By the time your baby is 18 months old, he or she should be able to do a variety of new things such as walking and use a spoon.
Jade Elliott spoke with Carrie Martinez, Utah Department of Health, to discuss the important milestones your child should reach by 18 months old and tools to help parents on this episode of the Baby Your Baby Podcast.
Can parents get their baby on back on track on their own, or is this something they need a professional for?
Most of the time, children get the developmental skills they need when they are given opportunities to practice. Parents play a huge role in their child’s development, and often can help their child right away. For example, if your child’s screening showed a delay in language, you help your child right away, just by practicing this area of development.
However, sometimes your child may need professional intervention. In these situations, it’s best to work with your healthcare or childcare provider to get resources or referrals to professional agencies who are trained to help your child reach their developmental milestone needs.
The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.
COVID-19 is a real threat to anybody, including pregnant women. Pregnant women are at an increased risk for severe illness from COVID-19 and death, compared to non-pregnant people. Additionally, pregnant women with COVID-19 might be at increased risk for other adverse outcomes, such as preterm birth (delivering the baby earlier than 37 weeks).
Jade Elliott spoke with Sean Esplin, MD, Sr. Medical Director, Women’s Health, Intermountain Healthcare, to discuss COVID-19 and how it impacts pregnant women on this episode of the Baby Your Baby Podcast.
What is the best way to protect yourself and to help reduce the spread of COVID-19?
Expectant mothers should follow CDC guidelines around mask wearing, social gathering and hand hygiene.
1. Limit interactions with people who might have been exposed to or who might be infected with COVID-19, including people within your household, as much as possible.
2. Take steps to prevent getting COVID-19 when you do interact with others.
3. Wear a mask, especially when you cannot keep distance from other people. Avoid others who are not wearing masks or ask others around you to wear a mask.
4. Stay at least 6 feet away from others outside your household.
5. Wash your hands with soap and water for at least 20 seconds. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.
6. Avoid activities where taking these steps might be difficult.
Why can it be difficult for pregnant women to distinguish between COVID-19 symptoms and pregnancy symptoms?
Pregnant women might confuse COVID-19 symptoms with the more traditional symptoms experienced during pregnancy.
People can have COVID-19 and actually be pretty sick and not know it. They can be unaware of how short of breath they actually are, or how low their oxygen levels are. During pregnancy, it’s really important to keep those oxygen levels high because if mom’s oxygen is low, then the baby’s oxygen level is even lower.
What risks are there for pregnant women if they get COVID-19?
Those with coronavirus are at higher risk for blood clots; so too are pregnant women. That’s why medication is now used to prevent blood clots in pregnant women.
Can COVID-19 affect your unborn baby?
Although the virus doesn’t cross the placenta, and get to the baby, it can get to the interface between the placenta and the lining of the uterus, where it can cause some changes in the blood vessels that changes how much oxygen and food and fluid are getting to the baby across the placenta. It can make it so that the placenta doesn’t really work as well in some women. It can age the placenta. Which may mean some pregnant women with COVID-19 may need to deliver their baby early.
What if I’m pregnant and get exposed to someone with COVID-19?
Get tested. Intermountain Healthcare recommends you get tested seven days after exposure. If someone you live with has COVID-19 have them isolate in a certain area of your home and use a separate bathroom if possible. Wear a mask, social distance and practice good hand hygiene and/or wear gloves when caring for them or handling their dishes or laundry. Have the sick person clean the areas they are using if they are well enough to do so.
What if I have COVID-19 when it’s time to deliver my baby?
Prior to giving birth, Intermountain asks that our patients are tested for COVID-19. This can be done a few days before your due date. Or if you go into labor early or need to be induced early, we can do a rapid COVID-19 test when you arrive at the hospital.
Our hospitals and labor and delivery caregivers are prepared to care for you if you are COVID-19 positive and will help inform you about special precautions that are taken about wearing a mask or personal protective equipment.
What if I have COVID-19 and want to nurse my baby?
Current evidence suggests that breast milk is not likely to spread the virus to babies. You and your healthcare provider can help decide whether and how to start or continue breastfeeding. Breast milk provides protection against many illnesses and is the best source of nutrition for most babies.
If you have COVID-19 and choose to breastfeed follow these guidelines:
Wash your hands before breastfeeding
Wear a mask while breastfeeding and whenever you are within six feet of your baby.
If you have COVID-19 and choose to express breast milk
Use your own breast pump, if possible.
Wear a mask during expression.
Wash your hands with soap and water for at least 20 seconds before touching any pump or bottle parts, and before expressing breast milk.
Follow recommendations for proper pump cleaning after each use. Clean all parts of the pump that come into contact with breast milk.
Consider having a healthy caregiver who does not have COVID-19, is not at increased risk for severe illness from COVID-19, and is living in the same home feed the expressed breast milk to the baby.
Any caregiver feeding the baby should wear a mask when caring for the baby for the entire time you are in isolation and during their own quarantine period after you complete isolation.
How can I keep my newborn baby safe from COVID-19?
Limit visitors to see your new baby
Before allowing or inviting visitors into your home or near your baby, consider the risk of COVID-19 to yourself, your baby, people who live with you, and visitors.
Bringing people who do not live with you into your home can increase the risk of spreading COVID-19. Some people without symptoms can spread the virus.
Limit in-person gatherings and consider other options, like celebrating virtually, for people who want to see your new baby.
