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Postpartum Anemia May be Avoided with Iron Supplements

Thursday, June 7th, 2012

Most women know that because of their menstrual cycle, it’s a good idea to take iron supplements to replenish the minerals lost during that time of month.  Otherwise, their deficiency could lead to anemia as well as other symptoms.  What women should also realize though is that iron deficiency is a big factor in causing postpartum anemia as well.

When you give birth, you are immediately thrown into a chaotic new schedule, added responsibility, and the constant task of taking care of a very fragile new human being.  Of course, as the child’s mother, you no doubt find great joy in this responsibility, but that doesn’t make it any less exhausting.  If your iron levels after giving birth aren’t where they should be, that exhaustion can be a lot worse.  Iron deficiency can cause people to feel exhausted, to have low endurance for physical activities, to struggle with short-term memory, to find themselves unable to focus, and to feel depressed and irritable.  When a mother gives birth, it puts a lot of stress on her body, which can cause imbalances and a decrease in iron levels in particular.  This is why it’s so important for women to maintain a very different diet when they are pregnant, about to give birth, and breastfeeding.  A study in the Journal of Obstetric, Gynecologic, & Neonatal Nursing states very clearly that, “the increased iron requirements of pregnancy cannot be met by the typical US diet or the iron stores of most women. Therefore, if women are left unsupplemented during pregnancy, they bear a considerable risk of developing iron deficiency,” which in turn increases their risk of postpartum anemia.  Other factors that can increase that risk include short intervals between pregnancies, because they don’t allow a woman’s body time enough to recover, and cesarean deliveries, which usually include more blood loss.

If you’ve ever been through a pregnancy, you know just how much it takes out of you.  This can make it difficult to determine whether you are just “new mom tired” or medically ill tired.  This is why it is imperative that you keep your physician as up to date as possible when it comes to exactly how you are feeling, whether physically, mentally, or emotionally.  This way, you can work together to make sure your vitamins and minerals stay balanced, along with your overall well-being.

 

– Yvonne S. Thornton, M. D., M. P. H.

 

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Just Because You’re On the Pill, Doesn’t Mean You Won’t Get Pregnant

Monday, May 28th, 2012

With contraception so much in the news lately, it seems that we have heard all there is to say about it.  A recent study regarding birth control though, has something quite different to say that definitely deserves our attention.  It’s evident from the attention that political contraceptive debates received that there are a lot of women in the US who take the pill or some other form of birth control.  According to the American Journal of Obstetrics and Gynecology though, many of those women wrongly assume that their contraception is infallible.

According to the Guttmacher Institute, 99% of women of reproductive age who have had sex use contraception.  That’s a lot of women, but Researchers at Washington University in St. Louis found that a shocking 45% of those women believe that contraception can prevent pregnancy 100% of the time.  With so many people taking birth control under this false assumption, it’s obvious there’s a need for education and media exposure.  While the pill, which is the most popular form of contraception, is mostly successful at preventing pregnancy, it can indeed fail between 2%-9% of the time.  And that’s the failure rate if you remember to take it every single day.  The failure rate can increase when women miss pills, are in their first month of taking the pill, switching dosages, or taking medications like antibiotics, migraine medications, or antidepressants.  Condoms have an even bigger failure rate of 15%-24%. This is why it’s so important for women to discuss their birth control options with their physician, and that discussion should include how effective each option is.  The rates of contraception failure with respect to perfect use and average use are outlined in my health book, Inside Information for Women.  Hopefully, that chapter will give you a better understanding of the types of contraception offered, their effectiveness and their applicability to your lifestyle.

This information shouldn’t make anyone panic, because as a whole, birth control is fairly effective, especially when compared to not using any contraception at all, which has a failure rate is 85%! However, knowing more about failure rates should make people aware of the actual risk involved in being sexually active, even while taking birth control.  This information probably won’t cause people to think again before having sex, and it may not prevent unintended pregnancies.  At the very least though, it gives parents like me yet another reason to teach our children that sexual activity does have consequences and is better saved for a time in our lives when we are ready to be responsible for our actions.

 

– Yvonne S. Thornton, M. D., M. P. H.

Posted in Childbirth & delivery, Contraception (birth control), Fertility & Infertility, Pregnancy | No Responses »
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Jobs Should Provide Health Insurance, Not Moral Judgment

Thursday, May 17th, 2012

The debate over health insurance has certainly been heated over the past few years, and most of those arguments stemmed from concerns over financing and constitutional rights.  More recently though, it seems they have decided to narrow their focus to something a little more personal for women, and that’s contraception.  Although employers rarely want to know what you’re using your health insurance for due to privacy concerns, some would like to prevent their female employees from using their insurance for birth control.

