Pregnancy

...now browsing by category

 

The Implications of a Prolonged Pregnancy

Thursday, March 7th, 2013

You’ve waited nine long and painful months. Your ankles are swollen, your mood swings are drastic, and your belly feels like it’s about ready to burst. When your due date comes and goes without those telltale contractions, it’s impossible for you not to get a little upset.

However, your doctor or midwife most likely gave you the midpoint of your due month, i. e., 40 weeks (280 days of gestation).  Actually, your baby is considered mature between 38 weeks and 42 weeks (266 days to 294 days of gestation).  A prolonged pregnancy is any pregnancy that lasts beyond 294 days or 42 weeks.  I know you didn’t want to hear that, but that’s the truth.  I did my post-doctoral thesis at Columbia on postterm pregnancies and we had mothers pregnant up to 44 weeks.  While it seems like a really long time, it’s actually more common than you might think. No one actually knows why a pregnancy is prolonged.   There are many theories, but no one has found the reason for a pregnancy going beyond 42 weeks, except in cases of anencephaly.

There is nothing abnormal about a pregnancy going beyond 40 weeks, even to 42 weeks. The best way to ensure that your pregnancy lasts the normal 38 to 42 weeks is to stay healthy and active. Maintaining a healthy weight and avoiding harmful chemicals such as caffeine and alcohol will help you ensure that your pregnancy is as normal as possible.  If that doesn’t work though, thanks to advances in modern technology and medicine, there are a few different options for women with prolonged pregnancies. After a pregnancy reaches the midpoint of term, i.e., 40 weeks, your obstetrician may want to test the baby for its well being with electronic fetal surveillance.  Changes occur after 41 weeks that may jeopardize the baby’s health if not closely monitored.  If mom’s perception of fetal movement is normal, i.e. at least four kicks in one hour, and the testing is normal, it is best to wait for Mother Nature to bring on labor naturally.  However, if your physician or midwife has evidence that your baby may be in jeopardy, he or she will choose to induce your labor.

Stillbirth is a concern at any time during the pregnancy, but especially after 42 weeks. The amniotic fluid around the baby peaks at  34 weeks and decreases as the pregnancy progresses to term.  That is the reason for monitoring and assessment of the fluid when the pregnancy has passed 40 weeks.  The American College of Obstetricians and Gynecologists still defines postterm (prolonged) pregnancy as one extending beyond 42 weeks——not 40 weeks and not 41 weeks.  Babies also gain weight in utero with each passing week, so the longer baby is in “the oven” the bigger it will become (but not by much) until it reaches a critical size and then its weight begins to decline.  A mother need not worry about delivering a Butterball turkey, if she continues to normally gain ½ to one pound per week.  Few babies born after their due date experience any real issues,

Much of pregnancy is up to chance. Once you conceive, the pregnancy is really on “automatic pilot”.  From the time of conception to the time of delivery, the outcome of your pregnancy depends on your particular body and the way the hormones are interacting. The word, “obstetrics” means to “stand by”.  Therefore, inducing labor in normal pregnancy before 42 weeks violates our very creed.  That’s the fun of being pregnant.  It’s up to Mother Nature.  Some women may deliver at 38 weeks (which is normal for a term pregnancy), while others may deliver at 42 weeks (which is also normal).  Both of my children were delivered beyond 42 weeks and both are Ivy-league graduates and totally healthy.

Try not to fret or force your doctor or midwife into inducing labor, which may not have been in the cards (or the best interest of your baby), only for you to end up with a cesarean birth rather than a natural one.

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

Posted in Pregnancy | No Responses »
Tags: , , ,

Conception and Congestion

Monday, March 4th, 2013

You probably thought you knew all there was to know about pregnancy. You’ve read all the books, talked to your obstetrician, visited every website, and browsed every forum. At this point, you probably feel like a pregnancy expert. Believe it or not, there are probably still some symptoms you don’t even know about.

