Pregnancy

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When New Moms – or New Dads – Get the Pregnancy Blues

Friday, May 21st, 2010

Most women are familiar with the term post-partum depression.  Start with all the stresses of adding a new member to the family – not just the financial burden, but the schedule upheaval, the sleep deprivation, and the demands of a tiny person who can only make his or her needs known by wailing. Add the wild surge of hormones flooding a woman’s body, and is it any wonder that she might not be the picture of serenity and assurance? Estimates vary on the prevalence but as many as 25 percent of new moms may experience some level of depression either before or after delivery.

That’s bad enough, but now a study suggests that new fathers, just like new mothers, can find themselves overwhelmed when baby makes three (or more).

“The study, published in the Journal of the American Medical Assn., found that 10.4% of men experienced serious depression at some point between his partner’s first trimester and one year after childbirth, more than double the depression rate for men in general. American men were more likely to experience prenatal or postpartum depression compared with men in other countries, 14.1% in the U.S. compared with 8.2% internationally.”

What can you do when the guy you depend upon to keep you sane is going through his own blue period?

Your most important step –the one you should take if either you or your partner starts to feel sadness, agitation or hopelessness – is to talk to your doctor. Don’t try to tough it out. Reach out for help at the first signs that something isn’t quite right. It’s possible that all you need to get back to your cheery old selves is a good night’s sleep, but sometimes, you need more. The good news is that help is available. But first, you have to be aware of the signs of depression.

Post-partum depression can be debilitating if you let it go, so take steps immediately to get yourself and your new family back into the swing of enjoying things together again.

- Yvonne S. Thornton, MD, MPH

Pregnant or new mom and feeling depressed? Get help now.

Tuesday, March 9th, 2010

Pregnancy and childbirth alter the hormonal balance, which may explain why depression is so common at this stage of women’s lives. Up to 23 percent of pregnant women experience symptoms of depression and that figure rises to up to 25 percent among new mothers.

Many women decide to simply suffer through it without seeking help, but that could be a big mistake. According to the American College of Obstetricians and Gynecologists:

“… untreated maternal depression negatively affects an infant’s cognitive, neurologic, and motor skill development. A mother’s untreated depression can also negatively impact older children’s mental health and behavior.”

Everyone feels sad some of the time. It’s normal to have a bad day. But if your bad day stretches into weeks, for your own sake and the sake of your baby, you need to get help. If you don’t have a therapist, ask your ob-gyn for a referral if you experience feelings of hopelessness, sadness or despair. Don’t suffer needlessly. Help is available.

- Yvonne S. Thornton, MD, MPH

Labor & Delivery: Don’t try this at home

Monday, November 30th, 2009

Most women today have no idea how dangerous it once was for a woman to give birth. The maternal death rate today is about eight per 100,000 births.  When home births were in style, the maternal death rate was 83 per 100,000 births – 10 times the number of deaths.

Women today almost never die in childbirth because, when things go wrong during labor and delivery, medical professionals can step in and prevent emergencies from becoming tragedies.

Which is why I want to scream when I read nonsense like the following, from a website calling itself “Born Free.”


“Welcome to Bornfree! This site is based on the belief that childbirth is inherently safe and relatively painless provided we don’t live in poverty, and do not interfere either physically or psychologically. Drugs, machinery, and medical personnel are not only unnecessary in most cases, they are also no match for a woman’s own intellect and intuition.”

The site quoted above advocates for unassisted childbirth at home. No doctor. No midwife. And no professional help at the ready if something goes wrong.

Ordinarily, I wouldn’t get too exercised over an obscure website. But, it’s how I found this website that has me troubled. It was featured in an article on ABC News.com in the “Entertainment” section. The article mostly extolled the concept of women giving birth at home, with neither a midwife nor a doctor present, giving only the briefest nod to the caveats from an ob-gyn.

In the age of reality TV, maybe a piece about women risking their lives to experience “freebirth” makes good copy. Maybe, because it was in the Entertainment section, this quote from a mother who recently gave birth on her own didn’t raise any eyebrows: “…it is not risky if you do your homework.”

But ask an ob-gyn and you’ll get a much different albeit less entertaining quote.

Yes, so-called “freebirth” is risky. And no, you can’t mitigate the risk by doing “homework.” Approximately 40 percent of high-risk patients appear to be low-risk before labor and delivery. No amount of “homework” can prepare a woman for suddenly finding herself among those 40 percent. If she’s at home, without medical attention, she and her baby could be in serious danger.

Most certified nurse midwives are affiliated with hospitals today precisely because the unexpected can and does happen during childbirth and having medical and surgical teams within shouting distance can mean the difference between life and death. The birthing process is still the 11th leading cause of death in women between 15 and 44 years of age.

When I was in the military, we received a stat call about a home birth gone wrong. The woman lost all muscle tone in her uterus after the birth of her child. By the time the ambulance got her to Bethesda, she had bled to death.

So I’ve seen firsthand how “freebirth” can be a recipe for disaster.

- Yvonne S. Thornton, MD, MPH

CVS: a first trimester alternative to amniocentesis

Tuesday, August 25th, 2009

Amniocentesis (amnio) is a test that identifies the presence of a chromosomal or genetic defect in the growing fetus, such as Down Syndrome or Tay-Sachs disease.

