Sunday, December 25, 2011
Be Ready to Birth!: Induction, why, how, when
Be Ready to Birth!: Induction, why, how, when: I have been getting a lot of questions about inducing labor. It seems that providers are offering thirty-nine week inductions at the same ti...
Induction, why, how, when
I have been getting a lot of questions about inducing labor. It seems that providers are offering thirty-nine week inductions at the same time that the March of Dimes is strongly campaigning against it. I hear why questions and how questions and especially when questions. As always, if you have trusted your providers to manage this pregnancy, I think you must trust them to manage the labor and delivery. However, I also believe in empowering yourself with the facts to understand their rationales and question whether you do have choices. Or not.
A pregnancy is forty weeks, give or take about two. Postterm is defined as forty-two weeks. You may be more likely to be postterm if this is your first pregnancy, dates of last menstrual period are vague or you've had overdue pregnancies before. It may be that this is a familial trait; you are at risk for postterm pregnancy if you are obese. Once again, the "Y" gene can be blamed; it seems that there are more boys who are postterm.
Sometimes it is a medical issue with the placenta or the baby. That's why you are monitored so closely when your pregnancy goes beyond about forty weeks. Whatever the cause for your lingering pregnancy, it will end. But everyday can feel like an eternity when your back aches and your feet swell. You are "over" the heartburn and the hemorrhoids, anxiety, nightmares and insomnia. The nursery is getting dusty and every well-meaning relative calls hourly for an update. Don't forget all the strangers in the mall who insist that you must be having twins. You'd know by now.
Prenatal care for postterm pregnancies may be taken up a notch. You might be seen two times a week, a perinatalogist my see you one time and your provider the next. You will have ultrasounds to determine baby's well-being and fluid levels. You'll be watched for signs of preeclampsia. Kick counts are important and so is fetal heart monitoring. Although it's not a great indicator of when you'll deliver, your cervix will be checked for effacement and dilatation.
Your team will determine, if weighing the benefits against the risks, that inducing the labor is best for the outcome of your pregnancy. Baby's size might be a time to consider induction. Perhaps fluid levels are too low or the placenta is aging. Meconium becomes more prevalent, with inherent complications. Ask your provider why the induction is preferred.
With first pregnancies, you may be looking at a two day induction. The cervix is checked and if it is determined that it needs some softening -up, then cervidil may be utilized to get that cervix ready the night before pitocin ( synthetic contraction hormone ) is ordered. Sometimes the cervix just gets a nudge, if it is open enough for an amniotomy ( breaking the bag of water ). That may be all it takes.
You and your provider will determine together what the best course is for this pregnancy. It is possible that this pregnancy will be overdue. It's okay to be disappointed and frustrated. Stay busy, keep working and enjoying a social life. Plans can be broken, so don't hesitate to make them. Change your voicemail greeting and update facebook so that everyone knows your status without the bother of all those inquiries.
Be proactive and monitor kick counts, notify your provider if you might be leaking fluid. Know the signs of labor but don't be afraid to call as much as you need to. I am fond of reminding patients that you are not issued a coupon book for phone calls or office visits. Err on the side of caution. And run any home remedies by your doctor or midwife before you decide to take this labor into your own hands. Many home remedies don't work and some may even be detrimental especially if your body isn't ready for labor.
Rest assured, you will not be the first woman in history to never deliver her baby. One way or another, this pregnancy will end. It's a terminal condition.
A pregnancy is forty weeks, give or take about two. Postterm is defined as forty-two weeks. You may be more likely to be postterm if this is your first pregnancy, dates of last menstrual period are vague or you've had overdue pregnancies before. It may be that this is a familial trait; you are at risk for postterm pregnancy if you are obese. Once again, the "Y" gene can be blamed; it seems that there are more boys who are postterm.
Sometimes it is a medical issue with the placenta or the baby. That's why you are monitored so closely when your pregnancy goes beyond about forty weeks. Whatever the cause for your lingering pregnancy, it will end. But everyday can feel like an eternity when your back aches and your feet swell. You are "over" the heartburn and the hemorrhoids, anxiety, nightmares and insomnia. The nursery is getting dusty and every well-meaning relative calls hourly for an update. Don't forget all the strangers in the mall who insist that you must be having twins. You'd know by now.
