True Birth

All the categories and classifications of fetal monitoring explained in this thorough episode. What is external fetal monitoring? What is the criteria? What can we do about it? and Is it a good or bad thing?

During pregnancy, monitoring the well-being of your baby is of utmost importance. One crucial tool utilized by healthcare providers is external fetal heart rate monitoring. In this blog post, we will explore the significance of external fetal heart rate monitoring, how it works, and its role in ensuring the safety and health of both mother and baby.

External fetal heart rate monitoring is a non-invasive method used to assess the baby's heart rate during pregnancy and labor. It involves placing sensors on the mother's abdomen to detect and record the baby's heart rate patterns. This monitoring technique provides vital information about the baby's well-being, helping healthcare providers identify any potential issues or complications.

The primary purpose of external fetal heart rate monitoring is to evaluate the baby's heart rate patterns, which can indicate distress or abnormalities. By tracking the heart rate, healthcare providers can detect signs of fetal distress, such as reduced oxygen supply or irregularities in heart rate variability. This allows for prompt intervention to ensure the safety and health of the baby.

External fetal heart rate monitoring offers several benefits. It provides real-time feedback, allowing healthcare providers to make informed decisions during labor, such as adjusting the mother's position or initiating interventions if necessary. It also enables the early detection of potential complications, helping to prevent adverse outcomes.

During external fetal heart rate monitoring, two sensors are placed on the mother's abdomen: one to detect the baby's heart rate and another to measure uterine contractions. The sensors are connected to a monitoring device that displays the heart rate and contraction patterns. The healthcare provider will carefully analyze the heart rate tracings and look for variations or irregularities.

Healthcare providers interpret the heart rate patterns to assess the baby's well-being. Normal heart rate patterns generally demonstrate consistency and appropriate fluctuations. If any concerns arise, healthcare providers may recommend additional testing, interventions, or further evaluation to ensure the safety of both mother and baby. Effective communication between the healthcare provider and the expectant mother is crucial for understanding the results and discussing any necessary steps or interventions.

External fetal heart rate monitoring plays a crucial role in monitoring the well-being of the baby throughout pregnancy and labor. By providing valuable insights into the baby's heart rate patterns, it allows for timely interventions and ensures a safe and healthy delivery.

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Progesterone supplementation in pregnancy and the preconception period has been debated for several years as to its effectiveness. In this episode, Dr. Yaakov Abdelahk gives his take on the use of progesterone for fertility, the prevention of first trimester loss and there prevention of preterm labor.

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Navigating through the intricacies of labor and delivery can be an overwhelming experience, especially if you're a first-time parent. The labor and delivery floor can seem like a bustling hive of activity with numerous healthcare professionals working together to ensure a safe and positive childbirth experience. In this episode, we'll take you on a journey to introduce you to the key players on the labor and delivery team. From high-risk perinatologists to certified nurse midwives and even doulas, we'll demystify the roles of everyone involved, helping you feel more informed and at ease during this transformative moment in your life.

Meet the High-Risk Perinatologist

A high-risk perinatologist is a specialist who focuses on the care of pregnant individuals with high-risk pregnancies. These pregnancies may involve complications like gestational diabetes, preeclampsia, or multiple pregnancies. The high-risk perinatologist plays a vital role in assessing and managing the health of both the pregnant individual and the baby during pregnancy and childbirth. If you have a high-risk pregnancy, you can expect close collaboration with this specialist to ensure the best possible outcome.

Meet the Certified Nurse Midwife

Certified nurse midwives specialize in providing personalized, holistic care to expectant individuals during pregnancy, labor, and postpartum. Midwives are known for their compassionate, low-intervention approach to childbirth. If you're seeking a natural birthing experience with minimal medical intervention, a certified nurse midwife may be a key member of your care team.

Meet the Doula

Doulas are invaluable members of the birthing team who provide emotional and physical support throughout labor and delivery. They're not medical professionals but are highly trained in comfort measures, relaxation techniques, and advocacy for the birthing person's preferences. Doulas ensure you feel supported, empowered, and informed during this transformative journey, helping to create a positive birthing experience.

Meet the Hospital Leadership

Hospital leaders, including the hospital president, may not be directly involved in your day-to-day care, but they play a crucial role in setting the hospital's standards and ensuring that you receive high-quality care. Hospital leadership works to create an environment where healthcare professionals can provide the best possible care to patients like you.

