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When New Moms – or New Dads – Get the Pregnancy Blues

Friday, May 21st, 2010

Most women are familiar with the term post-partum depression.  Start with all the stresses of adding a new member to the family – not just the financial burden, but the schedule upheaval, the sleep deprivation, and the demands of a tiny person who can only make his or her needs known by wailing. Add the wild surge of hormones flooding a woman’s body, and is it any wonder that she might not be the picture of serenity and assurance? Estimates vary on the prevalence but as many as 25 percent of new moms may experience some level of depression either before or after delivery.

That’s bad enough, but now a study suggests that new fathers, just like new mothers, can find themselves overwhelmed when baby makes three (or more).

“The study, published in the Journal of the American Medical Assn., found that 10.4% of men experienced serious depression at some point between his partner’s first trimester and one year after childbirth, more than double the depression rate for men in general. American men were more likely to experience prenatal or postpartum depression compared with men in other countries, 14.1% in the U.S. compared with 8.2% internationally.”

What can you do when the guy you depend upon to keep you sane is going through his own blue period?

Your most important step –the one you should take if either you or your partner starts to feel sadness, agitation or hopelessness – is to talk to your doctor. Don’t try to tough it out. Reach out for help at the first signs that something isn’t quite right. It’s possible that all you need to get back to your cheery old selves is a good night’s sleep, but sometimes, you need more. The good news is that help is available. But first, you have to be aware of the signs of depression.

Post-partum depression can be debilitating if you let it go, so take steps immediately to get yourself and your new family back into the swing of enjoying things together again.

– Yvonne S. Thornton, MD, MPH

Posted in Childbirth & delivery, General health news, Pregnancy, Women's health issues, Women's health news | No Responses »
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How late can you wait to have a baby?

Tuesday, April 13th, 2010

Today, many women are delaying starting families, most likely due to career and  economic concerns. Pregnancy rates are down in all age groups except for those 40 to 44 years of age, says the CDC, where pregnancy rates are up by 4 percent.

With all those over-40 women having babies, does this mean you can wait indefinitely if you hope to get pregnant? Not really.  A woman’s peak of fertility is about 25 years of age.  After that, “it’s all downhill.”  The likelihood of becoming pregnant drops dramatically well before you reach menopause, which is what many women think of as the end of their fertile years. A great number of those after-40 pregnancies are the results of medical interventions such as in vitro fertilization and donor eggs from 25 year olds.  Unlike our male counterparts who keep producing new sperm every 74 days, women are given their complement of eggs way before they are even born and there are no more new eggs to be produced.   Therefore, at 36 years of age, a woman’s eggs are 36+ years old with all the attendant risks that accompany any aging process.  According to the March of Dimes:

“At age 25, a woman has about a 1-in-1,250 chance of having a baby with Down syndrome; at age 40, the risk increases to 1-in-100 chance; and at 45, the risk  of carrying a child with a chromosomal anomaly such as Down syndrome, continues to rise to 1-in-30 chance.”

The advent of artificial reproductive technologies virtually transforms a woman’s “biological clock” into a perpetual calendar, but not without risks.  In studies, babies born via in vitro fertilization have been shown to have a higher risk of birth defects.

If an older woman doesn’t mind having a baby who carries none of her DNA, she may opt for a donor egg from a younger woman, which is then fertilized by her husband and the embryo transferred into her uterus.  Many of the older celebrities have chosen this route for their family planning.

Medical interventions, while they seem miraculous when they work, aren’t guaranteed to be successful. Just as in getting pregnant the old-fashioned way, your chances of success drop the older you are.  In vitro fertilization will result in a live birth among women past 40 only 6 to 10 percent of the time versus a 30 to 35 percent success rate among women younger than 35.

Nature’s message is clear, and unfortunately, it doesn’t offer any leeway in difficult economic times or while you are working your way up the corporate ladder: if you want to start a family, you’re more likely to be successful if you begin well before you turn 40.