Prenatal care for postterm pregnancies may be taken up a notch. You might be seen two times a week, a perinatalogist my see you one time and your provider the next. You will have ultrasounds to determine baby's well-being and fluid levels. You'll be watched for signs of preeclampsia. Kick counts are important and so is fetal heart monitoring. Although it's not a great indicator of when you'll deliver, your cervix will be checked for effacement and dilatation.
Your team will determine, if weighing the benefits against the risks, that inducing the labor is best for the outcome of your pregnancy. Baby's size might be a time to consider induction. Perhaps fluid levels are too low or the placenta is aging. Meconium becomes more prevalent, with inherent complications. Ask your provider why the induction is preferred.
With first pregnancies, you may be looking at a two day induction. The cervix is checked and if it is determined that it needs some softening -up, then cervidil may be utilized to get that cervix ready the night before pitocin ( synthetic contraction hormone ) is ordered. Sometimes the cervix just gets a nudge, if it is open enough for an amniotomy ( breaking the bag of water ). That may be all it takes.
You and your provider will determine together what the best course is for this pregnancy. It is possible that this pregnancy will be overdue. It's okay to be disappointed and frustrated. Stay busy, keep working and enjoying a social life. Plans can be broken, so don't hesitate to make them. Change your voicemail greeting and update facebook so that everyone knows your status without the bother of all those inquiries.
Be proactive and monitor kick counts, notify your provider if you might be leaking fluid. Know the signs of labor but don't be afraid to call as much as you need to. I am fond of reminding patients that you are not issued a coupon book for phone calls or office visits. Err on the side of caution. And run any home remedies by your doctor or midwife before you decide to take this labor into your own hands. Many home remedies don't work and some may even be detrimental especially if your body isn't ready for labor.
Rest assured, you will not be the first woman in history to never deliver her baby. One way or another, this pregnancy will end. It's a terminal condition.
Tuesday, December 20, 2011
Be Ready to Birth!: More About Genetic Testing and Eastern European Je...
Be Ready to Birth!: More About Genetic Testing and Eastern European Je...: I got a lot of comments about last week's blog and a lot of questions about why I didn't cover specific Jewish genetic disorders. So, here g...
More About Genetic Testing and Eastern European Jewish Ancestry
I got a lot of comments about last week's blog and a lot of questions about why I didn't cover specific Jewish genetic disorders. So, here goes and if any of you want more on anything, the best way to let me know is to contact me via my website @ barbara@readybirth.com. If I don't have the information that you need, I will research it for you.
One out of every Eastern Eurpean Jew is a carrier for a Jewish genetic disease. Big numbers. These disorders are all autosomal recessive which means that both parents must have the gene as part of their own genetic make-up. Not the disease, the gene. If one parent is a carrier of the gene and the other isn't, there is no way your infant will have the disease, but he could be a carrier. If both parents are carriers of the gene they may have a child with the disease, produce a carrier child or have a child without the gene. But the important thing to remember is that it takes two parents with the gene to produce a child with the disease.
The diseases include disorders that can cause early childhood demise, chronic debility and premature death in adulthood. There is no cure for these disorders. They include: Bloom Syndrome which causes death around thirty years of age after a miserable childhood characterized by short stature, sun-sensitive facial lesions, lowered immune system and increased incidence of leukemia.
Canavan's which is a neurologic disorder that is progressive andleads to degeneration of the brain and nervous system. Early in life there is loss of developmental skills, poor muscle tone, feeding difficulties and seizures. Death usually occurs within the first two decades.
Cysytic Fibrosis is a chronic disorder which affects the respiratory, and digestive and reproductive systems. Life expectancy is about forty years after a childhood of recurrent respiratory infections and impaired digestion and thus nutrition.
