Month: January 2018

In 2012, Heather Beckius developed gestational diabetes while pregnant. Like other forms of diabetes, gestational diabetes affects cells’ ability to utilize glucose properly. The condition can lead to elevated levels of blood sugar, which can impact the health of both the mother and the baby, according to the Mayo Clinic.
Since she had this condition, the doctor performed a nonstress test—a simple procedure completed during pregnancy to evaluate the baby’s health. During the test, the fetal heart rate kept dropping. The doctor followed up the nonstress test with an ultrasound, which showed a sizable spot on the unborn baby’s brain.
The spot would later be identified as a brain bleed or a stroke. Although Beckius was going through a very challenging situation, she says, “All of the doctors were very supportive. They tried to prepare me for the very worst—my baby not surviving—and, at the same time, they told me that the brains in babies have a great tendency to rewire themselves.”

Thankfully, Beckius’s story has a happy ending—she gave birth to a “miracle” baby boy. But the circumstances surrounding her pregnancy underscore the importance of the accessibility of maternal healthcare, from prenatal to postnatal, so that all mothers can receive the quality of care they require and reduce the risk of pregnancy-related complications.

What is maternal health?

The World Health Organization defines maternal health as “the health of a woman during pregnancy, childbirth, and the postpartum period.”

For many women, pregnancy and childbirth are a joyous and anticipatory experience. For others, however, this period can be marked with adversity, mental or physical health issues, and worst case scenarios—even in the United States. In fact, WHO reports:

• From 1990 through 2013, the maternal mortality rate in the U.S. increased from approximately 12 to 28 per 100,000 births.
• Currently, the United States has a maternal mortality rate higher than other high-income countries and countries like Iran, Libya, and Turkey.
• Nearly half of all maternal fatalities in the U.S. are avoidable.
• Approximately 1,200 women in the U.S. experience fatal complications during pregnancy or childbirth each year.
• Each year, almost 60,000 women endure complications that are near-fatal.
• Data from 2012 showed the upward trajectory of maternal complications and the mortality rate continued—even though the U.S. spent more than $60 billion on maternity care.

With that said, modern developments in maternal healthcare give women a much brighter outlook than they had in years past. Figures collected by Our World in Data show that the U.S.’ maternal mortality rate didn’t fall below 400-in-100,000 until 1940.

How was maternal medicine practiced back when?

Mary Jane Minkin, MD, a clinical professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at Yale and a private practice physician in New Haven, Connecticut, began medical school at the Yale School of Medicine in 1971. She delivered her first baby during her obstetrics rotation in 1973. With more than four decades of experience with women throughout pregnancy and childbirth, Minkin has seen some changes in maternal healthcare.
Minkin says the first significant advancements for obstetrics, gynecology, and maternal health occurred in the early 1970s. One of the primary areas of progress Minkin mentions is in early pregnancy detection. “When I started medical school, we literally had to wait for the rabbit to die to see if someone was pregnant,” she recalls.

The phrase “the rabbit died” was created between the 1920s and ’30s. To see if a woman was pregnant, physicians would inject urine from their patient into a rabbit. If the urine contained the pregnancy hormone hCG, it would cause the rabbit to ovulate and verify if a woman was pregnant.
Unfortunately, this method came at a tremendous cost to the rabbits—their lives! The rabbit’s ovaries couldn’t be seen without an autopsy or surgery to remove the ovaries; the latter was typically deemed a waste of effort. Eventually, this practice was replaced with home test kits like First Response, which allows a woman to tell if she’s pregnant six days before her missed period.

Another area Minkin cites as one of concern during her early years at Yale was with fetal well-being and the lack of imaging to assess fetal health. These pressing matters helped form the “backdrop for maternal and child health changes,” she says.
Through the decades, the technological developments have led to the invention of fetal monitoring, which allows for the fetal heart rate to be monitored during labor and delivery to determine the condition of the baby.

Additionally, breakthroughs in ultrasound technology have given clinicians the ability to view the placenta in all locations and positions, diagnose fetal abnormalities more quickly, and provide expectant parents a real-time, color image of the fetus in 3D/4D. Furthermore, advances in amniocentesis created a minimally-invasive procedure for doctors to test for chromosomal abnormalities, fetal lung health, and infections.

