Cholestasis of Pregnancy Part 2: For the Patient

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In the last post, I discussed the important points regarding Cholestasis of Pregnancy from the research article listed. In this post, I will discuss their findings as it relates to the patient.

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Cholestasis of Pregnancy Part 1: Research Review

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This post will be reviewing an article regarding Intrahepatic Cholestasis of Pregnancy (ICP). It discusses causes, symptoms, labs, complications, and treatment options.

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Hypertension in Pregnancy: Part 2

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In Hypertension in Pregnancy Part 1, I reviewed the ACOG recommendations for the management of hypertension and preeclampsia in pregnancy. In Part 2, I will discuss what this might mean for you, the patient.

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Hypertensive Disorders in Pregnancy Part 1: ACOG Management Recommendations

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Learn about ACOG recommentations  for the diagnosis and management of different types of hypertension in pregnancy.

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Welcome!

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Hello! I’m a nurse midwife practicing in Rockford, IL. I believe that education can help empower women in their healthcare decisions by allowing them to be active participants in their care. Education can also take some of the fear and self doubt out of  decisions, as well as help women understand what choices are available. This blog will focus on women’s health, from pap smears and mammograms to pregnancy and birth. I will be reviewing current research and presenting it in an understandable way.

Healthcare is an ever changing field, and it can be difficult to balance art and tradition with science and technology. Sometimes, the latest technology is immediately adopted as the standard of care without having the evidence to back up its routine use, or leads to the belief that, “if a little is good, more is better” (continuous fetal monitoring in labor for low risk women, for instance). Everyone wants to end a birth with a healthy mom and healthy baby. Sometimes fear of a bad outcome can lead to overzealous testing, or the use of unnecessary interventions (by both mothers, and providers). The unfortunate reality is that no one can guarantee a healthy mom, or a healthy baby, no matter how much we try to intervene. Sometimes, though, people fear technology and interventions and end up throwing the baby out with the bath water. Just like the overuse of technology can lead to unnecessary interventions, so can the dismissal of these interventions as being “bad” lead to poor outcomes that may have been prevented.

Do epidurals sometimes slow down labor or make pushing more difficult, leading to a c-section? Sure. Do they sometimes help a mom relax and help her progress in labor? You bet. Does pitocin sometimes cause contractions that are too strong and lead to a stressed baby and a c-section? Yes, it does. Can a pitocin induction also help a mom with preeclampsia (severely elevated blood pressure and other organ damage in pregnancy) deliver before she or her baby are seriously injured? Absolutely. It is never black and white. The important thing is that whatever decision is made, be it to induce or continue the pregnancy, or to get an epidural or labor naturally, or to breastfeed or bottle feed, that it ultimately comes from the mother, with the guidance of her healthcare provider and her own due diligence.

It is an unfortunate reality that the current birth climate can leave mothers feeling ignored, disrespected, or even traumatized. Women go to their healthcare provider for their education, training, and experience, but also need to build a partnership based on trust. It can be difficult for a patient to navigate a recommendation that might not be her first preference in this climate. For example, a woman being recommended induction when she hoped to go in to labor spontaneously. Is the induction medically necessary? Is it because the doctor has a vacation coming up?

Given the recommendation, the woman should discuss with her provider why induction is recommended (maybe the women has chronic hypertension and diabetes) and the doctor feels that the risks outweigh the benefits. She should find out what other options are available (maybe her diabetes and blood pressure are well controlled and she can do extra outpatient monitoring to make sure the baby is doing well?). She should hear what her provider says, and look on her own. If she finds conflicting information, she should take it back to her provider and ask their thoughts. Maybe the doctor still feels a risk is too great, or maybe she was unaware of the latest research. Doctors and midwives are human, too, and have their own preferences, fears, and comfort levels. From there, the mother can decide if yes, she agrees that induction is the best route for her, or that she’d like to do an alternative, or possibly she feels like the risk is not great enough and she will do nothing. The important thing is that the mother was the one making the informed decision, and that she felt respected and heard through the process.

It is important to remember that ultimately, whatever decisions you make as the patient are your own. No matter how much pressure is applied toward a certain choice by your provider, the ultimate decision is ALWAYS yours. Educate yourself on the risks, benefits, side effects, and other options available. This is a conversation to be had with your provider. However, if you are ever uncomfortable with the chosen plan of care (whether it’s being induced, having a c-section, getting extra ultrasounds to monitor baby’s growth, getting a breast biopsy, etc), it is your RESPONSIBILITY to question and decide if it is right for you. I hope that by reviewing the research that providers use to guide their recommendations, I can help you, as the patient, understand why they might make a recommendation, or to find alternatives that may also be appropriate based on the research. Please keep in mind that this is not individual medical advice and that all decisions should be discussed with your provider.

Students and practicing providers, I hope you are also able to benefit from this, either by learning something new, keeping up to date on research, or passing on your wisdom!

Please feel free to ask questions, make topic suggestions, or just say hello!