Barb's Daily Dose

Planning Pregnancy: 5 Things you Need to do Now

If you're planning to become pregnant in 2012, there are 5 things you need to do to prepare:

1.  Make a pre-conception visit with your health care provider - They will go over your health history, family history and order any necessary tests to help you be as healthy as possible.  You may be surprised to learn that some vaccinations may be recommended and that a careful look at family history may reassure some worries.

2.  Start taking a prenatal vitamin - There's lots of evidence that taking a prenatal vitamin with folic acid in it 1-3 months before conception decreases the risk of neural tube defects in babies, and now recent evidence indicates that prenatal vitamins also reduce the likelihood of delivering prematurely.

KV's Drug for Preterm Birth More Reasonable

Thanks to the outpouring of outrage from the public and many bloggers like me, KV pharmaceuticals has agreed to slash the price of Makena, their medication that helps prevent preterm labor from $1500. to $690. This is still many more times as expensive as the generic version which costs less than $20.00.  It's still too much, but at least they're moving in the right direction.

I wrote about this a few weeks ago.

Chalk one up for women's health advocates!

Makena Costs Too Much for Pregnant Women

What would you say if the price of a medication that helps prevent preterm birth went from $30/week to $1500? That's the situation with Makena, a medication recently approved by the FDA.  It's progesterone and has been shown to decrease premature birth, which has multiple consequences not only for the families and the child, but is extremely expensive.  I remember testifying to the FDA about this medication many years ago, when it was up for approval.

8 Premature Octuplets

I've been kind of staggered by the news of the Octuplets. You see, I used to work in a Pediatric Intensive Care Unit. Sometimes I had to "float" over to the NICU and care for the teeny, tiny preemies on ventilators, attached to so many tubes, it was hard to find them underneath. If those little survived their prematurity, gained enough weight, were able to eat on their own, breathe on their own, they could go home.

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Photo courtesy of Dr. Jim Byrne, Valley Medical Center

This is a growing preemie who's skin is a little thicker and who can breathe on their own.  The one at the end of this post, may be more difficult to view, because that baby has very thin skin, can't maintain their temperature, and can't breathe on their own.  I'm letting you know this, in case, you don't want to see it.

The Unexpected

I saw a mom the other day who is pregnant with her 2^nd child.  Her first baby is 16 months old and she’s excited to be pregnant again. As we went over her previous pregnancy, she related that she was much more relaxed this time.  I was curious about that statement and asked her to elaborate further.  Well, she explained, with her 1^st pregnancy, she had to go on bedrest for 10 weeks and that experience caused a huge and almost immediate shift in how she felt about her life. 

 “You see,” she explained, “I was definitely a Type A person. I had everything planned and did everything in my life perfectly.  I had no time or patience for anyone who didn’t measure up to my standards.  Then life threw me a curve ball and I woke up.” 

Being Born Prematurely

In the July 17 issue of the New England Journal of Medicine, researchers reported that babies who were born prematurely were more likely to have cerebral palsy and mental retardation, which are long lasting medical complications which would affect the quality of the child's life and also their parents. Surviving prematurity affects all areas of life, from having an increased risk of asthma and needing glasses to needing special education and even multiple surgeries. Researchers have also found that when preemies grow up, they often are less likely to make a high income, they may be unemployed and receiving social security benefits. (Washington Post)

Even with all the advances in medical science, still 1 in 8 babies is born prematurely in the United States, which translates to about a half a million, or 480,000! That's too many babies. Many of these babies will have mild issues and many will be more severely affected. The personal and emotional cost to their parents is enormous. One extra week in mom's tummy may mean:

• the difference between having asthma and not needing a daily inhaler

• It might be that a baby just spits up occasionally or has chronic reflux and throws up every day

• It might be the difference between being able to play soccer and needing multiple surgeries to lengthen tendons in the legs.

• Reading at grade level or needing special education.

Being born prematurely is no picnic, and one of the best ways to find out if you're at risk is to ask your health care provider to be tested for fetal Fibronectin, which is a simple test that can be performed in your provider's office that can predict which moms we need to worry about, and which ones are less at risk.

See http://fullterm.net/ , and Am I at Risk? for more information.

Am I at risk for a Premature Delivery?

Knowing the risk factors may help you and your provider decide
how best to monitor and treat you during your pregnancy. You are
at risk if you have:

• Had a previous preterm birth
• A pregnancy with twins, triplets, or more
• Uterine abnormalities such as fibroids
• Had a positive fetal fibronectin test previously
• Had the cervix treated for an abnormal pap smear
• Any infection in the vagina or urinary tract
• Experienced bleeding from the vagina
• Had abdominal surgery during pregnancy
• Diabetes, pre-existing (Type 1) or Gestational (diabetes that occurs in pregnancy)
• High blood pressure
• Conceived via IVF
• Periodontal disease, Gum disease
• Clotting disorders (thrombophilia)
• Low or elevated body weight before pregnancy
• Been unable to stop smoking or drinking alcohol during the pregnancy
• Been unable to stop using illegal drugs during the pregnancy
• Experienced physical or emotional abuse during the pregnancy
• Delivered another baby less than 6-9 months ago

What you need to know now about Premature Labor

Unfortunately, 1 in 8 babies are born too early. Though 50% of moms who deliver prematurely have no known risk factors, there are some things we’ve identified that put women at slightly increased risk.
Here are some of the known risk factors for preterm labor:
– Carrying twins or more babies
– History of fibroids in the uterus
– History of bleeding
– A history of previous preterm birth
– Cigarette smoking
– Bladder infection
– Vaginal infection

There is a test that your doctor or health care provider can do to help predict whether you are more likely to deliver early, whether you have contractions or not. The test is known as the fetal fibronectin test, is similar to a pap smear, and can be done during an office visit. A negative test means that a woman is very, very unlikely to deliver in the next 7 to 14 days. A positive test doesn’t mean that the woman will absolutely deliver early, but gives the doctor or health care provider an opportunity to check for infections or to do an ultrasound to check for other signs of a possible early delivery. For more information see www.fullterm.net

What does a contraction feel like? How to know if it’s false labor or preterm labor? How to tell the difference?

Just about every one of my patients wonders about this. Some women will contract daily throughout their pregnancy and not go into labor, others will have a few contractions launches them into labor. Each woman is unique and will have a different experience, so it’s best to be in contact with your doctor or midwife about what you should look out for.

And, trust your instincts, if you’re worried, go in and be evaluated. We health care providers often also need more information and to do some tests to figure it out ourselves. We use an external monitor that evaluates whether the mom is contracting while also checking the baby’s heartbeat. Sometimes we’ll also check for infections and do an ultrasound.

Here’s a good rule of thumb, when in doubt, call your health care provider and explain what you’re feeling.

Call your provider ASAP:
- If you think that your water bag has broken
- If you have any feelings of pressure or pain in your abdomen, lower back or thighs that comes and goes more than 4 times in an hour.
- If you have any vaginal bleeding