Before I review the common methods of inducing labor, let me first explain that these methods are used by licensed medical professionals. If you came here for “natural” induction techniques, then you clicked on the wrong article.

Let me just say that if you want to try at-home techniques, please talk to your healthcare provider. We are not opposed to natural methods, but there are side effects/risks that may put certain pregnancies at increased risk. Also, I never, ever recommend castor oil to induce labor. Diarrhea-induced contractions are not the type of contractions you want to suffer through.

Inducing labor can take several hours, if not days, and you may need multiple methods throughout the induction process. Please note the time limits posted for each method to prevent complications. These methods have been studied and proven safe for most pregnant people.

1. Nipple Stimulation: This isn’t as fun as it sounds! Nipple stimulation releases endogenous oxytocin which causes contractions. Nipple stimulation is best accomplished by applying a mechanical breast pump to both breasts. One problem with this method is once the stimulation is stopped, the oxytocin level drops, and contractions can also stop if labor wasn’t fully established. Time limit: 20 minutes on, 20 minutes off, for up to 2 hours

2. Foley Balloon: Mechanical dilators, like the foley balloon or Cook cervical balloon, put pressure on the cervix, stretch the lower segment of the uterus, and indirectly release cervical softening hormones called prostaglandins. The end of the balloon can be attached to traction to aid in cervical dilation. Once the balloon comes out, the cervix is usually 3–5 centimeters dilated, though contractions will usually need to be stimulated to induce labor. Time limit: 12–24 hours

3. Cervidil or Cytotec: These prostaglandin medications are placed directly behind your cervix to soften the cervix and help thin it out. Cytotec can be taken orally, which is great if the amniotic membranes are ruptured. Though the goal of these medications is to ripen a cervix for labor. Both are capable of producing contractions. Labor is more likely if you have had more than one baby. Time limit: 12 hours for Cervidil; Cytotec is given every 3–4 hours for up to 3–4 doses

4. Pitocin: Pitocin is the synthetic version of oxytocin. It is given through an IV and can be titrated to achieve an adequate contraction pattern. Pitocin is the most common method of induction or augmentation of labor and is rapidly cleared by the body once it is turned off. Pitocin can be given after delivery to prevent uterine atony and postpartum hemorrhage. While in labor, your nurse or healthcare provider will carefully monitor the fetal heart rate and contraction pattern to prevent complications. Time limit: No time limit; postpartum complication risks increase with prolonged exposure (>24 hours) for some people.

Your provider should explain the risks, benefits, and alternatives for any induction process. Each pregnancy is different so the method that worked for your first pregnancy may not be an option for future pregnancies.

Also, unless you have a medical condition validating an induction prior to 39 weeks gestation, your provider cannot induce labor. No matter how bad your back hurts or if your mom is coming in from out of town.

Trust the process and be patient!

This article was contributed by MacArthur Medical Center’s Certified Nurse Midwife Jen Rockhold

The post Common Methods of Inducing Labor During Pregnancy appeared first on Medika Life.

Disclaimer: All information and resources in this article are based on my personal research and opinions unless otherwise noted. I wish to contribute to the VBAC conversation from a patient point of view; I am not a doctor. My educational background is in English-Creative Writing. Please consult health care professionals before making decisions about your health. 

When I tell friends that Ceci , our second child, was my VBAC baby, I usually find a confused expression on their face or they ask me point-blank, “What is that?” to which I answer, “Vaginal Birth After Caesarian Section” in an even tone. I’ve had practice saying “vaginal” now for eleven years. At first, it felt a little embarrassing or like I was supplying information the questioner wasn’t prepared for. Then, I got over it. It’s part of being a positive force in the world of women’s health and it’s why I write articles about subjects I wish were discussed more, like maternal incontinence. 

If you’re reading this, I’m guessing you’ve either had a VBAC, are considering having a VBAC, or know someone who has had one. Now that I have thirteen plus years spaced between my traumatic and unplanned C-Section and my emotionally healing VBAC I feel I can finally share my experience with people who are interested in possibly pursuing this option. Let’s dive into my backstory and then I’ll give some details about what you can do to further research your options if VBAC is something you’re considering. 

My VBAC Story Starts With a Traumatic C-Section Story

Close to Christmas, I went into labor. I was terrified and denied I was in labor until my water broke many hours after labor started. At that point, David helped me waddle into the car and go to the hospital. I was at almost 8cm (out of 10cm) dilated and our son’s head was stuck in the brow position, meaning he was looking skyward instead of chin tucked in. My doctor was on vacation and a very pregnant doctor came in to introduce herself and break the news that we should consider a C-Section. Otherwise, we risked breaking our baby’s neck during vaginal birth. 

Neck Breaking. That’s all she had to say. We agreed and looking back, I do believe this was the right decision. After our son was born, I second-guessed myself, but the fact of the matter is either way he’d have been born, there would’ve been trauma to both my body and his. 

When we got to the hospital, I was in so much pain that I screamed for drugs. I let loose like they do on TV. And, the nurses shushed me for making such a scene. I got doses of pain medication and my thinking became blurry as the pain receded. David got suited up in scrubs and they wheeled me to the OR. I was not restrained. An anesthetist hooked me up to an epidural and rubbed a piece of ice across my huge belly. “Can you feel that?” he asked. “I’m not sure,” I replied, “Can you do it again?” At least that’s how I remember it. But, he shushed me as the nurses had. “If you don’t know, then you didn’t feel it.” 

