pregnancy, Women's Health

WHEN IS IT “SAFE” TO TELL PEOPLE YOU ARE PREGNANT

I was at an end of the year kindergarten party this week. After consuming the usual amount of sugary snacks associated with such class parties, but before saying their dramatic goodbyes that also included full body hugs, each kindergartner circled up to say what they were looking forward to most this summer. Most announced various beach and Disney trips, but one little girl began jumping up and down and squealed, “I’m excited about summer because my mommy has a baby in her belly!” Based on the way her mom’s eyes widened and jaw dropped open in horror, I’m guessing this new baby news was not yet meant to be public knowledge.

It’s hard to know when it’s ‘safe’ to tell people you are expecting. In this age of social media, it is difficult to tell just family and close friends. Even when you try to keep it quiet, the news has a way of sneaking out like it did for my friend whose great aunt had recently joined “The Facebook” and accidentally posted her congratulations on her wall instead of a private message.

Everyone’s biggest fear is making a big public pregnancy announcement, only to have to sadly announce a loss a few weeks later. With my first pregnancy, we called all our friends and family the day we found out. We simply couldn’t contain our excitement. Sadly about a week later, we experienced a loss. It really stunk having to then tell everyone we had a miscarriage, but at least people knew why I was sad and could offer their sympathy and support, which was very helpful. With the next pregnancy I was very guarded and waited until after 12 weeks before I shared the news.

When I see a couple for their first pregnancy appointment, after we see the heart beating strongly on ultrasound and they breathe their initial sigh of relief, one of the first questions they ask is “Is it safe to tell people we are expecting?” I get a sense they feel that if I give them the blessing, all will be OK. While I can never offer a guarantee, I can offer statistics that provide some reassurance as to when it’s safe to let all their great aunts know the exciting news.

Chance of miscarriage after a normal first trimester ultrasound (maternal age <35):

  • At 5 weeks the risk of loss is 8%
  • At 6 weeks the risk of loss is 7%
  • At 8 weeks the risk of loss is 3%
  • After 12 weeks the risk of loss is < 1%

While many women choose to wait until after the first trimester to tell their news, if the baby has a normal heart beat at 8 weeks, their chance of a normal pregnancy is 97%.

Risk factor that might increase the chance of miscarriage:

  • Maternal age >40
  • History of >2 miscarriages
  • Diabetes
  • High blood pressure
  • Lupus
  • Untreated thyroid disease
  • Abnormally shaped uterus

Sadly, miscarriage is very common with up to 15% of pregnancies ending in loss. This rate can increase an additional 10- 25%  if you count “chemical pregnancies,” when a woman’s initial home test is positive only to have her cycle start a day or two late. Due to the high rate of chemical pregnancies, I encourage my patients not to rely on ultra sensitive home tests days before their period will normally start, but instead try to wait until they are at least a week late.

The decision of when to announce your pregnancy is a very personal one. I was initially horrified when I realized I was going to have to “unannounce” my first pregnancy after my loss, but eventually I was thankful I had the support of all my friends as my heart was healing. For those looking for the best time to share your news, know this: the risk of loss drops dramatically once you have seen a healthy heart beat, and then becomes extremely low after the first trimester. 

Motherhood, pregnancy

My Birth Story

When my alarm began blaring at 5:20 am on January 21, 2004; I immediately hit the snooze button. I am normally a morning person, but the last few weeks of my pregnancy were beyond exhausting. As I reluctantly climbed in the shower I purposefully avoided the mirror. I really didn’t want to catch a glimpse of my giant whale body. I had stopped feeling like a ‘cute pregnant lady’ long ago. My feet where still swollen from the night before; I noticed my sock indention from the previous day’s work.

I was lucky. My pregnancy was healthy and had gone quite smoothly, with the exception of one small hiccup: at 32 weeks I learned that my son was breech, and he never flipped. My c-section was scheduled for 39 weeks. If I am completely honest with you, I was more afraid of a vaginal delivery than a c-section. A small part of me was slightly relieved that things would be nicely scheduled and I would never have to face all the drama of labor.

My parents had their plane tickets to Ohio. It would all happen in 2 more days.

I was in my OB/GYN residency training during my pregnancy. I worked 80 hours a week, often 12 to 14 hour days. Residency was challenging enough when you weren’t carrying around 50 pounds of extra baby weight and having to pee every 5 minutes. However this was my final day of work. Tomorrow I would take an exam, then the baby would be here on Saturday. It was surreal to know exactly when the baby would come. I couldn’t wait to meet baby Ryan (we didn’t know if it was a boy or girl, but the name was to be Ryan either way).

My last day at work was not an easy one. I was assisting with several surgeries and it was during the first case that the headache started. As the afternoon progressed, I started seeing little spots. I knew these were the sign of preeclampsia, so I stopped by labor and delivery to have my blood pressure checked. It was dangerously high. I wanted to go home and get my things, but my fellow residents insisted I stay and get blood work. “Really, I’ll be fine” I said. I had no insight. Intellectually I realized I had preeclampsia, and shouldn’t leave the hospital when my blood pressure was sky high, but it didn’t compute emotionally. It was strange. There was also an element of denial at play. This could not be happening to me.

