OB/GYN Corner

Questions are answered by John R Mantione M.D. Chairman, PinnacleHealth Obstetrics and Gynecology.

C-section or V-BAC?
Question:  I  am on my second pregnancy, and I am unsure if I should have a c-section or a V-BAC. I had a c-section with my son, but had a previous scar they used from a kidney surgery performed from when I was an infant. About  3 months before this pregnancy, I had a tubal pregnancy and had my right tube removed through a laparoscopic procedure. The doctor that performed it said if I have anymore children, I have to have a C-section. The doctor I currently have says that I can try a V-BAC if I want. I don't know what I should do. want to try a vaginal birth, but I'm a little worried ... not sure what to do. can you offer any advice?

Answer: The safety of V-BAC is well established given the right circumstances. In your case the important thing to consider is the procedure that was done to treat ectopic pregnancy. A review of the operative report and procedure performed would be necessary to see if it is acceptable to V-BAC, not acceptable to V-BAC, or an unknown risk. Using all the information you and your physician can make an informed decision on the safety of V-BAC for you and your child.

Yest Infection Related to Birth Control?
Question: I recently started taking a birth control pill called Tri-Sprintec. I started it the sunday after my period started like the directions stated, but a few days later I  started experiencing vaginal soreness, itching, and discomfort. Could this possibly be a vaginal yeast infection?

Answer:
Vaginal itching and soreness has many different causes and can not be accurately diagnosed with this information alone. In your doctor's office these symptoms would need to be evaluated by exam and a microscopic exam of the vaginal secretions. It would be best to make an appointment with your physician.

C-Section
Question:  I am due to have my second baby soon but I will be having another c-section. I'm just curious as to when I would probably be scheduled and if there is a certain day that the hospital does scheduled c-sections?

Answer:
As a hospital we suggest 39 weeks as an appropriate time to schedule elective c-Sections. Our elective cesarean sections are scheduled Mon- Fri. There are 4 time slots each weekday. and of course if labor happens prior to that scheduled time a c-section is then performed with the onset of labor

Breech Deliveries
Question:  Do doctors at PinnacleHealth deliver breech babies?

Answer:  Breech deliveries are done at Harrisburg Hospital in select circumstances. This would have to be discussed with your physician as to whether you would be an appropriate candidate.

Learn more about why some women are more prone to breech births:click here

Cord Blood Banking
Question:  I have been researching Public Cord Blood Banking in preparation for my upcoming delivery. I was curious if your hospital will collect the cord for donation?

Answer:  Yes, PinnacleHealth certainly does cord banking. You should discuss with your physician your intent to save cord blood.

Sex After Birth
Question:  My daughter is three weeks in a half now and I wanted to know is it ok to have sex since I waited for three weeks?

Answer:  If the  delivery was uneventful (did not have a vaginal tear ) it would be ok . You should check with your healthcare provider to address specifics concerning your delivery. Otherwise wait until after your six week check up.

Paternity Testing
Question: A friend of mine is pregnant and needs some advice on paternity. The first day of her last period was January 1st. Her menstrual cycles have always been highly irregular, likely due to poly-cystic ovary syndrome. She had protected sex with one  partner on January 14, though there was a little bit of spillage. After that date she had  unprotected sex with her significant other, who has varicocele, which he has never had testing on. The original date of conception, judged from the urine test and the assumed date of her period was given as January 14th and the ultrasound gave January 25th. My friend is concerned that the baby might not be her significant others. What is the likelihood that the child is with her significant other?  What would cause a doctor to feel comfortable performing an amniocentesis and a paternity test?

Answer: Paternity testing is now available through serum (blood) testing the company providing this service is Ravgen the patient can contact the company through the internet. I would not be comfortable with an exact date of conception if the contacts were within a week of each other. At least one contact will probably have to provide genetic material for confirmation.

Endometriosis
Question:  Is Endometriosis hereditary?

Answer: Women with a family history (first degree relative) of endometriosis have a 10 times the  risk of having it.