Meet the Labor and Delivery Nurses

Labor and delivery nurses are the unsung heroes of the birthing process. They provide constant support, monitor vital signs, administer medications, and offer guidance during labor. Their expertise and dedication ensure a safe and comfortable experience for both you and your baby.

Meet the Anesthesiologist

For those considering pain management options during labor, the anesthesiologist is a key player. They specialize in administering epidurals or other pain relief methods, ensuring that you're as comfortable as possible throughout the labor process.

Meet the Newest Members of the Healthcare Team

Even the newest members of the healthcare team, such as nursing students, play a valuable role. Nursing students gain hands-on experience under the guidance of experienced nurses and midwives, contributing to your care while honing their skills.

As you prepare for the incredible journey of labor and delivery, understanding the roles of the various healthcare professionals on the labor and delivery floor can help alleviate some of the anxiety and uncertainty. From high-risk perinatologists to certified nurse midwives, doulas, and even hospital leadership, each member of the team plays a vital role in ensuring your safety and well-being during this life-changing moment. Trust in their expertise, ask questions, and communicate your preferences to create a birth experience that aligns with your values and desires. With this newfound knowledge, you'll be better equipped to embark on the beautiful journey of bringing new life into the world.

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Anemia in pregnancy is a common concern that affects a significant number of expectant mothers worldwide. It is characterized by a deficiency of red blood cells or a decrease in the level of hemoglobin, the protein responsible for carrying oxygen throughout the body. Pregnancy places additional demands on a woman's body, as she needs to supply oxygen and nutrients to both herself and her growing baby. Consequently, anemia during pregnancy can have various adverse effects.

Firstly, anemia can lead to fatigue, weakness, and a decreased ability to perform daily tasks. The decreased oxygen-carrying capacity of the blood can result in feelings of exhaustion, making it challenging for pregnant individuals to maintain their usual level of physical activity. Additionally, severe anemia can pose serious risks to the baby, including preterm birth and low birth weight. Furthermore, maternal anemia can increase the risk of postpartum hemorrhage and impact the overall well-being of both mother and child. Therefore, early detection and appropriate management, often through iron supplementation and dietary adjustments, are crucial to ensuring a healthy pregnancy and a positive outcome for both mother and baby.

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Pitocin is the synthetic version of a natural occurring endogenous hormone called oxytocin. Oxytocin, also called the "love hormone" is produced in the hypothalamus and secreted by the pituitary gland.

Pitocin, often a word heard in maternity wards and labor and delivery units, plays a significant role in modern obstetrics. This synthetic form of oxytocin is frequently used to initiate or augment labor, making it a critical tool in the labor room. This blog post aims to demystify Pitocin, explaining its use, benefits, risks, and the controversies surrounding it.

What is Pitocin?

Pitocin is a synthetic version of oxytocin, a naturally occurring hormone that plays a vital role in childbirth. In the medical world, Pitocin is used to start labor contractions or strengthen them if they are too weak or irregular. It is administered intravenously, allowing healthcare professionals to control its dosage carefully.

When is Pitocin Used?

Pitocin is typically employed in a few specific scenarios: inducing labor for medical reasons, such as when a pregnancy goes past its due date, or augmenting labor when contractions are not strong enough to effectively dilate the cervix. Medical guidelines recommend its use only when necessary, as it is a powerful medication that significantly influences the birthing process.

Benefits of Pitocin in Labor

The primary benefit of Pitocin is its ability to progress labor, which can be vital for the health of both the mother and the baby. In cases where labor is not progressing naturally, or there are risks associated with prolonging pregnancy, Pitocin can be a lifesaver. It helps in effectively managing the timing and intensity of contractions, often leading to a safer and more controlled delivery.

Risks and Controversies

Despite its benefits, Pitocin is not without risks. It can cause intense and frequent contractions, which may lead to distress for the baby. There are also concerns about its impact on the natural childbirth experience and the potential for overuse in non-medical situations. Additionally, it's crucial for healthcare providers to obtain informed consent and educate patients about the potential risks and benefits of using Pitocin.

Alternative Approaches and Comparisons

While Pitocin is a common intervention, it's not the only method to manage labor. Natural labor, where the process is allowed to progress without medical intervention, is an option preferred by some. Other medical interventions, like breaking the water (amniotomy) or using different medications, are also available. The choice often depends on the specific medical situation and the preferences of the expecting mother.

