Topamax Trouble

A recent recall of the anticonvulsant medication Topamax has raised concern among health care providers and pregnant women.  Topamax is used to treat seizures caused by epilepsy and related conditions.  The medication has been found to put unborn children at risk for severe birth defects.

The most commonly seen birth defects as a result of taking this medication are oral birth defects, including cleft palate.  The FDA has recently put warning labels on the medication, but the main concern is that many women have already taken the medication while being pregnant, without knowing the risk for complications.  The risk for birth defects as a result of taking this medication is increased if you are taking more than one seizure medication.  It is not known how Topamax risk compares to other medications.  If you are planning on becoming pregnant and have a condition that requires medication, discuss this matter with your doctor and take every care to ensure that the medication will not harm your baby.

Preterm Labor Risk

A couple of weeks ago, the issue of the preterm delivery drug was addressed.  To follow up with that post, there have been some changes in price since the original monopoly.  The drug price has now been cut in have, and will cost $690 as opposed to $1500.  There are also some generic forms of the drug that are most likely going to be sold as well, despite the monopoly Makena currently possesses.

With all of the controversy about this drug, how much of it is worth your thought or concern?  This question can be answered with another question: What is your risk for preterm labor, and what can you do to prevent it?

Preterm labor occurs as a result of contractions that begin to open the cervix before the baby is ready, or any time before 37 weeks.  The following are the signs of preterm labor:

• Contractions every 10 minutes or more often
• Change in vaginal discharge
• Pelvic pressure
• Low, dull backache
• Cramps that feel like your period
• Abdominal cramps with or without diarrhea

Not every woman is at equal risk for preterm labor.  Not all of the causes of preterm labor are known, and in many cases it remains a mystery.  However, there are certain risk factors that increase a woman’s risk for preterm labor:

• Previous preterm labor or preterm birth
• Pregnancy with twins, triplets or other multiples
• Certain problems with the uterus, cervix or placenta
• Smoking cigarettes, drinking alcohol or using illicit drugs
• Some infections, particularly of the amniotic fluid and lower genital tract
• Some chronic conditions, such as high blood pressure and diabetes
• Being underweight or overweight before pregnancy, or gaining too little or too much weight during pregnancy
• Stressful life events, such as the death of a loved one or domestic violence
• Multiple miscarriages

If you do fit under one or more of these risk factors, it doesn’t mean your going to deal with preterm labor, but it does increase your risk.  Also, there are many women that don’t have any of these risk factors, and experience preterm labor anyway.

There is no sure way to prevent preterm labor, but there are several things that you can do to reduce your chances for it:

• seek regular prenatal care
• eat healthy foods
• manage chronic conditions
• follow doctor’s plan for your physical activity
• stay away from harmful or risky substances
• manage stress
• keep your teeth healthy

Not only will these things reduce your risk for preterm labor, they will also improve your health and your baby’s health throughout the pregnancy, and improve health outcomes for your baby throughout his or her life.

Oh the Possibilities!

I don’t know about you, but whenever I think about giving birth, I picture a hospital room full of medical staff, and a doctor delivering my baby.  It is probably safe to say that this is the idea most people have about giving birth.  While this is the most common way, it is not the only way!  There are several other birthing options that you could consider.  Below the locations and care provider options are listed:

• Hospital-doctor, family practitioner (for low risk pregnancies)
• Home-midwife
• Birthing Center-midwife

Before your baby arrives, it is also helpful to create a birth plan.  This is a one page statement of your preferences for your babies birth.  Such preferences include who you want to be there, preferred positions (walking, standing, squatting, hands and knees, etc.), whether or not you plan to use pain relief, and other details about the birth.  There is a lot more to giving birth than going to the hospital for a few (or more than a few. . .) hours of labor.  There are so many things to consider, and choices to make!

Positive Parenting

The way you interact with your baby has an immense impact on his or her development.  The CDC has recommended a few ‘positive parenting tips‘:

• Talk to your baby. It is soothing to hear your voice.
• When your baby makes sounds, answer him by repeating and adding words. This will help him learn to use language.
• Read to your baby. This helps her develop and understand language and sounds.
• Sing to your baby.
• Play music. This helps your baby develop a love for music and math.
• Praise your baby and give him lots of loving attention.
• Spend time cuddling and holding your baby. This helps her feel cared for and secure.
• The best time to play with your baby is when he’s alert and relaxed. Watch your baby closely for signs of being tired or fussy so that you can take a break.
• Parenting can be hard work! Take care of yourself physically, mentally, and emotionally. It is easier to enjoy your new baby and be a positive, loving parent when you are feeling good yourself.

The role of being a parent is not an easy one, but it is rewarding.  Following these recommendations, and doing everything you can to be a good parent will ensure the best possible outcomes for your child.

Newborn Nutrition

The topic of nutrition for your newborn is probably something you have talked with friends and family members about throughout your pregnancy, and something you have thought about even more.  You have likely asked yourself:  Am I going to breastfeed?  If so, for how long?  What is the best thing for me and my baby?