If you do plan to have in-person visits, ask guests to stay home if they are sick and ask them to stay six feet away from you and your baby, wear a mask, and wash their hands when visiting your home.
Ask your childcare program about the plans they have in place to protect your baby, family, and their staff from COVID-19.
What are the possible signs and symptoms of COVID-19 infection among babies?
Most babies who test positive for COVID-19 have mild or no symptoms. Severe illness in babies has been reported but appears to be rare. Babies with underlying medical conditions and babies born premature (earlier than 37 weeks) might be at higher risk of severe illness from COVID-19.
Reported signs among newborns with COVID-19 include:
fever
lethargy (being overly tired or inactive)
runny nose
cough
vomiting
diarrhea
poor feeding
increased work of breathing or shallow breathing
If your baby develops symptoms or you think your baby may have been exposed to COVID-19, get in touch with your baby’s healthcare provider within 24 hours and follow steps for caring for children with COVID-19.
If your baby has COVID-19 emergency warning signs (such as trouble breathing), seek emergency care immediately. Call 911.
Where can women go for more information about pregnancy and COVID-19?
The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.
If you’re pregnant, the best thing is to get more information so you can evaluate the risks and benefits of getting or not getting the COVID-19 vaccine. People are worried because we don’t have a lot of experience and data about pregnant women and the type of vaccine being used for the COVID-19 vaccine. Pregnant women want to be careful and might be nervous about the vaccine.
Jade Elliott spoke with Sean Esplin, MD, Sr. Medical Director, Women’s Health, Intermountain Healthcare about the vaccine and what pregnant women should know.
What information can help pregnant women decide if they should get the COVID-19 vaccine?
However, national organizations such as the American College of Obstetrics and Gynecology, the U.S. Centers for Disease Control (CDC) and the Society for Maternal Fetal Medicine recommend that each person consider their own potential risk factors and discuss them with their OB provider. They agree that in most cases there is no reason for pregnant women to not receive the vaccine.
What factors might influence a pregnant woman’s decision to get the COVID-19 vaccine?
You’ll want to evaluate your own risk of contracting COVID-19. Talking with your OB provider can help you further evaluate your risk. You are at higher risk if you have lots of contact with people outside your home. For example, if you are a teacher or healthcare worker. You are also at more risk of getting COVID-19 if you are pregnant and over age 35 or are overweight, or have other medical conditions, or smoke or belong to a minority groups. Generally, the vaccine makes sense for women in those groups.
You’ll also want to look at the rate of COVID-19 in your local community. Our positivity rates in Utah are high right now. Most pregnant women in Utah communities should opt to have the vaccine when it’s available.
When people who are pregnant get COVID-19 they have a slightly higher risk of ending up in the ICU and having a severe case COVID-19. It makes sense to protect yourself. The COVID-19 vaccine is a critical part of how we end this pandemic. We want as many people to get the vaccine as they can.
If you’ve had a severe reaction to another vaccine you’ll want to talk about the risks and benefits of the vaccine with your OB provider.
My patients who are pregnant have a wide spectrum of feelings about the vaccine. Some are biased by misinformation they’ve heard about vaccines. For years, we’ve encouraged pregnant women to take other vaccines, such as for the flu, Tdap, etc.
Were pregnant women included in the U.S. COVID-19 vaccine trials?
About 50 pregnant women were included in the U.S. trials for COVID-19 either because they didn’t know they were pregnant or they became pregnant after getting the first dose of the vaccine. Typically, pregnant women are not included in trials because it adds another variable and that can make it more difficult to separate out the results. The pregnant women in the trials didn’t have any unexpected side effects or problems. The vaccine seemed to work as effectively as in non-pregnant women.
Does it matter what trimester of your pregnancy you are in when you get the vaccine?
There is no evidence that women in their first or second trimester are at higher risk if they get the vaccine. It is OK to get pregnant after getting vaccine.
What type of vaccine is the COVID-19 vaccine? And how does it work?
This is an MRNA vaccine. Some other types of vaccines are made with a virus that has been killed. The COVID-19 vaccine contains pieces of MRNA, which is basically a recipe for making a protein. It is a very effective way to do a vaccine. It should be safe in pregnancy. It won’t cross the placenta or change MRNA code. It should protect both mom and baby.
Will pregnant women who get the vaccine be studied?
Future studies of the COVID-19 vaccine will include pregnant women. National registries are keeping track of data on pregnant women. We recommend pregnant women now be included in these trials and they continue to collect data.
What about the side effects of the COVID-19 vaccine?
If you get the vaccine, there will be side effects. That’s normal and expected and it’s a sign the vaccine is working. Side effects include a sore arm, body aches, fever, fatigue, headache. The vaccines currently available are 95 percent effective if you get both doses. The efficacy is much more pronounced after the second dose. Be sure to get the second dose.
If you get the vaccine do you still need to wear a mask and practice social distancing and good hand hygiene?
Yes. Getting the vaccine means you have a lower chance of getting the virus, but you can still get the virus. Getting the vaccine also means if you get the virus, your case is likely to be milder than if you didn’t get the vaccine. So wearing masks and practicing social distancing and good hand hygiene will further reduce your risk of getting COVID-19 and other viruses such as the flu or colds as well.
What are the medical experts recommending for pregnant women?
There are different recommendations from different organizations.