Familial Dysautonomia affects the autonomic and sensory nervous systems. Death often occurs in childhood but may be delayed until early adulthood. There is impaired pain perception, vomiting and lack of tears, unstable blood pressure and body temperature and growth retardation.
Fanconi's Anemia causes bone marrow failure, a predisposition to leukemia and other cancers. Children may be short in stature, have kidney, heart and limb abnormalities, learning disabilities and mental retardation.
Gaucher Disease is the most prevalent of all the Jewish disorders. Spleen and liver enlargement, anemia, bruising, fatigue, increased bleeding, bone pain and fractures are all part of the variable symptom complex. Age at onset and severity of the disease are highly variable also.
Glycogen Storage Disease is a metabolic disorder that requires a lifetime of management with a very strict diet. It can cause low blood sugar, enlarged liver, anemia, bleeding and growth failure.
Maple Syrup Urine Disease is due to a malfunction of amino acid metabolism, characterized by urine that smells like maple syrup. Again, it must be treated with strict dietary restrictions. It can cause irritability, lethargy, seizure and coma.
Mucolipidosis is anothe rdisorder of the brain and nervous system. It is usually detected in the first year of life and is quite variable as to severity and lifespan. There may be eye and vision problems, mental and physical retardation.
Niemann-Pick Disease is a neurodegenerative disorder that causes death between two and four years of age. Failure to thrive is seen very early in childhood accompanied by mental and physical retardation.
Tay-Sachs has an average lifespan of six years. Sypmtoms usually occur by six to eight months of age and deterioration is rapid: blindness, deafness, seizures, mental retardation.
Bad stuff. Carrier testing is done with a blood sample. All childbearing Jews of Eastern European ancestry should be tested for carrier status. Best done pre-pregnancy. There is prenatal testing for a pregnancy where both parents are carriers of a disease. Request a blood test for carrier status if you are of Jewish Eastern European ancestry. Simple to do, way before you even are engaged. Get it, if you are having unprotected sex ( another blog ) that could result in a pregnancy. If you are positive have your partner tested. If you both are positive, request genetic counseling. No excuses. End of story.
One out of every Eastern Eurpean Jew is a carrier for a Jewish genetic disease. Big numbers. These disorders are all autosomal recessive which means that both parents must have the gene as part of their own genetic make-up. Not the disease, the gene. If one parent is a carrier of the gene and the other isn't, there is no way your infant will have the disease, but he could be a carrier. If both parents are carriers of the gene they may have a child with the disease, produce a carrier child or have a child without the gene. But the important thing to remember is that it takes two parents with the gene to produce a child with the disease.
The diseases include disorders that can cause early childhood demise, chronic debility and premature death in adulthood. There is no cure for these disorders. They include: Bloom Syndrome which causes death around thirty years of age after a miserable childhood characterized by short stature, sun-sensitive facial lesions, lowered immune system and increased incidence of leukemia.
Canavan's which is a neurologic disorder that is progressive andleads to degeneration of the brain and nervous system. Early in life there is loss of developmental skills, poor muscle tone, feeding difficulties and seizures. Death usually occurs within the first two decades.
Cysytic Fibrosis is a chronic disorder which affects the respiratory, and digestive and reproductive systems. Life expectancy is about forty years after a childhood of recurrent respiratory infections and impaired digestion and thus nutrition.
Familial Dysautonomia affects the autonomic and sensory nervous systems. Death often occurs in childhood but may be delayed until early adulthood. There is impaired pain perception, vomiting and lack of tears, unstable blood pressure and body temperature and growth retardation.
Fanconi's Anemia causes bone marrow failure, a predisposition to leukemia and other cancers. Children may be short in stature, have kidney, heart and limb abnormalities, learning disabilities and mental retardation.
Gaucher Disease is the most prevalent of all the Jewish disorders. Spleen and liver enlargement, anemia, bruising, fatigue, increased bleeding, bone pain and fractures are all part of the variable symptom complex. Age at onset and severity of the disease are highly variable also.
Glycogen Storage Disease is a metabolic disorder that requires a lifetime of management with a very strict diet. It can cause low blood sugar, enlarged liver, anemia, bleeding and growth failure.
