Barb's Daily Dose

Why This Location Really Matters to Your Baby

Many times, my pregnant patients tell me that they never knew that there was so much to worry about until they became pregnant and started reading.

It's so true!  Before pregnancy, who knew that there were so many tests to decide on, or that during an ultrasound, the doctor would need to look at the position of the placenta. This is one aspect of pregnancy that people rarely mention, unless there's a problem.

Location, Location, Location

"I just had an ultrasound, and my doctor told me that I have a low-lying placenta. He didn't say much else, what does this mean?  I'm 18 weeks pregnant."

Whooping Cough Vaccine

 

Amazingly enough, Whooping cough is making a comeback. What's up with that?

Well, according to the CDC, with the recent surge of children who are not getting vaccinated, because of fears of side effects, pertussis, or whooping cough is becoming more of an issue.  

Epidurals & Back Pain

I recently received a questions about whether women with back pain can have epidurals.

Just like Gold-i-locks and the 3 bears, the key with epidurals are these: 

• It shouldn't be given too early because it might slow things down
• Not used too late because the baby will be born shortly.   

Epidurals are Just Right, when used with a mom in active labor.  This means that she has regular, strong contractions and her cervix is dilated to at least 2-3 centimeters.

They are safe

Thankfully epidurals are safe and don't cause back trouble or other complications. Whew! When you find out how anesthesiologists and nurse anesthetists provide pain relief to moms in labor using epidurals, it can seem scary, yet these are considered a very safe way for moms to manage the pain of contractions. 

Most moms feel a little pain at the time of insertion, and may notice it a for few days after delivery.  

Back Pain

For women with a history of back pain, scoliosis or injury, it's a good idea to talk to the anesthesiologist or nurse anesthetist before your due date.  Call the number for labor and delivery and ask to speak to the person on call and share your concerns. Then when you arrive at the hospital, ask to talk to the person who will be providing your care to discuss your circumstances.

Epidurals are safer than we thought

"If it wasn't for my epidural, when I was out of my mind in agony and pain during labor, I would have shot myself," said a mom in my mom's group. We all laughed, because it's a true sentiment.

When you're in labor, the last thing you want to worry about is whether the pain relief that's offered is dangerous.  Well, now we have more reassurance. A recent study from England found that epidurals given in labor are about 10 times safer than we previously thought.  The risk was estimated to be about 1 in 23,000 women will have a serious complication.  

Post Baby Dry Spell

I was just asked if there was a scientific explanation for the loss or decrease of sex drive or libido that some women experience after childbirth if women are breast-feeding? 

I think most moms would say, "Hello!  We're tired."  I think sleep deprivation for all parents is the # 1 factor for their completely normal decline in canoodling. 

There are other factors at play here when women breastfeed. The hormone prolactin that makes milk, inhibits the release of estrogen (our #1 hormone for sexiness and libido.) Remember that there are more estrogen receptors in the vulva (private girl parts, this is my scientific term) than any other place in the body. 

Women who breastfeed may notice that their private girl parts don't look the same as they did in the past. The labia shrinks and things are a little less moist. Some would say Desert Dry. This isn't from a vaginal birth, because it happens for women who had a C-Section. 

What happens is that mother nature doesn't want women to be hot for their partners too soon after giving birth. In order for that baby to have enough milk to survive, it's essential that a mom NOT ENJOY SEX and make another baby, which would decrease milk supply. 

In a nutshell

Prolactin inhibits Estrogen which decreases libido, makes areas Sahara dry, changes arousal patterns and frankly prolongs the time it takes to have an orgasm. Many breastfeeding moms find that having an orgasm takes Forever and they give up and get some sleep. (unless the breast stimulation overrides that, which is another story).

Choices

If you like to bet, when new parents are in the Casino of Love, and given the choice between Sex & Sleep, they choose Sleep more often than Sex. Read more on Sex Versus Sleep

After a C-Section

I like finding cool things for women that makes their lives easier. I didn't receive any payment or free undies for this endorsements. I just think it's great. You can check out these fun & flirty undies at www.czelablue.com.

