I cringe at the mere mention of the words Home Birth. As much as I don’t want to offend the exceptional nurse midwives who provide this approach, and do not want to belittle the exercise of self-determination by mothers who choose this route, I worry about the risk. Multiple studies have clearly demonstrated that the baby is at greater risk of injury or death when delivered at home. That fact alone makes home births–scary. 

Home Births Pose Greater Risks

Between 2010 and 2017, almost 14 newborns for every 10,000 live births died following planned home births – that’s more than four times the rate for babies born in hospitals.

Last Friday I had what would have been considered the perfect home birth candidate–young, thin, no medical problems, and had a previous successful vaginal delivery with no problems. For the first 12 hours she labored with no intervention but she did not dilate. Still, we decided to give it more time–we were patient, counting on her pelvis to do what it did with her first baby, give way. But, at 6:30am in the morning, on day 2, when the baby’s heart rate slowed and did not recover, we got her into the operating room and got that baby out in 4 minutes. That’s the difference. When nature takes a turn for the worst, how far away are you from help?

Many people counter, “well women have been having babies for centuries.” Ah, did we forget about all the mothers and babies who died in childbirth? Childbirth can be dangerous, for both mother and child. As an obstetrician, my job is not just to stand there and watch the baby slide out–like poop. Women bleed, women get horrendous lacerations that have to be repaired in the operating room, babies get hurt, and babies die.

Birth Centers

Midwives have a different approach to birth and it is really beautiful. This is often not a question of who did the delivery. Ask the question: is the mid-wife certified? And, did that person undergo training to manage complications?It is always a question of where the delivery takes place. How far and how long will it take you to get help if you need it?  I have been on the receiving end of the drive-by-the-emergency-room-and-dump-the-patient-and-leave. It’s always sad, and usually lends to a devastating outcome.

Birthing centers offer the setting that allows women to feel “at home.” And, most of them (always check) have a tested system whereby they a) have a relationship with the doctors at the hospital, and b) have a tested, and efficient, way of getting mothers to the hospital, if it looks like there is going to be a problem. Check with the American Association of Birth Centers (AABC) for certified centers near you. 

Don’t hand over control of your birth experience to someone else, other than Mother Nature. (You should read “What you can do to avoid a c-section.”) Do be completely informed about the risks and benefits of a home birth by asking the critical questions.

There you have it. Spread the word

~Juliet_MD~

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When we met it never occurred to me that she was going to die. But I can still hear the sound of her ribs crack with each chest compression. Sometimes I get a flash image of her unattended arm sliding off the bed alongside a swath of brown hair. Mary was dead. It was clear to everyone, though it took sometime before we could summon the courage to admit it. This pregnant woman, mother of a two-year girl with blonde hair, died from the flu.

Only Fifty three percent of pregnant women are vaccinated against the flu.

It’s really hard to convince pregnant women to take medicine, especially if it’s in the form of a vaccine. It’s medicine for an illness they don’t have. Even the tiniest, most theoretical, risk is thought too much. The unvaccinated, however, represent a lost opportunity for mothers to protect themselves and their babies, who cannot get vaccinated for the first six months of life.

This is one of the worst Influenza flu seasons on record. Thus far in the 2019-2020 flu season, 55000 people have gotten the flu and 2900 have died. Pregnant women are at greater risk of getting the flu because pregnancy itself hampers the immune’s system ability to ward off the infection. Pregnant women are more likely to get pneumonia when they have the flu. When pregnant women do become ill with the flu, they are more likely to need hospitalization, and more likely to need intubation and care in the Intensive Care Unit.

And, because the flu is an infection that causes a high fever, there is also an increased risk of going into labor prematurely.

On the morning Mary died she woke up and felt dizzy, and had an annoying cough.

Her husband brought her to the hospital because she had fainted. A half an hour after she arrived to the emergency room her heart began to beat irregularly. She was rushed to the cardiac catheterization laboratory, and while they were evaluating her irregular rhythm, her heart stopped beating. A code was called. The cardiologists and the critical care doctors began chest compressions. Obstetricians (me included) went about starting an emergency caesarean section to deliver her thirty-two week old fetus—while her body was bouncing up and down on the table.  Mary started to bleed profusely because of a reaction called DIC (disseminated intravascular coagulation). More doctors filled the little procedure room. More blood filled the abdomen. 