Maple Syrup Urine Disease is due to a malfunction of amino acid metabolism, characterized by urine that smells like maple syrup. Again, it must be treated with strict dietary restrictions. It can cause irritability, lethargy, seizure and coma.
Mucolipidosis is anothe rdisorder of the brain and nervous system. It is usually detected in the first year of life and is quite variable as to severity and lifespan. There may be eye and vision problems, mental and physical retardation.
Niemann-Pick Disease is a neurodegenerative disorder that causes death between two and four years of age. Failure to thrive is seen very early in childhood accompanied by mental and physical retardation.
Tay-Sachs has an average lifespan of six years. Sypmtoms usually occur by six to eight months of age and deterioration is rapid: blindness, deafness, seizures, mental retardation.
Bad stuff. Carrier testing is done with a blood sample. All childbearing Jews of Eastern European ancestry should be tested for carrier status. Best done pre-pregnancy. There is prenatal testing for a pregnancy where both parents are carriers of a disease. Request a blood test for carrier status if you are of Jewish Eastern European ancestry. Simple to do, way before you even are engaged. Get it, if you are having unprotected sex ( another blog ) that could result in a pregnancy. If you are positive have your partner tested. If you both are positive, request genetic counseling. No excuses. End of story.
Monday, December 12, 2011
Be Ready to Birth!: What in the heck is a triple screen anyway?
Be Ready to Birth!: What in the heck is a triple screen anyway?: Every couple must decide on whether to ask for the triple screen at the end of the first trimester. Often, the doctors office doesn't have t...
What in the heck is a triple screen anyway?
Every couple must decide on whether to ask for the triple screen at the end of the first trimester. Often, the doctors office doesn't have the time to explain what the test is all about; they had you a packet of information with an insert about it and its put away with all the other inserts. When you present for your 12-13 week appointment, they want to know if you are having the test and you are clueless. So, inthe interest of all those folks who call me for answers, here is a tutorial on the triple
There are still some "birth defects" that we cannot predict in utero. No way to determine if your child is going to develope autism, yet. Ultrasound has given us wonderful windows into in utero development that has been invaluable in detecting abnormalities in a comparitively young pregnancy. There are some tests that can be used for detecting chromosomal defects as early as twelve weeks gestation. Although studies pointing to advanced maternal age as a significant risk factor some some chromosomal abnormalies, The American College of Obstetricians and Gynecologists recommends the test to all pregnant women, regardless of their age.
The triple screen determines increased risk for trisomy 13, 18 and 21. What are these defects? What do they affect? Why is testing considered important? How is it done?
Is this the MSAFP test? If not, what is that for and how is that done? What do all these results mean. Is there anything I can do?
Trisomy 13 is caused by having an extra copy of chromosome 13; one more than a normal baby. It has a very poor prognosis with a life expectancy of under a year. These babies have mental retardation and multiple physical abnormalities which may include their heart, brain, spinal cord, eyes, extra digits, deformed mouths and weakened muscles. It is sometimes called Patau syndrome.
Trisomy 18 is called Edwards syndrome, which is caused by an extra chromosome 18. About fifty percent of babies with this syndrome are stillborn. If they live through childbirth, they face life-threatening complications that include cardiac abnormalities, deformities of hands and feet and the digestive system. Some have kidney problems and retarded growth and mental development.
Down's syndrome is trisomy 21 which is an extra copy of chromosome 21. There are more than 400,000 people in the US who have Down's problems including heart defects, mental retardation, hearing problems and leukemia and several who live independently and have a relatively normal life but usually a shorter lifespan. There is great varience from individual to individual.
Being tested for these abnormalities will give you information about your baby long before it is born. This information can help you in your planning for this pregnancy. Often you can be proactive about planning for medical care for your child even before birth.
The test includes a finger stick and an ultrsound. And results of both are used to estimate risk of these chromosomal defects. The test is accurate for trisomt 13 and 18 95% of the time. Ad accurate for Down's syndrome 91% of the time.
