Tag Archives: Pregnancy

With Delivery Times, Defer to Mother Nature

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“Let nature take its course.” Over the years, I’ve found this saying particularly applies to the process of giving birth. My personal experience as an ob-gyn and reams of scientific research demonstrate that Mother Nature knows best when a child is ready to be born. The start of natural labor is the main sign, but we’re not always patient enough to wait for it.

Today, one in three babies in the US are born by cesarean—the delivery of a baby through an incision in the mother’s abdomen and uterus. The rate of labor induction is also at an all-time high. Unfortunately, many of these births occur before the pregnancy is considered “term” at 39 weeks. These upward trends have long been a source of concern in the medical community, especially considering the increased risks to a baby who may not be fully developed at delivery.

Among cesarean deliveries, an estimated 2.5% (more than 100,000 births each year) are scheduled on a designated date by the mother and her doctor. Some women cite reasons such as a lower risk of future incontinence, better sexual functioning after childbirth, and fear of pain as motivations to schedule cesareans. Inevitably, some cesareans (and labor inductions, too) are scheduled before a pregnancy is full term, increasing the risk of negative outcomes for the newborn, including respiratory problems and time spent in the neonatal intensive care unit. The fact remains that due dates are estimates, and you can never be sure that the infant will have reached optimal maturity at the time of a scheduled delivery.

Women should keep in mind that cesarean delivery is no walk in the park. While it’s a safe option, cesarean delivery is a major surgery and comes with a number of risks, such as placental complications in future pregnancies, problems with anesthesia, infection, and longer recovery times.

Certain urgent situations—such as preeclampsia, eclampsia, multiple fetuses, fetal growth restriction, and poorly controlled diabetes—may make it necessary to deliver the baby before the onset of natural labor. However, newly issued guidelines from ACOG remind women and ob-gyns that in uncomplicated pregnancies, a vaginal birth that occurs after the natural onset of labor is ideal. Additional new ACOG guidelines reaffirm that cesareans and labor inductions should only be performed when medically-necessary.

Delaying delivery until labor starts naturally may not make ob-gyns too popular with a patient who’s uncomfortable and near the end of her pregnancy, but it’s a decision that will pay dividends by giving the baby the extra time it needs to face the world.

Big HIV News and An Important Reminder

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Earlier this week it was reported that a Mississippi toddler born with human immunodeficiency virus (HIV) apparently cleared her HIV infection and is now disease-free. The story of her innovative medical treatment and remarkable results is truly exciting. However, as an ob-gyn, I can’t help but think that this entire situation could have been avoided.

Today in the US, mother-to-child transmission of HIV is a rare occurrence. HIV-positive women have roughly a 2% chance of passing along the virus to their babies. This is due in large part to increased HIV screening among pregnant women. Those who test positive for HIV during pregnancy can begin treatment with antiretroviral medications before they give birth. These medications significantly reduce the risk that a child will be born with HIV. The earlier the medication is given during pregnancy, the better, but it can still have a positive effect when administered just 24–48 hours before delivery and/or to the newborn within the first two days of life.

ACOG recommends that all pregnant women be screened for HIV as a part of routine prenatal care. Repeat third-trimester testing is also recommended for pregnant women in areas with high HIV prevalence. Not all women receive prenatal care, and it’s not uncommon for ob-gyns to see women for the first time when they come to the hospital to deliver. In this case, rapid HIV testing can confirm a woman’s HIV status. If she tests positive, she may still be able to receive medication in time to protect her baby from infection.

I cannot stress enough the importance of knowing your HIV status. Screening is the best method we have to both head off HIV transmission to infants and stop the spread of the disease to people of all ages. In addition to the screening recommendations for pregnant women, ACOG also recommends that all women ages 19–64 be routinely screened for HIV, regardless of individual risk factors.

