Massachusetts Medical Society's Physician Focus

February 2012

Healthy Babies

PROGRAM HIGHLIGHTS:

  • Preparation for having a baby – well before you become pregnant – is vitally important to having a healthy baby.

  • Important steps for women to take before having a baby are taking a multi-vitamin with folic acid and keeping up-to-date with vaccinations.

  • If there’s no risk, it’s best to wait until after 39 weeks for delivery, as babies born after that time tend to do better.

  • Post-partum depression is normal and common and can be treated with medication and counseling.

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Having a baby is a wonderful event in a couple’s life, and perhaps the most significant action a woman can take to ensure a healthy baby is to prepare for it – well before becoming pregnant.

“Preparation is key,” says Glenn Markenson, M.D. “Women should make an appointment with their doctor and say I really want to talk to you about pregnancy and what I can do to prepare myself.”

“It is especially important,” says Erin Tracy, M.D., “if the patient has underlying medical problems such as diabetes or high blood pressure, to try to get those issues optimized before becoming pregnant.”

Dr. Markenson, Chief of Maternal Fetal Medicine at Baystate Medical Center in Springfield, and Dr. Tracy, a physician at Massachusetts General Hospital in Boston and Chair of the Massachusetts Section of the American Congress of Obstetrics and Gynecology, provided insights about pregnancy and having a baby as guests on the February edition of Physician Focus with the Massachusetts Medical Society.

The two physicians, both board-certified in obstetrics and gynecology, discussed many of the important aspects of pre-conception, pre-natal care, delivery, and post-natal care with host Lynda Young, M.D., a Worcester pediatrician and 2011-2012 President of the Massachusetts Medical Society.

Having a healthy baby begins before pregnancy, as both doctors stressed the need for taking steps before conception. They strongly recommend taking a multi-vitamin with folic acid (which decreases the incidence of Spina Bifida, a spinal abnormality that is the most common permanently disabling birth defect in the United States), and staying up-to-date on vaccinations against such diseases as measles, mumps, flu, and whooping cough.

“Once you think you’re pregnant,” Dr. Markenson says, “the key is to come in early to see the doctor to see how far along you are in the pregnancy, because everything that’s done from that point depends on the baby’s due date.” At that point, obstetric care includes regular check-ups, examining general health status, weight, blood pressure, and a variety of screenings for any signs of danger or defects. Both doctors stressed the need for an annual flu shot, as pregnant women have a higher risk of getting sick from the flu, and the only protection the baby has is from the mother.

For delivery, the doctors emphasized the importance of timing. While a Caesarean section, or surgical delivery, may be necessary at some times, they say it’s best, if there’s no risk, to wait until after 39 weeks to deliver. “Babies tend to do better after 39 weeks,” says Dr. Tracy.

In post-natal care, the doctors suggest that any preparation the mother – and father – can do ahead of time is a good idea, such as childbirth classes, given at most hospitals, which can be good preparation for the post-partum period.

They also encourage breast feeding (better for both the mother and the baby) and caution about post-partum depression after delivery.

“Patients should know post-partum depression is normal and a common occurrence,” says Dr. Tracy. But, she says, help is available, including medication and counseling. Adds Dr. Markenson: “It’s important to give these signs to the partners as well, because sometimes the patients are so depressed they can’t seek help, but the partners can watch for them.”

And what about the “handoff” to the pediatrician? Dr. Markenson says that while obstetricians try to meet with the pediatrician and discuss what went on during the pregnancy, unfortunately it may not happen sometimes, and patients may have to advocate for themselves.

“We’ll try to guide patients when that happens,” says Dr. Tracy. “Even if they’re not able to share the depth and breadth of their obstetric care, we hope they can target those issues that may be most important.”

Watch the accompanying video for the full discussion, including information on screenings and tests during pregnancy, which conditions should prompt pregnant women to alert their doctors, the risks of induced labor, and the importance of vaccinations to protect newborns.

Text:
MMS/Richard Gulla

ADDITIONAL RESOURCES
American Congress of Obstetricians and Gynecologists

Centers for Disease Control

March of Dimes

KidsHealth

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Healthy Babies PSA


From left: Lynda Young, M.D., Glenn Markenson, M.D., Erin Tracy, M.D.
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