National organizations such as the American College of Obstetrics and Gynecology, the U.S. Centers for Disease Control (CDC) and the Society for Maternal Fetal Medicine recommend each person consider their own potential risk factors and discuss them with their OB provider. They agree in most cases there is no reason for pregnant women to not receive the vaccine.
However, the World Health Organization recently announced it is not recommending the vaccine for pregnant women unless they are at high risk of exposure to COVID-19, for example if they are a healthcare worker.
However, in response to the WHO recommendation, ACOG and SMFM issued a joint statement yesterday affirming their guidance that both COVID-19 vaccines currently authorized in the U.S. should not be withheld from pregnant individuals who choose to receive the vaccine.
The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.
By the time your baby is 12 months old, he or she should be able to do a variety of new things such as saying a few simple words and playing games.
Jade Elliott spoke with Carrie Martinez, Utah Department of Health, to discuss the important milestones your child should reach by 12 months old and tools to help parents on this episode of the Baby Your Baby Podcast.
Social and Emotional
Is shy or nervous with strangers
Cries when mom or dad leaves
Has favorite things and people
Shows fear in some situations
Hands you a book when he wants to hear a story
Repeats sounds or actions to get attention
Puts out arm or leg to help with dressing
Plays games such as “peek-a-boo” and “pat-a-cake”
Language/Communication
Responds to simple spoken requests
Uses simple gestures, like shaking head “no” or waving “bye-bye”
Makes sounds with changes in tone (sounds more like speech)
Says “mama” and “dada” and exclamations like “uh-oh!”
Tries to say words you say
Cognitive (learning, thinking, problem-solving)
Explores things in different ways, like shaking, banging, throwing
Finds hidden things easily
Looks at the right picture or thing when it’s named Copies gestures
Starts to use things correctly; for example, drinks from a cup, brushes hair
Bangs two things together
Puts things in a container, takes things out of a container
Lets things go without help
Pokes with index (pointer) finger
Follows simple directions like “pick up the toy
Movement/Physical Development
Gets to a sitting position without help
Pulls up to stand, walks holding on to furniture (“cruising”)
May take a few steps without holding on
May stand alone
What do you do if your baby is not meeting these milestones?
Can parents get their baby on back on track on their own, or is this something they need a professional for?
Most of the time, children get the developmental skills they need when they are given opportunities to practice. Parents play a huge role in their child’s development, and often can help their child right away. For example, if your child’s screening showed a delay in language, you help your child right away, just by practicing this area of development.
However, sometimes your child may need professional intervention. In these situations, it’s best to work with your healthcare or childcare provider to get resources or referrals to professional agencies who are trained to help your child reach their developmental milestone needs.
The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.
By the time your baby is six months old, he or she should be able to do a variety of new things such as rolling over and recognize faces.
Jade Elliott spoke with Carrie Martinez, Utah Department of Health, to discuss the important milestones your child should reach by six months old and tools to help parents on this episode of the Baby Your Baby Podcast.
Social and emotional
Knows familiar faces and begins to know if someone is a stranger
Likes to play with others, especially parents
Responds to other people’s emotions and often seems happy
Likes to look at self in a mirror
Language and communication
Responds to sounds by making sounds
Strings vowels together when babbling (“ah,” “eh,” “oh”) and likes taking turns with parent while making sounds
Responds to own name
Makes sounds to show joy and displeasure
Begins to say consonant sounds (jabbering with “m,” “b”)
Cognitive (learning, thinking, problem-solving)
Looks around at things nearby
Brings things to mouth
Shows curiosity about things and tries to get things that are out of reach
Begins to pass things from one hand to the other
Movement and physical development
Rolls over in both directions (front to back, back to front)
Begins to sit without support
When standing, supports weight on legs and might bounce
Rocks back and forth, sometimes crawling backward before moving forward
What do you do if your baby is not meeting these milestones?
Can parents get their baby on back on track on their own, or is this something they need a professional for?
Most of the time, children get the developmental skills they need when they are given opportunities to practice. Parents play a huge role in their child’s development, and often can help their child right away. For example, if your child’s screening showed a delay in language, you help your child right away, just by practicing this area of development.
However, sometimes your child may need professional intervention. In these situations, it’s best to work with your healthcare or childcare provider to get resources or referrals to professional agencies who are trained to help your child reach their developmental milestone needs.
The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.
You may not be thinking about preparing your baby for school when he or she is still in diapers, but the Early Childhood Utah Program at the Utah Department of Health, says that making sure your baby meets developmental milestones helps get your baby ready for success throughout his or her lifetime. The Department of Health recommends a screening tool, called the Ages and Stages Questionnaire, to help parents and caregivers make sure your baby is right on track.
Jade Elliott spoke with Carrie Martinez, Utah Department of Health, to discuss the questionnaire and how it helps parents.
What is the Ages and Stages Questionnaire?
The Ages and Stages Questionnaire (often called the ASQ) is an evidenced-based screening tool parents or caregivers use to make sure your baby is developing all of the skills needed to be on track when he or she starts school. This can let parents know where their child is at developmentally and gives parents important information to help make the best decisions for their child.
The ASQ is made up of 2 different screening tools. Each tool has about 30 questions and takes 20-30 minutes. The first screening tool helps parents understand whether or not their baby meets developmental milestones and the other looks at your baby’s social and emotional development.
The first screening tool looks at the following developmental milestones:
Gross motor
Fine motor
Communication (both expressive and receptive)
Adaptive behaviors
Personal and social development
The second screening tool looks at a child’s social emotional development. Social and emotional screenings look at things that tell you whether your baby is interacting like he or she should in social situations.
