Let’s be honest, health care teams are busier than ever these days. Throughout our Trimesters we have given you lots of great info to help you have the empowered pregnancy you have always dreamed of. Here’s a recap of the important conditions that your health care team may not have time to tell you about ~ but we will! You need to be in the driver’s seat keeping your pregnancy healthy and safe from day one…
Around 30 weeks, speak with your health care team about the possibility of including two Fetal Non-Stress Tests (NSTs) per week and one Biophysical Profile (BPP) with a Doppler Ultrasound every other week for the remainder of your last trimester. These vital check-ups will provide the opportunity to detect any problems, especially with your baby’s lifeline at this time: the placenta and umbilical cord. This foresight provides peace of mind for you and allows your health care team to make the right decisions for you and your baby.
An amniocentesis, usually done between Weeks 15-20, is a test to check for fetal abnormalities such as Down syndrome, a genetic disorder, or spinal bifida, a neural tube defect, and has been a valuable tool in assessing fetal well-being since the 1970s. If you are at a particular risk for either one of these conditions, you can postpone having an amniocentesis until after you’ve seen the results of your second trimester screenings. An amniocentesis removes about 2 Tbsp. (30 ml.) of the amniotic fluid surrounding your baby for testing. This analysis may be a better choice over CVS if the results of other blood tests (such as the alpha-fetoprotein test) taken during your pregnancy have been abnormal. An amniocentesis may also be ordered during the third trimester of your pregnancy to confirm fetal lung maturity if your doctor is considering an early delivery.
It is the watery fluid surrounding your baby inside the amniotic membrane (sac) and is an essential part of pregnancy and fetal development. This fluid helps shield and guard your baby while performing a significant part in the maturity of many of your baby’s organs such as the lungs, kidneys, and gastrointestinal track.
(also known as hydramnios) occurs when there is too much amniotic fluid around the baby. This condition is present in approximately one percent of all pregnancies. Although there are both maternal and fetal causes of polyhydramnios such as a multiple pregnancy, maternal diabetes, twin-to-twin transfusion syndrome or a birth defect, the cause of polyhydramnios is unknown in approximately 65% of those diagnosed. This condition and its possible causes are usually diagnosed with an ultrasound and if detected, your health care provider will recommend a specific treatment plan.
It is where there is too little amniotic fluid surrounding your baby. It affects about four percent of women and is usually diagnosed during the third trimester. The causes of oligohydramnios may include birth defects, placental problems, leaking or the rupture of membranes, post date pregnancy or maternal complications such as hypertension, diabetes, dehydration, or preeclampsia. If diagnosed during the first half of your pregnancy, more serious complications may result such as birth defects or a greater likelihood of miscarriage or stillbirth. One complication of prolonged deprivation of amniotic fluid is pulmonary hypoplasia, which results in an abnormal or incomplete development of the baby’s lungs.
Moms either have an anterior or posterior placenta, which means that some have their placentas towards the front of the uterus (anterior) and others towards the back (posterior). If your placenta is towards the front (anterior), don’t be alarmed if you are not experiencing or feeling your baby’s movements early in your pregnancy. In fact with this placental position you may not feel as much movement from your baby even in the third trimester. This is because the placenta serves as a cushion between your tummy and your baby, making it more difficult for you to feel movement. Your health care team may also have more trouble hearing your baby’s heartbeat with this placental position especially earlier in your pregnancy. An anterior placental position towards the front of the uterus can also make an amniocentesis more challenging as the needle inserted to remove the fluid will need to avoid the placenta. An anterior placenta in and of itself poses no risk to the health of you and your baby.
Did you know that your third trimester of pregnancy is the perfect time to begin to prepare for breastfeeding? The Breastfeeding Center of Charleston “believes the health of the mother and her newborn are intricately intertwined. For this reason, we will be providing comprehensive, coordinated care to the mother and baby as a unit at the Breastfeeding Center of Charleston. Comprehensive care includes exams for the both the mother and baby to ensure optimal health for the breastfeeding duo. Our team will work closely with the mother’s OBGYN and the baby’s primary pediatrician to provide continuity of care for the breastfeeding duo. We will communicate the plan of care that is rendered at each visit back to the primary providers.” Dr. Bess Milliron MD, FAAP, IBCLC, is Board Certified in Pediatrics, a Fellow of The American Academy of Pediatrics, an International Board Certified Lactation Consultant (IBCLC) and is the Medical Director for the Breastfeeding Center of Charleston. To help insure the optimal breastfeeding experience, Dr. Milliron recommends the following:
For more information on breastfeeding, contact your local hospital, breastfeeding center or the Breastfeeding Center of Charleston today.
If you are over 35, have a family history of a genetic disorder, or have had a chromosomal abnormality in a previous pregnancy, you may want to consider having a Chorionic Villus Sampling (CVS). This is an invasive diagnostic test performed by sampling the chorionic villus from the placenta. These villi, which actually form the placenta and share the baby’s genetics, were first seen developing in Week 6.
Your medical team will also be able to determine where your baby’s umbilical cord is attached to the placenta. An ideal location is called a central insertion site. This is where the umbilical cord is attached to the very center of the placenta. It provides the healthiest attachment and allows your baby to easily receive oxygen and nutrients when compared to the other two types. The cord can have a marginal insertion site or be velamentous. Both of these conditions are considered abnormal and can cause other complications. It is important to know this attachment early in your pregnancy. If you are diagnosed with a marginal or a velamentous insertion site, your pregnancy will be and should be closely monitored. Your medical team will want to check on your baby often and most likely, you will have more prenatal visits, ultrasounds, Fetal Non Stress Tests (NSTs), and Biophysical Profiles (BPPs). These abnormal attachments can cause problems, and do create enough of a concern for more frequent monitoring.
“Most women who notice a decrease in movement will still have a healthy outcome,” says Obstetrician-Gynecologist Ruth Fretts, M.D., MPH, Assistant Professor at Harvard Medical School and Chair of the Stillbirth Review Committee at the Brigham and Women’s Hospital in Boston. “The biggest concern is when it happens repeatedly.” Dr. Fretts reminds every mom that as her pregnancy advances and her expected baby has less space, the movements won’t be as strong and obvious. But if it takes you more than two hours to count 10 movements, your health care team should be called. She says a Fetal Non-Stress Test (NST) is necessary to confirm your baby’s heart rate, “This rules out a life-threatening emergency, but it doesn’t address the underlying reason for decreased movement.”
Antenatal (or Prenatal) Depression is depression during pregnancy. Not only is it common, it may also continue or newly manifest as Perinatal Mood And Anxiety Disorder (PMAD) which encompasses a wide range of mood disorders after delivery and up to year after your baby is born. You may have signs of depression but not even be aware that you are depressed. It’s estimated that approximately 13 percent of pregnant women and new mothers experience depression. Every woman may have a few days where she feels sad, blue or down in the dumps. However with depression, the sad, anxious or empty feelings do not go away and your day-to-day routine and lifestyle changes because of these emotions. Your depression may present simply as feelings of unhappiness and gloom, or possibly spiral to feelings of overwhelming guilt, uncontainable hysteria or thoughts of inflicting harm on yourself or your baby.