The thing was, I did feel the ice. And, my drug-blurred brain wasn’t doing me any favors. The doctor started making the incision. I could feel the scalpel cutting into my flesh. I imagined people enduring torture and told myself if they could do it, so could I. It felt like forever before my brain caught up and sent me the signal that we were in an OR, this wasn’t torture to be endured, and I should speak up. I don’t remember what I said but I do remember reaching under the curtain trying to grab the scalpel and make it stop. 

David saw what was happening and got the doctor’s attention. She was shocked and sternly told the anesthetist to fix his mistake. As he upped the dose, it worked, but I was in another world, one of PTSD, terror, torture, and knowing I was about to have to take care of a baby who caused this pain, followed by guilt because it wasn’t our baby who caused the pain. And, was it my fault for taking medication during pregnancy, for going to the hospital too late in labor? My brain spun as the doctor made precise incisions. My scar is barely there — she did an excellent job. 

And, then it was time for our son to be born out of this slice in my abdomen that I couldn’t see. The doctor tugged to free him and he stayed firmly inside me. Another tug. And, the third, he was free. She’d had to dig her heels into the ground and pull with all her strength. She seemed to also be suffering a case of trauma — after all, she too was pregnant. 

Our son scored well enough on the Apgar test and they wheeled him off and David left and I was all alone in a room full of steel — wounded, weak, and scared. 

Many months later, the doctor who delivered Jaden and I found ourselves at a restaurant unexpectedly attending the same dinner party and discussing our deliveries. Mine had traumatized her as I’d thought. She ended up also having to have a C-Section. It was cathartic to have this unexpected conversation.

Recovery took weeks, months, years. There was emotional trauma beyond the physical toll of the unplanned C-Section. I share this backstory with you to illustrate why it was that I was so adamant about birthing our second child by VBAC. I didn’t want to endure unnecessary suffering and pain and didn’t want to put our baby through any trauma either.

It Wasn’t Easy Finding a VBAC Doctor, But it Was Worth It

Jaden was born in late December of 2007. David was ready to talk about having another child long before I was prepared for entertaining the thought of it. I needed to first find a way to heal. 

After the C-Section, I’d been unable to breastfeed. In my mind, this meant I failed at the most basic task of mothering. I no longer believe that and wish there wasn’t so much judgment of parent’s choices around breastfeeding. I also began having intrusive thoughts, which is part of Postpartum OCD (PPOCD) but was something I didn’t know about then and is only really coming into the postpartum discussion more prominently in the 2020s. Aymes Sarah has written a book about this subject, which is forthcoming. It took many years for me to finally obtain an OCD diagnosis to go with my Generalized Anxiety Disorder and Depression diagnoses. Medication, therapy, writing, and other modes of healing have helped me navigate the mental illness aspects of my life.

I knew I wanted another child as much as David did, but I was terrified of going through C-Section trauma again. Very few doctors had the insurance to practice VBACs where we lived (Oklahoma, US) in 2010:

“From 2005 to 2015, the main malpractice insurance company in Oklahoma, PLICO (Physician’s Insurance Company of Oklahoma), refused to cover care-providers who allowed their patients to have a trial of labor after a previous cesarean.” — Bethanie Verduzco, Tulsa Kids

The restrictions were lifted in Oklahoma in 2015, allowing many more doctors to offer VBAC services. From what I understand, this varies from state to state and country to country. Finding a local resource group is a good place to start if you are interested in pursuing a VBAC. 

Some VBAC Basics

I don’t remember how I even learned about VBACs, to be honest. I’d guess it was either from a local mom’s group or from a source like Babycenter. I do remember that I was led to the online resources that ICAN (International Cesarean Awareness Network) provides. ICAN describes its mission:

The International Cesarean Awareness Network is a non-profit organization whose mission is to improve maternal-child health by reducing preventable cesareans through education, supporting cesarean recovery, and advocating for vaginal birth after cesarean (VBAC). — ICAN

All the warnings against VBAC mentioned the risk of uterine rupture:

“A possible rupture: A rupture of the cesarean scar on the abdomen or the uterus itself is rare. If a rupture does occur, most often there are no significant complications for you or your baby. Very rarely, however, a rupture can result in serious harm to both you and your baby. Your obstetrician will inform you if you are at a high risk for a rupture. If you are at risk, it is not recommended that you have a VBAC delivery.” — Brighamandwomens.org

The Brigham and Women’s Hospital has very good basic information on the risks and benefits of VBAC. One of the reasons I wanted a VBAC was the shorter recovery period. I still deal with emotional trauma in my C-Section scarring area, though it is much diminished now. And, they were right — my vaginal birth recovery was a breeze compared to the recovery from a C-Section, which is, after all, abdominal surgery. 

Once you have decided that you want to pursue a VBAC, you will need to do some homework:

• Find doctors who perform VBACs in your town with a high rate of success. You can call and request the success rate. 
• Figure out which of these doctors accept your insurance.
• Call insurance to confirm that they’d cover a VBAC birth.

Catharsis Through Delivery

I don’t remember how I found the details for Dr. John R. Thompson, but I do remember finding that his rate of success with VBACs was very high. Because I desperately wanted a successful VBAC, I decided to go with Dr. Thompson and take all of his advice. He had a proven record. He did some things differently than other VBAC doctors, namely that he induced a week early, which is generally recommended against because it slightly increases the chance of uterine rupture. His argument was having a smaller birth weight baby would increase the rate of success.

The delivery went smoothly. We arrived early in the morning and began the Pitocin drip. I wasn’t expecting the pain that came with inducing so early in labor. I asked for an epidural when I was only 2cm (out of 10cm) dilated. It was very difficult to deal with labor pain while hooked to an IV and being told to lay on my back in bed. This part was not ideal but I accepted it for what it was.

