Viewing the Solar Eclipse - MacArthur Medical Center

Will the Solar Eclipse Hurt My Baby?

We are all very excited to witness something as rare as a solar eclipse but while this event has some of us rushing to find eclipse sunglasses, it can be a stressful event for pregnant women.

Some cultures have superstitions about an eclipse during pregnancy. For example, women in Mexican cultures are told to avoid it because an eclipse could cause a child to be born with a cleft lip (paladar leporino in Spanish). This superstition can be traced back to the Aztecs. They believed that a normally benign deity named Tzitzimitl would turn into a monster during an eclipse and attack pregnant women. A woman would have to have an obsidian knife (a knife with a blade made from volcanic rock) placed on her belly to protect her. The superstition is still common today but women use small metal objects like safety pins attached to the pants instead of knives.

In the Indian culture it is believed that women and their family members should stay inside during the eclipse and refrain from any activity including working, eating, etc. They believe any object that is touched during the eclipse could cause the baby to be born with a malformation urban birthmark in the shape of the object that was touched!

We now know that pregnancy complications have a variety of causes including genetic and environmental however none are attributed to the eclipse. Pregnant women should be able to go out and participate in witnessing this phenomenon without any concerns of this affecting their pregnancy. Women and men should both take precautions to protect their vision during this time, though. Looking at the eclipse without special protective lenses could cause permanent vision damage so be safe folks!

Zika Virus Blog - MacArthur Medical Center

The Zika Virus: Your Questions Answered

You have likely heard a lot in the news in recent days about the Zika virus and the serious birth defects that are believed to be associated with it if a pregnant woman becomes infected. Cases have now been reported in 23 countries internationally, and the World Health Organization plans to convene a committee in the days to follow to determine whether this outbreak is to be considered an international public health emergency. Moreover, the Center for Disease Control and Prevention (CDC) published a warning this month advising pregnant women to avoid travel to certain areas in Central and Latin America with high reports of the Zika virus. And it may already be hitting closer to home, as a case of an infected woman in Texas has been revealed. With all the media craze, it’s understandable that many of my pregnant and even my non-pregnant patients have very pertinent questions regarding their travel plans, their risks, and what symptoms to look for. Here are some of the questions being asked.

wud_zika_video

What is the Zika virus, and what areas are being affected by it?

The Zika virus is transmitted by the Aedes species of mosquitos, which can also carry the Dengue, Chikungunya, and West Nile viruses. The first reports of the Zika virus were in Africa, and since then, the virus has spread across Asia and to the Americas. In March 2015, the first case of Zika virus infection was reported in Brazil, and the last few months have seen a rapid increase in the number of cases in Brazil and in other areas of South America, Mexico, and Puerto Rico.  So far, the largest outbreak has been in Latin America.

Has it reached the U.S.?

There have been several diagnoses of the Zika virus in the U.S., however these individuals are believed to have contracted the virus during recent trips to Latin America. There is concern that if the virus does spread to the U.S., the states of Texas and Florida may be especially vulnerable given patterns of the mosquitos that carry it and the fact that these states tend to see a significant amount of commercial and business travel to and from Central and South America. However, at this time there have been no reports of anyone actually contracting the virus in the U.S., and there are no travel warnings against any region of the U.S.

What are the complications of a Zika virus infection?

In general, infection with this virus can cause mild symptoms such as fever, joint and muscle aches, rash, and red watery eyes, however only about 1 in 5 individuals with a Zika virus infection will actually develop any symptoms at all. An individual who has such symptoms and who happens to have traveled to Central and South America in the week prior to the onset of these symptoms should be evaluated for a possible infection.

In pregnancy, there may be more dangerous consequences as there is concern that the virus may be associated with microcephaly, a condition in which the infant’s head is significantly smaller than the heads of other infants of the same age and sex. Microcephaly can have several effects on a baby, ranging from developmental and intellectual delay to hearing or vision loss to seizures.  It can also cause infant death. With the large increase in cases of Zika virus in Brazil and Latin America, the number of cases of infants born with microcephaly has seen a parallel increase (3500 cases in Brazil so far).  Also, several infants who have died with suspicion of Zika virus infection have been tested and found to have Zika virus within the tissue or amniotic fluid.  Although there is no definite proof that the Zika virus causes microcephaly, these cases are serious enough to prompt the CDC to make its recent statements and recommendations. And, according to the CDC, as the virus only remains in a person’s blood for up to one week, an infection out of pregnancy does not pose a risk of birth defects for future pregnancies.

