Gestational Diabetes: Do I HAVE to drink that?

 

Short Answer:  Yes.

Long Answer:  You actually don’t HAVE to do anything you don’t want to do.  We won’t MAKE you do anything you don’t want to do.  This concept supports your autonomy as a patient.

However, you trust us to be the lifeguard of your pregnancy.  Throughout your pregnancy, we will monitor your blood work, vital signs, and the baby’s growth and development by using ultrasound, drawing your blood, listening to your baby’s heartbeat, and measuring the size of the uterus.  Trust us when we say that the second trimester glucose screen is very important to the health of both you and your baby.  We might even recommend it earlier in the first trimester if we are concerned about impaired glucose tolerance.

One complication of pregnancy that we screen for and treat is called gestational diabetes.  Gestational diabetes can occur in women of any size, even without a personal history of family history of diabetes.  Insulin is a hormone produced by the pancreas, and the body uses insulin to help transport blood glucose (sugar) from the bloodstream into the cells of the body.  The hormones of pregnancy can cause you to be resistant to insulin.  If you become resistant to insulin, your blood glucose levels become elevated and the glucose easily transports across the placenta to your baby.  This can cause the baby to grow very large, and at the same time it impairs the development of the baby’s lungs.  You can end up with a very large baby who, at the same time, has very immature lungs and needs help breathing after birth.

Maternal Complications of Gestational Diabetes:

  • You have a 70% chance of developing Type 2 Diabetes within 10 years
  • You are at a higher risk of high blood pressure or preeclampsia in pregnancy
  • You might require medication to help manage your blood glucose
  • You are at higher risk of miscarriage or stillbirth

 

Fetal Complications of Gestational Diabetes:

  • Your baby can grow very large
  • Your baby might experience a shoulder dystocia at delivery, which is an emergency situation where the head delivers but the large body is stuck behind your pelvic bones.  We might have to break the baby’s collar bone to help your baby deliver.
  • Your baby might require assistance breathing at delivery or in the first few days
  • Your baby might need to be observed or treated in the special care nursery for low blood glucose.

What happens if your one hour glucose screen comes back elevated? 

We will ask you to take a three hour glucose screen.  If the three hour glucose screen comes back elevated, you will have the diagnosis of Gestational Diabetes.  At that time, we will send you for a consultation with a Maternal Fetal Medicine physician called a Perinatologist.  These physicians are specially trained in high-risk pregnancy and obstetric ultrasound.  They can help us monitor the growth of your baby.  In addition, a diabetic educator will teach you how to test your blood glucose daily.  They will also teach you how to eat well to keep your blood glucose as stable as possible.  You will also be asked to increase your daily exercise, which will help your body be more sensitive to insulin and help you regular your blood glucose.

 

The glucose screen is usually done at the 24-28 week visit.  We ask that you eat normally that day, with good protein and not a heavy carbohydrate load.  Plan for the visit to take at least an hour because we have to draw your blood one hour after you finish drinking the liquid.  Pack a healthy snack with protein for the ride home.

 

So… yes.  Your midwives are aware that the glucose screen can cause nausea and discomfort.  You may not like the taste of the drink.  However, it is an important screening test that can help us provide the very best care for you and your baby.

 

For more information:

http://www.diabetes.org/diabetes-basics/gestational/

http://www2c.cdc.gov/podcasts/player.asp?f=11504&loc=WhatIsGestational

By: Kirsten Johnson | Certified Nurse Midwife

Preventing Pertussis or “Whooping Cough” in the newborn.

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Pertussis, also called “Whooping Cough” is a bacterial infection that you or your baby can catch when an infected person coughs or sneezes.  Infected droplets can travel through the air, and if you inhale the droplets you can become infected with pertussis.  Whooping cough begins like a cold, with a mild fever and runny nose.  Most adults do not have severe symptoms, but they can pass pertussis on to a newborn very easily without realizing it.

Whooping cough is especially dangerous for a newborn because their immune system is not fully mature and they cannot fight this infection.  Babies cannot get the vaccine for pertussis until they are two months old.  Even after they start the vaccinations, they are not fully protected by the vaccines until they are a year old and have had three vaccinations for pertussis.  Whooping cough in a newborn is a very serious illness, and it often requires that the baby be admitted to the hospital for breathing problems or pneumonia.  Some babies who get whooping cough do not cough at all – they just stop breathing.  Newborns can die from whooping cough.

