It’s another #WombtoWorld day with myself and Dr. Mona Amin @pedsdoctalk discussing how aspects of your prenatal care and pregnancy link to neonatal and infant health. 🦠 Today’s topic is GBS! If you’ve followed me for a while, you know I already have a post on GBS, but being a doctor is about staying up to date on all the latest recommendations, so I’m going to be re-share my basic info here with updates. 🦠 What is GBS? Group beta strep is a type of bacteria that lives in the GI tract and vagina of normal healthy adults. It is not a “bad bacteria” and does not make adults sick. When babies pass through the vagina, it is a GOOD thing that they are exposed to the maternal vaginal microbiome… except for this ONE type. Though 99.9% of the bacteria babies are exposed to in the vagina is normal and healthy, this ONE type, GBS, can cause babies to become very ill in the first week of life. 🦠 Why do we test for it? About 25-30% of women will be positive for GBS in the last few weeks of pregnancy. If the swab is positive, you will receive antibiotics during labor, either penicillin or ampicillin (if you are allergic, another antibiotic will be chosen). Using antibiotics during labor (also known as intrapartum prophylaxis) has drastically reduced newborn critical illness and death in the first 7 days of life, from 1.5 of 1,000 live births in 1993 to 0.22 in 1,000 life births in 2014. Thanks science! 🦠 When do we test for it? -ACOG updated guidelines recently to recommend testing beginning at 36 weeks, previously screening could start at 35 weeks. 🦠 What other situations do women receive intrapartum prophylaxis? -If you have the following risk factors and an unknown GBS status, antibiotics will be recommended… -Preterm delivery (<37 weeks) -GBS positive urine culture earlier in pregnancy (indicates a colonization of your vaginal area) -A history of a baby who had GBS septicemia -An unknown GBS but a history of a prior positive GBS in previous pregnnacy (this is a new recommendation!) -A fever during labor 🦠 These are @cdcgov & @acog_org recommendation. Interestingly, different countries have chosen different approaches based on their population studies.
Food. Nutrition. Diet. Health. Wellness. . It’s a big topic, and I haven’t posted or engaged with it on Instagram because of a huge disconnect I see online versus the reality of how my patients experience food in their daily lives. . Fact: Healthful habits, including nutritional choices, impact our health. . But, in many cases, the action taken from this information has not improved the lives and health of many Americans. Every day I interact with people that can not afford or have access to make the changes that could impact their health. For every blaming suggestion a person with privilege brings up, I see the real barriers my patients face. They are ones I quite honestly could never imagine, and with respect, none of you could either. . So it’s a little hard, sometimes, to engage with how the wellness industry complex has taken this interaction and fed a billion dollar industry of expensive supplements, fad diets, books, and products to sell to people who don’t want to be healthy, they want perfect. They want to be untouched by disease because they have been led to believe that if they eat perfectly clean and take that supplement, every bad health outcome can be prevented. . This results in MANY brand new problems of restricted eating, confusion, fad dieting, and orthorexia. The guilt and shame had to stop. . I thought recognizing those problems on social media would betray the REAL, PRESSING crisis of poverty and access. But I can do both. We can do both. In fact, if you haven’t been paying attention to poverty and access, I would encourage you too. . I’ll continue to focus on advocacy and education to remove barriers but I’m also excited to have the opportunity to address the confusion created by the wellness complex. I’m joining up with @breakdietrules to help encourage healthy relationships with food. Stay tuned and check my stories for more info.
499 days of being 919 miles & 2 flights with 1 layover apart. . 12 hours today. 176 days until forever. . A distance relationship is inconvenient. It’s frustrating and sad. It’s hating airports and exhausted traveling but hating 4 weeks apart more. It’s so expensive but worth every penny. It’s wondering if it’s worse that we can’t celebrate a win together or comfort each other on the bad days. It’s being grateful for FaceTime but wishing we could reach through the screen. . It’s so hard but then honestly feels so easy because there’s nothing I trust or believe in more than the love we’ve built. . Thank you @christinakarst for engagement photos that capture us, that are genuine, silly, and perfect.