Many of my patients come to me complaining about harmless but bothersome conditions during their pregnancy wondering if their issue is out of the ordinary. One common complaint is congestion. It is more worrisome than other symptoms because most women who experience it think they might be coming down with a cold, which they worry might harm their baby. Luckily, congestion is completely normal, and it makes sense when you consider the cause.

Your blood volume increases during pregnancy and many of your blood vessels expand to accommodate it. Since there are tiny capillaries and vessels in your nose, their expansion causes a drastic change in the nose’s structure. The stuffiness you’re feeling during pregnancy is not a result of mucus. Instead, it’s the larger blood vessels blocking air from flowing in and out normally.

Studies show that two-thirds of all women report severe stuffiness during their pregnancy, so it is not at all uncommon. Usually, it is mild enough to not cause any serious problems, but let your doctor know right away if it seems to be affecting your ability to breathe normally. It could also affect your ability to exercise, so bring that up with your physician as well.

Congestion is one of those weird pregnancy symptoms that your doctor didn’t warn you about. It is harmless, which is why people usually don’t even report it. It is still common, inconvenient, and uncomfortable though. There is no treatment to alleviate the congestion safely, but cigarettes can exacerbate the problem, so make sure you quit if the symptom is a problem. In fact, you should quit either way.

While congestion is completely harmless, it’s okay if you still want to bring it up with your doctor if you’re concerned. As a physician, believe me when I say that there are no silly questions during pregnancy. I actually like to see women who really pay attention to their bodies, because they are the ones who take care of themselves and their growing baby best.
 

– Yvonne S. Thornton, M. D., M. P. H.

Posted in Pregnancy | No Responses »
Tags: , ,

Just a Spoonful of Ginger Makes the Nausea Calm Down

Thursday, February 28th, 2013

Many of my patients ask about which medications are safe for morning sickness during pregnancy. Though many over the counter nausea relief treatments could be dangerous for a developing baby, there are a few that are both safe and effective. After recommending these to women who are fed up with nausea every morning and even throughout the day, I often suggest a much more natural remedy. Studies show that ginger is an extremely effective nausea suppressant and stomach neutralizer.

We all remember sipping ginger ale when we were home sick with a stomach virus as kids. That’s because even the small amount of ginger in the sugary soda is enough to help calm the stomach down and reduce that queasy feeling. If your nausea is interfering with your regular schedule, try getting approximately 1,000mg every day. It doesn’t matter how you get it, so find whichever method works best for you. Ginger soda, ginger capsules, ginger tea, and ginger oil are all great ways to extract the benefits of the root during your pregnancy.

If you’ve tried adding ginger to your diet and you still struggle with regular vomiting, make sure you talk to your healthcare provider about it as soon as possible. Even if you’re dealing with it just fine, frequent vomiting can have serious side effects. It could cause dehydration, a decay of the enamel on your teeth, and a wearing away of the lining in your esophagus. All of these problems, when prevalent during pregnancy, could negatively affect the rest of your and your baby’s life.

While it seems impossible for a root as common as ginger to have a positive effect, try increasing your intake before resorting to over the counter nausea relief. Even medications that have been approved for pregnancy by doctors are not always fully understood, so it’s best to avoid them when possible. However, ginger is completely natural, so it should be the first choice for any woman looking to keep her pregnancy as natural as possible. As long as you don’t go overboard with sugary sodas or ginger snacks, there is no harm in trying this natural remedy for your morning sickness.
 – Yvonne S. Thornton, M. D., M. P. H.

Posted in Pregnancy | 1 Response »
Tags: , , ,

Not Even Your Feet are Spared from the Changes of Pregnancy

Monday, February 25th, 2013

And you thought puberty was bad! When you become pregnant, your body will go through so many changes you’ll be left feeling like you were transported into a different body. Some of the strange bodily changes you’ll experience will go away. The extra curves, the thicker hair, and the pregnancy glow are a result of temporary hormonal changes. However, some changes will last forever. Unfortunately, your stretch marks are in that category, but we’ll save that painful discussion for another time. One surprising change you might notice is a bigger shoe size.

