible.

As a pregnant woman, one of the most important hospital features you should be concerned is its nursery. The type of neonatal nursery the hospital has is extremely important if your baby requires special care after it is born. Three types of hospital nurseries provide neonatal care.


A level I nursery provides basic neonatal care and is the minimum requirement for any facility that offers inpatient maternity care. The hospital must have the personnel and equipment to perform neonatal resuscitation, evaluate healthy newborn infants, provide postnatal care, and stabilize ill newborn infants until they can be transferred to a facility that provides intensive care.

In addition to basic care, a level II nursery provides specialty neonatal care (sometimes called intermediate neonatal care). The nursery can provide care to infants who are moderately ill with problems that are expected to resolve rapidly or who are recovering from serious illness previously treated in a level III nursery.

A level III nursery, or sub-specialty neonatal intensive care unit (NICU), can care for newborn infants who are extremely premature, who are critically ill, or who require surgery.

Should an unforeseen emergency arise, the type of nursery your hospital has is extremely important. There have been unfortunate cases where extremely preterm babies were delivered at Level II hospitals and could not be transferred to Level III hospitals because of a shortage of beds.

If you develop a complication that could become worse (such as a blood pressure or a fever that keeps rising), your physician needs to make arrangements as soon as possible to transfer you to a hospital where both you and your baby will receive the best possible care.

Staff and Ranking
In addition to looking at the hospital’s nursery, you need to ask the labor and delivery suite’s nursing director questions like these:

  1.  What is the nurse-to-patient ratio? Does one nurse have to take care of six or seven patients alone? While the nurse is attending to an emergency, who is going to be watching my fetal monitor or taking my vital signs?
  2.  Does the hospital have a nursing shortage? Is it constantly short-staffed? (Ask former patients who delivered at the hospital.) What is the turnover rate? Are nurses constantly quitting and, if so, why? Are there enough nurses in the nursery?
  3.  Are the labor and delivery suites overcrowded? If you make an unannounced visit on the labor floor, do you see patients lined up on the hallway? Sometimes, delivery beds will be at a premium, but this should be an exception rather than the rule. Overcrowding usually indicates a chronic shortage of beds and a hospital administration that is either insensitive to the problem or ill-equipped to deal with it.
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Select Your Health Provider

So, you’re having a baby and need to select a healthcare professional to take care of you. Selecting the proper healthcare provider for your pregnancy is an epic event, not a minor detail.

Sadly, some women invest more time in selecting a dress than choosing a physician. Everything worthwhile in life depends upon the choices we make; the challenge is to make the right ones. One of the most important choices you will make during your pregnancy is which health care provider will attend to you. If you live in an urban community, you might have lots of providers to select from. But if you’re in a rural area, your choices might be limited.

There are five types of health care professionals who are trained to take care of pregnant women: obstetrician-gynecologists, maternal-fetal medicine specialists, family practice physicians, certified nurse-midwives and direct-entry midwives. These professionals are trained to provide prenatal care and to perform deliveries. However, the level of training for each is quite different.

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Prepare for Labor and Delivery

The last few weeks of a pregnancy is both a time of excitement and caution as you approach the sacred date of your baby’s birth. In the last four weeks of the pregnancy, it is important to make certain that both the mother and baby are free from infections and the baby’s in the correct position before delivery. It is also important to make certain that you will be diagnosed properly when you go to the labor room for potential problems, including labor pain.

 

As you get closer to your due date, your body will start doing strange things. Your feet may begin to swell and your rings may no longer fit on your fingers. These changes are due to the extra fluid your body makes at the end of your pregnancy, called extracellular fluid. After the delivery of the baby and placenta, patients usually lose a lot of fluid. Therefore, in anticipation of this fluid loss, Nature provides you with extra fluid beginning at about 36 weeks.

 

You may also develop menstrual-type cramps or a squeezing sensation at the bottom of your abdomen. The activity of your baby may increase significantly or may decrease, depending upon how much room it has left in your uterus. If this is your first pregnancy, you will probably have at least one episode of “false labor.” False labor (or latent phase) is when you are having contractions that are painful but not strong enough to dilate your cervix to four centimeters. Four centimeters is usually the magic number that will grant a hospital admission.

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10 Things Every Pregnant Woman Needs to Know About Pre-eclampsia

May is Pre-eclampsia Month, a time to empower all women about the dangers of this very deadly disease. It has claimed the lives of many women, including the grandmother of Vanessa Williams. Although it has been described as far back as the days of Hippocrates, we still don’t have a cure in the 21st century.

Pre-eclampsia is a condition that involves high blood pressure, swollen feet or ankles and protein in a pregnant woman. It can occur anytime after 20 weeks but usually develops in the third trimester and affects up to 7.5% of pregnant women worldwide. Why is it so dangerous? Because the blood pressure can reach such high levels that a woman can have a seizure or a stroke and die. It can also reoccur for up to 6 weeks after the baby is born, is frequently and regretfully often misdiagnosed.  How is it treated? By delivering the baby and therein lies the dilemma. Sometimes it occurs so early that some healthcare providers will either miss the diagnosis or are hesitant to deliver the baby because of its prematurity. The baby has to be delivered because the placenta is abnormal and must be removed.

Pre-eclampsia is sneaky and the diagnosis is not straightforward so here’s what you need to know to make certain that no one will miss the diagnosis:

  • A severe headache that doesn’t going away with acetaminophen needs an immediate blood pressure check.
  • Blurry vision needs an immediate blood pressure check
  • A blood pressure of greater than 120/80 needs the attention of a doctor immediately
  • Swollen hands, feet or a puffy face, needs the immediate attention of a doctor
  • If you’ve developed 5 pounds in one week, see your doctor immediately
  • If you had pre-eclampsia during childbirth, are sent home and develop blurry, vision or a headache, call your doctor immediately
  • If you had pre-eclampsia during childbirth, are sent home and develop shortness of breath, return to the hospital immediately
  • If you had pre-eclampsia during childbirth and are sent home, you should have a repeat blood pressure check at your doctor’s office in one week for follow-up
  • If you had pre-eclampsia during childbirth and are sent home with a blood pressure that’s greater than 120/80, you should either have been given a prescription for medication or a return appointment to see your doctor in 2 to 3 days for follow-up
  •  If you’re blood pressure keeps going up during your pregnancy and your clinician doesn’t do anything about it, ask for a referral to see a high-risk specialist (aka maternal fetal specialist)

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

 

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Dr. Linda Witnesses Dr. Vivek Murthy Become the 19th U.S. Surgeon General

On April 22, 2015, I witnessed the official induction of my dear friend, The 19th U.S. Surgeon General, Dr. Vivek Murthy. He and his fiance, Dr. Alice Chen have been part of my journey through our activities in Doctors For America (DFA) and it has been an honor knowing him. Well done, Vivek!

 


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