Medications in pregnancy
Mamas on Bedrest: Medications During Pregnancy and BreastFeeding-A complete guide
April 19th, 2013
Happy Friday Mamas!!
One of the perks of what I do is that I get to view and screen a lot of material as it is just hitting the market. A few weeks ago I was asked to review The Complete Guide to Medications During Pregnancy & Breastfeeding and received a complimentary copy. This guide is by Carl P. Weiner, MD, a perinatologist and Kate Rope, a journalist and health writer. I have to admit, once I review many of the books and things I receive, I forward them on to you mamas. But I am sorry to say no one is getting this guide-I’m keeping it! It’s an excellent resource!!!
This is the type of guide I would have loved to have had while I was a practicing Physician Assistant or even when I was having my own children. It is a large book, but it is so well organized and comprehensive, I quickly lost sight of the size and focused on the information. There are a few short chapters at the beginning; the introduction from the authors, why they wrote the book, how medications work in pregnancy and breastfeeding and how to take care of yourself and your baby. The rest of the book is literally a listing of hundreds of over the counter and prescription medications, their indications, potential side effects and then pregnancy and lactation categories. It’s similar to the Physicians Desk Reference (PDR) but I think far easier to find what you need and the drug facts are far easier to read and understand.
I know many of you mamas are against taking any sort of medications. That is fine. But if you are prescribed something or are wondering what you can take if you have a little cold, this is a GREAT BOOK to refer to! For example, you can look up something like pseudoephedrine (Sudafed) and get the complete rundown on the drug and whether or not its safe in pregnancy and lactation.
I did wonder why some heavy duty medications were included, some that to me seemed very unlikely to be used during pregnancy and breastfeeding. However, there are always emergencies and/or complications and if a mama is prescribed a medication, it’s great that she can get some quick information that is complete and easy to read and understand as she makes her treatment decisions.
This guide is not for everyone. But for those of us who want to know “every little detail” (I am speaking about myself here!!) the $29.99 investment is nothing for the information and peace of mind. The book is available at the Mamas on Bedrest Bookstore, Amazon.com, Barnes and Noble.com, Walmart.com and from the publisher, St. Martin’s Press.
Mamas on Bedrest: “Pre-Partum Depression: What is it and what you need to know”
March 4th, 2013
“Pre-Partum Depression: What is it and what you need to know”
This was the promo title for the segment on The Rikki Lake Show. As I was cleaning out my DVR this weekend I came across this show and watched. Rikki had a young woman who was sharing that she felt overwhelmed about being pregnant with her second child at age 25. She was afraid that she wouldn’t have the energy to take care of both children, and she was particularly afraid that she wouldn’t love her younger child as much as her oldest daughter. Another woman related that she was depressed about being pregnant because she had just gotten back to her pre-pregnancy weight and physical condition after her first pregnancy. An expert was present assuring the women know that what they were feeling was normal and how to deal with the feelings. She discussed the difference between the “pre-partum blues vs. pre-partum depression”, and there were other support professionals there offering advice and tips.
Many people are unaware of the fact that many women suffer with depression during their pregnancies. According to the American Pregnancy Association, the American Congress of Obstetricians and Gynecologists (ACOG) estimates that depression during pregnancy occurs in 14-23% of pregnant women. Everyone agrees that depression in pregnancy can be a challenge to treat. One tries as much as possible to keep pregnant women off of medications. The expert on the show clearly stated that since depression is a major medical condition and can have negative effects on mama, the pregnancy and the baby, if medication is needed, it is prescribed. However, early identification and early intervention in the form of cognitive behavioral (talk) therapy and social support are the first lines of treatment in pregnant women with mood disorders.
