Childbirth & delivery browsing by category


Not Receiving Influenza Vaccinations Increases Infant Mortality

Monday, July 8th, 2013

There has been a lot of talk about vaccinations in the past several years, and the camp of people on the side of going vaccination-free is getting bigger every year. That is something that frightens me as a doctor, as vaccinations are the single most effective way to prevent disease, not just among individuals but also among the general population, known as herd immunity.  Vaccination acts as a “firewall” in the spread of disease.  In herd immunity, the more folks that are vaccinated against a contagious disease, the less likely a single individual will become infected.

However, part of being a doctor is a willingness to look at all the evidence as it is presented to you. As the debate about vaccinations continues, an increasing number of researchers are looking at the effects that vaccinations have on individuals, and whether they have the potential to do more harm than good among certain groups.

Pregnant women are a group of major concern. There are a lot of steps and preventative measures that a woman must take in order to maintain the health of her child while she is pregnant, and vaccinations have always been recommended to prevent the devastating effects of the Influenza virus. Doctors in one study have conducted research on pregnant women and the influenza virus, as well as the mortality rates in the infants of those that choose not to be vaccinated.  While vaccinations against the Influenza virus pose no significant threat to women or to their unborn children, women who go without the vaccination show much higher rates of infection, and those that were infected show much higher rates of fetal mortality.  Another vaccine, known as Tdap, for tetanus, diptheria and pertussis (whooping cough), should be administered to all pregnant women in their third trimester (27 weeks to 36 weeks) in order to maximize the maternal antibody response and passive antibodies that will protect the newborn.

The results are not surprising to doctors, but they are worrying when you take into consideration the fact that this year, many women will choose not to be vaccinated, and will choose not to vaccinate their children. While many trends are silly but otherwise harmless, this “popular” trend could be absolutely devastating. There are certain vaccinations that should not be performed during pregnancy, such as measles, mumps and rubella (MMR), varicella (chickenpox), zoster (shingles), anthrax, BCG (tuberculosis), Japanese encephalitis, typhoid, yellow fever and smallpox, but women should trust their doctors to guide them in the right direction when it comes to making these decisions about the necessary vaccinations.  Choosing to vaccinate against Influenza, even while pregnant, poses virtually no risks. Choosing not to vaccinate could be a big mistake.

– Yvonne S. Thornton, M. D., M. P. H.

Reproductive Science Helps Women With HIV-Positive Partners Give Birth

Thursday, July 4th, 2013

Although sexually transmitted diseases are a very serious matter no matter what an individual is facing, HIV is perhaps the most frightening diagnosis for many individuals. Even with vastly improved life-expectancy rates, there are a number of concerns that individuals and those who have HIV-positive partners face throughout their lives. One of the biggest concerns for those who have HIV is whether or not they will have the opportunity to conceive children.

It is absolutely imperative that among couples in which one partner is infected with HIV and the other is not that protection is used whenever intercourse occurs. This means that a couple in which one partner has HIV cannot conceive naturally—at least, not in a responsible manner. However, studies in reproductive medicine have investigated whether or not the sperm of men that have been infected with HIV can successfully impregnate women while still leaving both mother and child HIV-free.

It sounds like a scary and risky procedure, and there has certainly been a lot of debate over whether these kinds of studies are wise. However, this study has shown that there does not seem to be a risk of infection in cases where the male sperm has been “washed” and the woman has been artificially impregnated. This is intriguing news not only for researchers that study the mechanics of HIV, but also for doctors who specialize in reproductive help. It means that there seem to be more options for couples in which at least one partner is infected. Unfortunately, pregnancy among HIV-infected women can still be dangerous, as the virus can transmit to the infant either during pregnancy or childbirth, and much more needs to be done to determine the possibilities for couples during these cases.

Overall, it is intriguing news and it will certainly continue to raise a lot of questions for those that specialize in women’s health and reproductive medicine. However, it is imperative for any couples in which one partner is infected with HIV to realize that it is necessary to seek medical advice when the issue of conception comes up. Even if the possibility for a safe pregnancy is there, it is better to seek the advice of professionals and to avoid any potential infection. Childbirth is a wonderful and a beautiful experience, but currently the best option for these couples is still to seek alternate methods to become parents.

– Yvonne S. Thornton, M. D., M. P. H.

