Making Sense of Miscarriage During the Coronavirus Crisis
Often the result of chromosomal abnormalities, as many as 10 to 20% of confirmed pregnancies in the United States end in a miscarriage—a statistic that has not changed, even as coronavirus cases in the U.S. grow, and hospitals are overrun with patients seeking emergency medical care. As a result, many women are now left to navigate the ramifications of this traumatic experience in an environment of overwhelming uncertainty and omnipresent fear.
“Often, it’s helpful for women to get out there and go back to their normal lives after a miscarriage,” says Jennifer Butt, M.D., a Manhattan-based OB-GYN, adding that engaging in simple routines, like going to work, exercising, meeting with friends and family, can help ease the emotional toll of pregnancy loss.
Getting Pregnant After a Miscarriage: What to Know
A first-trimester miscarriage can be asymptomatic, Butt explains. Meaning that you can still feel pregnant (nausea, breast tenderness, tiredness) because the pregnancy hormone is still regulating in your body.
Butt also recommends talking to other women in your life about their own experiences. Because miscarriages are so common, being open about it with others and learning about their experiences can make you feel less isolated.
If you have experienced a first-trimester miscarriage and do feel emotionally and mentally ready to try again, Butt says you can begin as early as when you get your next period. However, if you have had a second-trimester miscarriage, you’ll have to discuss options with your doctor.
The ACOG noted that breech births occur in only 3 to 4% of full-term pregnancies.
Dr. Jennifer Butt is an OB-GYN affiliated with Lenox Hill Hospital in New York City, and she says that there are some risks related to "turning" a baby, specifically to ECV. She says these risks can include: "vaginal bleeding, placental abruption, rupture of amniotic sac, umbilical cord prolapse, fetal distress and non-reassuring heart rate, and stillbirth. Some of these risks may result in the need for an emergency cesarean section." Butt says some women might not be good candidates for ECV, and should discuss it with their doctor.
"Pregnant patients who have a breech baby at term should be properly evaluated, as breech presentation can be due to various causes. There are also contraindications to turning a breech baby, so it is important to discuss with a physician the specifics of one's pregnancy."
How to Navigate Your First Trimester During the COVID-19 Pandemic
"Everyone's prenatal course and history—obstetrics history, medical history, pregnancy history—is going to be different," says Jennifer Butt, M.D., a board-certified OB-GYN practicing in New York City. "Some people may need more frequent appointments in general, while some people are considered 'low-risk.' There are also certain appointments that are time-sensitive. So it's always important to have a conversation with your doctor and to discuss your concerns with them and work something out."
"I think people are concerned and wondering if they need a contingency plan. Questions have shifted from 'Should I travel?' and 'Should I stay home to work?' to concerns about resources, including hospital resources for labor and delivery," says Dr. Butt.
While there's so much information about pregnancy (how many week-by-week pregnancy guides did you read?), and even tons of advice about how to get through labor, we fall short when it comes to information about postpartum care.
"Everyone's story — pregnancy, labor, delivery, postpartum — is different, so try to avoid comparing yourself to others. And for everyone else, be kind, be supportive, and lift one another up," says Dr. Butt.
Fear and anxiety over the results are some of the main reasons people don't get tested more often, and the process itself can leave you feeling embarrassed and just uncomfortable.
"I think these home kits will provide access to some individuals, who for various reasons, may not be able or comfortable going to a doctor's office or clinic to get tested," says Dr. Butt.
"Nothing should replace an actual doctor's visit," says Dr. Butt. "A thorough health history and physical exam are key elements in the evaluation of a problem. Symptoms that might trigger concerns of an STI could actually be something else that would be otherwise be missed."
"In early labor, a woman will typically have mild and irregular contractions that are often not painful," says Butt. "She may have slight pink or bloody discharge or pass her mucus plug. This is normal, and we typically want women in early labor to stay at home unless her water has broken."
Active labor, however, is a different story: "Active labor is when contractions become stronger, regular, and much closer together, causing cervical dilation to progress from 6 to 10 cm. These contractions are typically very painful."
Which Trimester Is the Longest, Explained by Experts
Though each trimester is equal in theory, this breakdown assumes that you carry for at least 40 weeks, which is not always the case; individual pregnancies can be shorter or longer. The shortest trimester is most likely to be the third, however, because some people have their baby before they hit the 40-week. “Depending on if delivery occurs before or after the due date, the length of the third trimester can vary for each patient,” Jennifer Butt, MD, FACOG, tells Romper.
So, if you’re wondering which one will feel the longest, it’s most likely the second. This is probably a good thing because, for many women, "the second trimester can be 'the best trimester'," Butt tells Romper. "The nausea, fatigue, food aversions have most likely resolved by this point and patients are feeling physically better."
Could Telemedicine Be the Future for Women’s Health Care?
“I think the concept of providing medical care through telemedicine for women who otherwise would not have access to health care because of cost is an exciting one,” said Jennifer Butt, a renowned gynecologist at Upper East Side OB/GYN in New York City. “OB/GYNs are often times the only physicians women see and rely on as primary care physicians, so it is important that all women, regardless of medical coverage, can go to an OB/GYN when they need to.”
Why Is Laughing Gas for Labor Still Not the Norm in the U.S.?
Nitrous oxide has long been a go-to labor pain management tactic in countries like Canada, Australia, the United Kingdom, and the rest of Europe, says Jennifer Butt, M.D., FACOG, an ob-gyn at Upper East Side Obstetrics & Gynecology. It was also relatively common in America until the 1970s, when epidurals became commonplace.
“The scientific literature looking at nitrous oxide use for labor pain is poor, so many of the recommendations come from clinician experience and expert opinion,” elaborates Dr. Butt. “The general consensus is that neuraxial anesthesia, like an epidural, is more effective.”
The medication can also make you feel drowsy and disassociated, which isn’t ideal for women who want to stay alert throughout labor and delivery. “There is a dose-dependent relationship such that the more a patient uses it, the more drowsy they can feel,” explains Dr. Butt.
Sorry, This Exfoliating Herbal Stick Won’t Rejuvenate Your Vagina
Anything besides warm water and mild soap can irritate the vagina further, creating an imbalance of the pH levels, explains Jennifer Butt, M.D., a gynecologist and founder of Upper East Side OB/GYN. This seems more of a way to introduce bacteria into your vagina and that can actually cause, not prevent, an imbalance in the vaginal pH and foul-smelling discharge," she says.
As for claims it can restore women to their “former tightness” in just seconds, that's also bogus. As Dr. Butt explains, the idea of a "loose vagina" is largely a myth; the vagina is elastic, which basically means it's able to stretch and withstand different shapes and sizes, both entering and exiting.
Caribbean Says Zika No Longer an Issue. Doctors Say Not So Fast
Curious what everyday practitioners were advising on the heels of WHO’s new messaging, I called my own OB-GYN, Dr. Jennifer Butt, who owns a small private practice on Manhattan’s Upper East Side. “It’s too premature for me to change my recommendations,” she told me, citing that no reputable group—not the Academy of Obstetricians and Gynecologists, not the Society for Maternal and Fetal Medicine, nor the CDC—has changed its stance on Zika.
“The WHO is saying that the disease is less traceable, not that it’s any less of a threat,” she explained. “I would be very hesitant to jump the gun.”