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So often, pain affects how we live our lives…
Date Recorded
December 06, 2021 Health Topics (The Scope Radio)
Womens Health
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By the time the 39th week of your pregnancy rolls…
Date Recorded
May 05, 2015 Health Topics (The Scope Radio)
Family Health and Wellness
Womens Health Transcription
Dr. Miller: When should your birth be induced? We're going to talk about that next on Scope Radio.
Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.
Dr. Miller: Hi, I'm here with Howard Sharp, he is a professor of obstetrics and genecology at the University of Utah. Howard, what does it mean when a woman is induced?
Howard: We're talking about labor induction. That would be starting a patient into labor artificially. Most women will eventually go into labor, in fact if you wait long enough, over 90% are just to go on their own. But in the last several decades we have gotten into a habit of starting patients. Sometimes we start them electively and sometimes we start them because it's indicated, there's a problem, maybe there's high blood pressure or preeclampsia.
Dr. Miller: So, one would be to start to do the induction because of a health reason or to prevent a medical outcome.
Howard: Yes. That will be called a medically indicated induction. But there are a lot of elective inductions that have gone on.
Dr. Miller: Are there more elective or medical inductions now in this country?
Howard: That's a good question. It probably varies from site to site. We don't have as many elective inductions here at The University of Utah, but we do do them and we do them very carefully with a lot of counseling.
Dr. Miller: I think one of the concerns you may have had was that there is perhaps more inductions than may be there need to be?
Howard: I think so. It's interesting if you look at the... for example the C-Section rate back in the '60s, it was about 5% of women were getting C-Sections. Last year it was about 33%. So, something happened on the way to the 2000s. I think maybe there is a little bit of medic-legal worry, certainly inductions became a little but more popular, we had access to Oxytocin.
Dr. Miller: That's one of the hormones that induces the labor.
Howard: Exactly.
Dr. Miller: Starts labor.
Howard: A lot of things have kind of changed plus babies are getting bigger. Sometimes baby's just a little bit bigger than the pelvis. But I think that a lot of the reasons for the increased caesarean section rate is unnecessary. That's what we're really trying to focus on getting that lower.
Dr. Miller: Is it fair for a woman to say that she doesn't want to be electively induced? Is that part of the conversation?
Howard: Yes. In fact ideally, I think most of us would agree that if a woman can go in labor on her own that is ideal and that is really what we prefer.
Dr. Miller: Why is there disagreement in the medical community perhaps about this issue of elective induction? It doesn't sound like there's much of a disagreement about induction to prevent illness or medical complications, but it sounds like there may be some disagreements over elective inductions.
Howard: Yes, there is some disagreement. I think in terms of elective inductions there are some issues and that is, there is a convenience factor that it's sometimes more convenient for the physicians, sometimes it's more convenient for the patients, their families. And so we kind of have to weigh that against the risk of having a caesarean delivery.
I think most people, if you thought your risk of having a caesarean delivery was higher because you are doing an elective induction, most people would say, "Well okay, hold off a little bit." Having said that, it doesn't mean that all elective inductions are bad. If you have an appropriate patient there really isn't much of an increased caesarean delivery rate.
Dr. Miller: If a woman has a failed induction, is that a possibility?
Howard: Yes.
Dr. Miller: How often does that happen, where you're induced but yet you don't end with a full term labor?
Howard: That is more common in a first time mom. The first time around, we really encourage patients not to be induced until it becomes medically indicated. That would be if there was a medical problem or if they had reached a point in their gestational age, whether that's 41, 42 weeks there is going to be a higher risk of still birth. Or at some point if the percentage is not working as well, there is a little bit higher risk of getting a caesarean delivery as you wait too long.
Dr. Miller: It sounds like medical inductions need to listen to the advice of your obstetrician and elective inductions certainly a more of a problem in first time moms, probably to be avoided electively. In general, discuss the use of elective inductions in second term or more term labors with your physician.
Howard: I think it really does require a conversation. For example if it's their second or third baby and they've had a very favorable vaginal birth with their first or second and their cervix is ready by that, we actually have scores that kind of grade how ready the cervix is. As long as they're at least 39 weeks, that is a reasonable thing to discuss. One of the problems has been inducing before the baby is ready. We get in a little bit of trouble here in the United States doing elective inductions before 39 weeks and babies ended up in the newborn intensive care unit which is a terrible outcome. A lot of things to consider and it's just worth having a discussion.