Your symptoms will provide the basis for an accurate diagnosis from your health care team. Your doctor will ask the necessary questions to test for depression and may also refer you to a mental health professional that specializes in treating depression. Please know that depression does improve with treatment. If you are already on medication for depression, stopping your medicine when you become pregnant or are breastfeeding could cause your depression to come back. You must be open and honest with your health care team regarding your depression and pregnancy. Do not stop any prescribed medicine without first talking to your doctor as not taking it could be harmful to you or your baby. Untreated depression during pregnancy can hurt you and your developing baby, as you will have a difficult time caring for yourself. Depression may cause you to eat poorly, not gain adequate weight and suffer from insomnia. You may miss vital prenatal visits, become incapable of following medical instruction and even begin using harmful substance such as tobacco, alcohol or illegal drugs. Your baby may be small for his or her gestational age (SGA) and be born prematurely. Receiving professional treatment is important for both you and your baby. Depression Treatment In a recent study in the May issue of Obstetrics & Gynecology, researchers found that women with the symptoms of depression were associated with a 27 percent increased risk of delivering their babies before 37 weeks gestation, an 82 percent increased risk of delivering their babies before 32 weeks gestation, and a 28 percent increased risk of having a SGA baby. But they also discovered that approximately one fifth of the expectant women that were treated with antidepressants for depression had no association with the increased risks for any of these problems with their babies. Dr. Kartik K. Venkatesh M.D., Ph.D., the study’s lead author and Clinical Fellow in Obstetrics, Gynecology and Reproductive Biology at Harvard states, “By screening early in pregnancy, you could identify those at higher risk and counsel them about the importance of treatment. Treating these women for depression may have real benefits.” Screening mothers early for depression is the key to not only their health but also that of their expected babies. Following a diagnosis of depression, your may be treated with Talk Therapy that involves visiting a therapist, psychologist, or social worker to learn to change how depression makes you think, feel, and act. Or an Antidepressant Medication may be prescribed to relieve the symptoms of your depression. These treatment methods can be used alone or together. Talk with your doctor about the benefits and risks of taking medication while you are pregnant or breastfeeding. Other therapies such as exercise, acupuncture and support groups may be helpful. Perinatal Mood And Anxiety Disorder (PMAD) Did you realize that 1 in 5 women are diagnosed with mood disorders in the postpartum setting? Melissa Whippo, L.C.S.W. a Clinical Social Worker at the University of California, San Francisco’s (UCSF) Pregnancy and Postpartum Mood Assessment Clinic works with pregnant and postpartum women. She meets with women not only during pregnancy and after delivery, but also at any stage of their fertility process. Ms. Whippo emphasizes the single term “postpartum depression” fails to encompass the range of mood disorders women commonly experience in the postpartum setting, and although PMAD doesn’t roll off the tongue so easily, it is a more accurate description of depression in the postpartum period according to Ms. Whippo. Untreated PMAD limits the ability of a new mom to parent. The symptoms of PMAD last longer and are more severe than depression during pregnancy. You may experience decreased energy, the inability to focus, moodiness and be incapable or disinterested in meeting your baby’s needs. You may also experience thoughts of hurting your baby or hurting yourself. Your feelings of guilt and losing confidence in yourself as a new mother will exacerbate your depression. Researchers believe PMAD also affects your baby in numerous ways. It can cause your baby to have developmental language delays, difficulties with mother-child bonding, behavior problems and increased crying. It’s not a well-known fact that low levels of thyroid hormones might mimic PMAD after you give birth as these levels may drop. Thyroid hormones regulate how your body uses and stores energy from food. Low levels of your body’s thyroid hormones may cause symptoms of depression. A simple blood test can tell if this condition is causing your symptoms. If so, your doctor can prescribe thyroid medicine. Kristin Sample, writer, teacher, dancer and blogger immediately began her postpartum journey with extreme anxiousness and a quick weight loss of 25 pounds within the first two weeks of delivering her son Jackson. She wondered if this amazing feat was the result of breast-feeding, pumping and healthy eating? In her heart, she realized something did not seem right. Just two months later Kristen’s symptoms were reversed and she began experiencing relentless fatigue and effortless weight gain. Like many women in her situation, Kristin’s internist dismissed her new concerns of exceptionally low energy and unusually easy weight gain offering her Xanax and a consultation with a therapist for postpartum depression instead. A simple blood test with her OB six months later revealed thyroid levels so low that Kristen’s doctor wondered how she could get herself out of bed in the morning and keep moving throughout the day. She learned that her initial extreme anxiousness and immediate weight loss occurring in the days following the birth of her son was the result of Postpartum Thyroiditis, a condition causing mild hyperthyroidism (overactive thyroid) symptoms. The undiagnosed postpartum thyroiditis Kristen initially experienced gave way to Hashimoto’s Disease, a potentially more serious and chronic thyroid condition in which the thyroid becomes underactive (hypothyroid). Medication was prescribed that enabled her to loose weight and increase her energy levels. An endocrinologist closely monitored Kristen’s second pregnancy adjusting her medication monthly as the thyroid is vital in helping the body stay pregnant. A mismanaged thyroid condition may result in miscarriage and stillbirth and is often undiagnosed until surrounding a pregnancy. Every mom throughout her pregnancy journey must listen to her body and take care of herself. This will ensure that she stays in good health. The early days with a newborn can be draining for every new parent. Once your baby’s sleep schedule begins to normalize and you still do not feel like yourself before your pregnancy, speak with your doctor about PMAD or a possible thyroid problem. A simple blood test may just make all the difference! Postpartum Anxiety Disorder When you are a new mom, a certain level of anxiety is normal. However, when your anxiety starts to affect your ability to take care of yourself or your baby, it is time to see a medical professional for treatment. It’s estimated that about ten percent of new moms develop a significant anxiety disorder following delivery day. Postpartum Anxiety Disorder is manifested by an inability to relax and be still, racing thoughts, nonstop worrying, nausea, vertigo and faintness, and changes in sleep and appetite. Postpartum Psychosis Postpartum Psychosis for a new mom is rare but does exist. It occurs in about 1 to 4 out of every 1,000 births beginning in the first two weeks following delivery. Women who have bipolar disorder or another mental health problem called schizoaffective disorder have a higher risk for postpartum psychosis. Symptoms may include seeing things that aren’t there, confusion, rapid mood swings and trying to hurt yourself or your new baby. Other PMAD Disorders Postpartum Obsessive Compulsive Disorder (OCD) manifests as having unreasonable thoughts and fears that lead to a repetitive type of behavior. Developing OCD during or after pregnancy can be terrifying for women for many reasons but mainly because of the intrusive nature of repetitive thoughts. About three to five percent of new moms will experience OCD during their pregnancy or following delivery day. Intrusive thoughts such as, “What if I drop the baby, What if I forget the baby? or What if I stab the baby?” may plague an expectant or new mother. Although a blessed event, childbirth can be traumatic for some moms. Postpartum Post-Traumatic Stress Disorder (PTSD) is more common in women who have had a problematic childbirth (including miscarriage, stillbirth, unplanned C-section, prolapsed cord, forceps deliver, or transfer of the newborn to the NICU), and in women who worry about childbirth, have experienced prior childbirth trauma, or have a history of PTSD. Symptoms may include constant anxiety, nightmares, avoiding people and places, and flashbacks to the traumatic experience. Support During Depression To be proactive, alleviate or help relieve the symptoms of depression during and after pregnancy, you may want to consider these helpful tips:
If you are diagnosed with PMAD following your baby’s arrival, please realize that you are not alone and you are not to blame and with help you will feel like yourself again. It is vital to recognize your symptoms and seek the help of a qualified professional before your condition intensifies. If you are feeling depressed before, during pregnancy or after having your baby, don’t suffer alone. Please tell a loved one and call your health care team right away! To learn more about depression before, during and after pregnancy, or for a list of organizations ready to assist you, please visit Womenshealth.gov or call them at 800-994-9662 (TDD: 888-220-5446).
A Doppler Ultrasound checks the blood flow within the umbilical cord. A healthy umbilical cord will have two arteries, one vein, be the proper length and contain adequate Wharton’s Jelly. Wharton’s Jelly is a specialized tissue which serves many purposes for the developing fetus. Its specialized cells contain gelatin-like mucus that encase fibers. These properties give it an elastic and cushiony effect, which can tolerate the vibration, bending, stretching and twisting of an active fetus. In addition, it holds the vessels together, may regulate blood flow, plays a role in providing nutrition to the fetus, stores chemistry for the onset of labor, and protects the supply line. The Doppler Ultrasound may be more pivotal for umbilical cords that have only one artery, but it can also alert your health care team to other umbilical cord issues such as a knot, a kink, twisting or torsion, a nuchal cord and a short or long cord. This simple procedure tests the velocity and direction of the blood flow.
“Estimated Placental Volume (EPV) should be incorporated into prenatal care” explains Yale Researcher, Harvey J. Kliman, MD, PhD. Dr. Kliman is the Director of the Reproductive and Placental Research Unit Department of Obstetrics and Gynecology, Yale University School of Medicine. EPV is calculated using a simple 2-dimensional ultrasound to assess the ratio of baby to placenta. Kliman states, “Docs should know about abnormal placentas. Not knowing anything about a placenta is like driving a car without a gas gauge!”
Just about all women can and should be physically active throughout pregnancy. Exercise during pregnancy is safe and often recommended although some modification to your workouts may be needed due to natural anatomic and physiologic changes and your baby’s fetal requirements. The American College of Obstetricians and Gynecologists (ACOG) encourages women with uncomplicated pregnancies to engage in aerobic and strength-conditioning exercises prior to conception and following delivery.
Babies love to hiccup! Light, recurring and sequential patterns are what you will notice at first. Later in your pregnancy, your baby’s hiccups will become robust and recognizable. Although most babies have hiccups and they are harmless, some fetal hiccups may be a reason for concern. According to Obstetrician-Gynecologist Dr. Jason Collins, MD, MSCR, of The Pregnancy Institute, even though your baby’s hiccups can be recurrent, once the Week 32 gestational marker is reached, your baby’s hiccups should lessen and not be present on a daily basis. So, when your baby continues to hiccup every day with hiccups lasting longer than 15 minutes or a series of hiccups 3–4 times with 24 hours, alert your health care team and have your baby evaluated for possible umbilical cord concerns.
Three tests to check on your baby’s well-being in utero are: a NST, a BPP, and a Doppler Ultrasound. The first test, an NST, will monitor and evaluate your baby’s heartbeat. This test usually starts in the third trimester (for high risk moms as early as the Week 28) for moms and expected babies who need special care and monitoring with conditions such as diabetes or hypertension, blood clotting disorders, follow up for an amniocentesis, IUGR, a baby who is small or not growing properly, a less active baby, if you have passed your due date or if you hae had a previous loss. A NST usually takes 20-40 minutes to complete. Your baby’s heartbeat will be heard and recorded while your baby is inactive and active. The NST is a reactive test meaning your baby’s heart beats faster when moving. To be reactive, this must happen at least two times in 20 minutes. If your baby is sleeping or inactive, you may be given juice or water to drink to encourage your baby to move! The NST will be considered nonreactive if your baby’s heart does not beat faster when your baby is active, or quiet and not moving. Don’t panic if this happens! They will consider this a false NST, but it merely means the NST did not provide enough information and additional tests such as a BPP may be necessary.