The core features of emotional development include:
The ability to identify and understand your own feelings
Accurately read and comprehend others’ emotions
The ability to manage strong emotions and if you’re able t express them in a constructive way
Regulating (or controlling) your own behavior
Developing empathy for others
Establishing and maintaining relationships
What are Developmental milestones?
Developmental milestones are foundational skills your baby needs in order to do other things later in life. For example, your baby has to be able to master certain movements before he or she can walk. The American Association of Pediatrics has screening recommendations and developmental milestones for children up to 6 years old. These recommendations let parents know when their child should get screened and skills he or she should have at each age.
They recommend screening at:
6, 12, 18 and 25 months (2 years)
And then at and then 3, 4, and 5 years old
How often can parents use the screening tool?
Parents can screen on a regular basis with their child, any time from one month to 6 years. You can do the screening more than once because children develop at such a rapid rate.
Parents also have different needs at different stages of a child’s development. For example, you may be very comfortable and at ease about parenting your new infant but may need additional information when your child becomes a toddler and wants more independence.
Why would a parent want to use the ASQ screening tool?
You know your baby best.
Early Childhood Utah, healthcare providers, teachers, and ASQ recognize that you as a parent are the true expert on your child’s development. ASQ’s parent-completed screening tool uses the in-depth knowledge that families provide.
It’s family friendly.
Parents love being active partners in screening. The tool is easy to use and the fun learning activities are the perfect way for families to help children make developmental progress.
It is important to trust your parental instincts and to advocate for your child. If you have concerns about your child’s development, you can check with your Local Health Department, WIC offices, Early Intervention agency, Home Visiting Program, Local Medical Provider, Early Childhood Educator and Utah Department of Health.
If you feel like you need assistance, ask one of these providers for a referral.
Caregivers, teachers, and pediatricians also love using the screening tool. It validates parental involvement and knowledge of their child. This helps to strengthen the home to school or pediatrician relationship.
Where can I get an ASQ screening done for my child?
You can reach out to your caregiver, pediatrician, teacher, or Early Childhood Utah to help you find a resource or program in your area that uses the Ages and Stages Questionnaire.
Utah has many resources for parents who may have concerns about their child’s development:
Your local health department and WIC offices
Early Intervention agency
Home visiting program
Your pediatrician, doctor, or a local medical provider
An early childhood educator
The Utah Department of Health.
Anyone who is in early care and education, medical, or is a healthcare provider can get ASQ training for FREE:
If you are a child care provider, early care and education teacher, or a medical or health professional and are interested in using the screening tool within your program, please reach out to Carrie Martinez at the Utah Department of Health carriemartinez@utah.gov , or visit the Early Childhood Utah websitehttps://earlychildhoodutah.utah.gov/ for more information.
For more information about important developmental milestones, visit CDC’s website.
The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.
It’s an exciting time when you first get the results from a pregnancy test and find out you’re pregnant. Most pregnancies are normal, but during those first few weeks it’s not that uncommon to experience a miscarriage. Such news can be devastating.
Jade Elliott spoke with Dr. Jessica Page, a maternal fetal medicine physician with Intermountain Healthcare who specializes in managing high risk pregnancies and has researched and studied miscarriage, to answer some questions about miscarriage.
What is a miscarriage? What is the typical time frame when it occurs?
A miscarriage is the common term for an early pregnancy loss, or one that typically occurs during the first trimester at 12 weeks or earlier.
How common are miscarriages?
The percentage of pregnancies that end in miscarriage varies a bit, depending on if you’re taking into consideration women who had a positive pregnancy test, and then had pregnancy loss, it is about 10 percent. If you look at pregnancies that haven’t been confirmed by a test, that result in loss, the numbers may be as high as 30 percent.
What are the causes of miscarriage?
Generally it’s due to the genetics of the fetus. Other causes can be due to autoimmune conditions, uterine malformations or other underlying health conditions of the mother, that she may or may not be aware of.
Do women sometimes feel a miscarriage is their fault?
In the vast majority of cases, a miscarriage is not something a woman could have prevented or that could be intervened upon. You may have factors or conditions that you didn’t know about prior to attempting pregnancy. As maternal fetal medicine specialists, we work to optimize the underlying health conditions of pregnant women. If you have a chronic condition, it’s best to have a consultation with your doctor or a specialist before getting pregnant or early in your pregnancy.
Are there ways to reduce your risk of miscarriage?
There are no guarantees, but these general practices can help you have a healthier pregnancy.
Avoid all alcohol, tobacco products, illicit street drugs, and over-the-counter, prescriptions, and herbal remedies that haven’t been recommended by your OB provider
Keep your prenatal appointments with your doctor or midwife.
Take your prenatal vitamins.
Stay up to date on your immunizations
Why do some women experience more than one miscarriage and some experience none?
Most of the time we don’t know why women experience repeated miscarriages. Recurrent losses could be due to genetics or malformations or underlying health conditions. Risk factors for miscarriage include maternal age and history of prior miscarriage. In general for women aged 20-30 years the risk is about 10-15% but rises to about 20% at age 35 and 40% at age 40.
If you’ve had one miscarriage are you more likely to have another?
While one miscarriage does increase the risk of another one occurring, most women will go on to have a positive outcome. Even those women who experience multiple miscarriages that are idiopathic (or without a known cause), about 70 percent of them go on to conceive. And about 75 percent of those pregnancies result in a live birth.