I had seen patients act this way many times and assumed they were non-compliant. I realize now when patients have an irrational response to an emergency that it is likely denial more than ignorance. So often we spend so much time picturing and planning how our special day is supposed to happen that when things go awry, it zaps the wind from our sails and leaves us stunned in disbelief.

My doctor arrived and decided the c-section should be done immediately and a magnesium drip would be started to treat the preeclampsia and help control my blood pressure. I attempted to argue that I really didn’t need it. Magnesium was a miserable drug. She just glared at me, “Of course you are getting magnesium.” I took a deep breath and complied.

After several blubbering phone calls to friends and family, they set me up for delivery. My mom didn’t get to be there, but my husband and friends (fellow residents) were there to support me.

As they wheeled me into the cold OR, I realized I was terrified of the “unknown” despite doing hundreds of c-sections myself. As I lay strapped to the OR table, I felt vulnerable and afraid. It was so awkward to be on the other side of the knife. As the surgery got underway, though I felt more calm; comforted by the familiar sounds of the instruments and operating room banter.

2004-01-21-0003

As he was born, the entire room cheered. “It’s a boy” someone said. My husband and I were overwhelmed with joy.

2004-01-21-0006

As the doctor held him up over the blue sheet for me to see him, I remember thinking that he looked blue and they should really get him to the warmer. Myself, my husband and my friends (who we’re running various cameras) we’re all crying and cheering. It was an amazing day.

As I held him in recovery and nursed him for the first time, I remember thinking how incredibly blessed I was. I couldn’t believe how deeply I could love this sweet little boy. What an amazing gift.

 

pregnancy

Baby Pictures: Illegal Privacy Breach or Adorable Tradition?

I write the Apgars and weight on a sticky note as I survey the delivery room one last time. The new mom is staring in awe at the baby in her arms while dad is nearby trying to dry up his tears before the extended family descends on the scene from the waiting room. I reassure myself with a glance at the monitor confirming that mom’s vital signs are stable, as I quietly make my way to the door.

“Wait Doctor! Don’t leave, yet. We need a picture of you with the baby!” They insist.
Internally, I cringe. It’s 3 am. My hair resembles that of a Dr. Seuss character due to hours of wearing a surgical hat and my eyes are a swollen mix sleep deprivation and caffeine overload. But outwardly, I smile. I realize this moment isn’t about me, it’s about the parents preserving the memory of the birth of their child.*

At mom’s six week postpartum visit, she—like most of my patients—proudly hands me a copy of the picture, requesting for me to put it on my “wall.”

My office is lined with baby pictures, like almost every OB/GYN office in America. After 10 years in private practice, walking down my hall is a virtual scrap book of my life. As I see the faces of the hundreds of babies I’ve delivered, I can’t help but smile.

Recently, more and more offices are removing the baby pictures from their walls over for concerns for patient privacy. A recent article in the NY Times notes how most large hospital corporations are requiring physicians to take down photos out of fear of HIPA noncompliance. The article quotes Rachel Seeger, a spokeswoman for the Office for Civil Rights of the Department of Health and Human Services as saying “A patient’s photograph that identifies him/her cannot be posted in public areas” unless there is “specific authorization from the patient or personal representative.” It states that unless written permission is obtained, the pictures are illegal.

Patient privacy should be taken very seriously. But is displaying a picture of baby, which was given to me specifically for that purpose, truly a breach of trust? Can there possibly be a small ounce of common sense left in this over-legislated world?

I adore the pictures as well. Some pictures make me laugh, as I remember the delivery of a baby that splashed me with a tidal wave of amniotic fluid, which sadly I’ve learned tastes like coconut water. Other faces are a reminder of a delivery tainted with tragedy; these evoke a silent prayer for patients with loss. Most of the pictures bring a simple smile and a moment of gratitude that I’ve been blessed to be a part of so many miracles.

But just as the birth isn’t really about me, neither are the baby boards. When women come back for their second and third pregnancy, I often see them hoisting up their tots to show them their own baby picture on the wall. “Look, there you are! That’s you with the doctor that delivered you!” they say with a grin. The toddler often responds with a squishy faced grimace of disbelief and a chuckle. If they can’t find their picture (we get so many, we actually have to rotate the photos) they are disappointed.

The purpose of the baby boards is to celebrate life and bring a small moment of joy to those walking by, not to expose someone’s private health information.

For now, my office walls will continue to display unflattering pictures of me at 3 am holding crying babies, fresh from the womb, still coated in coated in creamy vernix. These pictures bring us joy and my patients want me to display them. Some say it might be illegal, but surely that is not the spirit of the law. There are real problems in health care right now that need addressed, baby pictures on my wall isn’t one of them.

*any patient references are used with patient’s permission or are a fictions conglomerate of multiple patient encounters.