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Oops: Pre-Term Labor Drug Does More Harm Than Good To Pregnant Moms

The Federal Drug Administration (FDA) recently issued a new warning about a medication that has been used for years and it has sent shock waves throughout my specialty. Terbutaline is an FDA approved medication that is used for asthmatic patients or patients who have significant narrowing of the airways. However for years it has been used as an “off-label” medication to treat preterm labor but now that’s about to change. An off-label drug means it hasn’t been approved for that specific use by the FDA.

According to the FDA, the injectable form of Terbutaline should only be used for a maximum of 24 to 72 hours because the drugs association with heart problems and death.  The FDA goes on to say that the oral version (pills) should not be prescribed to treat preterm labor because it’s ineffective and can cause similar problems. As an obstetrician, I feel utterly betrayed. The medication clearly had side effects that included shortness of breath and a racing heart. As resident physicians we were taught that the benefit outweighed the risks of having a premature baby and the patients should try to adjust to the medication. Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

Pregnant Women And Exposure To Paint

I came across an article the other day about paint and pregnancy. Yes, that paint — the kind that you put on a canvas or slap on your walls. Did you know that paint is made of pigment particles in a liquid base called a medium? Oil paints are thinned or cleaned with paint thinners. Latex paints are thinned or cleaned with water. Most paint that’s used in the home is latex.

Can environmental forces affected pregnancy? The short answer is “yes,” according to the Organization of Teratology Information Specialists (OTIS), whose mission is to study malformations of the unborn.

Regarding paint and pregnancy, the amount of exposure is important. A one-time household exposure causes fewer problems than ongoing exposure through a work setting. And there have been medical studies documenting babies being born with problems if their mothers abused toluene-containing paint in order to “get high.” Toluene is a paint thinner that can cause low birth weight, premature labor, small head size, and developmental delays. Again, these problems only occur if pregnant women have been exposed to very high levels of toluene — much higher levels than exposure based on a hobby or a professional painter.

According to OTIS, working as a painter doesn’t pose concrete risks to the pregnancy. However, any reduction in chemical exposure is always a good thing. Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

Postpartum Hemorrhage: What Every Pregnant Woman Should Know

Having a baby can be a beautiful thing until something goes wrong. The tragedy is that many high-risk conditions can be managed appropriately if the patient is cooperative and the healthcare provider is competent and well trained. Unfortunately, almost 600 pregnant women die in the U.S. each year from complications and the most common complication is significant blood loss after birth or postpartum hemorrhage (PPH). 

PPH occurs when there is a blood loss of 500 cc or greater for a vaginal delivery and 1,000 cc after a cesarean section (C-section). Or, if you were admitted with a hemoglobin of 12 and it drops by ten points to 11, there should be a high index of suspicion for PPH as well. Therefore, if you feel lightheaded or dizzy, have palpitations or an increased heart rate after delivering a baby, inform the hospital staff immediately.

The most common cause of PPH is uterine atony or lack of contractions after the baby is delivered. Any pregnant condition that stretches the uterus significantly — such as having twins or a higher gestation, excess amniotic fluid (aka polyhydramnios), a prolonged induction of labor (greater than 24 hours) — increases the risk of PPH. Retained products of conception, such as the placenta, also places the patient at risk for developing PPH.

Other risk factors for PPH include:

  • Women with a known placenta previa
  • African-American women
  • Hypertension or preeclampsia
  • Mothers with infants weighing greater than 8.8 pounds (or 4,000 grams)
  • Mothers with greater than seven children
  • Women with a history of hemophilia

If you have any of the risk factors listed above, please be proactive and discuss the possibility of a PPH with your healthcare provider. Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

Sex During Pregnancy Is Safe

The Canadian Medical Association Journal (CMAJ) has published a new primer designed to help physicians when they counsel pregnant women. They note that sex during pregnancy is normal and is generally considered safe. The authors point out that there are very few proven contraindications and risks regarding intercourse in normal pregnancy.

Pregnant women and their partners are often afraid to have sex. Men may think they are “invading” the home of the fetus and could actually harm the baby. In fact, the fetus is quite safe, ensconced in the uterus (womb) and the cervix (opening of the uterus) is closed in normal pregnancy. The penis has no contact with the fetus or the uterus during normal intercourse, no matter what the position.

When is intercourse considered risky? Only for women who are at high risk for preterm labor and for those with placenta previa because there is increased risk for hemorrhage. Even women who have had preterm labor may safely have sex unless they have cervical incompetence or a lower genital tract infection.

Women who are under the care of an obstetrician should know if they have any of these risks. The vast majority of women should be reassured that sex during pregnancy is safe for mom and baby.

*This blog post was originally published at EverythingHealth*

Will Your Hospital’s Maternity Ward Close?

When our country starts closing obstetrical units in hospitals because they “cost too much” money to operate, pregnant women need to pay attention because their babies are in serious trouble. Such was the case of the most recent casualty, South Seminole Hospital, a 200-bed hospital, that’s located within 30 minutes of my neighborhood.

More than 20,000 babies were born in South Seminole Hospital during the past 18 years, and many of the babies were delivered by a local obstetrician who died approximately three years ago. I recall sitting in the emergency room of the hospital with a fractured ankle and listening to a chime that used to ring every time a baby was born. It was a soothing and humbling sound knowing that a new life was making its grand entrance each time that chime rang. Now, it will be replaced with silence.

Unfortunately, this phenomenon is not unique to Florida. In 1997 the closing of a North Philadelphia hospital (Northeastern) affected six additional hospitals in the community and their 23,570 annual births. In my hometown of Brooklyn, New York, Long Island Hospital had an annual delivery rate of 2,800 babies, but still closed its doors to the community and sold the hospital as prime real estate to the highest bidder, citing low reimbursement rates and high premiums for malpractice insurance as the culprit behind the decision. The Bedford Stuyvesant community of Brooklyn lost St. Mary’s Hospital, a delivery center of thousands of babies in 2005. Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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