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So Why Does My Baby Need that Vitamin K Stuff Anyways?

4/25/2017

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If your baby is born in the hospital, they are usually offered three things: Erythromycin ointment in their eyes to prevent infection, their first Hepatitis B vaccination, and Vitamin K.  So what is Vitamin K?  Vitamin K is a fat-soluble vitamin that serves as a building block to help blood clot.  Our bodies cannot make Vitamin K and it is something we get from leafy green vegetables and the bacteria that live in our intestinal tracts.  Without Vitamin K, blood coagulation can be affected and this can cause us to bleed spontaneously.  Babies are born with low stores of vitamin K (because it does not cross the placenta well) and there is not much available in breast milk (because our own bodies don’t store it well).  In 1961, the American Academy of Pediatrics recommended that newborns receive a Vitamin K shot to prevent babies from bleeding spontaneously into their skin, head and abdomen.  Babies who received Vitamin K had a 5-fold reduction in the risk of bleeding to death in the first week of life!  It was estimated that for every 100,000 infants, Vitamin K would save the lives of 160 infants.  Also remember that babies that did survive after a head bleed, 40% of those infants had long term brain damage.

Parents have many concerns about the Vitamin K shot.  These are probably the most common ones that I hear:

1.  "Can the Vitamin K shot cause leukemia?"  No. Researchers have studied this for 20+ years and found no link between Vitamin K and childhood cancer. 

2.  "I am worried about the pain an intramuscular injection will cause my infant.  Why can’t you give my baby the oral version of Vitamin K?"  In the US, the preferred method of giving vitamin K is a shot for several reasons: First, it is absorbed more easily than the oral version.  Second, when the shot (IM) version is given, the chance of developing late Vitamin K deficiency bleeding is nearly zero.  Third, the oral version has to be given in a three-dose regimen (at birth, 1 week, and 6 weeks). While it lowers the chance of bleeding, it does not eliminate it.


3.  "I am worried about the toxins in the shot."  Just ask for the preservative free version of Vitamin K.  Any allergic reactions to the Vitamin K shot have occurred with the intravenous version which is rarely given in the newborn period except when the baby is already bleeding heavily.


4.  "Why will my pediatrician not perform the circumcision until my baby receives Vitamin K?"  First, most babies are circumcised within the first week of life and this is when their Vitamin K levels are the lowest. Second, circumcision sites are also a common site of bleeding for infants with Vitamin K deficiency bleeding. I have yet to meet a pediatrician that will perform a circumcision without a Vitamin K shot.


5.  "If I increase my intake of leafy green vegetables, will this increase vitamin K in my breast milk?  What if I take Vitamin K supplements?" The number one risk factor for Vitamin K deficiency bleeding in newborns is breastfeeding.  Increasing your intake of Vitamin K will not provide enough Vitamin K to your baby via breastfeeding to prevent Vitamin K Deficiency Bleeding. 


So, unless your baby is born with a full set of teeth to chomp some spinach (and if so, so sorry for mom!), then he or she would definitely benefit from Vitamin K supplementation.  Regardless of your decision, be sure to discuss Vitamin K administration with your pediatrician so they can be aware of your preference.

Dr. Pam ​

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Slimy, Green, and a Guardian for Your Baby:  Meet the Mucus Plug!

4/18/2017

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I can’t begin to count all of the phone calls I’ve received from moms-to-be who have just passed their mucus plug, and there’s generally some amount of anxiety to every one of those calls.  Don’t get me wrong, if something that looked like that came out of my body anywhere but my nose, I’d be pretty freaked out!  So, let me explain a little about what exactly a mucus plug is and what it does.

What is that thing?!  The mucus plug serves as a seal for the cervix once pregnancy is established, and it generally looks kind of like “snot,” although it may be pink, grey, or clear.  Think of it as the “caulk” that occludes the opening between the amniotic sac and bacteria in the vagina.  This helps to minimize the risk of infection in the uterus during pregnancy both by sealing the opening as well as via antimicrobial properties.
​

When it comes out, is my baby going to fall out, too?  Regardless of whether this is a hopeful question (please say my baby’s coming!) or fearful question (my little one isn’t ready to come yet!), the answer is still the same.  Passage of the mucus plug happens when the cervix either thins or dilates slightly, and the timing of when a woman passes her mucus plug in relation to when she actually delivers can vary A LOT.  For some women, it can be a sign that labor is imminent, but for others, this can happen weeks before labor occurs.  That’s usually when I see this face :(

Can losing the mucus plug ever mean anything bad?  It can if you’re also having contractions, heavy bleeding or your water breaks.  The difference between the mucus plug and when your water breaks is both the consistency (the mucus plug is thicker) and the volume (the mucus plug is generally only a few tablespoons in size vs a constant “flow” or big “gush” when your water breaks).  In that case, be sure to contact your doctor or go to labor and delivery.  Oh, the labor and delivery nurses asked me to inform you that you are not required to bring your mucus plug with you to labor and delivery.  They’ll take your word for it :)

There you have it!  Now you know all about your mucus plug and how it affects pregnancy.  If you pass yours, keep in mind that it doesn’t always signify the baby is coming immediately, nor does it mean that you will instantly develop an infection inside the uterus; however, you should probably take some precautions such as avoiding intercourse, swimming or other activities that may introduce more bacteria into the uterus.  If you do have questions about your mucus plug or your pregnancy, be sure to ask your provider for more details, and remember, no matter how ugly the mucus plug, the baby will always be cute :)

Dr. Nick

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Postpartum Hair Loss: Am I going to go bald??

4/11/2017

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Most women will notice a change in their hair when they are pregnant- it will be thicker and more lustrous- so what is going on?  Approximately 90% of your hair is in a growth phase (anagen phase) at any given time and 10% are in a resting or shedding phase (telogen phase).  Every couple of months, hair in the resting phase falls out and makes space for new hair to grow in its place.  During pregnancy there is an increase in the level of estrogen circulating in your bloodstream and this causes your hair to remain in the growing phase and stimulates the growth of hair.  Most women notice that their hair is thicker, and for the first time they feel like they may be in a Pantene commercial :D

So you just had a baby.  You are getting use to all sorts of changes in your body and you have a newborn that requires 100% of your time.  And now one to two months later, you notice that there is hair everywhere!  Your shower drain is clogged.   Every time you comb your hair, you notice clumps coming out.  So, what’s going on?!  No you are not going bald, but it certainly does feel like it!  While you were pregnant, your body freezes hair in the growth phase (anagen phase), but as your estrogen levels decline it pushes out all that hair that should have been in the resting/shedding phase. This usually starts in the second or third month postpartum and resolves by 6 to 12 months postpartum (thank goodness!).  

What can I do to survive this hairy transition?
1. Some women will get a shorter hair cut.  Talk to your stylist about ways to incorporate the finer hairs in the front.
2. Take your vitamins: Make sure you are taking a multivitamin with biotin, vitamin B, and vitamin C. 
3. Avoid certain styles: hair weaves, braids, pigtails, cornrows can put a lot of stress on your hair and this can make the hair loss worse.  
4. Be very gentle when combing your hair when it is wet.  Your hair is extra fragile when wet.
5. Be careful with heat styling instruments like blow dryers and irons.  You can use them to style your hair but use if more sparingly if possible.
6. Make sure you use a volumizing shampoo and plenty of conditioner on your hair.
7. Using color and a volumizing mousse can help with volume especially at the hairline where thinning is most obvious. 

Just remember, this is a normal post partum change that is unrelated to breastfeeding.  Unfortunately there is no miracle cure, and it just takes time for your hair to return to normal, but it will grow back just like it was before you were pregnant :)

Dr. Pam

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Wait a Minute, Stay in There, You Aren’t Supposed to Be Here Yet!:  A Quick Discussion of Preterm Birth

4/4/2017

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We are so happy to be able to appreciate all of the cute babies in our gallery, but if you’re like our family, it’s amazing and scary to see just how fast these little guys and girls are growing.  They all seem to want to grow up so fast!  That being said, some of them are not just in a hurry to grow up, but they were also in a big hurry to get here.  Having been through the scariness of a preterm delivery of our own, I’d like to take a few minutes to discuss what can bring babies into the world so far before their due date.


First of all, what is a preterm delivery?  Any delivery prior to 37 weeks is considered preterm, and there are more than 200,000 preterm deliveries each year in the U.S.  Some of the risk factors are history of previous preterm birth, multiple gestations (twins, triplets, etc.), short cervix, prolonged standing at work, substance abuse, either younger than 18 or older than 35 at time of delivery and use of assisted reproduction (IVF, etc.) can all predispose to preterm labor.  Other medical conditions that can cause early delivery include UTI (please, please, please complete your antibiotics), bacterial vaginosis, STDs, being either under- or overweight prior to pregnancy, vaginal bleeding during pregnancy, previous uterine surgery (removal of fibroid or prior cesarean section), elevated blood pressure or blood sugar, and less than six months between giving birth and the next pregnancy.


So, is there anything to do about it?  If your physician notes that you have risk factors for preterm delivery, then he/she may prescribe injectable or vaginal progesterone depending on the situation in order to decrease the chances of delivering early (these aren’t necessarily as effective of the delivery occurred just because mom’s water broke early).  Even though a mom may be “over” the whole pregnancy much sooner than 37 weeks, our goal is to help continue a pregnancy to term so that the baby gets to go home with mom.  Believe me, it’s really tough for a mother (and family) to leave the hospital without their baby.  While we learned a lot about taking care of a baby while ours was in the NICU, there are definitely cheaper ways to learn those lessons ;) 


Sometimes, though, delivery early is either indicated or inevitable (or a bit of both).  Occasionally, the delivery is so urgent that the absolute best thing is to simply help the baby out of mom and into the NICU for specialized care; however, for those who are urgent without being emergent, we try to maximize the baby’s time in utero.  In those cases, we do the best we can by providing steroids (from 23-36 weeks) to help with the baby’s lung development and magnesium (from 23-32 weeks) for prevention of cerebral palsy.  Depending on the maternal and fetal condition, we may also use other medications to allow the steroids and magnesium time to take full effect.


Unfortunately, some babies are just in a hurry to get here.  When we encounter moms-to-be who have known risk factors, we do what we can to decrease the chance of early delivery, but when we don’t have risk factors, sometimes we have to be content with doing what we can to help the little one be as prepared as possible for life outside of mom.  While we personally vouch for great NICU care if need be, it’s usually preferable to bring your newborn home with you.  If you have any concerns about preterm delivery, be sure to talk to your provider, and we’ll do all we can to help you and your baby leave the hospital together :)


Dr. Nick
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