Advanced Maternal Age

As more women are delaying childbearing until later in life, it is important to understand the risk involved in waiting. Advanced maternal age generally refers to a woman who has reached her 35th birthday by the date of delivery. The rate of births to women 35 and older has gradually increased, and in 2009, 14 percent of all babies were born to mothers 35 and older.

For most, the perceived risks outweigh the actual risk. An objective look at the risks of delivering after age 35 can be helpful to put them all into perspective.

One of the most common concerns for women in their 30s and 40s is whether they will be able to conceive. For most, the answer is yes. Studies show that fecundity (the rate at which a woman will conceive on the first attempted cycle) begins to slowly decline after age 32 through age 37. There is a more rapid decline from 37 to 45. Women 35 and older who want to conceive and have a history of irregular cycles, chronic pelvic pain or pelvic infections should have these problems evaluated by their healthcare provider prior to attempting pregnancy.

Aneuploidy, the presence of an extra or missing chromosome, can result in birth defects and developmental delay. The risk of Down’s syndrome, the most frequent chromosomal disorder seen in newborns, increases gradually with age. At 35, the risk is approximately 1 in 250 births. At 40, the risk increases to 1 in 50. If a woman delivers at 45, the risk is 1 in 10.

Chronic medical conditions such as high blood pressure and diabetes are more common in women of advanced maternal age. Even women 35 and older who have been perfectly healthy are at increased risk of developing pregnancy-induced hypertension and diabetes. Developing either condition can result in additional visits to the healthcare provider for monitoring the mother and the baby, bed rest and need for preterm delivery.

Cesarean section is more common in women 35 and older. Dysfunctional labor, complicating medical conditions and an increased rate of elective cesarean deliveries all contribute to a higher cesarean section rate.

Pregnancy and delivery are never risk-free. The risks encountered by women 35 and older are relative to the baseline risk and must be seen in light of the socioeconomic benefits of delayed childbearing. Preconception consultation can individualize and potentially reduce the risks for women considering a pregnancy at any age.

Jennifer Fuson, an OB/GYN with Lexington Women’s Health, practices at Central Baptist Hospital.

 

Doula Services

“I couldn’t have done it without you.”

I hear it all the time, and, although I know that each and every woman I serve would have given birth to their babies without my support, I also understand the value of a trained support person during birth. A doula provides continuous emotional, informational and physical support to women and their families. In the past 7 years I have been honored to see over 100 women become mothers, sometimes for the 3rd and 4th time, and it never ceases to amaze me. I still get teary-eyed when women speak to their babies for the first time, gaze into their eyes and count those precious fingers and toes. What makes these women feel that they couldn’t have given birth without my support? As a doula I never leave a woman’s side unless asked to do so. I wipe her brow with a wet cloth, know position changes that are helpful and constantly affirm her ability to become a mother. I help her understand informed consent so she can adequately determine for herself which path she will take if complications arise. I facilitate communication, never speaking on her behalf and allowing her to have open communication with her chosen care provider. I tell her what a good job she is doing with her birth and support her fully in whatever choices she makes, as well as give guidance and assurance to her birth partner if one is present. Doulas give confidence, and confidence is invaluable!

 

“When continuous labor support was provided by a doula, women experienced a: 31% decrease in the use of Pitocin, 28% decrease in the risk of C-section, 12% increase in the likelihood of a spontaneous vaginal birth, 9% decrease in the use of any medications for pain relief, 14% decrease in the risk of newborns being admitted to a special care nursery, 34% decrease in the risk of being dissatisfied with the birth experience.” Rebecca Dekkar, Evidence Based Birth (www.evidencebasedbirth.com)

Keeping those statistics in mind, who wouldn’t want to have a doula? Doulas can be found by asking care providers who they’ve worked with, searching doula databases, checking with local birth resources or asking friends and families who they have hired in the past. When you have narrowed your choices, you will want to set up in-person interviews to determine who will be the right person for your birth. Here are some suggestions of questions to ask during the interview process:

 

  1. What is her level of training and is she certified or working toward certification? There are many reputable organizations including, but not limited to DONA and CAPPA who train and equip doulas to serve women while abiding by ethical standards. Finding out what the doula abides by is essential in knowing how she will respond within the birth environment you have chosen.
  2. What is her level of experience? Every doula has to start somewhere and newer doulas are very excited and full of zeal for their new profession. If cost is a factor a newer doula is generally less expensive than a doula with up-to-date certifications and multiple birth experiences to draw from. The benefits of established doulas are that they have been exposed to the birth culture within the community, they have previous experiences from which to draw and they have good relationships already established with the providers in the area.
  3. How does she view her role? A doula’s role is defined by you as the parent while maintaining ethical standards of conduct and respecting the care team you have established. She may do a lot of behind-the-scenes work or be more hands-on and actively encouraging to you. She may be there as a support to the birth partner as well so that he/she can be more actively supporting you as well. Doulas are not medical care providers and do not offer vaginal exams, checks of the fetal heart tones or blood pressure readings.
  4. Does she have references? Are her own previous clients willing to vouch for her work and have your chosen birth care team worked well with her in the past? Speaking with a few previous clients can help determine if she will be the right doula for you. You can ask them what the doula did that most helped them or if there was anything they wished she had done differently or better.
  5. How many births does she take per month and has she missed any and why? It is inevitable that full-time doulas will eventually miss a birth due to sickness or clients having babies on the same day, but this should be the exception and not the rule! When interviewing doulas ask who they provide back up for and how often.
  6. How long would it take for her to reach you? If she has children does she have care arranged? A doula should be able to reach you fairly quickly, especially with adequate notice. Most will have a range of 1-2 hours depending on how far away they live. If childcare isn’t established then finding someone last-minute can prove difficult for most doulas. Ensure that she can attend to you fairly quickly and everything has been planned ahead for your birth. You should be a priority in her life!
  7. How would she feel if you were to opt for medical intervention even if it weren’t indicated by research? A doula should respect all decisions made by you in all instances. She can help you communicate with your care providers to be sure you understand your options, but not speak on your behalf. A doula will help walk you through any questions you have, present alternatives that may have been looked over and allow you to make the final decision without pushing her own philosophy above yours.
  8. What are your fees and policies? A doula should have everything outlined in a contractual agreement. This allows everyone to understand what happens in every birth situation. What happens if she misses the birth? What are her fees? What is the refund policy? Who is her back up? What is included? All of these questions are important and provide instant clarity of expectations.

 

Choosing a doula is something very personal and should be a smooth and fun experience for you. Call around, set up interviews and ask your important questions. Once you have taken some time to discuss and decide on the best doula for you, send in the deposit and relax, knowing you have made a wonderful decision regarding your pregnancy and birth. A healthy baby and healthy mom are important, but a positive birth experience is as well!

Enjoy your beautiful birth!

 

Julie Six is a local doula certified with DONA and CBI. She has attended over 100 births in the last 8 years and enjoys teaching Hypnobabies and helping women have easier more comfortable births. She is the owner and founder of the up and coming doula group, Birth Kentucky, LLC. For more information on finding a doula or childbirth classes in the Lexington, KY area please contact Baby Moon at 859-335-5949 or email julie@baby-moon.org

Why do they call it “morning sickness” when it lasts all day?

No one really knows what causes the nausea of pregnancy, but it affects over half of all pregnant women. It is thought to be related to the high hormone levels of pregnancy, like human chorionic gonadotropin (hcg) and estrogen.  The high progesterone level also relaxes a pregnant woman’s esophagus, so that she is more likely to have reflux and gagging.

Symptoms of nausea may be brought on by hunger or swings in blood sugar. Many notice that their nausea is worse when they are tired. Some moms report that smells may make their nausea worse. Sometimes even a vitamin is a trigger, but the vitamins are needed! There are some women who make extra saliva during pregnancy, and this constant swallowing makes them sicker.