The signs and symptoms of depression during pregnancy: (symptoms must persist for two weeks or more)
- Persistent sadness
- Difficulty concentrating
- Sleeping too little or too much
- Loss of interest in activities that you usually enjoy
- Recurring thoughts of death, suicide, or hopelessness
- Anxiety
- Feelings of guilt or worthlessness
- Change in eating habits (most notably weight loss)
As always, I approach issues in pregnancy with the lens of high risk pregnancy and Mamas on Bedrest, and again I was dismayed to see that Mamas on Bedrest were left out of this discussion. While I have not been able to find definitive numbers on rates of pre-partum depression in Mamas on Bedrest, Judith Maloni, PhD published extensively on the topic. In her publication, Antepartum Bed Rest for Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth, Maloni states in this journal article,
“In the presence of pregnancy complications, perinatal stress emanates, not only from having a high-risk pregnancy, but also from the increased threat to health, hospitalization, and obstetric treatments that are frequently physically and psychologically invasive and demanding and serve as a reminder of the precarious nature of the pregnancy…Exposure to chronic environmental stressors as well as anxiety, separation, and concerns for self and family contribute to behavioral stress response…The experiences of vigilant waiting for an important
future maternal or infant health outcome over which women have no control and of isolation likely compound maternal stress. Isolation has been identified as one of the major contributors to increased allostatic (emotional/behavioral stress) load.”
Treatment for Mamas on Bedrest who may be suffering with pre-partum depressive symptoms is no different than treatment for mamas not on bed rest. However, it is the isolation and lack of social contact that increases the likelihood that depression or depressive symptoms will be missed in Mamas on Bedrest. I posted the common signs and symptoms of pre-partum depression above and implore you, if any of these symptoms speaks to you or you have experienced them for 2 weeks or more, consult with your health care provider or at the very least, tell a trusted individual so that they can help you get help. One of the important nuggets the expert on the Rikki Lake show added is that most obstetricians are not skilled in treating depression of any sort. They are surgeons. So while it is important that you discuss your symptoms and situation with your obstetrician or midwife, if you are truly depressed (having symptoms for 2 weeks or more), ask for a referral to a mental health professional. They are more skilled at diagnosing and treating mood disorders and can offer suggestions on alternative forms of therapy besides medication.
Finally, the American Pregnancy Association also lists the following “alternative therapies” for the treatment of depressive symptoms in pregnant women.
- Exercise–Exercise naturally increases serotonin levels and decreases cortisol levels. (Purchase our DVD Bedrest Fitness for and exercise program specifically for Mamas on Bedrest!!)
- Get adequate rest–Lack of sleep greatly affects the body and mind’s ability to handle stress and day to day challenges. Work on establishing a routine sleep schedule that has you going to sleep and getting up at the same time.
- Diet and Nutrition–Many foods have been linked to mood changes, the ability to handle stress and mental clarity. Diets high in caffeine, sugar, processed carbohydrates, artificial additives and low protein can all lead to issues regarding your mental and physical health. Make a conscious decision to start fueling your body with the foods that can help you feel better.
- Acupuncture-New studies report acupuncture to be a viable option in treating depression in pregnant women. (Be sure to consult with an acupuncturist skilled in treating pregnant women!)
- Omega-3 fatty acids–For years its been know that omega-3 can help with a number of health issues, but the newest studies are showing that taking a daily supplement of omega-3/ fish oils can decrease symptoms of depression. Pregnant women would want to make sure to take a mercury free version of fish oil and check with their care provider or nutritionist on a recommended amount. (send e-mail to info@mamasonbedrest.com for information on pharmaceutical grade fish oils and the recommended dosages in pregnancy)
- Herbal remedies—There are a number of herbal and vitamin supplements known to affect moods and the hormone serotonin. Talk with your health care provider and nutritionist/ herbalist about the options of using St John’s Wort, SAM-e, 5-HTP, magnesium, vitamin B6 and flower remedies. Many of these can not be used in conjunction with antidepressants and should be evaluated on the dosage for pregnant women.
Unfortunately, pre-partum depression is a reality, and there is an increased risk of occurrence in Mamas on Bedrest due to the isolation and lack of social contact. If you are feeling sad, blue or truly feel depressed, please tell your health care provider or other trusted individual. If you don’t know who to tell, you can always send an e-mail to info@mamasonbedrest.com and we’ll help you get the support that you need.