Here's a guest blog from the fabulous Mom who created an innovative solution to what to wear after a C-Section: Czela Bellies

From Jennifer: It was three years ago, this Halloween that I found myself looking up at my nurses and doctor's, wearing googly antenna ears, and super hero capes prepping me for my second c-section delivery. 

The Female Brain

I'm reading The Female Brain by Dr. Louann Brizendine.  It's brilliant! Each page is a revelation and explains the neuro-chemical and hormonal influences on our behavior. She manages to take very dry science and bring it to life.  This book is a must read for women and the men who love us.

The book covers women of all ages.  I read a few pages before speaking to a group of parents last week about teens and sex. It helps to have the biologic explanation for what seems to be erratic and provocative behaviors.

Don't Name Your Baby That

How many times have you asked a pregnant couple what they plan to name their baby, then after they proudly let you in on thier decision, without realizing it, you find your foot squarely in your mouth. Yikes. 

 This is a minefield

Be careful wading into this particular pool of conversation. If you don't have a credible "poker face" then might want to practice a big smile and a quick and enthusiastic response, such as, "I love it."What ever you do, please don't cringe or give unsolicited advice on names as it can have long lasting and devastating consequences to new parents, which I hear about during the prenatal visits.  I've known 

moms who were so traumatized by comments from family members that they are reluctant to share any possible names for fear of being dissuaded. 

 What not to say

• I had a dog with that name.
• You're kidding,right?
• That's my cousin's name, and he's a real jerk.
• You should name your baby…..and then fill in the blank with your own preference.

For new parents

This is the advice I give my patients, have a list of names that you'd never in a million years consider for your precious new baby.  Names like Bathsheba,  Osgood, Thurston, etc. When someone asks, you can throw that name out and watch their reactions. 

During my pregnancy, my patients and friends couldn't help themselves , there was so much unsolicited advice, comments and suggestions, that finally I announced that we were naming the baby, Sparky.  It was plausible enough to stop their comments, and since that wasn't my real pick, I had no emotional reaction to the range of shocked and un-diplomatic responses.  

It worked for me.

Postpartum Depression resources

3 Simple Questions may predict who's at Risk

Recently an article in the Journal of Pediatrics found that 3 simple questions might help providers identify new moms at risk for postpartum depression. For this new screening tool, new mothers were asked to answer "Yes, most of the time," "Yes, some of the time," "Not very often" or "No, never" to the following statements:

1. I have blamed myself unnecessarily when things went wrong.
2. I have felt scared or panicky for not very good reason.
3. I have been anxious or worried for not very good reason.

These questions are modified from a much longer screening questionnaire, the Edinburgh Postnatal Depression Scale (EPDS). I have used this with my patients in the past and found it very helpful. 

Now, we are using a different questionnaire, the Beck Postpartum Depression Predictors Inventory (PDPI). 

In any case, it's my experience that not enough practices use any type of questionnaire. Hopefully, this new shorter version will make it easier and faster to identify moms who are more likely to be depressed and not just experiencing baby blues. 

Codeine After Birth

Careful with Pain Relief

Recently, there have been disturbing reports of new moms who were prescribed codeine to help reduce their pain after giving birth. Sadly, some moms have a genetic variance that causes them to be rapid metabolizers of codeine. When codeine is rapidly metabolized it produces high levels of morphine in the blood and breastmilk which can leave babies very drowsy and difficult to wake. In 2007, in Toronto, one baby whose mom had taken her prescribed codeine for pain relief died after breastfeeding.

Rare

Thankfully the genetic variance that causes rapid codeine metabolism is rare. So taking codeine is not risky for most women and is worrisome for a few.

• The US FDA found that 1% to 10% of Caucasians and about 3% of Asian and African Americans are rapid metabolizers.

• Women from North Africa, the Middle East and Africa have much higher rates of this genetic variance, and it’s estimated as high as 28%.

Don’t stop Breastfeeding

The most important thing that we all have learned from this terrible tragedy is to ask women if they’ve ever used these medications in the past and whether they felt drowsy of more of the effects than expected. These moms should try non-narcotic pain relief first.