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Covid-Vaccine

CDC is advising all pregnant patients to get the covid-19 Vaccine. All studies to date show that Covid-19 can have life threatening consequences in pregnancy and the vaccine does not. There are side effects to the vaccine. May people have sore arm, low grade fevers, and fatigue especially 1-3 days after the vaccine.

The antibodies created by this vaccine will protect your baby after it is born. We are not offering the vaccine to babies or kids under the age of 5, so you getting the vaccine is the only way to offer your baby some immunity from a very serious virus.

Some people say “We don’t know future consequences of the vaccine” and this is true. However, we have no reason to think that there will be few to no long term consequences. The vaccine has been shown to be very safe and effective in all studies done to date (New England Journal of Medicine Article is listed below and this is the best science we have).  The Corona Virus in unvaccinated people has been shown to have very serious consequences including life long chronic fatigue, heart desease, and lung disease.  

Corona virus does not appear to be going away. This may be our new normal. Please get vaccinated so your baby has some protection against the Corona Virus.

We are using the Madern mRNA vaccine or the Pizer vaccine, the choice is yours.



More information:

Getting Vaccinated While Pregnant: What You Need to Know – News Moms Need (marchofdimes.org)

Information about COVID-19 Vaccines for People who Are Pregnant or Breastfeeding | CDC

Preliminary Findings of mRNA Covid-19 Vaccine Safety in Pregnant Persons | NEJM – this study shows “adverse pregnancy and neonatal outcomes in persons vaccinated against Covid-19 who had a completed pregnancy were similar to incidences reported in studies involving pregnant women that were conducted before the Covid-19 pandemic”

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Labor Induction

The truth about Inductions

Sometimes it is better to help get labor started. Our bodies aren’t perfect at knowing the right time and sometimes it’s better for babies not to have to rely on a placenta. After 39 weeks labor has few risks. It does increase pain/perception of pain because you are stuck in the hospital, tied to machines It is unpredictable. I can’t tell you if it is going to take 5 minutes or 5 days to get your body to start the labor process. All I can do is try and get labor started.

Why?

There are a number of reasons why we may decide to induce labor, including,

  • you’re overdue. If there’s no sign of action from your uterus, your practitioner may induce you around 41-42 weeks, this is because after 42 weeks the placenta wears out and babies start to lose weight and get tired.
  • There’s a complication. Sometimes conditions like preeclampsia, diabetes, gestational diabetes, issues with the placenta, or problems with amniotic fluid (low levels or infection) make it risky to continue the pregnancy.
  • Your membranes ruptured. If your water has broken and contractions have not started on their own within 24 hours, your doctor may induce.
  • Your baby isn’t thriving. If tests suggest your baby is mature enough to deliver, your practitioner may opt for induction.
  • You live far from the hospital. You may be induced if you live far from where you’re delivering or have had previous short labor because there’s concern that you might not make it to the hospital or birthing center in time. Known as an elective induction, it should be scheduled at the place where you plan to deliver no earlier than 39 weeks.


How does labor induction work?

If you do end up needing to be induced, the process involves a number of steps, though you usually won’t go through all of them:

• Cervical ripening. Usually, your cervix will open up naturally on its own once you’re ready to go into labor. However if your cervix shows no signs of dilating and effacing (softening, opening, thinning) to allow your baby to leave the uterus and enter the birth canal, your practitioner will need to get the ripening rolling. She’ll usually do this by applying a topical form of the hormone prostaglandin (either a gel or a vaginal suppository) to your cervix. Your cervix will be checked after a few hours; often, this will be enough to get labor and contractions started. However if the prostaglandin is doing its work ripening the cervix but contractions haven’t started, the process continues on to the following steps. (Note that sometimes if you’ve had a C-section or other previous uterine surgery, you won’t be given prostaglandin to try to prevent uterine rupture. And in some cases, your practitioner may use a mechanical agent to ripen the cervix, such as a catheter with an inflatable balloon or graduated dilators, instead.)

