News Moms Need

Dr. Siobhan Dolan talks about her new pregnancy book, Healthy Mom, Healthy Babies.

It’s winter and many of us look pale and white. Knowing that tanning beds aren’t good for you, someone just asked if she could use a “tanning cream” to make her look less pale.  Self-tanning creams help to give you that sun-kissed glow without being exposed to the sun’s harmful UV rays. 
 
The active ingredient in self-tanners that makes your skin darker is dihydroxyacetone (DHA).  (This is not the same DHA that is an omega-3 fatty acid found in some foods and dietary supplements.)  DHA usually comes from plants and has been approved for use as a self-tanner by the Food and Drug Administration since the 1970s.

According to the Organization of Teratology Information Specialists (OTIS): “There is no published information suggesting that using self-tanners during pregnancy causes birth defects. When self-tanners are used, it is thought that only very small amounts of DHA are absorbed into the bloodstream through the skin. Therefore, very little DHA would be available to get to the baby if it does cross the placenta.”

But be careful if you are getting a spray-tan.  The fumes from the spray are likely to be inhaled which means that more DHA could be absorbed into your system.  You may want to request a mask to cover your mouth, nose, and eyes to prevent any inhalation.

You can read the complete fact sheet about self-tanners on the OTIS website.  Every woman and every pregnancy is different, so as always, make sure you talk to your health care provider.

If you’re pregnant or hoping to be pregnant soon, you need to choose a health care provider to care for you throughout your pregnancy. One of your options is a midwife.

A certified nurse-midwife is a registered nurse with advanced, specialized training and experience in taking care of pregnant women and delivering babies. Certified nurse-midwives are licensed to provide care before, during and after delivery.

The American College of Nurse Midwives has great information about midwifery on their web site. You will see that they are primary health care providers to women throughout the lifespan. They perform physical exams, prescribe meds including contraception, order lab tests, provide prenatal care, gynecological care, labor and birth care, as well as health education and counseling to women of all ages.

If you are interested in talking to a midwife, the Find a Midwife practice locator is a web-based service that allows you to find midwifery practices in your area. It also supplies you with basic contact information like practice name, address, phone number, e-mail address, web site and a map of the area.

You have several options for a healthcare provider: obstetrician (OB); family practice doctor; maternal-fetal medicine specialist; and certified nurse-midwife. Look into each one to find out who works best for you.

Working with our partners, the March of Dimes strives to develop and implement local programs that will ultimately improve the health of babies. Through our network of chapters and volunteers, these programs reach over a million people across the country and Puerto Rico each year. We provide information and services designed to prevent premature birth and birth defects and to promote healthy pregnancies.

Community grants are awarded annually to fund the best programs. Local programs like Centering Pregnancy®, group prenatal care, are focused on improving the availability and quality of health care. We also support services that help promote the health and well-being of women and couples before pregnancy to increase their chances of having a healthy baby. Other programs educate doctors and nurses about reducing the rates of elective labor inductions and c-sections before the 39th week of pregnancy.

Through NICU Family Support®, we provide information and comfort to families coping with the experience of having a baby in a newborn intensive care unit (NICU). NICU Family Support complements and enhances family-centered care practices in partner hospitals, addresses the needs of families and provides professional development to NICU staff.

Contact your local chapter of the March of Dimes to find out how we’re helping moms in your community.

Forty-eight states as well as the District of Columbia and Puerto Rico have pledged their support to give more babies a healthy start in life by reducing premature birth and infant mortality, the March of Dimes and the Association of State and Territorial Health Officials (ASTHO) announced today. One goal of the Healthy Babies Challenge is decreasing the country’s prematurity rates by 8 percent by the year 2014.

Nearly half a million babies, just less than 12 percent, are born too soon each year.  It is the leading cause of newborn death, and babies who survive an early birth often face the risk of lifetime health challenges, such as breathing problems, cerebral palsy, mental retardation and others. Worldwide, 15 million babies are born preterm, and more than one million die each year. 

Meeting the 2014 goal would lower the nation’s preterm birth to about 11 percent, and save about $2 billion in health care and socio-economic costs.

In addition to the physical and emotional challenges associated with prematurity, a 2005 Institute of Medicine report found that preterm birth and associated complications had cost the United States at least $26.2 billion that year. Reducing prematurity offers Healthy Babies Challenge participants the opportunity to save lives and reduce healthcare costs in their states.

From coast to coast, and without regard to politics, health officials in these 48 states, D.C., and Puerto Rico have signed on to help more babies get a healthy start in life.  Participating state health departments are partnering with the March of Dimes to address infant health needs, including helping more women quit smoking during pregnancy, promoting breastfeeding, increasing access to prenatal care, and conducting the “Healthy Babies are Worth the Wait” initiative with hospitals to educate the public about the health benefits carrying a baby full term.