Dr. Thompson early in my pregnancy said he didn’t understand why women choose natural childbirth when the pain is unnecessary. Although I didn’t agree, I held firm in following his advice, which was to avoid any brain-altering pain interventions and use the epidural. I was clear-headed during the entire labor and delivery and for that I’m very grateful. I’m also grateful I had the epidural since labor was especially painful and movement was so constricted.

When it came time to push, it was difficult to feel what I was doing, which is one of the downfalls of epidural use. Dr. Thompson told me I needed to push or we’d be looking at a C-Section. That, along with an episiotomy, and Dr. Thompson guiding my hand to hold Ceci’s head as she crowned moved things along.

I hadn’t considered holding my baby’s head as I birthed her as an option. Dr. Thompson’s gesture of inviting me to do so was a kindness I will never forget. My body and my baby were able to achieve a successful VBAC. It was an extremely healing experience for me, from the research, reading and self-advocating to the labor and delivery to the postpartum period, in which I successfully nursed for 10 months. At the 10 month mark, intrusive thoughts began creeping in and I made the difficult decision to go back on medication and stop breastfeeding.

Emotional Healing Through VBAC

The pregnancy with our daughter was much easier than the one with our son. I felt supported and excited. I craved healing through this VBAC experience. Intuitively, I felt this would help heal the psychological trauma that I’d undergone with the unplanned C-Section. 

I believe it was through ICAN that I discovered a book called Cesarean Voices edited by Martha Basham. I do not recommend this book for women planning C-Section birth or women who have had non-traumatic C-Section births because this book is entirely about traumatic C-Sections. For me, reading the stories of other women who’d had traumatic C-Section birth experiences helped me feel not alone and was a catalyst toward my own healing. The book description on the ICAN website states:

“In a culture where cesarean section is viewed as simply another way to have a baby, we seldom hear the voices of women whose experiences have not been so easy. This groundbreaking book answers the question “What’s so bad about a cesarean?” in a raw, honest, heart-shattering way. If you care for or about women and babies, hear these voices.” — ICAN

I also accepted help after Ceci was born. A breastfeeding friend stayed with us for a week and helped me get the hang of it while also normalizing it for the rest of our family. My mom and mother-in-law and other family members provided support. Where I had felt alone and hurt after having Jaden, I felt supported in my healing after having Ceci. 

The Choice Is Yours Whether to Have a VBAC or CBAC

One of the most healing things about having had a VBAC is that moms who are interested in also having a VBAC reach out to me because I’ve been so open about mine. I’ve had coffee shop chats, in-person chats, and online message chats about my positive experience. I’ve gotten to hear when other moms have successful VBACs. Oftentimes, moms didn’t know VBAC was an option until I mentioned it. 

Not all moms are candidates for VBACs and this is a personal choice. There’s not a right or wrong answer and I hope there is no judgment for the choices moms make. We are under a lot of pressure to make 100% “right” choices. That’s impossible. We do the best we can with the information we have. ICAN has resources for moms who have CBACs (Cesarean after Cesarean Birth) to help with resources and healing. Although their mission is to decrease the number of unnecessary C-Sections they understand that sometimes C-Sections are the best option.

Whatever you choose, I suggest reaching out to other women who have gone ahead of you with what you are doing. It helps to have the support of knowing you are not alone and of hearing about successful outcomes. 

Further Resources

VBAC (Vaginal Birth After Cesarean)
www.childbirthconnection.org

VBACs in Oklahoma: What you need to know – TulsaKids Magazine
www.tulsakids.com

Vaginal Birth After Cesarean (VBAC) – Brigham and Women’s Hospital
www.brighamandwomens.org

Vaginal Birth After Cesarean Delivery (VBAC)
www.acog.org

VBAC Education Project | International Cesarean Awareness Network
ican-online.org

The post I Had an Emotionally Healing Vaginal Birth After my C Section.  Why VBAC May Be Right For You, Too appeared first on Medika Life.

AHRQ, a branch of the U.S. Department of Health and Human Services, issued a challenge during the summer of 2020 for hospitals to present evidence-based plans to address the needs of women and families after having a baby. Helena’s St. Peter’s Health and Birmingham, Alabama’s Pack Health were the winners of a $50,000 award for their innovations.

St. Peter’s team implemented universal screening programs to identify at-risk mothers. The hospital screened patients for risk factors such as alcohol, substance use, depression, and anxiety. The health team connected patients and families with community resources.

Birmingham’s Pack Health program leveraged a digital health platform to connect new mothers to coaches and health advisors.

Photo: kieferpix Istock/Getty Images

Postpartum depression is an inaccurate term. Perinatal mood and anxiety disorders can occur anytime after conception up to one year after delivering a baby. One in seven women suffers from a mood disorder related to pregnancy and childbirth.

Risk Factors for Perinatal Mood Disorders include:

• Stressful live events.
• Low social support.
• Previous history of depression.
• Family history of depression.
• Difficulty getting pregnant.
• Being a mom to multiples, like twins, or triplets.
• Being a teen mom.
• Preterm (before 37 weeks) labor and delivery.
• Pregnancy and birth complications.
• Having a baby who has been hospitalized.

Perinatal depression can be dark and debilitating, leaving mothers unable to function or adequately care for themself or their baby. Symptoms vary from person to person but include crying spells, sadness, hopelessness, and guilty. Some may express a lack of happiness or feel the absence of bonding with the baby. Some may have thoughts of self-harm or of hurting the baby.

