Complications

...now browsing by category

 

Under Pressure

Monday, September 21st, 2009

Stress.  What pregnant woman ever experiences stress?  Ha!

Extreme stress comes in examples like divorce, death in the family, loss of job, etc. but even day to day stressors can wreak havoc on a mom trying to grow a healthy, happy baby in her tummy.  Did you know mothers in a two miles radius of 9/11 gave birth slightly earlier than usual and to lower birth weight babies?  They contribute this to the stress from the tragedy.

Besides the emotional effects of stress, physically a mother can experience increased heart rate and increased stress hormones (cortisol).  Some studies show a greater risk of late miscarriage in the first trimester and more birth defects if there has been severe stress in early pregnancy.  Other findings indicate pre-term and low birth weight babies and lower IQ.  The baby can also be effected later in life with things such as high blood pressure due to that increase in Cortisol while in the womb.

What can a mother do to avoid the effects of stress on her pregnancy?

  • Talk to family and loved ones and make sure you have a supportive outreach.
  • Use massage, meditation, yoga, etc. to reduce anxiety and manage stress.
  • Eat healthy.
  • Get plenty of exercise.
  • Rest when you can.
  • Don’t take unnecessary risks and postpone things that induce stress like a move or job change.
  • Avoid stressful people and stressful situations.
  • Maintain prenatal check-ups (relief that baby is doing well goes a long way to reduce stress).

Posted in Complications, Gestation | No Responses »

EFM: hinderance or help?

Tuesday, August 18th, 2009

Fetal monitoring comes in all shapes and sizes these days.  From a simple stethoscope and kick counts to the ultrasound, doptone and electronic fetal monitoring; each has it’s own pros and cons in checking in on your little one’s vitals.

Throughout your pregnancy, your medical professional probably uses a stethoscope or doptone to listen for your baby’s heartbeat.  You will also keep track of how active your baby is by noticing the kicks and movements inside your belly.  During labor, however, the trend has been towards a more technical method of monitoring.

If you have a hospital birth, odds are they will use an external fetal monitor (EFM) to track the baby.  The EFM is composed of an electronic transducer that is strapped to your belly by means of an elastic belt that send an electronic reading of the fetal heart rate (FHR) and mother’s contractions to a base station in your birthing room.  Anytime there are any dips or raises outside of the normal range (120-160 bpm), indicating stress, an alarm beep sounds.  This also goes off if the disks slide around while you are busy laboring or if it gets wet from your water breaking, etc. which usually causes nurses to rush in to see what is happening.

An obvious benefit to fetal monitoring is in diagnosing early fetal distress and being able to closely assess a high risk mother/pregnancy.

But the risk of the rate of high false-positives are an important one to weigh when allowing EFM.  Of course, no one has good data to back this up but it is noted that out of 1000 births, an extra 30 cesarean sections and an extra 38 forceps extractions occur in continuous EFM versus intermittent auscultation.  If a alarm situation does arise, changing positions, relaxing and giving mother oxygen can all help to relieve any stressors to baby.

There is no recommendation of EFM in low-risk mothers and it does not show an improvement in maternal or fetal outcomes.  So why is it such a common occurance (about 75% of births)?  It then becomes an issue of staffing as it is recommended that it be a 1:1 ratio of nurse to patient when using intermittent monitoring but obviously if a machine is doing the work for the nurse, then they can divide their time between more patients.

Besides the risk of unnecessary medical interventions, including cesarean section, continuous EFM can be cumbersome and an annoyance, especially if you wish to labor or deliver in a tub.  It can be discussed previous to birth to perhaps have intermittent monitoring.  I do however feel that if the labor is induced, it can be a great benefit to use continuous EFM as intermittent monitoring may not pick up on all the ups and downs that baby is experiencing due to the manufactured, chemical contractions from the pitocin.

As with any medical procedure, just be informed and aware of all the benefits and risks.  Ask why do I need this?  What can happen if I don’t have it done?  Are there any other alternatives?

Posted in Complications, Labor & Delivery, Medical Consumerism, Medical Procedures | No Responses »
Tags: ,

Perception of the perfect birth

Wednesday, August 12th, 2009

The Bradley Method® of Natural Childbirth does not have a slogan per se, but if it did, perhaps it would be “healthly mother, healthy baby” as that is always the goal for any birth, unmedicated or medicated.

