Women with Disabilities -The Healthcare Team- Part 2

Interviewing the Doctor

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Here are some questions you may wish to ask:

What are the pros and cons of pregnancy for me?

If the doctor is opposed, ask why?

What do you know about my disability, and what access do you have regarding it?

Do you have experience with the pregnancy and delivery of babies with disabled women? How much?

In what way will you be working with my regular doctor?

If there are unusual symptoms that arise, who should I call if I am not sure if those symptoms are pregnancy or disability related?

How will labor and delivery be affected by my disability?

Will there be a need for treatments that differ from the usual types, due to my disability, and how will we get the cooperation of the hospital for those treatments?

Do you think I may need a caesarian section? Why? Would you set a date, or wait for labor to begin spontaneously?

Can I get a referral for genetic counseling?

The physical exam

Besides the questions suggested previously, the examination is also another time to decide on the doctor who will tend to your care. How the doctor behaves during the examination and time taken to let you know what he/she is doing in that exam will assist in your final decision.

Does the doctor ask you questions during the exam? Are you treated with sensitivety and consideration? Are the questions the doctor is asking relative to your level of sensation, mobility, and flexibility? Regarding your comfort?

The doctor’s partners

If the doctor has partners or a physician that they use when they are not available, you will need to schedule an appointment with them on one of your regular visits, as early as possible. See if they also are “on board” and will be responsive to your needs and care.

You will need to feel comfortable with any one of these doctors, in case they are the one in delivery with you. It would be much more comfortable to have a familiar face, and know if they also will support your needs.

Sexually Transmitted Infections – Part 2

Gonorrhea

Gonorrhea is exclusively transmitted sexually, genital-to-genital contact; but can also be transmitted oral-to-genital or anal-to-genital. In females the disease can spread from the genitals to the rectal area. It can be spread to the newborn in the form of ophthalmia neonatorum through vaginal birth.

AGE is the most important factor. Statistically, sexually active teens, young adults, and African Americans are at the highest risk. The majority of those who have contracted this disease are under the age of 20.

Girls who are prepubescent the two most common symptoms is vaginitis and vulvitis. There may be signs of infection, or vaginal discharge, dysuria and swollen, reddened labia.

The factor of concern, most adolescent females show no signs or symptoms. When they DO have symptoms they are less pronounced than those of men. In women there may be some cervical discharge, but usually it is minimal of lacking altogether. Irregularity of the menses may be the presenting symptom or complaints of pain within the pelvis.

In rectal gonorrhea, the symptoms may not be asymptomatic or the opposite with severe discharge, pain and blood in the stool. There may be rectal itching, fullness, pressure, and pain…as well as diarrhea.

Since Gonorrhea is a highly transmittable disease all recent partners (30-days prior) should be reported, cultured, and examined. Most treatment failures occur due to reinfection.

Screening and Diagnosis

All pregnant women should be screened at the first appointment. Those women with risky behaviors indicated, should be re-screened at 36 weeks. The screening is done through “cultures”.

Management

45% of those women who are found to have Gonorrhea also have Chlamydia. For both pregnant and non-pregnant women, the treatment should be cefixime in a single dose.

All women with co-existing syphilis infections should be treated as for syphilis. Penicillin is the preferred drug for treatment. The alternative (especially for those allergic to penicillin) is Doxycycline, Tetracycline, and erythromycin. Tetracycline and Doxycycline are contraindicated in pregnant.

Morning Sickness

MORNING SICKNESS

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The experience of morning sickness differs with each woman, and each pregnancy. It is thought that the term comes from when it generally starts, in the morning. When in actuality it can start and end at any time of the day. It can range from a mild discomfort, to constant vomiting and nausea for the first trimester or longer. It generally can begin at around 6 weeks and last until the 14 week.

Triggers:

  • Empty stomach, low blood sugar (hypoglycemia), hunger.
  • Strong smells
  • Hormonal surges and imbalances
  • The normal pregnancy-related changes in the digestive system
  • Oily foods
  • Very sweet, sugary foods (which could include fruits).
  • Vitamin and/or mineral deficiencies
  • Lack of exercise
  • Fatigue
  • Constipation
  • Ambivalence or anxiety about the pregnancy

Normally, morning sickness is not a problem. But, it may be uncomfortable at times. Severe morning sickness with excessive vomiting may be a problem in that that dehydration and severe malnutrition may occur. In such instances a person should go to the hospital for rehydration with intravenous fluids. Note: medications prescribed for morning sickness have not proven to be safe for the fetus.

What can be done to lessen morning sickness:

  • Exercise. A lack of cardiovascular stimulation can make nausea more unmanageable.
  • Get plenty of rest, use relaxing herbs, and ask for help if you are fatigued.
  • Ambivalence about being pregnant can cause internal tension that may make it worse. Feeling guilty over the emotions is not helpful, so acknowledge what you feel and release negative thinking. Talk about it with someone.

Recommendations for your Diet:

  • Small, more frequent meals that are full of carbohydrates and protein
  • If you awaken in the middle of the night it may be that you actually are hungry. Try a snack before bed, and maybe one during the night.
  • Always carry with you nutritious food, especially if you are hypoglycemic. Hypoglycemia can cause not only nausea, but also could cause dizziness, headaches, hot flashes /followed by cold sweats, anxiety, and fainting.
  • Even if you think drinking fluids, especially water, makes the nausea worse…drink plenty of it. Dehydration can cause even more problems!
  • Chose foods that are prepared by steaming, water-saute-ing, or baking. Fried or oily foods are harder to digest!
  • Instead of sweets for quick-fuel food, eat complex carbohydrates (see nutrition hand-out).
  • Consider taking a vitamin/mineral supplement in case you have deficiencies in these areas as the cause of nausea.

HERBALS:

  • Ginger root, grate one teaspoon of fresh ginger root in one cup of boiling water, cover and steep for 10 minutes. Try to drink without sweeteners.
  • Suck on ginger flavored hard candies or crystalized ginger.
  • Any herbs of the mint family will help, including Ceyaka.

Source:
Romm, Aviva Jill. (2003)The Natural Pregnancy Book: herbs, nutrition, and other holistic choices. Celestial Arts.

 

* Next topic coming up: Prenatal Tests (Other than the usual blood-panel, etc)