Shame, guilt, and feelings of inadequacy prevent moms from reaching out for help. Moms fear judgment. They wonder “what is wrong with me” for not feeling blissful over the birth of their child. They fear their family will judge them. Others fear they may lose their baby if they express their true feelings out loud.

Some moms have intrusive thoughts causing fear and anxiety. Negative thoughts do not necessarily equal behavior. Help is available to manage these thoughts.

These symptoms indicate a new mom requires medical attention. The first step in treating perinatal mood disorders is recognizing the problem. Patients are often relunctant to share these feelings. Health providers may not be comfortable in screening for peripartum mood disorders.

Treatment options vary from person to person. Some women may only need to expand their social support network. Others benefit from group or individualized therapy. Pharmaceutical interventions may be needed for others.

The Agency for Healthcare Research and Quality recognized the increased challenges facing postpartum mental health care in the rural setting. Access to care, cost, transportation, and internet access all create barriers to identifying and treating those at risk for perinatal mood disorders.

The federal agency’s mission is “to make health care safer, higher quality, more accessible, equitable, and affordable,” The stated goals are to “keep patients safe, help doctors and nurses improve quality, and to develop data to track changes in the health care system.”

The AHRQ competition brought together digital health and other nontraditional health partners to find unique and innovative solutions to help rural families receive the help they need. Perinatal depression and anxiety universal screening programs for perinatal depression and anxiety along with patient and provider education programs help these women come out of the shadows.

Women need to know they should never feel ashamed to speak up about postpartum depression. These award-winning programs help patients and doctors learn to ask the right questions to get the help they deserve. 

The post Helena Hospital Awarded $50,000 for Helping Women with Postpartum Mental Health appeared first on Medika Life.

The American College of Obgyn and other Women’s health experts agree that Covid-19 vaccines should be offered to pregnant or breastfeeding people. Pregnant women were excluded from the initial Covid-19 vaccine clinical trials. Obstetrician/gynecologists, like me, follow the latest research to help our patients make safe decisions regarding their pregnancy.

The Boston research team published a study titled “Covid-19 vaccine response in pregnant and lactating women” in the American Journal of Obstetrics and Gynecology (AJOG). The paper is consistent with several small studies showing pregnant individuals have a robust immune response after the Covid-19 vaccination and secrete the antibodies into their breast milk.

This study analyzed blood samples and breast milk from 131 women in Boston and the surrounding area. The group included 84 pregnant, 31 lactating, and 16 nonpregnant individuals. The study also included five women who reported a previous SARs-CoV-2 infection. Each participant received the two-dose series of the Pfizer or Moderna Covid-19 vaccine following the FDA-approved protocols.

The research team tested blood and breast milk before vaccination and monitored the antibody response. The scientists compared antibody levels in pregnant women to 37 individuals with a history of natural infection during pregnancy and a cohort of nonpregnant people.

The results indicated a robust blood antibody response in all three groups. While scientists have shown already that moms pass protective antibodies to their baby after a natural Covid-19 infection, this study is important verification that pregnant women also develop an appropriate antibody response after vaccination.

Antibody transfer is good news for babies because a newborn’s immune system is not fully developed. Babies rely on maternal antibodies from blood and breast milk to protect against various infections during the first few months of life.

This study also reinforced encouraging news for lactating people. All the vaccinated mothers had antibodies in the breast milk samples. This finding provides further evidence that vaccinated women pass protective antibodies to their babies. Antibodies are present in breast milk within five to seven days of other viral vaccinations such as Tdap and influenza. Previous research also demonstrated women with a natural Covid-19 infection produce antibodies and secrete them into their breast milk. This study confirms published data from Portland that vaccinated women do too.

The side effects reported in the study were rare and similar in all three groups. The most common symptoms were fever and chills. These side effects are known to be good signs the vaccines are working to trigger an immune response.

This paper adds to the growing body of evidence supporting the safety and efficacy of Covid-19 vaccination in pregnancy and lactation. We continue to learn more about the novel coronavirus’s effects on pregnancy, newborns, and Covid-19 immunization in pregnancy.

Current research shows most pregnant people who contract Covid-19 have excellent outcomes but have an increased risk of ICU admission and preterm labor. Based on the known risks of Covid-19 infection in pregnancy, pregnant and lactating people are eligible for any one of the three Food and Drug Administration-approved vaccines.

None of the three FDA-approved vaccines contain a live virus. One cannot catch Covid-19 from the vaccine or spread the disease from the vaccines to a newborn through breastfeeding.

Pregnant patients can be confident knowing the three approved vaccines trigger an immune response to help protect themself and their babies.

Pregnant and lactating individuals are categorized as 1B in most states and1C in others.

To find a Covid-19 vaccine near you, click here.

The post High Antibody Covid-19 Vaccine Response During Pregnancy and Breastfeeding appeared first on Medika Life.

But nothing makes me more upset than hearing the delivery tales of terror from friends and family that come to *support* a laboring woman. Let me explain.

If you’ve ever been pregnant, you’ve heard the horror stories of painful deliveries, epidural mishaps, and awful labor experiences. Some of these stories are solicited, but most of them are shared spontaneously and without provocation. 

Don’t get me wrong. Sharing your bad experiences with your provider and birth center or hospital is essential and can improve future women’s outcomes. Birth trauma is very real, and I strongly encourage women to discuss their experiences with people to help them debrief and recuperate.

But the delivery room of your daughter, sister, friend, or cousin is most definitely NOT the place to recount your experiences.