When planning for our births, we tend to fantasize and maybe even glamorize on how it will go.  We will be glowing, beautifully made up with no sweat and when baby appears, he will be clean and cooing and daddy will be right next to us kissing our foreheads.  That is a wonderful image and there is nothing wrong with striving for something similar if that is what you desire for your birth.  However, we do need to come back to reality and at least prepare for alterations in that dreamed, perfected birth in order to be prepared for what God and your baby may actually have in store for your birth.

Women who put the time into preparing and educating themselves on why to and how to have a natural unmedicated birth sometimes get so focused on that as the goal, that if anything does go astray from that plan, there can be great disappointment and maybe even remorse for decisions made or steps taken.  This also applies to any mother’s or father’s birth ideal.  Even mother’s who elect for epidurals may be disappointed in their pain free birth if it didn’t take effect fast enough or it wore off too soon.  Father’s who envisioned announcing the gender but a nurse quickly said it instead may also experience disappointment.

These are all normal feelings but let’s keep in mind that priority (did you know by definition you can’t have “priorities” or nothing is then the priority?) of healthy mother, healthy baby and even if a birth that was desired to be natural and unmedicated resulted in a necessary cesarean section, we need to rejoice in the miracle of life and be thankful to God.

Posted in Complications, Labor & Delivery, Natural Childbirth | No Responses »

Prods and pokes to the little folks

Monday, June 15th, 2009

So you’ve prepared for your natural birth and have been a good medical consumer researching all your care for the pregnancy and birth of your baby but there are still many more informed decisions to make after your baby is born in regards to his care.  Depending on what location you give birth at or in which state you live, there are a variety of procedures, tests and shots that may/will be given/offered.

Peggy O’Mara in Having a Baby, Naturally suggests the following before making a decision about newborn care:

  • Weigh the pros and cons of each procedure or test.  Gather information from both sides.  Do this as early as possible.
  • Involve your partner in the process.
  • Ask if there are alternatives to the accepted treatment.
  • Seek medical providers who are sympathetic to your needs and wishes.
  • Consider the implications of both sides of the decision.
  • Consider delaying procedures, if that is an option.
  • Do one procedure at a time.
  • Hold your baby during each procedure, if you can.
  • Make peace with your decision and live with it, knowing you’ve tried your best to safeguard your baby’s health.

The first assessment to baby will be the APGAR rating at one minute and five minutes after delivery.  Baby will be given 2 points for each category of: appearance or color, pulse, grimace or responsiveness, activity and respiration.  Most babies score higher than a 7 and higher on the second assessment.  This test can be done with baby right at your side.  Keep in mind it is subjective.

In the first few minutes of your baby’s birth, hospitals will want to administer vitamin K.  Vitamin K promotes blood-clotting since babies are born with very low levels.  You can deny (you have the right to refuse any medical procedure) this treatment that can prevent a rare hemorrhagic disease.  An eye treatment of erythromycin or tetracycline ointment is often times a state law which is an antibiotic used to prevent the effects (blindness) of gonorrhea to baby.  Delaying this for an hour or two will aid in allowing for some visual family bonding (the ointment does cause temporary blurred vision in baby).

In the first first hours through the first few days, baby will also be assessed for jaundice.  Doctors will note the skin and whites of the eyes for yellowing due to hyperbilirubinemia.  There are three types of jaundice: jaundice of early onset – might indicate a serious problem, normal physiologic jaundice – occurs around 3rd day and is normal and jaundice of late onset – peaks at 10 to 15 days and is caused my a hormone in women.  Most jaundice cases are normal and require no medical treatment.  Normal jaundice is “treated” with breastfeeding and exposure to sunshine.  Your doctor may do blood draws to monitor the rise in the bilirubin levels and baby’s treatment could go to phototherapy lights or blood transfusions depending on the severity.  The occurrence of jaundice may be increased if drugs were used during childbirth, if labor was induced, if mom took birth control pills or mega vitamins or if it’s a male or Asian child.