As the end of your second trimester approaches, keep a check on your baby’s growth measurements. Fundal height measurements, EPV, or estimated weight with ultrasound performed monthly will let you and your team know if the placenta is supplying adequate nourishment for your baby.
By 26 weeks, make sure your health care team has scheduled you for a Glucose Challenge Screening (an adaptation of the Glucose Tolerance Test which tests for Type 2 Diabetes). This screening is for Gestational Diabetes, a type of diabetes present only when you are pregnant. This test is done between 26-28 weeks and will accurately measure the response of your body to glucose (sugar). If the test is positive, you will need to undergo further testing to confirm this pregnancy diagnosis.
An Incompetent Cervix, also called cervical insufficiency, or CI, is a condition of pregnancy that occurs when the expectant mother’s cervical tissue is weakened to such a degree that it may lead to an unexpected pregnancy loss. This may be due to a previous childbirth, cervical trauma such as a broad cervical conization (cervical biopsy), various abnormalities and irregularities of the uterus, the possible exposure to the synthetic estrogen Diethylstilbestrol (DES), or there may be no defining cause. CI can cause or contribute to premature birth, and in many cases, the loss of an otherwise robust pregnancy. While CI occurs in only one out of 100 pregnancies, the condition is responsible for approximately 25 percent of losses in the second trimester.
Cytomegalovirus (CMV) is a common virus that poses a major risk to pregnant women who are around babies and young children. Moms who are child care providers, daycare workers, preschool teachers, therapists, and nurses need to take extra precautions as preschoolers are the majority of carriers. CMV is present in saliva, urine, feces, tears, blood, mucus and other bodily fluids. You cannot catch CMV by simply being in the same room with someone, unless bodily fluids are exchanged. Additionally, there is no information to indicate CMV is transmitted in the air (airborne).
Some babies born with congenital CMV are symptomatic at birth, others are asymptomatic. Children born with congenital CMV may develop permanent medical conditions and disabilities, such as deafness, blindness, cerebral palsy, mental and physical disabilities, seizures, and death. Become your expected baby’s guardian today by taking an active role in your personal hygiene and healthcare decisions and prevent CMV. Consult your health care team if you are concerned about the CMV infection during pregnancy, you develop a mononucleosis or flu-like illness during pregnancy, or you feel you may be a candidate for CMV screening or treatment. If you would like further information on CMV and how it may affect your pregnancy and your baby’s future, please visit Stop CMV. If you would like to proactively pass this vital information via the CDC’s Health-e-Cards to other pregnant moms, please visit the CDC.
Genital Herpes is a chronic permanent viral infection. One in five pregnant women has herpes, either Herpes Simplex Virus (HSV-1) which is responsible for cold sores on the mouth and lips or Herpes Simplex Virus-2 (HSV-2), which is responsible for genital herpes. Although genital herpes can be caused by HSV-1 or HSV-2, most mothers of infants who acquire neonatal herpes are asymptomatic, meaning they have never had an outbreak of genital herpes!
Your urine will be cultured for Group B Strep (GBS). If your results are positive for GBS or for an asymptomatic bacteriuria, the U.S. Centers for Disease Control and Prevention (CDC) recommends appropriate antibiotic treatment if your urine culture shows over 100,000 colonies per cc. Once you finish your antibiotics, have a test of cure (TOC) to ensure that the infection has cleared completely. Make sure you ask for the results of your urine culture on your next visit.
According to the CDC, Listeria (listeriosis) is bacteria found in soil, water, dust, plants, raw meats, processed foods, some prepared vegetables, and in the feces of animals and humans. Most listeria infections affecting pregnant women come from eating contaminated foods. This infection may be passed to an expectant mother’s baby through the placenta, and the mother may not even show any signs of illness. Listeria can lead to miscarriage, stillbirth and premature delivery. In a newborn the presence of listeria may result in blood stream infections, meningitis and possible death. A late neonatal infection may even appear more than 5 to 7 days following delivery. Because of the potentially severe consequences of listeria, it’s important that you, as well as your health care team, are familiar with the prevention, symptoms, diagnosis and treatment of this infection.
It’s important to note that if you have eaten food contaminated with listeria and are asymptomatic, most professionals believe you don’t need any tests or treatment, even if you are pregnant. Although you should inform your health care team if you are pregnant and have eaten the contaminated food, and within 2 months experience flu-like symptoms. If a pregnant mom does contract listeria, antibiotics are given to treat it. In most cases, the antibiotics also prevent infection of the fetus or newborn. Antibiotics are also given to babies who are born with listeria. If you experience any symptoms of listeria, consult your health care team immediately. A blood test can be performed to find out if listeria is the cause of your symptoms. For more information on listeria prevention and how listeria infection can impact both you and your baby during and after pregnancy, please visit the CDC and the NIH.
Toxoplasmosis, considered one of the neglected parasitic infections, is an infection that a mom may pick up from something as simple as cleaning a cat litter box or making a hamburger patty. Toxoplasma Gondi is a parasite so small it is invisible to the human eye and, fortunately, most healthy immune systems will not allow the parasite to trigger an infection. It is estimated that 22.5% of Americans 12 years and older have been infected with toxoplasma. Although usually asymptomatic, symptoms accompanying toxoplasmosis may be similar to those of the flu with swollen lymph glands or muscle aches and pains that last for a month or more.
It’s a proactive step towards conception and pregnancy for you and you partner to make an appointment and meet with your health care team when you are considering starting a family. They can help you prepare your body for a healthy baby, answer your questions on fertility and give you both tips on conceiving.
Your doctor will most likely recommend a member of the American Society of Reproductive Medicine in your area to help you with your infertility. Causes Today, the trend of delayed marriage and childbirth are the main social causes of infertility. Physically, in order for you to become pregnant ovulation, sperm, regular intercourse, open fallopian tubes and a normal uterus must all co-exist working simultaneously together. However, there are several factors that can prevent this process from taking place and causing female infertility. Genetic testing will also help determine whether there’s a genetic defect may also be a source of infertility prompting the need for genetic testing. Ovulation disorders Ovulation disorders are responsible for roughly 25 percent of couples remaining infertile. This condition causes you to ovulate irregularly or perhaps not at all. Inconsistency in the reproductive hormonal regulation by either the hypothalamus or pituitary gland, or by difficulties within the ovary itself may be to blame for this problem. The Mayo Clinic defines ovulation disorders as: Polycystic ovary syndrome (PCOS). In PCOS, complex changes occur in the hypothalamus, pituitary gland and ovaries, resulting in a hormone imbalance, which affects ovulation. PCOS is associated with insulin resistance and obesity, abnormal hair growth on the face or body, and acne. It’s the most common cause of female infertility. Hypothalamic dysfunction. The two hormones responsible for stimulating ovulation each month — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) — are produced by the pituitary gland in a specific pattern during the menstrual cycle. Excess physical or emotional stress, a very high or very low body weight, or a recent substantial weight gain or loss can disrupt this pattern and affect ovulation. The main sign of this problem is irregular or absent periods. Premature ovarian insufficiency. This disorder is usually caused by an autoimmune response where your body mistakenly attacks ovarian tissues or by premature loss of eggs from your ovary due to genetic problems or environmental insults such as chemotherapy. It results in the loss of the ability to produce eggs by the ovary, as well as a decreased estrogen production under the age of 40. Too much prolactin. Less commonly, the pituitary gland can cause excess production of prolactin (hyperprolactinemia), which reduces estrogen production and may cause infertility. Most commonly this is due to a problem in the pituitary gland, but it can also be related to medications you’re taking for another disease. Damaged fallopian tubes (tubal infertility) The inability of sperm to reach the egg or the failure of the fertilized egg to reach and implant in the uterus may be due to damaged or blocked fallopian tubes. The Mayo Clinic states tubal damage or blockage may be a result of: Pelvic inflammatory disease, an infection of the uterus and fallopian tubes due to chlamydia, gonorrhea or other sexually transmitted infections. Previous surgery in the abdomen or pelvis, including surgery for ectopic pregnancy, in which a fertilized egg becomes implanted and starts to develop in a fallopian tube instead of the uterus. Pelvic tuberculosis, a major cause of tubal infertility worldwide, although uncommon in the United States. Endometriosis Uterine tissue that implants and grows elsewhere is called endometriosis. This additional growth of uterine tissue when removed surgically may cause scarring obstructing the narrow fallopian tube. If this occurs, the egg and sperm will not unite. Equally, endometriosis may also affect the lining of the uterus jeopardizing the implantation of the fertilized egg. This condition may also be indirectly responsible for upsetting fertility by causing injury to the sperm or egg. It is estimated that 25-50 percent of women have this condition. Uterine or cervical causes There are a number of uterine or cervical conditions that may interfere with your egg becoming implanted in the uterus. This increases the risk of a miscarriage. The Mayo Clinic defines these conditions as: Benign polyps or tumors (fibroids or myomas) are common in the uterus, and some types can impair fertility by blocking the fallopian tubes or by disrupting implantation. However, many women who have fibroids or polyps can become pregnant. Endometriosis scarring or inflammation within the uterus can disrupt implantation. Uterine abnormalities present from birth, such as an abnormally shaped uterus, can cause problems becoming or remaining pregnant. Cervical stenosis, a cervical narrowing, can be caused by an inherited malformation or damage to the cervix. Sometimes the cervix can’t produce the best type of mucus to allow the sperm to travel through the cervix into the uterus. Male infertility This may be caused by various factors. It is usually diagnosed by two semen analyses taken at least one month apart. A specialist evaluates the number of sperm (concentration), motility (movement), and morphology (shape). If the result is slightly abnormal, a diagnosis of infertility is not necessary made. However, if the abnormal result is due to an illness such as a viral infection, it will take roughly two to three months before the sperm parameters change and the test can be repeated. This analysis will aid in deciding how male factors are possibly contributing to the couple’s infertility. According to the CDC, the conditions that can contribute to an atypical semen analyses include:
The National Institute of Health (NIH) state that other causes of male infertility may include:
An incompetent cervix, also called cervical insufficiency, or CI, is a condition of pregnancy that occurs when the expectant mother’s cervical tissue is weakened to such a degree that it may lead to an unexpected pregnancy loss. This may be due to a previous childbirth, cervical trauma such as a broad cervical conization (cervical biopsy), various abnormalities and irregularities of the uterus, the possible exposure to the synthetic estrogen Diethylstilbestrol (DES), or there may be no defining cause. CI can cause or contribute to premature birth, and in many cases, the loss of an otherwise robust pregnancy. While CI occurs in only one out of 100 pregnancies, the condition is responsible for approximately 25 percent of losses in the second trimester. Before you become pregnant, your cervix is normally closed and firm. As your pregnancy advances and you prepare for delivery day, the cervix gradually relaxes, shortens in length (effaces) and opens (dilates). If your cervix is incompetent, it might begin to open ahead of time and you may deliver your baby too early without even feeling any contractions. CI usually manifests between Weeks 16-24, with most instances taking place between Weeks 18-22. It is difficult to diagnose CI and because of this, it is difficult to treat. A manual pelvic examination may detect CI. For a diagnosis of CI to be made, the cervical opening must be greater than 2.5 cm, or the cervical length must have shortened to less than 20mm. Funneling, a shortening of the cervix and dilatation of the internal cervical canal, can also be a sign of CI. A transvaginal ultrasound is the best technique to examine the cervix according to Dr. James E. Sumners, M.D., of St. Vincent Women’s Center for Prenatal Diagnosis in Indianapolis. This specialized ultrasound helps monitor cervical length and can check to see if the cervix is opening. This method visualizes the entire cervix and the complete cervical canal. Once diagnosed, preventative medication, repeated ultrasounds, or various techniques for closing the cervix may be implemented such as a cervical cerclage, a purse-string stitch that acts as an cinch to keep the cervix from dilating. This is usually performed in an outpatient setting between Weeks 12-15. Unfortunately, during pregnancy you may not experience or feel any signs or symptoms that your cervix is beginning to open too early. You could possibly notice some minor discomfort or vaginal spotting over several days or perhaps weeks. You should alert your health care team if you notice any of the following between Weeks 14-20: pelvic pressure, a backache, mild abdominal cramping and a variation in your vaginal discharge such as mucous or blood. Women who have already had a miscarriage because of incompetent cervix will likely have the same outcome in future pregnancies if they do not seek treatment. Not seeking treatment can lead to great stress and emotional suffering for women and couples hoping to become parents. To find out more information on diagnosis, treatment or understanding how CI may impact your pregnancy, please visit the March of Dimes and The University of Chicago Hospitals. Unexplained infertility Unfortunately, a source for your infertility may never be discovered. Unresolved fertility issues may result from a combination of various minor causes affecting the couple as a whole. It can be devastating to not know the reason for your infertility but the good news is that infertility can possibly be reversed in time. Risk factors According to the Mayo Clinic, there are definite risk factors that may increase your chances of infertility. They are:
It must also be noted that passive smoking has also been established to have an effect on fertility and the heavy use of marijuana decreases fertility in both men and women. Preparing for your appointment If you decide to have your infertility evaluated, it’s important that you begin tracking your periods, your symptoms and dates of intercourse before your first visit. You will also want to make a list of medications and supplements — either vitamins or herbal remedies — with doses and frequency for your specialist. Any pertinent medical records with previous tests or treatments should accompany you. Both you and your partner will have a medical and sexual history taken; any previous pregnancies with your current partner will be discussed. You will both be assessed for possible causes as well as potential treatments to correct this condition. Don’t forget to bring a notebook or iPad with you for two reasons. First, beforehand you can prepare any questions that you would like answered, and second, you will be able to jot down any essential information given to you at this time. Tests, diagnosis, treatments and drugs Your specialist may possibly order any number of tests that he or she feels will help to evaluate, diagnose and treat your condition. Testing may range from a simple over-the-counter ovulation prediction kit to a laparoscopy which is a minimally invasive procedure visualizing your fallopian tubes, ovaries and uterus to genetic testing which will indicate if a genetic problem is responsible for your infertility. It is important to remember that no one test is a perfect predictor of fertility. Nearly 85-90 percent of infertility cases are treated conservatively with drugs or the surgical repair of reproductive organs. Although numerous surgical procedures can correct difficulties or increase female fertility, the surgical interventions for fertility are rare these days as fertility treatments such as laparoscopic surgery, microscopic tubal ligation reversal surgery and tubal surgeries have high success rates. Endometriosis may be diagnosed by using ultrasonography and endometrial biopsy that are not considered part of the basic infertility investigation. Neither blood tests nor imaging studies alone can correctly diagnose endometriosis. Although ultrasound might identify an ovarian cyst that includes an endometrioma, a laparoscopy is still required to make the diagnosis. The fertility drugs used today may increase a woman’s chance of becoming pregnant with twins, triplets, or other multiples. If you are pregnant with multiples, additional problems, monitoring and health care visits may be increased. Multiple fetuses have an increased risk of being born prematurely and are also at a higher risk of health and developmental problems. Male factor infertility, depending on the primary cause, may be approached either medically, surgically, or helped with reproductive therapies. Medical and surgical treatments will normally be handled by a urologist specializing in infertility. A reproductive endocrinologist may also be needed. This specialist may offer intrauterine inseminations (IUIs) or assisted reproductive technology (ART). ART includes all fertility treatments in which both eggs and sperm are handled outside of the body. These procedures involve surgically removing eggs from a woman’s ovaries, combining them with sperm in the laboratory, and returning them to the woman’s body or donating them to another woman. The main type of ART to overcome male infertility is in vitro fertilization (IVF), which currently accounts for more than 99 percent of ART procedures; tens of thousands of babies have been born around the world with this procedure. Severe male factor infertility is associated with genetic disorders such as mutations in the cystic fibrosis genes and is treated effectively only with IVF. ART accounts for approximately 10-15 percent of the remaining infertility treatment options. Overall, many factors will determine how your specialist will treat your infertility. The complexity of infertility requires a substantial fiscal, physical, emotional and time commitment on your and your partner’s part. It may only take a couple of treatments to correct your infertility. However, some couples require numerous appointments and therapies before conception is possible. As mentioned above, medication or even surgery may be necessary to assist with conception, or complex procedures may also be warranted or introduced. Coping and support The quest for finding a cause for your infertility may be a strenuous and demanding one both physically and emotionally. Did you know that studies indicate that couples experiencing psychological stress have poorer results with infertility treatments? It will help to relieve any unnecessary anxiety by making sure you that you are aware, informed and understand the success rates, risks, and benefits of the potential therapies that are being offered. After consulting with your doctor, you and your partner will select the option that you feel is most advantageous to create a successful conception. Don’t forget to keep your close friends and family informed of your progress. Many couples find comfort and support through the anonymity of online groups via social media. Professional help is always available to you both so never hesitate to reach out to your health care team for advice or a reference. Continue your healthy lifestyle entertaining a moderate level of activity and exercise, and a well-balanced diet. This combination can boost your spirits as your tackle your infertility. Remember, that you always have alternatives to infertility. Adoption, surrogacy, gestational carriers or even deciding on not having any children may be choices you will want to consider. You should discuss these possibilities or another course of action that may appeal to you early in your infertility process as this can lower stress during treatments and disappointment if conception does not take place. Prevention It’s important that you try to improve your chances of normal fertility if you are considering becoming pregnant now or in the future. Simply incorporating the basics of good health is paramount. By maintaining a normal weight, eliminating smoking, alcohol and limiting your caffeine level to less than 200 to 300 milligrams a day, and reducing your stress level will improve your chances of normal fertility and the hope for conception to ensue.
