Women’s health issues
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Friday, January 13th, 2012
As an OB-GYN who has delivered thousands of babies—including several with rich and famous parents—I’m scratching my head over the insanity at Lenox Hill Hospital in New York City surrounding the birth of Beyoncé’s baby.
Here’s a sampling of what went on, according to The New York Times:
The familiar area outside the neonatal unit had been transformed: partitions had been put up, the maternity ward windows were completely covered, and even the hospitals’ security cameras had been taped over with paper. Guards with Secret Service-style earpieces roamed the floor.
“We were told we could walk no further,” Ms. Nash-Coulon said Monday. And when she and her husband, Neil, demanded an explanation, she added, the guard claimed, unconvincingly, “ ‘Well, they’re handling hazardous materials,’ ” even as a large group of people screened from view were passing through the main hallway he had declared off-limits.
Let me make this perfectly clear: The hospital had no right to bar other patients from having free access to their babies. Worse, from a safety perspective, doctors were prevented from visiting their own patients on rounds, because of this so-called “security.”
Someone in the hospital decided that the celebrity of a hip-hop artist was sufficient to ignore medical necessity and common decency. Not a good message to send to sick people.
Beyond that, I’m alarmed to learn that the baby was born by Cesarean, as so many celebrity babies are today. I could be mistaken, but I doubt that Beyoncé’s OB-GYN warned her of the risks before treating little Blue Ivy’s birth like just another item on the to-do list. The risks are real: a dramatic increase in maternal deaths due to hemorrhage and infection; more babies ending up in the neonatal intensive care units after Cesarean births because of respiratory distress.
If she’d been my patient, I’d have told her what I tell other mothers-to-be: if God wanted women to have Cesareans, he would have put a zipper in the pubic area.
- Yvonne S. Thornton, MD, MPH
Posted in Childbirth & delivery, General health news, Women's health issues | No Responses »
Tags: baby, Beyonce, Blue Ivy, Cesarean birth, Childbirth & delivery, Lenox Hill Hospital, Pregnancy
Wednesday, November 30th, 2011
You’ve probably heard the claim that exposing a baby in the womb to Mozart will increase his or her IQ. Despite the hype, the research doesn’t support major leaps in smarts (but, if nothing else, it might improve your child’s musical taste, later on).
Now, there’s some evidence showing that you may be able to shape a yet-to-be-born child’s taste in food.
“The flavor and odors of what mothers eat show up in the amniotic fluid, which is swallowed by the fetus, and in breast milk. There is evidence that fetal taste buds are mature in utero by 13 to 15 weeks, with taste receptor cells appearing at 16 weeks, according to researchers.
“’With flavor learning, you can train a baby’s palate with repetitive exposure,” said Kim Trout, director of the nurse midwifery/women’s health nurse practitioner program at Georgetown University.
“Trout recently co-authored a paper that reviews the evidence on prenatal flavor learning and its implications for controlling childhood obesity and diabetes, among the country’s most pressing health problems…”
Although I’m just as skeptical of this claim as I am about the one for baby-and-Mozart, I see real benefit in giving this a try, whether it makes your baby want broccoli or not. That’s because, in my practice, I see too many women gaining too much weight during pregnancy, which can not only cause complications for mother and baby, but can be almost impossible to shed once your baby is born.
So, bring on the Brussels sprouts, and eschew the Twinkies. Pass by the apple pie and bite into a nice juicy apple instead. Whether it does a thing to change your baby’s mind about what tastes good later in life, it will do a world of good for you both right now.
- Yvonne S. Thornton, MD, MPH
Posted in General health news, Pregnancy, Women's health issues, Women's health news, Your newborn baby | No Responses »
Tags: babies, baby, baby's tastebuds influenced by what mom eats when pregnant, diet, fetus, infants, newborn, Pregnancy
Monday, November 21st, 2011
You might have read the news that YAZ and Yasmin, two newer birth control pills, are riskier to take than older contraceptives due to higher potential for blood clot formation.
