(Miranda Hernandez)

Disclaimer: please understand I am not a physician or medical practitioner of any kind. Information contained herein is a summary or direct quotation of information provided by reputable medical sources. Should you have questions about information presented here, it is best to discuss with your medical provider.

Dear Parents,

Pregnancy is a complicated time. You are inundated with information, often conflicting, and you don’t always know what to believe. I am not a medical provider, but since the death of my son, I have made a point of becoming more informed on the risks and recommended best practices for pregnancy.

Because there is so much information, I have distilled what I can into the text below, and provided links to reputable sources for additional details. If you are concerned about your health or the health of your child, please contact your medical provider to discuss.

Love,
-Miranda

Disclaimer: please understand I am not a physician or medical practitioner of any kind. Information contained herein is a summary or direct quotation of information provided by reputable medical sources. Should you have questions about information presented here, it is best to discuss with your medical provider.

Best Practices for Safest Pregnancy:

Fetal Movement Tracking

Recommendation: Fetal Movement Tracking
 Starting between 24-28 weeks, become familiar with your baby’s individual pattern of movement. Do not compare your baby to other babies or other pregnancies
 Report noticeably higher or lower patterns of movement to your provider. Always go to your provider’s office or L&D if you notice a significant change in pattern in movement
 DO NOT rely on home dopplers for reassurance that your baby is okay

What’s the Reason?
 Changes in fetal movement have been proven to be the best indicator of potential problems in an otherwise healthy pregnancy
(Journal of Perinatal Medicine, Volume 32, Issue 1, Pages 13–24, ISSN (Print) 0300-5577, DOI: 10.1515/JPM.2004.003)
 A home doppler can only tell you that your baby currently has a heartbeat. It cannot provide information or warning on whether your baby is in distress (kickscount.org.uk)

How Successful is This?
 Initial studies have shown close to a 50% reduction in stillbirth when pregnant women were provided with information on fetal movement tracking during pregnancy
(Tveit, J.V.H., Saastad, E., Stray-Pedersen, B. et al. Reduction of late stillbirth with the introduction of fetal movement information and guidelines – a clinical quality improvement. BMC Pregnancy Childbirth 9, 32 (2009) doi:10.1186/1471-2393-9-32)
 Additional studies are forthcoming

 

Recommended Vaccinations

Recommendation: Vaccinations
 Get the Tetanus Diphtheria and Pertussis (TDAP) vaccine between 27-36 weeks of pregnancy, even if you have gotten the shot previously or in previous pregnancies. If you can’t get it in this time frame, get it as soon as possible, even if currently nursing
 Get the flu vaccine during flu season, between October and May each year
 Require all friends and family who will be spending time with your newborn to get both vaccines at least two weeks before seeing the baby in person

What’s the Reason?
 Pertussis (whooping couch) and influenza (distinct from the common cold or stomach flu) are especially dangerous to pregnant women and young children, and can result in complications, including death (cdc.gov)
• Pregnant parents who contract the flu are at risk for preterm labor and premature birth, and children are at risk for birth defects and death (marchofdimes.org)
• Pertussis can be deadly to both pregnant parents and infants (cdc.gov)
 Administration of the TDAP vaccine during pregnancy stimulates development of antibodies against pertussis which will protect the child for the first two months after birth (acog.org)
 Because the TDAP vaccine requires two weeks to be fully effective, friends and family should avoid contact with the newborn until they are fully vaccinated (acog.org)
 Administration of the flu shot during pregnancy reduces a pregnant parent’s risk of hospitalization from flu by 40%, and passes on immunity to her child (cdc.gov/flu)

How Common is This?
 The United States sees between 10,000-50,000 cases of whooping cough each year (down from 200,000 cases per year prior to the vaccine), and of those, 20 infant deaths (cdc.gov/pertussis)
 CDC estimates that influenza has resulted in between 9 million – 45 million illnesses, between 140,000 – 810,000 hospitalizations and between 12,000 – 61,000 deaths annually since 2010 (cdc.gov/flu)
 Each year, between 7,000-26,000 children are hospitalized due to complications of influenza, resulting in between 37-187 deaths (cdc.gov/flu)

 

Recommended Prenatal Testing

Recommendation: Prenatal Testing
 Get tested for GBS between 35-37 weeks of pregnancy
• If you test positive, you will require IV antibiotics during labor
 Get tested for gestational diabetes between 24-28 weeks of pregnancy, or earlier if your provider recommends
 Test regardless of personal health and history of past pregnancies

What’s the Risk?
 GBS can put the pregnant parent at risk for preterm labor and premature rupture of membranes, or for diseases like bacteremia, sepsis, or pneumonia. GBS can put the baby at risk for premature birth, lifelong handicap, or death (groupbstrepinternational.org)
 Babies can be affected by GBS both during pregnancy and up to 6 months after birth (groupbstrepinternational.org)
 Gestational diabetes may put the pregnant parent at risk for low blood sugar, need for C-section delivery, or high blood pressure, potentially leading to preeclampsia. It may put the baby at risk for excessive birth weight and propensity to develop diabetes later in life (cdc.gov/pregnancy)

How Common is This?
 Approximately 1 in 4 women carry or are “colonized” with Group B Strep. GBS is extremely common and personal cleanliness is not a preventative (groupbstrepinternational.org)
 Approximately 4-6% of babies who develop GBS will die (cdc.gov/groupbstrep)
 Nearly 10% of pregnancies are affected by gestational diabetes (diabetes.org)

 

Side Sleeping During 3rd Trimester

Recommendation: Side Sleeping
 Starting at 28 weeks of pregnancy, go to sleep on your side (either side) instead of your back
 If you wake up on your back, turn onto your side again

What’s the Reason?
 Sleeping on your back can compress the inferior vena cava; the vein that brings blood and oxygen to your uterus and baby. Extensive compression is thought to reduce blood flow to the baby (Robin S. Cronin et al, An Individual Participant Data Meta-analysis of Maternal Going-to-Sleep Position, Interactions with Fetal Vulnerability, and the Risk of Late Stillbirth, The Lancet, 10: Apr (2019): 49-57, DOI: 10.1016/j.eclinm.2019.03.014)

How Successful is This?
 Multiple studies have demonstrated a link between sleeping on one’s back a reduction in incidents of stillbirth by up to 50%
(Robin S. Cronin et al, An Individual Participant Data Meta-analysis of Maternal Going-to-Sleep Position, Interactions with Fetal Vulnerability, and the Risk of Late Stillbirth, The Lancet, 10: Apr (2019): 49-57, DOI: 10.1016/j.eclinm.2019.03.014)

 

Additional Resources:
Risk Factors in Pregnancy (planned article)
Warning Signs of Potential Problems (planned article)
Risk Management and Informed Consent (planned article)
Common Myths in Pregnancy (planned article)

 

Pieces of Potential Interest from this site:
Miranda’s Blog: Stillbirth & Statistics; What Does it Mean to be “Rare”?
Miranda’s Blog: Nature Isn’t Perfect
Miranda’s Blog: A Letter to the Woman who Wants the “Perfect Birth”