The entire family can help protect your newborn from whooping cough.  All teenagers and adults who are around your baby should get a pertussis booster, called Tdap.  The Tdap shot is a tetanus vaccine that includes pertussis.  If you are pregnant, the best time to get the Tdap vaccine is between 27-36 weeks of pregnancy.  Your body will have time to make antibodies against pertussis.  These antibodies are passed through the placenta to protect your baby.  You can protect your baby with antibodies long before your baby is old enough to get the pertussis vaccine.  After the baby is born, the antibodies are passed through your breast milk.

For more information:  http://www.cdc.gov/features/pertussis

-Kirstin Johnson, Certified Nurse Midwife

Who needs sleep?

What is the one thing we spend the most time doing?  Sleeping!  Sleeping is a very important part of our life and contributes to our health.  Getting a good amount of sleep gives our body time to rest, and our brain time to make new connections.  When we don’t get enough sleep we can see the effects in many areas of our lives:  difficulty concentrating, poor attention, poor judgment, decreased ability to learn, depressed mood, and even obesity, heart disease, and a depressed immune system.

Do you think your children are getting the sleep that they need to be successful in school and in relationships with friends and family?  A National Sleep Foundation study recently found that 85% of teens do not get adequate sleep!  Adequate sleep means 8-10 hours every night for a teenager and 9-11 hours a night for a school age child.

Poor sleep has become a larger problem over the last 20 years.  What can you do to help ensure your child gets enough sleep?  Here are a few sleep tips to try:

  1. Maintain a consistent bedtime.  It is important for your body to always get up and go to bed around the same time, trying to limit fluctuations to 1 hour or less.  This includes the weekends, holidays, and summer break.  For older kids, avoid naps.  Naps make it more difficult to fall asleep at bedtime.
  2. Make sure the room is cool, dark, and quiet. Use your bed only for sleep, not for playing or punishment.
  3. Eliminate caffeine or nicotine from your diet, especially after noon. The effects of caffeine on sleep can last for 8 hours!
  4. Try to spend some time outside in the sun during the day. Spending time in a dark house confuses the brain into thinking it is nighttime.  Natural light during daytime is the best way to make sure your circadian rhythms are on track.
  5. Make up a relaxing bedtime routine. Try to always follow the same schedule so your kids know what to expect.  Some good ideas are a shower, story time, listening to calm music, or writing in a journal.
  6. Eliminate one of the biggest enemies of sleep from the bedroom: The Screen!  Looking at screens, especially screens from phones or tablets actually make your brain believe it is day and not night so your brain doesn’t release the sleep inducing hormone melatonin.  Studies have shown people who have tvs in their bedroom get less sleep on average each night.  It takes longer to fall asleep and you are less likely to stay sleep when there is a TV in your bedroom.  Remove technology from the bedroom!

Try the above tips and see if you and your children start getting better sleep.

Sleeping_angel

Football Season is Here!!! Let’s Play…

Spokane Football

Fall sports have started and it’s time to get those kids in for their annual Well-child exams/sports physicals (please call their doctors office today if this hasn’t happened yet). We want to make sure all kids and adolescents are healthy enough to play sports and that they continue to stay healthy throughout the school year.

Injuries can happen to any child at any time and a concussion can happen in just about all sports. Statistically, girls are at a higher risk of suffering concussions in their chosen sports than boys are; however, concussions can impact any student athlete. Striving for scholarships, championships, and social acceptance drives kids to make a choice about continuing to play when injured, despite their lack of readiness. It is your job as a parent, and our job as your child’s Doctor, to convince our kids that if they have not recovered 100% from a head injury then they are not ready to jump back into the game. Going back early places them at increased risk for severe bodily injury, permanent brain injury, or, in rare cases, even death. If your child has had a head injury and is having any symptoms at all, please get them in to their doctor for an assessment.

Concussion is a clinical diagnosis and you do not have to be KNOCKED OUT to have a concussion…this only happens 10% of the time. The most common symptoms to develop after injury to the head are headaches, dizziness, nausea or vomiting, disorientation, confusion, and loss of coordination. Severe symptoms can result in changes to your child’s personality, grades or academic effort, and their friendships.

