Pregnancy & Childbirth

Welcoming to the world one bundle of joy…make that two bundles… actually three!

Posted on Oct 2, 2020 in Pregnancy & Childbirth, Scroll Images

When Zarmina and Haris Anjum learned they would be having triplets this spring, one of the first things they did was buy an SUV.

“We planned for one, then it was twins, and then two weeks later it was three. It was wonderful and not at all expected,” said Haris. “We joked that we better hold off on having any more ultrasounds.”

Fast forward to this fall.

The Anjum’s were scheduled to deliver at a San Francisco hospital. When that facility experienced a staph outbreak, the family was transferred to nearby Sutter’s California Pacific Medical Center Van Ness campus hospital.

“We were met with such warmth,” said Haris. “It was reassuring to be cared for by such professional doctors and nurses. The facility was phenomenal, and we were relieved there were private NICU rooms.”

Healthy delivery

The Anjum triplets – Yahya, Yakub, and Yusuf – were born at 34 weeks via cesarean section.

“Delivering twins is already fun, but triplets—now that’s super fun,” said obstetrician Ruth Olweny, M.D. “We’re well equipped to handle multiple births at CPMC and having three providers on that night made Zarmina’s delivery seamless. The room setup was mostly the same, too, except that for triplets we have three isolettes on hand (a clear plastic enclosed crib that maintains a warm environment) as opposed to one or two.”

Obstetrician Izumi N. Cabrera, M.D., added, “When the family arrived at CPMC, Haris had a big box of supplies for cord blood blanking.”

Cord blood is the blood from a baby that is left in the umbilical cord and placenta after birth. This blood contains special cells called hematopoietic stem cells that can be “banked” (stored) for later use by the individual and has been used to help treat certain diseases.

“Cord blood collection requires another step during delivery. When you consider that we were doing it for three babies, that means there’s even greater focus from the team. I was pleased we were able to capture the needed material from all three babies’ cords. We were basically a functioning assembly line as each baby was delivered,” said Dr. Cabrera.

Three facts about triplets

They’re rare. In 2018, the Centers for Disease Controls (CDC) and Prevention reported 3,400 triplet births, while there were more than 123,000 twin births. The CDC reported 3,791,712 total births in the U.S. in 2018.

They’re early birds. According to March of Dimes, the majority of triplets are born premature. Most triplets are born between 32-34 weeks of gestation and caesarean section delivery is common.

There’s often a family history of multiple births. The American College of Obstetricians and Gynecologist says that twins are the most common type of multiple births. Heredity on the mother’s side ups a couple’s odds of conceiving fraternal twins.

Settling in at Home

Born in early September, the Anjum triplets are getting stronger and gaining weight by the day.

“All three are wireless now,” chuckles Haris, referring to each baby no longer needing a feeding tube and now breathing room air.

As for what’s next, Zarmina and Haris are taking it one day at a time.

Haris says, “I have the honor of being their chauffeur and continuing to support my wife in her recovery. We’re looking forward to settling in at home and introducing our four-year-old son to his baby brothers. But first I have to conquer these car seats!”

Birth Never Takes a Holiday—Even During a Pandemic

Posted on Sep 24, 2020 in Pregnancy & Childbirth, Scroll Images

Nurse-Midwives Continue to Care for Moms during Pregnancy and Birth

Jessica Nagel, CNM. Photo: Birth Fusion/Jennifer Anderson Birth Photography

Many workers have been sidelined by the pandemic, but for nurse-midwives, life –quite literally— goes on.

“People still need us, pandemic or not,” says Jessica Nagel, a certified nurse-midwife for Sutter Medical Group in Davis.

Midwives the world over embody the caregiving ideals of compassion and calm under pressure. In designating 2020 the International Year of the Nurse and the Midwife, the World Health Organization could not have honored a more appropriate group at this not-so-calm time — nor could the American College of Nurse-Midwives in naming Oct. 4-10 National Midwifery Week.

In the United States, midwifery has evolved haphazardly from an unregulated home practice to the nursing-based model of today, with national standards and professional certifications and licensing similar to those for nurse practitioners. The profession now plays a vital role in the delivery of women’s healthcare, not just during pregnancy but throughout a woman’s life span.

“Midwives have become a valuable part of our care teams,” says Annette Fineberg, M.D., an obstetrician and gynecologist with Sutter Medical Group in Davis. “I’ve learned so much from the midwives I’ve worked with over almost 25 years. The collaboration between midwives and obstetricians is far more than the sum of its parts, and we all benefit.”

When Nagel was a college junior majoring in child development in the early 2000s, midwifery was not on her radar.

“I didn’t know anything about it,” she admits. “But I always enjoyed my classes in pregnancy and prenatal development.”