But it’s important to put this into perspective. No matter what birth control pill you use, blood clots are a possibility, if an uncommon one. What you might not know is that blood clots are even more common in pregnancy. Fortunately, the vast majority of the millions of women who get pregnant and give birth each year don’t suffer blood clots. Just as millions of women take birth control pills with no such side effects.
So, is there a unique problem with YAZ? Yes, but not the one identified in the headlines. The problem is in the marketing.
YAZ was promoted to women as a pill for bloating and acne in addition to its contraceptive effects. While that might be a good marketing strategy, it’s not a good medical one. Contraceptives are for birth control, and the best one for you, based on your medical history, might have nothing to do with acne. People shouldn’t pick their birth control the way they pick their toothpaste—on the basis of consumer advertising. You should consult your doctor who will look at your history and decide what form of contraception meets your needs. If your family has a history of strokes, blood clots, or thrombophlebitis (a blood clot that causes swelling in a vein), your doctor will almost certainly order advanced testing due to the possibility that any birth control pill—YAZ, Yasmin, or older medicines—might be inappropriate for your condition.
But if your doctor has already determined that YAZ or Yasmin is a safe bet, and you’re on one of these now? Keep taking it unless your doctor says otherwise. The alternative could be unintended pregnancy. And pregnancy, ironically enough, is more likely to cause a blood clot than your birth control pills.
- Yvonne S. Thornton, MD, MPH
Posted in Contraception (birth control), Fertility & Infertility, General health news, Pregnancy, Women's health issues, Women's health news | No Responses »
Tags: birth control pills, blood clots, blood clots in pregnancy, Contraception (birth control), risks of contraceptives, Yasmin, YAZ
Thursday, October 27th, 2011
It’s become common practice among some OB-GYNs to test for HPV, the human papilloma virus, due to the association of some strains of this sexually transmitted infection (STI) with cervical cancer.
But testing of women under the age of 30 is inadvisable. Because, although at least half of all sexually active men and women will get genital HPV at some point in their lives, the immune system will fight off and remove most of these infections from the body with no treatment. Seventy percent are gone within a year and 90 percent within two years.
It’s that 10 percent of cases we have to watch for. Some of those will lead to precancerous lesions in the cervix which, if left untreated, can develop into cervical cancer. But this process takes from 15 to 20 years. So, testing women under 30 for HPV leads to false positives, more testing, and perhaps invasive procedures in women who are at little or no risk of developing cervical cancer from HPV.
The American College of Obstetricians and Gynecologists (ACOG) therefore recommends that women under 30 not be tested for this STI, and I agree. If a woman under 30 has one of the high risk types of HPV, and if it persists, there will be ample time to find it and treat it. If she has one of the lower risk strains, it will probably be gone with no intervention within a year or two.
- Yvonne S. Thornton, MD, MPH
Posted in General health news, Women's health issues, Women's health news | No Responses »
Tags: ACOG, American College of Obstetricians and Gynecologists, cervical cancer, false positives HPV test, HPV testing, recommendations for HPV testing
Tuesday, October 25th, 2011
You might have read that the U.S. Preventive Services Task Force now recommends that most women have Pap smears just once every three years instead of once per year.
Does that mean you can skip the OB-GYN appointment until 2014?
No, no, no, and no.
You must have a pelvic exam every year. Pelvic examinations save lives. A Pap smear, which can help identify cervical cancer, is just one part of that examination. Your OB-GYN does much more during your annual. She also looks for any evidence of ovarian cancer, vaginal cancer, myoma (fibroids) and other abnormalities of the reproductive tract.
And while it’s true that cervical cancer is typically a slow-growing cancer that takes an average 10 years to spread, sometimes these cancers “don’t read the books” and spread in a shorter period of time.
In my new health book, INSIDE INFORMATION FOR WOMEN, I tell you in greater detail what to expect when you have a gynecologic examination.