I’ve heard birth stories of 4th-degree tears while pushing with a patient. I’ve heard about the agonizing back pain after receiving an epidural ten years ago while an anesthesia provider is preparing to insert an epidural catheter. I’ve listened to women drone on and on about being in labor for five days before finally ending up in an emergency c-section while I’m preparing a woman for induction of labor. 

I’ll tell you what I’ve never heard. I’ve never, not even once, listened to a support person talk about a positive birth experience while their friend or family is laboring 10 feet away. It’s as if every birth story has to have some dreadful or terrifying aspect. And like any good fisherman, a woman’s birth story always seems to become more hair-rising and more heinous with every retelling.

What validation do women receive by talking about these experiences while in someone else’s labor space? Is it cleansing for women to discuss their induction, contractions, labor, delivery, and pain while the laboring woman is anxiously experiencing their own birth story? Not to mention the older women recounting how “back when I had my babies…” Believe me when I tell you that obstetrics is continuously evolving and practices that were standard even five years ago are now obsolete. So your birth story from 30 years ago will probably not be relevant or helpful.

If you have the privilege of being a support person for a laboring woman in the future, check your birth story at the door and ask yourself three simple questions:

Is my birth story helpful?

Will the retelling of your experiences enhance or inhibit the labor experience? If someone told you this story while you were in labor, would it have helped or hurt you? While your family member is barely breathing through contractions, will your birth story help her cope with the pain?

Is my birth story hurtful?

Again, if your birth story will in some way demean, demoralize, or hurt in any way, don’t share it in the labor room. Will your birth story cause unnecessary fear? Don’t assume your experience was superior, and don’t tell a woman that her labor or delivery is doomed because of your own personal hurts or trauma.

Is my birth story true?

Have you embellished certain aspects of your birth story to make it seem like you should be receiving some medal of honor for enduring the impossible? Would your partner tell the same birth story if you weren’t around? So many labor and delivery stories are mundane and uneventful, and maybe it is human nature to have some fantastical element included in the birth of your child. But mundane and uneventful deliveries are the very best kind, so please don’t feel the need to recount your “fisherman” birth story at another woman’s delivery.

Lastly, please know that I want to hear all about the funny, good, positive, and crazy experiences you may have had during your pregnancy. Humor truly is the best medicine. 

And you should always confront the healthcare team about concerns or questionable practices. Just maybe leave the birth horror stories for the postpartum room 🙂

This article was contributed by MacArthur Medical Center’s Certified Nurse Midwife Jen Rockhold.

The post When You Shouldn’t Share Your Birth Story With a Pregnant Women appeared first on Medika Life.

Most of the time spent at an obstetric visit with your healthcare provider is used for education, counseling, reviewing normals/abnormals, and answering any questions you may have. So rest assured that all of your questions have probably been asked before…many times. There have only been a few questions that made me lose my neutral provider face (I won’t shame anyone here), but those are too few and far between. So I have compiled a list of the most common questions women or their partners have been scared to ask but honestly want to know the answer to.

What if I poop during delivery?

The number one question received by all obstetric providers and nurses involved poop. I’m going to let you in on a little secret. Almost all women poop at some point while pushing. There, I said it. And some women say, “I didn’t poop while pushing; I would have smelled it.” This is not necessarily true. We have soaps, sprays, and oils that we can use to diffuse ALL of the crazy smells in a delivery room, so you may not smell anything out of the ordinary. The fact is, your delivery team will keep you and your bottom clean no matter what happens. And hey, poop happens…a lot.

Do I need to shave my pubic hair before delivery?

No, absolutely not. You’re putting yourself at increased risk for infection by shaving your pubic hair before delivery. Waxing can be more painful during pregnancy, and laser hair removal isn’t recommended while you’re pregnant. Your obstetric team does not care what is going on down there, and it will not affect delivery or suturing. So, don’t bother.

Why do I pee when I sneeze/cough?

When you’re pregnant, your uterus puts a lot of pressure on your bladder. This leads to stress incontinence, otherwise known as peeing your pants. After delivery, your pelvic floor is lax and bruised, and it is common to have some incontinence in the first month or so after delivery. If it happens a lot, you can consider wearing a pantyliner or pad. Also, Kegels are a fantastic way of working on your pelvic floor muscles and averting incontinence. If you’re still dealing with incontinence 12 weeks after delivery, talk to your provider about pelvic floor rehab or another diagnostic test.

Will sex hurt after delivery?

Vaginas are incredibly elastic and will return to pre-pregnancy tone, or close to it, within a few months after delivery. We don’t recommend sex for at least six weeks after delivery, and I recommend a LOT of water-based lubrication the first time women attempt penetrative intercourse after delivery. But the short answer is, no, sex should not hurt after delivery. It may feel different or slightly uncomfortable if you had significant tearing or an episiotomy, but it should not hurt. If you’re anxious about the pain, you can engage in more foreplay before attempting sex.

Will the baby feel it when I have sex during pregnancy?

Unless you’re having sex in the delivery room, your baby will not feel anything when you’re having sex. In this case, size truly does not matter. The uterus and cervix provide a barrier between you and your partner. It is common to have cramps or mild contractions if you orgasm, but these contractions will not affect the baby.

Find a provider that you really trust so you can ask potentially embarrassing questions without fear or shame. And just remember that all of these questions have been asked by thousands of women throughout history, so there’s no reason to be scared to speak up!

This article was contributed by MacArthur Medical Center’s Certified Nurse Midwife Jen Rockhold.

The post Embarrassing Pregnancy Questions; We Have the Answers. appeared first on Medika Life.