We extended her incision from the pubic hairline to the breastbone in order to better see and control the bleeding. Her bowels fell out of her body and rested on the white sheets; they changed color from pink to a dusky brown. More blood. The cardiac doctors were compressing her chest, still trying to revive her heart. Ribs cracked. Her head lobbed to the side, and her brown hair cascaded off the bed in slow resignation. 

That’s when I could feel it; she was gone. In our fear and anguish we feverishly tried to pound and stich life back into Mary. No one could accept the sudden loss of this young mother–from the flu. I was so relieved when the code leader said it: stop. This woman was alive two hours before, and now this family, these two girls, will have to forge ahead without her. She declined her influenza vaccine and the virus infected her heart—a rare and ridiculous reason to die. I’m still angry.

Get vaccinated.

And if you have symptoms, get treated. The Center for Disease Control and the American College of Obstetricians and Gynecologist state that pregnant women can be safely treated for flu symptoms with Tamiflu (Oseltamivir) or Relenza (Zanamir).

~Juliet_MD~

The post Pregnant With The Flu:One Story appeared first on Below The Belly Button.

Avoiding mosquito bites offers the best protection against Zika virus.

Use DEET. But, you should know that this insect repellant is absorbed through the skin. DEET crosses the placenta. This compound will get into the babies bloodstream. But, DEET has never been shown to cause developmental delay or birth defects.

Aedes aegypti is the mosquito that infects persons with Zika. It bites day and night, indoor and outdoor. Important, the Centers of Disease Control recommends that you use products with at least 30% DEET to help protect your baby, .

Second, Permethrin is also used to kill mosquitoes. Often, it is used in homes, in fields, and in areas where there is a need to control the mosquito population. Also, it is recommended for treating clothing. There is some indication that Permethrin, at high levels, can have unwanted effects on the brain development babies and young children. But, more studies have to be done on this topic before we can say more.

Remember, Zika causes death, hearing loss, microcephaly (small brain) and poor growth in babies of mothers who have been bitten. Always, weigh the risks of Zika verses the benefits of using DEET, or possibly Permethrin. Of course, it is impossible to avoid mosquito bites all together if you are living or visiting an infested area. Best, avoid traveling to, or having sex with people who have traveled to areas where Zika is known to be present.

There you have it. Now spread the word!

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Cesarean births dates back to the sixteenth century. Its use, then and now, has saved the lives of countless babies and mothers. But now, one in three babies are delivered via cesarean-section.

What one hospital is doing to reduce the number of cesareans was printed in the Chicago Tribune.

The procedure is considered major abdominal surgery with its attendant risks of bleeding and infection.  The procedure is an essential tool used by obstetricians, but the vaginal route offers a shorter recovery.

Here are three ways to exert some influence on how your baby comes into the world:

Wait for labor to ensue. In a recent study, Dr. Deborah B. Ehrenthal, et. al. cited that women who underwent an induction were twice as likely to end up with a cesarean-section than those who waited for active labor. And, for first time mothers who were induced, 1 in 5 landed on the operating table. Understandably, by the time women get to about 37 to 38 weeks, many doctors cave in to requests to “Please, get this baby out!” Instead of watching the pot boil, get a manicure, spend time with friends, go to the movies or get some sleep.

Schedule fun events for yourself that don’t include pints of ice cream. When you gain weight, your baby gains weight. If a baby is estimated to weigh close to or more than 9 lbs, most obstetricians will offer a c-section, and rightfully so. If there is concern that a vaginal birth cannot take place without significant injury to either party, a c-section is the best route. Too much weight gain also increases the chance of complications, like diabetes and pregnancy induced hypertension (PIH). Dr. Robert H. Debbs, Director of Pennsylvania Hospital Maternal Fetal Medicine Network, was asked to comment, “Weight is a major predictor of whether or not someone will have a cesarean-section. Patients who are overweight are simply at higher risk for adverse outcomes.”

Your obstetrician can provide these guidelines on how much weight you should gain. Although, genetics do play a role in how much the baby weighs, eating right and exercising before and during your pregnancy may just keep the scalpel at bay. Don’t diet. Instead, focus of developing a healthy lifestyle that you can pass on to your son or daughter.

Third, weigh your options, having had one cesarean-section does not mean that the next baby must be delivered the same way. Talk to your doctor about TOLAC (trial of labor after c-section). Sixty to eighty per cent of women who attempt VBAC (vaginal birth after c-section ) are successful! Speak up and ask questions.