According the the American Academy of Pediatrics (AAP), breastfeeding is the best option for the baby as long as the mother is healthy, and babies should be breastfed for at least 6 months to get maximum benefits.  The AAP recommends that if possible, breastfeeding mothers breastfeed for 1 year.  The World Health Organization recommends 2 years.  Ultimately, the amount of time you breastfeed will be unique to you and your child, so do what is best for you! If you are planning on breastfeeding, good for you, and good luck!  There are many challenges associated with breastfeeding, but if you can stick with it, both you and your baby will be happier because of it.

There are many reasons why many women cannot breastfeed.  It could be that you will not be able to produce enough milk, you are taking medications that could affect the baby, you have a severe infection that could harm the baby, or various other reasons.  If this is the case, do not feel as though  you are failing as a mother.  You are not!  The fact that you have given birth to a beautiful baby girl or boy is an incredible thing, and you have the ability to provide for  you baby in the best ways available.

Breastfeeding or not breastfeeding, when should your baby start eating normal food?  There is not an exact age that will be accurate for all babies as to when they can start eating solid foods.  The typical and recommended age is about 6 months.

Click here to access a recommended nutrition timeline for your baby.

Click here to access a blank food chart to fill out for your baby. This may be helpful for follow-up doctor’s visits.

There is no set plan for newborn nutrition that will work all across the board, and so it is important to provide for your baby’s needs as they are unique to your baby.  As always, discuss any concerns about your baby’s nutrition with  your doctor as well.

Preterm Delivery Drug

There have recently been some changes in the pricing of a drug that prevents preterm delivery.  This increase could affect you if you are currently pregnant or are planning on becoming pregnant in the future, or at least within the next 7 years.  The popular preterm delivery preventive drug, Makena, has only cost about $10-$20 each for each dose in the past. However, a drug company called KV Pharmaceutical recently gained monopoly on the drug.  Since they are the only company that will be selling the drug, the price for each dose will now be $1,500.  The FDA approved this drug to be sold exclusively through this company for the next 7 years, but has no say in the pricing, which is determined by the company.  It seems all to clear that this company is unfairly raising the price of this drug in order to make money.

Preterm delivery is a significant concern for expecting mothers.  It  is important to know and recognize the signs of preterm labor:

• Contractions every 10 minutes or more often
• Change in vaginal discharge
• Pelvic pressure
• Low, dull backache
• Cramps that feel like your period
• Abdominal cramps with or without diarrhea

Among those who are identified as at risk, receiving a preterm delivery drug can save a baby’s life.  It is estimated that because of the this drug, 10,000 premature births will be prevented each year.  There is no question that this drug holds extreme value in our society, but how much should we be willing to pay?  Should there be restrictions placed on the margin allowed between cost of production and profit for pharmaceutical companies?

Much of the burden of the increased cost is going to fall on insurance companies, and in turn, on us as consumers of health insurance.  There will likely be an increase in copays and premiums.  Some insurance companies, such as Medicaid, will not be able handle the increased burden, and may not be able to pay for the drug for their clients, or will have to enroll less people in their coverage.  We cannot now know the extent to which this increase will affect us as a nation, but there is no doubt that there will be an impact somewhere.

The development of a drug to stop preterm labor has been an incredible breakthrough.  The increase in its price is currently an unpleasant fact.  Thankfully, insurance companies and organizations will continue to offer the drug, and do everything they can to provide coverage for mothers that will need this drug.  The drug is not for every expecting mother, and is also not for every expecting mother at risk for preterm delivery.  The need for this drug is to be determined by your doctor.

More than the Baby Blues?

It is not uncommon for women to experience feelings of sadness and times of tears after their baby is born.  If you have given birth, you may relate to these feelings.  However, sometimes new mothers experience depression that can affect parenting.  The most likely cause for depression after delivery, more commonly known as postpartum depression, is the drastic change in hormones your body experiences.  You have been carrying a baby for the last 9 months, and all of the sudden your body is no longer supporting that baby.  The hormones that supported the pregnancy decrease, and your body tries to adjust these levels.

If you are experiences symptoms of depression after delivery, evaluate the severity and longevity of your symptoms. Seek help if your symptoms are severe and are affecting your ability to be a good mom to your newborn.

Symptoms of Postpartum Depression:

• restlessness, irritability
• sadness, hopelessness
• feeling overwhelmed
• lack of energy/motivation
• eating too  much or not enough
• loss of interest in activities you normally enjoy
• feeling worthless/guilty
• withdrawal from friends and family
• headaches/chest pain/heart palpitations
• trouble focusing and making decisions
• fear of hurting your baby
• no interest in your baby

If you experience these symptoms for 2 weeks or more, and the symptoms are severe, inform your doctor and seek appropriate treatment.

What you can do to prevent and reduce depression symtpoms:

• get enough rest (easier said than done with a new baby)
• decrease stress in other areas of your life.  Ask your husband to help out with the baby and other household chores.  Don’t try to keep up the same pace with everything you did before the pregnancy.
• talk about your feelings with your husband and other family members or close friends
• spend quality time with your husband
• build a support group with other new mothers
• don’t spend a lot of time alone
• don’t make unnecessary life changes (moving, new job, buying a new car, etc.)

There are several things you can do to reduce any symptoms of depression you may be having.  Resources are available to help you learn more about what you are dealing with.  Access helpful resources here.