She was only 26 weeks pregnant, and her life was in imminent jeopardy. The doctors recommended immediate delivery. Her baby survived the emergency c section but spent the first three months in the neonatal care unit.

Now that she is pregnant again. She wants to know how to reduce her risk.

Reducing the rate of preeclampsia in pregnant women through daily low-dose aspirin in high-risk patients may save lives and reduce the risk of poor pregnancy outcomes.

The American College of Obstetricians and Gynecologists (ACOG) and the US Preventative Services Task Force (USPSTF) are two leading medical associations that recommend daily low-dose aspirin for women with an increased risk of developing preeclampsia during pregnancy. Low-dose aspirin is an inexpensive and easily-accessible medication that lowers the risk of preeclampsia in high-risk women.

What is preeclampsia?

Preeclampsia is a common blood pressure disorder affecting 2–8% of pregnancies worldwide. Preeclampsia is the cause of 12% of maternal deaths. The USPSTF reports one-third of severe obstetric complications and 15% of preterm births in the United States arise from preeclampsia.

Preeclampsia is a leading cause of US maternal deaths, severe maternal morbidity, maternal intensive care admissions, cesarean section, and prematurity. Each year, preeclampsia and other pregnancy blood pressure disorders cause over 70,000 maternal and 500,000 fetal deaths worldwide.

Preeclampsia is diagnosed when high blood pressure occurs after the 20th week of pregnancy in conjunction with other signs and symptoms. Symptoms include headache, right upper abdominal pain, or visual changes. Signs include swelling, weight gain, urine protein leakage, or fluid retention in the lungs. Lab work may show low platelets, poor kidney function, or an elevation in liver enzymes.

Preeclampsia risk factors include:

• Previous pregnancy complicated by preeclampsia
• Chronic hypertension
• Pregestational diabetes mellitus
• Antiphospholipid syndrome
• Obesity
• Advanced maternal age
• Young maternal age
• Racial disparities — Black women are at increased risk of developing pregnancy-related blood pressure complications.
• Underlying kidney disease
• Pregnancies from assisted reproductive technologies

Low-dose aspirin reduces the risk of preeclampsia

The USPSTF and ACOG recommend the use of low-dose aspirin for women at risk of developing preeclampsia. Any pregnant woman with one or more of the above risk factors may benefit from this low-cost, low-risk intervention to reduce their pregnancy hypertension risk. 

The current clinical trial data shows daily low-dose aspirin reduces the risk of preeclampsia by 24%. The recommendation is to begin low-dose aspirin (81 mg/day) between 12 weeks and 28 weeks of gestation and continue daily until delivery.

The studies also show aspirin use in pregnancy is safe with a low risk to mom and baby. A USPSTF meta-analysis did not show aspirin increased the risk for bleeding complications such as placental abruption, postpartum hemorrhage, or fetal intracranial bleeding. 

The underlying cause of preeclampsia is unknown, but we know it is a complex multisystem inflammatory syndrome. Low-dose aspirin has anti-inflammatory, antiangiogenesis, and antiplatelet properties. These unique features may account for the beneficial effects on placenta development and placenta perfusion. 

An aspirin a day keeps preeclampsia away

Scientists continue to study preeclampsia. Researchers are looking to understand its origins and triggers. Medical studies attempt to find reliable biomarkers and improve diagnostic tools.

In the meantime, we can reduce the risk of preeclampsia by encouraging the daily low-dose aspirin in women who have an increased risk for high blood pressure in pregnancy.

The post Daily Aspirin; This Simple Solution Saves Pregnant Women’s Lives appeared first on Medika Life.

In contrast, men create new sperm every day. During ejaculation, about 400 million sperm are released. Only one needs to survive the long journey to find the egg. Sperm swim from the vagina through the uterus and make their way into the fallopian tube.

Typically, the sperm unites with the egg in the fallopian tube where fertilization occurs. The embryo then travels back to the endometrial cavity and implants into the uterine wall to begin to grow.

How do we know if his sperm is normal?

Sperm can be tested through a semen analysis. Semen is collected through masturbation. Most clinics have a private room with a library of videos or images to help stimulate the process.

The semen sample is tested at a fertility office. The sperm is evaluated for four main features: the amount of fluid (volume), the number of sperm (concentration), the size and shape (morphology), and the ability to swim in the right direction (motility).

How do I know if I ovulate?

If you have regular, predictable, menstrual cycles that occur every 21–35 days, then you are most likely ovulating. Some couples will test at home using an over the counter ovulation kit. We encourage this for couples struggling to conceive.

We do not recommend using them as a tool to avoid pregnancy, as these tests are not always reliable. Some women can learn to check changes in their cervical mucus to predict ovulation. The most accurate test for ovulation is to have a Progesterone blood test 7 days after the expected date of ovulation.

How do I know if my tubes are open?

The most common risk factor for tubal occlusion is a history of sexually transmitted diseases such as gonorrhea and chlamydia. These infections can cause scarring in the tubes.

Other risk factors include endometriosis, previous tubal pregnancy, and previous surgery. Although rare, multiple abortions or surgeries for miscarriage can lead to scarring in the uterine cavity called Asherman’s Syndrome. This is where the top of the uterus sticks to the bottom of the uterus, effectively sealing the cavity.

An Xray called a hysterosalpingogram (HSG) can be performed to determine if the tubes and uterus are open. The medical term is tubal patency. During an HSG, a dye is injected through the cervix and X-rays are taken to see how the uterine cavity fills. This allows doctors to view the shape of the uterine cavity and the patency of the tubes. If the dye goes through the tubes and spills into the pelvic cavity, then the tubes are open.