– Yvonne S. Thornton, MD, MPH

Posted in Childbirth & delivery, Fertility & Infertility, Pregnancy, Women's health issues, Your newborn baby | 1 Response »
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Compared to white babies, twice as many African-American babies die in their first year of life

Monday, January 18th, 2010

As we celebrate the birthday of one of America’s greatest African-American leaders, Dr. Martin Luther King, and we take pride in the leadership of our first African-American president, Barack Obama, it’s easy to assume that racial disparities are a thing of the past.

But our infant mortality rates tell us that that’s not so.

According to the Centers for Disease Control (CDC), infant mortality among African-American babies is more than twice that of white babies. Among the other troubling statistics in the CDC report:

  • African Americans had 1.8 times the sudden infant death syndrome mortality rate as non-Hispanic whites, in 2005.
  • African American mothers were 2.5 times more likely than non-Hispanic white mothers to begin prenatal care in the 3rd trimester, or not receive prenatal care at all.
  • The infant mortality rate for African American mothers with over 13 years of education was almost three times that of Non-Hispanic White mothers in 2005.

America is still a country where people of color face discrimination at every turn, even if it’s less overt than it was in our past. Bias limits educational opportunities, employment opportunities, and it even limits the opportunity of pregnant women to get access to good healthcare.

If Dr. King could see us today, I know he’d be pleased at how far we’ve come. But if we haven’t provided our youngest and most vulnerable citizens equality in medical care, we still have a long way to go.

– Yvonne S. Thornton, MD, MPH

Posted in Childbirth & delivery, General health news, Pregnancy, Women's health issues, Your newborn baby | 1 Response »
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Leading Ob-Gyn Group Backs Findings of My Weight Gain in Pregnancy Study

Tuesday, January 12th, 2010

Last June, in the Journal of the National Medical Association, I published the results of clinical trials that showed that it was safe for obese pregnant women who followed a well-balanced diet to gain little or no weight. Prior to my study, the conventional wisdom was that all women, even obese ones, should gain 26 to 35 pounds. That guidance had come from the most august body of ob-gyns in the U.S., The American College of Obstetricians and Gynecologists (ACOG), whose recommendations were based upon what we knew in the 1980s. That was before we fully understood the dangers of obesity in pregnancy. Yet, the guidelines had never been updated.

Being obese during pregnancy greatly increases the risks of preeclampsia, diabetes, stillbirth, and blood clots, among other problems. Gaining more weight if you’re already obese makes complications more likely while limiting weight gain makes them less so.

But until my study was published, obstetricians lacked the evidence that limiting weight gain among pregnant women was safe. The ACOG’s guidance from the 1980s stated that, unless a woman, obese or not, gained at least 26 pounds, the baby in her womb would be at risk of dying.

Right before my study results were published, a government body recommended that obese women gain somewhat less weight: between 11 and 20 pounds. It was a start but still not enough. And most board certified obstetricians would wait for the ACOG to – you’ll excuse the pun – weigh in before they changed their practices.

I’m delighted to say that, in a commentary in the peer-reviewed journal Obstetrics & Gynecology, the ACOG has just come out in favor of limiting weight gain among obese pregnant women. My study, which was quoted in the commentary, appears to have been instrumental in effecting this turnaround.

Now that the ACOG is changing its recommendations, obstetricians are more likely to change how they manage their patients. Fewer women will be told that it’s fine to gain weight during pregnancy if you’re already obese. And that will mean healthier moms and healthier babies.

I’m proud to have played a role in helping to make this happen.

– Yvonne S. Thornton, MD, MPH

Posted in Childbirth & delivery, Pregnancy, Women's health issues, Women's health news, Your newborn baby | 1 Response »
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Yvonne Thornton on the Dr. Nancy Show: Should Pregnant Girls Play Contact Sports?

Thursday, December 10th, 2009

Today on Dr. Nancy, I was invited to appear to discuss a controversial issue. A young pregnant woman, whose high school took precautions against injury to her fetus by treating her differently than other girls on her volleyball team, has filed a complaint, claiming discrimination.

On the show, Dr. Nancy and I explained why this isn’t a discriminatory action but an appropriate one that protects the health of mother and fetus. Although some may not think of it this way, volleyball can be a contact sport. A player can get an elbow shoved into her abdomen when someone else reaches for the ball. A player can get pushed down on the court. There is always risk of injury but for most young women, the risk is minimal. Not so with a young pregnant woman. She risks harm to her fetus in the rough and tumble of such competitive sports.

