Search for tag: "newborns"

Interviewer: So, today, we're here with Dr. John C. Carey. He's an MD and professor of pediatrics at the University of Utah Health and Primary Children's Hospital. So when we're talking about hearing loss in children, you know, when we're talking with newborns, you were telling me that there was a bit of this screening process that we do, what's it called?

Dr. Carey: So it's called universal newborn hearing screening. It was initiated in Utah in 1999, which was one of the first states to actually pass the legislation to screen all of our newborns. But by the mid part of the next decade, the mid-2000s, all 50 states had mandated that their health departments had to provide newborn screening so that we could detect early on, literally first few days of life, that that particular newborn had a hearing loss.

Interviewer: So, I guess, how frequently are we testing? Are we doing like, you know, the first week, the first month? I've heard 1-3-6.

Dr. Carey: In testing for all the babies that are born in the hospital, which in Utah is about 99%, the hearing screen is done before they're discharged. So it's done by one, two, three, four days of age. If they fail either ear, they get a second screen. That's usually done a week or so later. That's the one of the 1-3-6. We want to make sure that second screen is done before one month of age. And then from that, it turns out that the majority of those children who fail the first screen, don't have a hearing loss. There's something plugging their ear, like, you know, the ear wax of the newborn and so on.

So when they get their second screen, that really narrows things down to now we have a few percent of babies. And then when they're seen by three months by the audiology specialist, by the actual hearing specialist, we can determine whether or not they have what is called a permanent hearing loss or not. If there's fluid in the middle ear, it's not considered permanent because our ENT colleagues can drain that fluid with tubes. And eventually that, with time, can resolve itself. So that's not considered permanent. What's permanent is when it's not due to fluid and they still fail one or both ears, and then that's confirmed by the audiologist before three months.

Interviewer: And then you bring them in one more time at the six-month mark?

Dr. Carey: And then, well, by six months, we're hoping that all of those children who are determined to have permanent hearing loss of some degree could be mild, it could be more, but by six months all will have their hearing aids and also be, if they need them, and also be lined up for early education of children with hearing loss. So, by six months, we want that to be in motion.

Interviewer: And how many kids do you find are affected by these types of conditions?

Dr. Carey: After you go through the screening first time, second time, get the test by the audiologist, you're left at about 1 in 500 newborns. Now, there are a few weeks or months old. One in 500, which would be about 100 children a year in Utah, have a permanent hearing loss. After heart defects, hearing loss is the most common birth defect in human babies.

Interviewer: Wow.

Dr. Carey: So everything else you can think about from oral facial clefts or some of the orthopedic abnormalities or other syndromes, like Down syndrome, they all have a frequency of less than 1 in 500.

Interviewer: And what does the screening for a baby look like? Do you put little headphones on them? What does that look like?

Dr. Carey: You actually do put something in their ears. In the first screening, you put something in their ears, and this almost sounds magical, but what they're doing is they're putting a sound wave in through the ear canal. It goes through the eardrum and the three famous middle ear bones, the smallest bones in the body, through the oval window to the hearing structure called the cochlea. And so, when it gets to the cochlea, the hair cells inside, people are familiar with all that with maybe a hair cell problem, get to the hair cell, the hair cells bounce the sound wave back, and the computer detects that change.

So what you're doing, in Utah, what we're doing . . . other states do something different. Most states do what we do, which is to test cochlear, the inner hair cell function by bouncing these sound waves through, the hair cells react, bounce it back, and the computer at different frequencies, at different loudness records whether or not the cochlea is working properly.

Interviewer: Wow.

Dr. Carey: So if the hearing loss is due purely to the nerve and not necessarily the hearing nerve connected to the cochlea, but purely to the nerve, a child will pass the hearing screen much of the time. So the limitation of our hearing screening, which most states do, this is called an otoacoustic emission. You can see the words, oto, ear, acoustic, the sound. Emission is the hair cells bouncing it back, you know. Most states do otoacoustic emission.

Interviewer: So for one of these parents whose children are identified with one of these hearing issues, what kind of services can the Utah Hearing Center provide?