When should we have sex if we want to get pregnant

The short answer is to have sex as often as you want. The more, the better. 90% of couples will get pregnant within twelve months of unprotected intercourse. If you want to be more systematic, there are some strategies you can employ.

First, count the number of days from the start of one period to the start of the next. Subtract 14 days from the anticipated date of the next period. This is the most likely day of ovulation.

Having sex every other day around the expected days of ovulation allows optimal sperm count. Another option is to use an ovulation kit. Have intercourse on the day your ovulation stick is positive and then once a day for the next 3 or 4 days.

There are multiple apps available to help track ovulation. I suggest ignoring these at first. Let nature happen. Couples spend most of their lives trying to avoid getting pregnant. There is something special about having sex with your partner to start your family. Enjoy this unique intimacy without adding technology or stress. Keep it natural and avoid medicalizing sex.

How long does it usually take to get pregnant?

Most people get pregnant within one year. Infertility is defined as a healthy couple having unprotected intercourse without conception for twelve months. If it has been over one year and pregnancy has not occurred, then it is time for an evaluation. If you are over age 35, have irregular periods or other medical issues, then an assessment can start sooner.

Happy baby-making!

The post How to Find Out If You Can Get Pregnant? appeared first on Medika Life.

What should she do?

Every year, Influenza and Pertussis (Whooping cough) cause significant harm to pregnant women and their babies. The CDC recommends all pregnant women receive an annual flu shot and a pertussis vaccine (Tdap) during each pregnancy. Vaccinating pregnant women with the influenza vaccine and Tdap protects moms and their babies.

Both influenza and Tdap vaccines reduce the risk to pregnant women and protect babies who are too young to get vaccinated. These vaccines transfer antibodies through the placenta from the mom to baby providing protection until they are old enough to receive their own vaccinations.

The CDC analyzed eight years of surveillance data (2010–2018) to determine influenza and pertussis’s impact on pregnant women and their babies. The MMWR Burden and Prevention of Influenza and Pertussis Among Pregnant Women and Infants evaluated 2097 pregnant women and infants in an internet survey published in October 2019.

The survey outlines the significant danger of influenza and pertussis and tracks the vaccination rates of both vaccine-preventable diseases. Only half of the pregnant women receive one of the vaccines, and only one-third of pregnant women receive both vaccines.

Improving these vaccination rates saves lives.

Impact of season flu on pregnant women

Influenza is a common seasonal respiratory viral infection. The virus spreads via respiratory droplets from person-to-person. Droplets spread through coughing, sneezing, and breathing. Particles get on our clothes and hands. We then pass the virus through handshakes, hugging, kissing, and other close human contacts.

Pregnant women are not at an increased risk of catching the flu, but physiological changes of pregnancy place women at an increased risk of serious, adverse complications.

Pregnant women have a suppressed immune system and changes in their lung function. These changes put pregnant women at a higher risk of respiratory problems when they contract viruses. For this reason, pregnant women are considered an at-risk group for respiratory compromise if they contract influenza. Women who catch the flu are 2.4 times more likely to end up requiring hospitalization.

The Advisory Committee on Immunization Practices (ACIP) recommends all pregnant women receive an annual flu shot regardless of gestational age. Influenza vaccination is critically important to preventing infection. The best prevention is the flu shot. If you have not received your annual flu vaccine, you should do so now.

The CDC states that flu shots reduce the risk of influenza-associated hospitalization by an average of 40%.

The MMWR data from 2010–1018 show pregnant women accounted for approximately one-third of all influenza-associated hospitalizations.

Key highlights from the MMWR report showed:

1. 2,341 pregnant women were hospitalized for influenza.
2. Pregnant women account for one-third of reported influenza-associated hospitalizations each year.
3. Only 53.7% of pregnant women received a flu shot.
4. Influenza vaccination rates improved to 65.7% when the patients’ healthcare provider offered the office vaccine.

Impact of seasonal flu on infants

Influenza is also dangerous for babies. The MMWR data demonstrated infants less than six months old who have influenza are hospitalized more often and have the highest risk of death. One hundred infants less than 6 months died from a laboratory-confirmed influenza-associated illness.

While the majority of influenza-infected children recover after about seven days, some children suffer serious adverse effects. Complications such as pneumonia and sepsis can be life-threatening. Influenza can also invade the tissues of the heart, causing a dangerous condition called myocarditis. Neurologic complications from influenza range from febrile seizures to viral infections of the brain called encephalopathy.

The best way to protect infants from the flu is to vaccinate the adults who will be around the baby and for mom to get vaccinated during pregnancy. Giving pregnant women a flu shot reduces the risk of infant influenza-associated hospitalization by an average of 72%.

The crossover antibodies help protect the infant until they are old enough to get their own flu vaccine. Children qualify for seasonal flu shots after six months of age.

Pertussis

Pertussis, also known as whooping cough, is a highly contagious respiratory infection caused by Bordetella pertussis bacteria. All of us can get sick from pertussis, but babies who are too young to get vaccinated are most at risk.

Newborns are at high risk of getting sick from Pertussis (whooping cough). Children less than 1-year-old have the highest chance of Pertussis cases and account for 88% of pertussis deaths. The CDC recommends all pregnant women receive a pertussis vaccine during each pregnancy.

Vaccinating pregnant women with Tdap protects moms and their babies. An NIH study reports that third-trimester maternal Tdap vaccination is “77.7% effective in preventing pertussis cases and 90.5% effective in preventing pertussis hospitalizations in infants less than two months old.”