While exercise is good for a pregnant woman’s health, contact sports are not, certainly not when the sorts of things we see happening in games have the potential to injure a fetus.

This isn’t a women’s rights issue. Dr. Nancy and I are both staunch defenders of women’s rights. It’s about keeping a baby and mother safe.

– Yvonne S. Thornton, MD, MPH

Posted in General health news, Media appearances, Pregnancy, Women's health issues, Women's health news | No Responses »
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Pregnancy and Swine Flu: a Dangerous Combination

Friday, December 4th, 2009

The word from the Centers for Disease Control is that women who are pregnant are at high risk from the H1N1 virus, also known as the swine flu.

If you’re pregnant, you need to get vaccinated with both the seasonal and the H1N1 vaccines. It’s the single best way to protect yourself and your baby from the flu. And don’t let the anti-vaccination rumors swirling around the Internet scare you into delaying or avoiding a flu shot. According to the CDC, the seasonal flu vaccine has been administered to millions of women and has not been shown to harm women or their babies. The 2009 H1N1 flu shot is made in the same way and in the same places as the seasonal flu shot.  You may receive both flu shots at the same time; however, they should be given at different sites on your body, e.g., left arm and right arm.

Although recent cases of swine flu have been diminishing, influenza epidemics tend to come in waves. So even if there are few new cases of the flu in your area, it may just be a lull and you could get hit by the next wave. Get vaccinated now, if the vaccines are available in your area. Get everyone in your household vaccinated to prevent the disease from spreading among family members. Babies under 6 months of age are too young to get the vaccine so it’s especially important to their health that other members of the household are vaccinated to protect against family members spreading the virus.

Here are some other ways you can protect yourself from the germs all around us.

  • Wash your hands often with soap and water. Or use small bottles of alcohol-based hand sanitizer you can carry in your purse.
  • If you have flu symptoms, call your doctor immediately. Pregnant women tend to get more serious cases of this flu and it’s important to get treatment. Your doctor can prescribe medicines that will help.
  • Don’t assume that, just because you don’t have a fever, you don’t have the flu. This flu doesn’t always cause fever.
  • Try to avoid contact with others who appear ill. If someone in your family gets sick, ask your doctor to prescribe medications that may prevent you from getting sick, too, such as Tamiflu® or Relenza®.
  • Cover your nose and mouth with a tissue when you cough or sneeze and throw the tissue away immediately. If a tissue isn’t available, sneeze into your sleeve, not your hand.
  • Keep your cabinets well stocked with non-perishable foods as well as other basics and medicine that you might need if you got sick.

The CDC warns that if you are pregnant and experience any of the following, you must call 911 immediately:

  • Difficulty breathing or shortness of breath
  • Pain or pressure in the chest or abdomen
  • Sudden dizziness
  • Confusion
  • Rapid pulse over 100 beats per minute
  • Severe or persistent vomiting
  • A high fever that is not responding to Tylenol®
  • Decreased or no movement of your baby

Just remember, the nasal spray vaccine is not licensed for use by pregnant women because it is a live, attenuated virus. Pregnant women should not receive nasal spray vaccine for either seasonal flu or 2009 H1N1 flu. After delivery, women can receive the nasal spray vaccine, even if they are breastfeeding.

In summary, get vaccinated, practice good hygiene, and call your doctor immediately if you get sick, and you and your baby should come through this flu season just fine.

– Yvonne S. Thornton, MD, MPH

Posted in General health news, Pregnancy, Women's health issues, Women's health news, Your newborn baby | No Responses »
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Labor & Delivery: Don’t try this at home

Monday, November 30th, 2009

Most women today have no idea how dangerous it once was for a woman to give birth. The maternal death rate today is about eight per 100,000 births.  When home births were in style, the maternal death rate was 83 per 100,000 births – 10 times the number of deaths.

Women today almost never die in childbirth because, when things go wrong during labor and delivery, medical professionals can step in and prevent emergencies from becoming tragedies.