Dr. Carey: The beneficial aspect of early detection is that you actually get the kids in for treatment and proper education. And the majority of those children will go to a regular class in a regular school. Those that have the most profound degrees of hearing loss, that don't necessarily respond to hearing aids, can go to our outstanding special schools we have throughout the state. They're the schools for children with hearing loss and visual disabilities. They still do say deaf and blind. So those schools have their branches of them throughout the state. They provide for the children that have some of the more moderate to severe, but especially those that have the profound degree that if untreated with something like a cochlear implant, those children would go on to be called deaf.

So deafness is the degree of hearing loss preventing regular communication as you and I would have it in this type of setting so that one would have to learn sign language and then be a part of a very rich community of people with deafness. But on the other hand, would have more challenges with communicating with the rest of society. That particular place we're talking about, that particular situation, just, you know, in the last two decades, in half of my career here at Primary Children's can now be altered dramatically with a cochlear implant so that children with a cochlear implant will usually, with the right rehabilitation and such, will actually go to regular kindergarten.

Interviewer: We're here with Dr. Barbu Gociman, a craniofacial surgeon and the Medical Director of the Cleft Center here at the University of Utah. Dr. Gociman, when does a parent usually find out that their child might have a cleft lip or a cleft palate?

Dr. Gociman: Here in the United States, most cleft lip patients are diagnosed with their condition during pregnancy. So the parents will know that the baby is going to be born with a cleft. By contrast, when the babies have only a cleft palate, usually the diagnosis is not obvious on ultrasound and is not made prior to birth. So the diagnosis is made in the first day of birth.

Interviewer: So what are some of the things that a parent needs to be doing those first few months with their child to make sure that . . . how early are they getting surgeries? What do they need to be doing the first couple months?

Dr. Gociman: Considering what the problems are, as we said, the lip, the gum, the hard and soft palate are involved. One of those structures or all of them, you can imagine the baby will have difficulty with feeding, with suckling. If a cleft lip is present, they cannot create a seal around the nipple. If there is a clefting of the palate, the babies will have a very hard time developing suction. Specialized devices are needed to provide adequate caloric intake, meaning adequate amount of milk or formula to keep with the needs of the newborns.

Interviewer: When does the first surgery usually take place?

Dr. Gociman: For a cleft lip patient, if we assure adequate nutrition, there are no other anomalies associated with the condition, and the baby grows normally, the timing is approximately three months of age. And the reason for that is the baby has grown sufficiently enough to withstand the anesthesia without any additional risk, and all the structures that are involved in the cleft are bigger and stronger, and the operation is performed easier, with less risk of things breaking down or having other complications during the surgical procedure.

Interviewer: What happens during those first three months while you're waiting for the child to get stronger? Who should they be visiting?

Dr. Gociman: Here at the University of Utah, we have an excellent system in place to assure that all the needs of cleft patients are met. For a cleft lip patient, the diagnosis is most of the time made prenatally, so the parents already had a prenatal visit with the nurse coordinator, with the physician assistant in charge of the cleft team, and with the craniofacial surgeon that will perform the repair. So they already have a good idea of what is coming.

Once the baby is born, especially if it's born here, close, at the university hospital, or even at a hospital in close proximity, a cleft surgeon will visit with the family, evaluate the exact anatomy of the cleft, and start with the process of treatment. And this involves two major elements in the first three months of life. One is assuring adequate feeding, and, as I said, there are different modalities through which this is achieved with specialized nipples, specialized bottles, specialized techniques of holding the baby to prevent regurgitation.

And the second thing that is as important is what we called molding. We are trying to achieve normal anatomy. Due to the lack of continuity in the muscles of the lip and the palate, the elements that compose those structures can migrate apart, and the anatomy becomes very difficult to recreate. So in those first three months of life, we attempt to bring all those structures together. We try to reshape the nose, the lip, the alveolus, and the palatal shelves.

Interviewer: Seems like the treatment of cleft lip and cleft palate has more than just the surgical components and just the restructuring. There's also speech. There's also feeding. There's also socialization. What sort of resources are available to a new parent here with the cleft team?