The Advisory Committee on Immunization Practices recommends all pregnant women receive the Tdap vaccine between 27–36 weeks to provide immunity to the baby through the placenta. Children do not receive their first dose of pertussis vaccine until age two.

Key highlights from the MMWR report showed:

1. 27,370 infants aged <12 months developed pertussis.
2. 69% of pertussis deaths occurred in infants less than two months old.
3. 3,928 pertussis-related hospitalizations were in infants less than two months old.
4. One third (9,199 cases) occurred among infants aged <2 months.
5. 7,731 infants were hospitalized for pertussis.
6. 3,928 (50.8%) were among infants aged <2 months
7. Only 54.9% of women received a Tdap vaccine during pregnancy.
8. Tdap vaccination rates for Tdap improved to 70.5 % when a healthcare provider offered the vaccines in the office.

Why don’t people get the flu and Tdap vaccines?

This report showed that only half of pregnant women received an influenza or Tdap vaccine. Despite the CDC recommendations to protect themselves and their infants, only 34.8% of women received both vaccinations.

The most common reasons for non-vaccination cited in this report were:

1. Believing the vaccine is not effective (influenza; 17.6%)
2. Not knowing that vaccination is needed during each pregnancy (Tdap; 37.9%)
3. Safety concerns for the infant (influenza =15.9%; Tdap = 17.1%).

Lower rates of vaccination were seen in:

1. Non-Hispanic Black women
2. Women who had less than a college education
3. Unmarried women
4. Women who lived below the poverty line
5. Women living in the South
6. Women with public insurance or without health insurance
7. Women who did not receive a vaccine offer from their health provider in the office
8. Influenza vaccination coverage was lower among nonworking women
9. Tdap coverage was lower among working women.

Why do Tdap and Flu vaccines matter?

The MMWR Burden and Prevention of Influenza and Pertussis Among Pregnant Women and Infants report uses eight years of surveillance data to illustrate the impact on influenza and pertussis.

Approximately 9% of US females age 15–44 are pregnant at any given time each year, but only about half of these women receive the flu or Tdap vaccine and only one-third receive both.

The low vaccination rates in pregnancy lead to disturbing statistics.

Improving our maternal vaccination rates can prevent hospitalizations and save lives.

The post How Best to Protect Your Unborn Child against Whooping Cough and Influenza appeared first on Medika Life.

She was a nurse. I worked with her daily. She was my friend and also my patient. Happily married. Perfect pregnancy. Easy delivery.

How did I not recognize she was suffering from postpartum depression?

She could not get out of bed. Although madly in love with her baby, dark and dangerous thoughts filled her head. Each day she forced herself out of bed. She cried daily. The stress of hiding her depression from her husband was tearing her marriage apart.

One year later, she confessed. During her annual exam, she revealed all that she had been through. Struggling in silence. Sharing with no one. She was miserable.

I am the doctor she trusted. Once I knew of her illness, she got better. Why did I not catch it sooner?

I didn’t ask. She didn’t say.

I’m sorry.

A teen mother

She was a 17 years old child. She and her newborn lived with her mother and mom’s four other children. She grew up without a father. The father of the baby was long gone. Her house was full of family, but she was living all alone.

Four years later, she is pregnant again. She shares with me her fear of having postpartum depression again. She cried as she explained the terrifying thoughts of hurting her baby that flooded her mind after her delivery. She loved her baby. She asked what was wrong with her for thinking this way.

All the risk factors for postpartum depression were right there in front of me four years ago. How did I miss it?

I didn’t ask. She didn’t say.

I’m sorry.

A high-level executive

She was a senior vice president of a large tech company. After years of infertility treatment, she and her husband got pregnant. Always the overachiever, she was not pregnant with one baby. She had twins. During her six-week postpartum visit, she told me she was getting divorced. I was surprised. On the surface, they seemed like the perfect couple. Was postpartum depression a factor?

I didn’t ask. She didn’t say.

I’m sorry.

Depression has many faces

One patient’s husband had an affair. Another struggled with her teenager’s rebellion. One lost her job for not showing up for work. Another couldn’t pay her bills. Another repeatedly came to the office for various vague abdominal pains.

I didn’t ask. They didn’t say.

I’m sorry.

Postpartum depression is real

One in seven women suffers from postpartum depression. I had been treating it throughout my career. I caught the easy cases. I helped them, and they got better.

The world of women’s health has started paying more attention to the 4th trimester. I realized I was missing the harder to spot cases. I had overlooked the subtle clues that were there along. I had underestimated the efforts patients would take to hide their mood disorder. Shame, fear of being judged, and embarrassment forced those suffering from postpartum depression to hide alone in the dark.

We implemented universal screening

We added universal screening for postpartum depression to our office protocol. The Edinburgh Postnatal Depression Scale (EPDS).

Ten questions. Five min.

This simple tool made it safe to step into the light. Each patient fills out a simple questionnaire. The score is not diagnostic, but the questions open a window and an opportunity for dialogue. The tool triggers me to ask the right questions. Five min can change someone’s life.

My eyes are now open to the prevalence of postpartum depression and the subtle ways people hide it. It also revealed to me that these cases were there all along.

They wanted to talk, and I wanted to listen.

I just didn’t ask, and they didn’t say.

A new approach

Universal screening opened a window and shed light on postpartum depression. I have changed my approach. I am asking the right questions. Now we are talking. Patients are speaking up.

I asked. You answered.

I’m so thankful.

You are not alone.

Never be afraid to talk about postpartum depression.

The post Better Care is Needed for Postpartum Depression appeared first on Medika Life.