Conclusion

Pitocin is an essential tool in modern obstetrics, with its ability to induce or augment labor. However, like any medical intervention, it comes with benefits and risks. Understanding these, along with the available alternatives, is crucial for expectant mothers and healthcare providers. This knowledge enables informed decisions, ensuring the best outcomes for both mother and child.

Pitocin is a medication most often used to stimulate uterine contractions to induce or augment labor. Because it can be use to stimulate uterine contractions it is also beneficial in preventing postpartum hemorrhage after birth.

Listen in as Dr. Yaakov Abdelhak gives his take on this medication and all the good and bad it has to offer.

Our practice website can be found at:

Maternal Resources: https://www.maternalresources.org/

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Retained placenta is when the placenta is not delivered within 30 minutes of the delivery of the baby. Some facilities or institutions will consider the placenta to be retained only after 60 minutes or even more, but for the majority of locations, 30 minutes is considered a placenta that is retained (stuck).

There prevalence of retained placenta is about 2-3% of deliverer and can happen in vaginal deliveries or cesarean births. There are several factors that can increase the changes of a retained placenta such as :

• Previous retained placenta
• Preterm delivery
• uterine anomalies
• previous uterine scar
• preeclampsia
• stillbirth
• small for gestational age infant
• velamentous cord insertion

In the episode, we discuss what to expect in the case of a retained placenta.

We hope you are enjoying this and all of our podcasts. Please share with a friend and tell them about your favorite episode. We greatly appreciate those of you who have written in and told us about what you want to hear about in pregnancy and birth. Please keep these notes coming. You can reach out to us directly on our website on www.truebirthpodcast.com

Our practice website can be found at:

Maternal Resources: https://www.maternalresources.org/

Remember to subscribe wherever you get your podcasts. Please consider leaving us a review on iTunes

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Placenta previa is when the placenta (disposable organ of the pregnancy) extends over the cervix and cervical os. When the placenta is completely covering the cervix, this necessitates birth by cesarean, vaginal delivery is not safe or even doable. Even in a practice where there is usually a route to safe vaginal birth, in the case of placenta previa it cannot be done.

There is a different between low lying placenta and placenta previa and this episode explores this topic and why a low lying placenta may not necessitate a need for a cesarean birth and vaginal delivery may still be attempted.

Other great things covered in this podcast include how placenta previa is managed throughout pregnancy and when bleeding and hemorrhaging could be a concern.

We hope you are enjoying this and all of our podcasts. Please share with a friend and tell them about your favorite episode. We greatly appreciate those of you who have written in and told us about what you want to hear about in pregnancy and birth. Please keep these notes coming. You can reach out to us directly on our website on www.truebirthpodcast.com

Our practice website can be found at:

Maternal Resources: https://www.maternalresources.org/

Remember to subscribe wherever you get your podcasts. Please consider leaving us a review on iTunes

Our Social Channels are as follows

Twitter: https://twitter.com/integrativeob YouTube: https://www.youtube.com/maternalresources IG: https://www.instagram.com/integrativeobgyn/ Facebook: https://www.facebook.com/IntegrativeOB

In this fantastic episode check out all you need to know in that time in between your first positive pregnancy test and getting to your first OB/GYN appointment to confirm your pregnancy. Which prenatal vitamins are important? What foods should you avoid? Can you sleep on your back and more? Everything you wanted to know about those first days and weeks of early pregnancy.

Here are some of the things covered in this episdoe.

1. Confirming Your Pregnancy:

• Once you get a positive pregnancy test result, it's a good idea to take another test a few days later to confirm the pregnancy.
• Some home pregnancy tests are more sensitive than others, so you may want to use a highly sensitive test for an early confirmation.

2. Choosing a Healthcare Provider:

• Research and select an OB/GYN or midwife who will provide prenatal care throughout your pregnancy.
• Schedule your first prenatal appointment with your chosen healthcare provider. It's essential to start prenatal care early to monitor the health of both you and your baby.

3. Prenatal Vitamins:

• Start taking prenatal vitamins as soon as you find out you're pregnant, even before your first appointment.
• Prenatal vitamins typically contain essential nutrients like folic acid, iron, calcium, and various vitamins and minerals important for fetal development.

