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Managing pain during labor

One of the most common concerns women have during their pregnancy is how to manage pain during labor and delivery.  Labor pain may be more or less intense than you expected, or may hurt in a different way. It is hard to predict how any labor will go or how anyone will respond to pain.

Labor pain is due to contractions of the muscles of the uterus and by pressure on the cervix. This can feel like strong cramping in the abdomen, groin, and back. Some women experience pain in their sides or thighs as well. Women can also feel pressure on the bladder and bowels by the baby's head and the stretching of the birth canal and vagina. Some find the hardest part is not the contraction itself, but the fact that the contractions keep coming.  

One of the best ways to alleviate fears for women is to learn about the available strategies for coping with pain. There are both medical and non-medical tools that may be a good match for you.

While you are deciding, think about what appeals to you most. Ask your health care provider these questions:

If your newborn is diagnosed with hypospadias

As a pediatric urologist, I am frequently asked to consult with parents whose newborn son has hypospadias.  

Hypospadias is usually diagnosed during the physical exam right after the baby is born.  When parents see the abnormal penile anatomy they naturally want to learn about the diagnosis and understand what, if anything, needs to be done. Answering these questions, discussing options, and performing reconstructive surgery to help restore normal penis appearance and function are some of the most rewarding things I do as a pediatric urologist. 

I would like parents who have a son born with hypospadias to be reassured that the anatomy can be reconstructed, the surgery is well tolerated, and a good outcome with a normal, or near normal, penis appearance and function can be achieved.

It is not urgent to treat newborns with hypospadias because they can usually pee (urinate) just fine through their existing urinary opening.

In fact, when hypospadias is the only condition noted in a newborn physical exam there is a low chance of additional developmental abnormalities. Additional tests and studies on the baby are usually not necessary.

It is important to note that if any unusual shape of the penis or urethral opening (where the pee comes out) is present then circumcision (if desired) should not be performed until after the child is examined by a pediatric urologist. This is because the pediatric urologist may need to use the foreskin tissue for the surgical repair. 

Here are answers to some commonly asked questions:  

Lymph nodes in children

One of the most common referrals to my pediatric surgery practice is (in the parents’ words) “to check out this lump and make sure it’s nothing to worry about.”  Lymph nodes are part of the less publicized part of the circulatory system: the lymphatics.  Lymphatics play a key role in our body’s immune system, and lymph nodes grow in response to an infection in the “neighborhood” to produce cells necessary to hopefully resolve the infection. 

About half of all children will develop enlarged lymph nodes (cervical lymphadenitis) in the neck for example, and the vast majority of these are in response to a minor infection in the area (sore throat, sinus infection, ear infection, etc.).  Often the infection is quite subtle and might not be identified.  These nodes typically go through a pattern of growing and then receding in size once the infection resolves.  This process can take several weeks to months.  The nodes may become tender, warm, and there may be some redness of the overlying skin.  Your child might complain of pain in the area, be fussier, have fever, and/or have decreased appetite.  If the node itself becomes infected, it can turn into an abscess and would require antibiotics and a drainage procedure.  Any possibly infected lymph node should be evaluated by your doctor.
 
Some enlarged lymph nodes ...

When do kids need antibiotics?

Winter can seem like one long continuous “sick day” for families - kids pick up frequent infections at school or daycare and pass them around to everyone at home.  Often it feels like by the time the illness has worked its way through the household, a new one has started!  Even for physicians, it can sometimes be difficult to distinguish between viral and bacterial infections.  Since antibiotics cannot treat viruses, they are often over-prescribed - which can lead to significant side effects in children and also contributes bacteria becoming resistant to existing medications.  In November 2013, the American Academy of Pediatrics released an updated guidance regarding antibiotic treatment, helping answer the frequently asked question about when kids need antibiotics.

Here's what you should know about antibiotics in these situations:

  • Ear infections ...

