October, 2013

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Congratulations, It’s Twins!

Thursday, October 31st, 2013

An increasing number of expectant parents are hearing those words these days. If you are expecting twins (or more), then one of two things has happened. In natural twinning, either your body has released two eggs, and they have both been fertilized, or one fertilized egg has split into two. The former will result in fraternal twins; the latter, identical.

Learning that you are expecting twins is normally quite a shock. It can take some time for the news to sink in, and for all the concerns and questions to arise. You may be concerned about pregnancy complications or what the birth will be like; you make also worry about being able to cope with having two babies at once. These concerns are completely normal and common.

Realize that the majority of twin pregnancies turn out just fine. You can probably expect to be tired throughout the pregnancy and require a lot of rest; this is your body telling you what it needs, so be sure to listen. Some pregnancy symptoms can be exacerbated with twins, such as morning sickness (which can actually occur any time of day). Your higher levels of hCG will often mean more nausea and possibly vomiting than women with singleton pregnancies experience.

Later in your pregnancy, you may also experience other symptoms to higher degrees, such as shortness of breath, constipation, heartburn, and bloating. Back or hip pain may also be more of a problem as your babies grow.

Another difference you will notice in your twin pregnancy is increased weight gain. Understand that if your are average weight, you will need to gain more weight than women who are carrying only one fetus – but also realize that it needn’t be a lot more. While mothers of a singleton pregnancy need only eat 100-300 calories more per day, a mother of twins needs to ingest about 500 more calories per day. More may be advised if she is underweight to start with; if she is overweight, less is fine, as long as the babies are growing and healthy.

Mothers of twins should expect more prenatal care, as well. More ultrasound examinations are common to keep an eye on how well your twins are doing. You will also have regular blood pressure and urine checks, because as a pregnant woman expecting twins, you have a higher likelihood of developing high blood pressure, gestational diabetes, preeclampsia, and anemia.  Because of the higher risk of depleting the maternal iron and calcium stores with a twin gestation, additional supplementation with prenatal iron and calcium is prescribed in order to prevent anemia or osteoporosis later in life.

Look out for the same danger signs as in any other pregnancy and report them to your doctor immediately. If you aren’t sure whether a symptom is normal or not, or even if you just feel instinctively that something isn’t right, consult with your doctor to be on the safe side. Report any of the following symptoms to your doctor:

  • Severe headaches
  • Sudden swelling
  • Vomiting
  • Abdominal pain
  • Excessive fatigue

Take all the help you can get during this challenging pregnancy. Let others care for older children regularly so you can rest; allow your partner to run errands and do more than his or her normal share of the housework. The important thing for you to focus on is keeping yourself rested and healthy. And try not to worry; the fact is that the most likely outcome of your twin pregnancy is two healthy, normal babies.

– Yvonne S. Thornton, M. D., M. P. H.

WHO Issues New Guidelines Calling for Earlier Treatment of HIV

Monday, October 28th, 2013

HIV (human immunodeficiency virus) infects immune system cells, impairing or destroying their function. In the early stages of HIV infection, there may be no symptoms, but as it progresses, immune system function deteriorates, rendering the person more vulnerable to other infections. AIDS (acquired immunodeficiency syndrome) is the most advanced stage of HIV. Once a person becomes infected with HIV, it usually takes about 10-15 years to develop AIDS. This amount of time can be lengthened even more with antiretroviral drugs.

HIV can be transmitted in several ways, including unprotected sexual intercourse (vaginal or anal), transfusion of contaminated blood, passed from mother to infant during pregnancy, childbirth, or breastfeeding, and through sharing contaminated needles. Over the past 30 years, HIV has claimed over 25 million lives. HIV infection is diagnosed through blood tests than detect the presence of HIV antibodies. While there is no known cure for HIV infection, antiretroviral drugs control the virus and allow many people with HIV to lead productive and healthy lives.

This past summer, WHO (World Health Organization) issued new recommendations for earlier HIV treatment than had been used previously. The new guidelines call for offering ART (antiretroviral therapy) earlier on in the infection. This is in response to new research that shows that when people receive ART earlier, they live longer, healthier lives, and have a lower chance of transmitting the infection to others by lowering the amount of virus in the blood.

The previous guidelines, which were set in 2010, recommended offering ART once the patient’s CD4 cell count fell to 350 cells/mm3 or less. 90% of all countries have adopted these guidelines. However, this year, the WHO changed their recommendation to beginning ART at 500 cells/mm3 or less, before immune system function weakens.

