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United States Pregnancy Rates Continue to Drop

Monday, May 26th, 2014

For decades, pregnancy rates in US women have been sliding, and this is largely thanks to a steep decline in teen pregnancies, according to a new report.

The study showed that teenage pregnancies reached a historic low in 2009. For all US women between 15 and 44 years of age, the pregnancy rate in 2009 was 102.1 per 1,000 women, down 12% since 1990. The only time it has been lower was in 1997, and even then, the difference was slight. The birth rate for married women is 72% higher than for unmarried women; the abortion rate is five times higher for unmarried women than for married women, and has also dropped overall.

For women across all categories, unintended pregnancy accounts for almost all abortions, so the decline in abortion rates is closely correlated with the decline in unintended pregnancies, and this has been seen in all groups including married women. Increasing options and education are clearly beneficial for all women.

Pregnancy rates are down in every category except women over 30, the only group with a continually increasing incidence of pregnancy. Women in their 20s represent the largest group of pregnant women, but even their rates have dropped.

The data stopped at 2009 because the complete set of more recent data is not available yet, but newer statistics do suggest that pregnancy rates continue to decline, although at a slower pace than the dramatic drop from 1990 to 2009.

The recession that began in 2007 probably has had an impact. Birth rates plummeted during the Great Depression of the 1930s; a similar effect is probably taking place now. In addition, women have been having fewer children than their mothers and grandmothers, and more women are waiting until their 30s to start their families, waiting for either the economy or their personal financial situations to stabilize.

While the levelling-off of the decline in most categories may be a sign of the recession’s abating impact, the teen birth rate shows no signs of slowing its striking drop. In 2012, the teen birth rate was less than half its 1992 peak of 62 birth per 1,000 girls, making this the group with the largest decline. The data show that fewer teenagers are having sex as well as a significant increase in contraceptive use among the ones that do. The exact reasons for the decline may not be clear, but those teaching both abstinence and sexual health, including contraceptive use, are probably on the right track.

Even with the decline, the pregnancy rate in the United States is still among the highest in the industrialized countries. The countries with the ten highest birth rates worldwide are all located in Africa.

– Yvonne S. Thornton, M. D., M. P. H

Bleeding during Pregnancy – What You Need to Know

Thursday, May 22nd, 2014

Vaginal bleeding during pregnancy is almost always a source of worry for a pregnant woman, but it’s not always a sign that something is wrong. Studies such as this one show that around 20% of pregnant women experience early bleeding, and little more than half of those pregnancies end in miscarriage.  Even in this study, the number of pregnant women may have been underreported and therefore, the true number of women who have bled in early pregnancy is not known.  However, it is a common occurrence, which must be investigated by your practitioner when it happens.

Less Serious Causes

One of the most common reasons for bleeding early in pregnancy is implantation. Implantation bleeding occurs around two weeks after conception and is the result of the fertilized egg burrowing into the endometrial lining. Sometimes this bleeding is mistaken for a normal period, so a woman may not realize she is pregnant until the following month. Those women who are Rh-negative should be very cognizant of this fact because what is believed to be a late normal period, actually may be a miscarriage in disguise and can cause problems for subsequent pregnancies with respect to alloimmunization. Please refer to my health book, “Inside Information for Women” for more on Rh-alloimmunization.

Other causes of bleeding during pregnancy that do not indicate harm to the fetus can include a cervix that is more sensitive and tender than usual, which can lead to bleeding, especially after intercourse. However, there is no way to know for sure what is causing your bleeding without an examination, so bleeding during pregnancy should always be evaluated by your doctor.

More Serious Causes

Ectopic pregnancy is another reason for bleeding early in pregnancy. These are pregnancies that implant in the fallopian tubes or other location outside the uterus. This type of bleeding may be accompanied by pain, either sharp pain or cramping, and lower-than-normal levels of hCG, or there may be no pain at all, that is, until it ruptures. Women who have had ectopic pregnancies before, pelvic surgery, or infection in the fallopian tubes are more likely to experience an ectopic pregnancy in a subsequent pregnancy. Untreated, an ectopic pregnancy can result in a ruptured fallopian tube, causing massive hemorrhage and may lead to death of the patient.