Recognizing her interests, Nagel pivoted to nursing school, working in a birth center and ultimately training in midwifery through Kentucky-based Frontier Nursing University. In 2009, she joined Sutter Medical Group in Davis, where she provides prenatal care at Sutter Davis Women’s Health Clinic and assists deliveries at Sutter Davis Hospital.

Kristen Ayer, a certified nurse-midwife and obstetrics/gynecology nurse practitioner for Sutter-affiliated Palo Alto Medical Foundation in Santa Cruz, stumbled into midwifery.

Kristen Ayer, CNM

“When I was pregnant with my first son in 1980, I decided to have my baby at home with a midwife and became fascinated with pregnancy and birth, which led to my interest in midwifery as a career,” she says.

Under the guidance of seasoned midwives, Ayer studied normal pregnancy and birth and began apprenticing at home deliveries. After completing an apprenticeship, she decided to go to nursing school to become a certified nurse midwife.

Ayer completed her midwifery education at the University of California, San Francisco, in 1993 and has practiced in Santa Cruz County ever since. She estimates she’s delivered 3,000 to 4,000 babies in her nearly 30-year career.

Ayer and Nagel find their greatest job satisfaction in supporting women.

“The joy in my work is starting with someone who’s scared, and then, after spending time with them, seeing them walk out feeling empowered,” Nagel says. “They feel comfortable and brave and strong.”

Listening is key to that process, Ayer says.

“It’s a tremendous service to listen to women deeply, to connect with them and help them have the kind of delivery they want,” she says. “The value for patients is having someone who’s gentle and thorough and communicates well.”

Midwifery care looks a bit different in the age of COVID-19. Nagel and Ayer can no longer offer in-person group prenatal sessions, where pregnant women and their partners gather to learn and socialize. Ayer says group care and some office visits are transitioning to a virtual platform. Prenatal checkups look different, too.

“Now we do one-on-one checkups just with Mom,” Nagel says. “No more bringing in other kids to listen to the heartbeat, and now the partners are on Facetime in the room. There’s definitely a lot more use of technology and telehealth.”

Pandemic restrictions have produced at least one unexpected blessing. After giving birth, many moms return home feeling less exhausted because they haven’t had the pressure of extra people in the labor room and visitors dropping by later.

“Now, you can have only one healthy support person,” Nagel says. “The one-person rule has created some very intimate experiences for the woman and her partner. Women don’t feel they have to get presentable afterward, and they can both just take their time. They can relax and get to know their baby.”

Learn More about Nurse-Midwife Services at Sutter Health

At many Sutter hospitals, you have the option to choose a certified nurse-midwife. Sutter’s certified nurse-midwives deliver babies and can provide comprehensive prenatal care throughout your pregnancy.

Read on for more information on our certified nurse-midwife services.

Caring for a Newborn in a Pandemic

Posted on Aug 17, 2020 in Pregnancy & Childbirth, Scroll Images

This article was written by Anita Mantha, M.D., pediatrician with the Palo Alto Medical Foundation for the August 2020 issue of Bay Area Parent magazine. 

Raising a newborn has never been easy. Nighttime feedings, coping with your own body’s recovery and the constant worry that comes with keeping your little bundle of joy safe are all part of being a new parent. In the midst of a pandemic, that job may be even more challenging. In the era of COVID-19, how do we keep our newborn baby safe, while enjoying the beautiful journey ahead?

If a mother is suspected or known to have COVID-19, how do doctors care for the newborn?

This is an evolving topic, as we learn more about this virus. Many hospitals are currently testing pregnant women around the time of their delivery for COVID-19. You can check with your obstetrician and the hospital team to find out if and when this test is being done if you have questions.

If you do test positive, do not panic. Hospitals have policies and procedures in place to help keep you and medical staff protected. While your care team may look a bit different than you imagined – gowns, face shields, masks and gloves – they will still work hard to support you during your delivery.

Once your baby is born, your care team will likely recommend that you wear a mask and practice good hand hygiene. Your baby may also be tested. Your care team will likely discuss additional precautions around topics such as physical distancing and feeding. Please remember not to put face coverings on children less than 2 years of age.

Can I still breastfeed my baby if I have COVID-19?

The benefits of breast-feeding have been long documented. One of the benefits is that breastmilk has antibodies that help protect the body against bacteria and viruses, potentially making it all the more important to breast feed your newborn now. In limited studies, COVID-19 has not been detected in breast milk. However, we do not know for sure whether mothers with COVID-19 can spread the virus via breast milk. 

What we do know is that it’s important to practice good hand and breast hygiene while pumping. Also, consider having a caregiver in good health offer bottles of your milk. If you have tested positive for COVID-19, you and your care team can discuss when and how to nurse your baby directly. 

What are the symptoms of COVID-19 in a newborn?