Dr. Gociman: We have a comprehensive cleft team. First, we see the patient right after birth to assure adequate feeding and the molding has been started. And at the same time, we schedule a clinic visit with the cleft team so the family gets a chance to visit with all the members of the team. And each member has an important role in cleft care. So the team is made up of a cleft craniofacial surgeon, an ENT surgeon, pediatric orthodontist, a speech therapist, feeding specialist, and a social worker. So the reason for that is to assure that all the problems encountered in cleft are addressed from the beginning and the family has a complete understanding on all the steps and all the elements that need to be addressed.

As such, the cleft surgeon will talk about a cleft repair, the sequence of different operations based on the particular anatomy of the patient.

The ENT surgeon will talk about hearing. Most cleft babies have a hard time with draining the ears and have significant infections of the middle ears and require tubes early on. Also, they have to assure later on that the speech is adequate, possibly perform speech correction surgeries down the road.

The orthodontist, as I said before, initially will have a very significant role in performing the molding and then, later on, in assuring eruption of the teeth, orthodontic work, and help with any orthodontic operations.

The speech therapist will be there, initially, to help with feeding, assure that the method that is most effective is used, and then, later on, as the speech starts developing, address any problems, involve the patient in speech therapy, and so forth.

Finally, the social worker is there at all steps of cleft care just to address any social problems that may arise, and we have quite a long number of issues that arise in our cleft patients. So it's a very useful component of the team.

Interviewer: So I understand that cleft care can be a long process. It's years and years of treatments and procedures. But it seems like this type of team can really help set a child and their family on the right path and get them started and give them a step up.

Dr. Gociman: It has been shown over and over again that having a cleft team and having a professional cleft team makes all the difference. This is a standard across the United States. We are proud to have the largest, oldest, dare I say, the best team in Utah and in surrounding states. So we are getting patients from all the states around us. We pride ourself with our results, with innovation. We publish a lot. We are actively involved in research. And we are always trying to improve our technique and our results. We are very critical with our results, and we are trying to achieve perfect outcomes every time.

Dr. Jones: Getting let down. Getting let-down. The first is a psychological consequence and the second is about breastfeeding. How are they connected? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health, and this is The Scope.

Announcer: Covering all aspects of women's health. This is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: There's a world of data that suggest for newborns "Breast is Best." That puts a lot of pressure on new moms to be successful breastfeeders. In the days before formula, a newborn's life depended on a mom's ability to provide breast milk, and a mom's health might already be precarious after what might have been a dangerous delivery. For this reason, many cultures have a time after delivery, several weeks or a month, to allow moms to heal and breastfeed.

Okay. That's all good. But after that in the US of A many moms have to go to work. That means if moms are still going to provide breast milk, that breast pumping pump at work becomes a reality. Now, to provide breast milk, a mom has to be at least moderately well-nourished and well-hydrated. But almost all American moms can accomplish that in the workplace. Then, there's the problem of let-down.

To make milk, moms need to be in reasonable health. They have to be breastfeeding, meaning they have to suckle. When the infant suckles, their nerves on the chest wall and the nipple feed information back to the brain to release the hormone prolactin from the pituitary gland. This hormone helps the breast make milk. But the milk just doesn't come out in a continuous dribble. It's made in the far parts of the breast called the alveoli and collected in tubes or ducts in the breast waiting for, you got it, let-down.

When the infant suckles, nerve fibers in the nipple cause the posterior pituitary to release oxytocin, which stimulates myoepithelial cells. These are little muscular cells to squeeze milk from the milk producing part of the breast called the alveoli so it can drain into the lactiferous ducts and then squeezes the milk down the pipeline to the nipple. It takes less than a minute from the time when the infant begin suckling -- the latent period -- until the milk is secreted -- the let-down. But what happens if the baby isn't there?