The MSAFP is a separate blood test to screen for open neural tube defects, like spina bifida. It tests for levels of alpha-fetopropein which when high may indicate an open nueral tube defect.
Further testing can be done to corroberate positive findings of triple screens and AFPs. CVS and amniocentesis are done by perinatologists. What is most important for you to remember is that negative findings occur 95% of the time and a negative is normal! I believe that any information that you can receive about your baby is vital for you to be able to be prepared to make all the choices you may need to consider when fetuses are positive for these syndromes and defects.
There are still some "birth defects" that we cannot predict in utero. No way to determine if your child is going to develope autism, yet. Ultrasound has given us wonderful windows into in utero development that has been invaluable in detecting abnormalities in a comparitively young pregnancy. There are some tests that can be used for detecting chromosomal defects as early as twelve weeks gestation. Although studies pointing to advanced maternal age as a significant risk factor some some chromosomal abnormalies, The American College of Obstetricians and Gynecologists recommends the test to all pregnant women, regardless of their age.
The triple screen determines increased risk for trisomy 13, 18 and 21. What are these defects? What do they affect? Why is testing considered important? How is it done?
Is this the MSAFP test? If not, what is that for and how is that done? What do all these results mean. Is there anything I can do?
Trisomy 13 is caused by having an extra copy of chromosome 13; one more than a normal baby. It has a very poor prognosis with a life expectancy of under a year. These babies have mental retardation and multiple physical abnormalities which may include their heart, brain, spinal cord, eyes, extra digits, deformed mouths and weakened muscles. It is sometimes called Patau syndrome.
Trisomy 18 is called Edwards syndrome, which is caused by an extra chromosome 18. About fifty percent of babies with this syndrome are stillborn. If they live through childbirth, they face life-threatening complications that include cardiac abnormalities, deformities of hands and feet and the digestive system. Some have kidney problems and retarded growth and mental development.
Down's syndrome is trisomy 21 which is an extra copy of chromosome 21. There are more than 400,000 people in the US who have Down's problems including heart defects, mental retardation, hearing problems and leukemia and several who live independently and have a relatively normal life but usually a shorter lifespan. There is great varience from individual to individual.
Being tested for these abnormalities will give you information about your baby long before it is born. This information can help you in your planning for this pregnancy. Often you can be proactive about planning for medical care for your child even before birth.
The test includes a finger stick and an ultrsound. And results of both are used to estimate risk of these chromosomal defects. The test is accurate for trisomt 13 and 18 95% of the time. Ad accurate for Down's syndrome 91% of the time.
The MSAFP is a separate blood test to screen for open neural tube defects, like spina bifida. It tests for levels of alpha-fetopropein which when high may indicate an open nueral tube defect.
Further testing can be done to corroberate positive findings of triple screens and AFPs. CVS and amniocentesis are done by perinatologists. What is most important for you to remember is that negative findings occur 95% of the time and a negative is normal! I believe that any information that you can receive about your baby is vital for you to be able to be prepared to make all the choices you may need to consider when fetuses are positive for these syndromes and defects.
Tuesday, December 6, 2011
Be Ready to Birth!: Multiple Miracles
Be Ready to Birth!: Multiple Miracles: Every year I get more calls for information about pregnancy and delivery of multiples. Is it in the water? Mmmmmmmm, I don't think so. I thi...
Multiple Miracles
Every year I get more calls for information about pregnancy and delivery of multiples. Is it in the water? Mmmmmmmm, I don't think so. I think it's ovarian stimulation and IVF. When we start to stimulate ovaries to produce more eggs, we run the risk of multiple gestations. And we then harvest lots of eggs and fertilize them and then transfer two or three or four, knowing we may lose a few, we also know that we run the risk of multiples. Sometimes what turns out to be a miracle of conception turns out to be a multiple miracle.
There may be special problems and different care necessitated by the miraculous multiple conceptions. It is easiest understanding and most commonly occurring as twins. Fraternal twins develop from two separate eggs and sperms, creating their own placenta and amniotic sac. They are different, just like any other siblings and can be of either sex. Identical twins are the result of one fertilized egg splitting and developing into separate but equal fetuses, sharing genes and thus characteristics like blood type, coloring and sex. Each baby usually has its own sac even though they may share a placenta.