WHO also now recommends providing ART to all children under five years of age, all pregnant and breastfeeding women with HIV, and all people with HIV who are in a relationship with an uninfected partner – regardless of CD4 cell count.

Of course, in spite of advances in treatment and more enlightened recommendations, challenges remain. The number of HIV-positive children receiving ART has not increased as quickly as the number of adults receiving the treatment. Another problem is that certain people, such as intravenous drug users, sex workers, and transgender people often encounter cultural or legal barriers that stop them from getting treatments that are more readily available to others. In addition many people, for various reasons, discontinue treatment. This is a prevalent problem that needs to be addressed.

In spite of these challenges, the fact remains that today almost 10 million people are receiving lifesaving treatments for HIV infection. The goal now is to continue pushing to make treatment available to the over 10 million more who need it, and increase awareness of prevention and treatment methods worldwide.

– Yvonne S. Thornton, M. D., M. P. H.

Sex during Pregnancy: When to Indulge, When to Abstain

Thursday, October 24th, 2013

Pregnant women and their partners often have questions about sex. Is it safe during pregnancy? Will it induce labor? How long do we have to wait after delivery to have sex? In spite of doctors’ reassurances, many pregnant women still have fears related to sexual intercourse while they are pregnant, such as whether it could cause miscarriage or otherwise harm the fetus. In addition, body image, physical discomfort, and fatigue often curtail the sex lives of pregnant women.

In fact, for women with low-risk pregnancies, sex is perfectly safe. Studies have shown a slightly increased risk of preterm labor in women who had sex and symptoms of lower genital tract infection, but in low-risk women with no symptoms of infection, sex does not in any way increase the risk of preterm labor. Fears of harming the fetus are also unfounded; the fetus is very well-protected and completely oblivious to the mother’s sexual activity.

Women at increased risk for complications, such as those who have a history of preterm labor, incompetent cervix, or multiple gestation, may be advised by their doctors to abstain from sex, but even in these women, an increased risk of complications may not exist. Studies have not shown elevated risks of preterm labor even in women with higher-risk pregnancies, despite the fact that these women are often cautioned that sex could be dangerous for them. Studies also show that women with twin pregnancies and women with cervical cerclage due to incompetent cervix have no greater risk than other pregnant women of preterm labor caused by sex. Although these women are commonly advised not to have sex, the evidence does not exist to support these concerns.

What studies have shown is that women with a higher number of sexual partners throughout their lifetimes do have an increased risk of preterm labor. This is probably because in these women there exists a higher probability of asymptomatic bacterial colonization in the genital tract, which does present a higher risk. Therefore, women with high-risk pregnancies should, at a minimum, be screened for bacterial vaginosis before engaging in sexual intercourse.

It should be said that regardless of actual risk, abstaining from sex causes no harm and is a simple intervention that can be implemented to remove any doubt about whether sex during pregnancy is safe. Therefore, in women with high risk pregnancies, this is still a reasonable recommendation, until further studies present even more solid evidence.

Besides preterm labor, other possible complications thought to arise from having sex during a high-risk pregnancy are venous air embolism, antepartum hemorrhage in placenta previa, and pelvic inflammatory disease.

As for whether sex can be used to induce labor in a full-term pregnancy, there is no evidence showing that it works. Nipple and genital stimulation have commonly been recommended as ways to induce labor by supposedly promoting the release of natural oxytocin, and prostaglandins in semen have been said to encourage cervical ripening. However, there is no scientific evidence to prove that these methods have any effect. But again, there is no harm in trying them in low-risk pregnancies, either.

The bottom line is that there are very few known risks involved in sexual intercourse or other sexual activity during pregnancy, so don’t worry.  I fondly remember my grandmother saying, “Why would you want to have sex?  You’re already pregnant!”  With that said, abstinence may be a reasonable action to take to remove the risk altogether in high-risk pregnancies, but still, the evidence does not show that this makes a difference in the outcome of the pregnancy. After delivery, follow your doctor’s instructions and your own physical and emotional comfort level in deciding when to resume intercourse.

– Yvonne S. Thornton, M. D., M. P. H.


Should Your Gynecologist Be Your Primary Care Physician?