The arguments behind this have been few.  Some claim that cutting birth control out of their health insurance plans would save money.  While this is somewhat true, in the grand scheme of things, it’s a bit ridiculous.  Birth control is easy to produce and access, and with so many competing contraception options and companies, the price is affordable.  Additionally, when female employees take birth control, they prevent pregnancies, which are much more costly for health insurance plans in the way of prenatal check-ups, hospital stays, maternity leave, and eventually, another family member to add to the plan.  In the long run, employers would actually save money by giving their employees access to contraception.

Money isn’t the only argument though.  There are religious organizations that don’t want to provide birth control to their employees out of religious, or moral, concerns.  Although the foundation of their organization stems from a particular religion, they employ people who are not necessarily a part of that faith.  There are religious hospitals, private schools, and nonprofit organizations for example, who have hundreds of staff members from all walks of life.  They feel that they have a right to impose their moral judgment on all of their employees. If they must abide by the same antidiscrimination laws that prevent them from firing someone because of their religion, race, or sexual orientation, then why should they be allowed to discriminate when it comes to health insurance?

Obviously, as a physician, I believe that the gift of life is precious.  That’s also why I believe though, that women need to be ready to receive that gift.  It takes a huge commitment to raise a child, and even more to develop that child into an intelligent, caring, and well-balanced person.  Our jobs are there to give us the opportunity to provide for our families, both in terms of money and health insurance and in terms of allowing a woman, mother or not, to feel as if she is self-sufficient, contributing and using the talents that she has developed over a lifetime. Mothers especially need an outlet other than their children.  Our jobs have no right to decide when we start that family though and by no means do they have the authority to judge the morality of our decisions.

– Yvonne S. Thornton, M. D., M. P. H.

Posted in Childbirth & delivery, Contraception (birth control), Parenting, Pregnancy, Women's health news | No Responses »
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Are Cesareans the Lazy Way Out?

Thursday, May 10th, 2012

The process of giving birth has certainly evolved over the years.  Women can now opt for an assortment of painkillers, choose to do a home birth, and even substitute doctors for midwives.  The most recent trend though, seems to be cesarean deliveries.  Instead of enduring hours of labor, being coached by the doctor, and toughing out a natural, vaginal birth, babies are getting the quick way out.  Is this increase because of concerns for the mother’s or child’s health, or simply because obstetricians are looking for the lazy way out?

Right now, one out of every three births happens through cesarean.  In 1965, only 4.5% of births were cesareans.  Why the big increase?  Unfortunately, it’s not a result of medical need.  Instead, 29% of Obstetricians polled in a survey said, “they were performing more Caesareans because they feared lawsuits.”  (Some other physicians, myself included, happen to be of the mindset that it is more about convenience, on both the parent and physician side, than anything else. It takes serious stamina to stand by and coach a woman through thirty hours of difficult labor. And I do it because I love my job. I am a warhorse, and I am there for my patients.) Because they’re concerned about being held responsible for potential harm to the baby from vaginal labor and deliveries, they would rather opt for cesarean deliveries.  While this kind of labor may be quicker, it is by no means safer.  A cesarean is an invasive surgery that is actually more likely than a vaginal birth to pose a risk for complications that might, “put the mother back in the hospital and the infant in an intensive-care unit.”  Some hospitals are not giving moms all the information.  Instead, they offer the cesarean as a casual choice in order to skip providing long-term labor support, to get through the labor as quickly as possible, and to avoid malpractice claims.  Cesareans are also much more expensive, consequently, making hospitals more money.  While there are women who do need cesareans for valid medical reasons such as breech for first-time Mom’s, high-order multiple births in one delivery, cephalopelvic disproportion (the baby’s too large for Mom’s pelvis) or eminent danger to the mother (such as hemorrhage) or fetus (sudden abnormal heart rate), these do not make up nearly enough of the more than 30% cesarean rate.  That means that the majority of cesareans are happening because obstetricians are choosing them, not mothers.  If Mother Nature wanted our babes to be born by Cesarean, she would have put a zipper on our abdomens.  The consequence of this increase in Cesarean births (some by maternal request) is the increase in maternal death and Cesarean hysterectomies in subsequent pregnancies due to hemorrhage caused by abnormal placental location and uterine rupture.