Getting Pregnant & Norplant Concerns
Question: I use to have a Norplantimplant ...  it was put in when I was 13 but it was removed when I was 18. I am now 28 and I cannot seem to get pregnant.  Could it still be affecting me even though it was removed over ten years ago? What could it be?  Please help, I desperately want to have a baby with my husband.

Answer: The Norplant was a progestin only form of contraception that was removed from the market several years ago. Ten years later even if  it was not removed it would have no active progestin. In this case, are your cycles regular?  Has your husband been  checked?' These are questions that need to be reviewed with your gynecologist.

Missed Period: Stress or Pregnancy?
Question: I didn't have my period in October, but had it in November.  I am a very regular person never late never missed a period until now. It is late December and no period yet. I took a pregnancy test (Negative). I have been through some stress ... could there be a possibility I could be pregnant and not know it ... or is it just stress? What do you suggest? I have been pregnant before but my period had stopped completely and a home pregnancy test came out Positive

Answer: I would repeat the urine test if it is still negative than your are not pregnant. If your period still does not come the next week or two contact you GYN or family physician for a further work up. Extreme stress can cause you to miss your period.

Vaginal Birth After C-Section (VBAC) 

Question: Do any of the doctors do VBACs at the hospital in Harrisburg?

Answer:  A significant number of practices that deliver at PinnacleHealth still offer VBAC if certain criteria are met. You should discuss this with your physician very early in the pregnancy to determine if you are a VBAC candidate.

Question: I had a c-section 3 months ago with my first baby.  I am planning on getting pregnant in January.  How successful do you think a VBAC would be?

Answer: Multiple factors influence the chance of a successful VBAC including the reason for the first c-section. In general the success rate is 70 %. There are risks involved. These need to be discussed with your Obstetrician pertaining to the specifics of your first labor.

Human Papilloma Virus (HPV) 
Question:  Can a child be born with HPV?

Answer: A child can be born with HPV although it is much less likely than previously thought.

Question:  I just recently went to my OBGYN and he told me that I have HPV. He told me that you get it from sex. but what I don't understand is both me and my boyfriend were virgins. How do I have HPV and a precancerous lesion from him if he's never had sex with another girl nor me with another boy. help?!

Answer: Human Papilloma Virus (HPV) is usually spread from skin to skin contact. It is not necessary to have intercourse to  spread the virus. There have been reports of the virus being spread by non-skin contact. This is is much less likely. Sexual acts such as oral or anal sex can spread the virus. Also touching an infected individual can also spread the virus.

Pregnancy and Heart Rate
Question:  While pregnant, is normal for your heart to beat fast? I feel weak when it happens. Like I'm about to pass out.

Answer:Palpitations or irregular heart beats are not uncommon in pregnancy. If the patient becomes symptomatic, i.e short of breath or lightheaded, they should be evaluated by a physician.

Am I Pregnant?
Question: If I were pregnant, it'd be my third child. With the following information do you think that could I be pregnant again: I haven't been on birth control for about two months, we had a big oops about one month ago, I had a regular period right on schedule at the beginning of this month, I have had  bloating and cramps like I'm on my period but I'm not, I've had more discharge and urination, I've had more  headaches and some sweats and chills like I have a fever but I'm do not, my husband's noted my "bigger breasts"and they're tender around the nipples, and I'm extremely tired! ... nevertheless I had that regular period, can I still be pregnant?

Answer: The simplest way to resolve this is to check a urine home pregnancy test. They  are quite sensitive and inexpensive. If negative and still no menses after 35 days contact your physician for further testing.

Breast Enhancement
Question:  I am currently thinking about getting breast implants because I am unhappy with my breast size. But considering all the risks and costs with that type surgery, I wanted to know if there was anything "naturally" that I could do to enlarge my breast size?

Answer:There are no proven natural preparations to increase breast size. Most of the advertised products are useless. I would recommend a consult with a reputable plastic surgeon to discuss your concerns

Sleeping Positions During Pregnancy 
Question: I have recently found out I am pregnant. I haven't been able to find out when I'm  due yet but am afraid of how to sleep just in case anything could happen. Is there any position in which you can not sleep?