You're in your office or you're in the ladies restroom with your breast pump or if you're lucky you have a private room with a lock and an electric outlet and an electric breast pump and a rocking chair. Nice, but you still have to get let-down. Many experienced breastfeeding moms know that just the sound of their baby giving a hungry cry can begin let-down and that could be embarrassing if the baby isn't close and you start to leak through your clothes. However, for new moms, pumping at work let-down can be difficult to get started.

If let-down is a neuroendocrine reflex from the brain, many things can get in the way of timely let-down. Anxiety, pain, embarrassment, stress, stimulants like caffeine and nicotine, too much alcohol gets in a way but a little bit of alcohol might be relaxing, but not in the workplace. Acute fear or anxiety can suppress let-down. The fight or flight mechanism inhibits let-down, as it should if you're running away from tigers or something else.

Many years ago, when I was a young obstetrician back at work shortly after the birth of our son and pumping when I could find the time, my residents gave me as a joke, I think, a pager duct taped to a breast pump. Now, there isn't anything less conducive to let-down in my world than my beeper going off and a disaster happening to some poor laboring woman on labor and delivery. What a let-down.

So what's a new mom at work to do? Some suggestions include bringing a picture of your baby to look at when you're pumping. Bring something like a little t-shirt that smells like your baby with you. Try to get your head in a calm space before you put the breast pump to work. Deep breathing, focused visualization of having your baby at your breast and instead of that pump can be useful. Turning up the vacuum on the breast pump or just pumping harder with the hand pump won't do. The problem is let-down, not suction.

In an effort to increase the success at milk production and future breastfeeding for moms of very premature infants, some research has been illuminating. You can imagine that having a very sick newborn that you've never been able to nurse because they're too little and you're sitting in a pumping room next to the intensive care nursery might not be conducive to let-down.

A paper published in advances in neonatal care took 162 mothers of premature babies who were trying to provide breast milk for their babies and divided them into four groups. One group had standard instructions in a breast pumping room. The other group was taught guided imagery, imagining their babies and imagining themselves in a safe, warm, quite place with their newborns. Another group was given soothing music. And the fourth was given imagery and soothing music.

Women who were taught guided imagery or given soothing music had more output of milk. And the women who had music and guided imagery together has the most milk of all. Now, this wasn't just a little difference. Moms who had the interventions had two to three times more milk than moms who didn't. Mothers who had interventions to decrease stress also had more milk fat, had richer milk in the first days of the study.

So what else is out there? Last year the annual Make the Breast Pump, Not Suck Hackathon -- isn't that a great meeting -- awarded the Technology Frontiers Award to group that were testing out virtual let-down by transforming pumping rooms at work and in public places into a nursery decorated with pictures and videos and sounds of their babies by using a virtual reality headset.

So what do you do? For a new mom committed to breastfeeding and is returning to the workplace or needs to travel away from their baby, what do you do? Practice using your pump at home in your baby's room before you take it to a strange place. Get your head in the right place. This can take time and practice before you're rushing into a pumping place or a bathroom in the airport or your workplace. Get some soothing music and, yes, there are YouTube videos with music and guided imagery and meditation that you can use. You can just power it up on your phone, put in your headphones.

But use these first with your baby so the association can be stronger. Stay well-hydrated. And if you're struggling, get a coach through your hospital nurse lactation specialist or a La Leche League. This is hard, but you can do it. Don't get let down.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Dr. Gellner: With this being my fifth year of recording, my producers have asked me to do a best of episode with the top five topics I think parents need to know about before bringing their child to their pediatrician. These are concerns that I hear often or ones that really need to be in the spotlight. I'm Dr. Cindy Gellner, and you're listening to my "Five Best Topics" on The Scope.

Announcer: Keep your kids healthy and happy. You are now entering the "Healthy Kids Zone" with Dr. Cindy Gellner on The Scope.

Dr. Gellner: It was pretty easy to come up with my top choice -- the poop on poop, everything parents want to know about their kid's poop. It's pretty amazing how obsessed parents are with their kid's poop. Parents have even brought me poopy diapers and sent me pictures of their child's poop wondering what's going on. Babies and kids have developing digestive systems, so their pooping cycles are different from those of us as adults.