Is there treatment for the Zika virus?

There are no medications available to fight the Zika virus and there is no vaccine to prevent someone from becoming infected with it. The CDC advises to treat symptoms by staying in bed, staying hydrated, and taking Acetaminophen as needed. It is also recommended that pregnant and non-pregnant patients suspected of having the Zika virus avoid Aspirin and other non-steroidal anti-inflammatory drugs, or NSAIDs. Most importantly, those with a possible infection should stay indoors and in isolation for at least one week after the onset of symptoms, to avoid getting bitten by another mosquito and then transmitting the virus to another person.

How can I protect myself from it?

First of all, heed all travel warnings, particularly if you are pregnant.  This is especially important for the public to recognize given the upcoming 2016 Olympics that will be held in Brazil. If you are considering travel, make sure to look for the travel advisory on the CDC’s website for the updated list of areas to avoid or postpone.

Use insect repellant and cover up. Apply insect repellant frequently and wear long sleeve shirts and long pants to help protect yourself from mosquito bites.  Use screens on your doors or windows if you must leave them open. Get rid of standing water around your home to prevent mosquito breeding.

And of course, if you are pregnant and have any questions or concerns regarding your recent travel or plans for any upcoming travel, see your doctor.

For more information, visit www.cdc.gov/zika.

Safe Vaccinations in Pregnancy - MacArthur Medical Center

Are Vaccinations Safe in Pregnancy?

Keeping your baby safe during pregnancy is likely the most important concern on your mind if you are pregnant, and it depends on many factors. Just like taking your prenatal vitamins and keeping your doctor’s appointments, one of the best things you can do for the health of your baby is to protect him or her from getting sick, and many women go through pregnancy without realizing that they can prevent certain diseases simply by keeping up with all recommended vaccinations.

What are vaccines?

Vaccines contain substances that prepare your body’s immune, or defense, system so that it can fight off certain infections when exposed to a particular virus or bacteria in the future. In this way, your body is trained to resist a disease, and you become immune to it. Vaccines can help prevent certain infections and serious complications during your pregnancy and in the first few months of your baby’s life.

Are vaccines safe in pregnancy?

Certain vaccines are safe in pregnancy and certain ones are not. In general, vaccines that contain inactivated or killed viruses are considered safe, while those that contain live viruses may be harmful to an unborn baby, and are therefore not given during pregnancy.

Which vaccines should I get during pregnancy?

Two vaccines are routinely recommended for all pregnant women and will be offered to you during your prenatal visits. They are the influenza vaccine and Tdap.

Influenza –  You may think of  having “the flu” as having a fever, runny nose, and muscle aches, however this infection can actually be especially dangerous in pregnant and post-partum women and can lead to serious complications including hospital stays and even ICU admissions. The influenza vaccine, or flu shot, can help prevent these serious complications. And by delivering protective antibodies to your baby through the placenta during pregnancy and through breastfeeding post-partum, the flu shot also helps protect your baby during his or her first few months of life, as babies cannot receive the flu shot before they are six months old and can also get very sick from an infection. The flu shot is recommended for all women who are pregnant or who might be pregnant during the flu season (typically October through March). It can be safely given at any week of pregnancy (even in the first trimester), and is in fact recommended as soon as it becomes available during a season and ideally before the outbreak of the flu in the community. While the inactivated influenza vaccine, which is given in an intramuscular injection, is safe in pregnancy, the nasal spray influenza vaccine is made from a live virus and is therefore avoided during pregnancy.