Obesity a Direct Cause of Preterm Birth

Monday, June 17th, 2013

Though mothers shouldn’t be forced to think they need to remain svelte throughout their pregnancies, and shouldn’t be shamed of healthy weight gain during pregnancy, there is one serious issue that women need to keep in mind when they are preparing to become pregnant. It is impossible to plan out every step of a pregnancy, and there will always be unexpected complications that arise during the 40 weeks to delivery. However, there are precautions that women can take to prevent serious problems and to decrease the risk of preterm delivery, according to one study.

One of the biggest risk factors for preterm delivery is obesity in pregnant women. One study in Sweden has shown that not only is preterm delivery a risk, but some obese mothers shown signs of extreme preterm delivery. Even though this cohort study was conducted in a country that is not as heterogeneous as the United States, this is a serious concern, and one that may have serious implications for both doctors and potential parents. The most important thing for everybody involved in a birth with one of these risk factors to keep in mind is that such complications are not only possible, but that they are heightened due to the circumstances. Everybody involved must make plans for the possibility of an earlier birth, and everybody involved should be more open to the possibility of safety measures such as bed rest, gestational diabetes, kidney and heart problems as well as a host of other medical issues that can arise. In general, women who are obese when pregnant will likely need to be in contact with their physician more often than a woman who maintains a healthier weight.

Women who have not yet become pregnant and who are considered obese may want to speak with their doctors about their options before pregnancy. Even a small weight loss can be enough to curtail some of the biggest problems related to pregnancy, while a significant weight loss can have even more lasting effects. However, remember that any weight loss plan must be discussed in detail with your doctor—making yourself unhealthy just to drop a few pounds will not do your or your family any favors.

– Yvonne S. Thornton, M. D., M. P. H.

How Does “Bedside Manner” Affect Patient Pain?

Thursday, June 6th, 2013

You’ve probably heard somebody talk about a doctor’s “bedside manner”. It can be fun to watch television shows such as House, M.D., where the doctor is not-so-nice to his patients, but there is a very real reason that doctors like this are often not successful in the real world, and why part of a doctor’s medical training includes learning how to communicate with their patients and treat them appropriately, especially after a major medical event such as childbirth or surgery.

While you can guess that the way a doctor interacts with their patient can affect their psychological well-being, you might not have considered the fact that the same interaction can influence the patient’s perception of pain. In fact, one study has shown that discussing pain with patients who have had a Caesarean childbirth adversely affects their perception of pain, and can actually make them feel worse.  This raises several important for both doctors and patients as they consider what it means to have a good “bedside manner”.

There are two ways to quantitate the perception of pain.  One is a numerical scale ( and the other is a visual analog pain scale, also known as the FACES or Wong-Baker scale (,   These pain scales allow the physician or nurse to get a better idea of the extent of the patient’s discomfort.  Still, even with these pain scales, some doctors still will act like “House”.

Talking about pain  is also a complex issue because it forces both doctors and patients to consider how they will manage pain and discomfort after surgery or childbirth. On the one hand, it is important for the doctor to know that their patient is feeling all right, and that there are no potential complications that need to be addressed. Some patients, especially those who have never undergone major surgery before, may feel that certain types of pain are “natural” and will not speak about these issues with their doctor. However, if asking about pain leads to negative effects, it important for doctors to choose their wording carefully in order to acquire the information they need while still aiding in their patient’s comfort.

It is always important for patients to have a doctor whom they feel that they can trust—who they already know through interacting with them has a bedside manner that meets their needs. This is especially important for women who are preparing to give birth, as they will want to heal as quickly as possible so they can begin to care for their newborns.

– Yvonne S. Thornton, M. D., M. P. H.

Know the Facts When Making the Decision to Breastfeed

Thursday, April 25th, 2013

There is not a doctor out there who will deny there are some definite benefits to breastfeeding. Both mother and baby experience these benefits, which range from helping mom to lose some of her baby weight to helping your infant gain greater immunity to childhood diseases. But when my patients ask me whether or not they should breastfeed after they give birth, the last thing I want to do is bully them, or use scare tactics to pressure them into breastfeeding if they don’t think that it is the best option for them.

Perhaps it’s just me, but I think these decisions are best left to the mother. It is not my job as a doctor to make those decisions for you. However, it is my job to make sure that you have the facts, and all the facts, before you decide either way. A lot of women might not know just how many benefits there are to breastfeeding, but on the contrary, a lot of women may have heard information that is just plain false. For example, plenty of people trying to push breastfeeding on young mothers will tell them that mother’s milk can prevent obesity later in life, but studies show that this is not the case at all.