Mamas on Bedrest: My Bout with the Flu
January 19th, 2013
The Flu crept into my home and took up residence for the past week. It started last Thursday when my daughter began complaining of a sore throat. It struck with full force on Saturday when my daughter come home from her Dad’s with a fever, sore throat and lethargy. She seemed to get better on Sunday and we spent the better part of the day getting her science project finished. All seemed well, we seemed to have dodged a bullet, but on Monday, I dropped both kids off at school only to be called back at 10:30 am to pick up my daughter who had a 102 degree fever.
The flu was unrelenting. As I tended to my daughter on Monday and Tuesday, I was caught off guard when my son awoke with a fever on Wednesday. He was not as ill as my daughter had appeared, but the barking, unrelenting cough was concerning so I took him into the after hours clinic (because of course his symptoms didn’t get worse until after 5 pm!). A nasal culture confirmed flu and he was started on Tamiflu. By the time we left the after hours clinic, my head was throbbing and I had chills. We were all sick.
Tonight, a week later, we are all on the mend. Both of my children are in much better shape than I am, fever free and in pretty much their usual state of exuberance. I am better, fever free and able to sit up with my head no longer pounding, but I am not quite well after having been the sickest that I have ever been in my life (that I can recall).
My bout with the flu really got me thinking about Mamas on Bedrest. This flu is really severe, and I have to say, it knocked me down in the way that nothing else has that I can recall. I am a strong, healthy person. Mamas on Bedrest, even the healthiest mamas, have compromised immune systems. Pregnancy impacts a woman’s immune system and puts them at risk for numerous opportunistic infections like the flu. So how should Mamas on Bedrest protect themselves (and their babies) in the face of what many are calling a flu epidemic?
The Flu shot. Whether or not to take the flu shot remains a controversial decision. I have to admit that neither my children nor I are able to take the flu shot (my kids are allergic to eggs and I have violent reactions to the shot for unknown reasons!). However, the current medical recommendations are that those at greatest risk (and pregnant women fall into that category) receive the flu shot. As we have previously posted on this blog, The US Centers for Disease Control and Prevention recommends that every woman who will be pregnant during the flu season get the flu shot. However, many women have fundamental hesitations to taking the flu shot. The only thing that we here at Mamas on Bedrest & Beyond can suggest is that you have a candid talk with your health care provider and learn as much as you can about this year’s flu, the flu vaccine, your personal risk and whether or not taking the flu shot is the best option for you.
Antiviral Medications. My son was prescribed Tamiflu, an antiviral medication prescribed to lessen the duration and severity of the flu. Unfortunately, Tamiflu and many other flu remedies are not indicated in pregnancy, so again, Mamas on Bedrest need to remain vigilant in their flu prevention and to have a very low threshold for seeking medical attention when or if symptoms begin to present.
Alternative/Homeopathic Remedies. These remedies are always controversial. While most alternative and homeopathic remedies are generally non-toxic as compared to their pharmaceutical counterparts, there is typically far less data available regarding efficacy and safety. Again, We cannot recommend or advise Mamas on Bedrest try alternative or homeopathic remedies, we can only say learn as much as you can about any proposed remedies you are considering taking and speak with an experienced, skilled practitioner who can guide you what to take and how to take it.
Finally, the best flu defense is an aggressive offense. We recommend the following measures for Mamas on Bedrest:
- Those who may be infected with the flu should not be around Mamas on Bedrest. Any visitor who has symptoms indicative of flu should not be allowed to visit Mamas on Bedrest.
- Infected family members should be kept away from Mamas on Bedrest. Now I know that this can be hard, especially if those affected are your older children or even your spouse. But you mamas are at great risk for developing a severe case of the flu and you and your unborn child are at increased risk for severe complications. As much as possible, have someone else care for sick children and ask your spouse to sleep in another room until they are symptom free.
- Increase Rest and Fluid intake.
I don’t want to seem like a Nervous Nelly, but I have to tell you, this flu is serious and I would hate for any mama on bedrest to suffer or for her and her unborn child to be at risk for severe complications or even death. Mamas, be well, be safe and be healthy!