There are 4 R’s for concussion to consider:

  1. Recognition- You have to recognize that a concussion has occurred.
  2. Remove- You need to remove that athlete from the risk of repeat injury.
  3. Recovery- Athletes need time to be symptom free before going back to activity.
  4. Return- To cognitive activity as well as return to play.

Diagnosis after injury should be done by your child’s primary care provider so they can follow up during and after the recovery period. There are many tools and tests people use to diagnose a concussion, but the symptoms should be followed closely by a medical provider to help prevent re-injury as well as to educate the athlete about risks of a second concussion. This typically results in worse symptoms, much longer recovery times and potential removal from the activity entirely. Missing a week for 100% recovery is certainly better than missing the entire season due to repeat injury.

With a single concussion, 85% of high school athletes have full symptom recovery within 2-3 weeks. When an athlete is highly symptomatic they should take a couple of days (48 hours) off from school. Their doctor can help make a plan as to the speed of their return to school and sports based in the extent of the concussion and symptoms. Returning to light aerobic activity that does not put the athlete at risk for repeat injury can help maintain fitness and mental health during the recovery period. In the past, athletes were strongly advised to avoid all physical activity until recovery had reached 100%. But new evidence shows that physical activity can help with brain growth and repair while doing nothing may prolong the recovery time.

So when should your child stop their activity or be disqualified from sports?

Three concussions in a lifetime requires having a serious conversation about risks associated with repeat head injury. Things that should disqualify your child from continued activity are increasing length of or severity of symptoms, concussions caused by less trauma then the first or second, decreased time in between concussion or prolonged post-concussive symptoms.

Remembering to help your child place their overall health and wellness above their sports performance may just help keep them playing sports for years to come.

BE A CHAMPION! PLEASE IMMUNIZE!

Community Health Association of Spokane Valley Clinic

It is National Vaccine Awareness Month and that means… it’s time to talk about immunizations.

I will keep this short and sweet as we want to stay focused. Please come in and talk to a provider at any time if you have any questions or concerns about vaccination so we can discuss why they are safe and so important for you, your family and your community.

 

  1. Starting in September CHAS will have flu shots available for anyone who comes to any of our clinics. We will be here and ready to go to help keep you healthy thus If you have an appointment prior to the start of September you can come back in at anytime for a nurse visit to get your annual flu vaccination. If you are wondering “Do I need a flu shot” this post from a nurse who questioned her need for the vaccine while pregnant  may be just for you. http://www.voicesforvaccines.org/nurses-vaccinate-to-protect-families-and-patients/

 

  1. Please ask our medical staff at every visit if you need any vaccines. We should check every time you come in so we take every opportunity to keep you protected and healthy. If you don’t ask, who will? One question and 30 seconds of your time could save your life or the life of someone you love.

 

  1. For Teens- In 2014, nationally, 4 out of 10 teen girls and 6 out of 10 teen boys had not even started the HPV vaccine (Gardisil) series making them vulnerable to cancers caused by HPV. Your teenager also needs to shots to protect them from meningitis and a TDaP to protect them from tetanus and Pertussis (whooping cough). Please start asking about HPV and if your teen starts this vaccine series, please remind them to finish it.

 

  1. Be a Champion! This month, I encourage everyone to be a champion for vaccine Please look up just one vaccine, any one of your choice and become passionate about it for your community. Be familiar with the results of getting such an infection and how not getting immunized can impact your community. Please go to http://www.immunize.org/vaccines/ this site will give you discussion points about each illness, pictures of what the illness looks like, and tons of resources to access so you can learn everything you need to know about vaccination. Let’s work together to make our community as safe as it can be. Please look at this resource  http://www.voicesforvaccines.org/ too as it helps you see each illness through the eyes of families and individuals affected by each preventable illness.

Healthy Choices for Kids.

Do you know why there’s so much talk these days about obesity in children?

Children who are overweight when they are young have a much harder time losing weight when they are older than adults who were not overweight as kids. If you make improvements in your child’s diet and increase the amount of physical activity he gets now, you will have a much better chance of keeping him healthy as an adult.