After 24 hours, most states require the PKU test.  It is a heel prick for blood samples to test for a group of genetic conditions including phenylketonuria (inborn error of metabolism to digest phenylalanine), galactosemia and genital hypothyroidism.  The state will notify you if there are any positive results.  If baby is left untreated, some degree of retardation will occur.

Two other newborn procedures that are very large topics to be covered in other posts are: circumcision and immunizations.  If baby is a boy, circumcision may be chosen to be performed.  This is a very personal choice as nothing medical supports the removal of the foreskin of the penis.  Immunizations are highly controversial and sometimes required by schools.  The concern over some of the additives of vaccines is still an issue even though they are not in the immunizations anymore.  Another of the big issues is the schedule of the vaccines and the quantity given to the child at one visit.

Posted in Complications, Medical Procedures, Newborn Care | No Responses »
Tags:

Did I pass?

Monday, June 8th, 2009

testWell the stick read positive didn’t it?  But your test taking doesn’t stop there, it may have just begun.  Depending on your medical support professional (primarily comparing doctor vs. midwife), the type of and frequency of prenatal tests can vary greatly.  Did you know since it is your body you have the right to refuse any medical procedure?  Although there are some tests that are good to take, there are also a lot that can give false or misleading information, can worry you for nothing and can “mark your file” negatively.  Let’s go over the most common prenatal tests in this post (go here for information on genetics testing).

At your basic visit (monthly or weekly depending on gestational duration) with your medical support professional, various things shouldbe checked.  Blood pressure for one.  This one is obviously non-invasive and is important especially in the last trimester to make sure you are not developing hypertension (high blood pressure) which can be an indicator of preeclampsia.  Growth is another thing to check.  Yours and the baby’s.  You will be weighed to check that you are gaining adequate weight for the health of your baby.  A fundal height (from the top of the pubic bone to the top of the uterus) using a measurement tape will also be taken.  This can help to indicate issues with the amniotic fluid or position of baby.  Urine may be tested regularly as well which monitors sugars and proteins in your body which can suggest diabetes, bladder infection or hypertension.  One other regularly checked item is fetal heart tones.  A fetoscope or doppler device can listen to the baby’s heartbeat.

Somewhere along the line, you will probably have your blood checked.  This could be to establish your blood type, screen for Rh factor (if mom has a -Rh factor and dad has a +Rh factor, baby will be +Rh and mom’s system may create antibodies to fight off baby) check for sexually transmitted diseases (some can be passed to your baby or cause complications during pregnancy and birth).

Near the 20 week gestation mark, it is common to have an ultrasound performed.  We will discuss ultrasound in a future post.

A glucose test is performed around 24 to 28 weeks gestation.  You ingest a sugar mixture and after an hour, you have your blood sampled.  If it is too high, there usually is another test performed and you wait four hours after drinking the sugar mixture.  If the glucose level is too high then, they will diagnose you with gestational diabetes.  That will be a post unto itself in the future as there is a lot of controversy of this test that can never be reproduced, asks your body to process a large volume of sugar that you would never typically eat and does not have back up statistics to the risks of mother or baby.

Group B Strep (GBS, beta strep) is a bacteria that commonly lives in humans and approximately 25% of women carry it.  It is of no harm to mother but it can be a risk (lung, spinal cord or brain infection, meningitis) to your baby at birth.  98-99% of babies born to mothers with group B strep will not contract it if treated (mother recieves antibiotics during labor) at the time of birth.  A vaginal and rectal swab is taken around 35-37 weeks gestation.

Cervical exams are invasive and do not provide much information.  They should not be a part of routine care as an increased risk of infection occurs with frequency of vaginal exams.  Checking effacement and dilation does not indicate when the baby will arrive and just causes anxiety to the mother.

As with any prenatal test/exam, Robin Elise Weiss, LCCE suggests these questions to ask beforehand:

  • Why should this test be performed? 
  • How will the test be done? 
  • What risks, if any, does the test pose to the baby or to me? 
  • How experienced are the people doing the tests, and how dependable are the results? 
  • When and from whom will I get results? 
  • What typically happens following good or bad results? 
  • How might the results change the management of my pregnancy? 
  • What could happen if the test is not done? 
  • Could we get the same information in another way? How? 
  • What is the cost, and will it be covered by my insurance?

    • Posted in Complications, Medical Procedures, Tests | No Responses »
    Tags: