Depending on your age and other risk factors, you may have been offered an amniocentesis at some point during a pregnancy. Unfortunately for me, this happened in my most recent two pregnancies. After my first amnio, I never wanted to experience that again, and yet I did just last week . . . but more on that later.
The typical amnio story involves a mom-to-be, typically over the age of 35, who is offered an amnio to rule out the possibility of Down Syndrome. The risk of Down Syndrome increases with increasing maternal age, especially after the age of 30, when most of us are having our babies. There are also many women who have a positive screening test known as the Integrated Prenatal Screen (IPS), which combines blood work and the second trimester anatomic ultrasound. It is used to rule out the possibility of genetic abnormalities, such as trisomy (three copies) of chromosomes 13, 18, and 21 (Down Syndrome). This was my story with both Ryan and son-to-be (named ‘Critter’ by my oldest).
When I was pregnant with Ryan in 2012, I had a major scare at 17 weeks. I was working in the emergency department overnight and had sudden onset chest pain. Due to the increased risk of pulmonary embolism in pregnancy, and progressive vomiting that night, I found myself at Mount Sinai Hospital at 5 a.m. getting a CAT Scan of my lungs. My husband and I called our OB to see what her opinion was, and she too told us to have the CAT scan and pop by her office when we were done, presumably to fill her in on what happened.
So after a terrible night in the ER, both as a physician and a patient, my husband and I dragged ourselves to our OB’s office. I love my OB and value her no bull**** approach. But I was not prepared for this. To add to the pulmonary embolism concerns of the previous night, my husband and I had to hear about my IPS results—our baby had a 1/40 risk of having Down Syndrome. Being only 29 years old at the time, my typical risk of Down’s was more like 1/200,000, so a risk of 1/40 seemed incredibly high.
I sat there shocked, exhausted emotionally, and physically drained from working in the emergency room and all the vomiting I had done the previous night. On top of this, I had a very stressful radiation-containing investigation that proved unnecessary, and now this.
I went home and cried while staring at our baby’s ultrasound pictures for hours, trying to figure out what to do. Should I get an amnio or not? Could I wait it out and hope for the best? Could I live with the consequences of not knowing and having a baby with a potential genetic abnormality? Would we continue with the pregnancy if we knew the baby did have a genetic abnormality? How would this affect our then one-year-old son, Dylan?
What would you do?
For more on how this stressful situation turned out, stay tuned...
Is Having A Child With Down Syndrome An Ethical Dilemma?
How to support families who are living with a child who has special needs.
For more no-nonsense kids health info and advice, check out DrDina.ca.
I don’t often talk about the unbelievably heartbreaking things I sometimes see at work, or the countless, amazing families I am blessed to meet every day. I was one of the many staff working at Sick Kids on a warm July night when I was witness to a parent's worst nightmare, the preventable death of a child from a motor vehicle accident. I was immensely proud to be a physician at Sick Kids that night, as we worked together with the first responders as a team to support one another in the aftermath.
Much is written online about this horrifying event and the tragic death of Georgia Walsh. Sometimes a tragic death enables a community to come together to find meaning in something so unbelievably tragic. In this instance, a grieving community has created a campaign to make our streets safer for our kids. I am so thankful that something amazing is coming of this unimaginable loss.
If you live in the GTA you may have noticed one of the many signs on your neighbours lawns — a simple black and white sign reading “Slow Down Kids at Play.” I hope you have seen many. Concerned Leaside residents have banded together, creating the non-profit organization Kids at Play to “give the residents of cities a collective voice with which to speak out against careless driving.” The goal: urge drivers to slow down in residential areas to prevent further accidents like Georgia’s. The group explains, this is “a reminder to all drivers that this is a neighbourhood community first and a thoroughfare second” and we have “a collective commitment to drive responsibly.” This simple message is clear — stop speeding and watch where you are driving. For a small donation you can have your own sign, as I proudly display on my own lawn.
I see more of these daily. Some streets are lined with them, likely from a generous neighbour who brought several to the area. I hope the city will soon be covered in these signs. But not just for the sake of the campaign, but for the real intended success of reducing pedestrian-related injuries and deaths.
As a parent this has also re-enforced the absolute necessity of teaching and re-teaching our children and their caregivers about road safety.
Consider talking to your kids about walking only on sidewalks or paths, using traffic signals and crosswalks.
Children younger than 12 years of age should never cross streets without a caregiver present. Kids younger than this have difficulty assessing the speed and distance of cars, putting them at risk.
Teach your children to put down electronic devices and look left, right and left again when crossing the street. My mother-in law taught our kids “look left, look right, use your eyes and use your ears before you use your feet.
Remind children to make eye contact with drivers before crossing the street and to watch for cars that are turning or backing up.
When driving, appropriately sized, developmentally appropriate car seats should be used with consistency, even for brief rides.
Tragedy can strike in a brief second, literally. I hope these signs will reduce driver speeds, but we must also take care to educate our little ones about safe outdoor play. Perhaps armed with this, those of us on the front line will see fewer unimaginable injuries.
I have to admit that when I was pregnant with my first, Dylan, I was terrified of labour, the pain it would likely cause, and, of course, the inevitable tearing I would endure. I was the first of my friends to have a baby and had no one to rely on to find out how bad it really was. So, like many women out there, I assumed I would have the worst birth ever, with awful pain, a long labour and many weeks of excruciating healing. Do other women think like this?
My birth story with Dylan actually turned out very differently than I anticipated. It was fast—almost too fast (about 90 minutes of labour and 2 minutes of pushing)—and ended with no doc in the room, and my husband catching my son. Not expected. Maybe it was my strength, maybe the preparation I did before delivery, or maybe luck, but it certainly wasn’t as I imagined it would be.
What I know now is no delivery is what you expect. Of course, I thought my second baby would come into this world as quickly and easily. Not so. My labour was longer and I ended up being induced, and he ended up spending a night in the NICU. Who would have thought?
At one obstetrics appointment in my third trimester with Dylan, my obstetrician asked me offhand if I was doing Kegel exercises. Embarrassed that I hadn’t even thought of it, I answered no, ashamed. Maybe I was missing out on doing something of paramount importance? She proceeded to tell me that the evidence for them was mixed, but why not? So, I went home and started Googling to find out what those exercises are and how they could help. My type-A personality and science mind makes me a stickler for "evidence-based recommendations." This, coupled with an obsession for exercising, made this an ideal little project for me to undertake.
What I found was a hodge-podge of recommendations and suggestions from doctors, midwives, and doulas around the world. Some experts recommend these exercises and some think they are useless.
Here is some important information about kegels that I think every new and expecting mom should know. Even if you are already a mom, read on—there as are some useful tips for you, as well.
Kegels are exercises you can do to strengthen your pelvic floor muscles. These muscles help support your bladder, uterus, and rectum. A gynecologist created them in the 1940s to prevent urinary incontinent after childbirth. Some believe they will help prevent urinary and anal incontinence during and after pregnancy. Scarily enough, these ailments affect 70% of women! They may also help you heal after delivery and keep hemorrhoids at bay by improving blood circulation to the area. Listen up ladies, the best evidence for Kegel exercises are for . . . you guessed it . . . sex.
The stronger these muscles are, the more enjoyable sex will be for both of you (have you read 50 Shades of Grey?). Have I sold you yet? (Find out more about exercise during pregnancy.)
Make sure you pee first, so you don’t have an accident. Now imagine that you are trying to stop yourself from passing gas and peeing at the same time. Visualize "squeezing and lifting" your pelvic muscles upward. A kegel is as simple as that. No need to clench your stomach, butt, or legs—it's all in your vagina (in a matter of speaking, of course).
After my search through the literature, I decided they couldn’t hurt the baby or me, so I might as well give it a go. Around 30 weeks, I started 5 minutes of holding my pelvic muscles for increasing increments. Clench, unclench, clench, unclench, holding for longer periods of time each week. By the time I was due, I was able to hold for a few minutes or longer. It helps that I often go the whole day without peeing when I am running around seeing patients or in a busy emergency room. This is a true "medical practitioner" skill I learned in residency (yes, I know it isn’t a good idea as it predisposes to urinary tract infections).
Some women do them once a day, others several times throughout the day. Whatever you fancy, consider doing Kegels daily and make them part of your routine. Don’t just do it before baby—you can keep up the practice and make it part of your daily routine whether at home, work, or having a mani. No one but you will know you are doing them.
For me, I am lucky and haven’t suffered any of these dreaded incontinence side effects after two deliveries, but am not counting my chickens yet. I have at least one more delivery to go, and I am all too familiar with the decreased bladder control that often comes with age. So, I keep doing Kegels whenever I remember. I haven’t torn badly with either delivery, so maybe they helped?
Will Kegels become part of your routine?
Let me know if they work for you! Your partner may notice a difference too!
There's a new way to track your kegel training with this handy device that will see you on your way to stronger pelvic floor muscles. Would you buy it?
You think you have a good "I peed my pants" story? You've got nothing on this mom. NOTHING.
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