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A Healthy Weight for Pregnancy

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It’s no secret that the US has a weight problem. Roughly two-thirds of us could stand to lose a few (or more) pounds. Today, more than half of all pregnant women in the US are overweight or obese. Maintaining a healthy weight is always important to overall health, but it becomes an even more important vital sign when a woman is pregnant or planning a pregnancy.

Carrying too much weight can throw a wrench in a woman’s reproductive works. Not only can it interfere with getting pregnant, but it can also make pregnancy more difficult once achieved. Overweight and obese women are at increased risk of a number of complications during and after pregnancy, such as high blood pressure, preeclampsia, gestational diabetes, and cesarean delivery. They are at a higher risk of problems related to cesarean delivery—including complications with anesthesia, excessive blood loss, blood clots, and infection. Overweight and obese women also have increased odds of miscarriage, stillbirth, premature birth, or having a baby with a birth defect.

So what’s a woman struggling with weight to do if she wants to achieve the best pregnancy outcome? Losing weight before becoming pregnant is ideal, but that doesn’t always happen. According to new ACOG recommendations on weight gain and obesity during pregnancy, some overweight and obese women may be cleared to gain less weight than typically recommended to reduce risk factors. Gaining less weight during pregnancy may also help with losing extra pounds post-delivery.

If you’re considering getting pregnant in 2013 and are currently outside of a healthy BMI range, it’s not too late to make a New Year’s resolution to lose weight. There are many resources and articles focused on eating right and getting fit at this time of year, so investigate and develop your plan of attack. If you’re already pregnant, be sure to ask your doctor about a healthy amount of weight gain and an exercise plan to help you stay active.

A Turn of the Stomach

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We heard exciting news out of the UK this week: Prince William and his wife Kate Middleton are expecting their first child. But the excitement was tempered with concern when reports of the Middleton’s pregnancy-related hospitalization surfaced. She’s reportedly suffering from hyperemesis gravidarum, a severe form of morning sickness that affects up to 2% of pregnant women.

“Morning sickness” refers to the nausea and vomiting of pregnancy. The phrase is misleading because it’s not confined to the morning—as many pregnant women can attest—but the condition is common in early pregnancy, affecting roughly 70%–85% of pregnant women. Symptoms usually strike without warning and can range from mild, occasional nausea, to severe, continuous nausea with bouts of vomiting. Some women may become nauseated by the smell of certain foods or get sick after eating.

Morning sickness typically begins within the first nine weeks of pregnancy, with symptoms often improving by week 14. What causes morning sickness is unknown, but the surge of pregnancy hormones is a likely factor. Though morning sickness can weaken a pregnant woman’s quality of life, most mild to moderate cases will not harm you or your baby’s health.

More serious problems can arise in women who can’t keep any food or liquids down and begin to lose weight, as is the case with hyperemesis gravidarum. Women who cannot tolerate liquids without vomiting and show signs of dehydration may need to be given intravenous fluids and nutrients in the hospital. The risk of developing hyperemesis gravidarum may be higher if you are carrying multiple fetuses, have a mother or sister who had the condition, are carrying a female fetus, have a history of hyperemesis gravidarum in a previous pregnancy, or have a history of motion sickness or migraines.

Many women assume that morning sickness is a pregnancy rite of passage and avoid telling their doctor about their symptoms or downplay how bad they feel. This is not the time to grin and bear it. Symptoms can get worse over time and it’s often harder to treat morning sickness once it becomes severe. If you can’t keep any food or fluid down for more than a day or are becoming dehydrated, contact your ob-gyn right away.

If you have mild morning sickness, these tips may help:

  • Try vitamin B6 supplements
  • Eat crackers before getting out of bed
  • Drink beverages made from real ginger such as tea or ginger ale
  • Consume smaller nutritious, high-protein meals and snacks throughout the day
  • Get enough rest
  • Avoid foods and smells that make you feel sick.

For more severe cases, anti-nausea medications or a short hospital stay may be necessary.

Learn more.

Guest Blog: Pregnant Women—Avoid the Flu, Get Vaccinated

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Laura E. Riley, MD

Preventing flu when you’re pregnant is an essential element of prenatal care, and the best way to do that is to get your annual flu shot. Seasonal influenza is a virus that spreads easily and is most common in the US between October and May, often peaking in February.

It is especially important for pregnant women to be vaccinated because they can become sick enough from the flu that it can lead to severe lung infections requiring hospitalization and preterm delivery. I offer flu shots to all my pregnant patients and those who are considering becoming pregnant. In fact, ACOG and the Centers for Disease Control and Prevention recommend that everyone older than six months of age receive the flu vaccine every year.

It’s important that pregnant women get the flu shot, not the nose spray version of the vaccine, which contains a live attenuated virus. The flu shot is safe for pregnant women and their unborn child during any trimester; it is also safe after delivery and for breastfeeding women. Flu vaccination will not only protect new mothers but can provide protection to their babies in the first six months of their life. Family members, caregivers, and others who will be around the baby should also be vaccinated.

Ob-gyns should offer the flu shot to all their pregnant patients. During pregnancy, the flu shot is the best protection there is against serious illness from seasonal influenza.

The flu vaccine is now widely available at doctors’ offices, clinics, pharmacies, and health departments. To find a vaccination location near you, see this HealthMap Vaccine Finder.

For more information about the flu vaccine, other vaccine-preventable diseases, and the immunization needs of special populations, visit ACOG’s Immunization for Women website.

Laura E. Riley, MD, is chair of The American College of Obstetricians and Gynecologists’ Immunization Expert Work Group. Dr. Riley is director of Labor and Delivery at Massachusetts General Hospital in Boston.

Placenta Problems during Pregnancy

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How much do you know about the placenta? If you’re like most people, probably not much. But for the millions of women in the US who become pregnant each year, the placenta becomes a very interesting organ.

The placenta forms during pregnancy and serves as the life support system for a growing baby. It supplies the baby with oxygen, nutrients, and hormones, removes waste products through the umbilical cord, and is vital for a healthy pregnancy and delivery. In some pregnancies, problems with the placenta occur that can endanger mother and baby.

You may have recently heard about placenta previa, a condition that threatened actress Tori Spelling’s fourth pregnancy. Roughly 1 in 200 pregnant women will experience this potentially serious complication. Blood vessels attach the placenta to the uterus. In women with placenta previa, the placenta lies low in the uterus and may partially or completely cover the cervix, blocking the baby’s exit from the uterus. Placenta previa can also cause excessive bleeding in the mother when the cervix begins to thin and open in preparation for delivery. The risk of developing placenta previa is higher in women who’ve had more than one child, a cesarean delivery, surgery on the uterus, or who are carrying twins or triplets.

Roughly 1% of women will experience placental abruption—the detachment of the placenta from the uterus before or during birth. Placental abruption deprives the baby of oxygen and can cause the mother to lose large amounts of blood. Symptoms may include vaginal bleeding and severe abdominal or back pain. Placental abruption usually occurs in the last 12 weeks of pregnancy and is more common among women who have high blood pressure, smoke, or use cocaine or amphetamines during pregnancy. Women who’ve had a previous placental abruption, have had children, are older than 35, or have sickle cell disease are at higher risk.

Placenta accreta occurs when the blood vessels that attach the placenta grow too far into the uterine wall. The condition can cause bleeding during the third trimester of pregnancy and severe, life-threatening blood loss during delivery. Previous cesarean delivery is the main risk factor for placenta accreta, and the risk increases with each cesarean a woman has had.

If you experience bleeding during pregnancy, talk to your doctor right away. It may be related to a placental problem that requires prompt treatment. Learn more about placenta problems during pregnancy.