During pregnancy, your body produces large amounts of hormones that are meant to make the pregnancy and birthing process easier. One such hormone is known as relaxin. This hormone loosens the muscles and ligaments, which make your stomach’s expansion easier and will eventually make it easier for your baby to pass through your birth canal. Unfortunately, it doesn’t distinguish which muscles need to be loosened, so it affects all of them at once.

Now that you know what relaxin does, you’ll be able to imagine how it affects your feet during pregnancy. Since the arches of your feet are mainly made up of ligaments, the relaxin hormone will cause them to stretch out as you put weight on them. The bones in your foot will also adjust based on this expansion. After you’ve given birth, the relaxin will leave your body, but your feet will stay at their new, longer length.

Studies show that obese women will experience more of a stretch, so it is more likely your shoe size will change after pregnancy if you’re overweight. Similarly, women who spend a lot of time on their feet will suffer from a more increased shoe size.

Unfortunately, there is no telling how much the relaxin in your body during pregnancy will affect the size of your feet. However, you might be able to minimize it by achieving a healthy weight before pregnancy and spending as little time as possible standing. If your shoe size does go up, just think of it as the perfect excuse to buy more shoes.

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

 

Posted in Pregnancy | No Responses »
Tags: , , ,

A Little Known Side Effect of Cesarean Deliveries

Thursday, February 21st, 2013

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

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

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

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

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

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

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

Posted in Childbirth & delivery, Pregnancy | No Responses »
Tags: , , , , , ,

Can A Myomectomy Prevent a Second Miscarriage?

Monday, February 18th, 2013

A miscarriage is a horrible experience for any woman. When the excitement of pregnancy is suddenly cut short by the unexpected news of loss, the grief is difficult to manage. Many women who go through this feel they need many months to heal after the ordeal, but some move on and feel ready to try again right away. Luckily, recurrent miscarriages are rare, but that’s not to say it’s easy to trust that the second pregnancy won’t go the same as the first.

Before we continue, let’s define some terms.  Miscarriage is a lay term for a “spontaneous” abortion, occurring before 20 weeks of gestation.  When most people hear the term “abortion”, they quickly recoil because they believe it to be an “induced” abortion, which is the loss of a pregnancy before 20 weeks by artificial methods.  Fibroid is a lay term for myoma, which is the appropriate term for a benign tumor of the smooth muscle of the uterus. This growth is not fibrous.

Studies show that women who had a miscarriage (spontaneous abortion) as a result of uterine fibroids (myomas) are more likely to have one in their second attempt. However, those same studies show that the surgical removal of said myoma can greatly increase a woman’s chances of having a live birth despite a previous miscarriage.

Fibroids (Myomas) are benign tumors that grow on the walls of the uterus, and they actually affect a significant number of adult women. Twenty-five percent of all women have myomata, with the percentage rising  to 50% in Black women.  When myomas grow into the uterine cavity and thus distorting the inner contour of the womb , they can cause miscarriages (spontaneous abortions). In other locations, such as growing on the outside of the uterus like Mickey Mouse ears (subserosal), they are absolutely harmless and women don’t even know they have them.

Once a doctor diagnoses myomas (myomata) as the cause of a spontaneous abortion (usually in the second trimester), he or she might recommend surgical removal before a second attempt at pregnancy. This surgery is technically called a myomectomy (not fibroidectomy), and it is a relatively safe procedure. Unfortunately, there is a 25% chance the myoma could come back over time, but in many cases, they don’t reappear until years later.   For further information about myomas and myomectomy, you are referred to my book, INSIDE INFORMATION FOR WOMEN on the topic.

If you have had one or more spontaneous abortions, your gynecologist should perform a comprehensive evaluation of your uterus to determine whether or not myoma played a role. This may include a sonohysterogram, and/or a hysterosalpingogram. Most often, spontaneous abortions are totally random, but in some cases, they are caused by an abnormality in the reproductive system. Should your doctor find intramural or submucosal myomata (myoma in the wall of your uterus), you should consider surgery before trying again. While a second attempt at pregnancy won’t make up for the disappointment of the first loss, addressing the problem and correcting it will go a long way in achieving a successful outcome.

