pregnancy

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Painkillers? Prozac? Brazilian Blowout? Hotline Counsels Pregnant Women On Risks

(Tatiana VdB/Flickr/Creative Commons)

(Tatiana VdB/Flickr/Creative Commons)

Joy Shapiro of Framingham, Mass., was the sort of hyper-cautious expectant mother who doesn’t just cut out alcohol and caffeine. She worried about the ingredients in everything she consumed or put on her body, from fitness drinks to sunscreen.

But thanks to a referral from her obstetrician, she had a secret weapon against her anxiety: Patricia Cole, the program coordinator for MotherToBaby Massachusetts — also known as the Pregnancy Exposure Infoline — whom she “bombarded” with queries.

“At one point, I emailed her like 20 ingredients that were in my face cream to say, ‘Are any of these going to be a detriment to my pregnancy?’” Shapiro says. “You’re essentially living for two, and you want to make sure you’re not doing anything that could harm your child.”

Cole helped Shapiro navigate not just food and cosmetics but medications — prescription steroids, acid reflux, nasal sprays. The sorts of decisions that have become commonplace, nearly universal, in a country where 9 out of 10 pregnant women take at least one medication during pregnancy, and 7 out of 10 take a prescription drug.

“Less than 10 percent of approved medications have enough data to show what, if any, concerns there are for fetal effects.”

– Dr. Cheryl Broussard, CDC

Many of the old concerns about risky exposures during pregnancy — leaded paint, thalidomide — have faded, but in this nation of prescription-fillers, meds have become a major worry.

Last year, the CDC launched its Treating for Two Website, part of a national initiative aimed at making medication use during pregnancy safer. It seeks better research on the effects of meds during pregnancy, and better guidance for expectant mothers and their doctors. The agency warned just last month about the potential risks of opioid painkillers — such as codeine or oxycodone — for pregnant women.

“Really, the problem is that we just don’t know a lot of information,” says Dr. Cheryl Broussard, a CDC expert on medication use during pregnancy. “We know that up to 9 out of 10 pregnant women take at least one medication during pregnancy, but less than 10 percent of approved medications have enough data to show what, if any, concerns there are for fetal effects.”

Clinical trials on drugs seeking approval generally do not include pregnant women, or drop women if they become pregnant. Continue reading

CDC: Risks Loom As Many Women Of Child-Bearing Age Are Prescribed Painkillers

Source: CDC

Source: CDC

The U.S. Centers For Disease Control and Prevention reports that many women of child-bearing age (notably, women on Medicaid) are taking opioid pain medications and that these drugs taken during pregnancy can increase the risk of birth defects.

According to the agency’s latest Morbidity and Mortality Weekly Report:

During 2008–2012, more than one fourth of privately insured and more than one third of Medicaid enrolled reproductive-aged women (15–44 years) filled a prescription for an opioid from an outpatient pharmacy each year. Prescription rates were consistently higher among Medicaid-enrolled compared with privately insured women.

The most frequently prescribed opioids, says the CDC, were hydrocodone, codeine and oxycodone.

The report details why early exposure is particularly risky:

“The development of birth defects often results from exposures during the first few weeks of pregnancy, which is a critical period for organ formation. Given that many pregnancies are not recognized until well after the first few weeks and half of all U.S. pregnancies are unplanned, all women who might become pregnant are at risk.”

Continue reading

Culture Clash: U.K. Embraces Homebirth As Best For Some Women

Sarah Parente shortly after the homebirth of her daughter Fiona (Courtesy of Leilani Rogers)

Sarah Parente shortly after the homebirth of her daughter Fiona (Courtesy of Leilani Rogers)

By Jessica Alpert

Sarah Parente, an Austin, Texas-based doula and mother of four, gave birth to her first child in the hospital with no complications. But then she decided to make a shift: Parente delivered her next three babies at home. “For women with low-risk pregnancies, home birth can be a great choice,” she says. “You have less stress because you are in your own home surrounded by a birth team of your choosing.”

