Good Morning Mamas!!
Question: Did any of you undergo “preconception” counseling before becoming pregnant?
I ask this question because a couple of days ago, I was trolling twitter and inserted myself into the #acogchat. The topic of discussion was preconception evaluations. When I entered the discussion, I’m thinking a good 20-30 minutes into the chat, the group was discussing how more women need to be aware of their health histories and essentially should have all their “medical ducks in a row” prior to becoming pregnant to avoid complications. Well you all know me. The statements were making my neck hairs stand on end because they seemed to be saying that when pregnancy complications arise, it’s because of something mamas haven’t addressed prior to getting pregnant, a sort of negligence. In my experience with Mamas on Bedrest that simply isn’t true. For many mamas, there is no rhyme or reason that they have the complications they have. And on that note, I jumped into the conversation.
Let me begin by saying that the moderators and participants of the chat were very gracious and receptive to me and my views. I didn’t exactly “tip toe” my way into the chat, I went in full throttle in defense of mamas! But as the chat progressed, we all reached a really good consensus about preconception health care and health care in general. With a candid discussion about the limitations of our current health care climate as well as cultural and societal opinions, we all left the chat with the following “agreement” regarding preconception evaluations/examinations/counseling:
A Preconception Exam/Evaluation is really preventive maintenance. As the chat progressed, we all realized that if health care providers ask, AT EACH AND EVERY VISIT, about a person’s medical history; if any new complications have arisen, if the patient has any new concerns, is there any change in family history…Then we are doing preconception counseling-the way that it should be done. A woman’s health (or anyone’s health) should always be optimized at any doctor/patient interaction. When we providers don’t ask these questions and update a patient’s record each and ever visit, we drop the ball not the patient.
Preconception Exams/Evaluations must be done for men as well as women! Conception takes 2 PEOPLE!! We focus so much on women (as the carriers) but we cannot forget the fact that the sperm quality will also affect whether or not conception takes place and has just as significant an impact on the health of the baby as the quality of the egg and mama’s health. Just as it’s important for mamas not to smoke or drink if they are trying to get pregnant, fathers who smoke, drink or have other health issues won’t impart healthy genes to their offspring and may also be impeding the conception process.
Preconception Exams/Evaluations must begin in pediatrics. This is one area in which there was some controversy. We all know that teen pregnancy is an issue in the United States. Yet, there is no consensus on when/how to teach sex education in schools. What we as a group came up with is that if we teach children to always take exemplary care of their bodies; stressing the importance of not smoking, not drinking alcohol in excess, avoiding recreational drugs, maintaining a healthy weight for height, getting regular exercise, avoiding risky sexual behavior, etc…We are teaching not only good health habits, but imparting good preconception habits. By focusing on good health, we can reduce the stress many parents feel regarding “sex education” and not step on toes. For example, talking to a teenager about how condoms work and how they prevent the spread of disease is a different conversation than, “You should use condoms at every sexual encounter. ” We impart the medical information and allow parents to speak to the moral implications as they see fit. (And while we know that many parents won’t speak with their children about sex, it is still the parents’ right to impart their moral code on children, not ours-no matter how much we feel it is needed. We can suggest to parents that they discuss certain issues with their children, but in the end, as it was brought up by a parent on the chat, it’s the parent’s obligation, responsibility and right to educate their children (or not) about sex.)
Do discuss medical costs. I brought this to the attention of the group that many insurance companies don’t cover maternity care and require a separate rider on policies. So many woman have been caught by this. Who wouldn’t? It’s natural to assume that if you have insurance, it will cover you if you become pregnant. This just isn’t the case! So as clinicians, we must ask our patients at each and every visit if their insurance has changed, and to give them a simple “heads up” that many treatments and procedures aren’t covered and they should review their insurance policies annually (and most especially if they are planning to become pregnant).
Make Sure Pre-Existing Conditions are Well Controlled Prior to Conception. Again, this was a topic that got us wound up for a minute. But as we discussed it, we all realized, that if health care providers are truly monitoring their patients’ medical conditions, say diabetes, then the goal should always be tight control. At each office visit the importance of blood sugar control should be discussed and emphasized-whether the patient is trying to become pregnant or not. So again, it’s not a question of preparing the patient for pregnancy, it’s about making sure the patient is in optimum health always.