A miscarriage, which is the lay term for a spontaneous abortion, will also cause bleeding, and unfortunately, cannot usually be prevented or stopped. Most miscarriages occur during the first trimester (the first 12 weeks of gestation), and may cause vaginal bleeding, cramping, and the passage of tissue through the vagina. A miscarriage, while heartbreaking in many instances, is not a sign that the mother did anything wrong, nor is it a sign that future pregnancies are likely to end in miscarriage.

Bleeding in the second half of pregnancy is more likely than earlier bleeding to be caused by something serious. These causes can include placental abruption, or placenta previa. In placental abruption, the normally-implanted placenta separates from the uterine wall prematurely, such as after a motor vehicle accident or after a fall or other blunt trauma. In placenta previa, the abnormally-implanted placenta is positioned too low in the uterus, partially or completely covering the cervix. Any bleeding during pregnancy requires immediate attention in order to properly diagnose and treat the condition.

Again, to emphasize the importance of bleeding during pregnancy, let me reiterate: Any bleeding during pregnancy warrants an immediate call to your doctor to rule out serious causes or take appropriate measures to treat them.

– Yvonne S. Thornton, M. D., M. P. H

Pregnancy Weight Gain: When the Guidelines Might Not Be Right for You

Monday, May 19th, 2014

When you find out you’re pregnant, one of the first things your doctor will probably want to discuss with you is how much weight you should gain over the course of your pregnancy. The guidelines say that most pregnant women should gain between 25 and 35 pounds – more if they start out underweight, less if they are overweight to begin with. How does that weight gain break down?

  • 1  pound for the placenta
  • 2 pounds for amniotic fluid
  • 2  pounds for the increased weight of the uterus
  • 1 pound for increased breast size
  • 3 ½ pounds for increased blood volume
  • 6 ½ pounds for maternal fat stores
  • 6-7 ½ pounds for the full-term baby

All of this adds up to between 22 to 24 pounds that a healthy woman of normal weight can safely gain during her pregnancy.  The operative term here is “normal weight”.

However, many women don’t start pregnancy at their ideal weights. For a woman who is very underweight, somewhat more weight gain may be optimal, and may be the natural outcome of eating enough nutritious food to nourish herself and her growing fetus.

A much more common problem, though, is that of the woman who starts her pregnancy overweight. One in five pregnant women (20%) are obese at the start their pregnancy.   Gaining too much weight during pregnancy is one of the most preventable causes of complications, ranging from gestational diabetes to preeclampsia to overly large babies that require cesarean deliveries.

A woman who is overweight or obese can safely gain less than 25 pounds during her pregnancy as long as she eats a healthy diet. Keep in mind that “eating for two” should mean that you are eating twice as well, not twice as much.  The fetus usually weighs less than 1/20 of its Mom’s weight. So for an overweight or obese woman, switching to the healthy diet she needs for pregnancy may actually mean a reduction in calories, and gaining less than the recommended amount or even losing weight may be the natural result.  And, an obese pregnant woman shouldn’t get overly concerned about it.  If you are obese, you already have a fluffy substrate or matrix upon which your pregnancy will grow.  A numerical end-point, i.e., weight gain or loss, should not be used in obese pregnant women, but rather a healthy, balanced nutritional intake should take priority. 

This is perfectly fine as long as your doctor agrees (always discuss matters related to your pregnancy with your own doctor, because your situation is unique), and as long as your diet contains all the necessary nutrients and fluids you and your baby need.  I, as the principle investigator, have done the original research and have published the first and, to date, the only randomized clinical trial regarding the outcomes of nutritionally monitored obese pregnant women.  A well-balanced diet is the way to go resulting in less problems during the pregnancy.

A pregnant woman should be drinking lots of water – at least eight cups a day – and another four cups of skim milk, leaving very little room for soda or fruit juice (which are both mostly sugar). And eating all the fresh fruits, vegetables, lean meats, fish, and whole grains you need does not, for the most part, leave room for junk food.

The occasional treat is fine. A cup of coffee, a small serving of chocolate, and the like do not have to be abandoned entirely for nine months, and trying to do so would most likely set you up for failure anyway as the temptation to “cheat” would be too great. Tell yourself you can have treats – just not every day and not in large amounts.