Guest Blog: Women and Alcohol–Think Before You Drink

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David J. Garry, DO

As an ob-gyn taking care of women every day, it’s not uncommon for one of my patients to tell me, “I just have some shots and beers on the weekend—what’s the harm in that? All my friends do it.” However, what a patient may consider “normal” drinking could put her health at great risk now and in the future.

Women who drink too much often end up losing out. Judgment becomes clouded. They may have accidents and car crashes. If the drinking continues, they may lose their job, their friends, their family, and other things they hold dear. Women who drink and have sex without using birth control are at risk for becoming pregnant and having an alcohol-exposed infant. Sunday, September 9, is International Fetal Alcohol Spectrum Disorders (FASDs) Awareness Day. Alcohol use during pregnancy is the greatest preventable cause of mental retardation in children. Children exposed to alcohol during pregnancy may also have problems with coordination, controlling emotions, socialization, decision-making, understanding consequences of their actions, and more.

The amount of alcohol in a drink can vary widely. A 12-ounce can of beer, 5-ounce glass of wine and 1 ½-ounces of hard liquor (rum, tequila, vodka, etc.) all contain the same amount of alcohol. But, just one martini or margarita could actually have three servings of alcohol in it. Risky drinking for women is defined as more than three drinks per occasion or more than seven drinks a week.

If it takes a woman more than two drinks in one hour to feel tipsy, she may be developing a tolerance to alcohol, a strong sign of problem drinking. Other signs include:

  • Friends and family telling her that she drinks too much
  • Her own personal feelings that she needs to cut down on drinking
  • Her needing or wanting a drink the morning after a night out to relieve a hangover

Do not drink any alcohol if you are pregnant, trying to become pregnant, taking medications that warn of alcohol use on the label, or have medical conditions in which alcohol use can cause further harm. If you drink, use birth control exactly as prescribed, and if you miss a pill, use condoms until your next period. Be smart and learn your safe limits.

David J. Garry, DO, is co-director of obstetrics and maternal-fetal medicine and associate professor of clinical ob-gyn, Montefiore Medical Center/Einstein College of Medicine, Bronx, NY.

Workout to Prepare for Baby

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Pregnant or planning a pregnancy? If so, how have you worked exercise into your prenatal care? During pregnancy, exercise can reduce backaches, constipation, bloating, and swelling; boost mood and energy; promote muscle tone, strength, and endurance; and improve sleep quality. It can reduce the risk of gestational diabetes, too. Pregnant women who exercise may also have an easier time with labor and delivery and weight loss after childbirth.

Most pregnant women should aim for 30 minutes of moderate-intensity exercise on most, if not all, days of the week. Contrary to what you may have heard, there’s no magical heart rate or beats per minute threshold for pregnant women during exercise. Just keep in mind that if you can’t talk at normal levels at all times, you may be working too hard and need to reduce your intensity. Talk to your doctor before beginning or continuing an exercise program to be sure you don’t have any health problems that would limit your activity.

A few tips to remember:

  • Gentle exercise such as walking, swimming, cycling, or low-impact or water aerobics is suitable for exercisers of all levels.
  • Avoid contact sports and activities that could injure your abdomen such as soccer.
  • Skip activities that come with a high risk of falling, such as downhill skiing, horseback riding, or vigorous racquet sports.
  • Stop exercising and call your doctor if you experience dizziness or feel faint, increased shortness of breath, uneven or rapid heartbeat, chest pain, trouble walking, vaginal bleeding, calf pain or swelling, headache, uterine contractions that continue after you rest, fluid leaking or gushing from your vagina, or decreased fetal movement.
  • Be sure to wear comfortable clothes and a supportive bra and shoes.
  • Drink plenty of water to avoid dehydration and overheating.

Getting moving is the most important part, so pick an activity you enjoy and have fun!Read more about exercise during pregnancy in ACOG’s Patient FAQ.

