Ladies in Waiting
The day you find out you’re pregnant is easily one of the most exhilarating of your life—and the most overwhelming. You’re happy, you’re anxious. You’re awestruck, you’re frightened. There’s so much that can go wrong—and even more that needs to go right. After all, there’s a miracle growing inside you and it’s up to you to bring it happily and healthily into the light—no pressure there! But let’s hold on a moment and take a deep breath. You’ve got nine months to get through and, yes, that’s a long time, but we’re here to help. We’ve asked experts from around the state for their take on some of the hottest topics in maternity care today and what follows should help guide you on your way. No worries, mommies-to-be, we happen to think you do great work.
We have good news and unsettling news. The good news for those of you preparing to deliver: When the American College of Obstetricians and Gynecologists held its annual clinical meeting this past May in Washington, D.C., perinatal safety was at the forefront of discussion—as it is among most ob/gyns these days. The unsettling news for the rest of us: What about back when we were the ones in the delivery room? As it turns out, no worries for us, either.
“It’s not as if our goal has not always been to be safe,” says Dr. Christian Pettker, medical director of labor and birth at Yale-New Haven Hospital. It’s just that “as medicine becomes more complex, it becomes more powerful—and involves more potential to do harm.” Indeed, “technology has the ability to outpace an individual’s ability to manage,” says Sandra Roosa, R.N., vice president of patient-care services at Saint Mary’s Hospital in Waterbury. “And we want—we need—to be perfect.”
For help with that, myriad hospitals, Saint Mary’s for one, are taking lessons from the cockpit, of all places. Its “Team Performance Plus” program, taught by Beth Israel Deaconess Medical Center in Boston, applies the concepts of “Crew Resource Management” used by commercial and military flight teams to improve team effectiveness. Think detailed checklists and data collection, benchmarks and thrice-daily meetings across all disciplines, whether doctor or midwife, nurse’s aide or clerk. “It’s a scientific approach,” says Roosa, “that’s really about enhancing communication.”
By now you’ve likely started to get literature in the mail from cord-blood banks. Cord blood, the blood left in your baby’s umbilical cord after the cord is snipped, is a uniquely rich source of stem cells that have been used to treat some 40 diseases, from leukemia to sickle cell anemia to multiple sclerosis. Recent research even suggests these “super” cells’ potential to treat brain injury, Alzheimer’s disease and Type 1 diabetes—hallelujah! So what’s the problem? Experts estimate there’s only a 1-in-20,000 chance someone in your family may eventually need that blood—and banking it isn’t cheap. Private cord-blood banks are the only type available in Connecticut and charge $1,500 to $2,000 to prepare the blood for storage and a $150 to $200 yearly fee thereafter. That, however, looks like it’s about to change.
At press time, a bill establishing Connecticut’s first public cord-blood bank had passed the Senate and was on the calendar for the House. A public bank in Connecticut, which would join just a few dozen other states in having one, would enable parents to donate their child’s cord blood free of charge. Will you have rights over that blood should the need arise? No. But considering that according to the National Marrow Donor Program 70 percent of patients who need a cord-blood or bone-marrow transplant are unable to find a matching donor, imagining the possibilities of a public bank is pretty inspiring.
“This is a huge resource, like gold really, that we’re currently throwing away,” Dr. Charles Lockwood, chair of the Department of Obstetrics, Gynecology and Reproductive Sciences at Yale University School of Medicine, has said. Dr. Winston Campbell, interim chair of the Department of Obstetrics and Gynecology at the University of Connecticut Health Center-School of Medicine and Lockwood’s co-chair of the Connecticut Cord Blood Taskforce, calls it “a tremendous opportunity for not only the state of Connecticut but also the nation,” one that would “allow more citizens more opportunities to help each other.” Here’s hoping.
We know you’ve seen the images: ultrasounds of your co-worker’s baby that are so clear you swear you can tell exactly who the baby looks like—right down to the dimple in his chin. These are “3-D” ultrasounds and they are, in a word, “amazing,” says Catherine Gallagher, a certified nurse-midwife at the Connecticut Childbirth & Women’s Center in Danbury. But here’s the rub: Despite what you may have seen or heard, “3-D ultrasounds are not the norm,” says Dr. Victor Fang, an obstetrician and gynecologist at Hartford Hospital, noting they are used only in “limited applications.”
Three-dimensional images, as well as “4-D,” which show images in real time, are done only “if we suspect some sort of developmental problem,” says Yale’s Pettker. That being said, “We do recognize that from a patient’s point of view an ultrasound is as much an emotional experience as it is a medical one,” says Pettker—and try to be sensitive to that. You can expect your first routine photo op at eight weeks (to “date the pregnancy and check for a heartbeat”), as part of your first trimester screen between 11 and 13 weeks, and as an anatomy peek between 18 to 22 weeks to determine the child’s gender.
As for splurging on a session at one of the “keepsake” ultrasound facilities that have popped up over the past five years or so, it won’t happen here. In 2009, we became the first state to bar ultrasounds on pregnant women unless under a doctor’s orders for medical or diagnostic purposes, the idea being that the potential harm of excess radiation to both mother and child is not justified for “entertainment” purposes.