Although some itching in pregnancy is normal, if you notice itching, primarily at night on the palms of hands, arms, legs, soles of feet or all-over itching which typically increases in severity, speak with your health care team. Intrahepatic Cholestasis of Pregnancy (ICP), a liver disorder occurring during pregnancy, affects 1 – 2 women per 1000 with itching being the most common symptom. While ICP has been reported early on in pregnancy by some individuals, it commonly begins in the third trimester when hormone concentrations peak.
Tennis superstar and new mom Serena Williams trusted her body when she felt something wasn’t right. By 36 years of age, her career had withstood its share of physical and personal challenges. Knee injuries, a life-threatening blood clot in her lungs, harsh body criticism by fans and commentators alike, and frequent racial insults propelled her to overcome adversity. With 23 Grand Slam titles to her name and a serve clocked at 128.6 miles per hour, Williams was at the top of her game.
On September 1, 2017 Williams gave birth to her daughter Alexis Olympia via emergency C-section. The following day she became short of breath and immediately recognized this sign of a dangerous condition she knew only too well. Gasping for breath she told a nurse she might have another blood clot. The nurse did not take Williams seriously at first suggesting her “pain medication must be making her confused.” Williams trusted her instincts and asserted something was not right. After a negative ultrasound on her legs, a CT scan was performed on her lungs showing several blood clots. Heparinized, she was on the road to recovery. Or was she?
Williams endured harsh coughing episodes opening her C-section wound. An ensuing surgery revealed a hemorrhage at the location of the incision. When finally discharged, She was put on bed rest for six weeks.
Do you find yourself contemplating pregnancy? Is your research revealing the fun, fabulous and amazing aspects of your impending nine-month journey? Will this be the lucky month for you? What about next month?
Before your started your pregnancy research, you were most likely very comfortable with your pregnancy decision timetable. After all, you live in the United States, and the USA is the richest and most medically advanced county in the world. Right?
As your research intensifies you’re discovering some unfamiliar aspects of pregnancy. There are organizations combating various conditions such as Preeclampsia, Stillbirth, Intrahepatic Cholestasis of Pregnancy (ICP) and Gestational Diabetesto name a few.
Then you stumble upon Maternal Mortality and Morbidity. What? You mean, “I may not make it out of my pregnancy journey alive?” Slowly you realize the risks of pregnancy and delivery day are genuine, yet silently hidden.
Maternal Morbidity And Mortality
So what exactly is maternal morbidity and mortality?
The Center for Disease Control (CDC) definesSevere Maternal Morbidity (SMM) “to include the unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health”.
Maternal Mortalityis defined by the CDC as “the death of a woman while pregnant or within 1 year of the end of a pregnancy regardless of the outcome, duration or site of the pregnancy–from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.”
Dr. Priya Agrawal, OB.Gyn, Executive Director of Merck for Mothers,states that although maternal mortality is comparatively rare in the USA, one preventable maternal death is one too many. The United States has a higher rate of maternal deaths than 45 other countries globally andmore women will die from child-related causes in the United States than in any other developedcountry.
In her recent editorial in the Bulletin of the World Health Organization (WHO), Dr. Agrawal informs us that the USA costs of maternity care exceeded $60 billion in 2012. Although maternity costs continue to rise, approximately 1200 women in the USA will experience complications during pregnancy or childbirth that prove fatal every year. Sadly, another 60,000 women will endure complications that are near fatal.
The USA’s maternal morbidity and mortality rates remain extremely problematical. Unbelievably, roughly half of all maternal deaths in the USA are preventable. Dr. Agrawal cites three factors that are influencing the rising maternal mortality and morbidity trend in the USA:
So what is being done in the USA?
Medical personnel and community organizations are working to address the above factors. Hospitals are now creating standard approaches for obstetric emergencies. This will help to ensure that wherever a woman gives birth, she will be given suitable evidence-based care. Community initiatives are now managing care for high-risk women to safeguard good health and the management of chronic disorders during and after pregnancy. More states are creating and standardizing maternal mortality review boards.
New changes to nationwide health policies will hopefully improve maternal health outcomes. The USA’s participation in the global dialogue on maternal health is mandatory. Every state needs to rally health providers, policy-makers and communities in making maternal health a priority. With increased awareness of maternal mortality and life-threatening events – and concrete actions to ensure that pregnant women get the quality care they need – many fatal and near-fatal complications could be prevented.
On the global front, to make maternal morbidity and mortality even more profound, maternal losses sustained by underdeveloped countries are much more disturbing as countless numbers of women do not have access to maternity care. For these women, more than 800 a day will die from complications related to pregnancy or childbirth. Statistics show that between1990 and 2015 maternal mortality worldwide dropped by about 44%.However impressive this appears, it’s estimated 303,000 women died during and following pregnancy and childbirth globally in 2015 and almost all of these deaths occurred in low-resource settings. Alarmingly, almostallglobal maternal deaths are preventable.
Globally, one of the WHO’s foremost priorities is improving maternal health.
“WHO works to contribute to the reduction of maternal mortality by increasing research evidence, providing evidence-based clinical and programmatic guidance, setting global standards, and providing technical support to Member States.
In addition, WHO advocates for more affordable and effective treatments, designs training materials and guidelines for health workers, and supports countries to implement policies and programs and monitor progress.
During the United Nations General Assembly 2015, in New York, UN Secretary-General Ban Ki-moon launched the Global Strategy for Women’s, Children’s and Adolescents’ Health, 2016-2030 (7). The Strategy is a road map for the post-2015 agenda as described by the Sustainable Development Goals and seeks to end all preventable deaths of women, children and adolescents and create an environment in which these groups not only survive, but thrive, and see their environments, health and wellbeing transformed.”
Every Mother Counts
Christy Turlington Burns is the Founder and CEO of Every Mother Counts. After experiencing childbirth complications following the birth of her daughter Grace on October 23, 2003, Christy learned that hundreds of thousands of women were dying every year because they do not have access to the maternity care that they need. Realizing there is not enough political will or resources dedicated to this issue she devoted her work to understanding the challenges of and opportunities for improving access to maternity care around the world. She founded Every Mother Counts in 2010 following the release of her documentary film, No Woman, No Cry.
Every Mother Counts raises awareness by educating the publicabout this extremely sensitive subject touching us all. Sadly, most people are not aware of this potential tragedy until it is too late. The hope of this organization is to share their documented stories widely so others will learn from them, making these devastating stories a thing of the past.
Maternal mortality is unacceptably high. Although 99% of all maternal deaths occur in developing countries, it must be remembered that between 1990 and 2013, the maternal mortality ratio for the USA more than doubledfrom an estimated 12 to 28 maternal deaths per 100,000 births. The rate of maternal mortality is markedly higher among black women in the USA. Thesewomen who are expecting or who are new mothers die at rates similar to those of the same women in lower-income countries. Simultaneously, the maternal mortality rate for white USA mothers more closely resembles rates in more affluent nations.
Serena Williams understands this only too well. She agrees that she received excellent care for her postpartum complications for the most part. But concurs, “Imagine all the other women, who go through that without the same health care, without the same response.”
Empowering your knowledge of pregnancy day-by-day and trimester-by-trimester is important.The need for every pregnant woman to understand the joys as well as the perils of her remarkable nine-month journey is vital. It’s just that simple.
By knowing the facts, journaling your pregnancy milestones and tracking your baby’s movements you will be working closely with your health care team, which is key. Taking an active role in your pregnancy is essential. For more information on maternal mortality and morbidity in the USA and globally, please visit the WHO, CDC and Every Mother Counts.
Your baby could possibly pass meconium, a solid greenish-brown waste, in utero prior to delivery. Meconium-stained amniotic fluid (AF) occurs in about 13% of live deliveries. According to Medline Plus, a service of the U.S. National Library of Medicine, National Institutes of Health (NIH):
Risk factors for this condition should be identified as early as possible. If the mother’s water broke at home, she should tell the health care provider whether the fluid was clear or stained with a greenish or brown substance. Fetal monitoring is started so that any signs of fetal distress can be found early. Immediate intervention in the delivery room can sometimes help prevent this condition (meconium aspiration). Health care providers who are trained in newborn resuscitation should be present.” If your water breaks or you notice a leakage which is greenish-brown in color, indicating the presence of meconium in your amniotic fluid, call your health care team immediately and go to L&D or the ER.
Pregnancy is such an exciting time in your life. However, we have come to realize that it is beneficial for you to be aware of miscarriage in the event that you or someone you knows faces one. Learning about early fetal development in your first trimester enables you to have a better understanding of what is happening inside of your body as your pregnancy progresses, and what your health care team may be looking for in the case of a possible miscarriage.
Miscarriage is often a process and not a single event. It may be hallmarked by an abrupt decrease in the signs of pregnancy such as breast sensitivity or morning sickness. You may also experience lightheadedness, dizziness or feeling faint and weight loss. Vaginal spotting with white-pink mucous, or brown or bright red bleeding may be noticed. A gush of clear or pink fluid or tissue may also be passed vaginally. Cramping, often more intense than normal menstrual cramps, may or may not be present. True contractions that might be extremely painful occurring every 5-20 minutes may be experienced, and mild to acute pain in the lower abdomen or back may be observed. If fetal tissue passes from your vagina, it should be placed in a clean container and taken to your health care team’s office or to the hospital for analysis. If you experience any or all of the above symptoms, it is important that your health care team be notified immediately, or that you visit the nearest Emergency Room (ER) for an evaluation. Please remember that some bleeding may be experienced in 20 to 30 percent of all pregnancies, and approximately 50 percent of the women who experience vaginal spotting or bleeding in the first trimester do go on to have successful pregnancies.