Thursday, October 17th, 2013

There is an ongoing struggle between patients, physicians, and managed care plans involving whether gynecologists should be able – or be expected – to serve as primary care physicians to women. Even among each group, there is disagreement on the best course of action. Patients may like the convenience of having only one main doctor. Gynecologists, while acknowledging that they do have adequate training to function as primary doctors, have conflicting preferences, with some believing that they should be primary doctors and others preferring to remain consultative specialists. Managed care plans allow women varying levels of access to gynecologists.

So how can a women decide what is right for her? Many women visit their gynecologists faithfully but never think about an annual physical. Others request physicals from their gynecologists. Still others visit both doctors regularly. The right choice depends on your preferences, the viewpoint of your gynecologist, and the guidelines set by your insurance company. One thing is certain: you need both exams yearly – a gynecological exam and a general physical exam – to promote good overall health and catch any potential problems early.

Why You Need a Yearly Physical Exam

During a physical, your doctor will not only perform a complete physical exam, but also discuss lifestyle habits, order appropriate screening tests, and administer age-appropriate immunizations. Lifestyle issues such as weight and tobacco use are discussed and plans formed for making positive changes.

Depending on your doctor’s style, your physical may include assessment of your vital signs, your family medical history, a heart and lung exam, a dermatological exam, an exam of your head, neck, extremities, and breasts. Blood tests may be ordered to screen for anemia, kidney disease, diabetes, high cholesterol, and other conditions. Depending on your age and history, other screening tests like colonoscopies and mammograms may be ordered.

An internist is experienced in managing high blood pressure, diabetes, high cholesterol, asthma, and other chronic conditions; they may also refer you to a specialist or coordinate your care with specialists you may already be seeing.

Why You Need a Yearly Gynecologic Exam

Regular physical exams are important, but it is equally important to take advantage of the specialized knowledge of gynecologists. When you visit a gynecologist for a well-woman exam, he or she can address issues such as fertility, birth control, sexually transmitted infections (STIs), cancer prevention, and other issues.

Gynecologists are also highly trained in performing pelvic exams and Pap smears, as well as counseling women on various health issues and lifestyle habits. Gynecologists also function as your consultants for major health issues regularly faced by women, now and through every stage of your life. At every age, there is a reason for a woman to see a gynecologist. She may need to discuss contraception, fertility, or genetic testing; she may need a clinical breast exam, a pelvic exam, or STI screening.

You decision about whether to see a gynecologist alone or a gynecologist and an internist depends on your preference, your medical history, your existing conditions, and the willingness of your gynecologist to serve in this role. If you decide to make your gynecologist your primary care physician, make sure he or she knows about this choice and is comfortable with it and willing to function this way.

– Yvonne S. Thornton, M. D., M. P. H.

What Prenatal Screening Tests Should You Expect?

Monday, October 14th, 2013

Prenatal tests are diagnostic procedures used to uncover potential chromosomal or structural fetal disorders. All expectant mothers, but particularly mothers over 35, should have thorough prenatal testing because of the increased risk of birth defects and other abnormalities. These are a few of the tests your doctor may want you to have; talk to him or her about others that may be necessary or helpful.

Maternal Alpha-Fetoprotein

Alpha fetoprotein (AFP) is a protein normally produced by the liver and yolk sac of a developing baby during pregnancy. AFP levels decrease soon after birth. AFP probably has no normal function in adults. The amount of AFP in the blood of a pregnant woman can detect abnormalities in the fetus, be they chromosomal or structural, such as Down syndrome or spina bifida, respectively.

This test is routinely administered to every pregnant woman, except those over 35 who will be having amniocentesis. If screening reveals worrisome levels (too high or too low) of AFP in the mother’s circulation, additional tests like amniocentesis are administered to further investigate the problem.

Cell free fetal DNA testing

Noninvasive prenatal testing that uses cell free fetal DNA from the plasma of pregnant women is now being offered as a screening tool for fetal aneuploidy (Down syndrome and  other trisomies). The only problem with cell free fetal DNA testing is that it requires informed patient consent after pretest counseling and should not be part of routine prenatal laboratory assessment. Cell free fetal DNA testing should not be offered to low-risk women or women with multiple gestations because it has not been sufficiently evaluated in these groups. A negative cell free fetal DNA test result does not ensure an unaffected pregnancy.  So why have this test?  Because many patients do not wish to be stuck with a needle or have any invasive testing done.  To me, it just delays the inevitable, but it is important that my readers know it exists.  A patient with a positive test result should be referred for genetic counseling and should be offered invasive prenatal diagnosis, i.e., chorionic villus sampling or amniocentesis, for confirmation of test results.