For newborns, dyschezia or apparently painful pooping is the norm until they learn how to coordinate all the muscles needed to poop. For breastfed babies, pooping with every feeding or only once a week are both normal. While formula-fed babies can go several times a day to once every three to four days.

Kids who are potty training often get scared of pooping and start holding it in leading to constipation issues. Some kids develop constipation shortly after they turn one, especially if there's a family history of others with constipation.

I see so many kids with constipation, I've actually been given the nickname of the poop whisperer at my office. Not one I choose for myself, but apparently I'm good at fixing constipated kids. The bottom line literally is everyone poops a little differently. If it hurts, if there's blood, if it's rock hard and causing stomach pain, then it's time for your child to be seen.

For number two, I would choose anything mental health related. Most pediatricians will tell you that we are the ones managing anxiety, depression, ADHD, behavior issues, most of the psychiatric issues in kids lately. There are days I see so many patients with behavior or mental health issues that I feel like a child psychiatrist.

Sadly, there's been a notable increase in mental health issues in people of all ages, and there's not been an increase in the number of mental health providers to help manage these issues. While all of us pediatricians are able to address many mental health diagnoses, there are some that are just out of our scope. We aren't counselors or therapists. Many of us cannot manage complex mental health issues, and medication prescriptions can be tricky as there aren't as many options for patients under age 18.

Your pediatrician will be the one that you bring your child to for the initial evaluation. But please understand that we can only help so much and often we need to refer you to a specialist. I always explain it as you wouldn't want your child's psychiatrist to manage your child's asthma. The pediatrician is better at that. In the same way, a child psychiatrist is better for addressing your child's mental health needs if they are beyond what we as pediatricians are trained to do and are comfortable treating.

Number three would be kids and colds. It seems that's my daily special lately. Everyone is coming in coughing, sneezing, not wearing a mask, so I wear mine and look like a duck all day. It's hard when you see little ones coming in and they look miserable and parents are exhausted. And for most of these viruses, all you can do is nasal saline, humidifier, honey if they're over one and lots and lots of TLC.

Parents often bring their kids in wanting something to help make their kids feel better faster, but unfortunately there isn't much out there other than supportive care. Antibiotics won't help unless they have a bacterial infection, like an ear infection or pneumonia. Breathing treatments won't help unless they have asthma. Green boogers don't always mean a sinus infection and pulling at ears doesn't automatically mean an ear infection.

Cold meds aren't safe in kids under age six, and many adult cold medications contain aspirin which aren't safe for anyone under 18. As a parent, I know how frustrating it is and how one would do anything to make their child feel better, but with cold viruses, it's symptom relief only.

Number four would probably need to be any of my Debunking Old Wives' Tales pieces. I spend a good deal of time on these in the office. No, your child can't get a cold because the weather changed or they went outside without a coat. Yes, your child can get their vaccines if they just have a mild virus. No, teething doesn't cause a fever or diarrhea. And yes, a little bleeding when your newborn's umbilical cord is coming off is actually normal and expected. And unfortunately, no, telling your child to eat their carrots won't really improve their eyesight.

Number five would have to be picky eating in toddlers. I get this concern at least once a day. I've had it twice today. Usually at a well-child visit when I asked how a child's eating is and parents tell me they were doing so good and now I can't get him to eat anything, I'll look at the growth curve and show the parents that their child has gained two pounds since I last saw them, and the parents are like, "How can that be? They're not eating?"

Well, kids' metabolisms put the brakes on between one and five. They only gain a few pounds a year during that before they hit their kindergarten growth spurt, so their eating patterns change. Some days they'll eat great. Other days they'll have five Cheerios and call it a day. Some days they will only eat mac and cheese for a whole week, and the next week mac and cheese is the most disgusting food on the planet and they won't go near it. Yep. All normal.

Our kids wouldn't eat well at home, but they did great at daycare or at a restaurant and we decided they just needed an audience to eat. As pediatricians, we're good at tracking your child's growth and if there are any red flags, we'll let you know. Until then the best advice is don't force your child to eat. Limit milk to 24 ounces per day, so they don't fill up on liquids, and make meals a positive experience. And trust that when your kid is hungry, they'll eat.