What are the signs and symptoms of miscarriage?
Some miscarriages occur without any symptoms. The most common symptoms are bleeding and cramping. If you experience either of those, call your doctor.
Should you see a doctor after a miscarriage? Is treatment needed?
If you experience a miscarriage, reach out to your doctor. In some cases, the miscarriage may not have completely passed. Some women may need medications or surgery to complete the miscarriage.
How soon can you try to get pregnant again?
After you’ve talked with your doctor to address any medical needs and as soon as you and your partner feel emotionally ready, you can try to get pregnant again.
How can women recover emotionally after a miscarriage?
Even though miscarriage is common, when it happens to you, it is significant. You need to grieve that loss and reach out for social and family support. Give yourself time to go through the grieving process. Talking with other moms who have experienced miscarriage can help.
How does miscarriage affect your partner or family?
A miscarriage can place stress on your partner and the rest of your family as well. Each person may feel a sense of emotional loss. Families should offer support and help each other through the loss and not place blame. Sometimes your partner may feel powerless. But tell them that just their companionship and emotional support is key. Be mindful of the emotions or anxiety that can occur as you approach the anniversary of a previous loss or a new pregnancy. Talk to your doctor about your history and your loss, so he or she can closely monitor your subsequent pregnancy.
How might the COVID-19 pandemic magnify some of the feelings experienced after miscarriage?
We find support in being around others. The pandemic has been very isolating, because we’ve reduced the interaction we have with friends and family to help protect each other from the virus. Utilize resources around you and those in your household. Reach out virtually to friends and family. Take it easy on yourself. Take one step at a time.
You may experience a variety of emotions from denial to anger to sadness, to depression to acceptance. If your feelings of depression and sadness are affecting your ability to function or are long-lasting, talk with your doctor. A referral for counseling or other treatment may help.
What type of behavioral health resources are available?
Intermountain Emotional Health Relief Hotline number is 1-833-442-2211.
This free general emotional support hotline was started during the COVID-19 pandemic and can be reached seven days a week from 10 am to 10 pm. It connects callers with a trained care coordinator who can provide appropriate self-care tools, peer support, treatment options, crisis resources, and more.
Intermountain Walk-In Behavioral Health Access Centers
Intermountain LDS Hospital in Salt Lake, McKay Dee Hospital in Ogden and Dixie Regional Medical Center in St. George offer walk-in general behavioral health access centers that are open 24 hours. Check with other Intermountain behavioral health locations to see if they have urgent appointments available.
The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.
Losing a baby late in your pregnancy is devastating. Understanding why fetal demise sometimes occurs is a complex topic that continues to be studied.
Jade Elliott spoke with Dr. Jessica Page, a maternal fetal medicine specialist with Intermountain Healthcare who cares for patients with high risk pregnancies and has studied stillbirths, to discuss what we do and don’t know about stillbirths.
What is a stillbirth? How is it different from a miscarriage?
Stillbirth is defined as fetal death at or after 20 weeks of gestation. Miscarriages refer to pregnancy at 12 weeks or earlier. Early fetal losses (those between 13 and 19 weeks) are sometimes managed similarly to stillbirths.
How common are stillbirths?
Stillbirths are less common than miscarriage. In the U.S., stillbirths happen in about 6 per 1000 pregnancies. It doesn’t sound like a lot, but each loss is devastating, and it happens more often than it should. In the U.S. we continue to study the issue, learn more and work to improve.
What causes stillbirth?
It’s often hard to know the precise cause, as there can sometimes be more than one potential condition and it can be difficult to assign causality. One of the most common potential causes of stillbirth is placental insufficiency. This refers to situations in which the placenta doesn’t work well to provide the fetus with blood and oxygen. This can be due to maternal medical conditions, disruptions such as placental abruption or umbilical cord occlusion. Sometimes preterm labor prior to fetal viability (about 24 weeks) occurs and leads to stillbirth.
What tests can help determine the cause of the stillbirth and why are they important for women and their families?
Identifying a potential cause of death after a stillbirth can help families achieve emotional closure, and can help providers better manage that woman’s future pregnancies. Additionally, better identification of potential causes of death improves our ability to prevent and better understand stillbirth.
As OB providers it is important for us to deliver compassionate and clear information about what tests are most likely to identify a potential cause of death. Families often need time to consider their options and it is helpful to given them multiple chances to ask questions and process the information.
Types of exams and tests
The most useful tests for identifying a potential cause of death are fetal autopsy and placental pathology. Fetal autopsy is an exam of the baby. This can be a difficult topic for patients emotionally and it is important for providers to explain the options and high yield of this exam. The patient can spend as much time as desired with the baby prior to the exam and following the exam, and the incisions are easily hidden with normal baby clothes. This gives families the option to have funeral services or other memorials as desired. There are also options for less invasive exams which may include an external exam only or imaging with MRI. Autopsy can identify fetal anatomic abnormalities, evidence of infection or other pathologic processes leading to the death.
Placental pathology is a detailed microscopic examination of the placenta and umbilical cord. This is very useful for understanding if placental abnormalities or damage led to the stillbirth.
We also recommend genetic evaluation and testing for antiphospholipid syndrome in cases of stillbirth. If abnormal results are found, this may affect management of future pregnancies.
How do these tests help aid in research and help other women?