Although there are several types of miscarriages, usually it is simply referred to as miscarriage without specifying the kind. However, your health care team may also use the following terminology to define miscarriage as provided by American Pregnancy Association:
There are many different causes for a miscarriage, however, the major cause of miscarriage during the first trimester is genetic or chromosomal, meaning the fetus isn’t developing normally. Most chromosomal abnormalities are the cause of a damaged egg or sperm cell, or are due to a problem at the time that the zygote goes through the division process. Typically in this situation, the embryo divides and grows abnormally for an unknown reason, and not a problem inherited from the mother and father. According to the Mayo Clinic, examples of this particular abnormality are:
Blighted ovum occurs when no embryo forms.
In this situation the embryo is present but has stopped developing and died before any symptoms of pregnancy loss have occurred.
A molar pregnancy is a noncancerous (benign) tumor that develops in the uterus. A molar pregnancy occurs when there is an extra set of paternal chromosomes in a fertilized egg. This error at the time of conception transforms what would normally become the placenta into a growing mass of cysts. This is a rare cause of pregnancy loss. There are also various maternal health conditions that may lead to miscarriage such as uncontrolled diabetes, infections including bacterial, viral, parasitic and fungal or sexually transmitted diseases (STD’s), hormonal problems for instance Polycystic Ovary Syndrome, cervical or uterine disorders, thyroid disease or maternal trauma. Environmental toxins such as excessive exposure to lead, mercury or organic solvents, low levels of folic acid and taking certain antibiotics such as clarithromycin are linked to the possibility of causing a miscarriage. Never take any herb, supplement or medication during pregnancy without the consent of a medical professional. Your routine day-to-day activities such as moderate exercise, sexual intercourse or work (as long as you are not subjected to unsafe chemicals or radiation) will NOT cause a miscarriage! Equally, neither nausea nor vomiting, not even morning sickness, will cause a miscarriage. The Mayo Clinic states that there are several maternal factors that may increase the risk of miscarriage:
Prenatal genetic tests such as Chorionic Villus Sampling (CVS) and Amniocentesis that are described in Week 12 are invasive procedures and do carry a slight risk of miscarriage.
The diagnosis of miscarriage is a sensitive one. If bleeding or pain is noticed, you must contact your health care team immediately as you may be experiencing a Threatened Miscarriage. Rest will most likely be advised until your symptoms subside; exercise and sexual activity will probably need to be avoided. Although these suggestions have not been proven to reduce the risk of miscarriage, they might improve your comfort and overall wellbeing during this time. Avoid travel right after your diagnosis as prompt medical attention may be necessary. If your symptoms do not subside, an examination will follow. Your health care provider will perform a pelvic exam to determine if there are any problems with your uterus and if dilatation has begun. An ultrasound will allow your baby’s development and heartbeat to be assessed and visualized. If it is determined that the embryo has died or was never formed, a miscarriage will occur. Your health care team will follow a specific protocol for the treatment of miscarriage. Their primary goal is to prevent hemorrhaging or infection at this time. The Mayo Clinic explains three possible protocols:
If you have no signs of infection, you might choose to let the miscarriage progress naturally. Usually this happens within a couple of weeks of determining that the embryo has died. Unfortunately it might take up to three or four weeks. This can be an emotionally difficult time. If expulsion doesn’t happen on its own, medical or surgical treatment will be. Medical treatment. If, after a diagnosis of certain pregnancy loss, you’d prefer to speed the process, medication can cause your body to expel the pregnancy tissue and placenta. Although you can take the medication by mouth, your health care provider might recommend inserting the medication vaginally to increase its effectiveness and minimize side effects such as nausea and diarrhea. For about 70 to 90 percent of women, this treatment works within 24 hours. Surgical treatment. Another option is a minor surgical procedure called suction dilation and curettage (D&C). During this procedure, your health care provider dilates your cervix and removes tissue from the inside of your uterus. Complications are rare, but they might include damage to the connective tissue of your cervix or the uterine wall. Surgical treatment is needed if you have a miscarriage accompanied by heavy bleeding or signs of an infection. Once your health care team has implemented the appropriate protocol and care for your miscarriage, you will need to pay close attention to the possibility of bleeding over the next few days. In the event of increased bleeding or the start of chills or fever, your health care team must be called immediately.
Following a miscarriage, you will often have many questions about your physical and emotional recover, and when you can begin to try and conceive again. Physically, your journey back to day-to-day life after a miscarriage is a relatively speedy one. It may take a mere few hours to a couple of days depending on your baby’s gestational age and the protocol chosen, and may take longer if anything unusual is experienced such as excessive bleeding, a fever or abdominal pain that would cause your health care team to be notified. It will take about 4-6 weeks for your period to return to normal. Any type of contraception should be started immediately after a miscarriage. However, it is important that two weeks following your miscarriage sexual activity should be avoided in addition to inserting anything into the vagina, such as a tampon. Your emotional healing after a miscarriage may be a slow process and may take much longer than your physical healing. Miscarriage can be an immense loss that your colleagues, friends and family might not fully understand. Your emotions might run the gamut from rage and blame to utter hopelessness. Time is needed to grieve the loss of your pregnancy, together with the hopes and dreams that come with your pregnancy. Seeking help from loved ones is vital as well as from professionals, especially if you are experiencing profound sadness or hopelessness. Miscarriage is usually a one-time occurrence and will follow with a healthy pregnancy. Statistics tell us that less than five percent of women have two consecutive miscarriages, and only one percent have three or more consecutive miscarriages. If you experience multiple miscarriages, typically greater than three in a row, you should consider scheduling an in-depth consultation and an intense prenatal workup with your health care team. This includes being tested to identify a possible underlying cause such as uterine abnormalities, coagulation problems or chromosomal abnormalities. Your health care team may encourage this testing after two losses. Following testing, if the reason for your miscarriage cannot be discovered, please don’t despair as approximately 60 to 70 percent of women with unexplained repeated miscarriages do go on to have healthy pregnancies. You may want to consider in vitro fertilization, embryo transfer, or artificial insemination to achieve a successful pregnancy if you have a history of unexplained miscarriages. Following a miscarriage, you should discuss getting pregnant again with your health care team, and seek guidance about the right time to conceive. Being physically and emotionally prepared is vital while waiting for conception to occur and that includes maintaining a healthy diet. Saying no to caffeine, alcohol and tobacco, which are known to raise the risk of miscarriage, is paramount. Indulge in calcium-rich foods, low-fat dairy products, almonds, beans, and nutritious green vegetable such as kale and spinach. Organic free-range protein sources are essential such as eggs and poultry. Olive oil is also a wonderful healthy option. Together diet and exercise will benefit you in maintaining a normal weight. A daily dose of folic acid is recommended and can be found in a prenatal supplement. Low levels of folic acid have been associated with miscarriage. If you have been diagnosed as a high-risk pregnancy, bed rest may be advised. A low-stress lifestyle is always beneficial. Although there have been no studies showing that homeopathy prevents miscarriage, the literature on homeopathy does report women who have had successful pregnancies after miscarriage when being treated with this type of alternative medicine. Did you know that after a miscarriage it is possible to become pregnant during the first menstrual cycle? If a pregnancy occurs immediately following your miscarriage, your health care team should be notified. They may also advise bed rest and progesterone if there is a history of previous miscarriages, along with the close monitoring of any chronic medical condition in safeguarding your pregnancy. For the most part, there is nothing you can do to prevent a miscarriage. What you can do is work closely with your health care team and be extremely prudent and watchful for known pregnancy risks. With regular prenatal care, good-quality sleep, abstinence from contact sports, and implementing the pregnancy strategies mentioned above, you can reassure yourself that you are taking the best care of both yourself and your developing baby.
Since prenatal appointments are not on a daily basis, it is up to you to pay close attention each day to your baby’s movements. By simply counting your baby’s movements, this non-invasive, easy, and free method allows you to get to know your baby’s movements patterns and will alert you to the possibility of a potential problem.
Through scientific research, we know that umbilical cord abnormalities are seen in one-third of all live births. Cerebral palsy and quadriplegic cerebral palsy are a direct result of such umbilical cord abnormalities.
Ask your health care team if a Nuchal Translucency Screening (NTS) should be performed, as this test is not routinely performed in many states. This screening consists of a blood test and an ultrasound. Administered between Weeks 11-13, this screening for chromosomal abnormalities gives families important information on potential outcomes as early as possible. First trimester screening results can be combined with second trimester screen results to detect Down syndrome and Trisomy 18. This testing provides an estimate of risk only. A positive result, which indicates an increased risk, does not mean your baby has a problem.
