Maternal Health Awareness, The 4th Trimester, Know The Warning Signs
Guest
: Linda Neiswender, DO
From the Show: UPMC Pinnacle
While the maternal mortality rate is high in the United States, actions are being taken to reduce that rate. Dr. Linda Neiswender, OB/GYN at UPMC Obstetrics and Gynecology Specialists- Hanover, discusses what contributes to these rates and how to reduce maternal mortality rates.
Transcription:
Caitlin White (Host): More women die from pregnancy complications in the United States than in any other developed country in the world. Despite advances in medicine and medical technologies, the United States saw a 26% increase in the death rate of expectant mothers from the year 2000 to the year 2014. According to a 2016 report from America’s Health Rankings, based on Centers for Disease Control National Vital Statistics System Data; Pennsylvania ranks 21st in the nation in maternal death rates. Pennsylvania established Maternal Health Awareness Day in 2019 to highlight this problem and the work being done to improve maternal health across Pennsylvania.
Today, we’ll talk about these statistics with Dr. Linda Neiswender. She’s been a practicing OBGYN for 31 years and works at UPMC Obstetrics and Gynecology Specialists Hanover. This is Healthier You, a podcast from UPMC Pinnacle. I’m Caitlin White. Dr. Neiswender, let’s start with a question most listeners probably have right now. Why is the maternal mortality rate higher in the US than in other countries?
Linda Neiswender, DO (Guest): So, I don’t have a clear understanding as to why the US is so high morbidity and mortality wise. With that said, when we’ve looked at the World Health Organization data on especially deaths, a lot of it is associated with number one is hemorrhage and then of course it is followed by other things such as preexisting comorbidities, medical conditions the preceded the pregnancy and followed by hypertensive disorders, maybe some type of sepsis or infection, pulmonary emboli and other morbidities that include homicidal, suicidal, anesthetic, or even trauma. So, I want to stop for a minute.
So, in the United States, we have access to healthcare and there seems to be some discrepancies and that can be related to socioeconomic reasons and or ethnicities. So, we have this melting pot. Healthcare might be more accessible to some groups of people versus others. And it also can be not just related to the finance of it but just what’s available in their rural region. Do they take advantage of the healthcare that’s available? Is there compliance with the healthcare available? Also on both ends of the spectrum, we have unplanned pregnancies so we have the teenager who comes in or belatedly comes in, comes in with care that’s in the third trimester and things that could have been addressed earlier had not been and then on the other end of the spectrum is more and more women put off having a pregnancy until after the age of 35. As we advance in age especially in the pregnant state, we are setting ourselves up for conditions that can be related to pregnancy induced problems such as diabetes, and more importantly hypertensive disorders.
Many times for the woman that is advanced in age with her first pregnancy or subsequent pregnancies; maybe she never even was aware that she had underlying comorbidities related to diabetes and or hypertensive disorders. And again, hypertensive disorders is one of our number one condition associated with some of the diseases and morbidities that we see in pregnancy. So, again, we are not scoring high, but I understand we are 21st in the world as far as maternal morbidity mortality and it’s a tough one. It’s all those things I just said. Because there is good care in the state. It’s just a matter of are patients taking advantage of it. Do they have access to it? Is it available to them? Where are they located? What is their financial situation? What is their ethnicity? And what’s their educational level?
Host: So, it sounds like there’s quite a range of issues that factor into pregnancy complications. Let’s break down some terminology up front here. What is the fourth trimester?
Dr. Neiswender: So, the post delivery period. So the postpartum period. In a textbook, we might say to week six. But there is discrepancies in how we want to define the post delivery period. And honestly, it could be as long as a year. So, by week twelve, three months out; we are referring to that as our fourth trimester and we need to pay attention to our wellbeing in that period of time.
Host: What are some signs and symptoms that women may experience in that fourth trimester both medical and emotional?
Dr. Neiswender: First of all, having a baby is a normal process and so with that said, we need to pay attention to anything that seems away from that. Something that is changing in your disposition whether it be physically and or emotionally. So, the things we’re watching for in that postpartum period, that fourth trimester; is there a change in if you have a history of headaches, is there a change in the quality of that headache. Is there a new onset of a headache? Shortness of breath? Is there new onset of dyspnea, shortness of breath associated with just tasks that you could do very comfortably in the pregnant state, pre-pregnancy but now you are uncomfortable with. A new onset of a cough. Temperature elevations, chest pain, lower extremity edema, swelling.