Dr. Miller: Do you think that discussions should occur early during the visits to the obstetrician's office well before time of delivery?
Howard: I do. I think once you kind of get close to delivery, some people are a little tired of pregnancy. I'm a guy, so obvious I've never done this but
Dr. Miller: I think as you look, you are. I get that.
Howard:
but I can only imagine it's uncomfortable. If someone is kind of expecting to be induced or if that's what they've had and then you're telling them otherwise, that's a little bit tough to take.
Dr. Miller: In your practice or your colleagues practice, do you generally bring this up from your standpoint in your discussion with your patients early on? You generally are sort of not looking to do elective inductions if possible.
Howard: Right. We usually try to bring it up at least before during the early third trimester.
Announcer: TheScopeRadio.com, is University of Utah Health Science's Radio. If you like what you heard, be sure to get out latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.
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The joy of discovering you’re pregnant can…
Date Recorded
April 14, 2015 Health Topics (The Scope Radio)
Family Health and Wellness
Womens Health Transcription
Dr. Miller: You're pregnant. You feel sick. You feel miserable. What can you do about it? We're going to talk about that next on Scope Radio.
Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on the Scope.
Dr. Miller: I'm here with Howard Sharp. He's a professor of Obstetrics and Gynecology at the University of Utah. Howard, you see a lot of nausea and stomach upset in pregnant women. What can they do about it?
Dr. Sharp: Yeah, that first trimester is rough, and there are some women that it just continues even to the second and third.
Dr. Miller: I heard that it was less common in the subsequent pregnancies, but not always true.
Dr. Sharp: Right, and I really feel badly for those that just don't get a break. There have been times we've had to bring patients in for IV fluids, a number of things, for something called hyperemesis gravidarum, which is basically throwing up all the time.
Dr. Miller: Is they throw up all the time.
Dr. Sharp: Exactly.
Dr. Miller: And we have to have a special medical name for that.
Dr. Sharp: It makes us sound smart.
Dr. Miller: It does.
Dr. Sharp: We need that.
Dr. Miller: But at any rate, are there new treatments out that can help women with this?
Dr. Sharp: Yes. There are new treatments.
Dr. Miller: Back in the day it seemed like you just had to suffer through it. Poor women. I know my wife was very sick with her first and second child.
Dr. Sharp: It's interesting. The new treatment is the old treatment. There's a new drug and it's called Diclegis, and it is a trade name but I'll have to use it because it's the only one available that is FDA-approved. A long time ago there was a drug called Bendectin which was basically vitamin B6 and half a Unisom tablet or doxylamine. The patients were given that. They did pretty well and then someone said, "Hey, we're seeing more birth defects with this." And so there was a big lawsuit over this and it was taken off the market.
Dr. Miller: For the Bendectin?
Dr. Sharp: Bendectin. And then when it was re-looked at, they found that there actually were not more birth defects with it. So now it has come back as Diclegis. And it is . . .
Dr. Miller: New and fortified.
Dr. Sharp: Yes, it is. You can get it at the pharmacy, and it is FDA-approved.
Dr. Miller: You need the physician to prescribe, of course?
Dr. Sharp: Yes. It is. And it's a little different than just picking up those two medications over the counter, because it's compounded in a way that it is more of a sustained release than just the shorter-acting or the counter vitamin B6.
Dr. Miller: So when do you decide to give this antiemetic?
Dr. Sharp: If a patient is really uncomfortable, or uncomfortable at all, I'll go ahead and give it to them. Nausea is miserable, so if they're not able to hold down liquids or if they're just feeling poorly all the time, I think it's totally reasonable.
Dr. Miller: When did this come on market? Is it recently?
Dr. Sharp: Just in the last year or so. It's fairly recent. Now there are other meds we've used. We've used Phenergan. We've used Compazine.
Dr. Miller: The standards, but they have awful side effects.
Dr. Sharp: They do. They just totally wipe you out. You're just so sleepy.
Dr. Miller: Some people say that they're still nauseated, but they're so sleepy they don't care.
Dr. Sharp: Exactly. And so that brought another medication on board called Zofran.
Dr. Miller: That's been around for a little while now.