• Rupturing the membrane. If your cervix has already begun to dilate and efface on its own but your water hasn’t broken, your practitioner might jump-start your contractions by artificially rupturing the membranes. In other words, she’ll break the bag of waters that surrounds your baby manually using an instrument that looks like a long crochet hook with a sharp tip. It might feel uncomfortable, but it shouldn’t be painful. This is one of the procedures that the new ACOG guidelines suggest may not be necessary for all women with low-risk pregnancies.

• Pitocin. If neither the prostaglandin gels nor the stripping nor rupturing of the membranes has brought on regular contractions within a couple of hours, your practitioner will slowly give you the medication Pitocin (a synthetic form of the naturally-occurring hormone oxytocin) via an IV to induce or augment contractions. When Pitocin is used, contractions — which usually start about 30 minutes later — are usually stronger, more regular, and more frequent than those where labor has begun naturally (though if this is your first baby, you won’t have anything to compare it with). If you’re considering an epidural, you might want to ask your practitioner about getting it started while you’re getting the Pitocin so it’s in place once labor does start.

The risks of labor induction


While in the majority of cases labor induction goes smoothly, complications sometimes arise. They include:

  • Inductions increase pain because you are stuck in the hospital, and can’t move around naturally.
  • Inductions are unpredictable, you might get stuck in the hospital for several days before we get labor started
  • Fetal stress, we monitor the baby the whole time you are in labor and sometimes artificial contractions can stress the baby out. Studies have shown that babies do not have any long term risks/stress, but temporary fetal stress is stressful
  • Increase stress on your body.
  • Increase stress on your body.
  • Bleeding after delivery
  • Inductions do not increase the risk of cesarean section. Many studies have shown that earlier inductions do not increase this risk.

Do-it-yourself labor induction

While there are plenty of natural methods you can use to try to bring on labor (and plenty of old wives’ tales to go along with them), none of them have been shown to work more than placebo pills. After 39 weeks no matter what happens you will eventually go into labor on your own, and if you want to wait, and your baby is doing well….you can wait.

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Labor and Hospital Bag

Come to the hospital when:

Contractions are ~5 minutes apart and painful for more than 1 hour.

You are leaking fluid, enough that it goes through your clothes

Use your best judgment, if you think you should be checked out……

When going into labor you can call ahead and we will be more ready for you. 503-842-4444
OB department if you have questions 503-815-2289


What should I bring with me to the hospital?

Hospital bags are mostly for creature comforts. Everything you need while you are in the hospital will be provided for you. If you show up without a hospital bag, you need not worry. Here are some things you may want to add.

  1. Going home
    a. Comfortable clothes for you- not too tight, not to lose. You won’t be your pre-pregnancy size and you don’t be your 40-week size either
    b. An outfit for the baby
  2. Entertainment
    a. Phones
    b. Computers
    c. Card games
    d. A good book
    e. Movies
    f. Whatever you like to keep your mind occupied
  3. Car seat
    a. the only thing you are required to have to take a baby home
  4. Camera
    a. Make sure that someone other than the person having a baby knows how to use it
    b. Make sure to talk about what you want/don’t want to be photographed
  5. Insurance and ID card
    a. At Tillamook Regional Medical Center we know who you are and have all your information already, but just in case something changed it’s good to have a backup.
    b. You don’t need to pre-register, we have already done that for you.

