There are a million and one things to think about before arriving at your medical facility to deliver your baby. You may want to think about your La Maze exercises or if all your favorite songs are on your iPod. But, there is one thing you should think about long before you leave your house with contractions.

Clamping

I believe clamping of the umbilical cord is a conversation all pre-parents should have with their OBGYN early on during pregnancy. I speak to my patients about this because the outcomes of the timing are so important. Why? Because clamping of the umbilical cord not only has important implications for the newborn infant… but because both mothers and infants can be affected positively or negatively. That’s why there is an ongoing debate between doctors and midwives regarding the benefits and risks of the appropriate time to cut and clamp the umbilical cord. This argument generally refers to clamping within the first 15 seconds of life or to delay clamping as long as one to three minutes after birth.

Below is a summary of the literature regarding the pros and cons of immediate vs. delayed clamping of the cord.

What are some of the advantages of delaying the clamping of the cord?

1. Reduces the incidence of anemia in the newborn.
2. Hemoglobin concentrations remain elevated for 2 to 4 months after birth.
3. Iron stores are increased for at least 6 months after birth.
4. Fewer infants need blood transfusion.
5. Studies of very low birth weight infants showed some protection against intraventricular hemorrhage (bleeding into a baby’s brain), late onset infections, and prevention of motor disability especially noted in male infants.

Facts:
A delay of even 30 to 45 seconds in cord clamping, especially in preterm infants can provide more blood volume and improve cardiovascular stability. By delaying even 30 seconds, blood volume can increase by 8 to 24% (2–16 ml/kg at cesarean section or 10–28 ml/kg after vaginal birth). In preterm infants , this can be critical in increasing blood pressure, establishing higher hemoglobin levels which can transport more oxygen to the tissues resulting in fewer days on a ventilator, fewer transfusions, lower rates of intraventricular hemorrhage, fewer cases of necrotizing enterocolitis (death of bowel tissue), and fewer cases of bronchopulmonary dysplasia. (chronic lung disease of newborns).

The theory behind this is that immediately after birth, the infant must increase the heart’s output to the lungs dramatically which requires adequate blood volume. If the cord is clamped too soon, not enough volume is present so the body must “borrow” it from other areas of the body such as the brain and the gastrointestinal tract and the lung itself resulting in lower blood flows in these areas with potential damage occurring. This damage can result in increased morbidity, mortality, and developmental delays. By delaying the clamping of the cord, the additional amounts of blood can stabilize blood flow to the brain and these vulnerable tissues, and increase the oxygen supply preventing infections and damage to these organs.

What are some of the disadvantages of delayed clamping of the cord?

1. Polycythemia—hyperviscosity (large increase in packed red cell volume which can result blood clots or possibly stroke.)
2. Higher peak bilirubin concentrations requiring possible treatment with phototherapy.
3. Increased risk of maternal blood loss while waiting for clamping of the cord.
4. Possible delay in resuscitation of the infant if needed (less than 10% of infants need resuscitation) causing respiratory distress.

Facts:
Studies have shown that although babies can have more packed blood volume from the delay in clamping of the cord, no adverse consequences have resulted from this. In addition, none of the infants studied had any increased risks of respiratory distress, or increased need for intensive care or length of hospital stay. Some infants had an increase in serum bilirubin causing jaundice requiring phototherapy at birth. There was no increased risk of maternal bleeding by delaying the clamping of the cord.

How is blood volume in the infant changed by the delay and position of the newborn after birth?

The total fetoplacental blood volume is about 120 ml/kg of fetal weight. The distribution of blood between the fetus and the placenta is 2 to 1 which remains the same if the cord is clamped immediately. Delayed cord clamping can result in an extra 20 to 40 ml of blood per kilogram of body weight to the fetus which is also an extra 30 to 35 mg of iron. By delaying 3 minutes, these higher infant blood volumes are obtained, especially if the infant is held about 10 cm below the level of the placenta. By holding the infant even lower, at about 40 cm, the placenta hastens blood transfusion to the infant to within one minute. Without lowering the infant, placental transfer of blood may fail to occur.