The focus on your nutrition is not only vital for your expected baby but provides the extra energy needed for you and baby to make it to delivery day as healthy as possible. By simply indulging in sensible, nutrient-enriched and well-balanced meals, you and your baby will thrive from day one of your pregnancy.
Pregnancy is a time of great anticipation, weekly changes and a new mindset. A savvy birth plan enables you to share your intended choices and wishes leading up to and during delivery with your health care team. But did you realize that delivery day is not the finish line? Or that your baby’s birthday is really the starting point? Enter the Postpartum Plan. According to Elly Taylor, a parenthood researcher and author of the book Becoming Us: 8 Steps To Grow A Family That Thrives, “Most couples find it hard to think beyond the birth, but there’s so much they can do to plan for a positive postpartum experience. I call it nest-building: plan to take as much time off work as possible, gather your support system (it takes a village!) and have your partner actively involved from the get-go.”
There are many ways to fashion the postpartum plan that’s right for you. In realizing the importance of creating an innovative and complete pregnancy experience, Phoenix, Arizona’s leading team of doulas, Phoenix Family Birth (PFB) introduced their tangible postpartum birth plan. As Carrie Murphy mentions above, PFB also advocates using the services of a Postpartum Doula. PFB encourages you to explore the tough questions and varied opinions that will make your plan feasible and realistic. Close your eyes for a moment…
Did you know that you might avert mood disorders and possible postpartum depression by using a postpartum plan? Remember that like your birth plan, your postpartum plan is also flexible. Share your plan with everyone ahead of time so there will be no surprises or hurt feelings. Keep in mind that the plan you drafted on your iPhone may not work best for you in reality at times and that’s perfectly okay! With a little planning prior to your baby’s arrival, you will make your hospital stay, arrival home and the weeks and months following delivery enjoyable and practicable. For more information on a Postpartum Plan, an Easy Postpartum Plan Worksheet, the services of a Postpartum Doula or the importance of a postpartum plan, please visit Phoenix Family Birth and Parents.
One condition to watch for is Preeclampsia which affects about five percent of pregnant women. Preeclampsia has risen by twenty-five percent over the last twenty years and is a major source of maternal and infant illness and death. Preeclampsia may occur during the last half of pregnancy and also during the postpartum period. This condition affects thousands of women and babies every year and is typically hallmarked by an increase in blood pressure. Although additional protein may be present in the urine (proteinuria), it is no longer a criterion for diagnosing preeclampsia, as many women do not have significant levels of protein present in their urine, which ultimately can delay diagnosis and treatment. Once you reach Week 20, your health care team will be evaluating you at every visit to make sure you are symptom free and not exhibiting any signs of preeclampsia.
A study conducted by the NIH and Ohio State University recently published in the journal Fertility and Sterility found a worrisome link between caffeine consumption and miscarriage. Quite simply, the data proves that couples who drank more than two caffeinated drinks a day during the weeks prior to conception had a greater risk that the woman would miscarry.
Ask your health care team to explain the signs and signals of preterm labor. Always inform your health care team of any contractions that you experience.
Did you know that the amniotic sac surrounding your baby usually ruptures during labor? You may hear your health care team comment, “When your water breaks” in anticipation of this natural phenomenon.
The symptoms of PPROM can differ from pregnancy to pregnancy. The major sign to be aware of is fluid leaking from your vagina. Initially, you may experience a popping sensation, a gush, slight leaking or a feeling of wetness in your vagina or underwear. Women may mistake a slow leak of amniotic fluid for urine and not be alarmed. If you notice any leaking, use a pad to absorb the fluid. Then look at it and smell it. If you smell ammonia, it’s probably urine. Amniotic fluid is colorless with a sweet smell. As with any new or different symptom of pregnancy and to avoid confusion, call your health care team immediately to be on the safe side. Your health care team will ask you about your symptoms and make the diagnosis of PPROM following an examination. Your cervix may have softened and possibly be beginning to dilate. The fluid leaking from your cervix will be tested to see if it is amniotic fluid, vaginal fluid, or urine. An ultrasound may also be done to measure the amount of amniotic fluid around your baby. The primary risks of PPROM are:
If your doctor finds that you have PPROM, you may need to be in the hospital on bed rest until your baby is born. Your treatment plan will depend on various factors. If you are between 34 and 37 weeks when your water breaks, your provider will likely suggest that you be induced; this may be done earlier if complications arise. It is safer for your baby to be born a few weeks early than it is for you to risk an infection. If your water breaks before 34 weeks, it is more serious. If there are no signs of infection or labor starting, you may be put on bed rest. You will be closely watched and monitored for any signs of labor or contractions, and any sign of infection such as fever, pain or an increase in your baby’s heart rate. Your baby’s movements and heart rate will also be monitored. Your treatment may include antibiotics to help prevent infections, steroid medicines that will help your baby’s lungs mature and tocolytic medicines to stop preterm labor. Tests to check your baby’s lungs may be done such as an amniocentesis to check for infection or to see if your baby’s lungs are mature enough for delivery. When the lungs have matured, labor will be induced. Both you and your baby will be watched very closely. If your baby is delivered prematurely, your health care team will guide you with the safest and best course of action. Once you deliver your baby, he or she will be sent to the Neonatal Intensive Care Unit (NICU) for specialized care. However, if there is not a NICU where you deliver, both you and your baby will be transferred to a hospital with a NICU and care for you both. Prevention Depending on your risk factors and circumstances, speak with your health care team about the possibility of preventing PPROM. Together you can discuss the potential benefits of progesterone supplementation, cervical cerclage and other possible treatments that may help your pregnancy reach 40 weeks. For more information on PPROM, please visit University of Rochester Medical Center, WebMD and Little Heartbeats.
The Quad Marker Screen is a blood test that is performed between Weeks 15-20 of your pregnancy. This screen determines if you are at a higher or lower risk of carrying a baby with a birth defect such as Down syndrome, Open Neural Tube Defects (NTDs) including spina bifida, or Trisomy 18. This test predicts the likelihood of several potential problems with your baby and/or carrying your baby; it does not diagnose the problem.
Why not begin sleeping on your left side now? According to BabyCenter Sleep Expert, Donna Arand, Ph.D., Clinical Director of the Kettering Sleep Disorders Center and Associate Research Professor in neurology at the Boonshoft School of Medicine at Wright State University explains:
So check with your health care team and see if they recommend left-side sleeping for you. Did you know some pregnant women prefer an air bed for comfort? Air beds provide an adjustable technology creating a desired firmness or softness that accommodates a mom’s changing weight, dimensions and comfort levels. For more information on pregnancy and sleep, please visit BabyCenter and the National Sleep Foundation.
In the United States Stillbirth refers to the loss of a baby of twenty or more weeks gestation. Stillbirth is not a cause of death but rather a term indicating a baby has died in utero. The universal definition of when a loss is a stillbirth varies internationally making it difficult to gather and compare data and ultimately determine how frequently stillbirth occurs.
No race, income level, age group or ethnicity is immune to stillbirth. However, there are risk factors that may increase the likelihood of stillbirth. There is a higher incidence of stillbirth if you are of the black race, 35 years or older, overweight, a smoker, have endured an earlier loss, or have a medical condition such as diabetes or high blood pressure. These issues may put an expectant mother at risk for stillbirth or preterm birth. A gradual decrease in fetal movement was noticed by fifty percent of mothers a few days prior to the death of their babies. A recent study in Norway noted a thirty percent reduction in stillbirth when pregnant women were encouraged to track fetal movement by their healthcare provider, and were told to immediately seek medical attention when they noticed any decline in their baby’s movements. If you have had a previous stillbirth, your next pregnancy will be considered a High Risk pregnancy by your health care team and you will be referred to a Maternal Fetal Specialist for exceptional care. This necessary attention will be given to all aspects of your pregnancy. It may include more frequent medical visits, additional ultrasounds or specialized testing, and increased monitoring to be sure you and your baby are both doing well. If your health care team does not consider your subsequent pregnancy to be a high risk pregnancy, you should discuss your concerns with them including the option of transferring your care to another health care team. Beginning at Week 20 every mom is encouraged to begin keeping a journal tracking her baby’s movements. Getting to know your baby’s movements and taking note of when your baby is stirring or slumbering is fundamental. Daily journaling will enable you to become familiar with the movements of your little one so your baby’s daily routine will become second nature to you. Knowing your baby’s patterns of movement will enable you move easily into Kick Counting, which will begin around Week 28. PAK encourages all pregnant moms to use our Mom & Baby Tracking Chart from Week 13 onwards. If for any reason you detect an unusual level of activity for your baby (an increase or decrease in fetal movement), you notice any sudden changes in movement, or once movement counting has commenced you are unable to obtain the usual 10 movements in your normal amount of time, call and visit your health care team to make sure that your baby is well. If you are unable to contact or visit your health care team, go to Labor and Delivery (L&D) as most L&D units will see you immediately for Decreased Fetal Movements (DFM), or go to the nearest Emergency Room (ER). Discuss any changes to your Mom & Baby Tracking Chart with your health care team and don’t ever hesitate to call them about any questions or concerns that you may have, or comments that they may have made to you that you don’t understand. Your team is there to educate and inform you, that’s their job! You know your baby best, so always trust your instincts. For more information on stillbirth and movement counting please visit the CDC, babyMed, PAK’s Third Trimester, Week 28 and PAK’s Operation Due Date Mom & Baby Tracking Chart on our website.