Dr. Sharp: It has, and the nice thing about it is it doesn't make you so sleepy, and so that got a lot of traction for a while. The only thing is it does really slow down the bowels so it makes people very constipated.
Dr. Miller: And they're already constipated.
Dr. Sharp: Yeah. So that's the issue. And then a little over a year ago the FDA put out a warning on that. There was a slightly higher incidence of cleft lip and palate.
Dr. Miller: So you no longer use that?
Dr. Sharp: We do use it, but we counsel that there is a small risk of this birth defect. But now that we do have an FDA-approved medication, I prefer to go with that.
Dr. Miller: What are your patients telling you after they take the new antiemetic?
Dr. Sharp: Well, it doesn't always work. It's one of those things that not everything works for everybody. You just never know. Some people do well taking ginger. Some people do this acupressure or they'll use bands on their wrists, and if that works, great. It's like that skeleton key. You've got to find the right one to unlock that door.
Announcer: TheScopeRadio.com is University of Utah Health Science Radio. If you like what you heard, be sure to get our latest content by following us on Facebook. Just click on the Facebook icon at TheScopeRadio.com.
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Medical experts recommend pregnant women sleep on…
Date Recorded
July 12, 2018 Health Topics (The Scope Radio)
Womens Health Transcription
Dr. Miller: You're pregnant and you're uncomfortable. Do you really have to sleep on your side? We're going to talk about that next on Scope Radio, and I'm Dr. Tom Miller.
Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists, with Dr. Tom Miller is on The Scope.
How to Sleep When Pregnant
Dr. Miller: I'm here with Dr. Howard Sharp. He's a professor of obstetrics and gynecology here at the University of Utah. Do women really need to sleep on their side when they're pregnant? What's the story there, Howard?
Dr. Sharp: Well, it is recommended, and the reason for that is the big vessel, the aorta, comes off the left side and it's the higher pressure.
Dr. Miller: The aorta is a blood vessel that brings blood down to the lower part of the body and to the baby.
Dr. Sharp: Exactly. And then on the right side there is the vena cava, which is the return pipe. Ideally, sometimes when a pregnant patient is more than 20 weeks pregnant, there is a little bit more compression against that vena cava. So if you can have them kind of pressing against the aorta, which is the high pressure side, it's not as big a deal. It's easier for the blood to get through.
Dr. Miller: But does that matter or is that just an old wives' tale that you have the sleep on your side?
Dr. Sharp: Well, there is one study that was relatively good, but not fantastic, that did show improvement in outcomes where patients slept on their left side. But the truth is everybody wakes up on their back, and there's rarely a pregnant woman that I see who doesn't ask that question.
Dr. Miller: So the key thing is if the woman starts out lying on her side and wakes up on her back, which is pretty common, that's probably just fine.
Dr. Sharp: Yes, because this has been happening certainly for centuries and centuries, so probably not a huge deal. Now, I'll tell you one funny thing. I did have a really sweet patient who taped a tennis ball onto her back with duct tape. You do not need to do that.
Dr. Miller: To keep herself from rolling onto her back?
Dr. Sharp: Exactly. But I thought, well, that is a dedicated mom. But what you can do, and the truth is even the right side is probably okay, it's mostly just that you're not flat, you could also prop yourself up with wedges, and that helps if you just can't sleep on your side.
Also, a lot of people get these body pillows where they're able to take this really long pillow and they're kind of able to clutch that, put it between their thighs, and that kind of helps them stay on their side. So that's another option.
Dr. Miller: Well, so one of the things you talked about was compression of the major vessels in the body, but what would potentially be the bad outcome?
Dr. Sharp: The worry is that if the blood is not flowing back to the baby, could that deprive the baby of oxygen and nutrients. I think it's really more of a theoretical concern. I don't think it's the end of the world if one ends up on their back.
Dr. Miller: So it sounds like women that are pregnant beyond 20 weeks should start out lying on their side, try to sleep on their side, but if they wake up and they're on their back, don't worry about it.
Dr. Sharp: But if they're on their back, they shouldn't lose sleep over it.
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.
updated: July 12, 2018
originally published: April 7, 2015 MetaDescription
You're pregnant and you're uncomfortable. Do you really have to sleep on your side? We're going to talk about that next on The Scope
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