Understanding causes of stillbirths enables us to better identify targets for prevention of stillbirth and to characterize those pregnancies at the highest risk.
Why are stillbirths especially difficult emotionally?
Pregnancy loss at any point is difficult, but particularly as pregnancy progresses it can be emotionally devastating. It’s important to take time and space for families to grieve. Creating mementoes are helpful for many families as they navigate this grieving process.
How do labor and delivery nurses, OBs and midwives help provide comfort to mothers who experience a stillbirth?
Labor and delivery staff are experienced in all aspects of childbirth, from the joys in celebrating a new birth to comforting those who experience loss. A lot of it is meeting the patient where she and her partner are at that moment and providing the emotional support they need during their grief process. During a difficult time such as this, it’s common not to internalize all the information and details. Giving patients time and opportunity to ask questions and to acknowledge the loss of their child is especially important.
What are Cuddle Cots and how do they help families spend more time with their baby?
Many Intermountain hospitals have Cuddle Cots available, which are basically a special bassinet that provides some refrigeration for a baby who has passed away, which allows the family to spend more time with the baby they’ve lost, before rigor mortis or stiffness of the body sets in. Often they are donated by another family who has experienced a loss. We give patients as long as they want with the baby. We don’t limit that at all. Having the mementoes and support from other moms is also really helpful.
What else should women know about stillbirths?
While rare, it affects more families than you think. It’s important to recognize the role of that child in that family’s life. Just acknowledging the baby and supporting the family and listening without making judgments or commentary are what are often most helpful.
How might the COVID-19 pandemic magnify some of the feelings experienced after a stillbirth?
We find support in being around others. The pandemic has been very isolating, because we’ve reduced the interaction we have with friends and family to help protect each other from the virus. I tell patients to utilize the resources around them and those in their household. Reach out virtually to friends and family. Take it easy on yourself. Take one step at a time.
You may experience a variety of emotions from denial to anger to sadness, to depression to acceptance. If your feelings of depression and sadness are affecting your ability to function or are long-lasting, talk with your doctor. A referral for counseling or other treatment may help.
During the pandemic the numbers of support people allowed in the hospital may be limited. The hospital staff also provides experienced support. Some families may connect virtually with those not present and staff can assist.
What type of behavioral health resources are available?
Intermountain’s Angel Watch Program offers support for women experiencing pregnancy loss.
Women experiencing stillbirth can reach out to Intermountain’s Angel Watch program that offers support for women experiencing fetal demise. The program is staffed by master’s level social workers, nurses, bereavement specialists and chaplains who are available on-call to provide counseling specific to this type of loss, through in-home or virtual visits. The service is free and available to anyone, not just Intermountain patients. For more information call, 801-698-4486 or visit: https://intermountainhealthcare.org/services/women-newborn/resources/angel-watch/
To listen to the Baby Your Baby Podcast about the Angel Watch Program, click here.
Intermountain Emotional Health Relief Hotline number is 1-833-442-2211.
This free general emotional support hotline was started during the COVID-19 pandemic and can be reached seven days a week from 10 am to 10 pm. It connects callers with a trained care coordinator who can provide appropriate self-care tools, peer support, treatment options, crisis resources, and more.
Intermountain Walk-In Behavioral Health Access Centers
If depression or anxiety persists and you don’t have a mental health provider there are some walk in services available.
Intermountain LDS Hospital in Salt Lake, McKay Dee Hospital in Ogden and Dixie Regional Medical Center in St. George offer walk-in general behavioral health access centers that are open 24 hours. Check with other Intermountain behavioral health locations to see if they have urgent appointments available.
The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.
What if you have diabetes or high blood pressure or an autoimmune disease like lupus or rheumatoid arthritis and you want to get pregnant? Or what if you become pregnant and have one of those chronic conditions?
If so, you probably have lots of questions. Jade Elliott spoke with Dr. Helen Feltovich, a maternal fetal medicine physician with Intermountain Healthcare who manages high-risk pregnancies, to discuss chronic conditions.
How common are chronic conditions among pregnant women?
The most common chronic conditions among American women are overweight/obesity (>50%), pregestational (type 1 or 2) diabetes (1-2%), high blood pressure (1-1.5%), and, less commonly, autoimmune diseases like lupus or rheumatoid arthritis.
What should women who have a chronic condition know and do before they get pregnant?
If you have a chronic condition, including obesity it’s best to get a pre-pregnancy consultation with a maternal fetal medicine specialist if you want to get pregnant. If you’re already pregnant and have a chronic condition, see a specialist as early as possible in your pregnancy, since that will lead to better outcomes for you and your baby.
How can maternal fetal medicine specialists help pregnant women who have these conditions?
Women with medical conditions that put them at increased pregnancy risks usually are managed by both high-risk pregnancy specialists and their regular obstetric provider. Every woman and every pregnancy is different. Sometimes a pregnant patient will see her high-risk obstetrician just once during a pregnancy, to design a management plan for monitoring her and her fetus. Other times she will be co-managed, which means she’ll see both her high-risk and regular provider throughout her whole pregnancy, for instance if she needs specialized tests like Doppler ultrasound or interventions like in-utero surgery.
Can chronic conditions affect your pregnancy or the baby?
Yes. It depends on the type of chronic condition. That’s why it’s so important to see a maternal fetal medicine specialist.
Why is it important to manage diabetes during pregnancy?