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

 

Posted in Fertility & Infertility, Pregnancy | No Responses »
Tags: , , ,

Botox and Baby Bumps Don’t Mix

Monday, January 28th, 2013

If you’ve gotten Botox or any other medical skin firming treatments in the past, you might be tempted to get more when you become pregnant. Let’s face it, pregnancy might leave you feeling less than your best. Your favorite clothes will be in exile, and all of your hard work in preparation for swimsuit season will be on a beach vacation without you. Botox might seem like a quick solution to get you feeling like your young and vibrant self when you’re pregnant, but studies show that this is not a good idea. Experts agree that while there is no clear evidence of the dangerous effects of Botox on a developing fetus, there is also no clear evidence against them.

Collagen contains vitamins A, K or BHA, which should all be avoided during your pregnancy because their side effects are also not entirely understood. Alpha-hydroxy acid (AHA) is the only treatment cleared by medical experts for use during pregnancy, but even that can have seriously negative effects. It makes you more sensitive to the sun, and your skin is already so during pregnancy, so sunburn is highly likely.

It’s best to avoid any unnecessary medications or treatments during your pregnancy. Think of all the women who are absolutely beside themselves when they are diagnosed with a real illness and are forced to take prescribed medications during their pregnancy. They worry constantly about the effects on their baby, and there’s no reason you should put your little one at risk for vanity’s sake.

Believe your friends when they tell you that you look absolutely glowing because you probably do. There is no need for collagen or Botox during pregnancy. During gestation, your blood vessels will open up and cause swelling all over your body. This is bad news for your ankles, but excellent news for your face. Your cheeks will look rosy, and your lips will look soft and supple. In reality, pregnancy is a natural and safe form of Botox, and you’ll see results that money can’t buy. Enjoy this look now, because it’s the cheapest cosmetic improvement you’ll ever get.

– Yvonne S. Thornton, M. D., M. P. H.

Posted in Pregnancy | 1 Response »
Tags: , , ,

Avoid High Altitudes if You’re Expecting

Thursday, January 24th, 2013

If you’ve ever tried baking at a high altitude, you know that the decreased oxygen is truly enough to ruin a batch of cookies. When we travel to destinations that are 7,000 feet above sea level or more, our surroundings change drastically because there is less oxygen there than closer to the ground. You can imagine then the negative effects high altitude might have on women who are pregnant. Oxygen is absolutely vital to a baby’s development, which is why activities like smoking are so dangerous. Does this mean women who live at high altitudes have to move when they become pregnant?

If you’re pregnant and you live in a high altitude area such as Denver, you do not need to move to an area with more oxygen. Since you spend all of your time at that level, you’re used to the oxygen level, and your body has already adjusted itself to accommodate. Besides, high areas in the United States like Denver are only around 5,000 feet above sea level. Even women who are used to these high altitudes shouldn’t be traveling to areas any higher than what they’re used to though. If you’re pregnant and accustomed to lower lands, do not travel to high altitudes. Studies show that you could easily restrict oxygen flow to the baby by doing so, which could have serious consequences such as impaired fetal growth, preeclampsia, and fetal mortality. If you must travel to an area at a higher altitude while pregnant, make sure you take things very slowly and check in with your doctor beforehand. If you start to feel lightheaded or weak, sit down and spend as little time in the location as possible.

For the most part, travel during your pregnancy is safe, assuming you’re not going to be miles away from medical care around your due date. However, traveling to high altitudes you’re not used to could be dangerous because your baby needs as much oxygen as possible during your pregnancy. If you’re already used to high altitudes, don’t feel as though you need to move. Assuming you’ve been there for at least a few months, your body has already adjusted to meet the demands of lower oxygen levels.