Ultrasound, or sonogram, is a test commonly administered during pregnancy that uses sound waves (not X-rays) to render an image of your baby inside your womb. Ultrasound is safe to use throughout pregnancy, and can be helpful in determining  an accurate gestational age  if the Mom is uncertain and can detect gross abnormalities, such as anencephaly or open neural tube defects.  Ultrasound has also been used to attempt to screen for Down syndrome by using specific markers, such as thickness of the fold behind the neck, or abnormal kidneys or absence of or abnormal development of the nasal bone.

Ultrasound is typically used at 16-20 weeks, when fetal structures have grown large enough to be seen somewhat clearly, and many abnormalities can be detected. The ultrasound technician checks to make sure the skull is present, the spinal column has closed, and various organs are present and developing normally, including the heart. Ultrasound does have its limitations; for example, it is not a perfect way to detect fetal heart malformations, as this study shows. That is because the fetal heart is so tiny and complex. Nonetheless, ultrasound remains a safe and effective tool for detecting many potential fetal problems.  However, there is a tendency to overuse and abuse ultrasound in an attempt to “have a picture of the baby in utero.”   Any imaging study needs to be performed because of a medical indication and not for entertainment.


Amniotic fluid contains the baby’s metabolic products and desquamated fetal skin cells, and therefore can be tested for genetic disorders that may be present. During amniocentesis, ultrasound is used to detect pockets of amniotic fluid, and a small amount of it is drawn out through a needle inserted into the amniotic sac. This fluid will then be used for chromosomal analysis as well as checked for AFP.

Amniocentesis can detect conditions characteristic of chromosomal and developmental disorders. It is used in conjunction with ultrasound.  Amniocentesis has the advantage of actually examining the chromosomes, not just the structure and appearance.

Chorionic Villus Sampling

Chorionic villus sampling (CVS) is the best-kept secret in obstetrics, which is a pity because it provides the earliest opportunity for prenatal diagnosis. In contrast to ultrasound and amniocentesis at 16 to 20 weeks, CVS is done in the tenth to the twelfth week of pregnancy, with the tenth week calculated as starting at nine weeks and one day.

Chorionic villi are the beginnings of the placenta. Rapidly growing, fingerlike projections in the sidewalls of the uterus, they look like sea kelp. By means of a soft catheter introduced vaginally and guided by ultrasound, a sample of these villi can be aspirated and sent to the laboratory for culturing. The cells are dividing very rapidly at this early stage and they grow quickly in the culture, giving results in seven days, in contrast to amniocentesis, which takes two weeks for results. As well as providing material for a chromosomal analysis, CVS allows us to rule out Tay-Sachs, sickle-cell anemia, and any inborn error of metabolism or enzymatic problem. The only thing this test does not do is establish the AFP level, but because every woman not having amniocentesis is screened with a blood test for AFP, this is not a problem.

Chorionic villus sampling yields the same information as an amniocentesis done five, six, or seven weeks later. The presence of anomalies can be confirmed at ten weeks—before the pregnancy is showing, before the woman is feeling fetal movement, and before there is the degree of bonding with the baby that is likely to have taken place by 20 weeks. Thus, if the findings give rise to a decision not to continue with the pregnancy, it can be interrupted with a D and C with far less morbidity and psychological stress than occasioned by a second trimester termination.

Even parents who know that they would never terminate a pregnancy regardless of the circumstance should undergo prenatal testing because education and preparedness can make such a difference in the quality of life for parents and children. You can find more detailed information on these and other common prenatal tests, as well as advice on deciding how to proceed in the event that a test reveals something troublesome, in my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

Women with Polycystic Ovary Syndrome Often Have Cardiovascular Disease Risk Factors, Too

Thursday, October 10th, 2013

A study published in the Journal of Clinical Endocrinology and Metabolism highlighted the relationship between polycystic ovary syndrome (PCOS) and cardiovascular disease (CVD). Researchers noted that women with PCOS were more likely to have risk factors for CVD. They carried out a study in which evidence-based reviews were provided of studies that examined the risk relationship and to develop guidelines for lessening the risk of CVD.