Having diabetes during pregnancy can lead to increased risks or complications for the mom or baby. When moms have diabetes, their babies are more likely to have a larger than normal birthweight, which can lead to delivery complications. Their babies are also at increased risk for birth defects, stillbirths, respiratory distress and low blood sugar.
For pregnant moms, most complications occur in women who have diabetes before they are pregnant. Pregnant women with diabetes are at increased risk for high blood pressure or preeclampsia, as well as preterm birth, cesarean delivery and other problems.
What are the signs of diabetes?
Excessive thirst.
Frequent urination.
Extreme hunger.
Unexplained weight loss.
Fatigue.
Irritability.
Blurred vision.
Presence of ketones in the urine (can be detected through lab tests)
What’s the difference between Type 1 and Type 2 diabetes and gestational diabetes?
They are different in terms of risk factors and onset. Type 1 or 2 diabetes is pregestational, or diabetes that exists before pregnancy. Pregnancy can complicate diabetes in these women, and outcomes are closely tied to degree of glucose control during pregnancy.
Gestational diabetes is defined as a new onset of diabetes that occurs during pregnancy. However, some women diagnosed with gestational diabetes actually have undiagnosed pre-gestational type 2 diabetes. Like type 1 and type 2 diabetes, outcomes are closely tied to the degree of glucose control. This is part of why it’s important to learn what is in your genes and understand your health before you get pregnant.
Why is it important to manage high blood pressure during pregnancy?
Complications can include:
Preeclampsia, when high blood pressure can lead to organ damage in the mother.
A stroke due to very high blood pressure.
Decreased blood flow to the placenta can lead to baby receiving less oxygen and fewer nutrients, causing low birth weight or premature birth.
Why does obesity add risk to your pregnancy?
Obesity is defined as a body mass index (BMI) over 30, and BMI over 40 in particular, poses risk to a pregnancy. Fetal complications include a higher chance of miscarriage, birth defects, abnormal fetal growth (usually overgrowth), abnormal fluid (usually too much fluid), and rarely, stillbirth. Preterm birth is more likely in obese women, either spontaneously or medically-indicated because of maternal complications such as gestational hypertension or preeclampsia, or gestational diabetes with poor glucose control.
What advice would you give to women who are obese and either want to get pregnant or are already pregnant?
A good diet and exercise plan are always key elements to a healthy pregnancy. Before pregnancy, obese women can optimize their pregnancy outcomes by losing weight to reach an ideal body weight. Obese pregnant women can also optimize outcomes by following a healthy diet and exercise plan. Although we typically associate healthy pregnancy with weight gain, depending on a patient’s BMI, it may be best for her to gain little weight.
Why is it important to manage your autoimmune disease during pregnancy?
Most of the time, women with autoimmune disorders can expect a normal pregnancy. However, some serious problems like fetal growth restriction or even stillbirth can occur, depending upon a patient’s exact diagnosis and disease control. Also, sometimes medications have to be adjusted before pregnancy if they aren’t safe for the fetus. Patients with well-controlled disease before pregnancy do best during pregnancy. So, it’s important to have a plan, ideally before pregnancy.
Are there some chronic conditions, where women actually feel better when they’re pregnant than when they’re not?
About one third of patients with autoimmune diseases report feeling better while pregnant, and one third report no change and another third feel worse or have a first episode during pregnancy. This is probably because of the natural steroid production that occurs during pregnancy.
Are there any chronic conditions where getting pregnant is not recommended?
Rarely, a high-risk obstetrician might advise against pregnancy, for instance, in women with antiphospholipid syndrome and history of recurrent blood clots, or severe pulmonary hypertension, or certain kinds of heart problems. That doesn’t happen often, but anticipating serious problems is one reason to contact your high-risk obstetrician before becoming pregnant.
Keep in mind most pregnancies and births are normal
If you have a chronic medical condition, it’s important to meet with your doctor early, ideally before you are pregnant, to develop a management plan. This helps you and your healthcare team to optimize your situation for the best possible outcome for you and your baby.
And search for high risk pregnancy or maternal fetal medicine.
The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.
Predicting when your baby will be born and whether she’ll arrive early, on time or late has been a mystery since the time of Hippocrates, the ancient Greek physician known as the father of medicine, who developed the Hippocratic Oath, still accepted by physicians today. Medical experts in 2020 are still trying to solve the mystery to predict whether the timing of your baby’s delivery will be preterm, at term or post-term.
Jade Elliott spoke with Dr. Helen Feltovich, a maternal fetal medicine OB/Gyn and associate professor at Intermountain Healthcare who manages high-risk pregnancies to shed some light on the mystery of the possible causes of preterm birth.
What is the definition of preterm birth?
Babies born at 37 weeks or later are considered at term. For babies born before 37 weeks, the earlier they are born, the more likely they are to have health issues. So, we categorize preemies into these general categories.
Babies born between:
34-37 weeks are considered late preterm
34 or 32 weeks are considered early preterm
26-28 weeks are considered very early preterm
Does preterm birth just happen on its own or are there reasons why it would be recommended for a mom to give birth before 37 weeks?
Preterm birth can be either medically-indicated (because continuing pregnancy is not safe for the mother, baby or both) or spontaneous (labor happens on its own). Currently, at least 2/3 of preterm births are spontaneous, and, while we do know some factors increase the risk of preterm birth, most preterm births actually have no biological explanation. Unfortunately, by the time labor is happening, we have no therapies at all that can stop it.