4. Nutrition:

• Pay attention to your diet. Aim to eat a balanced and nutritious diet that includes:
  • Folate-rich foods (leafy greens, citrus fruits, fortified cereals) to help prevent birth defects.
  • Iron-rich foods (lean meats, beans, spinach) to prevent anemia.
  • Foods high in calcium (dairy products, fortified plant-based milk) for strong bones and teeth.
• Avoid raw or undercooked seafood, unpasteurized dairy products, and deli meats to reduce the risk of foodborne illnesses.

5. Hydration:

• Stay well-hydrated by drinking plenty of water throughout the day. Proper hydration is essential for a healthy pregnancy.

6. Sleep Position:

• During the early stages of pregnancy, sleeping on your back is generally considered safe. However, as your pregnancy progresses, it's advisable to sleep on your left side to improve blood flow to the uterus and baby.

7. Exercise:

• Maintain a regular exercise routine if you were physically active before pregnancy. Exercise can help with energy levels and overall well-being.
• Consult with your healthcare provider about suitable exercises during pregnancy, and avoid high-impact or contact sports.

8. Medications and Supplements:

• Inform your healthcare provider about any medications or supplements you are taking. Some may need to be adjusted or discontinued during pregnancy.

9. Emotional Well-being:

• Pregnancy can bring a range of emotions. It's essential to take care of your mental and emotional health.
• Seek support from loved ones or consider joining prenatal support groups.

10. Lifestyle Adjustments:

• If you smoke or consume alcohol, seek guidance on quitting or reducing these habits. Both can be harmful to the developing fetus.
• Minimize exposure to environmental toxins and chemicals.

11. Be Informed:

• Educate yourself about the stages of pregnancy and what to expect during each trimester.
• Keep a pregnancy journal to document your experiences and questions for your healthcare provider.

12. Plan for Future Appointments:

• Prepare a list of questions and concerns to discuss with your OB/GYN or midwife during your first prenatal appointment.
• Keep a record of any symptoms or changes in your health.

These early days and weeks of pregnancy are an exciting and crucial time. Taking proactive steps to care for yourself and your developing baby sets the foundation for a healthy and successful pregnancy. Your healthcare provider will be your best resource for personalized guidance and support throughout this journey.

For everything you need about this podcast, check out True Birth: https://www.truebirthpodcast.com/

Our practice website can be found at:

Maternal Resources: https://www.maternalresources.org/

Remember to subscribe and tell a friend! Please consider leaving us a review on iTunes

Our Social Channels are as follows

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Thyroid disease can be tricky to detect in pregnancy because many of the symptoms of thyroid disease can be mild and go undetected or are so similar to the normal side effects of pregnancy they can often be missed. In this episode, Dr. Yaakov Abdelhak, high risk perinatologist and Kristin Mallon certified nurse midwife walk us through everything we need to know about thyroid disease in pregnancy.

What is Thyroid?

[1:08]

The thyroid is an endocrine gland in the neck and produces thyroid hormone. The hormone regulates your metabolism, which is your energy usage, how you absorb, and how you release it into your system. If your thyroid is working well, you wouldn't know it because you feel fine. But if your thyroid is overactive, called "hyperthyroidism," you might find yourself releasing too much energy into your system.

Diagnosing Thyroid Disease

[2:47]

Before you start diagnosing schizophrenia or bipolar disease, find out if their thyroid hormones are in the right place because they can be disguised as many psychological issues. With hypothyroidism, you might find yourself cold intolerant where everybody else seems to be comfortable, but you need a sweater or an extra jacket. You have tremendous fatigue, and you're not active. All of these symptoms are not uncommon, especially in pregnancy. So when a woman is pregnant, it's tough to diagnose if they have hypothyroidism.

[3:36]

The most common cause of hyperthyroidism is Graves disease, which stimulates your thyroid by outside antibodies that are tricking your thyroid into producing too much hormone, then you get your thyroid is overactive, and you have too much thyroid hormone in your system. The opposite is hypoactive thyroid which we call "Hashimoto's thyroiditis." It's when your thyroid is underactive and is secondary to Graves disease. The thyroid gets overactive, and it turns out you get stimulated too much by the thyroid-stimulating antibodies. Then it produces an excess of thyroid hormone until it burns itself out, and now you have a thyroid that's not working.

Understanding the Thyroid Glands

[5:04]

To understand the thyroid, you have to understand the most basic thyroid hormone is produced. The thyroid is a gland, but the gland does not decide how much hormone to release to the brain. The pituitary gland releases TSH or thyroid-stimulating hormone. TSH is a messenger hormone to the thyroid, which responds to TSH by generating thyroid hormones in the form of T4 and T3.