Exercise will also help you feel better and keep your weight in check during pregnancy. Walking, swimming, and using a stationary bicycle are excellent exercises now. Keeping track of everything you eat and which exercise you perform each day and for how long can help you stay accountable and motivated.

Just because countless people – even strangers – will tell you that you “should” be gaining 25-35 pounds does not make this necessarily right for you. They don’t even know you!  Talk to your doctor to determine whether you can safely gain less; delivering a baby in better shape than they were in nine months ago is a very real possibility for many women. See my book, Inside Information for Women, for much more information on this and other women’s health issues.

– Yvonne S. Thornton, M. D., M. P. H

Dealing with Springtime Allergies during Pregnancy

Monday, May 5th, 2014

Spring is here, and if you’re like many people, you’re dealing with the watering eyes, coughing, sneezing, and sniffling that pollen causes those sensitive to it. When you aren’t pregnant, you usually don’t need to think twice before popping a pill to relieve those symptoms, but once you are pregnant, you start to question everything you put into your body – and rightfully so. You want to do everything you can to keep your baby safe and healthy, but you also don’t need the continual stress of dealing with your allergy symptoms, whether they are caused by pollen, dust, pet dander, or whatever else triggers them. 

Many pregnant women deal with allergies. Some of these are women who have always had them and find that they don’t magically disappear just because they are now pregnant; some women find that they experience allergy symptoms during pregnancy that they have never had before. Sometimes swollen nasal passages, a common result of pregnancy hormones, can mimic the symptoms of allergy sufferers. This can occur alone or in conjunction with actual allergies, multiplying the misery of the affected woman.

What You Can Do

The best way to get relief, of course, is to avoid your triggers in the first place, whenever possible. Secondhand smoke (which is dangerous for you and your baby anyway), pollen, cat dander, and mold are all common triggers; so are paint thinner and other household chemicals. Use common sense and stay indoors when pollen is at its worst, invite your cat-loving friends to your house instead of going to theirs, and use natural cleaners that don’t make your symptoms flare.

If your best efforts to avoid symptoms are unsuccessful and you need to take a more proactive approach, the first step is to talk to your doctor to see what steps you can safely take. Even if you have been taking an allergy medicine for years, check with your doctor before continuing it now – and this includes prescription, over the counter, and homeopathic medicines.

There are some general guidelines for what drugs are safe in pregnancy. For example, over-the-counter antihistamines are usually considered safe for use by pregnant women, but they can make you sleepy. Pregnancy itself can also cause considerable fatigue, so this may not be ideal for you. Conversely, decongestants such as Sudafed or other decongestants containing vasoconstrictors like pseudoephedrine may constrict the vessels in your placenta and cause fetal compromise. The bottom line is that you should ask your doctor before taking any medication at all during your pregnancy to make sure the drug is safe for your individual situation.

Desensitization for allergies needs to be discussed with your obstetrician and your allergist in a mutual consultative meeting, understanding the risks and benefits. You can also try natural remedies such as using a neti pot (with sterilized water), as long as your doctor is aware of the treatment and gives you his/her approval.

– Yvonne S. Thornton, M. D., M. P. H

Understanding and Preventing Fetal Alcohol Spectrum Disorders

Thursday, May 1st, 2014

Do you know what the only preventable form of mental retardation is?  Fetal Alcohol Syndrome.

For some reason, there seems to be a lot of confusion among pregnant women about how much alcohol they can safely consume. The answer is extremely simple: NONE.  There is no amount of alcohol consumption known to be safe during pregnancy, and no specific minimum amount a pregnant woman must drink in order to put her baby at risk for being born with a fetal alcohol spectrum disorder (FASD).

Unlike an adult, the fetus does not have the liver enzyme alcohol dehydrogenase and consequently cannot metabolize alcohol; resulting in alcohol hanging around and causing damage. 

FASDs occur in babies whose mothers drank alcoholic beverages while pregnant, and can cause a range of symptoms including physical, behavioral, and learning problems. It is very common for a person with an FASD to have a combination of these problems. FASDs are entirely preventable – by simply not drinking while you’re pregnant. There is no known safe time during pregnancy to drink, and no known safe amount you can drink. And because women often don’t know they’re pregnant until several weeks in, any woman who might become pregnant should not drink, either.