    Want a List?
    https://makingofmom.com/wp-content/uploads/2019/03/hospital-bag-checklist-printable-2.png?ada25a&ada25a
    https://southernmamaguide.com/wp-content/uploads/2015/10/Hospital-Bag-Checklist-Free-Printable-for-mama.jpg
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Back pain

Almost everyone has some back pain in pregnancy. Sometimes back pain is worse than other times. The good news is it usually goes away after delivery. In the meantime here are some things to do.
-Heat- Can help relax sore muscles, this can be done with rice packs, heating pads, tubs, or showers.
-Massage- you, your partner, or a professional can help massage some of the pain.
-Maternity belts- Following is some information on maternity belts. It is helpful to reposition the baby.
-Physical Therapy- we have a great physical therapist for back pain at Adventist Health Tillamook. If your back pain is really bad, do some physical therapy.
-It is OK to use bengay/ icy-hot/lotion to help sore muscles.
-Stretching/Yoga is very helpful. The following are some links for stretching in pregnancy and also some stretching.
https://www.youtube.com/watch?v=Sja4az8lnvc

Back pain during pregnancy isn’t surprising, but it still deserves attention. Consider seven ways to relieve back pain during pregnancy — from good posture and physical activity to complementary therapies.
By Mayo Clinic Staff
Back pain during pregnancy is a common complaint — and it’s no wonder. You’re gaining weight, your center of gravity changes, and your hormones are relaxing the ligaments in the joints of your pelvis. Often, however, you can prevent or ease back pain during pregnancy. Consider seven ways to give pregnancy back pain the boot.
As your baby grows, your center of gravity shifts forward. To avoid falling forward, you might compensate by leaning back — which can strain the muscles in your lower back and contribute to back pain during pregnancy. Keep these principles of good posture in mind:
• Stand up straight and tall.
• Hold your chest high.
• Keep your shoulders back and relaxed.
• Don’t lock your knees.
When you stand, use a comfortably wide stance for the best support. If you must stand for long periods of time, rest one foot on a low step stool — and take time for frequent breaks.
Good posture also means sitting with care. Choose a chair that supports your back, or place a small pillow behind your lower back.
Wear low-heeled — not flat — shoes with good arch support. Avoid high heels, which can further shift your balance forward and cause you to fall.
You might also consider wearing a maternity support belt. Although research on the effectiveness of maternity support belts is limited, some women find the additional support helpful.
When lifting a small object, squat down and lift with your legs. Don’t bend at the waist or lift with your back. It’s also important to know your limits. Ask for help if you need it.
[ADVENTISTHEALTH:INTERNAL]
Sleep on your side, not your back. Keep one or both knees bent. Consider using pregnancy or support pillows between your bent knees, under your abdomen and behind your back.
While evidence to support their effectiveness is limited, massage or the application of a heating pad or ice pack to your back might help.
Regular physical activity can keep your back strong and might relieve back pain during pregnancy. With your health care provider’s OK, try gentle activities — such as walking or water exercise. A physical therapist also can show you stretches and exercises that might help.
You might also stretch your lower back. Rest on your hands and knees with your head in line with your back. Pull in your stomach, rounding your back slightly. Hold for several seconds, then relax your stomach and back — keeping your back as flat as possible. Gradually work up to 10 repetitions. Ask your health care provider about other stretching exercises, too.
Some research suggests that acupuncture might relieve back pain during pregnancy. Chiropractic treatment might provide comfort for some women as well. However, further research is needed. If you’re considering a complementary therapy, discuss it with your health care provider. Be sure to tell the chiropractor or acupuncturist that you are pregnant.
If you have severe back pain during pregnancy or back pain that lasts more than two weeks, talk to your health care provider. He or she might recommend medication such as acetaminophen (Tylenol, others) or other treatments.
Keep in mind that back pain during pregnancy might be a sign of preterm labor or a urinary tract infection. If you have back pain during pregnancy that’s accompanied by vaginal bleeding, fever or burning during urination, contact your health care provider right away.

Back-pain-In-PregnancyDownload
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Corona Virus and Adventist Health Tillamook

  1. This document is up to date as of October, 2021
  2. You can have only one person with you in labor as of 10/1/21.  We hope this will increase in the near future.  
  3. You can have one support person in the hospital, and you can bring one with you to clinic.  
  4. You do not need to wear a mask while you are in labor. 
  5. Your partner can not come with you if they have a fever.
  6. You will be tested for Corona-Virus when you arrive at the hospital, your partner will not.  
  7. Your partner (s) must be over the age of 18.  We still are not allowing children into the hospital unless they have medical needs.  