[6:25]

The brain or the pituitary, which is a part of the brain, produces TSH. That hormone stimulates the thyroid to produce T3 and T4. There's another concept that's important called thyroid-binding globulin. It's the protein that carries T3 and T4 through the system. If there's an excess of that binding globulin, you might have higher numbers like in pregnancy.

What happens to your thyroid hormone levels during pregnancy?

[8:13]

Another hormone produced by the pituitary is the Human Chorionic Gonadotropin, which is almost identical to TSH. When a person produces a tremendous amount of HCG early in pregnancy, their TSH gets suppressed.

[12:27]

Because TSH is so affected by HCG, we use different numbers in pregnancy in non-pregnant women. A TSH above 4.5 would indicate that she's hypothyroid and high TSH, meaning too low thyroid. High TSH means her thyroid is underactive. Think of it as the thyroid is the horse, and the TSH is the jockey whipping the horse. So if the TSH goes up very high, it's a sign that the horse is not moving fast enough, and if the TSH goes down too low, it's a sign that the horse is moving fast. So if the TSH is minuscule in pregnancy, we might consider that "subclinical hyperthyroidism." Otherwise, it's subclinical hypothyroidism.

The Bottom Line

[18:00]

Hypothyroidism is much more common than hyperthyroidism in the general population. There's a lot of underactive thyroids, not so much overactive. Even if it is overactive, it's usually transient until it gets underactive, and then you have the underactive problem.

[18:43]

No matter what disease you have, there's almost nothing. You just have to take a little Synthroid. If you've never had it, there's no problem. Your body works fine. You just bypass the thyroid, you get Synthroid into your system orally, and you're perfectly fine. If you have to choose a disease to have, don't go with liver cancer. Go with hypothyroidism.

Common Medication for Thyroid Disease

[19:15]

Synthroid is the generic form of levothyroxine. Your chronologist titrates the amount of Synthroid or levothyroxine that you need. They give you some, and then they check your thyroid hormones. In pregnancy, your body's going to metabolize thyroid hormone quicker. So even if you are on Synthroid, you need to check those levels because you might have to adjust your dose.

[21:10]

Methimazole is a contraindication to use in the first trimester. You need to take something because it can lead to miscarriages, preterm delivery, preeclampsia, and all the bad things. Even hypothyroidism can lead to miscarriages or conception issues.

Postpartum thyroiditis

[23:45]

Postpartum thyroiditis is much more common. It is inflammation of the thyroid, which eventually can turn into Hashimoto's or hypothyroidism. So if a woman is having problems with sleeping, depression, postpartum depression, or weight gain, it's ideal for screening the thyroid to see if it is underactive or during active thyroiditis. It can be overactive or masquerade as Graves disease or hyperthyroidism and later show up as hypothyroidism.

The Fetal Thyroid

[26:09]

The fetal thyroid doesn't even come into play in the first trimester. There is no fetal thyroid action in the second. It's important to have good normal thyroid numbers in the first trimester because you're supplying thyroid for you and your baby. In the second trimester, the fetal thyroid gland starts to work.

Hormones and Pregnancy

[28:12]

When you look at TSH and other hormones in pregnancy, you look at the reflection of ATG production, especially early in pregnancy. If you grade a baby based on his TSH and T4, you're saying, "Is HCG production high or low?" Maybe you're saying, "Was it a great pregnancy from the get-go or not?" That has much more to do with overall performance later in life.

For everything you need about this podcast, check out True Birth: https://www.truebirthpodcast.com/

Our practice website can be found at:

Maternal Resources: https://www.maternalresources.org/

Remember to subscribe and tell a friend! Please consider leaving us a review on iTunes

Our Social Channels are as follows

Twitter: https://twitter.com/integrativeob YouTube: https://www.youtube.com/maternalresources IG: https://www.instagram.com/integrativeobgyn/

As Covid lingers on into the New Year especially with the new Omnicron variant on the loose, the question every pregnant woman wants to know is whether or not to get the Covid Booster vaccine while pregnant.

In this episode, Dr. Yaakov Abdelhak explains why he recommends the covid booster to pregnant women in pregnancy. We'd love to know what you think?

As always we would love to hear from you!

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