Newborns can have a wide range of symptoms including fever (defined as a temperature greater than 100.4F), poor feeding, being very tired, coughing, congestion, runny nose and/or breathing difficulties. The tricky part about newborns is that these symptoms can be caused by a variety of things, so it is important to discuss any concerns with your care team. The good news is that most children (including newborns born on time) with COVID-19 are asymptomatic or have mild symptoms. Prior to going home with your newborn, consider having a thermometer at home and being comfortable taking a rectal temperature, which is the most accurate temperature reading in newborns. Having your physician’s advice line number on hand is also important in case questions arise.

Can I let family members visit the baby? How do I keep my newborn safe from COVID-19?

Aside from COVID-19, we recommend caution, especially in the first month of life, to prevent your baby from catching an infection. Your newborn has an immature immune system and is at risk for serious bacterial infections. For these reasons, a fever is considered an emergency, and you should seek care for your child right away if it happens.

Now, more than ever, try to limit visitors in the first month of life. Anyone who visits should practice careful hand hygiene, practice physical distancing and wear a mask as much as possible. Please remember, even in the midst of a pandemic, normal newborn concerns still exist: jaundice, weight checks, etc. Please keep all regularly scheduled newborn care appointments and inform your care team if you or your baby are symptomatic prior to these visits so they can determine next steps.

I know moms can go through “baby blues.” Won’t physical distancing only make this feeling of isolation worse?

With all that is going on, it is natural for new mothers to feel as if they are on an emotional roller coaster. The important thing is, even though you may need to physically distance yourself to keep your newborn safe, you do not need to emotionally distance. Make sure to connect virtually with friends and family as much as possible. Connecting with other parent friends via video or phone calls can be helpful as well. La Leche League (llli.org) also provides great support to new parents.

What can I do to help my postpartum worries?

Make sure to take time for yourself and try to maintain a bit of a routine to help feel more balanced. Try to avoid frequently checking the news or social media, as this can lead to more stress. Consider some time for meditation, spending time outdoors or anything else you find enjoyable. Postpartum blues can turn into something more serious such as postpartum depression or anxiety, so please seek help if you are feeling that your mood is making it difficult to function. There are many resources to help, so do not wait to reach out. As things are constantly changing, please check with your healthcare team for updates on the care of newborns in this challenging time. The CDC also offers helpful information here.

Care Team Enables Communication Solution for Laboring Mother Who Relies on Lip Reading

Posted on Jun 16, 2020 in Pregnancy & Childbirth, Scroll Images

SAN FRANCISCO – When the COVID-19 pandemic began, Sutter’s California Pacific Medical Center (CPMC) put strict infection control measures in place to keep patients and staff safe. These measures included temperature screenings, masking and visitor restrictions. But while masks are crucial for slowing the virus’ spread, they can present a communication problem for certain patients. That’s why Sutter Health purchased clear face masks for those people who would have difficulties communicating otherwise.

Karma Quick-Panwala was an expecting mom, who relies on lip reading to communicate. The clear face masks allowed her to see her labor and delivery nurses’ facial cues for reassurance and encouragement.

Technology + Teamwork

“Giving birth during COVID-19 has brought new challenges—but also many opportunities,” said Yuan-Da Fan, M.D., chairman of obstetrics and gynecology at CPMC’s Van Ness campus. “We were determined to find a solution that fit Karma’s need. We wanted communication between Karma and her care team to be as seamless as possible in order to provide the best possible care to her and her baby.”

The solution? Before her due date, Quick-Panwala worked with CPMC’s staff to put into place real-time captioning, also called Communication Access Realtime Translation (CART). CART works by a stenographer translating spoken word into text that then appears in real time on a tablet screen.

When she arrived at CPMC to deliver her baby, Quick-Panwala’s care team called a captioner via the CART service. The captioner listened to the conversations happening in the labor room over speaker phone and translated the speech into text. Nearly instantly, the text appeared on a screen at Quick-Panwala’s bedside.

Seamless Communication

“Thanks to technology, the Internet and iPads, we were able to make it happen so that I could have relatively simultaneous access to speech through all the instructions, questions and answers,” said Quick-Panwala. “From the moment we arrived, everyone [on the care team] knew they needed to put on their clear mask and change the way they communicated a little bit.”

“It’s been a good experience. [The technology] helped my labor and delivery go smoothly because I was able to see, communicate and understand what was taking place in the room. Fortunately, it was a straightforward delivery. Everyone has been absolutely wonderful,” she said.

Axel Panwala arrived happy and healthy on June 10.

“We were happy to make this delivery experience a success for Karma and her husband,” said Dr. Fan. “Our staff were able to adapt to her needs and learn a new piece of patient communication and technology in the process. It was a win for everyone.”