Signs and Symptoms of FASDs

FASDs is a term that refers to the whole group of possible disorders babies whose mothers drank while pregnant are vulnerable to. The specific symptoms range from mild to severe and may include:

  • An abnormal facial appearance
  • A smaller-than-normal head
  • Short stature and low body weight
  • Problems with coordination
  • Hyperactivity, attention deficit, memory problems
  • Learning disabilities
  • Mental retardation
  • Speech delays
  • Poor reasoning skills
  • Sleep problems
  • Hearing or vision problems
  • Heart, kidney, or bone problems

Types of FASDs

There are several types of FASDs. The term used to describe an individual disorder depends on the specific symptoms present. For example, fetal alcohol syndrome refers to the more severe symptoms on the FASD spectrum. Fetal death is one such possible outcome of maternal drinking during pregnancy. Fetal alcohol syndrome sufferers may also have growth problems, problems involving the central nervous system, and abnormal facial features, among other problems.

Alcohol-related neurodevelopmental disorder can cause intellectual disabilities, and these individuals generally do poorly in school, especially when it comes to math, attention, memory, and impulse control. There are also alcohol-related birth defects which can range from hearing loss to heart problems and more.

Treatment for FASDs

There is no cure for FASDs. However, early treatments are imperative and can be effective at improving a child’s development and quality of life. Treatment options include medication for certain symptoms, certain types of therapy, parent education, and more. There is no one treatment that will be right for every child or every type of FASD. Early diagnosis and intervention, a stable and loving home environment, and involvement with special education services can all help people with FASDs overcome their disability and reach their full potential.

It’s never okay to drink alcohol while you are pregnant.  Read my book, Inside Information for Women, for more information on this. You’re only pregnant for a few months, and the choices you make now last two lifetimes: yours and your baby’s.

– Yvonne S. Thornton, M. D., M. P. H

What Your Home Pregnancy Test Can and Can’t Do

Monday, April 28th, 2014

If you have just noticed that your period is late, your first inclination may be to run out and buy a home pregnancy test (HPT). With various brands now purporting to be effective as early as the first day of your missed period, it’s understandably tempting. However, be aware that these claims may not always be exactly accurate. You can improve your odds of getting an accurate reading by being familiar with when and how to take one of these tests, but understand that HPTs are no stand-in for the reliability of a test administered by a doctor.  These tests are from the urine and are imprecise.  The pregnancy tests taken from a blood sample are more accurate and will allow your gynecologist to see a “trend” in the amount of hormones in your system, in case there is an equivocal result.

How Soon Can You Take a Home Pregnancy Test?

Don’t get too excited about those tests that claim to work before your period is even late. Wait until a little later for the best results – once your period is a week late, go ahead and test. By this time, if you are pregnant, you’ll have enough HCG (human chorionic gonadotropin, the hormone produced in your body when you become pregnant) in your blood for the test to detect. Earlier than this, some HPTs aren’t precise enough to detect the smaller amounts of HCG present in the first days of pregnancy.

False Positive/False Negative Results

There are several factors that could interfere with the results of an HPT, including the design of the test itself, taking the test too early, and certain medications such as fertility drugs. Both false negatives and false positives are possible, but false positives are much rarer.

A false positive could occur after taking a medication such as a fertility drug that contains HCG, or it could mean that there was a pregnancy that was lost very soon after the fertilized egg had attached to the uterine lining. An ectopic pregnancy may also produce a positive HPT result, and this requires immediate medical attention. Most often, however, a positive result indicates a normal pregnancy. Either way, a positive result warrants an appointment with your gynecologist.

A false negative result is more likely than a false positive. This means that your HPT will indicate that you aren’t pregnant when you actually are. This can be life-threatening, especially if you are pregnant in one of your fallopian tubes or your cervix or your abdomen (ectopic pregnancy).  The pregnancy may rupture in the fallopian tube or cervix and cause hemorrhage leading to death. You may end up with a false negative if you take the test too early, check the results too soon (without following the package directions explicitly), or using urine that is diluted – for example, if you have recently drunk a lot of water. That’s why even though many HPTs claim to be accurate at any hour, your best bet is to take the test first thing in the morning, when more concentrated urine boosts your chances of getting an accurate result.  In the final analysis, you need to have the result confirmed in a doctor’s office.