Which is why I want to scream when I read nonsense like the following, from a website calling itself “Born Free.”


“Welcome to Bornfree! This site is based on the belief that childbirth is inherently safe and relatively painless provided we don’t live in poverty, and do not interfere either physically or psychologically. Drugs, machinery, and medical personnel are not only unnecessary in most cases, they are also no match for a woman’s own intellect and intuition.”

The site quoted above advocates for unassisted childbirth at home. No doctor. No midwife. And no professional help at the ready if something goes wrong.

Ordinarily, I wouldn’t get too exercised over an obscure website. But, it’s how I found this website that has me troubled. It was featured in an article on ABC News.com in the “Entertainment” section. The article mostly extolled the concept of women giving birth at home, with neither a midwife nor a doctor present, giving only the briefest nod to the caveats from an ob-gyn.

In the age of reality TV, maybe a piece about women risking their lives to experience “freebirth” makes good copy. Maybe, because it was in the Entertainment section, this quote from a mother who recently gave birth on her own didn’t raise any eyebrows: “…it is not risky if you do your homework.”

But ask an ob-gyn and you’ll get a much different albeit less entertaining quote.

Yes, so-called “freebirth” is risky. And no, you can’t mitigate the risk by doing “homework.” Approximately 40 percent of high-risk patients appear to be low-risk before labor and delivery. No amount of “homework” can prepare a woman for suddenly finding herself among those 40 percent. If she’s at home, without medical attention, she and her baby could be in serious danger.

Most certified nurse midwives are affiliated with hospitals today precisely because the unexpected can and does happen during childbirth and having medical and surgical teams within shouting distance can mean the difference between life and death. The birthing process is still the 11th leading cause of death in women between 15 and 44 years of age.

When I was in the military, we received a stat call about a home birth gone wrong. The woman lost all muscle tone in her uterus after the birth of her child. By the time the ambulance got her to Bethesda, she had bled to death.

So I’ve seen firsthand how “freebirth” can be a recipe for disaster.

– Yvonne S. Thornton, MD, MPH

Posted in Childbirth & delivery, General health news, Pregnancy, Women's health issues, Women's health news, Your newborn baby | No Responses »
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CVS: a first trimester alternative to amniocentesis

Tuesday, August 25th, 2009

Amniocentesis (amnio) is a test that identifies the presence of a chromosomal or genetic defect in the growing fetus, such as Down Syndrome or Tay-Sachs disease.

But amniocentesis can’t be done until a woman is between 16 and 20 weeks pregnant. If a serious problem is found, and the patient chooses not to continue with the pregnancy, then it is a more involved procedure than during the first trimester. And it can be more heart wrenching to have to make such a decision after investing so much hope in a pregnancy that has progressed to 18 or 20 weeks.

What many prospective parents don’t realize is that there is an alternative to amniocentesis that can be done during the first trimester, as early as 10 weeks. It’s called chorionic villus sampling (CVS). It’s about as safe as amniocentesis. Either procedure (CVS or amnio) has a fetal loss rate (miscarriage) of less than 1%. And, in most cases, CVS can be as good a choice or better.

As one of the investigators for FDA trials of the procedure in the mid-1980s, I was among the first physicians in the U.S. to gain significant experience in chorionic villus sampling.

If you are older than 35 and your ob-gyn has recommended prenatal genetic testing but hasn’t offered this alternative to you, it may be because fewer physicians are trained in CVS than in amnio.

But you and your pregnancy should not be penalized just because your physician does not perform CVS.

If you’d prefer to have chorionic villus sampling, check with one of the major academic medical centers in your area where CVS is more likely to be performed regularly. And be sure to have it done by a physician who has over 100 procedures under his or her belt, because the procedure has a steep learning curve. The miscarriage rate is directly related to the experience of the person performing CVS.

The advantage with CVS is that you will know the results of the test within a week, while you are still in your first trimester.

– Yvonne Thornton, MD, MPH

Posted in Pregnancy, Women's health issues | 1 Response »
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Why your Ob-Gyn should be board-certified

Wednesday, July 22nd, 2009

It’s almost impossible to judge a professional’s skills if you’re not a member of that profession. Only a radiologist can say whether another radiologist accurately read a CT scan. Only a dentist can attest to the quality of the crown another dentist fits over a molar.