Dr. McGregor advises that pregnant women avoid unnecessary, frequent or forceful cervical exams that may push bacteria closer to your baby; both vaginal or perineal ultrasounds in place of cervical exams are less invasive.
Some form of anxiety is normal for pregnancy, a time of high emotions, excitement, as well as nervousness. But did you know some women are absolutely terrified of pregnancy and anything related to it? Tocophobia, from the Greek tokos, meaning childbirth and phobos, meaning fear, is a pathological dread of pregnancy. Primary tocophobia affects roughly 13 percent of women who have never been pregnant. Though these women are desperate to have a baby, many will postpone or totally avoid pregnancy due to this pathological and irrational fear. Some will even terminate a pregnancy. Secondary tocophobia may be seen in women who have experienced a traumatic obstetric event, a termination of pregnancy, miscarriage, stillbirth, a normal healthy delivery (and for some very distressing reason, she will not consider having another baby) or a depressive illness in pregnancy.
The best time to receive vaccinations is before you become pregnant according to the U.S. Department of Health and Human Services (DHHS) so discuss this possibility with your health care team if this pertains to you. Vaccinations will help safeguard your body from infection and this protection passes to your baby during pregnancy. You are encouraged to have a preconception exam to make sure you are up to date with your “adult” vaccines; bring a copy of your vaccination record with you. If you don’t have this record, a simple blood test will let your health care team know what vaccinations you need. If you aren’t current, ask your doctor for the requisite vaccines. Women are generally advised to wait one month following any vaccinations to become pregnant. Your health care team may or may not advocate vaccinations during pregnancy.
If you are not current with your vaccinations, you have discussed being vaccinated with your health care team and you would like to be vaccinated, Dr. McGregor advocates being immunized around Week 28 for Influenza (Inactivated) and Tdap (Tetanus, Diphtheria and Pertussis). The Tdap vaccination is also recommended for relatives, friends and caregivers who will spend time with your baby.
The Tdap vaccination is suggested for relatives, friends and caregivers who will be spending time with your new baby.
If your baby has not arrived on time, please don’t be surprised or upset. Many moms have babies past Week 40; this is a crucial time during pregnancy as the amniotic fluid surrounding your baby is beginning to decrease and the placental function needed to sustain your baby’s life may be beginning to slow. You will need to discuss with your health care team the probability of when to expect your baby’s arrival or the possibility of planning your baby’s delivery day.
Your baby’s movements and heart rate will basically stay the same during the last trimester of your pregnancy. All moms need to continue being their baby’s guardian up until delivery day. Make sure you continue with movement counting ideally three times a day. Remember, a change in your baby’s movements such as speeding up or slowing down, or changes in sleep-wake cycles could be the sign that your baby is not well. Call your doctor, midwife, or health care team with any questions or concerns. If you are unable to reach them go to L&D or the nearest ER to check on your baby. Always trust your instincts.
This amazing week will be one of your baby’s most important. After completing your 20-week ultrasound, you will be equipped with vital information. This ultrasound closely examines both your baby’s anatomy and the environment within the uterus.
Request an ultrasound around this time to examine the umbilical cord and placenta for normal development and position. If your ultrasound is not covered by your insurance, use your Pregnancy PUR$E to help fund this test.
If a problem is seen on your baby’s ultrasound with the umbilical cord or placenta, a plan of action needs to be decided upon with your health care team. Examples of close monitoring include repeat office visits, ultrasounds, Fetal Non-Stress Tests (NSTs), Biophysical Profiles (BPPs), Doppler Ultrasound, very diligent movement counting and daily home fetal heart rate monitoring offered by companies such as Genesis Obstetrical Home Health Care Services. Your health care team may determine your baby should have further monitoring following your 28-week ultrasound or maybe you are considered high risk. It is comforting and reassuring to know your baby is healthy and stable thanks to the frequent monitoring. The four main reasons for monitoring your baby are to ensure that your baby is comfortable in utero, to ensure that your baby’s heart rate is normal and steady with no significant decelerations (decels) present, the placenta is working efficiently and not appearing to be aged, and to ensure that there are no signs of preterm or premature labor present. “Most women who notice a decrease in movement will still have a healthy outcome,” says Obstetrician-Gynecologist Ruth Fretts, M.D., MPH, Assistant Professor at Harvard Medical School and Chair of the Stillbirth Review Committee at the Brigham and Women’s Hospital in Boston. “The biggest concern is when it happens repeatedly.” Dr. Fretts reminds every mom that as her pregnancy advances and her expected baby has less space, the kicks won’t be as strong and obvious. But if it takes you more than two hours to count 10 movements, your health care team should be called. She says a Fetal Non-Stress Test (NST) is necessary to confirm your baby’s heart rate, “This rules out a life-threatening emergency, but it doesn’t address the underlying reason for decreased movement.”
Unfortunately in the United States ultrasounds will be performed only about 20% of the time in these situations, so mom will need to assert her proactive skillfulness requesting one is done. With a normal NST, movement counting should be completed and kept track of every day. Mom should never hesitate to be evaluated every time a problem is perceived. If the thought of counting and charting your baby’s movements makes you nervous, remember that movement counting is the safest and easiest course of action that every mom can take to monitor her baby’s movements on a daily basis. This simple concept is also free and non-invasive. Studies inform us that being attentive to your baby’s movements and informing your health care team of any changes such as speeding up or slowing down, or changes in sleep-wake cycles will decrease the likelihood of having a stillbirth. Ask your health care team for the signs that your baby may not well and their protocol for such signs.
Request an additional ultrasound now to examine the umbilical cord and placenta for normal development and position. If your ultrasound is not covered by your insurance, use your Pregnancy PUR$E to help fund this test.
If a problem is seen on your baby’s ultrasound with the umbilical cord or placenta, a plan of action needs to be decided upon with your health care team. Examples of close monitoring include repeat office visits, ultrasounds, Fetal Non-Stress Tests (NST), Biophysical Profiles (BPP), Doppler Ultrasounds, very diligent movement counting and daily home fetal heart rate monitoring offered by companies such as Genesis Obstetrical Home Health Care Services. Your health care team may determine your baby should have further monitoring following your 36-week ultrasound or maybe you are considered high risk. Remember, it is comforting and reassuring to know your baby is healthy and stable thanks to the frequent monitoring. The four main reasons for monitoring your baby are to ensure that your baby is comfortable in utero, to ensure that your baby’s heart rate is normal and steady with no significant decelerations (decels) present, the placenta is working efficiently and not appearing to be aged, and to ensure that there are no signs of preterm or premature labor present. And continue movement counting ideally three times a day until your baby arrives.
All women considering becoming pregnant must be aware of the Zika Virus. Current research on Zika is in its infancy globally. There is a correlation with pregnant women infected with Zika and microcephaly; babies born with abnormally small heads.
It is spread by Aedes mosquitoes. They are found throughout the Americas except for Canada and Chile where it is too cold for them to survive. The World Health Organization (WHO) expects Zika to spread throughout the Americas, but other scientists have warned that countries in Asia could face large outbreaks too. The CDC updated its Zika virus guidance for pregnant women, advising them to protect themselves if their male sexual partner has traveled to or lives in an area where Zika virus is circulating as sexual transmission has been confirmed.
Deaths are rare and only one in five people infected is thought to develop symptoms. These include:
The link between Zika virus, pregnancy and microcephaly has been confirmed. Microcephaly is when a baby is born with an abnormally small head, as their brain has not developed properly in utero. The severity varies, but it can be deadly if the brain is so underdeveloped that it cannot regulate the functions vital to life. Children that do survive face intellectual disability and developmental delays.
As there is no treatment, the only option is to reduce the risk of being bitten. Health officials advise people to:
The mosquitoes lay their eggs in standing water, so people are also being told to empty buckets and flower pots. The US Centers for Disease Control (CDC) has advised pregnant women not to travel to affected areas including Latin America and the Caribbean.
The CDC issued an early-release Morbidity and Mortality Weekly Report (MMWR)(www.cdc.gov) in July, 2017 updating its short-term guidance for health care professionals that care for pregnant women with probable Zika virus exposure. Please remember “the CDC’s definition of possible Zika virus exposure(www.cdc.gov) — that is, from ‘travel to, or residence in an area with risk for mosquito-borne Zika virus transmission, or sex with a partner who has traveled to or resides in an area with risk for mosquito-borne Zika virus transmission’ — remains unchanged.” The CDC’s MMWR offered the following key recommendations:
Director General Dr. Margaret Chan states that the priorities are to protect pregnant women and their babies from harm and to control the mosquitoes that are spreading the virus. Dr. Chan reaffirms that pregnant women should not travel to countries affected by Zika and to seek advice from their doctors if they are living in areas affected by Zika as well as protect themselves against mosquito bites by wearing repellent. Currently, there is a concerted global effort to develop a vaccine for the Zika virus that will protect the general population against its adverse effects.