The study included only other studies where PCOS patients were compared with control patients, and excluded any articles that included unclear PCOS diagnoses or unclear controls. The conclusion of the study was that women with PCOS who are also obese, smoke, or have high blood pressure or impaired glucose tolerance are at risk for CVD. Women who have PCOS and type 2 diabetes are at high risk for CVD.

PCOS is common, affecting 6-10% of women of childbearing age, and is characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. Other symptoms that women may notice to varying degrees include irregular menstrual periods, hirsutism, acne or other skin problems, weight gain (especially around the waist), thinning hair, pelvis pain, sleep apnea, and anxiety or depression. In young women with PCOS, there may be multiple risk factors for CVD, such as metabolic syndrome, type 2 diabetes, abdominal obesity, and high blood pressure. For these women, taking measures to prevent future CVD is an absolute necessity.

If you feel you may have PCOS, talk to your doctor about it. Your doctor will take some steps to see if you really do have PCOS or if another condition is causing your symptoms. Expect your doctor to ask you about your medical history, including your menstrual cycle and any weight changes; perform a physical exam, including blood pressure, waist size, and areas of increased hair growth; a pelvic exam, to check your ovaries for enlargement; a vaginal ultrasound, to further examine your ovaries; and blood tests to check for androgen and glucose levels in your blood.

If you do find out you have PCOS, even though there is no known cure, there are effective treatments that can help you manage your symptoms and prevent further problems. The right treatment for you will depend on your individual symptoms and whether or not you may become pregnant. Goals of treatment include lowering your risk for CVD and relieving your symptoms. A combination of treatments is the most effective route for most women.

The first line of defense against PCOS is losing weight. Eating healthfully and exercising can help you manage your symptoms with great success. Limiting sugars and processed foods will lower your blood glucose levels, improve the way your body uses insulin, and help normalize androgen levels. Even losing 10% of your body weight can make a big difference in irregular periods. If you don’t want to become pregnant, birth control pills can regulate your menstrual cycle, reduce your levels of male hormones, and help clear up your skin.

If you have diabetes, metformin is a drug your doctor may prescribe. It affects the way insulin is processed in your body and lowers male hormone production; it can also relieve many PCOS symptoms such as excessive hair growth, lowering cholesterol levels, and assisting with weight loss. It is important to note that metformin has not been approved by the FDA for treating PCOS, but it is approved and effective at treating diabetes, and studies show that it does, indeed, help with many common symptoms of PCOS.

– Yvonne S. Thornton, M. D., M. P. H.

Recurrent Yeast Infections: Causes, Solutions

Monday, October 7th, 2013

Unfortunately, it seems every vaginal discharge has been diagnosed as a “yeast infection” by the patient and she runs off to the drug store to get an over-the-counter antifungal medication to treat her “yeast” infection when in actuality it may be chlamydia, bacterial vaginosis or trichomoniasis.  The truth of the matter is that every vaginal discharge is NOT a yeast infection and needs to be diagnosed by a physician or a person who is well-versed in microscopy and wet mounts and who is able to tell the difference between a “yeast” infection and other infections that are causing the vaginal discharge.  However, for the purpose of this installment yeast infections and if the yeast infection has been properly diagnosed, the following applies:

If you suffer from recurrent yeast infections, you know how imperative it is to pinpoint an underlying cause, or at least a way to stop the infections from occurring. Yeast infections are not bacterial infections at all, and as such, antibiotics will not cure them and may actually cause them in some cases. Yeast infections are caused by a type of fungus, and therefore a medication or treatment with antifungal properties must be used.

At some point, three out of four women will suffer from a yeast infection; interestingly, between 1980 and 1990 the incidence of yeast infections doubled.  Why?  Because the patient was self-diagnosing and calling every discharge a “yeast” infection and coincidently, that is the time period when anti-fungal treatments  (creams and vaginal suppositories) were allowed to be sold over-the-counter without a prescription. The symptoms include itching, irritation, redness, and a cottage cheese-like discharge. One yeast infection is enough for most women, but many women are unlucky enough to endure them repeatedly. To get a handle on your recurrent yeast infections, first consider what may be causing them.


Despite the fact that most doctors and the American College of Obstetrics and Gynecologists recommend not douching, some 20 to 40 percent of American women do it anyway. It is important to understand that douching is completely unnecessary at best, and at worst, is connected to a host of problems like yeast infections, bacterial vaginosis, sexually transmitted infections, and pelvic inflammatory disease. Douching upsets the balance of vaginal flora and acidity and pushes bacteria farther into the vagina, worsening existing infections rather than helping them. If you douche for any reason other than that your doctor told you to for a specific problem, stop – especially if you have recurrent yeast infections.