Though home birth has recently gained cache in the U.S. — with some celebrities trumpeting the benefits of having their babies at home  — the practice remains uncommon and the majority of pregnant women give birth in a hospital setting. Still, Parente may be getting a little more company, albeit slowly. Data released by the Centers for Disease Control (CDC) earlier this year shows the rate of homebirths in the U.S. has increased to 0.92 percent in 2013 and the rate of out-of-hospital births (including home) has increased 55 percent since 2004.

Experts in the United Kingdom are saying that’s a good thing.

The London-based National Institute for Health and Care Excellence (Nice) recently released recommendations that homebirths and midwife-led centers are better for mothers and often just as safe for babies as hospital settings, the BBC reports. Of the 700,000 babies born in England and Wales each year, nine out of 10 are born in obstetric-led units in hospitals. Continue reading

Opinion: New Pregnancy Drug Guidelines A Mixed Bag For Consumers

pumicehead/flickr

pumicehead/flickr

By Dr. Adam Urato
Guest Contributor

Last week the Food and Drug Administration published a final rule that will change how drug companies present information on the risks of medications during pregnancy. This is considered a very important step as there are approximately 6 million pregnancies in the U.S. every year and the average pregnant woman takes between three and five prescription drugs during the course of a pregnancy.

For decades, the public has relied on the FDA’s Letter Category system in which a Category A drug was considered safe, Category D unsafe, with B and C falling in between, and Category X meaning contraindicated in pregnancy.

This past week the FDA announced that it is scrapping that letter system and replacing it with a new system that will offer descriptions about the effects of the drug during pregnancy and lactation. A third section (the “Females and Males of Reproductive Potential” subsection) will include information about pregnancy testing, contraception and about infertility as it relates to the drug.

So what exactly does all this mean for consumers?

As a Maternal-Fetal Medicine specialist, here’s my read on the changes:

What this means is that men and women are going to have to actually go to the drug information label and read it. No longer will a pregnant woman simply be able to look up a drug and find out that it’s a Category D in pregnancy, for instance, and then avoid it.

And this is a major problem that I see with the new system: many patients and physicians do not take the time to read through the label prior to using a medication. A description-based system risks losing the benefit of warning that the current Letter System provides when the drug is simply listed as Category D or X.

Also, it seems that the drug companies themselves are going to be asked to write these pregnancy sections on the label. This strikes me as absurd. Continue reading

Study: Pregnant Women Hungry For Better Info Earlier On

Pregnancy test (Wikimedia Commons)

Pregnancy test (Wikimedia Commons)

The “+” sign pops up on your pregnancy test. You call the office of the obstetrician you’ve chosen for just this eventuality, and the receptionist congratulates you and sets you an appointment four or six or eight weeks away.  “But,” you think, “I have so many questions now!” The books aren’t enough. So you turn, of course, to Google, and navigate the thickets of information alone.

If this was your pregnancy experience and it struck you as odd or off or wrong, you’re not alone, according to a recent small study that likely reflects a far broader opinion. Writes one pregnant friend: “My docs are wonderful and insanely knowledgeable, and I call them for the big stuff. However, there’s so much little stuff when you’re pregnant, especially for the first time. It’s constant googling, is this normal? Everything from symptoms, food, exercise routines, massages, whether to dye your hair – it’s endless.”

And some things you need to know early, she notes. “I did have the books – I found the Mayo Clinic guide to a healthy pregnancy to be quite good. But, not so easily searchable, especially when you’re at dinner and you’re like, ‘Can I eat xyz?’ My husband downloaded a few apps right away that allow you to search what you can eat, what to avoid. Some are obvious: alcohol, sushi, some way less so – um, lunch meat?”

From the study’s press release:

Pregnant women are using the Internet to seek answers to their medical questions more often than they would like, say Penn State researchers.