So those are my top five topics that I think parents need to listen to before rushing to their pediatricians' office. Hopefully, they've been helpful.

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Dr. Jones: Moms are most likely to experience depression in their mid-30s and 40s. Well, is that because it's the time of life, or is it because they're the moms of teens? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care, and this is The Scope.

Announcer: Covering all aspects of women's health, this is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: A recent study of over 2,000 mothers with children from newborns to early adulthood looked at levels of anxiety and depression in these mothers. We all know that post-partum depression is common, affecting about 12% of women who just had a baby. That feeling of being overwhelmed, being inadequate to the job of being a mom. Depression and anxiety is well-described, and clinicians are ever more focused on identifying moms with postpartum depression and helping them get better.

However, what this new study published in the Journal of Developmental Psychology suggests is that moms are more likely to be overwhelmed and depressed when their kids are early teens than when they're newborns. What's going on here and what shall we do about it?

Firstly, being the mom of teens is much harder than being the mom of a healthy newborn, even if it's your first baby. Babies are moderately predictable. Yes, you get sleepless, but usually you have the tools to figure out what the baby needs and get the job done. There is a very significant hormonal shift after giving birth that can upset the emotional applecart for women.

They're vulnerable, but for most women, the combination of increased awareness, social and psychological help and occasionally, some medicine, gets most women over the hump of postpartum blues in about a year. The baby starts to smile and giggle, you feel more comfortable in your role, and things are still pretty well-defined.

But being the mom of a teen is really hard for many women, and at least a baby will give you a full-on genuine smile once a day. There's no guarantee that an early teen will give you a smile once a month, one that isn't a little twisted with a "Gotcha." They're pushing the boundaries of their bonds with their mom, and it isn't very pretty and it isn't very predictable.

The solutions to their own unhappiness isn't found in a simple checklist. Are they doing drugs? Check. Are they having sex? Check. Are they really going evil places in the Internet? Check. Are they being bullied? Check. Will they even talk to you? Check. Mothers with kids this age have the highest level of stress and loneliness of moms of kids at all ages, and the lowest levels of life satisfaction and fulfillment.

The second possibility is that some of the same hormonal re-wiring of the kids' brain is happening in the moms' brains. The study looked at "well-educated" women who probably didn't have their kids when they were 15 and now they're just 30. More likely, first kid at 25 and now they're about 40. And if they're moms of several teens, they're probably in their mid-40s. Their own hormones are less predictable.

Symptoms of women with PMS are often most prevalent and the most severe in women in their late-30s and early-40s. Our own health may be changing and our relationships may be changing. This is a time of significant stress in marital relationships, and that can add to the loneliness. It's totally unfair that our children are going through very significant mental, physical and social changes at the very time that we're going through our own. In fact, for mothers, "the mid-life crisis" is most likely when their kids are in their early teens.

The third possibility is that this is just part of the biopsychosocial phenomenon called the U-shaped curve of happiness. Studies done all over the world, men and women, rich and poor, highly educated and less educated, millions of people studied show that the levels of happiness are relatively high in the late teens and early 20s, lowest in the 40s, and starting to rise up again about 50, and are the highest in the late 60s to 70s.

Is the U-shaped curved with the bottom of the U of happiness coinciding with the time that most of us have early teens? There are many reasons proposed for this, combined with crazy teens, tough marriage, aging parents, perception there is more good years behind us than ahead of us, and physical aging. The U-shaped curve of happiness is the same for men and women, so it can't be blamed on menopause or pre-menopause.

So what's to do? There are lots of blogs, hotlines for new moms. There are movies and pop stars coming out to talk about their postpartum depression, and it's all the rage. But mid-life moms are on their own, and they don't need to be. The answer of mid-life moms who are tweens who struggle, they share the same similarities with those other new moms. Let's get someone to talk to, someone who's there or has been there. Maybe your mom or sister, or maybe not. Be assured that your friends with the kids of the same age are going through the same things.