Answer: Early in pregnancy position is not as important. Later in pregnancy  (20-25 weeks) the maternal left side is preferred as it optimizes blood flow to the baby.In most cases it is not an issue.
In certain high risk pregnancies position becomes more of an issue. For example, if the baby is
growth restricted or there are problems with blood pressure. These individual concerns should be addressed with each patient's provider. In general maternal left is best followed by the right side.

Caffeine During Pregnancy 
Question: I just saw the latest news again about caffeine consumption and miscarriage. I also just found out that I am pregnant (10 weeks) and I have been drinking caffeine just about every day, usually a cup of coffee in the morning. I was told this was ok, but now I am not sure. Is any amount safe or is just better not to consume it at all?

Answer: Generally speaking one cup of coffee or other caffeinated beverage a day is considered safe. The recent study showed an increased risk of miscarriage with caffeine intake. If the patient is concerned she should avoid caffeine for the first trimester. Based on one study the recommendations have not changed and limited intake is ok.

Blood in Urine
Question: Recently my girlfriend, who is five months pregnant, has been having a sufficient amount of blood in her urine.  The doctor made her take a urine sample and they came up with no reason why, but they said she could have a kidney stone. If that’s the problem, will the child in her belly be fine?

Answer: Blood in the urine can mean many things. Infection and/or a kidney stone are probably the most likely causes. Certainly a further workup is required if this reoccurs. Most kidney stones have little effect on the baby. Again, she would need further testing for this problem if it has not resolved completely.

When to call the doctor?
Question  I am in my last trimester of my pregnancy. I have not been feeling well lately … crampy, swelling and diarrhea. I am worried my unborn child is in danger because of these symptoms, but I don’t want to overreact; what should I do?

Answer: You should contact your physician immediately. It is always better to err on the side of caution. Do not take the advice from the Internet or outside resource instead of your physician. Follow your instinct and don’t be afraid to call your doctor with questions or concerns any time of day or night … that is why they are there. If there is a problem you will get prompt attention and if there isn't you will be reassured.

Hysterectomy Choices and Recovery
Question: After having three children, I have decided to have a hysterectomy, but have heard this is major surgery so I am a little reluctant. Can you provide me feedback on this surgery? Are there minimally invasive options available and what is the recovery time?

Answer: Multiple options are available concerning a hysterectomy .  Depending on the indications certain options including minimally invasive surgery  would be available. The specifics need to be discussed with your physician. Recovery time could vary from three to six weeks depending on the type of surgery.

Abnormal Vaginal Bleeding
Question: I have been having vaginal bleeding after sexual intercourse. What could be causing this and should I be concerned? And if so, what might my physician do to diagnose a problem?

Answer: There are multiple possibilities that could cause post coital (after intercourse) bleeding.  Structural causes (polyps, fibroids) or infection are possibilities.  A complete GYN exam is necessary.  Further testing may be required by your physician.

Contraceptive Options
Question: I've heard about a new oral contraceptive called Lybrel. What is it and how does it work?

Answer: Lybrel is a continuous birth control pill with no week off (28 days).  The theoretical benefit would be no menses or a decrease in the number of periods per year.  The main side effect would be break through bleeding.

Foods and Pregnancy
Question: I recently found out I'm pregnant with my first child. I've heard that some foods (some seafood or lunchmeat) and beverages (diet soda) are off limits. What's the truth?

Answer: The main concern with eating fish is mercury levels.  Mercury impairs development of the nervous system.  Certain fish are higher in mercury than others.  Such as Shark, Sword fish, Mackerel and Tilefish.  Other fish such as salmon or white/light tuna are considered safer.  In general one to two servings of fish/shrimp per week should be OK.

The concern with lunch meat is listeria.  This bacteria could cause flu like symptoms in the mother and could lead to premature delivery or still birth in the fetus.  If the meat is reheated/micro waved until steaming it is considered safe.  Also avoid soft cheese and unpasteurized milk (which kills the bacteria) and also do not let food sit out and practice safe food handling.