The worst week of morning sickness is usually in the middle of the first trimester. By the second trimester, your body will have some relief.   If you need relief sooner, here are some things to try:

1.       Get lots of rest.   Fatigue can cause nausea even when you are not pregnant. What a great excuse to take a nap!

2.      Try frequent small meals that include some protein or fat.   The old advice of eating crackers may help temporarily, but a little cheese and turkey on the crackers will bring longer relief by keeping blood sugars stable. Sipping on flavored beverages all day long not only improve hydration, which makes you feel better, but may also help those with excess saliva production.

3.      Antacids. Tums contain calcium, and are good for pregnancy. In some cases, the heartburn and gagging is helped by pepcid 20 mg every day.

4.      Antihistamines. Doctors often prescribe antihistamines like phenergan to help with nausea, but benedryl (diphenhydramine) 25 mg as needed every 6 hours may also help.

OR   An older remedy for nausea was to recommend ½ of a unasom tablet (doxylamine 12.5 mg) every 6 hours.  Remember that any antihistamine may cause fatigue, and see step 1!

5.      Vitamin B supplementation.   Some people have less nausea with extra vitamin B6, 50 mg every day.

6.      Ginger. Ginger snap cookies, ginger ale, and candied ginger have all been said to improve nausea, though not well studied.

7.      Prescriptions have improved over the last 10 years. Doctors often recommend Zofran, Kytril, Reglan, Compazine or others to help with the nausea. Of course, all have side effects that should be discussed with a physician.

The extreme form of morning sickness is called hyperemesis. It causes relentless vomiting and can result in dehydration, weight loss, and nutritional deficiencies. While vomiting occasionally is common, hyperemesis occurs in less than 2% of pregnancies. Hyperemesis needs to be treated aggressively with medications and fluids, and should not be ignored.

 

Emily Cunningham, MD

Lexington Women’s Health

 Emily Cunningham 2014

 

Elective induced labor not without its risks

Induction of labor refers to stimulating labor to cause contractions before spontaneous natural labor begins. The term elective induction of labor is used when a woman undergoes stimulation of labor without a medical reason for doing so. A medical reason would include conditions that put the health or life of the mother or fetus at risk. Labor inductions are appealing for many reasons. First, they are convenient. The prospect of organizing a birth into an already overbooked family or work schedule can be very tempting. Excitement about meeting the infant, stress, discomfort and even pressure from friends and family are other reasons women may schedule an induction of labor. Although these seem like justifiable reasons to have a baby on a predetermined date, it is important to remember that labor induction is a medical procedure that could have life-threatening risks for both the mother and fetus.

Many methods are used to induce labor. Understanding those methods is an important part of understanding the overall risks involved. The more common methods include rupturing the amniotic membranes surrounding the fetus— often referred to as “breaking water”—and the use of intravenous Oxytocin, a synthetic form of a naturally occurring hormone that is responsible for labor and breastfeeding.

Studies have hown that the risk of Caesarean section can be as much as two-fold higher for women undergoing induction of labor. This is especially true for first-time mothers. Other associated risks include fever, infection, rupture of the
uterus, hemorrhage, blood transfusion and even death in rare instances. Fetuses
may experience stress during the process. Fetal distress is an indication for
Caesarean section.

There are also health care costs associated with induction of labor. Women who undergo labor induction require more medical intervention, more equipment, more medications and usually have longer hospital stays. Because of this, some insurance companies are now refusing to pay for elective labor inductions.

Women considering an induction of labor should discuss it with their doctor or
midwife. The discussion should include reasons induction might be appropriate,
risks, benefits and what procedures will be used to stimulate labor. Women should have a clear understanding of the entire process before proceeding. It is
important to remember that swollen feet and discomfort evident at the end of
pregnancy are only temporary conditions and that the most desired outcome for
any pregnancy is a healthy mother and a healthy baby.
Alisha C. Morgan, CNM