Get a group, go out to dinner with your tweenie-mom friends. Giggle a little, reach out to them. You know the kids who are in trouble, more trouble than your own. Reach out and help someone else. Get out of your own head and share with others. Just get out, go for a walk, take an exercise class. Best of all, go for a walk with other tweenie-moms. Many moms had a support group called a playgroup when their kids were little. Now, you should invent a tweenie-moms playgroup for moms to go get out and play.

But sometimes, this won't be enough. If you need more help, and there's no shame in asking for it, healthcare professionals know about this mid-life slump and can help. Women in trouble can get better with therapy, and sometimes a medication can help. It is often a hard time for the kids, the partners, the entire family, but remember, in the event of a sudden loss of cabin pressure, put on your own mask first.

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Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health," with Dr. Kirtly Jones on The Scope.

Dr. Jones: Every woman comes on to Labor and Delivery . . . well, most women come into Labor and Delivery hoping for a healthy, wonderful, peaceful, home experience in the hospital where it's safer. We really count on people to give us the information that helps us prepare for when things don't go well.

Today in The Scope studio, we're talking to Janet Fisher, the nurse educator on Labor and Delivery at University of Utah Hospital. What would you recommend in terms of dialog with your clinician and information that would help your clinician be prepared for something that might not go well?

Janet: It's really important that a woman shares with us all information about her medical history, any surgeries that she's had, any social things that she may do. This is not by way of making judgments of people, it's really just important that we know everything because things may have an impact on the woman or her baby. In order for us to take safe care of somebody, if we have complete information about you, then we are going to make very safe decisions on how to care for you if you are having an emergency.

Dr. Jones: Right. So women who've had, let's say, we'll take high blood pressure and pregnancy in the past, they're at risk for that again. We would be very careful watching them during their pregnancy and labor and delivery. Women who might be taking some recreational drugs and maybe they don't want to talk about it, but it may profoundly affect not only their blood pressure, but it may have a counter-effect on what we treat their blood pressure with. So honesty is the best way for a healthy baby and a healthy mom, yeah?

Janet: It absolutely is. Once again, there are absolutely no judgments being made here. Our sole objective is to take safe care of you and safe care of your baby. And the best way to do this is for you to be very open and honest about everything.

Dr. Jones: The other situation that I remember seeing on Labor and Delivery are . . . I would say there's a tension between women who want a natural process to happen and a birth is a natural process, but they feel like there's too much intervention and there are too many medications. About 50% of women who become high-risk deliveries walked into the hospital as low-risk women.

Janet: That's true, yes.

Dr. Jones: So when women come with a set of expectations, and some of these are written down, a delivery plan, asking for a little flexibility, we'll do the teaching and the explaining, but a little flexibility when we see things happening that make us worry, and having a discussion.

Janet: Well, I think, once again, we want everybody to have the birth experience that they have planned. It's very important to us to support every woman's plan because it is a major life event. It's something that you will always remember. But part of the reason you came to the hospital, and one of the major responsibilities as a health care provider, is that we have to constantly be monitoring you to make sure that you are staying on the path that we know is normal.

If we see you starting to deviate from that normal, it's our responsibility to tell you that and to talk to you about what our concerns might be and what our recommendations are. When this works best is if, as a woman, you are open to listening to us and to realize that what we bring to you is a lot of years of experience and knowledge and that we are not trying to circumvent your plan. Our goal is for you and your baby to be happy and healthy.

Dr. Jones: Both of these things we've just talked about, one is being open and disclosing all the parts of your health, and the other is being, both clinicians and women, being open to conversations when things aren't going so well, is all about having a conversation.

Janet: Very much so.

Dr. Jones: Doctors and nurses need to have the conversation so our patients feel safe. And patients need to have the conversation with us when they're nervous about something so that we can explain. I think at University Health Care, we work very hard to make those conversations go both ways.