“We found that first-time moms were upset that their first prenatal visit did not occur until eight weeks into pregnancy,” said Jennifer L. Kraschnewski, assistant professor of medicine and public health sciences, Penn State College of Medicine. “These women reported using Google and other search engines because they had a lot of questions at the beginning of pregnancy, before their first doctor’s appointment.” Continue reading

Pregnancy Woes: Why Did The Price Of My Progesterone Skyrocket?

(Photo: Rekha Murthy)

(Photo: Rekha Murthy)

By Rekha Murthy
Guest Contributor

Update: KV Pharmaceutical changed its name to Lumara Health, two days after this post was published.

I’m 34 weeks pregnant and working hard to keep this baby inside me for as long as possible. As with my last pregnancy, there’s a real risk that the baby could come too early. But we’re both holding on so far, thanks to a combination of luck, modified bed rest and medical science.

The science is my biggest concern right now. I will spare you much of it because, man or woman, you will instinctively cringe and close your legs. However, one critical medical intervention that has been proven to work for countless women and babies is again under threat, and I must speak up.

Every week, my husband injects me with 250 mg (1 ml) of 17 alpha-hydroxyprogesterone caproate (“progesterone” for short). Leaving aside what this does to an otherwise tender and loving marriage, these injections have been found to significantly lower the risk of preterm birth.

Two weeks ago, my insurance co-pay for progesterone went from $5.50 per dose to $70 per dose. Just like that. For those without insurance (or with a deductible), the medication went from $32.50 per dose, according to my local compounding pharmacy, to…wait for it…$833 per dose, according to the new pharmacy my insurer is now requiring me to use.

$833. Per. Dose.

Pricing varies somewhat across pharmacies and insurers, but not enough to make this price change any less breathtaking. In fact, the drug’s list price is $690 per dose.

The 12-fold leap in my co-pay sent an epic shock through my (natural and synthetic) hormone-laden system. I immediately called both pharmacies, my insurer, and my doctor, and started digging around online. I soon learned that the price increase came from a new requirement to buy expensive brand-name progesterone, instead of the affordable compounded version I had been getting. A disturbing picture came into focus. Continue reading

Mass. Senate Approves Anti-Shackling Bill

State House News Service reports:

The Senate approved legislation Thursday aimed at preventing the shackling of pregnant inmates in Massachusetts correctional facilities. Sen. Karen Spilka said the bill (S 2063) would also make sure that women in prison, who she said often have high-risk pregnancies, receive medical screenings and assessments and nutrition and post-partum counseling.

The passage comes a month after Gov. Deval Patrick issued emergency regulations banning restraints on pregnant inmates in labor. He also urged the Legislature to send him pending legislation that would make his ban the law.

Campaign To Reduce Early Births Pays Off — Mass. Now Leads Nation

Most obstetricians agree that babies should not be delivered early, before 39 weeks, unless the health of the mother or her child is at risk. Research shows important brain, lung and vital organ development occurs late in pregnancy. So hospitals across Massachusetts have been working to reduce so-called “early elective deliveries.”

(popularpatty/flickr)

(popularpatty/flickr)

Over the last three years, most hospitals have either stopped scheduling early deliveries, or set a goal of less than 5 percent. Last year, the state’s rate dropped, on average, to 1 percent, the lowest in the country. There is still variation from one hospital to the next. But the numbers, compiled by Leapfrog, a business group that advocates for improved hospital quality and safety, show the significant progress hospitals made in just one year.

The state’s low rate “should decrease some of the complications that newborns may experience from being born electively,” including, “admissions to the intensive care unit and long-term complications,” said Dr. Glenn Markenson, an obstetrician at Bay State Medical Center. Continue reading

Ban On Handcuffing Pregnant Inmates In Labor Clears Hurdle In Mass. Legislature

A proposal to prohibit the scary practice of handcuffing pregnant inmates during labor has cleared its first hurdle through the Massachusetts Legislature. If passed, the so-called “anti-shackling bill” would “create uniform laws in county jails and the state prison system banning the shackling of pregnant women during childbirth and post-delivery recuperation — unless they present a specific safety or flight risk,” according to an earlier WBUR report.