Diet soda in moderation one to two servings per day with artificial sweeteners is generally considered to be safe.

Postpartum depression
Question: I have a two-week-old newborn, who I adore. But all I seem to do is sleep, nurse and change diapers. My husband has returned to work, my friends all work full-time and I haven't been out of the house since we came home from the hospital. I'm worried that I may be getting depressed. Do you have any suggestions?

Answer: Post partum depression generally begins within the first four to six weeks after childbirth.  About 15 percent of women suffer from post partum depression.  I would recommend seeking help by speaking to your obstetrician and asking about treatment options that can dramatically improve the depression.  Also a delay in treatment will obviously prolong the duration of the illness. 

When to get pregnant again
Question: I have a 3-month old baby and my husband and I would like her to have a sibling relatively close in age. We would like to start trying again soon. Are there any risks for me or the fetus if I get pregnant again soon or is it better to wait a few more months?

Answer: Most OB/GYNs would agree a 12-18 month interval is ideal; depending on complicating factors such as previous pregnancies. Also it would depend on your past medical history (diabetes or hypertension). It is important to discuss all particulars with your physician. A very short interval is associated with higher risks to the mother and baby.
 
Birth Plans
Question: I am having my first child this summer and am trying to prepare myself (as much as I can).  Is a birth plan a good idea, and if so, what key factors should I consider when creating one?
 
Answer: A birth plan is a good idea as long as it is realistic. It should be formulated after you have taken childbirth classes or at least done extensive reading or self educating on the subject.  I would advise against simply copying a birth plan off of the Internet. Also after a plan is formulated it should be reviewed with you health care provider prior to labor. Factors should be individualized as to your particular needs or desires.

Pediatrician Corner

Questions are answered by B.K. Varma, MD, PinnacleHealth Pediatric Services or Joel Rose, Pediatrician, PinnacleHealth FamilyCare, West Hanover.   

Kidney Issues
Question:  Can a child who is born with just 1 Kidney lhave a normal life?

Answer: Yes, a child born with just 1 kidney could lead a normal life. There needs to be a determination of why there is just 1 kidney and many times there is no clear answer. In additon, the child needs to be evaluated regularly to keep an eye on the 1 remaining kidney. Certain sports and activities that may cause kidney damage (usually collision sports-football,lacrosse, etc. ) should not be played due to the risk of injury of the remaining functioning kidney

Newborn Screening Tests
Question: Does a newborn screening test include HCU (Homocystinuria)?
 
Answer: HCU is included in our comprehensive Newborn screening program within the amino acid profile.

Vaccines
Question :I am due in a few days and I was told they will need to give my child a Hepatitis B vaccine. I am going to request they do not do that. My question is can I also request not to be given the Vitamin K vaccine?

Answer:
Vitamin K injections are given routinely to all newborns in the US. Vitamin K is essential in blood clotting mechanisms. A percentage of babies may be born with low vitamin K levels which may lead to spontaneous bleeds in the babies brain.These bleeds can lead to permanent neurological damage or even death. A controversy over whether Vitamin K can be carcinogenic has been disproven in multiple studies. The potential benefits of administering Vita. K to infants far outweighs any potential risks.

Premature Babies and Aspiration Prevention
Question: I have a great-niece that was born at 32 weeks and had had a feeding tube in place for her feedings.  The tube has been removed but now she is having difficulty with aspiration. Is there any relationship between removal of the feeding tube and this new problem with aspiration?  What recommendations do you have for the further prevention of aspiration?

Answer: Premature babies are often initially fed by a tube running from their nose to their stomach called  a naso-gastric because they are often to ill to feed are they are unable to coordinate their swallowing mechanisms. I suspect your great niece may still be having some swallowing difficulties which are leading to her aspiration now that the nasal-gastric tube has been removed. Aspiration results when the formula goes down the airway toward the lungs instead of the normal pathway down the swallowing tube to the stomach.  Hopefully with time the babies' swallowing mechanisms will mature and the problem will resolve  spontaneously. There are feeding specialists that can help coordinate the swallowing mechanism.The babies mother should consult with the Neonatologist taking care of her for further recommendations in terms of further testing to define the underlying cause of the aspiration and management recommendations. 