Why is this important to me? Because I don’t think that any woman should be shamed for making the decision not to breastfeed if she doesn’t think that option is right for her. And there are plenty of women who have good reasons not to, whether they produce low amounts of milk, they need to return to work or take care of the rest of the family, or the process is just too painful for them. This is an important choice to make—possibly the most important choice that new parents will make in the first months of their child’s life. I want people to be informed about every option that they have, and will always encourage those who are uncertain about that choice to know everything they can, and to get their information from a source that isn’t trying to push some sort of an agenda. Let’s face it—parenthood is hard. You need information to make the right decisions. And there is absolutely nothing wrong with formula feeding. Unlike the milk from breastfeeding, which is deficient in Vitamin D and iron, formula feeding has enhanced those vital nutrients and there is also a quantitative check on just how much your baby is receiving in milk.  There are NO randomized clinical studies or trials (Level I) that have compared exclusive breastfeeding with formula feeding.  Therefore, the recommendations made are not based on evidence-based medicine.  Breastfeeding sounds good, so it must be good and sound.  With breastfeeding, that may not be the case.  Each mother has to decide what is best for her family, her baby and her self.  A panel of “experts” cannot recommend a course of action based on what “sounds” good without definitive outcomes of the two modes of management.  This has not been done when it comes to comparing breastfeeding to formula feeding.  Only observational studies exist and they are not the appropriate study design upon which to make decisions about such an important aspect of infant nutrition. The goal is to give your child the nutrition that he or she needs in order to grow.

– Yvonne S. Thornton, M. D., M. P. H.

A Cesarean Delivery Will Not Lower Your Chances for Incontinence

Thursday, April 4th, 2013

Obviously, childbirth can really do a number on a woman’s lower body. While we have all dreamed of the day we become mothers since we were little girls, we have also all feared it. Both women and men alike understand the pain and discomfort of childbirth. Some of that discomfort can even last beyond the pregnancy itself. Many women report incontinence after they’ve delivered a baby. Whether it’s a long bathroom line or a hearty laugh, you might find yourself darting to the nearest empty stall in horror as you realize you don’t have the bladder control you used to. It’s a common misconception that women who opt for Cesarean delivery are impervious to incontinence postpartum. Believe it or not, studies show that the mode of delivery actually has no influence on whether or not a woman will experience incontinence after she gives birth.

You’re probably wondering what causes incontinence postpartum then since the mode of delivery has no effect. If you are having bladder control problems after you give birth, it’s more likely a result of your age. Older women are more susceptible to incontinence to begin with, so childbirth will only bring it on sooner. Also, genes play a role. If your own mother was incontinent postpartum, there’s a better chance you will be also. Finally, your lifestyle might also play a role. Women who maintain a healthy weight and exercise regularly become incontinent less often. By avoiding those fatty pregnancy temptations and resisting the urge to become a couch potato during your gestation, you will be preventing incontinence.

If you’re thinking about having a Cesarean for health reasons, don’t let the potential for incontinence sway you. You have just as great a chance of becoming incontinent from a Cesarean delivery as you would from giving birth vaginally. Make other adjustments in your pregnancy if you are hoping to avoid incontinence. Stay healthy, plan the age at which you conceive wisely, and talk to your family members about their own incontinence postpartum to determine whether or not genes might play a role. While incontinence is embarrassing, it is temporary for many new moms who struggle with it for the first time.


– Yvonne S. Thornton, M. D., M. P. H.

A Little Known Side Effect of Cesarean Deliveries

Thursday, February 21st, 2013

For women who deliver their baby by Cesarean, there are a few extra considerations that must be taken into account both on the due date and during the baby’s infancy. Whether the Cesarean was elected or required for the baby and mother’s health, there are a few ways in which the outcome differs from a vaginal delivery. Of course, the new mom will need to care for her surgical incisions to make sure they heal properly, and doctors will have to pay extra close attention to a baby’s vital signs during the process. However, there is one Cesarean side effect that few women know about the first time around.

Studies show that babies who are delivered by a Cesarean do not have as much healthy intestinal bacteria as those delivered vaginally. Specifically, the research indicated that Escherichia-Shigella and Bacteroides were not abundant in the gut. These bacteria are essential to a healthy intestinal balance.