An ultrasound is the most common way of diagnosing twins. Two heartbeats can be identified at six weeks gestation usually at the first ultrasound done for viability at around that time in the pregnancy. A twin pregnancy is considered one pregnancy with two deliveries at completion.
Care is different with multiples. You will see in addition to your obstetrician, a perinatologist who is an expert in fetal growth, development and multiples. This doctor will administer extra prenatal care but your obstetrician will actually help you deliver the babies. You need more calories with twins. Probably about 2,700 calories per day. Maybe extra vitamins and iron, for sure ( anemia is common in women carrying multiples ) and extra folic acid, more than just in your prenatal vitamin. Instead of the twenty-five to thirty pounds expected weight gain with a singleton, you should expect to gain about thirty-five to forty-five pound; one pound per week until about twenty weeks and then probably a little over that during the second half of the pregnancy.
Naturally, your body gets bigger with multiples. You may ache more and require more rest. But extra precautions and bed rest are prescribed for women with complications, so don't put yourself to bed. The perinatologist and obstetrician will give you guidelines that are appropriate for you and it's one of the reasons that they see you so much, for extra exams and ultrasounds and monitoring.
The risk of many complications is higher with multiples: hypertension, anemia, preterm labor and growth problems sometimes caused by twins sharing a single placenta. Occasionally, one of the fetuses will expire in utero ( vanishing twin ).
Delivery of the multiples is dependent on many factors and there is a higher than average occurrence of cesarean section due to babies' positions and conditions. Many women are more than able to breastfeed both twins. Extra help is great and peer support from groups like Marvelous Multiples is wonderful, even way before delivery. As we see more and more multiples, more information and guidance becomes available for what we handle as common- place pregnancies these days.
There may be special problems and different care necessitated by the miraculous multiple conceptions. It is easiest understanding and most commonly occurring as twins. Fraternal twins develop from two separate eggs and sperms, creating their own placenta and amniotic sac. They are different, just like any other siblings and can be of either sex. Identical twins are the result of one fertilized egg splitting and developing into separate but equal fetuses, sharing genes and thus characteristics like blood type, coloring and sex. Each baby usually has its own sac even though they may share a placenta.
An ultrasound is the most common way of diagnosing twins. Two heartbeats can be identified at six weeks gestation usually at the first ultrasound done for viability at around that time in the pregnancy. A twin pregnancy is considered one pregnancy with two deliveries at completion.
Care is different with multiples. You will see in addition to your obstetrician, a perinatologist who is an expert in fetal growth, development and multiples. This doctor will administer extra prenatal care but your obstetrician will actually help you deliver the babies. You need more calories with twins. Probably about 2,700 calories per day. Maybe extra vitamins and iron, for sure ( anemia is common in women carrying multiples ) and extra folic acid, more than just in your prenatal vitamin. Instead of the twenty-five to thirty pounds expected weight gain with a singleton, you should expect to gain about thirty-five to forty-five pound; one pound per week until about twenty weeks and then probably a little over that during the second half of the pregnancy.
Naturally, your body gets bigger with multiples. You may ache more and require more rest. But extra precautions and bed rest are prescribed for women with complications, so don't put yourself to bed. The perinatologist and obstetrician will give you guidelines that are appropriate for you and it's one of the reasons that they see you so much, for extra exams and ultrasounds and monitoring.
The risk of many complications is higher with multiples: hypertension, anemia, preterm labor and growth problems sometimes caused by twins sharing a single placenta. Occasionally, one of the fetuses will expire in utero ( vanishing twin ).
Delivery of the multiples is dependent on many factors and there is a higher than average occurrence of cesarean section due to babies' positions and conditions. Many women are more than able to breastfeed both twins. Extra help is great and peer support from groups like Marvelous Multiples is wonderful, even way before delivery. As we see more and more multiples, more information and guidance becomes available for what we handle as common- place pregnancies these days.
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