Dispelling OB Myths

1. Dispelling OB Myths Martha J. Brewer, MD Associate Professor Department of Obstetrics and Gynecology University of Arkansas for Medical Sciences Little Rock, AR

2. Objectives • learn some of the prevalent folk wisdom regarding pregnancy • start to think about the origins or basis • start to think about the hidden messages • consider using these folkways as an educational tool

3. Dispelling OB Myths or how to convince the patient that grandma’s not always right

4. OB Myth a fictitious or false notion about some aspect of pregnancy often of popular belief passed down by relatives, friends and acquaintances

5. Qualities of OB Myths • benign • entertaining • can be dangerous • can interfere with medical care • can create educational opportunities

6. Why don’t they die out? • usually partially based on truth • difficult or impossible to disprove • a way to cope with a scary mystery or to justify personal distress • fun and entertaining • conversation starters • many like to have someone to blame if something goes wrong

7. a few OB Myths • don’t dye your hair • don’t eat cabbage or _______ • herbal therapy is safe • don’t paint the baby’s room (or anything) • __________ will make you go into labor • cocaine makes labor easier • don’t use the microwave

8. MYTH The seat belt will hurt the baby if I’m in a car wreck

9. real story • part of a popular rationalization not to wear seat belts at all • everyone knows someone who “would have died if they had had a seat belt on” • the police, EMTs, nurses and doctors all know better

10. FACT Seat belts save lives both mamas and babies

11. THEY DON’T KNOW • The most common cause of fetal death from a car wreck is death of the mother in that same car wreck • So, save the baby by saving the mother • Wear your seat belt -- ALWAYS

12. MYTH I can’t go to the dentist while I’m pregnant

13. Mythlets • Teeth and gums are a long way apart from the baby, so they don’t affect each other • Mom can wait to deal with her tooth or gum issues after she delivers • My gums are already bleeding, I’m scared of the dentist, it will hurt--they probably can’t use painkillers because of the pregnancy

14. FACT there is a strong correlation between untreated peridontal disease and low birth weight and preterm labor and preterm delivery

15. Take Home Message • Dental check-ups are very important, especially if you are pregnant • Dental check-ups and dental/gum treatments eventually will become part of the strategy to reduce preterm labor and its sequelae

16. MYTH lose a tooth per child

17. FACT • a study published in Lancet confirmed this in a population of Swedes long ago • main thing the study showed was a much stronger correlation between lower socio-economic levels and tooth loss than between number of pregnancies and tooth loss

18. WE ALSO KNOW • The origin of this myth predates modern dentistry • No such association exists in other populations

19. MYTH Lower heart rate means it’s a boy, higher a girl

20. We know • Fetal heart rates are extremely variable in the short tern and in the long term

21. the gentle approach • benign, entertaining, who cares • useful as a way to engage family members in the pregnancy • totally obsolete since we now know the sex of the baby by routine ultrasound

22. Gambling tips: • Always bet it’s a boy • Bet often • Statistics are on your side

23. MYTH Carrying low or out front means it’s a boy

24. Facts Maternal abdominal appearance • maternal habitus • maternal posture • maternal abdominal muscle tone • maternal uterine tone • gravidity • position of the fetus • maternal weight

25. the gentle approach • benign, entertaining, who cares • useful as a way to engage family members in the pregnancy • totally obsolete since we now know the sex of the baby by routine ultrasound

26. MYTH If you have a lot of heartburn, the baby will have a lot of hair

27. FACTS • most pregnant women have heartburn • most babies have some hair • so it’s all relative anyway

28. We Think • there is no known relationship between the amount of birth hair and mom’s GI tract • heartburn is frequently a signal that you are eating too much or too badly

29. MYTH Eat more because you are eating for two

30. Truth Eat more if you want to look like you are two

31. Facts • the actual increased caloric requirement of pregnancy depends on the size of the fetus at the time • is between 150 and 300 calories per day • Quality is much more important than quantity

32. MYTH Raise your arms above your head and risk strangling the baby

33. Where did this come from? • probably based on observations of nuchal cord or true knots on some stillborns • nuchal cord loops at the time of delivery are very, very common • Sets the stage to blame the mother for a bad outcome

34. Truth • No maternal position is known to predispose to nuchal cords or other abnormalities • This sort of thinking should be strongly discouraged as not only unscientific but mean. This is your chance to become the mother’s advocate.

35. MYTH You should sleep only on your left side when you are pregnant

36. Science Based • Maternal cardiac output (and therefore uterine perfusion) is diminished in the supine position once the uterus is in the abdomen • Diminished cardiac output is secondary to diminished venous return to the heart because of compression of the vena cava as it courses up the right side of the abdomen • So, lying on the left side decompresses the vena cava

37. Truth • Patients seem to worry about this a lot • Lying on either maternal side restores cardiac output and relieves the vaso-vagal symptoms of dizziness and nausea

38. MYTH Pregnant women should not take a bath

39. Similar Mythlets • washing your hair after a birth is dangerous • bathing or showering after a birth is dangerous • swimming when pregnant is dangerous

40. Where did this come from? • fear of getting water in the vagina • fear of infection in the uterus • fear of pneumonia • danger of leaving the baby alone • ? effective contraception postpartum?

41. Facts • Cleanliness is good for everyone in the family • Water does not “get up in” the vagina • Soaking in the tub or going swimming should increase cardiac output at least as well as lying on the left side • Floating in water relieves the relentless effects of gravity on pregnant women

42. MYTH Having passionate sex will make you go into labor

43. QUESTION Would this be a good thing or a bad thing?

44. or is it ? Having passionate sex will make you go into labor (or hurt the baby?)

45. It’s a mismatch • many men are afraid to have sex with their very pregnant wives/girlfriends—body issues, afraid of pregnancy, ACTUALLY AFRAID OF HITTING THE BABY • many very pregnant women really want to have sex—body image issues, hormones, need for closeness/support/love • this is a good opportunity to talk about lots of issues

46. THE SCIENCE • theoretically the prostaglandins in the male ejaculate could initiate labor • fortunately the term uterus is much more sensitive to low levels of prostaglandins than is the preterm uterus

47. FUTURE RESEARCH • Previous studies have investigated the role of membrane stripping in the initiation of labor • Why not this one?