But amniocentesis can’t be done until a woman is between 16 and 20 weeks pregnant. If a serious problem is found, and the patient chooses not to continue with the pregnancy, then it is a more involved procedure than during the first trimester. And it can be more heart wrenching to have to make such a decision after investing so much hope in a pregnancy that has progressed to 18 or 20 weeks.

What many prospective parents don’t realize is that there is an alternative to amniocentesis that can be done during the first trimester, as early as 10 weeks. It’s called chorionic villus sampling (CVS). It’s about as safe as amniocentesis. Either procedure (CVS or amnio) has a fetal loss rate (miscarriage) of less than 1%. And, in most cases, CVS can be as good a choice or better.

As one of the investigators for FDA trials of the procedure in the mid-1980s, I was among the first physicians in the U.S. to gain significant experience in chorionic villus sampling.

If you are older than 35 and your ob-gyn has recommended prenatal genetic testing but hasn’t offered this alternative to you, it may be because fewer physicians are trained in CVS than in amnio.

But you and your pregnancy should not be penalized just because your physician does not perform CVS.

If you’d prefer to have chorionic villus sampling, check with one of the major academic medical centers in your area where CVS is more likely to be performed regularly. And be sure to have it done by a physician who has over 100 procedures under his or her belt, because the procedure has a steep learning curve. The miscarriage rate is directly related to the experience of the person performing CVS.

The advantage with CVS is that you will know the results of the test within a week, while you are still in your first trimester.

- Yvonne Thornton, MD, MPH

Pregnancy and the pill

Tuesday, June 16th, 2009

For many women, taking the pill is more a matter of delaying pregnancy until the time is right rather than preventing it all together.

So, the big question becomes, how long after you stop taking the pill can you expect to become pregnant? No two women are alike but, generally speaking, pregnancy is possible the next time you ovulate. You may ovulate within two weeks after finishing up your last package of birth control pills. So, theoretically, you could become pregnant almost immediately. However, as we all know, there are many variables. Some couples try for years to become parents without success.

It almost seems an unfair trick of the heavens that it’s sometimes the women who don’t want to become pregnant who easily do.

That means, if you’re dead set against pregnancy, and you stop the pill, you need to begin another form of contraception immediately. I actually recommend that my patients begin using an alternate contraceptive before getting off the pill so they get into the habit of using it.

Otherwise, you may have to get into the habit of changing diapers.

- Yvonne Thornton, MD, MPH

More media attention for the study

Friday, June 5th, 2009

Forbes reports on my study, showing that obese pregnant women should limit weight gain as does Medline.

Other media outlets giving the study prominent coverage are United Press International, Yahoo News, The Baltimore Sun, US News and World Report, and even the Times of India.

- Yvonne S. Thornton

My study on obesity and pregnancy in the news

Wednesday, June 3rd, 2009

I’m pleased to see that the media is getting the word out: obese pregnant women should be eating healthier diets and limiting their weight gain.

In the past few days, I’ve been interviewed by a number of news organizations about the study. You can see some of the reports at the following links:

WebMd

The Atlanta Journal-Constitution

Science Daily

The Los Angeles Times

and Health Day

- Yvonne S. Thornton, MD, MPH

Study’s author concerned that new guidelines for pregnant obese women don’t go far enough

Tuesday, June 2nd, 2009

You may have read the headlines last week that The Institute of Medicine (IOM) is changing its guidelines for obese pregnant women. Instead of recommending that women who are obese gain at least 15 pounds during pregnancy, the IOM now recommends a weight gain of 11 to 20 pounds.

It’s a start. But, as the lead researcher of a new study of obese women, pregnancy and weight gain, I’m concerned that obese women are being told to gain any weight.

My study, which is being published today in the Journal of the National Medical Association, found that obese pregnant women who followed a well-balanced diet and gained little or no weight had maternal-fetal outcomes that were equal to or better than those who gained substantial weight.

As a specialist in high-risk pregnancies who has delivered more than 5,500 babies over a 35-year career and supervised the delivery of 12,000 more, I wasn’t surprised by the findings of our study. I know that those extra pounds mean extra risks for both mother and baby. Obesity greatly increases the chance of developing complications in pregnancy such as preeclampsia, stillbirth, and blood clots, among others.

Twenty-three of the more than 200 obese women in our study lost weight. The average weight gained was just 11 pounds. And yet, these women and their babies were at least as healthy as those who put on substantial pounds. There were fewer babies weighing 10 pounds or more, fewer cesareans, and the mothers were less likely to develop gestational diabetes.

You can read more about the study, here.

So, if you’re carrying significant extra weight, forget the old adage about eating for two. Believe it or not, for a pregnant woman of normal weight, only an additional 300 calories per day is needed during her pregnancy – the equivalent to a quart of skimmed milk per day.

- Yvonne S. Thornton, MD, MPH

My interview with Bob Salter of WXRK

Monday, June 1st, 2009

This weekend, Bob Salter of WXRK radio, interviewed me about my memoir, THE DITCHDIGGER’S DAUGHTERS, and about my new study, showing that obese pregnant women should gain little or no weight. You can download the interview here. I’ll have more on this blog about the study, tomorrow.

- Yvonne S. Thornton, MD, MPH