In addition to ASTHO and the March of Dimes, many other organizations and agencies have funded and worked on programs with the common goal of improving birth outcomes. The Association of Maternal and Child Health Programs has long been a leader in the field; the Health Resources and Services Administration’s Healthy Start has been working to eliminate health disparities in child and maternal health for two decades; the Center for Medicare and Medicaid Services and other agencies recently launched the Strong Start program to “reduce the risk of significant complications and long-term health problems for both expectant mothers and newborns;” and the Centers for Disease Control and Prevention listed maternal and child health as priorities in both Healthy People 2010 and Healthy People 2020.

For more information on the Healthy Babies Challenge, read the full press release.

Some guys seriously can’t handle the delivery room (the sight of blood makes them pass out cold – not so helpful) and that’s OK… but if you’re not too keen on being bedside when your little one arrives, consider the following. Don’t say no without making an informed decision. Sure, this whole birthing thing is scary, but you can be a lot more supportive than you may think.

Attend prenatal care appointments with your partner. Talk with her provider and nurses to understand a typical birthing routine within their practice. Ask who will be present, what will happen and who will be in charge of your partner and the baby after delivery.
 
Take childbirth classes and learn more about the process and how you can be supportive during labor. Make a list of questions and ask them all. You’ll learn a lot and meet other soon-to-be dads.

Take a tour of the hospital maternity ward so that you’ll be somewhat familiar with the layout once you arrive and, again, ask questions.

Ask yourself what you want out of the birth experience. Do you want to “catch” the baby? Cut the cord? Or just do your best to stay upright?

Talk with your partner about how she would like the delivery to go, what she sees as your role in it and what she needs and wants you to do.  Make a birth plan together, one that works for both of you. Be sure to discuss different scenarios in case things don’t go as planned.

Don’t get your feathers ruffled or take it personally if she gets a little snippy on the day of… it isn’t you.

If you’d love to support her but really don’t think you can take a ringside seat, talk with her about getting a doula or coach involved for that part. We’re all different and we can only do what we can do and, truly, that’s OK. But let her know that one way or another you’ll do all you can to see to it that she has what she needs when the time comes.

You have waited 40 long weeks to have your baby.  You are ready to be done with pregnancy and meet your little bundle of joy.  But your due date comes and goes and there is no baby.  And then another week passes…and there is still no baby.  By now the joy of pregnancy has probably worn off and you are more than ready to have your baby.  You may begin to wonder if your pregnancy will ever end!

Although most of us focus on our due date, you have to keep in mind that it is really only an educated guess.  It is completely normal for a baby to be born either before or even after his due date.  In fact, that is why a term pregnancy is considered anywhere between 37-42 completed weeks. 

But what happens if your pregnancy looks like it may actually go past 42 weeks?  A pregnancy that lasts more than 42 weeks is considered post-term. We don’t know why some women (about 3-12%) have post-term pregnancies.  Frequently, it is because their dates were miscalculated. 

Some other reasons you may have a post-term pregnancy include:
• First pregnancy
• History (personal or family) of prior overdue pregnancies
• Baby is a boy
• Obesity

Rarely, overdue pregnancy might be related to problems with the placenta or the baby.

As your pregnancy continues past 40 weeks, it is important that you keep going to your prenatal care appointments.  If at any time it looks like the baby or you may not be as healthy as your health care provider would like, or you show no signs of going into labor on your own, your health care provider will begin to discuss inducing labor. 

You may not want to be induced and you may prefer to let nature take its course, but remember that there are things that your health care provider needs to consider.  Your baby will continue to grow, so his size may become an issue.  The volume of amniotic fluid may begin to decrease and the placenta may start to age and not work as effectively.  This can put your baby at risk for complications.  And there is an increased chance that your baby will inhale meconium (fecal waste) during delivery which can cause breathing problems or an infection after birth.  Remember that the goal of managing a post-term pregnancy is to prevent complications and deliver a healthy baby.

If you and your health care provider do decide that inducing labor is best, there are different methods available. You can discuss which option is best for you with your provider.  There may be some risks associated with inducing labor, but there are also risks to allowing a pregnancy to continue for too long.  Make sure you talk to your health care provider—she will weigh the risks and benefits and together you can decide on a plan that is safe for both you and your baby.  And once your baby is born and in your arms, the long, long wait will be a distant memory!

If you are pregnant or thinking about getting pregnant, it is very important that you be tested for sexually transmitted infections.  Each year in the United States, about 19 million individuals contract a sexually transmitted infection (STI). STIs are infections a person can get by having sex (genital, oral or anal) with someone who has one of these infections. Many infected individuals do not know they have an STI because some STIs cause no symptoms.