This is why it’s so important to become as informed as possible about child birth before making any decisions.  Make sure you have a caring, ethical obstetrician who is willing to give you all the information you need to make the safest choice for you and your child.  If they recommend a cesarean, ask them about their reasons and whether or not it is medically necessary.  Remember, it is your body, your baby, and your choice.

— Yvonne S. Thornton, M. D., M. P. H.

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In came Beyoncé and the security guards. Out went the hospital’s common sense—and common decency.

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

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Learning Your Baby’s Gender at Seven Weeks –Test is Mixed Blessing

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

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Drug Maker Attempted to Capitalize on the Lives of Infants

Tuesday, April 5th, 2011

There is a synthetic form of progestin called hydroxyprogesterone caproate, or 17P, that is used to prevent mothers-to-be from delivering prematurely. Treating a mother at risk of having a preemie with hydroxyprogesterone caproate was found, in tax-payer funded studies by the National Institute of Child Health and Human Development, to reduce the incidence of pre-term births, which naturally means that babies suffer fewer of the complications that plague preeemies. The studies also found that giving this drug to mothers-to-be at risk of premature delivery could save the health care system at least $2billion per year.

Until recently, the drug had been available only through “compounding pharmacies” (pharmacies that formulate drugs that aren’t commercially available), at a cost of about $10 to $20 per dose. But the FDA recently licensed one manufacturer, KV Pharmaceuticals, to manufacture the drug commercially, and exclusively, for the next seven years.

What usually happens at the point where a manufacturer is given exclusive rights to market a drug is that compounding pharmacies are told that they may no longer produce the drug.

And that would have happened this time – if KV Pharmaceuticals hadn’t done something that has caused a huge uproar in the maternal-fetal medicine and obstetrics community. It raised the price of the drug from the $10 to $20 per dose that compounding pharmacies had been charging to (are you sitting down?) $1,500 per dose.

No, that’s not a typo.

They raised the price by an average of 100 times what it had been.

Remember, it was tax-payer dollars that funded much of the research, so the raise in price could not be attributed simply to recouping research costs. And driving the price that high would put it out of reach of most women (and babies) who needed it. A full course of the drug, given between the 16th and 36th weeks of pregnancy, had previously cost about $400. The price increase would push that cost to $30,000!

This story, at least, has a happy ending. Although, according to this article in the Seattle Times, KV Pharmaceuticals agreed  to drop the price to $690 per dose (still outrageously high, in the opinion of most in the obstetrics community), the FDA decided to allow compounding pharmacies to continue to formulate the drug when presented with a prescription.

But just imagine all the mothers and babies who would have suffered had the FDA allowed KV to put profits ahead of all else, and ordered compounding pharmacies to cease formulating the prescription.

As a maternal-fetal specialist and a mother, it sends shivers up my spine.

– Yvonne S. Thornton, MD, MPH

Posted in Childbirth & delivery, Health care policy, Pregnancy, Women's health issues, Women's health news, Your newborn baby | No Responses »
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Time to Deliver? Mother Nature Knows Best

Thursday, December 30th, 2010

For years, I’ve been sounding the alarm about Cesarean delivery on-demand, and have persuaded my patients that childbirth isn’t something you can simply pencil into your schedule when convenient. It’s not just that a baby needs all the time nature gives her within the womb to develop, and that delivering just a few days early can mean that lung development and other functions may be potentially compromised. Cesareans are major surgery, which brings inherent danger to both mom and newborn. Necessary Cesareans are often life-savers. Unnecessary Cesareans can be just the opposite.

And now, at last, the word is spreading.

The San Jose Mercury News reports:


Babies born early through induction or C-section without a medical reason are nearly twice as likely to spend time in the neonatal intensive care unit, researchers say. They also are more likely to contract infections and need breathing machines, according to a 2009 study in the New England Journal of Medicine and a number of other reports.


“We are finding out that the last weeks of pregnancy really do count,” said Leslie Kowalewski, an associate state director for the March of Dimes.


“At 35 weeks, the brain is only two-thirds of what it will weigh at 40 weeks.” Many organizations are responding with programs designed to eliminate early elective deliveries. Most significantly, chapters of the American Congress of Obstetricians and Gynecologists have begun to notify doctors about the serious consequences of performing early elective births.

With luck, as information about potential consequences spreads, expectant mothers and their doctors will decide to let nature take her course, for the sake of the mom’s health and her baby’s.