Picking A Pediatrician
Question: I'm a first-time mom who is new to the area. What should I look for in a pediatrician?

Answer: Here are a few suggestions to guide your choice:

• Check if he or she is board certified or board eligible
• Board certified doctors have extra training after medical school to become specialists in a field of medicine such as pediatrics
• Detailed physician profiles, complete with medical education and board certification information, are available through PinnacleHealth's online physician finder service
• Seek the recommendation of your own family physician
• Contact your local hospital Department of Pediatrics office for recommendations
• PinnacleHealth's Department of Pediatrics is available by calling (717) 231-8494

Infant Sleep Positioning
Question: I know that research shows that babies should sleep on their backs to reduce the risk of SIDS. However, my friend's child has a noticeable flat spot on the back of his head from sleeping on his back. Her mom says she should have been letting the baby sleep for naps on their side or belly to prevent this. Is this true? How can I prevent my newborn from getting a flat spot on her head?

Answer: The Academy of Pediatrics and National Institute of Child Health and Development do not recommend that a child who sleeps on their back should be sleeping for naps on their side or belly to prevent flat spots on the back of their head. It increase the chance of SIDS by seven to eight percent. Consistency is important.

To prevent flat spot on back of head, the baby may be provided "tummy time" when the baby is awake and under observation.  Avoid too much time in car seats, carriers and bouncers.

Infants and Sleeping through the Night
Question: My baby is 12 weeks old and still wakes up 2-3 times during the night. Is there something wrong? What can I do to help my baby sleep better through the night?

Answer: Your 12 week old has a normal sleep pattern.  There is nothing wrong.

According to the American Academy of Pediatrics, babies do not have regular sleep cycles until about six months of age. While newborns sleep about 16 to 17 hours per day, they may only sleep one or two hours at a time. As babies get older, they need less sleep. Although, different babies have different sleep needs. It is normal for a six-month-old to wake up during the night and go back to sleep after a few minutes.

Here are some suggestions that may help your baby sleep better at night:

• Try not to stimulate your baby much during the middle of the night. Keep her calm and quiet when you need to feed or change her.
• Make daytime more active. Talking and playing with your baby during the day will help lengthen his awake times leading to longer sleep periods during the night.
• Put your baby to bed when drowsy but still awake. This will help her learn to fall asleep on her own. Rocking her until she is completely asleep may make it hard for her to go back to sleep if she wakes up during the night.
• Wait a few minutes before responding to your baby’s fussing. See if he can fall back to sleep on his own. But if he continues to cry, check on him but don't turn on the light or pick him up. If he cries frantically or cannot settle himself, consider what else might be bothering him. Is he hungry, in need of a diaper change, feverish, or otherwise not feeling well?

Lead Exposure
Question: My 3-year old had some of the toys that were recalled due to lead. How dangerous could her exposure to lead have been and what can I do now to see if she was endangered and reduce any potential harm that was done?

Answer: The best way to determine your child’s risk is to get a simple blood lead test.  This can be ordered by your physician or at your nearest pediatric clinic.  Your doctor will advise you regarding the significance of the blood lead level.

You may also be able to take advantage of periodic, free lead screening provided by the PinnacleHealth Children’s Lead Poisoning Prevention Program in their new Lead Mobile. The mobile lead screening unit is designed to provide blood lead screening for children and at-risk pregnant women across the state.  For more information call 1-800-374-7114.


Please note: Questions sent to our physician experts will be reviewed weekly. Responses will be posted on MyLaborDay.com, and not sent to the individual requester. Advice provided through MyLaborDay.com does not replace the advice of your primary healthcare provider. Please be sure to check with your provider before accepting any advice over the Internet. If you are having an emergency, call your doctor and/or 911 immediately. Do not wait for a response from the physician expert before seeking emergency assistance.