The reason the mode of delivery might have an effect is a matter of how the baby might obtain the bacteria. When a baby passes through the birth canal, he or she will come into contact with the vaginal bacteria present in the mother’s body. During a Cesarean, the baby rarely comes into contact with such bacteria, and any contact is usually limited to bacteria found on the skin.

As adults, our gut flora and bacteria can be upset by antibiotics and other medications that upset the natural balance of cells. When a baby is delivered, it is really the first time she is making contact with the outside world, so it’s no wonder the bacteria she ingests will have long-term effects on her internal balance.

Another little-known fact about babies delivered by Cesarean is that they are more likely to make a detour and visit the neonatal intensive care unit (NICU) for respiratory distress or difficulty breathing following their birth.  Why? Because the natural act of compressing it’s little chest during the birthing process by way of passing through the vagina and thereby squeezing out the excess fluid in the lungs is not present during a Cesarean.  This retained fluid, as it were, can cause rapid, distressed breathing of the infant, known as transient tachypnea of the newborn (TTN) requiring time in the NICU for some drying out.  Fortunately, the condition rarely progresses to a more serious complication.

So, Mother Nature, for the most part, does know what she’s doing when it comes to birthin’ babies. The frequency of Cesarean birth has skyrocketed over the past two decades, some for medical indications and more recently, at mother’s (or obstetrician’s) convenience.  Just know that if Mother Nature wanted babies to be born abdominally, she would have put a zipper above the pubic bone.

 – Yvonne S. Thornton, M. D., M. P. H.

Eclampsia Has Its Fifteen Minutes of Fame

Thursday, February 7th, 2013

It’s always very exciting when a women’s health issue finds its way into the spotlight through popular media. Though some issues are difficult to talk about and even sad sometimes, talking about them helps raise awareness, which can bring us all closer to effective treatments and cures.

On Sunday night’s episode of the popular series “Downton Abbey,” a main character named Lady Sybil Branson died shortly after she delivered a baby due to a condition called eclampsia.  Eclampsia has been identified as a clinical condition since the times of Hippocrates. The term “Eclampsia” comes from the Greek meaning “lightning” and the description of convulsions or spasms appeared in the medical literature as early as the 17th century. It is a life threatening disorder which kills the baby 30 percent of the time and the mother may die 10 to 15% of time, as seen in the episode of Lady Sybil.

The incidence of eclampsia is high in developing countries, e.g., 13 – 17 per 1000 deliveries in Africa compared to 1 in 2000 in the United Kingdom.  The maternal death rate for the developing countries may be more than 25%.

To understand eclampsia, you should first understand preeclampsia. Preeclampsia is a pregnancy complication that causes dangerously high blood pressure and rapid weight gain. It is an insidious process that is little understood and occurs after 20 weeks of pregnancy.  In its more progressive form, preeclampsia adversely affects fetal growth and causes the baby to be smaller than expected. Women with preeclampsia need to be closely monitored for the duration of their pregnancy. Eclampsia is a continuum of preeclampsia. Women who suffer from eclampsia have seizures during or after birth. In today’s society, with about four million births per year, eclampsia occurs in approximately 1 in 2,000 pregnancies.  In underdeveloped countries, the prevalence of eclampsia is over twenty times higher!

Though the show is set in the 1900’s, eclampsia and preeclampsia still negatively affects women in the United States and all around the world today and there is no known understanding and effective treatment for the condition because there is no animal model and it only occurs in humans.  The treatment for preeclampsia is delivery.  A medicine to control seizures (magnesium sulfate) is used to prevent seizures when preeclampsia is diagnosed, but it still makes for a very risky pregnancy and delivery.  Eclampsia becomes much more frequent as a patient approaches term.  About 50% of eclamptic seizures occur before delivery, 25% during delivery and about 25% within 48 hours after delivery.  In fact, eclamptic seizures may occur up to seven days postpartum.

During your pregnancy, your doctor will perform tests to find out whether or not you have preeclampsia. Usually preeclampsia has no symptoms, i.e., pain or bleeding.  However, if you are in your late second or third trimester and you experience symptoms such as abnormal swelling, sudden weight gain, headaches, abdominal pain, nausea, and vision changes, you should see your doctor immediately. These are all signs that the preeclampsia has progressed, and it’s important that your doctor evaluate your condition with the possible recommendation of immediate delivery.   Eclampsia should be managed in a specialized, well-equipped medical center and not at home (as was the case with Lady Sybil).  A combined team of an obstetrician or perinatologist, obstetric anesthesiologist, and neonatologist with experience in management of eclamptic patients is essential.

