Illness in pregnancy

Mamas on Bedrest: Pregnancy Safe Ways to Prevent Infections

May 15th, 2013

Hello Mamas!!

In this video blog, I share information on pregnancy safe ways to prevent infections. Pregnancy overloads a woman’s system and consequently she is not as readily able to ward off infections or to fight them when she does become ill.

As discussed in previous blogs, it is essential that pregnant women have adequate Vitamin D levels, to supplement with fish oil rich in the Omega 3 Fatty Acids docosaheaenoic acid (DHA) and eicosapentaenoic acid (EPA), to drink lots of water, get lots of rest and to eat a nutrient dense diet. In this video blog I offer a few other suggestions to help mamas on bed rest keep their bodies healthy and strong. On an additional note, I forgot to include probiotics that are helpful against yeast infections. They are found in most yogurts and can also be taken as supplements.

How are you staying healthy while on Bedrest? Share your tips in the comments section below this video. If you have more questions, feel free to e-mail me at info@mamasonbedrest.com.

 

 

Mamas on Bedrest: You are the captain of this team!

March 22nd, 2013

IMG_3750 1x13I received the following comment to one of the blog posts from Mama on Bedrest H:

Hi, I was diagnosed with hyperechoic bowel, placentomology (?placentomegaly) with the Uterine artery showing flow reversal(IUGR) during my first pregnancy last year. My bp shot up to 135/85 during my 4th month, and I started having swelling in my tummy, yet never showed till my 6th month. My OB didn’t diagnosed anything  until the 6th month, and kept telling me that everything was fine. At the beginning of 6th month I changed my OB and was diagnosed with all the problems but then it was too late and my new OB suggested  an abortion as the arteries started reverse flow and the baby may die on its own. Now again I m pregnant and its my 4th month . I had an ultrasound done and the result  was “both  arteries showing high resistance flow”.  My OB has suggested full bed rest. Are these all symptoms of preeclampsia? I’m also taking Ex(?ternal) heparin(?) injections everyday. Please guide me. Will this pregnancy  remain safe?

While I LOVE hearing from mamas, I am always so sad when they ask for guidance. I cannot provide medical advice. First and foremost, I am not licensed to do so. I am a physician assistant but I am not currently practicing so I cannot offer medical advice. Second, given that I cannot see any of you, put hands on you or read your medical charts, even if I were licensed and practicing clinically, it would be shooting in the dark to offer medical advice on a person not directly in my care.

So what is a mama to do?

Mamas, when you are confronted with major medical complications during your pregnancy, the one bit of advice that I will give is for you to assemble your very own “dream team” of medical providers. “But I have an OB!” you may be saying. Yes, and your OB is a very important part of your team in that s/he will likely be the point of contact for all of your other “team members”. And while your OB will be your #1, your right hand Man (or woman) always remember that YOU are the captain of this team!

As Mama H’s case shows us, sometimes complications arise in bundles. While this is flat out scary, it doesn’t have to render you powerless. Assemble your dream team. Look at it this way. If you are going to remodel your kitchen (I love HGTV!!) and during the process you  find some structural problems. What do you do? Well, on HGTV, they call in a structural engineer and make sure that there is nothing that needs to be done to assure the integrity of the structure. If repairs are needed they are made. In this case, the OB has noted placental complications, so carrying out the analogy, we need to call a “structural engineer” or a Maternal Fetal Medicine Specialist (MFM). These OB’s specialize in Obstetrical complications. They see and treat the “weirdest of the weird”. So if you have obstetrical complications, a consultation with a MFM should be at least considered if not undertaken to make sure “the underlying causes of the problem are managed with the greatest skill and expertise available.”

Mama H also has some bowel problems, so a consultation with a gastroenterologist is in order. Again, it may be nothing for her to worry about and may not impact her pregnancy in any way, but having someone who sees intestinal problems day in day out give their opinion is the best course of action in my book.

Finally, Mama H has an arterial issue that is causing back flow and elevated blood pressure. That to me screams cardiologist, in particular a vascular surgeon. She may be suffering from some sort of arterial narrowing or constriction, or she may have some other cause of the reverse flow. A vascular surgeon will be able to recognize the malady and make recommendations for treatment.

Now I know that many of you may be wondering, “Is it really necessary for Mama H to see all those specialists? Why can’t her OB manage her problems?” Back to our HGTV analogy. If the contractor notes an electrical problem, he doesn’t try to fix it himself, he calls in an electrician. If there are plumbing or sewage issues, he calls a plumber. So if  “specialists” are needed for our homes, why not for our bodies?? Some of you may be saying, “But my insurance may not cover all those doctor visits? What do I do?” I wholeheartedly recognize that seeing specialists is expensive and time consuming (especially getting the referral and pre-authorizations) but it is so worth it! Because specialist deal with the issues you are facing daily, they are typically up to date on the latest treatments, the latest research evidence and the latest nuances of your condition. In my experience, they are well worth the time and expense for the consultation. (More on the expense in the next post!)

Lastly, I want to add a little word here about OB’s. I have had more than one mama write and tell me that when she asked for a referral to a specialist that her OB got angry with her for questioning their judgment and expertise.  At least one mama had her OB “fire” her from the practice for questioning his judgment. To this I say YOU have to be the captain of your team and at all times, you have to guide your treatment! Not only should you ask questions about your care, if you have any reservations or even a desire to just know more, you are well within your rights to seek another opinion. And DO NOT LET YOUR OB BULLY YOU!! If an OB threatens to fire you or withhold medical care or refuses to share your medical information, they are in breach of the Hippocratic Oath that says “first do no harm” as well as acting illegally (in the case of the medical records) and you may want to really consider if this is the person you want taking care of you and your baby. A really good OB will play a vital role in your care, but just like everyone else, they don’t know everything and you want an OB who is willing to admit that they don’t know everything and has no qualms or ego issues about consulting and working with a specialist.

I cannot stress enough the importance of assembling a dream team and assuming the role of team captain. Mamas, your pregnancies are very likely going to be the most significant medical issues of your life. Their outcomes can have significant health ramifications down the road for you and your child. This is no time to be shy or to assume that your OB knows what is best. Ask questions, stay informed and by all means, always make wise, informed health care choices! “Pro-Action” All the way!!

Mamas on Bedrest: “Pre-Partum Depression: What is it and what you need to know”

March 4th, 2013

depressed woman“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.