Here are a few ideas to make changes in your family’s diet:

  •   Drink water!  (no juice, no soda)
  •   Eat at home!  (don’t eat out more than once or twice a week)
  •   Keep cut up fruits or vegetables around so your kids will snack on them instead of chips
  •   Eat together! Keep the TV off!
  •   Make sure you have 20-30 minutes to eat together (eating too fast makes it easy to over- do it)
  •   Eat 3 meals a day! (skipping leads to overeating )
  •   Keep junk food out of your house!
  •   Make salads with vegetables, not eggs, meat or cheese
  •   Toss your salad to use less dressing
  •   Treat yourselves sometimes!

Here’s some suggestions to increase physical activity in your family:

bike-helmet-child

  •   Ride a bike
  •   Go for a walk after dinner
  •   Dance
  •   Swim
  •   Play sports
  •   Walk when you talk on the phone
  •   Take a martial arts class
  •   Limit TV and video games to 1-2 hours per day

 

Good luck and enjoy the rest of your summer.

The Itch of a biting insect: How do I protect my child from them?

With the hot wet days and nights of summer come the biting insects, especially in those early evening hours when eating outdoors and enjoying the gentle weather of a summer evening.

Children are at risk for multiple types of insect bites; biting flies,  mosquitoes, and ticks to name a few. The best way to protect your child from these pesky critters is to apply a repellent containing DEET.

According to the AAP (American Academy of Pediatrics) DEET remains themost effective in repelling these biting insects. It can safely be applied by an adult to the children’s clothing and exposed skin.

Application of the product is best done in an open area. DO NOT spray this directly onto the child’s head and face, instead spray into the adult’s hand and rub onto the face/ears/neck avoiding contact with the eyes.  Follow directions on timing for re-application typically anywhere from 2 to 5 hours depending on the concentration of DEET in the repellant being used.

A common question heard can be: Is it safe for my young child?

The answer is simply:  Yes.  A repellent containing DEET of no more than 30% is safe for application to an infant older than 2 months of age when safely applied by a responsible adult.  Remember to always wash the child’s skin at the end of the day to remove the product to avoid irritation and wash their clothing.

Avoid use of scented lotions/fabric softeners/detergents as these can attract those pests more.  Dressing a child in floral prints and bright colors also can attract the pests.  It’s a good idea to protect the child’s head/ears by having them wear a hat with a wide brim.  Using mosquito netting around strollers and those portable cribs also can help protect the child from those pesky flying insects.   Avoiding stagnant water is a good idea as these are frequently breeding grounds for mosquitoes.

BugBite_0

Despite your best efforts your child ends up with an itchy bite, what next?

There are many over the counter products designed for this. Some good options to use are: a topical cream such as Calamine Lotion, Hydrocortisone Cream, or Benadryl Cream.  Another simple product is to mix baking soda and water into a paste and apply to the bite.

Remember if ever there is a question your Pediatrician is just a phone call away.  🙂

Enjoy your summer stay safe and protected!!

Daniel Moorman, MD

Talking with baby

Community Health Association of Spokane Valley Clinic

 

Did you know something as simple as talking to your baby can help them be more successful in school?  75% of your baby’s brain development occurs in the first 2 years of life.  You are your baby’s first teacher!  The more words they are exposed to during this time the better.  Simple things like telling your child what you are doing, “Mommy is making your bottle now,” and pointing out things you see, “Look at the big red ball,” help their language develop.  You may be tempted to turn the TV on and let your baby be exposed to language that way.  Unfortunately, studies have shown this actually makes their language development worse.  Instead, turn the tv off and talk directly to your baby throughout the day, making eye contact with them, and giving them a chance to respond.  This helps with language and communication skills that are needed throughout life.

Books and songs are another way to help develop their language skills.  Sing simple songs over and over again, and you will quickly see that they will begin to recognize the song.  Exposing them to books is a great opportunity.  You might find your 6 month old baby has no interest in sitting down and reading a book, but let them explore books.  They will probably start by sticking it in their mouth, but soon they will start looking at the pictures, and before you know it they will have their own favorite book.  Your baby may not want to sit on your lap and read the entire book.  That’s ok!  Flip through the book with them.  Point out different pictures.  Practice animal sounds.  Your baby will enjoy the time spent cuddling with you, while also building a foundation for their developing language and a love for reading.

By Ashlee Mickelson, Physician