The best way to prevent maternal or fetal death due to eclampsia is to make sure all of the doctors and nurses are ready to handle the emergency should it arise.

Now that eclampsia has been discussed in popular media via “Downton Abbey,” more women should seek early prenatal care and should know what to look out for during their pregnancy, so that more might be treated in time, and they and their babies don’t suffer the serious health problems associated with it.

– Yvonne S. Thornton, M. D., M. P. H.

One Postpartum Pain You Should Never Ignore

Monday, January 14th, 2013

After you’ve delivered your baby, you’re going to feel like you’ve been hit by a bus. Your legs will be sore, your arms will be sore, and your voice will be scratchy from the screaming and crying. Think back to that horrible day you pushed yourself too hard at the gym and could barely walk the next day – now imagine that three times worse and you’ve successfully envisioned the day after delivery. You’ll feel aches and pains in places you didn’t know existed. However, there is one pain in particular you should watch out for. While it might be difficult to discern it from the other aches, a localized pain in your calf should raise alarm.

As opposed to an overall feeling of achiness in your leg, you might feel a singular, pinpointed pain caused by a feeling of pressure. You might also notice that the leg with the pain is swollen, red, and hot in comparison to the other one. This could be a very clear sign of deep vein thrombosis or a blood clot. Studies show that deep vein thrombosis is likely throughout pregnancy, but that in the six weeks postpartum, new moms are at their highest risk for it. This is because the body is slowly re-adjusting and settling back into its normal position, so the blood could move abnormally in the veins. If you notice this pain after you’ve given birth, see your doctor immediately. It might be difficult to get out of the house now that you’ve finally settled in with your newborn, but the consequences of the clot being left untreated could easily be fatal. Even if it’s nothing, it’s better to be safe than sorry in this scenario. Consider this—it’s better to call a relative to watch your little one for a day while you are treated than for a lifetime if you don’t make it.

Many of the aches and pains after you give birth are perfectly harmless, and the chances of you suffering from deep vein thrombosis are actually quite slim. However, while complaining to your partner about the usual pains, stop yourself if you happen to mention anything in your calf because it may be time to see your physician.

 – Yvonne S. Thornton, M. D., M. P. H.

There’s Something Genetic about Twins

Monday, November 12th, 2012

If you’re a mother of twins, you’ve probably had people come up to you and ask if twins run in your family. Many women have heard this before, but few are entirely certain whether or not the likelihood of giving birth to twins is truly genetic, or if it simply happens by chance. You might be surprised to find out that the notion isn’t entirely a myth. To understand the genetic forces behind having twins, you first need to understand how twins are born.

There are two types of twins a woman can have. Monozygotic twins are the ones that are identical, and their genetic build is essentially the same. These twins were formed after the mother’s egg was fertilized. The egg split into two and became two separate eggs, and eventually two separate people. Rest assured that this is simply a strange bodily occurrence, and there is nothing genetic about it.  It is nature’s cloning.

On the other hand, dizygotic twins are those that are fraternal. They might be different genders, and they look no more alike than regular siblings. These twins were actually formed when the mother released two eggs at the same time. Both eggs were fertilized separately and two people began to form. Here is where genetics come into play. If a woman has released two eggs at the same time, she is predisposed to hyperovulation. Most women release a single egg with every cycle, but women with dizygotic twins release two (or sometimes more in the case of multiples). Hyperovulation is in fact genetic. If your mother or grandmother experienced hyperovulation, you probably will too. Certain tribes in Africa are prone to multiple ovulation and consequently a high incidence of twinning.  Women of color, older women, women with several children (high parity) are more likely to have twins.  Conversely, Asian mothers are about half as likely to have dizygotic twins.

Women taking fertilization treatments using Clomid or Pergonal will be more likely to hyperovulate resulting in a dizygotic (or monozygotic) pregnancy or even higher-order multi-fetal gestations, such as Octomom.  Also, those women who are undergoing artificial reproductive technologies, such as in vitro fertilization, which may insert more than one fertilized egg into the uterus may have twins.   But these women are not genetically predisposed to carrying twins.  The bottom line is that if you or other members of your blood-related family are dizygotic twins and you’re trying to conceive, you might want to stock up on twice the amount of baby supplies.