Prenatal Screenings: Spot Health Risks Before Birth

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During pregnancy, ob-gyns use routine lab and diagnostic tests to help monitor the health of women and their babies, identify problems, and develop treatment plans. Most women will receive these common screenings as part of their prenatal care:

  • Blood glucose tests screen for the amount of sugar (glucose) in the bloodstream. High levels can signal diabetes. Unchecked diabetes can lead to liver damage, birth defects, stillbirth, and other complications for mother and baby.
  • Blood type and antibody testing determines a woman’s blood group (A, B, AB, or O) and Rh type (positive or negative). Fetal problems may occur when an Rh negative woman carries a fetus that is Rh positive.
  • Screening for birth defects (such as Down Syndrome) may be performed in the first and/or second trimester.
  • Late in pregnancy, women are tested for group B streptococcus (GBS) bacteria, which can cause infections of the blood, lungs, brain, or spinal cord in infants. GBS can be transmitted from an infected mother to the baby during delivery.
  • Hemacrit and hemoglobin tests check the blood for low iron levels (anemia).
  • HBV testing screens for Hepatitis B, a virus that affects the liver and can cause severe complications in newborns if passed from mother to baby.
  • All pregnant women should be screened for HIV infection—a disease that attacks the body’s immune system. Treatment of HIV-positive mothers during pregnancy can drastically reduce the risk that the infants will become infected and help improve the mother’s health.
  • A blood test is used to check for signs of past rubella (German measles) infection. Pregnant women who have not had or not been vaccinated against rubella should avoid any infected individuals and be vaccinated after delivery.
  • Screening for sexually transmitted diseases, such as chlamydia, gonorrhea, and syphilis, may be recommended. They can cause preterm birth, miscarriage, eye infections, birth defects, or other problems.
  • At each prenatal visit, urine analysis checks for elevated blood sugar and protein levels and signs of bladder and kidney infections.

Depending on a woman’s age, health history, or ethnic background, additional screenings may be offered for genetic disorders and birth defects, such as cystic fibrosis or spina bifida. Learn more about prenatal screenings on ACOG’s website.

Plan for the Unexpected

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You may have heard the statistic that roughly half of all US pregnancies are unplanned. As ob-gyns, we worry about this number because many women discover that they are pregnant before they’ve had a chance to make lifestyle changes from which they and their developing fetuses can benefit. The days that immediately follow conception are some of the most important in the development of a child, so it’s never too early to prepare for a healthy pregnancy, birth, and baby.

ACOG encourages all reproductive-aged women to talk to their doctors about preconception care whether actively trying to have a baby or not. You can discuss your desire for children, the optimal time to have them, the amount of space you’d like between pregnancies, and your current birth control needs. Your doctor can also review personal health information that could affect a future pregnancy, such as family medical history, environmental and work-related exposure to harmful substances, the risk of sexually transmitted infections, and substance abuse.

If you are considering having children, your doctor may suggest some changes before you conceive:

  • Enrich Your Diet. Folic acid and other vitamins and minerals are vital for healthy fetal development, but most women do not receive enough of these nutrients in their diets. It’s a good idea to begin taking a prenatal vitamin before pregnancy.
  •  Get Enough Exercise. If you do not currently get at least 30 minutes of exercise on most days, your doctor may recommend that you increase activity now for a more active and comfortable pregnancy later.
  •  Achieve a Healthy Weight. Being overweight can cause high blood pressure and diabetes, put extra stress on your heart, and increase the chance of having a very large baby. Underweight women may find it difficult to conceive and are at risk of delivering low-birth-weight babies. Aim to fall into the normal BMI range for your height.
  •  Control Preexisting Medical Conditions. Women with medical conditions such as diabetes, high blood pressure, seizures, heart disease, or obesity may need special care during pregnancy or may be using medications that are harmful to fetuses. Try to get your condition under control and discuss the safety of all current medications with your doctor.
  •  Confront Substance Abuse. Smoking, drinking, and using illegal drugs have been proven to cause birth defects in newborns. Women contemplating pregnancy should not use these substances.