Janet: Absolutely. I know it seems rather odd because here you are coming into the hospital to have a birth, a very personal and intimate experience, and these strangers are walking into the room, but you will be amazed at how quickly we bond. You come to rely on us and, hopefully, trust us. That is one of our biggest goals, when we're taking care of you, is to develop a trustful relationship. A big part of that is ongoing conversations with you and we want to listen, we want to hear what you have to say. By contrast, we want you to listen to us as well.

Dr. Jones: What our goals are for the ideal experience of a very difficult time because no one who has had a birth would say it's an easy process, but we want what's best for the mom and the baby. We want happy memories as well.

Janet: Absolutely. A positive birth experience is a number one goal for you and your family.

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Dr. Jones: Across the industrialized world, women live 5 to 10 years longer than men. Among people over 100 years old, 85% of them are women. What's this all about? This is Dr. Kirtly Jones from Obstetrics and Gynecology at the University of Utah Health Care and this is about why girls rule in the longevity world on The Scope.

Announcer: Covering all aspects of women's health. This is the Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Life expectancy in the US isn't at an all-time high according to a report released last week from the Centers for Disease Control and Prevention and while the news that we're living on average to the ripe old age of 78 years and nine and a half months is not surprising. There's one step it is. A girl born in 2012 can expect to live 81.2 years almost five years longer than a boy born the same year who's likely to live age 76 years. What's going on here? Female newborns, particularly preemies, are more likely to survive than males. Males develop a little later than females especially in lung capacity which is really important for preemies. As a statistical issue, if you lose a male baby shortly after birth, it has a larger impact on statistical average years than if you lose a man at 78 years.

However, even if you're only counting on children having survived to five years old, women live longer than men. Accidents and suicide deaths are much more common in men than women and in young men. You could blame it on culture. You could blame it on testosterone, but the stats are powerful and the fact that they're many more early deaths due to accidents and suicides in men than women. Of course there have been times when the world was at war when the average lifespan of men and women was powerfully affected by the fact that we sent men to the battlefront and not women.

In midlife, men have more heart disease and deaths from heart disease. Smoking is a big issue. Men smoke more than women. Estrogen which men make, but not as much as women, is protective against heart disease until menopause and stress is an issue too. Men process stress culturally a little differently than women. They hold more inside. On the stress issue, women have more friends and stronger social networks. A study from BYU demonstrated that people with stronger social networks live longer than people who don't. Social networks help modify stress.

It may be why married men live longer than unmarried men, or maybe married men get nagged by their wives to get health care. Women access health care more than men. Women are more likely to get their cholesterol checked and get regular checkups and they're more likely to have health insurance than men. Some suggest that 70% of longevity is environmental and 30% is your genes. And remember women have one more X chromosome than men and the Y chromosome doesn't do very much for you. Sorry guys. Well, it does make you a guy and it makes sperm, but in the longevity world it doesn't do that much for you.

This may affect many more areas of longevity than we currently understand and there's a lot of research in this area. And consider this, for chimpanzees in captivity who live to their first birthday, median life expectancy is 31 years for males and 38 years for females. Of course this suggests average. The oldest chimp in captivity was 72 and we're learning more about older chimps every day. These figures were provided to us by the Lincoln Park Zoo's chimp data as part of a unique program we participated in and we are doing work here in Utah to help project future demographic trends in sanctuaries and based on 35 years of records from zoos and aquariums.

Also, female orcas, killer whales in the wild live up to 90 years and males rarely live over 50 years. The average in some studies for females in the wild is about 50 years and for males it's 29. This is hard to test because you have to identify individuals in the wild and orcas in captivity have much shorter lifespans and female dogs are longer than males about two years. Dogs don't smoke. They don't commit suicide. They don't get much heart disease, but a dog's life can be stressful, I guess.

What do we do with these facts? Ladies, don't smoke. Do keep talking to your friends. Share your troubles. Get your checkups.

Men, if you're listening, you could consider the same things. But be careful with your social networks because we all know what guys can get up to when they hang out with just guys and as the scout master of my son's Boy Scout troop said, over and over and over, "Don't do stupid stuff." And we should all take care of each other; men and women together." As for that extra X chromosome thing, sorry guys. Thanks for joining us on The Scope.

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