Why is it so difficult for physicians to predict preterm birth?
While physicians have various ways to try to guess at when a baby will deliver, like how long or dilated the cervix is, none of these work well, even during labor itself, to predict when a baby will be born. Preterm birth is particularly vexing to OB/Gyn caregivers because of its potentially serious health consequences to the newborn.
What are some of the challenges in preventing preterm birth?
Preventing preterm birth is even more challenging because we have only two basic approaches, that have been around since about the 1950-1960s and they both have limits in their effectiveness. One of these approaches is progesterone (hormone) supplementation, which although it’s been tried in various formulations and doses, prevents preterm delivery less than half of the time.
The other approach is mechanical support of the cervix by cerclage (basically stitching a purse-string around the cervix), which prevents preterm birth less than half of the time.
Although these therapies don’t work all the time, they certainly work some of the time in the right patients. So, it’s very important to see a high-risk pregnancy specialist, ideally before pregnancy, to discuss which approaches might be appropriate for the next pregnancy.
This lack of overall progress seems astonishing, but it’s because preterm birth is so complex, and there are so many factors that come into play, and so many different pathways.
What are some of the possible risk factors that may lead to preterm birth?
Studies show the two strongest risk factors for preterm birth are:
History of PTB, and
Short cervix during your current pregnancy
Other risk factors include:
Infection or inflammation
(There are many different types of infections or causes of “sterile” or non-infectious inflammation. Some studies have shown that COVID-19 increases the risk of preterm birth).
Smoking or substance abuse during pregnancy
Short time between pregnancies (less than 18 months)
Expecting multiples, twins, triplets, etc. 50 percent of twins come early.
Vaginal bleeding
Abnormal shape of the uterus
Maternal and fetal stress (probable, difficult to measure/prove)
What about stress – how does that have an impact?
Stress is a very difficult thing to measure, because there is physiological stress, psychological stress, and a combination of the two and they do all kinds of things in a person’s body. That said, it is becoming increasingly clear that social determinants of health that are associated with both physiological and psychological stressors (like education, income level, ancestry, race or ethnicity, access to healthcare, social support, etc. can change preterm birth risk.
The COVID-19 pandemic is highlighting this, because in some countries (like the Netherlands), the rate of preterm birth has decreased among higher income women, thought perhaps due to less stress because of working from home, etc, while in the U.S. (where we do not have widespread governmental support for income maintenance, or universal healthcare), the CDC data suggests an increased risk of preterm birth. This is an extremely complex issue, which affects an extremely complex and multifactorial outcome (preterm birth), but this pandemic is showing us new ways to look at potential contributors to and solutions for preterm birth.
What kinds of symptoms of preterm labor should a woman call her doctor about?
Call your obstetric provider right away if you notice any of these signs or symptoms:
Change in type of vaginal discharge (watery, mucus, or bloody)
Increase in amount of discharge
Pelvic or lower abdominal pressure
Constant low, dull backache
Mild abdominal cramps, with or without diarrhea
Regular or frequent contractions or uterine tightening, often painless
Ruptured membranes (your water breaks with a gush or a trickle of fluid)
See a specialist if you have a history of preterm birth or complications in your pregnancy
If you have had a preterm birth in the past, it’s important to see a high-risk pregnancy specialist, ideally before you become pregnant, to discuss your particular situation and the types of strategies to decrease your risk of recurrent preterm birth.
What does the future look like for preventing preterm birth?
We need to think about preterm birth not as a diagnosis, but rather one possible outcome of a variety of different causes and processes. We need to follow the successful path of our cancer colleagues.
Before the 1950s, “cancer” was considered a singular diagnosis, and treated similarly with surgery, chemotherapy and radiation, no matter where or how it occurred in the body. But today, through the use of imaging biomarkers like those identified with PET or CT scanning combined with fluid biomarkers found in blood or urine or the tumor itself, we understand that there are thousands of different types of cancers, and the approach to treating them should be individualized to a specific tumor in a specific patient at a specific point in time.
This involves understanding the internal (for example, genetic) and external (for example, environmental stressors) environment of a person. This is called precision (or personalized) medicine, and it’s why now the previously unthinkable has become true – some cancers are curable!
Could understanding a patient’s genetics and environmental factors help doctors determine what might help prevent preterm birth in a certain patient?
This is where we are slowly starting to go with preterm birth.
One of our maternal fetal medicine doctors at Intermountain, Dr. Sean Esplin, recently led a nationwide study looking at an imaging biomarker (length of cervix measured by ultrasound) and fluid biomarker (presence of fetal fibronectin in the vagina) related to preterm birth. More than 9000 women were evaluated, and the study showed that even the combination of these two biomarkers did not effectively predict preterm birth.
However, more importantly, it told us we need more, and better, imaging and fluid biomarkers to direct their therapies. What will happen from further investigations is we will have many more biomarkers so we can develop new therapies and target them to a particular person in a particular pregnancy. When we are able to do that, we will undoubtedly have the same sort of success as our oncology colleagues – and the previously unthinkable will happen – a cure!
Decades ago, nobody thought cancer would actually be curable, but today we know that several cancers are actually curable, or at least can be managed as chronic diseases. This is where we can go with the problem of preterm birth!
The Baby Your Baby program provides many resources for all pregnant women and new moms in Utah. There is also expert advice from the Utah Department of Health and Intermountain Healthcare that air each week on KUTV 2News.