Summary:
Full term infants
Delayed clamping in the cord of full term infants is safe. Waiting for at least a minute, but preferably 3 minutes, before clamping the umbilical cord reduced the risk of neonatal anemia without incurring any major side effects in the newborn or the mother. Positioning of the baby should be on the mothers abdomen or lower. In poorer countries, where fetal anemia is common and often associated with higher mortality with impaired mental and motor development, delay in clamping of the cord can serve as a simple and very effective means of improving infant survival.

Oxytocin can still be administered after delivery to reduce maternal blood loss while waiting the three minutes for cord clamping. Use of oxytocin can also enhance placentofetal transfusion.

Premature infants
For premature infants , even a delay of 60 seconds with the infant lowered, can be critically important. Studies found no impact on risk of polycythemia, respiratory distress in the newborn, serum concentration of bilirubin, need for intensive care, length of hospital stay, or infants weight when clamping was delayed. Clamping the cord too soon can result in decreased blood volume in premature infants which can result in poor blood flow with reduction of oxygen delivery to parts of the premature brain resulting in enhanced possibility of motor damage and developmental delays. Also, the risks of postpartum hemorrhage (blood loss of 500 cc) was no different from delayed vs immediate cord clamping.

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Beware of False Claims About Stretch Marks Creams

Beauté de Maman Stretch Mark Cream for pregnancy actually prevents the unsightly scars that many women get during pregnancy.

If you have ever gazed into the mirror after a pregnancy, only to see unsightly stretch marks covering your lower belly, breasts or thighs, you are not alone. Sadly, once women have stretch marks, it’s too late to do much about them because these types of skin imperfections can not be erased. They can only be prevented.

However, if you are pregnant now, or planning to become pregnant for the first time or again, you may want to read this article carefully.

The key to minimizing stretch marks before they occur requires knowledge of how your skin functions and knowing the truth about prevention.

1. What Causes Stretch Marks?

   Stretch marks are caused by the breakage of skin proteins during the rapid expansion of the skin during pregnancy. Stretch marks can appear on the abdomen, hips, breast, thighs, and underarms. No matter what a product boasts, once formed, stretch marks are permanent. Various skin creams have been developed to try to reduce the appearance of stretch marks once formed. However, prevention should be the main goal because most remedies intended to diminish the appearance of stretch marks do not work.

2. What are the Important Qualities of a Good Stretch Mark Cream?

   Remedies intended to prevent stretch marks mostly hydrate and moisturize the skin, thus allowing the existing skin proteins to stretch and not tear. However, a better approach is to increase the skin collagen and elastin production giving much more distensibility to the skin.

3. Is Adding Collagen to the Ingredients Sufficient?

   Beware of false claims! Certain products do contain collagen in their ingredient list—but this is not sufficient. It is well known that the skin has to manufacture its own collagen and elastin for any product to go to work preventing stretch marks.

4. What Ingredients Should I Avoid when Choosing a Stretch Mark Cream?

   Here are several ingredients COMMONLY found in many of the popular brands that should be avoided in pregnancy.

   • PARABENS: This includes methylparaben and propylparaben.
   • RETINOL: Vitamin A has in large doses has been associated with an increased risk of congenital anomalies. In addition, retin A type products can be very irritating and cause rapid cell turnover so special precautions need to be taken with regard to the sun.
   • SODIUM LAURYL SULFATES AND SODIUM LAURETH SULFATE: Can cause dermatitis., also a skin and eye irritant.
   • PHTHALATES: Studies have shown that this interferes with the development of the male testes in animals.