A magical moment caught on camera during a 4D ultrasound. A tiny fetus waves to his mommy and daddy. pic.twitter.com/5HYLBqfLzr

— KHOU 11 News Houston (@KHOU) January 12, 2018

These are a few of the ways in which maternal healthcare was practiced in the last four decades and how it has made strides.

What are some ways healthcare providers are working to improve a woman’s experience with pregnancy and beyond?

There’s a growing trend to provide expectant mothers with a comprehensive birthing experience. Vice Chief Medical Officer Michael Moxley, MD, and Department Chair of OB-GYN Miguel Fernandez, MD, are professors at Georgetown University School of Medicine and physicians at Virginia Hospital Center. One way medicine is working to improve maternal health is through a multidisciplinary approach to care.
“We have sought to become more collaborative with our colleagues. Traditionally, medicine has been siloed, with each group acting independently,” Moxley and Fernandez say. “Now, at VHC, we work in teams that include not only doctors and nurses, but administration and, most importantly, patients.”

Besides a more collaborative approach to maternal health, Moxley and Fernandez say medicine is taking cues from the field of aviation to reduce errors. Medical flight simulations, so to speak.
“In the last 10 years, we have started regularly practicing to react for emergencies that rarely happen so that we are better prepared and have better outcomes when the time comes,” they stated.
Furthermore, Moxley and Fernandez aim to cut down on unnecessary C-sections, which increase the maternal risk of having complications during childbirth.

“The statistics indicate after the first C-section, repeat births will be done via C-section 90 percent of the time. Since the risk of complications increases with C-sections, we want to make sure that the C-section is medically needed,” they say. “We follow the guidelines that were created in 2014 by the American College of Obstetricians and Gynecologists—the guideline that made the biggest change was allowing more time for the labor to progress.”

Regarding how healthcare providers are working to enhance a woman’s maternal experience, Minkin furthers the conversation by stating, “The most important advances in maternal and child health actually pertain to getting ready for pregnancy. We know that smoking [and substance use] … are very toxic to the fetus. So we encourage all of our patients to stop taking drugs, stop drinking … , and stop smoking before pregnancy, or limit these as best as possible.”

Additionally, Minkin acknowledges that women with chronic medical conditions—either mental or physical—have better outcomes when they have the opportunity to carefully plan their pregnancies. To illustrate an example, she says, “If a woman has high blood pressure, she should meet with her primary care provider to make sure she has her blood pressure well-controlled and is not taking certain drugs that are bad for babies.”

“Also, we know that if a woman is diabetic, her baby will do much better if mom’s blood sugars are in excellent control before she gets pregnant. A pre-pregnancy meeting with an obstetrician is ideal before a woman conceives to maximize her healthy outcomes.”

Finally, Minkin emphasizes the importance of addressing a woman’s mental health needs throughout her pregnancy. “These days, all women are screened during pregnancy for depression and hooked up with a mental healthcare provider before delivery to minimize the chances of postpartum depression,” she says. “We do know that certain antidepressants are safe to use during pregnancy, and some of these may be prescribed if the woman is suffering from depression.”

Advice and Tips

Although maternal healthcare in the U.S. still has obstacles to overcome, particularly in its accessibility to all women, these are a few tips women can follow to prepare for a safe childbirth and develop a strong patient-doctor relationship:

• Look for a physician who will seek to meet your needs. If you’re unhappy with your current doctor, don’t be afraid to try another one—either within the same practice or a different one. Wherever you go, it’s important you feel heard and valued as a patient.
• If you have pre-existing health conditions, work with your doctor to get those under control before, during, and after pregnancy.
• Your doctor may offer you lifestyle, supplement (like prenatal vitamins), or exercise recommendations. Try to be as compliant as possible with these recommendations.
• If you’re considering a midwife or doula, our experts suggest using a hospital that has midwives or doulas as a part of their birthing team. Or find a doctor who is willing to work with them to give you and your baby the best care possible.
• “One thing that I strongly recommend is that women don’t take advice from a celebrity about medical health just because she is a celebrity,” Minkin says. “You hear all sorts of crazy things put out by folks who really don’t know any medicine!” Instead, focus on creating a reliable social network, so when you have the baby, you have the support you need.