So, these are the things that might be away from the norm that need to be addressed. And that means picking up the phone and calling your obstetrician and finding out is this okay. Regarding emotional wellbeing, most women day two, three after baby is born can experience the baby blues. But there needs to be resolution of that typically by day 10 to 14. So, if the baby blues is extending out beyond day 10 to 14; it’s important to pick up the phone. Postpartum depression is real in pregnancy and it complicates mommy care and it compromises baby care. And there is an association with suicide and it’s real important to pick up the phone if baby blues continue after 10 to 14 days.
And baby blues, we’re talking beyond just that adapting, the transition of being home now with a new baby. We’re talking about you don’t want to get out of bed. You don’t want to do personal care for yourself or the baby. You’re sad. You’re tearful. You stop eating. You want to sleep. That’s not normal. That’s a telephone call.
Host: You listed a bunch of things that are phone calls to your doctor but when should you even take that next level and call 9-1-1 or directly go to a hospital?
Dr. Neiswender: Suicidal ideations, homicidal ideation, chest pain that is severe, a headache that is the worst you’ve ever experienced, bleeding as in soaking pads and temperature elevation that you cant get to the hospital without assistance.
Host: So, wrapping up here, this could be seen as a lot of negative information. How do we reassure women who are thinking about getting pregnant or are currently pregnant?
Dr. Neiswender: Yeah, thank you for that question. Because I began this by saying, pregnancy is a normal state. We are in a process. Our bodies are designed to adapt to the process of a pregnancy and the postpartum period. So, honestly, I mean patients do exceptionally well and they care for themselves and their baby in a happy way. So, a patient is paying attention to something that is changing, that’s a deviation from what is your norm and something that’s a new onset. And the likeliness of that happening can happen, but the majority of pregnancies have good outcomes.
Host: Well thank you for your time and for the information today Dr. Neiswender. It’s always good to be prepared when it comes to something that can potentially be so complicated like the birth process. That was Dr. Linda Neiswender OBGYN at UPMC Obstetrics and Gynecology Specialists Hanover. Visit www.upmcpinnacle.com/4thtrimester, that 4-T-H trimester to find more information about what we discussed today and remember Pennsylvania’s maternal health awareness day is Thursday January 23. If you enjoyed this episode, make sure to check out our full podcast library for episodes that may interest you and be sure to share them on your social channels. This is Healthier You, a podcast from UPMC Pinnacle. I’m Caitlin White. Thank you for listening.
Caitlin White (Host): More women die from pregnancy complications in the United States than in any other developed country in the world. Despite advances in medicine and medical technologies, the United States saw a 26% increase in the death rate of expectant mothers from the year 2000 to the year 2014. According to a 2016 report from America’s Health Rankings, based on Centers for Disease Control National Vital Statistics System Data; Pennsylvania ranks 21st in the nation in maternal death rates. Pennsylvania established Maternal Health Awareness Day in 2019 to highlight this problem and the work being done to improve maternal health across Pennsylvania.
Today, we’ll talk about these statistics with Dr. Linda Neiswender. She’s been a practicing OBGYN for 31 years and works at UPMC Obstetrics and Gynecology Specialists Hanover. This is Healthier You, a podcast from UPMC Pinnacle. I’m Caitlin White. Dr. Neiswender, let’s start with a question most listeners probably have right now. Why is the maternal mortality rate higher in the US than in other countries?
Linda Neiswender, DO (Guest): So, I don’t have a clear understanding as to why the US is so high morbidity and mortality wise. With that said, when we’ve looked at the World Health Organization data on especially deaths, a lot of it is associated with number one is hemorrhage and then of course it is followed by other things such as preexisting comorbidities, medical conditions the preceded the pregnancy and followed by hypertensive disorders, maybe some type of sepsis or infection, pulmonary emboli and other morbidities that include homicidal, suicidal, anesthetic, or even trauma. So, I want to stop for a minute.
So, in the United States, we have access to healthcare and there seems to be some discrepancies and that can be related to socioeconomic reasons and or ethnicities. So, we have this melting pot. Healthcare might be more accessible to some groups of people versus others. And it also can be not just related to the finance of it but just what’s available in their rural region. Do they take advantage of the healthcare that’s available? Is there compliance with the healthcare available? Also on both ends of the spectrum, we have unplanned pregnancies so we have the teenager who comes in or belatedly comes in, comes in with care that’s in the third trimester and things that could have been addressed earlier had not been and then on the other end of the spectrum is more and more women put off having a pregnancy until after the age of 35. As we advance in age especially in the pregnant state, we are setting ourselves up for conditions that can be related to pregnancy induced problems such as diabetes, and more importantly hypertensive disorders.