5. What Ingredients are Responsible for Hydration and Moisturization?

   The shea butter and various oils are responsible for the moisture and hydration. Unfortunately, most of the stretch mark creams for pregnancy ONLY have these ingredients and this is not sufficient to prevent stretch marks. The oils tend to make the product extremely greasy. Oils are nonabsorbent by the skin since water is a major component of skin cells. The oils tend to sit on the surface layers and stain clothing, especially in a large pregnant belly. In addition, keep an eye on the price. Such products are commonly very expensive for these relatively inexpensive, moisturizing ingredients.

6. What Other Ingredients Should I be Concerned About?

   Alpha-hydroxy acid (AHA) is an ingredient commonly used in many creams. The purpose of this ingredient is to remove old skin and regenerate new skin—basically a mini-peel. This can be very irritating to many women. One also must be very careful about being in the sun as sunburn can occur much more readily with this ingredient on the skin. AHA treatments are now undergoing scrutiny. There is a question of the effects of long term home usage of chemical peels with regard to potential negative effects on the skin.

7. What Makes Beauté de Maman Products Superior to Other Brands on the Market?

   • Our Beauté de Maman product line does not exfoliate skin.
   • Beauté de Maman does not use acids to peel away skin.
   • In addition to our ultra moisturizing and skin softening ingredients,  we have included natural and herbal ingredients proven to help the skin manufacture collagen and elastin (Psium sativum, Bambusa vulgaris, Gardenia Tahitensis, and glucosamine HCL)
   • It is NOT a messy oil. Beauté de Maman stretch mark product is an absorbent cream that does NOT stain clothes.
   • Beauté de Maman has no odor.
   • Beauté de Maman is obstetrician created specifically for pregnant women.
   • Beauté de Maman has been pre-tested on hundreds of pregnant women and is safe for both mother and baby.

Finally, it is very important to me that Beauté de Maman remain affordable for ALL pregnant women. While our packaging is very pretty and feminine, our philosophy is to invest on the inside… bringing you safe and effective ingredients to keep your skin glowing and beautiful though out your pregnancy… and beyond!

Best regards,

Dr. Michele Brown, OBGYN

As you know, airbags can save lives in car crashes, but many of my pregnant patients are very concerned about the risks involved to their unborn child if an airbag is deployed in an accident. Their concerns are warranted in that motor vehicle accidents present a greater risk to a fetus than to infants, or children. Why? Because while a child is vulnerable, that same child is physically independent from the mother. The fetus, on the other hand, relies on the placental connection for blood circulation which in turn provides all nourishment and oxygen necessary for survival in the womb. Any interruption or impairment of that connection places the fetus at high risk. While the uterine environment provides some protection to the fetus, we must remember that the fetus is living and totally dependent.

Beauté de Maman Pregnancy Skin Care Combo Pack

Unfortunately, motor vehicle accidents (MVA) are the leading cause of fetal trauma in pregnant women, often resulting in fetal and maternal death. Approximately 2.8% of all pregnant women are involved in a motor vehicle accident, with the youngest age groups most affected. Reports of MVAs in pregnancy carries the risks of placental abruption (most common), low birth weight, prematurity resulting from premature labor, premature rupture of the membranes with loss of amniotic fluid and fetal death resulting from the direct trauma. Additionally, poor developmental outcomes, later in the child’s life, may be linked to the original trauma from a MVA.

One of our previous blogs discussed the use of seat belts and the evidence that suggests that seat belt use in pregnancy adds substantial protection to both fetus and mom. The American College of Obstetrics and Gynecology confirms improved safety of pregnant women wearing properly positioned seat belts. This newsletter will discuss the use of airbags, because knowing the optimal way to protect a pregnant woman in a car crash is of paramount importance.

Airbags and the ten inch rule.

Airbags have now become standard in all automobiles and have been reported to reduce death in non-pregnant motorists. However, the effect of airbags on those positioned too close to the airbag, such as children younger than twelve years of age, infants with rear facing car seats, the elderly, and short women can result in increased injuries and death. To avoid airbag injury, the National Highway and Traffic Safety Association recommends a minimum of a 10 inch distance from the center point of the airbag cover, (the plastic piece facing the driver) which is located either in the steering wheel or the dashboard, depending on the car model.