(MOZ278/flickr)

(MOZ278/flickr)

“This bill has been on file for over a decade — the language has changed a bit — but it’s never seen the light of day,” says Megan Amundson, executive director of NARAL Pro-Choice Massachusetts. The bill was reported out of committee on Friday, and now it will be given a new number and then most likely go to the House Ways and Means Committee, Amundson says.

Here’s more from the NARAL Pro-Choice Massachusetts news release:

In a step toward joining the 18 states that have passed legislation banning the shackling of pregnant incarcerated women, the Massachusetts Joint Committee on Public Safety has released the Anti-Shackling Bill, a bill the prohibits the practice of shackling pregnant women in our jails and prisons, sponsored by Senator Karen Spilka. The bill has now passed the first hurdle to passage.

“As hard as this is to believe, it is not unusual for pregnant women in Massachusetts jails to be handcuffed to the hospital bed even while in labor,” said Megan Amundson, Continue reading

Opinion: License Professional Midwives For More Childbirth (And Home Birth) Options

Home birth announcement (Courtesy Sarah Whedon)

Home birth announcement (Courtesy Sarah Whedon)

By Sarah Whedon
Guest Contributor

When I was expecting my first baby in 2009, I planned a home birth with a wonderful midwife. My pregnancy was healthy and normal, my prenatal care with my midwife was both empowering and attentive to my health needs and my labor began spontaneously at full term.

Everything was going according to plan, until about 20 hours into active labor at home when my midwife alerted me that my baby’s heart rate indicated a serious problem and we needed urgent medical attention.

In the amount of time it took the ambulance to arrive at my Somerville home, my midwife cut an episiotomy (a skill in which home-birth midwives are trained but don’t practice as a matter of routine) and performed an emergency delivery. My baby had aspirated meconium (the sticky tar-like substance in a newborn’s bowels that is occasionally expelled during birth) and was having trouble breathing even with the aid of the oxygen my midwife carried with her. She needed a transfer to the level III NICU at Children’s Hospital, where she made a complete recovery.

I had a home birth because I wanted the kind of low intervention pregnancy and birth that Certified Professional Midwives (CPMs) offer. But I tell my birth story publicly because it demonstrates something important that people don’t often realize about CPMs: they are skilled professionals who are prepared to handle emergencies, including facilitating transfer to medical care when needed.

CPMs are midwives who are specially trained in out-of-hospital care. They differ from Certified Nurse Midwives (CNMs) who are trained as nurses and typically practice in hospital settings. Currently, Massachusetts licenses CNMs but has no licensing system for CPMs, who provide care for approximately 500 women across the state each year.

So when I recently learned of a petition asking me to support licensing of CPMs in Massachusetts, I immediately wanted to get more involved. I found other moms who want this bill to pass and I’ve had the pleasure of lending my support to this work being carried out by a coalition of advocates from the Massachusetts Midwives Alliance, Massachusetts Friends of Midwives and others. More than 500 Massachusetts residents have now signed the petition.

The bills (HB 2008 and SB 1081) would require all midwives practicing out of hospital to become CPMs, create state licensing requirements for CPMs and establish a Committee on Midwifery under the Board of Registration in Medicine. The nine-member committee will include five CPMs, one obstetrician, one CNM and one consumer of midwifery services.

Supporters of the measures that would license and regulate home birth midwives were energized by an amazing turnout at a Committee on Public Health hearing last month, testifying to the professional skill of these midwives and the valuable ways they serve Massachusetts families. Several moms even brought their charming home birth babies along for the day at the State House.

I have heard from some midwifery supporters who oppose licensing, worrying that new regulations will hamper midwives’ ability to truly practice the midwifery model of care. But midwives themselves will be involved in determining details of regulation. Overall, licensing of our midwives would mean more moms will feel able to choose home birth, because they’d have the security of knowing that in order to hang out her shingle, a midwife must meet state licensing standards.

The Massachusetts Medical Society has also opposed the bills, expressing disapproval of any health care that is delivered outside the team context with immediate M.D. supervision. Continue reading