STIs pose special risks for pregnant women and their babies. These infections can cause:
• Miscarriage
• Ectopic pregnancy (when the embryo implants outside of the uterus, usually in a fallopian tube)
• Preterm delivery (before 37 completed weeks of pregnancy)
• Stillbirth
• Birth defects
• Illness in the newborn period (first month of life)
• Death

If STIs are not diagnosed and treated, they can be passed from the mother to the baby.  Most frequently a baby becomes infected during delivery, while passing through an infected birth canal. But a few of these infections can cross the placenta and infect the baby while the baby is still in utero.  And in many cases the signs and symptoms of STIs are so mild that a woman may not even know that she is infected.

During one of your first prenatal visits, your health care provider will test you for some STIs, such as HIV and syphilis.  Some STIs, such as syphilis, can be cured with drug treatment.  But others, such as HIV, cannot be cured. 

However, if a woman does have an STI that cannot be cured, steps usually can be taken to protect her baby.  For instance, a woman with HIV can be started on a group of drugs called antiretrovirals.  The use of these drugs during pregnancy will significantly reduce the chances that her baby will be become infected with HIV. If women take these drugs before and during birth, and their babies are given drugs after birth, HIV transmission is reduced from 25% (with no treatment) to less than 2%. 

Your partner should also be tested and treated and you should not have sex until your treatment is complete and your health care provider has said that it is OK.  Make sure that you are honest with your health care provider about your risk factors for STIs.  This will help to ensure that you get the appropriate testing and therefore treatment to protect you and your baby.

For more information about some common STIs you can go to our website.

Getting early and regular prenatal care is very important for having a healthy pregnancy and baby. Choosing the right care provider is your first step, but how do you know who to choose? Should it be an obstetrician, a family practice doctor, a certified nurse-midwife or a maternal-fetal medicine specialist? Here’s a link to info on who’s who in the profession.

It helps a lot to choose a health care provider who makes you feel comfortable and who listens to you. Questions you may want to consider include:

- Does the provider have a good reputation?
- Does the provider listen to you and take the time to explain things clearly and thoroughly?
- Are you comfortable with the gender and age of the provider?
- Does the provider make your partner feel comfortable, too?
- Is the office staff pleasant and respectful?
- Is the location of the office convenient? Do the hours fit your schedule?
- What hospital is the provider affiliated with? Does the hospital have a good reputation? Is its location convenient?
- Is the provider in a solo, group or collaborative practice?
- Will you always be seen by the same provider during your office appointments?
- Who covers for the provider when he or she is unavailable?
- Who handles phone calls during office hours? Does the provider charge for phone consultations? How are calls and emergencies handled after hours?
- Does your insurance cover this health care provider?

Remember, if you find that you are partway through your pregnancy and are not happy with your care, you are perfectly within your rights to look for another provider and make a change.  Do what is best for you.

The March of Dimes commends the Institute of Medicine for its thoughtful recommendations in the report released yesterday, “Clinical Preventive Services for Women: Closing the Gaps.” If adopted by the federal government, these recommendations will have a significant impact in improving the health of women, infants and children.

Dr. Jennifer Howse, President of the March of Dimes, said “the March of Dimes is pleased that the panel affirmed our recommendations that insurers be required to cover, without cost-sharing, prenatal and preconception care, as well as all contraceptives approved by the Food and Drug Administration. The March of Dimes also commends the panel for recommending coverage of the services of lactation consultants and rental fees associated with breastfeeding equipment.

“The March of Dimes strongly supports the panel’s recommendations for mandatory coverage of routine prenatal care for pregnant women. Prenatal services should include not only physical examination and specific tests but also counseling on nutrition and tobacco cessation.” Last week, a comprehensive systematic review of all studies over the past 50 years demonstrated that tobacco use during pregnancy is linked to higher rates of birth defects. Given that up to 14 percent of U.S. women report smoking during pregnancy, these counseling services are critical to healthy pregnancies and healthy babies.

With regard to contraception, numerous studies have shown that pregnancies spaced too closely together present a medical risk factor for preterm birth, the principal cause of newborn death. Appropriately spacing pregnancies — for which access to family planning services is critically important — has been shown to reduce the risk of preterm birth. The Institute of Medicine has estimated that the economic cost of preterm birth totaled at least $26.2 billion in 2005, the latest year for which data was available. The medical component of that total was $18.8 billion – 85 percent of which comprised health services provided to infants.

Dr. Howse made it clear that “the March of Dimes looks forward to supporting the panel’s recommendations as the U.S. Department of Health and Human Services considers their adoption.”