What to Do After Taking the Test

If the test is positive, make an appointment with your gynecologist to confirm the pregnancy with a pelvic exam and a blood test.  Of utmost importance is to confirm that the pregnancy is actually in your uterus and not an ectopic pregnancy where it has an increased risk of rupture and hemorrhage. The sooner prenatal care begins, the better, so make this call immediately.

If your test is negative, and you have missed a period, you need to make an appointment to see your gynecologist as soon as possible. There are lots of reasons why you may miss periods, including stress, weight loss, strenuous exercise, and illness. However, if you missed a period, you are pregnant until proven otherwise.    Read more about pregnancy tests and early pregnancy in my women’s health book, “Inside Information for Women”.


– Yvonne S. Thornton, M. D., M. P. H

Faced with an Unintended Pregnancy? Here Are Your Options

Thursday, April 24th, 2014

Half of all pregnancies are unintended.  Finding out that you are pregnant can be a shock even if you were trying – but even more so if you weren’t. If you have become pregnant without intending to, you have three basic options, but first take some time to let the news sink in and think about your choices. If you haven’t already, see your doctor as soon as possible to confirm the pregnancy. Then talk to him or her – or a counselor – to make sure you understand your options and are equipped to make the best decision for you. The choices you have are:

1. The Decision to Become a Parent

Parenting is both challenging and rewarding. The experience of growing a baby inside of you is unlike any other, and then you get to raise a child to be a unique individual with his or her own talents, interests, and personality.

If you choose this option, keep in mind that a good support system is essential. There are seemingly endless decisions to make: if you are single, will you marry the father? If not, what type of financial and parental support is he able to provide? Will you have the financial support you’ll need otherwise? How can you make raising a child fit in with continuing to strive for your personal long-term goals?

In addition to making choices about your future lifestyle and choices about parenting, there are even more immediate concerns, and those include the fact that you have gotten pregnant without first preparing your body and ensuring that you were doing everything you could to be as healthy as possible. Prenatal care is especially important, and be sure to discuss with your doctor any medications you have been taking, including herbal or “natural” supplements. You’ll need to start taking care of yourself and your baby immediately, but don’t worry – your chances of delivering a healthy baby are excellent.

2. The Decision to Place Your Baby for Adoption

Adoption has come a long way, so if raising a child isn’t a good option for you and abortion isn’t right for you either, you should be aware of the wide range of options available to mothers looking to place their babies for adoption today.

Benefits of adoption include being able to choose the adoptive family, having considerable control over many of the details that will affect your child’s future. You can also choose what type of relationship, if any, you would like to have with your child over the coming years. Remember that you can change your mind at any point in the process, up until the child is six months old in many states. Support groups and other counseling services can help you work through your feelings and feel good about your choice – whatever that choice turns out to be.

3. The Decision to Have an Abortion

The decision to have an abortion is never an easy one, but sometimes it is the right one. Learning about the different types of procedures and the risks they carry can help you make an informed decision.

Every woman’s situation is unique, and women choose abortion for many reasons, including not being ready to be a parent, not being financially able to support a baby, feeling that having a baby would make school, work, or caring for other children too difficult, being too young to be an effective parent, feeling that her family is already complete, having health problems, and having a pregnancy that is the result of incest or rape.

Talking to someone you trust who has had an abortion can be helpful, as can learning as much as you can about the laws in your state regarding abortion. Think about your values and your views on abortion, as well as your reasons for choosing this option. Talk to your doctor about any concerns you have about how an abortion might affect your health, relationships, or future fertility.

Unintended pregnancy is never easy, but getting as much information as you can about your choices, talking to someone who can help you through the process, and being honest with yourself about your individual situation can help you make the right decision for you.

– Yvonne S. Thornton, M. D., M. P. H

Understanding Group B-Streptococcus in Pregnancy

Monday, April 14th, 2014

Group B β-Streptococcus (GBS or GBBS ) is a bacterium commonly found in the rectum, and vagina. Group B Β Streptococcus  should not be confused with the bacteria that causes strep throat (Group A); these are two different types of bacteria. Group B β-Streptococcus  infection is not generally serious for women and can usually be treated easily with antibiotics. But things change when a woman becomes pregnant.