There you have it. Now spread the word!

The post What You Can Do to Avoid a Cesarean appeared first on Below The Belly Button.

A happy doctor will practice better medicine. 

TheBMJ published a study this month, which highlights the problem or poor staffing on weekends. This can lead to worse outcomes for mothers and babies who deliver on the weekends. This did not surprise me at all. In part, I reduced my clinical work because I as exhausted! Even in my thirties, I didn’t have the physical, or emotional, stamina to work the hours that private practice demanded.

I was miserable. Not happy. I missed a delivery, the thirteenth baby born that weekend, simply because I literally could not get up.  The phone rung every–what felt like–few minutes. I remember answering and telling the nurse that I was on my way, but I would tell myself that I only needed five more minutes of rest before getting up. Actually, they called every two hours. But by day ten, I was long past my ability to be cognizant. More important, I was certainly in no condition to deliver a baby.

When I had my son, withdrawing from medicine became even more urgent

My son knocked over a standing lamp when he was nine months old. Pieces of glass came crashing to the floor. He was not hurt and there were no cuts on his body. As you can imagine, I felt terrible because I was alone with him in the house, and I fell asleep. Again, not happy.

The hospitalist model is a better system.

Having a baby in a hospital where a doctor is available “round-the-clock” makes a difference. Properly staffed and with fairly distributed shifts, this system of call could lend to a better work/life balance for obstetricians. Most importantly, the patients get care from doctors who are energized; who can think clearly; and who don’t feel emotionally depleted.

There you have it. Now spread the word.

Juliet MD

The post A Happy Doctor Saves Lives appeared first on Below The Belly Button.

Another great read!

By

Juliet MD

Published on

blackandbrownnews.com

Cut and Paste!

http://blackandbrownnews.com/lifestyle/health-fitness/this-way-out-what-you-can-do-to-avoid-a-c-section/

The post This Way Out: What You Can Do To Avoid A C-Section appeared first on Below The Belly Button.

Across the nation about 30% of deliveries are done by caesarean section (c-section). Most c-sections are performed at the recommendation of an obstetrician, but in recent years, more women have asked to be delivered by caesarean and have optedout of labor.

Women request the surgery for a many reasons including a previous painful or traumatic birth experience or tales about the “horrors” of a vaginal delivery. Often though, when asked why they want a c-section, the answer is some variation of…“I don’t want to go through all that…I just want a c-section.”

There is no such thing as just a c-section. Although, the rate of complication from this surgery is extremely low, it’s still considered a major abdominal operation and patients have become overly nonchalant about it.

Delivery by surgery can benefit the baby in that they have fewer birth injuries and infections. However, babies born by c-section have the highest rate of breathing problems and often need assistance from neonatologists. They also have higher rates of hypoglycemia (low blood sugar) at birth. The passage through the birth canal helps clear the lungs and allows the baby time to correct glucose abnormalities.

For the mother, there’s a lower for hemorrhage risk with a c-section. And, women who have c-sections have fewer problems with urinary incontinence (leaking of urine), but only for the first year after delivery.

On the flip side, it’s important to consider the total number of c-sections that a woman undergoes. A bikini cut may look better, but it still extends into the abdomen and significant scarring can occur underneath the skin. Scar tissue also forms on the uterus and can cause the placenta to attach abnormally in subsequent pregnancies. These patients often end up needing a c-section and a hysterectomy. In addition, if the scar on the uterus separates, the baby will have to be delivered—sometimes prematurely—by an emergent c-section, which further increases the injury risk for the mother.

Consider also that c-sections do not always “save” the vagina. Studies have shown that c-sections do not necessarily keep the uterus from dropping into the vagina (known as uterine prolapse). However, to decrease this risk, I would advise women to limit weight gain. This limits the size of the baby and reduces trauma to the vagina.

I will admit, if a woman experienced a vaginal delivery where she had a horrendous tear down into the rectum, I would advise her to have a c-section for the next delivery. Urinary incontinence is one thing to worry about, but fecal incontinence is quite another, and no woman should have to face that.

Overall, women who leave the hospital with healthy babies are happy, regardless of how they were delivered.

But before you elect to just have a c-section, think carefully about the consequences. If you are planning to have more than one or two babies, the drawbacks of having a multiple surgeries start to outweigh the benefits.

Spread the word

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