Happy National #thxbirthcontrol Day! . Here’s a GIVEAWAY! . I first heard about #thxbirthcontrol as an OB-GYN resident at @washuobgyn. Their division of physicians, public health professionals, and epidemiologists performed probably THE MOST IMPORTANT study on contraception in the last 50 years, called the Contraceptive CHOICE Project, a prospective study of over 9,000 women aged 14-45 who were offered birth control for FREE and followed for many years to assess effectiveness, side effects, and more. When contraception was FREE women were more likely (75% of them) to pick Long Acting Reversible Contraception (LARC, i.e. IUDs and the arm implant) resulting in MAJOR declines in unintended pregnancy and abortions compared to a matched control population in the same area. . At the same time the CHOICE data was coming out, the ACA/Obamacare mandated 100% birth control coverage for women who have insurance. . The unintended pregnancy rate in the U.S. has decreased from 51% in 2008 to 45% in 2011. Teenage unintended pregnancy rates continue to decrease, largely due to access to LARC. . On a personal note, I paid hundreds of $ for my IUD in 2011 (before ACA) as a 2nd year med student. I then participated in ongoing CHOICE clinical trials on effectiveness past the FDA approval time for a total of 7 years. Then, I replaced it with another IUD. . The ability for women to control their own bodies and reproductive life is a fundamental human right. Unfortunately not all women have this access. . To support access and raise awareness for contraceptive access, I teamed up with @bedsider and @powertodecide for a GIVEAWAY for 3 lucky people to get FREE SWAG! . To enter: -Like this post -Comment a reason you say #thxbirthcontrol (with hashtag!) -Tag a friend! . 3 winners will be chosen Sunday, Nov 17th, so make sure to enter! Follow links in my stories for more info!
“When will I feel the baby moving?” is a question I get all the the time in the first and early second trimester visits in the office. . The answer is… “it depends!” . Some women feel fetal movement as early and some feel it later. . You’ll feel it earlier if… -It’s not your first second trimester pregnancy . You’ll feel it later if… -It IS your first second trimester pregnancy -Your placenta is in the front -You’re not really thinking about it too much -You have a lot of gas . Ok, ok I was kidding on that last one. But I couldn't help myself because most women, when they know what they’re feeling is the baby end up saying, “in hindsight I thought that was gas but it’s the baby!” . The range of when I hear women report fetal movement is 15- 24 weeks, though MOST feel movement between 16- 22 weeks, depending on the factors above. . The older term for feeling the baby move is called “quickening.” I’ve always thought that sounded so cute and quaint. . When did you first feel your baby move? What about the second one? #prenatalcare #firsttrimester #secondtrimester #thirdtrimester #pregnancytips #fetalmovement #pregnancyhealth #obgyndoctor
Happy #WombtoWorld Wednesday! This week, @pedsdoctalk and I are discussing Preelcampsia. This is a big topic, so stay tuned for my follow up posts this week. . If you watch Downton Abbey, Lady Sybil dies from a “toxemic” seizure after birth. 😱 Thankfully, tragic outcomes like this are rare due to screening and intervention to decrease the chances of injury and death. Still, 6.9% of maternal mortality is attributable to this cause, so there is more work to be done. . Preeclampsia spectrum is a group of syndromes called the ▪️Hypertensive Disorders of Pregnancy (HDP). They are common at 10% of pregnancies (as an OB, it feels like way more). There are several types. ▪️Gestational hypertension: mild elevations in blood pressure without any signs of effects on other organ systems ▪️Preeclampsia without severe features: mild elevations in blood pressure with effect on the kidneys (proteinuria) but without other effects ▪️Preeclampsia with severe features: mild OR severe elevations in blood pressure with or without effects on other organ systems. ▪️ Chronic hypertension with superimposed Preeclampsia ▪️More rare but serious types include HELLP syndrome & eclampsia. . Presentations of HDP can be VERY broad - some women start with gestational hypertension and proceed to severe while others don’t. Some women have severe symptoms right away. Some women get these illnesses as early as 24 weeks while others present for the first time postpartum. . We don’t know the full mechanism, but the cause is that chemical messengers created by the placenta cause maternal vasospasm throughout maternal circulation (an intermittent constricting of blood vessels). . HDP have risk factors (twins, diabetes, age, smoking) but ANYONE can get preeclampsia. See my post on “risk factors” to better understand what that means. . What to look out for: -Blood pressure over 140/90 -New, severe headache that doesn’t go away with routine measures -Vision changes like going black, blurring, blindness -Chest pain & difficulty breathing -New severe pain under the right rib -Sudden, severe amounts of swelling . Next up: posts on treatment of HDP, effects later in life, and more! Ask questions below!!