There isn’t a surefire way to keep from passing Group B β-Streptococcus  from mother to baby during delivery. Group B β-Streptococcus  infection can be fatal to a newborn, and although this is rare, it does happen. That’s why it’s so important to do everything possible to minimize the risk.

Group B β-Streptococcus is one of those bacteria that a woman can carry without realizing it. Although it is transmitted sexually, it is not considered to be a sexually transmitted disease, like gonorrhea or syphilis. The chances of passing the bacteria on to the baby during delivery are high, but most babies are not affected. However, a small number will develop a Group B β-Streptococcus  infection, which can cause problems ranging from the mild to the severe, perhaps death.

Screening for Group B β-STREPTOCOCCUS

Some doctors choose to routinely test every pregnant patient for Group B β-Streptococcus between 35-37 weeks of gestation and treat the ones who test positive for the bacteria with antibiotics at the beginning of labor. This is the method that has been shown to be the most effective at catching Group B β-Streptococcus  colonization and preventing infection in newborns.  Because the urine in the bladder is sterile, any Group B β-streptococcal infection found on a urine culture indicates that the mother is a “colonizer” and she will need antibiotics during her labor.

Some doctors, however, choose to treat only mothers who are at high risk for passing Group B β-Streptococcus on to their babies. These women include those who go into labor prematurely, those whose membranes rupture early and labor looks like it will be long, those with unexplained fever, those who have had a baby with Group B β-Streptococcus  infection before, and those who have or have had a kidney or bladder infection caused by Group B β-Streptococcus.

The test itself is simple and painless, and involves inserting a special cotton swab into the woman’s vagina and rectum. The swab is then placed in a solution in which the bacteria will grow if present. This is called a culture.

Treatment for Group B β-STREPTOCOCCUS

When an expectant mother tests positive for Group B β-Streptococcus , or is at high risk for passing it on to her baby, she is given antibiotics when she goes into labor. Giving the antibiotics earlier on, during pregnancy, is not as effective, as this allows the bacteria time to re-grow before delivery.

As for babies, they can develop one of two types of infections. The most common (and most dangerous) is early-onset disease, wherein the baby is infected while moving down the birth canal. Symptoms of this type of infection appear during the first week of the baby’s life, and the infection can be severe and difficult to treat. Antibiotic treatment during labor is designed to prevent this type of Group B  β-Streptococcus  infection in the baby.

The other type of Group B β-Streptococcus  infection is late-onset disease, and babies do not show symptoms of this until after their first week. These babies may have contracted the disease from their mothers during delivery or from contact with her or someone else carrying the disease after birth. This type of infection is not prevented by antibiotic use during labor, but can be treated with antibiotics after the baby is born.

However, whether early- or late-onset, Group B β-streptococcus is an infection not to be taken lightly and could result in disastrous results for your newborn.  So, make sure you keep your prenatal visits during the last weeks of your pregnancy in order to be tested for Group B β-streptococcus.

– Yvonne S. Thornton, M. D., M. P. H

Newly Discovered Dangers of Secondhand Smoke

Thursday, April 10th, 2014

Researchers already know that secondhand smoke, or passive smoking, is linked to myriad risks, including an increased risk of hearing loss, diabetes, and obesity. Now they have discovered new risks to add to the growing list: the increased risk of ectopic pregnancy, miscarriage, and stillbirth.

The new study points out that while smoking during pregnancy is known to be related to a higher risk of birth complications and miscarriage, more information was needed to determine whether passive smoking by pregnant women has similar effects. The study included over 80,000 women who had been pregnant at least once and gone through menopause.

Some of the women were current smokers (around six percent), some were former smokers, and some had never smoked. The women who had never smoked (or, more specifically, had smoked fewer than 100 cigarettes in their lifetimes), were divided into groups according to their secondhand smoke exposure as children, adults at home, and adults at work.

The study found that women who had been smokers during their reproductive years had a 44% higher risk of stillbirth, a 43% higher risk of ectopic pregnancy, and a 16% higher risk of miscarriage than the women who had never smoked and had not been exposed to secondhand smoke.