Tdap – The tetanus toxoid, reduced diptheria toxoid, and acellular pertussis, or Tdap vaccine is safe in pregnancy and is recommended to be given to all pregnant women between 27 and 36 weeks. It most importantly protects against Pertussis, or the “whooping cough,” a bacterial disease that can spread through air droplets by coughing or sneezing. This disease has the most severe consequences in infants less than three months of age, and in the 1900s before the vaccine was available, it was a major cause of sickness and death in babies and children. After the vaccine was developed, the number of cases significantly decreased, however in recent years we are again seeing a rise in the disease and it is important for everyone to get vaccinated. You likely received DTaP, another form of the vaccine that is given in five doses during childhood, however Tdap is a booster you need to get in every pregnancy (even if you just got it during your last pregnancy) in order to protect you from getting sick and allowing for transfer of protective antibodies through the placenta to protect your baby during the first few months of life when he or she is too young to get vaccinated. If TDap is missed during pregnancy, it should be given immediately postpartum so that your baby can receive the protective antibodies through your breast milk. The TDap booster is also recommended for all teenagers and adults who have not previously received it and especially for household members who will be having close contact with an infant.

Should I receive any other vaccines during pregnancy?

You may need a certain vaccine to be given during pregnancy if you are at risk for a particular infection due to travel, a certain job, or other risk factors. These may include Hepatitis A or B, meningococcus, Yellow fever, or others. Don’t forget to tell your doctor if you plan on international travel, especially to tropical areas of South America and sub-Saharan Africa, although travel to such places should be avoided during pregnancy if possible.

What if I’m not pregnant yet but planning for pregnancy?

It is important to be up to date on all your vaccines and boosters prior to pregnancy. This can help prevent certain serious complications when you do become pregnant. Besides routine vaccines that you should have received as a child or teen, it is also important to receive immunity against measles, mumps, and rubella (MMR) and varicella (chicken pox) if you are not already immune. The reason is that these vaccines cannot be given during pregnancy as they contain live virus, and getting one of these infections during pregnancy can have serious consequences such as miscarriage or birth defects. If you do receive one of these vaccines, it is recommended to wait at least one month (or 3 months with varicella) prior to conceiving. You should see your doctor for a “preconception counseling visit” during which your doctor will review your vaccine history (bring your immunization record if you have one) and possibly draw some blood tests to help identify what vaccines if any you should receive in order to prepare for a healthy pregnancy.

Influenza vaccination during pregnancy. Committee Opinion No. 608. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;124:648–51.

Update on immunization and pregnancy: tetanus, diphtheria, and tetanus vaccination. Committee Opinion No. 566. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013; 121:1411-4.

Labor 101 - MacArthur Medical Center

Labor 101: When Am I in Labor and What Do I Do?

A lot of my time in the office is spent on educating patients about their bodies and the changes that occur during pregnancy. As women get closer to their due date, many questions come up about pelvic pressure, belly pain, and contractions. Pregnancy is a time of great physical stress on a woman’s body and changes do occur that are foreign to most women. These physical changes can be unusual and even scary for some patients. There is a lot of confusion surrounding the following questions: “When exactly does my labor begin?  When will my baby be born? When should I go to the hospital? What can I do about labor pain?” We doctors are responsible for educating all patients early and often on these topics so that they feel prepared and comfortable with the labor process.

“My doctor gave me a due date. Is that when my baby is going to be born?”

Finding out a “due date” is very exciting for mothers and fathers to be. Once a due date is given, patients often mark it down on their iPhone calendar or due date app or immediately text it to family members and close friends. However, I always caution them about this and tell them that a “due date” is NOT THE EXACT DATE when the baby will be born. It’s actually a calculated date that tells us when you are exactly 40 weeks and is based on your last menstrual period and first ultrasound of your pregnancy. Your baby could come a little earlier or a little later than that date depending on when your body is ready for labor. Labor is defined as when a woman experiences regular contractions with progressive cervical dilation (opening). Dilation from 0 to 4 centimeters takes days to weeks, however dilation from 4 or 5 centimeters to 10 centimeters (when a woman is ready to push) only takes hours! For this reason, you are not considered “in labor” and not required to stay in the hospital until you have reached 4 or 5 centimeters. Consequently, you may be allowed to go home if your cervical dilation is less than 4 cm although you may be feeling contractions.

“How do I know if I am in labor?”

The natural follow up questions that patients have are “How do I know when I am 4 centimeters? Can I tell by my contractions? How do I know when to go to the hospital?” Great questions. The answer is there is no way to know for sure unless you get checked by your doctor or at the hospital. My recommendation is to time your contractions. Look at the clock to see how often your contractions are coming and for how long they have been lasting. If they are irregular, on and off, or coming every 15 to 30 minutes apart, just wait. These are Braxton-Hicks contractions (false labor). They are not associated with labor but can be uncomfortable. Once your contractions start coming every 3-5 minutes for more than 30-45 minutes then you should go to the hospital.