– Yvonne S. Thornton, MD, MPH

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Ready to Deliver and Morbidly Obese: One of My Most Challenging Cases

Wednesday, June 23rd, 2010

A recent article in The New York Times talked about how the obesity epidemic is affecting pregnant women and their babies:

About one in five women are obese when they become pregnant, meaning they have a body mass index of at least 30, as would a 5-foot-5 woman weighing 180 pounds, according to researchers with the federal Centers for Disease Control and Prevention. And medical evidence suggests that obesity might be contributing to record-high rates of Caesarean sections and leading to more birth defects and deaths for mothers and babies.

New York City’s health department reported last Friday that half of the 161 women who died because of a problem with their pregnancy between 2001 and 2005 were obese. Black women were hit hardest, with a mortality rate seven times that of white women. While deaths are extremely rare in pregnancy, the city’s rate of 23.1 per every 100,000 births is twice the national average.

My new book, SOMETHING TO PROVE, is a personal memoir first, but because I’m a maternal-fetal medicine specialist and a surgeon, it also details a number of gripping moments in the operating room.

One of my most challenging cases involved a pregnant patient transferred to my care. When I walked into my new patient’s hospital room, I discovered she weighed more than 500 pounds and her baby was showing signs of distress on the fetal monitor.  The patient needed to be delivered. Let me give you a sense of the challenge with a brief excerpt:

…Many surgeons would begin their cut above her navel in an attempt to avoid that enormous layer of fat, while trying to find the uterus to get the baby out. …The area above the pubis, even in a morbidly obese woman, is usually flat and firm. Instead of a vertical incision from the navel down, I’d lift up the apron of fat and do a horizontal incision just above the pubis. That would allow me to get into the uterus and get the baby out. …We taped her massive belly to her chest, swabbed her with an antiseptic solution, and I went in. I was able to perform the cesarean quickly, without incident or excessive bleeding, and delivered the baby in only a few minutes.

The surgeon who handled the case recounted in The New York Times decided to cut through all the mother’s layers of fat, rather than using my technique of retracting and taping the massive layers of fat, which a colleague dubbed the “Thornton suspenders.” While there might have been excellent reasons for the physician’s decision, I hope more obstetricians learn to use the “Thornton suspenders” for such difficult deliveries in obese moms. Because, as the Times article explains:

… where every minute counted, it took four or five minutes, rather than the usual one or two, to pull out a 1-pound 11-ounce baby boy.

– Yvonne S. Thornton, MD, MPH

Posted in Childbirth & delivery, Something To Prove: A Daughter’s Journey to Fulfill a Father’s Legacy, Women's health issues, Women's health news, Your newborn baby | No Responses »
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Why is the Maternal Mortality Rate in the U.S. So High?

Thursday, May 27th, 2010

In the richest nation on earth, with an advanced health care system, and the technology available to monitor and treat mothers and their babies, you’d expect the United States to have among the lowest rates of maternal mortality. So it’s distressing to learn that, although it’s still relatively rare for mothers to die as a result of pregnancy and childbirth, it happens here more often than it should. The U.S. is ranked 41st in maternal deaths among 171 nations analyzed by U.N. experts. That’s a worse record than virtually any other developed country — even worse than a good number of under-developed countries. What’s even more distressing: the death rate is rising.

The question is why? Why is pregnancy so risky in such a rich nation?

Often, the reason is a pre-existing disorder that complicates pregnancy, such as obesity, high blood pressure, or diabetes. The lack of access to good quality care among the uninsured also puts women at risk, leaving them without diagnosis and treatment for conditions that can cause problems until the condition gives rise to a full-blown emergency.

But there’s one contributor to maternal death that might surprise you. Our wealth, itself, could be contributing to the risk, because it encourages the prevalence of Cesarean-on-demand.

According to the CDC, in 2007, 31.8 percent of births were by Cesarean section. The rates of births by C-section have risen every year for at least eleven years.

While C-sections can be, and often are, life-saving, it’s difficult to justify that high a rate. The World Health Organization estimates that the U.S. rate is twice what would be medically necessary.

Cesarean births are now treated as routine, but major surgery is never routine. Major surgery comes with the risk of complications, including hemorrhage. And the C-section, as common as it has become, is still major surgery.

Childbirth is usually very safe, but it could be safer. Giving all women access to pre-natal care and preventive medicine is an important start. But it’s also important to remember that a woman’s body was designed to deliver babies the old-fashioned way. And choosing unnecessary surgery instead could be inviting trouble.

– Yvonne S. Thornton, MD, MPH

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