So how do you, a layperson, judge the qualifications of your doctor? If they drive fancy cars, wear designer clothes, and charge the highest fees in the community, you can be sure they’re successful. But does that mean they’re qualified? You can ask your girlfriends or your sister or mother to recommend someone. You can determine whether you have rapport with a physician. But that won’t tell you about qualifications, either.

If you want to know whether the kind, caring person you select has the minimum qualifications, there’s one way to determine that. Go here to see whether your doctor is board-certified.

Board certification isn’t mandatory. Once a doctor gets a medical degree and a state license to practice medicine and surgery, he or she can practice any specialty. No law requires a doctor to complete a four-year residency in a specialty, such as ob-gyn, in order to be called a specialist. Nothing prevents a doctor from giving him or herself the title of obstetrician or fertility expert or perinatal specialist or really, almost anything.

But only board certification assures you that the doctor has earned that title.

A board certified doctor has gone a giant step further than a physician who hasn’t passed her boards. After completing a residency program, passing a written test in the specialty, and practicing for a year or two, she’s gathered up all her cases and submitted them to an august body known as the American Board of Obstetrics and Gynecology. Before these distinguished university professors and chairs of departments, she’s been extensively questioned about real and hypothetical situations and asked about diagnoses, patient management and treatment.

As an oral examiner for the American Board of Ob-Gyn since 1997, I’ve certified hundreds of new ob-gyn candidates who have proven their capabilities under difficult circumstances. And there were some who did not pass because they didn’t meet those high standards.

So I speak from experience when I say that board certification is the minimum you should expect from your doctor.

– Yvonne S. Thornton, MD, MPH

Posted in Childbirth & delivery, Contraception (birth control), Fertility & Infertility, Hormone replacement therapy, Menstruation, Pregnancy, Women's health issues, Women's health news, Your newborn baby | No Responses »
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Daily sex for healthier sperm?

Monday, July 6th, 2009

A new study by an Australian fertility expert, Dr. David Greening of Sydney IVF, has caused a bit of a stir. Greening studied 118 men whose sperm had greater than average DNA damage and found that, when they ejaculated daily, the resulting sperm was healthier.

All well and good so far but Greening’s prescription for greater fertility success made me cringe in empathy for my patients who are trying to get pregnant.

Greening recommends that couples engage in sex every day to improve their chances of conceiving.

Maybe it takes a woman to understand that this isn’t the greatest advice in the world. Too many women come to my office, sore and miserable, because their husbands want to do it every day. They don’t want to say no when they’re on a mission to conceive. And now, this (male, you’ll notice) doctor is saying this is the best way to go?

All right ladies, sit down (if you’re not too sore), because you don’t have to take Greening’s advice. Greening’s findings were that daily ejaculation improves sperm quality, not daily sex.

If you and the man you love want to improve your chances of conception, having intercourse three times a week is plenty.

Don’t look at clocks; don’t look at calendars and yell, “Honey, get in here quick, I’m ovulating.” That causes so much performance dysfunction for men. And it’s completely unnecessary.

All it takes is one sperm. Men ejaculate about 60 million of those little guys at a time. And the sperm hang around, ready to jump on that egg when it appears, for up to seven days. So, even though, when we ovulate, the egg is only fertilizable for up to 24 hours, it doesn’t mean that conception is now or never. With up to 60 million sperm hanging around waiting, one of them is likely to be in the right spot when the ovum shows up.

Most important for couples who want to conceive is to remember that sex, even when you’re on a baby-making mission, should never be a chore. Make sure neither of you skimps on romance, cuddling and cooing. In other words, keep the love in making love. It should be as much fun today as it was the first time (even if that first time was in the back seat of a vintage Chevy). Relax and enjoy the experience and each other. Soon enough, if neither of you has problems with fertility, baby will make three.

– Yvonne S. Thornton, MD, MPH

Posted in Fertility & Infertility, General health news, Pregnancy, Women's health issues | No Responses »
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