Nervous about heading to the doc? “CenteringPregnancy” could be the answer. This group approach to prenatal care, developed by Cheshire’s Sharon Schindler Rising, CNM, MSN, back in 1998 and now offered nationwide, brings women out of exam rooms and into “girl power” groups of their peers for prenatal care. The concept, as explained by Nancy DeGennaro, certified nurse-midwife at the Center for Women’s Health and Midwifery at the Hospital of Saint Raphael in New Haven: You come in for your first and sometimes even your second visit alone to have your initial physical and lab work done, and then, at around 16 weeks, join a group of three to 10 women all due around the same time. Groups meet for two hours monthly and then twice a month starting around 28 weeks—the same schedule you’d follow if you went for visits alone.
“Our patients absolutely love it,” says DeGennaro. “They appreciate the support, the bonding [topics of discussion range from nutrition to newborn care to relationships] and the chance to reach out and advocate for one another.” The structure also “empowers them to be a real part of their own care,” adds DeGennaro, who leads the groups. Centering participants check their own weight, blood pressure, even how far along they are on the gestational wheel. Belly and heartbeat checks are all done in the same room. If there’s a problem, you simply schedule an additional visit on your own.
“Not only is it more fun for the women involved,” says Robyn Brancato Ozovek, a midwife at Norwalk Community Health Center, which is considering its own Centering group, “it’s easier for providers, too, who no longer feel the pressure to rush women in and out.”
SHADES OF BLUE
It’s a big responsibility, this growing-a-human-being thing, and it can be easy to get overwhelmed, if not depressed, by the seeming enormity of it. And yet, Pettker says, despite the fact that “the risk of a depressive episode during pregnancy is 15 percent—higher than the risk for gestational diabetes or high blood pressure—we’re probably all a little behind in treating it.”
“Depression in pregnant women often goes unrecognized and untreated, in part because of concerns about the safety of treating women during pregnancy,” says fellow Yale physician Kimberly Yonkers, lead author of a recent study by the American College of Obstetricians and Gynecologists and the American Psychiatric Association, which reports that both depression symptoms and the use of antidepressant medications during pregnancy have been associated with negative consequences for the newborn, such as an increased risk for irritability and less activity and attentiveness. Not to mention the fact that clinical depression may lead to premature delivery.
The thing to remember: You’re not alone: Talk to your doctors about whether medication is advised in your case, and if so, which to choose (some are better than others—the free Connecticut Pregnancy Exposure Information Service at 800/325-5391 can also help with that). And, above all, keep that chin up. “It’s always better to be on medicine than to suffer being depressed,” says Dr. Yoni Barnhard, chairman of the Department of Obstetrics and Gynecology at Norwalk Hospital. “Medication is a risk worth taking.”
THERE’S A CLASS FOR THAT
Chances are you’re aware that your hospital offers childbirth classes. You’ve seen the expectant mothers arrive, pillows in hand, and heard the echo of their breathing exercises in the halls (all together now: “he he ho, he he hoooo”). But have you seen them arrive for infant massage class? Yoga? Spiritual counseling? Indeed, the resources out there for expectant mamas and their kin are pretty impressive.
“It’s all about taking a team approach to patient-centered care and integrative medicine,” says Norwalk Hospital’s Barnhard—think mind, body and spirit. Norwalk itself offers massage, reflexology, yoga, Reiki and, yes, that spiritual boost when needed. The “Family at Birth Class” at Bridgeport Hospital prepares children to attend the birth of their soon-to-be sibling, and its “Breastfeeding: Back to Work” covers everything from a review of state laws concerning breastfeeding in the workplace to milk storage and handling. You can learn pediatric and family CPR as well as how to properly install that bleeping car seat at Middlesex Hospital (it’s not so bad); or when visiting Yale can explore “Total Pregnancy Fitness,” “Dogs & Storks,” “Anesthesia Pain Management in Labor & Birth” or, on the other hand, a series on “HypnoBirthing”—the hot new approach to an unmedicated or low-intervention birth. Greenwich Hospital, meanwhile, even offers classes for grandparents-to-be.
As for what’s doin’ at the Connecticut Childbirth & Women’s Center, “Nutritional counseling has become something we spend a lot of time on,” says Gallagher. “It’s so easy to get caught up in what a scale says.” But don’t be surprised if you also discover classes in prenatal yoga, belly dancing during labor, breastfeeding and even a support group for new moms. And how much do we love Hartford Hospital’s class that teaches husbands how to support and comfort their wives during labor!
“First-time parents just don’t understand what’s in store for them,” says West Hartford’s Sharon Thomason, Ph.D, creator of The MomSource and an instructor of Hartford Hospital’s latest class, “We to Three (or More).” Happily, “There are all kinds of support services out there,” she says. “If we all help moms-to-be get that ‘village’ in place before they deliver, they’ll have the safety net they need.”