Chance of Miscarriage

I had a miscarriage last year and am afraid of becoming pregnant. What are the chances this will happen again?

Having a miscarriage is a difficult and emotional experience, and despite what I say, it is normal to worry with your next pregnancy. There is a natural guilt, but be reassured, it was not due to something you did or didn’t do, However, having one miscarriage does not increase your risk of another, and your chances of having a healthy baby is excellent. Most doctors do not suggest any special testing after one miscarriage, but your medical history is important. Loosing a pregnancy before 12 weeks is related to a greater chance of genetic problems with later losses, possible incompetent cervix or “weakness” in the lower part of the womb. Seeing a heart beat early in pregnancy is reassuring and can reduce your risk to about10%. My advice for a future pregnancy is to eat right, rest well, get early prenatal care, reduce stress ad stay positive.

How can you tell someone has perinatal depression or just the normal “baby blues”?

One of the happiness events in a woman’s life can so easily turn to depression. About 85% of women suffer from some form of “baby blues” after a delivery, as elation is often compromised with sadness, irritability, frustration, insomnia, mood changes anxiety and despair. These feelings usually go away within two weeks and family support, understanding and assistance is helpful. Another 20% of women have perinatal depression. Symptoms are similar to the “baby blues” but go beyond two weeks and are more severe. Support and sometimes medication is needed. Unfortunately 1% of women will develop postpartum psychosis with destructive behavior and need close medical attention

What do you feel about having a natural delivery vaginally after having had a cesarean section?

Up to 80% of women who are appropriate candidates and choose to have a vaginal birth after a cesarean section (VBAC) will be successful. The American College of Ob/Gyn (ACOG) released its latest recommendations for VBAC in July 2010, and states, “This is a safe and appropriate choice for most women.” In addition they, “emphasize the need for thorough counseling of benefits and risks, shared patient-doctor decision making, and the importance of patient autonomy.” They also stated women with no more than two (before only one was acceptable) previous cesarean sections, a low transverse (horizontal) incision on the uterus, twins, and an unknown scar could still request to have their next pregnancy vaginally. However, there are still concerns. Some hospitals, insurers and physicians do not offer VBAC’s, so do your homework.

There is a risk of a uterine (womb) rupture of about .5% or one out of every 200 women, and can be an emergency, with significant injury to mother and baby. Adequate staff needs to be available that can perform immediately an emergency cesarean Also if you have had a cesarean section and will deliver within 18 months, a repeat cesarean section is recommended. A medication called cytotec be not be used to induce labor. Still many women have had successful VBAC’s, recovered more easily from their delivery and prevented the complications of a surgery. Having a VBAC is still a very reasonable option, if you choose.

They keep saying, “Less is better”. So now I am on a new birth control pill that is suppose to have the lowest dose. Does that mean I have a greater chance of getting pregnant?

In early 2011, LoLoestrin was introduced, a birth control pill with 10 micrograms of the hormone estrogen. Other traditional birth control pills labeled “low dose” contain 20-35 micrograms of estrogen. The pregnancy rates are similar for all the oral birth control pills, usually reported as 1%, but will depend on taking the pills accurately. Recent trends have been towards using less of the hormone estrogen, to reduce the risk of complications, but they can still occur. This includes nausea/vomiting, headache, menstrual abnormalities, weight gain, anxiety, breast tenderness, acne, and depression. More severe problems consist of stroke, heart attacks, or blood clots in the legs or lungs. Always consult your doctor if you develop these symptoms or have pregnancy concerns.

My doctor suggested I have an HIV test. I was insulted because I have been with the same person for 5 years. Do you think I should?

The “Journal of the American Medical Association” (JAMA), estimated in 2006, 56,300 new HIV infections. Of these, about one third were from heterosexual and half from homosexual male relationships. Some of them probably thought they were in monogamous relationships too. Checking for HIV also allows an opportunity to discuss concerns in your sexual history and be checked for other sexually transmitted diseases. I can’t tell you how to make decisions that affect your life. Just that you should always make sure “you” are an important person, and be careful making decisions on trying to figure out what other people are doing.