The safety and efficacy of airbags for pregnant women has not been clearly demonstrated. Since the gravid abdomen can be the leading point of contact from an airbag, especially in the second half of pregnancy, concerns about placental abruption, uterine rupture and direct fetal injury have been raised. It is extremely difficult to comply with the 10 inch safety distance from the airbag to the gravid abdomen, especially in the third trimester of pregnancy. However, it is still felt by the NHTSA that the use of airbags far outweigh the risks.

A recent study by Dr. Melissa Schiff in the January, 2010 article in Obstetrics and Gynecology, found no increased risk of maternal or fetal outcomes in front seat motorists involved in car collisions in which airbags were deployed. However, several other reports have demonstrated the reverse. Dr. Fusco, in the Journal of Trauma 2001, described a case of uterine rupture and fetal demise in a motor vehicle accident, possibly secondary to airbag deployment. Other reports (Schultze, 1998, Pearlman, 1996) described a case of placental abruption with fetal death associated with airbag deployment in a head-on crash. It is difficult to ascertain whether the impact of the collision or the airbag deployment is the cause of the uterine rupture or abruption. We must recall that there is a trade-off. Airbags may protect the mother from serious injury upon any impact with the dashboard or steering wheel.

Why is natural protection not enough protection?

Protection of the fetus from injury relies primarily on the cushioning effect of the amniotic fluid, the thick uterine musculature and the bony supporting structure of the pelvis. However, in a MVA, the placenta does not have the resilience to expand, contract and rapidly change shape with the traumatized rapidly shape-changing uterus, which explains why a shearing effect abruption occurs with rapid acceleration and deceleration forces. Obviously, crash severity affects the generation of fetal injury, but even relatively minor accidents, with speeds as low as 5 miles per hour can be associated with severe fetal trauma when the airbag is deployed at the standard expansion rate of 125 miles per hour.

Seat belts are still the first line of defense.

While further research needs to be done to support a definitive statement on the safety of airbags for the pregnant woman and the fetus, the best advice for now is to keep your belly at least 10 inches from the airbag cover, if possible. It is known, however, that shoulder and lap restraints prevent ejection from the car and forward movement of the mother in a front or rear-end collision, and therefore decrease maternal mortality and protect the fetus.

Make sure your seat belt is fastened. Unfortunately, there still exists a substantial group of pregnant women who do not wear seat belts, and when worn, do not wear them properly. Make sure your seat belt is positioned correctly. Seat belts decrease force transmission to the gravid uterus, but airbag deployment might contribute towards increasing force transmission to an anterior placenta resulting in an abruption, uterine rupture, brain hemorrhage, and skull fractures with consequent fetal demise. Another possibility includes the sheer impact of the collision causing these complications. Generally a protocol of monitoring a pregnant patient for at least 4 to 6 hours after a MVA has been adopted by most medical centers to detect whether traumatic injury to the fetus has occurred, as signs can be very subtle.

Summary

More research needs to be done that takes into account the gestational age of the fetus, the force of the collision, location of the placenta, and whether a seat belt was used in conjunction with the airbag. A definitive statement will have to await the outcome of such a  future study. I sincerely hope that my readers will be educated by this article and exercise caution, particularly in the second half of pregnancy. In other words, buckle up, remember the ten inch rule and please DRIVE CAREFULLY!

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Here is an update on an airbag study and pregnant women.

http://video.foxnews.com/v/3996144/car-safety-for-pregnant-women

Baby, it’s cold outside but perhaps you are lucky enough to have a nice trip planned to someplace warm and romantic. If so, and you are  pregnant or traveling with a newborn and/or breast feeding baby, please take the time to read this warning about insecticides.