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

Posted in Pregnancy | No Responses »
Tags: , , ,

Don’t Let Postpartum Depression Get the Best of You (And Your Baby)

Thursday, January 17th, 2013

You’ve been waiting nine long months, and you’ve finally had the baby you’ve always wanted. While you expect to be flooded with joy, you might find that you are stricken with fear, sadness, and even depression. If you have feelings of utter despair after delivery, you’re likely suffering from postpartum depression. Unfortunately, postpartum depression is difficult to predict and control, but it is not uncommon. There is absolutely no reason to be ashamed if you feel depressed, and you should bring it up to your doctor instead of hiding it. Research shows that trying to hide it makes the problem much worse and leaving it untreated could actually affect your baby’s behavioral development.

It’s obvious how postpartum depression will affect you. You might become withdrawn from your friends, uninterested in otherwise exciting activities, and you could resort to stress activities such as overeating. However, studies show that postpartum depression has a profoundly negative effect on babies, as well. When babies are born to mothers affected by this type of depression, they will have more cognitive development deficits and behavioral problems when they turn one than babies who were born to unaffected mothers. These developmental problems are measured by social behavior, fear, and stress reactivity, which are all indicators of life problems later down the line.

You might feel ashamed to admit that you have postpartum depression because you’ll feel like it makes you look like an inadequate mother. Doctors know that this is not the case, and that postpartum depression is actually a result of hormonal imbalances brought on by the pregnancy itself. Don’t be afraid to bring it up as soon as you start to feel sad. Early detection will lead to early treatment, which will let you get back to your new job as a mom sooner. By taking care of it early, you’ll help your baby develop more normally because you will not be hindered by the feelings of depression. No one will doubt your abilities as a mother when you admit that you’re feeling depressed. Instead, they will respect your courage and honesty and help you get to a mental state where you can raise your child as you know you should.

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

Posted in Pregnancy, Women's health issues | No Responses »
Tags: , ,

Apgar Scores May Predict ADHD

Thursday, October 25th, 2012

As you’re nearing the end of your pregnancy, you’ll probably be relieved in some ways. You’ll be able to lift your own ban on caffeine, start working back towards your normal body weight, and say goodbye to the relentless back pain. At the same time, you might be nervous about entering motherhood. There are many questions you’ll need to know the answers to upon your baby’s birth, and motherhood will become your new unpaid – albeit wonderful – full time job. One concern many mothers have as their baby starts to develop is the risk for attention deficit hyperactivity disorder (ADHD).

Many kids are prescribed with different medications for ADHD, and there is endless controversy surrounding it. Unfortunately, the disorder affects many children and their ability to learn in a classroom setting, so it can be detrimental if left untreated. The worst part is that we as physicians are unable to find the cause for the condition. However, one recent study suggests that you might get a clue about your child’s susceptibility to ADHD right after birth.

After you’ve given birth, your doctor will perform an Apgar examination. The test measures your baby’s vital signs such as his or her heart rate, muscle tone, and breathing. Essentially, it is a score that measures the health of your baby immediately after birth at 1 and 5 minutes.   It tells the pediatrician whether or not your newborn needs to be resuscitated because it doesn’t demonstrate the essential hallmarks.  Your baby will be ranked on a scale of 1-10, and babies with a score under 7 need additional medical attention. Amazingly, the results of the recent ADHD study show that children with a low Apgar score immediately after birth are more likely to develop the disorder later in life. Even in children with a score of five or six, their risk was 63% higher than those with a score above seven.

If your baby is born with an Apgar score below seven, you shouldn’t immediately assume that he or she will suffer from ADHD. Instead, you should be prepared and look for signs as your child grows up that he or she might need some assistance in school. Being a good mom is tough, but knowing in advance that your child is at risk makes your job a little easier. The low Apgar score could be a sign that there were some developmental problems in the womb, and you should assist your child accordingly should any learning disabilities present themselves.

– Yvonne S. Thornton, M. D., M. P. H.

Posted in Parenting, Pregnancy | No Responses »
Tags: , ,

« Older Entries
Newer Entries »