Many times for the woman that is advanced in age with her first pregnancy or subsequent pregnancies; maybe she never even was aware that she had underlying comorbidities related to diabetes and or hypertensive disorders. And again, hypertensive disorders is one of our number one condition associated with some of the diseases and morbidities that we see in pregnancy. So, again, we are not scoring high, but I understand we are 21st in the world as far as maternal morbidity mortality and it’s a tough one. It’s all those things I just said. Because there is good care in the state. It’s just a matter of are patients taking advantage of it. Do they have access to it? Is it available to them? Where are they located? What is their financial situation? What is their ethnicity? And what’s their educational level?
Host: So, it sounds like there’s quite a range of issues that factor into pregnancy complications. Let’s break down some terminology up front here. What is the fourth trimester?
Dr. Neiswender: So, the post delivery period. So the postpartum period. In a textbook, we might say to week six. But there is discrepancies in how we want to define the post delivery period. And honestly, it could be as long as a year. So, by week twelve, three months out; we are referring to that as our fourth trimester and we need to pay attention to our wellbeing in that period of time.
Host: What are some signs and symptoms that women may experience in that fourth trimester both medical and emotional?
Dr. Neiswender: First of all, having a baby is a normal process and so with that said, we need to pay attention to anything that seems away from that. Something that is changing in your disposition whether it be physically and or emotionally. So, the things we’re watching for in that postpartum period, that fourth trimester; is there a change in if you have a history of headaches, is there a change in the quality of that headache. Is there a new onset of a headache? Shortness of breath? Is there new onset of dyspnea, shortness of breath associated with just tasks that you could do very comfortably in the pregnant state, pre-pregnancy but now you are uncomfortable with. A new onset of a cough. Temperature elevations, chest pain, lower extremity edema, swelling.
So, these are the things that might be away from the norm that need to be addressed. And that means picking up the phone and calling your obstetrician and finding out is this okay. Regarding emotional wellbeing, most women day two, three after baby is born can experience the baby blues. But there needs to be resolution of that typically by day 10 to 14. So, if the baby blues is extending out beyond day 10 to 14; it’s important to pick up the phone. Postpartum depression is real in pregnancy and it complicates mommy care and it compromises baby care. And there is an association with suicide and it’s real important to pick up the phone if baby blues continue after 10 to 14 days.
And baby blues, we’re talking beyond just that adapting, the transition of being home now with a new baby. We’re talking about you don’t want to get out of bed. You don’t want to do personal care for yourself or the baby. You’re sad. You’re tearful. You stop eating. You want to sleep. That’s not normal. That’s a telephone call.
Host: You listed a bunch of things that are phone calls to your doctor but when should you even take that next level and call 9-1-1 or directly go to a hospital?
Dr. Neiswender: Suicidal ideations, homicidal ideation, chest pain that is severe, a headache that is the worst you’ve ever experienced, bleeding as in soaking pads and temperature elevation that you cant get to the hospital without assistance.
Host: So, wrapping up here, this could be seen as a lot of negative information. How do we reassure women who are thinking about getting pregnant or are currently pregnant?
Dr. Neiswender: Yeah, thank you for that question. Because I began this by saying, pregnancy is a normal state. We are in a process. Our bodies are designed to adapt to the process of a pregnancy and the postpartum period. So, honestly, I mean patients do exceptionally well and they care for themselves and their baby in a happy way. So, a patient is paying attention to something that is changing, that’s a deviation from what is your norm and something that’s a new onset. And the likeliness of that happening can happen, but the majority of pregnancies have good outcomes.
Host: Well thank you for your time and for the information today Dr. Neiswender. It’s always good to be prepared when it comes to something that can potentially be so complicated like the birth process. That was Dr. Linda Neiswender OBGYN at UPMC Obstetrics and Gynecology Specialists Hanover. Visit www.upmcpinnacle.com/4thtrimester, that 4-T-H trimester to find more information about what we discussed today and remember Pennsylvania’s maternal health awareness day is Thursday January 23. If you enjoyed this episode, make sure to check out our full podcast library for episodes that may interest you and be sure to share them on your social channels. This is Healthier You, a podcast from UPMC Pinnacle. I’m Caitlin White. Thank you for listening.