Parent's guide to newborn testing, screening, and prevention measures

When picturing the first days of an infant’s life, what we look forward to the most is love. We express our love in so many ways: skin-to-skin, breastfeeding, swaddling and snuggling. 
 
Love also means keeping them safe. 
 
Advances in maternal-infant health are one of the greatest success stories of the 20th century, with a drop in the death rate of 99%. But some of those dangers only stay in the past through constant vigilance. Behind every screening test and preventive measure is a careful, research-driven rationale. Here are seven newborn tests, screenings, and prevention measures you should know about:
 
Vitamin K injection 
Vitamin K is vital for blood to clot properly. Newborns cannot make Vitamin K and it is poorly transferred in breast milk. Without this injection, babies are at risk for spontaneous bleeding from the umbilical cord, mucus membranes, even in the brain. Giving Vitamin K has greatly reduced this "hemorrhagic disease of the newborn," but rates are increasing as more parents refuse it. Oral Vitamin K has not been shown to prevent this potentially devastating disease. 
 
Hepatitis B vaccine
This is an anti-cancer vaccine. Before this vaccine existed, approximately 10,000 kids under age 10 contracted hepatitis B each year. Most had no known exposure to it. Kids are more likely than adults to get very sick and to have complications. Vaccination at birth has greatly reduced rates of pediatric liver cancer due to hepatitis B. 
 
Antibiotic eye ointment
This prevents bacterial eye infections. Some of these infections are associated with sexually transmitted bacteria, but not all of them are. Negative testing or a monogamous relationship does not ...

Jaundice in newborn babies

As a new parent, you’re understandably eager and excited to leave the hospital and settle into your new routine with your baby. Sometimes, that routine is delayed due to the baby’s blood test confirming hyperbilirubinemia, also known as jaundice.

Jaundice in newborns is caused by an excess of red blood cells. Jaundice is seen as a yellow color to the skin, appearing first at the head (skin and sclera – or “whites of the eyes”) then progressing to the feet. As it decreases, it lessens in reverse. Before birth, the placenta removes bilirubin from the baby’s system; after birth, the baby’s liver takes over. In breast-fed babies, an imbalance between mother’s milk supply and baby’s feeding can lead to a higher-than-expected bili level. In addition to ensuring the baby is feeding well and having enough wet/stool diapers, phototherapy or “bili lights” may be needed. Bili lights help speed up the process by breaking down the bilirubin in the skin.

For phototherapy, your baby will be ...

Why pregnant women should receive flu vaccine and pertussis booster

Why do we recommend that pregnant women receive both the flu vaccine and the pertussis booster during pregnancy? Here are a few reasons:
 
The influenza virus, better known as the flu, has been proven over and over to have the potential to cause serious disease in pregnancy.  That includes an increased risk that when pregnant women “catch” the flu, they may require admission to the intensive care unit, require a ventilator and, less commonly, even death.  It’s serious.   Babies of women who are infected with the flu during pregnancy are more likely to be born prematurely and are at increased risk for stillbirth.

We recommend the flu vaccine at any point in pregnancy and offer the single dose, preservative free vaccine in our office to all pregnant women (with the exception of those who have a medical reason not to get it.)  A common misconception is that the vaccine causes the flu - it does not.  Another misconception is that it is not safe for the developing baby to be exposed to the vaccine itself or the immune response it generates.  There is no evidence to support this fear in almost 50 years of administrating this vaccine and close follow up of those receiving it.

We recommend the flu shot, which is an inactivated virus. The Flumist is a live attenuated virus that is not recommended in pregnancy.

Your family members should also receive the vaccine as they can pass the flu on to a newborn who has not yet gotten the vaccine.  Babies can suffer severe complications if they are infected with the virus before they can receive the vaccine.
 
The other vaccine we recommend during pregnancy is the Tdap booster.  The benefit of the pertussis booster outweighs any perceived risk.  Pertussis, or the whooping cough, is at epidemic levels especially on the west coast including Washington State.  That may be  ...
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