The reason why antibiotics can cause yeast infections is not rocket science: antibiotics kill bacteria. That means not only the “bad” bacteria, but the “good” bacteria as well. When the level of good bacteria drops too low, it cannot protect you against fungal infections. Antibiotics are valuable, often life-saving drugs, but they should be reserved for times when no other treatment will work.

Other Causes

Diabetic women are more likely to get recurrent yeast infections. Yeast thrive on sugar, and the elevated blood sugar in diabetics affects the whole body. If you are diabetic and have recurrent yeast infections, getting your blood sugar under control may help. In addition, pregnancy is a condition that makes yeast infections more likely. The dramatic chemical changes in the vaginal area during pregnancy make it hard for your body to keep up. There may also be more sugar in your vaginal secretions, which, similar to diabetes, can encourage yeast overgrowth.

Further Steps You Can Take To Eliminate Yeast Infections

Bathe daily and keep your genital area clean and dry. Use condoms to help you avoid catching or spreading a sexually transmitted infection. Avoiding the use of products like feminine hygiene sprays and fragrances can help, as can using pads instead of tampons (especially scented tampons). Also, your underwear should be cotton; materials like silk or nylon are problematic because they restrict air flow to the area.

Additionally, you will probably need to take a medication prescribed by your doctor in order to cure an acute yeast infection. There are several effective options available today; ask your doctor if you aren’t sure what the best option is. Finally, if none of the above causes apply to you and none of the suggested treatments work, talk to your doctor about the possibility of a more serious underlying issue. For more information, see my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

Thinking of Giving Birth at Home? Read This First

Thursday, October 3rd, 2013

More and more women are choosing a home birth experience when it comes time to start, or add to, their families. They say that childbirth is completely natural, that it is not a disease and there is no reason to be in a hospital bed. That their bodies know just what to do; that women have been giving birth at home for much longer than they have been going to hospitals. They say that they are perfectly healthy; maybe they have even given birth before with no complications. And they fear that “interference” from doctors and nurses and machines will mar their birth experience.

Most of this is perfectly true. But here’s something else that’s true. Did you know that the mortality rate is three times higher for babies born at home, compared with babies born in hospitals? The problem is that childbirth is notoriously unpredictable. Even if a woman is healthy and her entire pregnancy has been normal; even if she has already had an uneventful labor and delivery in the past, there is no way to predict some of the circumstances that may arise, or when medical intervention may become necessary.

The birth of your baby is indeed a very special time, and if you can have the experience you really want, that’s great. But remember that you also have a responsibility to keep your baby safe. So, with that in mind, how can you get the birth experience you desire without subjecting your baby to an increased risk of danger?

Choose a Midwife Who Practices in a Hospital Setting

Many women want a midwife to deliver their babies because they believe that midwives offer more personalized attention and try to interfere as little as possible with the natural course of events during labor and delivery. Many midwives practice in hospitals, and this is the ideal setting for birth in case of an emergency – which, again, you cannot predict. Yes, women have been giving birth at home for millennia. But the infant mortality rate is lower now than it ever has been. That’s because most women now give birth in hospitals.

Add a Doula to Your Support Team

A doula is a non-medical support person who can attend to your needs, help make you comfortable, help keep you focused, rub your back, bring you ice chips, and whatever else it is you might need, leaving your coach free to focus on you as well as his or her own experience.

Make the Hospital More Like Home

Get to know your hospital’s maternity floor ahead of time; being familiar with the setting will help you feel more comfortable. And feel free to bring things that are comfortable and homey, like a favorite blanket, pair of pajamas, or mug. After your delivery, you may necessarily be visited by medical personnel who will want to check your vital signs and make sure you and your baby are recovering well – but you can make the most of the times when you, your partner, and your baby are alone together by turning off the TV, dimming the lights, and getting to know each other. Celebrate with a glass of sparkling wine, play cards, decide on a name if you haven’t yet – do whatever you would do at home.

Making some compromises can keep you and your baby safer while still giving you a special birthing experience. Remember that the doctors are not there to get in the way, but to help you, especially if there is an emergency. You can read more about this topic in my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.