I really am glad that I “crashed the chat”. I had the opportunity to speak on behalf of Mamas on Bedrest and to contribute to a really great discussion on patient care. The one area we were not able to address is the notion that all of this can be done in 8-12 minutes. But I am confident that given the passion and dedication to this group of health care professionals, even that “obstacle” will soon be eliminated.
With the Re-election of President Barack Obama, The Affordable Care Act (aka Obamacare) is pretty much solidified as part of American Culture. Here, Bedrest Coach Darline Turner reviews just what the Affordable Care Act provides for women, Mamas on Bedrest in particular.
Mamas on Bedrest: New Recommendations for Tetanus, Diphtheria, Pertussis Vaccination During PregnancyOctober 26th, 2012
On October 24, 2012, The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention voted unanimously to recommend that all pregnant women receive a Tetanus, Diphtheria, Pertussis (Tdap) Vaccination during pregnancy. Additionally, ACIP recommends that all women receive a Tdap during each and every pregnancy.
Vaccinations in the United States are controversial. Vaccination during pregnancy is extremely controversial because of the concern of harm to the unborn child. However, ACIP has found that the risk of newborn infants developing pertussis (whooping cough) greatly outweighs any risk of severe adverse reactions to mama or unborn child receiving the Tdap vaccine.
According to Jennifer Liang, MD, from the CDC National Center for Immunization and Respiratory Diseases, who presented the proposed changes during the ACIP meeting in Atlanta, Georgia,
“Although there are no data to address what we really want to know [the potential for severe adverse events associated with repeat vaccinations for pregnant women who have multiple pregnancies in a short time interval], the data from studies in which healthy adults received 2 doses of Tdap are reassuring, and the historical experience with tetanus toxoid vaccine suggests no excess risk of adverse events with multiple doses.”
What is known is that infants that develop pertussis under two months of age have a much higher rate of complications and are at greater risk of death from the disease. It was previously believed that if Mama was up to date with her vaccinations, then baby would be okay. What the ACIP workgroup found is that many women are unsure of their immunization status or they had their Tdap vaccines so long ago (while still within the 10 yr window of “normal” for adults) that transferal of immunity to there babies was minimal if at all. Initially the CDC recommended that women who were unsure of their vaccine status receive Tdap, but now, given current data, they are recommending that all pregnant women receive Tdap during pregnancy between 27 and 36 weeks gestation.
The biggest change to their recommendations is that ACIP recommends that women have Tdap vaccines with all subsequent pregnancies. Based upon a review of published and unpublished studies on the use of Tdap in pregnant women and Tdap safety data from pregnancy registries and the Vaccine Adverse Event Reporting System, the ACIP Pertussis Vaccine Work Group concluded
“A single dose of Tdap at one pregnancy was insufficient to provide protection for subsequent pregnancies and that the benefits of vaccination outweigh the theoretical risks of severe adverse events.”
The work group found that since most women in the US have no more than 2-3 pregnancies, and given the safety and efficacy of Tdap, the additional doses of vaccine (theoretically) pose no threat to Mamas. (I was wondering if multiple doses of Tdap were safe for women who have pregnancies close together, i.e. children born 13 months apart. But given that infants receive multiple doses of a similar vaccination within the first year, this likely poses no immediate threat to mamas.) The working group supports and recommends continued research and study to definitively assess safety of Tdap administration in multiple (and perhaps close) pregnancies.
Other recommendations include vaccinating women in the immediate post partum if immunization status is unknown or if they were not immunized during pregnancy. ACIP also recommends that the childhood immunization schedules be updated so that teenagers that become pregnant receive Tdap according to this new protocol.
With approval of these recommendations by the US Department of Health and Human Services, they will be published in the 2013 edition of Morbidity and Mortality Weekly Report, the guide routinely referred to by health care providers for the latest recommendations to standards of care.