Don’t take risks with your health. Your “annual” is called that for a reason. Make sure you see your OB-GYN for your pelvic examination every year.
- Yvonne S. Thornton, MD, MPH
Posted in General health news, Women's health issues, Women's health news | No Responses »
Tags: annual ob-gyn examination, cervical cancer, INSIDE INFORMATION FOR WOMEN by Dr. Yvonne S. Thornton, new Pap smear guidelines, Pap smear, pelvic examination
Thursday, October 20th, 2011
We’ve all been told how important it is to eat well in order to stay healthy. Now, new research shows that what you eat when you’re pregnant can be as important for your baby as it is for you.
A study published in the Archives of Pediatrics and Adolescent Medicine shows that when mothers-to-be ate healthful foods, such as those that make up the so-called Mediterranean diet, their babies had fewer birth defects such as cleft palates and neural tube defects.
The Mediterranean diet focuses on vegetables, beans, fruits, grains and fish, and is lower in meat, dairy and “empty” carbs.
Before you panic if you’re reading this while gorging on burgers and fries, no, your baby isn’t going to be born with birth defects just because you’re taking a vacation from your diet. The birth defects researchers looked at in the study are quite rare to begin with. It’s just that they are rarer still among women who eat well.
But the study does hint at something we know: your baby’s development depends, in part, on the nutrients you consume. So, give your little one a head-start on a good future. You’ll be doing a favor for both of you.
- Yvonne S. Thornton, MD, MPH
Posted in Pregnancy, Women's health issues, Women's health news, Your newborn baby | No Responses »
Tags: babies, baby, birth defects, Childbirth & delivery, healthy newborn baby, infant, infants, Mediterranean diet, newborn, Pregnancy, pregnancy study
Tuesday, October 4th, 2011
Many women are too embarrassed to talk to their doctors about urinary incontinence—which means that they may be suffering needlessly for a common complaint that often has an easy fix.
You’d probably be surprised to learn that about half of all adult women share this problem.
What’s behind urinary incontinence? There are several possibilities, including certain medications, but the two most common culprits are the loss of pelvic floor muscle tone, causing stress incontinence (urine escapes during activities such as exercise, laughing, or coughing), and over-active bladder (you feel the need to “go” more often than normal).
Stress incontinence can often be successfully treated with pelvic floor strengthening techniques called Kegel exercises. These exercises are remarkably simple to do, once you have the hang of it, and you can do them anywhere: sitting in traffic, watching TV, even at your desk.
If incontinence is brought on by an over-active bladder, different re-training exercises, including biofeedback and behavioral therapy, may be helpful. And there are several medicines that your doctor may prescribe, depending on the underlying causes.
What’s most important to know is that help is available, and not just in the Depends aisle of your pharmacy. Remember that you’re not alone in dealing with incontinence. Chances are good that about half of the women you know are dealing with some form of this disorder.
Don’t let embarrassment keep you from discussing this all-too-common issue with your doctor.
- Yvonne S. Thornton, MD, MPH
Posted in General health news, Women's health issues | No Responses »
Tags: help for incontinence, Kegel exercises, Urinary incontinence
Tuesday, August 16th, 2011
For parents-to-be, impatient to know whether to paint the nursery blue or pink, a simple test can provide answers as early as seven weeks into the pregnancy. These tests have been available for some time but weren’t widely used in the U.S., because their accuracy wasn’t known. Now, The New York Times reports, a new study in The Journal of the American Medical Association, has “found that carefully conducted tests could determine sex with accuracy of 95 percent at 7 weeks to 99 percent at 20 weeks.”
But is it really necessary to know your baby’s sex that early? For some parents, it can be. The Times reports that European doctors routinely use such tests to:
… help expectant parents whose offspring are at risk for rare gender-linked disorders determine whether they need invasive and costly genetic testing. For example, Duchenne muscular dystrophy affects boys, but if the fetus is not the at-risk sex, such tests are unnecessary.