“Should I go to the hospital for anything else other than contractions?”

Yes. You should go to the hospital if you are experiencing leakage of fluid or vaginal bleeding. The “bag of water” is the amniotic sac. It holds the amniotic fluid that bathes the baby. The bag of water can rupture on its own at any point during labor or even prior to labor. Once the bag has ruptured there is no longer a protective layer around the baby, and infection can potentially set in. For this reason, you should go to the hospital immediately when your water “breaks”, and if you are found to be less than 4 centimeters, your labor will be induced. Regarding bleeding, it is never normal to have bleeding, however bleeding isn’t always an ominous sign. Sometimes, bleeding can occur after a cervical check in the office or just from cervical dilation during labor. However, bleeding can also be a sign of fetal distress so my recommendation is that vaginal bleeding should always be evaluated by your doctor at the hospital.

“What things can I do to relieve labor pain from contractions?”

Labor is appropriately named because having a baby is very hard work! Whether false labor, early labor, or real labor, pain from contractions can be very uncomfortable and at times, downright intense. Contractions can affect your ability to sleep, your appetite, can make you feel nauseated, or your ability to move around like normal. The first thing to remember is that contractions are a normal part of late pregnancy as you approach your due date. Don’t be scared. Being of sound mind and not panicking is key when contractions start. There are also several things that you can do to help relieve some of the pain from your contractions. First, you can perform breathing exercises in order to relax your body. Controlling your breathing and establishing a regular breathing pattern will help alleviate some of the pain and the anxiety that comes along with labor. Next, taking a warm bath can help relieve pain as immersing your belly in water will have a soothing effect. Just ensure that the water is warm and not too hot. Massages are another helpful option. Involve your significant other with this. Gentle rubbing of the lower back, shoulders, or sides can provide a lot of relief. Other things that can relieve the pain from contractions are applying warm or cool compresses to your belly, putting yourself in a low stress/quiet environment, and continuous movement to get to a comfortable position (on your right or left side, on your back, leaning against pillows to optimize back/front support).

“What about an epidural?”

Labor pain is intense, and I always feel bad for patients who are experiencing a great deal of pain. Standing at the bedside and watching an expecting mother go through labor pain is not an easy sight to see. Luckily, we now have epidurals and medications that weren’t around in the past to help us alleviate the pain you feel from contractions. An epidural is a small catheter that is placed in your back, whereby medications can be administered that will numb the areas from the top of your belly to the vaginal area to decrease the pain sensation from contractions. Epidurals are safe for the baby and are the most effective way of relieving pain from contractions. Epidurals are only given to women who are in labor (4 centimeters or more) or who have already ruptured their bag of water (regardless of cervical dilation). With an epidural, you will be much more relaxed, your baby will tolerate labor better, and you can enjoy the childbirth experience much more. As always, I leave the decision up to the patient as to if and when she wants an epidural, but I believe that epidurals are a great way to take your mind off labor pain so that you can better focus your attention to what’s really important, which is having your baby.

Miscarriages: Tough Questions and Tough Answers

I chose to become an OBGYN because I love delivering babies and bringing joy to expectant parents. It is by far the MOST REWARDING part of my job. Seeing the sense of pride on a new dad’s face, the joyful tears in a happy mother’s eyes, or the inquisitive look of a young big brother or sister is priceless and makes my “job” feel more like a privilege. Bringing a new life into the world is an opportunity that all of us OBGYNs keep sacred and is the main reason why many of us chose the field. But like all things in life there’s a downside to everything, and my job is no different.

Miscarriage is a topic that no one likes to discuss, myself included. It’s something that no expectant mother even wants to think about. Similarly, no athlete wants to discuss the possibility of a career ending injury, no pilot wants to talk about plane crashes, and no CEO wants to discuss the possibility of his or her company going bankrupt. Women who have miscarried are usually reluctant to discuss their experiences or share their feelings about it, which is totally understandable. It’s a private and personal matter for most that can often bring back painful memories and feelings of uneasiness. It can make women feel isolated, fearful, heartbroken, and at times, even guilty. In addition, it raises many questions like “Did I do something wrong?” “Is there something wrong with my body?” “Can I get pregnant again, and if so, when is the best time to try?” But the most important question for women and couples is “Why did this happen?” Unfortunately, the answer is one of the most challenging and elusive to provide.