Asit Panwala, Quick-Panwala’s husband, said, “There can be a lot of unpredictability in labor and delivery, so this communication channel was important.”

The San Francisco Chronicle featured Quick-Panwala’s story here: How clear face masks helped a Bay Area mom who’s hard of hearing give birth.

Pregnancy, Birth and COVID-19: What to Expect When You’re Expecting

Posted on Apr 2, 2020 in Pregnancy & Childbirth, Scroll Images

SAN FRANCISCO – Pregnancy can often be filled with a lot of questions. Parents welcoming babies into the world right now face an unusual new set of fears. Health experts are reassuring expectant mothers and answering key concerns about pregnancy amid the COVID-19 pandemic.

“Above everything, we don’t want moms to worry. Our teams are going to take good care of both mom and baby,” says Yuan-Da Fan, M.D., department chair of obstetrics and gynecology at Sutter’s California Pacific Medical Center in San Francisco.

Pregnant mom using digital technology

Pregnancy Best Practices

Common sense hygiene—even when there isn’t a novel coronavirus among us—is the best way to avoid getting sick. Dr. Fan says that precautions are the same for pregnant women. He advises expectant mothers to, “wash your hands for a full 20 seconds as often as possible, and routinely clean and disinfect frequently-touched objects and surfaces.”

Katarina Lannér-Cusin, M.D., administrative director of Women’s Services at Sutter’s Alta Bates Summit Medical Center in Berkeley, encourages pregnant women to “limit in–person social interaction and remain at home to avoid potential exposure to COVID-19.”

“If you’re pregnant and you are experiencing potential COVID-19 symptoms, such as a high fever (greater than 100.3), sore throat and dry cough, contact your primary care physician to see if you should have testing done,” says William Isenberg, M.D., OB-GYN and VP, chief quality and safety officer at Sutter Health.

Preparing for Birth

“Staying positive is the best thing for pregnancy,” says CPMC’s Dr. Fan. Anxiety isn’t good for anyone—but especially expectant mothers. Click here for tips on limiting anxiety from a Sutter mental health expert.

Additionally, pregnant women should engage in frequent communication with your OB-GYN as your pregnancy progresses. Talk to your care team about your options for virtual appointments like video visits through My Health Online as well as taking childbirth classes via online platforms such as YouTube, Zoom, and Skype.

The Big Day Arrives: What to Expect at the Hospital

Labor and delivery units across the Sutter Health not-for-profit network of care are putting measures into place aimed at keeping expectant mothers and their newborns safe. Sutter hospitals have also instituted temperature checks for all visitors and staff before entering any of the facilities.

William M. Gilbert, M.D., regional medical director for women’s services, Sutter Health Valley Region in Sacramento, wants to let all patients know that Sutter is following all recommended procedures to keep our mothers and their babies safe even if this may mean some inconveniences for our families. Limiting numbers of visitors is just one example to help prevent COVID-19 infection.

“This is an unprecedented situation and our top priority is to protect the health of mothers and newborns. So, for safety’s sake, laboring mothers are allowed one support person, such as a spouse or partner, to accompany them to the delivery room and remain postpartum. The support person must be healthy and thoroughly wash their hands,” says Alta Bates Summit’s Dr. Lannér-Cusin. “We’re also encouraging new parents to use technology like FaceTime to connect with friends and family after the baby is born.”

For pregnant moms who have tested positive for COVID-19 or who are considered a “person under investigation” when you go into labor, you’ll likely be placed in a negative pressure room, where the ventilation system is sealed off from the rest of the facility, and physicians and staff wear additional personal protective equipment.

Positive New Research

According to Dr. Fan, who has consulted with colleagues in Wuhan, China, by Skype, early research shows that pregnant women may be at no greater risk for contracting COVID-19 than other healthy adults. In smaller recent studies completed since the outbreak began, Dr. Fan says doctors in China found that no infants born to mothers with COVID-19 tested positive for COVID-19 viral infection. Additional cases showed the virus was not passed to newborns from their mothers’ amniotic fluid or breastmilk (Lancet study here).

Postpartum Support

Giving birth during a pandemic isn’t ideal and it’s important to be realistic about what to expect.

“Consider building your virtual village to keep yourself connected,” says Dr. Isenberg.

After your baby is born, talk to your provider about what appointments can be done virtually—for you and your baby. Explore new ways to connect. For example, if you were preparing to go to ‘mommy and me’ classes after your new baby arrives, you may want to investigate virtual meet-ups up via Google Hangouts with other new moms in your area. Remember, staying connected through a screen is better than total isolation, especially if you were planning on having a family member stay with you during your first few weeks post-partum to help care for you and your new baby.

For more information about COVID-19, please visit Sutter Health’s resources page.