Throughout their terms, pregnant women get overwhelmed with information. They hear advice from their doctors, of course, but also family members, friends—even people on the street will stop a pregnant woman to give them their two cents. It’s the most natural thing in the world, they say. You’re eating for two, they exclaim. So, how can mothers-to-be separate fact from fiction?
It isn’t easy. Pregnancy does have plenty of strange side effects. Did you know, for instance, that being pregnant can cause your gums to bleed? It can. Pregnancy hormones cause increased blood flow, which in turn increases your susceptibility to gingivitis. The American Pregnancy Association recommends diligent oral care during women’s terms.

And have you heard that pregnancy actually does make your feet grow? A study in the American Journal of Physical Medicine & Rehabilitation showed that pregnancy tends to flatten the arches of your feet, making them wider and longer, according to Medical News Today‘s review of the study. Sadly, this doesn’t go away once the baby is born: The arch is often permanently flattened. Pregnant women should wear low-heeled, soft shoes with proper arch supports to combat these changes, wrote John M. Sigle, a doctor of podiatric medicine, for Herald & Review.
So when pregnancy has so many strange and true side effects, it’s easy to see why a pregnancy rookie would accept anything their mother, or a random passerby, tells them. But there is plenty of misinformation out there. You’ll hear it from well-meaning, misinformed peers; you’ll see it in advertisements and on movie screens.
If you’re expecting, or if you’re just curious about the life of a mother-to-be, here are some pregnancy myths to pay no mind.

Myth: Spicy food—or any food—induces labor.

Though an overdue woman would love to pop a jalapeño and go into labor, it just doesn’t work that way. Eliza Ross, MD, OB-GYN, of the Cleveland Clinic said that there’s no evidence that spicy food causes labor. “It might give you heartburn,” she wrote, “but it won’t bring baby into the world any sooner.”
Still, some restaurants have gotten famous based on their supposedly labor-inducing foods—even if they aren’t spicy. In a 2007 article, fact-checking site Snopes provided six examples of eateries that, willingly or not, earned reputations for pushing babies along. Some served hot wings, others served Italian food.

In 2017, Scalini’s, an Atlanta-based Italian restaurant mentioned in the Snopes piece, claimed that their eggplant parmesan has “helped more than 1,000 women go into labor,” according to Today. Women who go into labor 48 hours after leaving the establishment get a Scalini’s gift card and a space on the wall for their baby’s photo.
But since Scalini’s, and restaurants like it, attract overdue women, the correlation is likely due to coincidence, not causation. “If you were to chart the results of a group of [overdue] women,” reads the Snopes piece, “you’d find that a great many of them would give birth to their children within a day or so no matter what they ate or did, with almost all of the rest delivering no more than two or three days after that.”
That said, it seems Robert Bogino, the owner of Scalini’s, understands that it’s all in fun. “Of course,” he told Today, “you have to believe a little bit, too.”

Myth: It’s the most natural thing in the world.

In regards to pregnancy and breastfeeding, mothers will often hear a familiar refrain: “It’s the most natural thing in the world.”
It makes sense, too. Biologically, pregnancy—during and after—is about as natural as it gets. But it turns out that the experience is anything but.
Maryann Davidson, a mother of three, says that though pregnancy may technically be a “natural” process, it feels entirely foreign for the mother-to-be.

“I certainly wasn’t accustomed to feeling nauseous at all times of the day and night; having my moods swing wildly without warning; putting on weight which wasn’t caused by excessive overeating; having a wriggling, jumping, growing baby inside me which was part of me yet already completely independent.”
Then there’s birth itself. Many women get epidurals, are hooked up to IVs, or need to have emergency cesarean sections. There’s nothing wrong with any of that—in fact, the global maternal mortality rate has declined significantly in modern times—but it’s not what most people would call “natural.”

Even if a mom chooses to have a natural birth (a birth without any medication or surgery), the feeling will still be completely foreign. Sure, she can read about how it will feel or ask other mothers to share their experience, but nothing can prepare her for the moment itself.
Though the process of pregnancy is completely natural, it’s one of the most unnatural, crazy experiences an individual will ever go through.

Myth: Morning sickness stops after the first trimester.

Morning sickness is very common. Most women experience it as some point early in their pregnancies, but they’re often told that it stops after the first trimester.
“Is it? Is it?” asks Davidson. “Well, my body must not have read that particular instruction, as I continued to suffer from this particular affliction well into the second trimester.”