Why?

Studies have shown that people are often misinformed when it comes to understanding the causes of miscarriages. In a recent survey of the general public, people were asked what they thought was the most common reason for a miscarriage. The top 7 answers were:

  1. A traumatic event
  2. Stress
  3. Lifting a heavy object
  4. An STD
  5. A previous miscarriage
  6. An IUD
  7. Woman not wanting to be pregnant

The answer to the question of “Why?” is very important for women who have experienced a miscarriage. Finding an answer or cause can lead to a sense of closure, the possibility of a solution, and a plan moving forward as most couples will want to get pregnant in the near future. The truth is that there are many causes of miscarriages none of which include the above. Various causes do include uterine or cervical anatomic problems, immunologic disorders, diabetes, thyroid disease, advanced age, smoking, alcohol, drugs, or environmental toxins. However, the vast majority of miscarriages are from chromosomal abnormalities (problems with the genetic makeup of a fetus), which cause over 50% of all miscarriages. When a genetic abnormality occurs, a woman’s body recognizes that the embryo’s genetic integrity is faulty and aborts or rejects the pregnancy. In a sense, nature is able to tell when development is abnormal and triggers a response to “start over”.

The important thing for women to understand is that while some of the above mentioned factors can be controlled such as smoking, alcohol, or environmental exposures, most of them cannot. For instance, many women are born with anatomical abnormalities or are diagnosed with chronic diseases during their childhood or adult life. Due to social reasons, some women may not be able to start a family until later in life when they are older. Because these causes cannot always be controlled, I tell my patients that they should never feel like it’s “their fault” and understand that sometimes unfortunate things just happen. I always reiterate to patients that they did nothing wrong and there was nothing that they could have done to prevent the miscarriage from happening.

Is there anything I can do?

Unfortunately, preventing a miscarriage from happening is impossible. My main advice to women who are considering conceiving is to optimize their health and body in preparation for a healthy pregnancy. These are some recommendations that I give to my patients.

  1. Eat a balanced diet that includes fruits, vegetables, meats, and carbohydrates. This will provide your body with essential nutrients, minerals, and vitamins for a healthy pregnancy.
  2. Maintain a healthy body weight. Being overweight or underweight can affect the health and the outcome of your pregnancy. It can also lead to complications later in life.
  3. Optimize your well-being if you have chronic medical diseases such as diabetes or thyroid disorders. For diabetics, your hemoglobin A1c level should be low and you should keep a daily log of your sugars and review them with your doctor. If you have a thyroid disorder, remain compliant with your thyroid medications and check with your doctor to make sure that your thyroid levels are within the normal limits.
  4. Stop bad habits. Quitting smoking and alcohol are some of the most important things you can do for a healthy pregnancy.
  5. Eliminate environmental exposures (lead, arsenic, radiation). No amount of exposure is considered “safe” especially if you have a very early pregnancy.
  6. Ensure sufficient folic acid intake. You should start taking prenatal vitamins with adequate amounts of folic acid (at least 400 micrograms daily) ideally 1 month prior to conceiving. Prenatal vitamins can be purchased over the counter at any local pharmacy or grocery store.

What now?

As vital as it is to take appropriate time for grieving and questions, most women will want to find closure and move forward. You should discuss with your doctor what the next steps are, your future plans for children, and how soon you wish to get pregnant if you so desire. You should also discuss the chances of a successful pregnancy and any interventions that may be needed for the next pregnancy. Some women may need laboratory testing or imaging procedures for some of the previously stated causes while others may not. Birth control is also an option as some women do not want to get pregnant for a certain period of time after a miscarriage. Lastly, it’s important for you to understand that while this was a tragic and disappointing time, you should not be afraid to get pregnant again. Even after a miscarriage, the vast majority of women will have no issues conceiving and will go on to have completely normal, healthy pregnancies. With my patients I strive to provide a sense of support, hope, and optimism through this process.

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