When your patient tells you that her method of birth control is “he pulls out.” . The medical term is the “withdrawal method.” It is about 78% effective, much less than other highly reliable contraception. . If you’re feeling ambivalent about pregnancy, and wouldn’t mind a surprise it could be a good method. But if pregnancy is not at all on the brain, it’s better to use a condom and schedule a visit to your OB-GYN for something more effective!
Happy Friday Ladies! 💥 Let’s talk about sex. Let’s talk about good sex. Let’s talk about having good sex with people who aren’t “the one” or at least not yet. If this doesn’t apply to you, send this post to a friend to spice up her weekend 🌶 . I am a sex positive woman and gynecologist and believe all women get to choose what’s right for them and their sex life. But as a doctor who daily sees the repercussions of STI’s and unintended pregnancy, I believe good sex has to be healthy to be great. Here are my tips: . CONSENT: Good sex is consensual sex. Both parties say YES. Sex is not owed after a date or a favor. . CONDOMS: Always. Even if that IUD is 99% effective at preventing pregnancy. Even if your partner doesn’t have a penis. Condoms don’t completely protect against all STI’s (HPV, herpes), they do a great job at preventing spread of chlamydia (at an all time high in the U.S right now!), gonorrhea, trichomonas, and HIV. If you and your partner want to ditch condoms, I advise both people get tested and commit to monogamy. If not, buy them with pride and keep them in your purse and nightstand! . COMMUNICATION: All women are different. Tell your partner what feels good. They can’t read your mind and if THEY are any good, they want you to have a great time too. Speak up! I also advise asking about history of any STI’s and recent testing and results. . There’s probably another C that relates to good sex... get it girls 😜😏😉
Does anyone know what this is?! . This is a true knot in the umbilical cord! . Umbilical cord knots are rare (<1% of births) and usually discovered after birth of the baby when the placenta and umbilical cord delivers. They are rarely, if ever, diagnosed on ultrasound because the knot may not be a knot at all (may be loose loops) before the baby descends out there birth canal and tension is applied to the cord during that process. . A true knot with tension could cause fetal heart rate abnormalities or cord accident, but many are asymptomatic. If found during pregnancy, it may mean closer observation with ultrasound of fetal monitoring. . I’ve had about 5-6 true knots in deliveries over the last several years, all but 1 was an uncomplicated vaginal delivery (the C-section was not because of the baby’s heart rate either!). . OB is crazy cool. 😜🤪🤓
Michael and I are feeling so grateful for the love and generosity of our loved ones this weekend. It filled our hearts with joy to watch our siblings, ALL of whom travelled hundreds of miles to be here, meet and laugh together. Listening to our aunts and uncles try to figure out if our families’ paths crossed in Cuba 50 years ago was surreal. The most wonderful friends threw a gorgeous party and we enjoyed new and old friends from near and far. We had way too much fun taking engagement photos. It was the best. . Weekends this wonderful make Sunday airport goodbyes even harder but also make the life we are building together feel closer each day. . There was so much rich love in every room for the past 48 hours. Is there such thing as a “love hangover?” Ok, just maybe it’s a bit of a regular one too... 😉 . So excited for our #chomatrimony May 9th!