She’s not alone. Though most women see their morning sickness symptoms subside after 12 weeks, the American Pregnancy Association says that up to 20 percent of women experience it throughout their pregnancy—this severe form of the illness is called hyperemesis gravidarum, which can require hospitalization.
To combat average, first-trimester morning sickness, pregnant women can eat frequent, small meals and sip on fluids throughout the day, according to the American Pregnancy Association. Even hyperemesis gravidarum is treatable—the Hyperemesis Education and Research Foundation lists medication and nutritional treatment as effective options—and usually doesn’t cause much of a risk to the baby. But it’s surely unpleasant for the mom.

Myth: You can’t eat seafood.

Most women think that all seafood is completely off limits during their pregnancy, but according to the U.S. Food and Drug Administration, you can enjoy specific sea treats even when you’re with child.
The warning does have some truth to it. The FDA urges women to avoid fish with high mercury contents—bigeye tuna, shark, marlin, and king mackerel, for instance. They recommend against sushi, too, because of uncooked fish’s higher chance of carrying parasites.

But other fish? Eat up! Salmon, shrimp, tilapia, and cod are among the 30-plus fish that the FDA recommends pregnant women eat two to three servings of weekly. There are nearly 20 fish they recommend pregnant women have one serving of weekly.

Myth: You’re eating for two!

Want an extra slice of pizza or four? Well, eat up, say purveyors of this myth, because you’ve got to get in all those extra calories to help the baby grow.
Sadly, this isn’t entirely true. OB-GYN nurse practitioner Emily Silver recommends that women only need around 300 extra calories a day to support their pregnancy. “To put it in perspective, that’s about equivalent to a bowl of cereal,” says Silver. (According to MyFitnessPal, a bowl of Cheerios with whole milk is 203 calories, so let’s say you have a second helping.)

She’s not far off from The Academy of Nutrition and Dietetics‘ recommendation, which says women in their second trimester should eat 340 extra calories, and women in their third trimester should eat about 450 extra calories. More, sure, but not double.
Though it’s totally okay to want to pig out when you’re pregnant (pregnancy cravings are not a myth), you don’t actually need another human’s worth to keep your baby safe. What’s most important is what you eat: Pregnant women should eat fruits and vegetables, whole grains, and healthy protein, and drink low-fat, calcium and vitamin D rich liquids, recommends the National Institute of Diabetes and Digestive and Kidney Diseases. So if you think that pint of ice cream will help the baby, you might want to think again.

Myth: You’ll know when you’re going into labor.

Shauna Armitage has three kids and a special hatred for this myth. Over and over again, she heard people tell new moms to “listen to your body” or “you’ll know what to do” when it came to labor…but Armitage found the opposite to be true.
Armitage says that everything hurts, especially late in pregnancy, and it’s hard to discern your pain’s meaning. Is that pain the beginning of labor, or is it just some random pain from having a growing baby inside of you? You almost never know.

Labor comes in two stages: early and active. According to health care organization Kaiser Permanente, you shouldn’t go to the hospital until you’re in active labor.
Early labor has inconsistent contractions, and they’re typically less painful. Also, early labor can last for days! So if you go to the hospital too early, you could be asked to go home and wait it out.
Active labor doesn’t start until your contractions are three to four minutes apart and last for about a minute a piece. That’s when they go from moderately painful to insanely painful.

Still, as a pregnancy rookie, it can be hard to judge how painful your contractions are. Often, moms confuse their ordinary “a child is growing in my belly” pain for contraction pain, which makes labor even more confounding.
In the end, it’s all confusing, and Armitage insists that you almost never “just know” when it’s time to have the baby.

Of course, if you’re experiencing extreme pain—and if it’s extreme to you, it is extreme—contact your doctor. Even if it turns out to be nothing, it’s always better to be safe than sorry.

Myth: Birth involves lots of screaming.

If you’ve seen any movie with a birth scene, you’ve probably heard the mom-to-be comically screaming as she pushes the baby out. Think Knocked Up or The Back-up Plan. But according to birth doula Darby Morris, screaming is actually discouraged during the birth itself.

This isn’t because doctors don’t want damaged ear drums or that ladies are too shy to scream—yelling just makes it harder to push.
Morris compares the feeling of pushing during labor to pushing when you’re constipated. Imagine trying to push and scream at the same time in the bathroom—it’s almost impossible. Morris says that women are usually quiet: One, so they can focus on pushing, and two, because they’re exhausted from the lengthy process of labor.