Pregnancy and Insecticide

Exposure to insect repellents has always been a source of concern with regard to adverse outcomes to the infant because they contain the chemicals DEET (N,N-diethyl-m-toluamide) or permethrin which can cross the placenta and are considered toxic in high doses. Generally 6 to 8 % of the repellent is absorbed when applied topically to the skin.

Studies in the past have shown that exposure of DEET to the skin of rats has caused developmental problems, low birth weight, and even death of the rat embryo. Exposure to DEET in chick embryos has caused cardiovascular malformations. Topical use of DEET by children has documented reports of toxic encephalopathy and anaphylactic reactions. Other previous studies in humans have shown minimal or no health risks or adverse pregnancy outcomes in the neurological, gastrointestinal, or dermatological systems with exposure to DEET.

Permethrin is another insecticide. It is sold as a 5% cream and is commonly used in the treatment of scabies during pregnancy. Similar controversies exist from reports of no reproductive effects to feminization of male rats.

A new study published in Occupational and Environmental Medicine by Nieuwenhuijsen in December 2009 reviewed 471 cases of hypospadias born to women in South East of England between January 1997 and September 1998. There was a significant association between the incidence of hypospadias and the use of insect repellents during the first trimester of pregnancy. In addition there was an association between multiple pesticide use and hypospadias.

Hypospadias is a common birth defect where the opening of the urethra (meatus) is on the underside of the penis. The incidence of hypospadias has increased with reported occurrences varying between 1 in 500 in the 1970’s to 1 in 250 in the 1990’s. The opening can be located in various places from the under-surface near the tip of the penis to to the base of the penis, or even behind the scrotum (more severe cases). Some cases can be genetic, some due to surgical injury, but some can also be environmentally associated. It can also be associated with other congenital anomalies. Children can have abnormal spraying of the urine, malformed foreskin, and often have to sit down to urinate. All male infants should be carefully examined by their pediatricians after birth for this condition since these infants should NOT be circumcised. The foreskin is commonly used for surgical repair.

In summary, a common congenital anomaly, hypospadias has been associated with insect repellents. Further studies are needed to delineate the type, and the mechanisms of action of pesticides in causing this problem. Because of the controversy regarding toxicity, recommendations have been to apply the smallest amount of insecticide on protective clothing rather than directly to the skin. It is also advisable that better protection from biting insects through use of long sleeved shirts and leg coverings be used. All male children should be carefully examined for this condition at birth.

Newborn, breastfeeding babies and insecticide

Researchers are still trying to connect the dots between disease, breathing problems and pesticides, but there is no reason to take any chances. Here are few alternative ideas to insecticide usage that both parents could follow when in an area prone to biting insects.

1. Avoid taking yourself and your baby outdoors at dusk or dawn.
2. Do not use scented soaps for bathing yourself or your baby, as they attract mosquitoes easily.
3. When going outside dress yourself and your baby in lose and light colored clothing, and preferably full sleeved tops and pants.

If you must use a repellent with insecticide:

1. Never spray insect repellent in an enclosed area. This might cause breathing difficulties for your baby.
2. Never spray the repellent directly on the baby’s face. Instead, first spray the repellent on your hands and then apply to your baby’s face and exposed skin.
3. Before trying any insect repellent for babies, apply a small patch on the baby’s arm to check if the baby’s skin is sensitive to it or not.
4. Do not use insect repellent near the baby’s eyes, mouth and avoid applying the insect repellent on cuts.
5. Avoid, using insect repellent on the baby’s hands as most babies have the habit of putting their hands into their mouth.
6. Avoid applying the insect repellent on the baby’s skin more than once a day.
7. Once you and your baby are back inside the house, wash off the insect repellent immediately with unscented soap and water.
8. Never use insecticide on your breast or chest if you are breast feeding.

You can purchase out nipple gel at drugstore.com

Best regards,

Dr. Michele Brown,

OBGYN and Founder of Beauté de Maman