But the big downside, and one that concerns me greatly as a doctor and a mother, is that some cultures have such a bias against baby girls that the wide availability of such testing will result in ever more otherwise healthy female fetuses being aborted.
Several companies do not sell tests in China or India, where boys are prized over girls and fetuses found to be female have been aborted. While sex selection is not considered a widespread objective in the United States, companies say that occasionally customers expressed that interest, and have been denied the test. A recent study of third pregnancies in the journal Prenatal Diagnosis found that in some Asian-American groups, more boys than girls are born in ratios that are “strongly suggesting prenatal sex selection,” the authors said.
At least one company, Consumer Genetics, which sells the Pink or Blue test, requires customers to sign a waiver saying they are not using the test for that purpose. “We don’t want this technology to be used as a method of gender selection,” said the company’s executive vice president, Terry Carmichael.
Cultural preferences won’t be deterred by a signature on a form, but at least, it’s a start. At some point, all cultures will learn to value both genders equally. Until then, a test that holds promise for some, can be a terrible incentive for the ultimate act of bias against females in others.
- Yvonne S. Thornton, MD, MPH
Posted in Childbirth & delivery, Pregnancy, Women's health issues, Women's health news | No Responses »
Tags: babies, bias against female babies, Fetal testing, infants, Pregnancy
Wednesday, August 3rd, 2011
In keeping with the Institute of Medicine’s recommendations that free birth control be made available to all under their insurance policies, a new rule from the White House mandates birth control coverage without co-pays or deductibles. The new rules also cover domestic violence screening and breastfeeding assistance without co-pays or deductibles.
Starting Aug. 1, 2012, new health insurance plans will be required to cover women’s preventive care without charging a co-pay or deductible. The new guidelines require health insurers to provide FDA-approved birth control, including emergency contraception such as the morning-after pill, HIV screenings, and well-women visits, among other services.
The guidelines also include an amendment that allows religious institutions that offer insurance to their employees the choice of whether or not to cover contraception services.
- Yvonne S. Thornton, MD, MPH
Posted in Contraception (birth control), General health news, Health care policy, Women's health issues, Women's health news | No Responses »
Tags: birth control pills, contraception, Free birth control, new regulations for women's health care, no co-pays
Friday, July 22nd, 2011
When you’re on a strict budget, out-of-pocket costs can convince a woman to forego birth control. But getting pregnant is a much more expensive proposition and comes with a lifelong commitment — one that many women are neither emotionally or financially ready to make.
The new health care law requires the Department of Health and Human Services to create a list of health services that new health insurance plans must provide without deductibles or co-pays. And the National Academy of Sciences’ Institute of Medicine (IOM) has prepared a report recommending that birth control be on that list.
…the Guttmacher Institute estimates that 98 percent of sexually active women will use contraception at some point during their reproductive years, and that cost concerns are frequently cited as a reason for inconsistent use or use of a less then optimal method.
In fact, Guttmacher said in testimony submitted to the IoM earlier this year, “Women citing cost concerns were twice as likely as other women to rely on condoms or less effective methods like withdrawal or periodic abstinence.”
Along with the recommendations concerning birth control, the IOM recommended a number of other preventive care services for women be made available without deductibles or co-pays:
…annual “well-woman” visits; screening of pregnant women for gestational diabetes; screening for sexually transmitted diseases, including HIV; more support for breast-feeding mothers; and counseling and screening for possible domestic violence.
I urge HHS Secretary Sibelius to accept the IOM recommendations. Women’s health issues have taken a backseat for too long.
- Yvonne S. Thornton, MD, MPH
Posted in Contraception (birth control), Health care policy, Women's health issues, Women's health news | 1 Response »
Tags: birth control, birth control pills, co-payments, contraceptive, contraceptives, deductibles, Dr. Yvonne Thornton, Institute of Medicine, IUD, women's health