This was probably not a huge surprise to anyone, but the really interesting results were found in the group of never-smokers. The ones who had experienced secondhand smoke exposure also had a higher risk of miscarriage, stillbirth, and ectopic pregnancy compared with the ones who had never smoked and had not been exposed to secondhand smoke. In addition, the increase in risk was directly related to the level of secondhand smoke exposure the women had experienced.

The women with the highest levels of secondhand smoke exposure – over ten years either as a child, as an adult at home, or as an adult at work – had an extremely elevated risk of miscarriage, stillbirth, and ectopic pregnancy. The risk of having an ectopic pregnancy was a whopping 61% percent greater than that of women with no cigarette smoke exposure, and they were also 55% more likely to have experienced a stillbirth and 17% more likely to have had a miscarriage.

With many states enacting bans on smoking in public places and places of business in recent years, we are certainly headed in the right direction. However, the new research certainly highlights the need for more progress, especially in the states that still have no bans on smoking in public places whatsoever, in order to further protect women and their future babies from secondhand smoke, which appears to be even more harmful than previously thought.  

– Yvonne S. Thornton, M. D., M. P. H

VBAC vs Repeat Cesarean Delivery

Thursday, March 6th, 2014

Not so long ago, a vaginal birth after a cesarean delivery (VBAC) was unheard of. Because the uterus was cut in such a way that weakened it and made it vulnerable to rupture in subsequent pregnancies, women were often scheduled for cesareans before they could even go into labor if they had had a cesarean delivery in the past.

Now, with improved surgical techniques, VBAC is a choice that many women get to make, depending on the reason for the original cesarean. For example, if the first cesarean was performed because of a too-large baby and a too-small pelvis, that reason will in most cases still exist in subsequent pregnancies. On the other hand, if an isolated event such as breech presentation mandated the first cesarean, the event does not reoccur, and the correct surgical procedure was used the first time, then attempting a VBAC is usually safe.

Benefits of VBAC

This is important for a number of reasons. The most important reasons involve the safety of both mother and baby. A vaginal birth is safer than a cesarean delivery. Although the risk of infection or hemorrhage is relatively low with a cesarean, it is still several times greater than with a vaginal delivery. Therefore, a cesarean should be a last resort whenever possible.

Another reason VBAC safety matters is because many women prefer the natural experience of childbirth. This, of course, should not be a reason to put her life or the life of her fetus in jeopardy, but when it’s feasible, childbirth is a nicer experience when it fulfills the mother’s wishes.

Other benefits of VBAC include avoiding an additional scar on your uterus, which is important if a future pregnancy is desired. The more scars on the uterus, the more likely the uterus is to rupture.  Also, the placenta is more likely to be more adherent to the scarred uterus and not separate naturally, causing a life-threatening condition known as placenta accreta and resulting in massive hemorrhaging which may lead to maternal death.

Vaginal birth also comes with an easier recovery period, less pain afterward, a shorter hospital stay, and a more active role for you and your partner in the birth of your baby.

Risks of VBAC

The possibility (however remote) still exists for the uterus to rupture at the site of the previous cesarean scar, and this is one of the main fears when attempting VBAC. If the uterus ruptures, an emergency cesarean and possibly hysterectomy will be required to prevent severe injury to both baby and mother. That is why it is so important to be delivered in a hospital or medical center that has 24-hour anesthesia and in-house obstetrical coverage with a good blood bank.   With that the said, the risk of uterine rupture after a VBAC is 0.2% compared to 0.1% in those patients who had scheduled another cesarean.  Both figures mean that in 99.8% to 99.9% of the cases, a VBAC does not result in uterine rupture.

If you are hoping to have VBAC, you should clearly discuss this with your doctor to see if it is a good fit for your individual situation. In addition, you will need to deliver in a facility that has the equipment and staff capable of handling any emergency that might arise.

If you and your doctor decide that VBAC may be safe for you, you will be able to have a “trial of labor,” or TOLAC (trial of labor after cesarean). This means that you will go into labor naturally with the goal of delivering vaginally. However, there are no guarantees. Some women who attempt VBAC end up with necessary cesareans anyway. A trial of labor is a safe choice as long as the conditions that necessitated the first cesarean no longer exist and the baby is monitored closely for signs of distress. For more information on this and other women’s health issues, see my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.