Prevention for Pregnant Women

you might have heard this before…….

  1. Wash your hands
  2. Wear a mask
  3. Stay 6 feet away from people you don’t live with
  4. Do not go to group activities more than is needed for your mental and economic wellbeing

Common questions

If I am positive for Corona virus when I am in labor what happens?

Most experts are recommending that the baby is kept in another room.  If you are breast feeding it is done with a shield, mask and gloves.  

In the end this is your choice and it depend on how sick you are. 

What if my husband/Partner has a fever?  

Any visitor with a fever can not enter the hospital.  Have a back up in mind. 

What are common symptoms of covid and what do I do if I have those symptoms?  

Common symptoms in pregnancy are fevers, Stomach upsets, generally not feeling good, many people are asymptomatic.  If you have symptoms and are worried you were exposed, give us a call.   If you have a primary exposure the health department will call you.  

How many people can come with me to the hospital?

We are now allowing everyone to have two visitors when you are delivering a baby and after the baby is here.  

It can be any two people.  However, they can’t  be under 18 yo, and if they have a fever, they can not come in.  

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Whose going to deliver my baby?

I would love to deliver 100% of the babies delivered in Tillamook. I know many of you. But obstetrics by its very nature is unpredictable with long hours. I don’t know any obstetric physicians that deliver all their own patients. It isn’t safe.

In Tillamook, there are only two of us. Myself and Dr. Welch. Even though we take call one week on, one week off, we each take care of our own patients during the workweek meaning that both of us end up delivering ~80% of our own patients.

If you are one of my patients you may have Dr. Welch as your delivery physician, when you are close to your due date ask me about the call schedule and I will tell you who is on call and when.

I trust the whole staff here at Adventist Health Tillamook, the nurses, Dr. Welch and I all work together as a team. We will take care of you and your baby to the best of our ability. If you have special requests, every single one of us will strive to honor those requests and if we can’t, we will explain why. If you have special requests or don’t understand something, it is your responsibility to ask for clarification.

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C-Section

At Adventist Health in Tillamook, our c-section rate is lower than the national average.  If you are a first-time mom with a baby that is head down your risk of a cesarean section is ~15%, which is a lot lower than the national average of 25%

I find it interesting when people talk about cesarean sections. I hear things like “too many, correct rate, always delivered vaginally in the past”. I want to remind everyone that in 1900 1 in 200 moms died in childbirth and 1 in 10 babies died in their first year of life. In addition to high death rates, deliveries left some mothers or babies deformed for the rest of their life.

C-sections are the most wonderful thing to happen to mankind. We have come so far, it is easy to lose perspective.

I have had mothers who have had a C-section and a vaginal delivery tell me that their C-section was an easier/quicker recovery*

ADTRH8 Cesarean Delivery

Risks

  1.  Increase risk of infection
  2. Increase time to recover
  3. More discomfort as you are recovering
  4. Increase risk for serious injury to internal organs, especially if you have more than 2 cesarean sections.

Benefits

  1. Decrease risk of serious bleeding
  2. Decrease risks of urine or fecal leakage as you get older
  3. Decrease risk of prolapse of your uterus or bladder as you get older
  4. Can be safer for the baby
  5. More predictable, a cesarean section can be planned and is relatively fast. 

Recovery

No sex or tampons for the first six weeks

No lifting more than 10 lbs (your baby and a light bag) for the first week

You will be in the hospital for ~2 nights after your delivery

When you go home you will be able to move around comfortably

You will not be able to do general household chores

 You will be tired and sore

We will send you home with pain medications

*most people would say a vaginal delivery is easier to recover from, but most people that have C-sections need them and the surgery is easier on their body or their baby. There is always a reason we do C-sections.