Week 8: Miscarriage Fears

Download The Week 8 Podcast
6.20 MB 8:49 Min


This is your Pea in the Podcast for week eight of your pregnancy. I'm Bonnie Petrie joined by Dr. Laurie Swaim, an obstetrician from Houston Women's Care Associates in Houston, Texas.

Welcome to week eight and at eight weeks your bean is the size of a lima bean, a lima bean with a very large head, but a lima bean. The paddles it had for arms last week well this week you'll be able to make out elbows, webbed fingers and toes appear too. Your baby's face becomes recognizable this week as a face and nerve cells begin to connect in the brain forming the ground work for the ability to communicate. Now your uterus started out the size of a plum, now it's the size of a grapefruit. With all that expansion some of you may still be panicking over the crampiness that comes with it. Dr. Swaim says you can call your doctor any time you're scared. This is what she tells her patients, "Now if you wake up in the middle of the night, you have a little spotting and you're not having any pain and you know that your pregnancy is in your uterus, you can wait until morning to call your doctor but you can also call in the middle of the night too if you want, but that would be okay to wait. Reasons you should call your doctor right away are bleeding and pain. If you are bleeding and saturating a pad in an hour, then you need to call, most women will call if they're having severe pain too."

Now some women may still miscarry even though the miscarriage rate dropped 10% when you saw the heartbeat. Dr. Swaim says even early in your pregnancy a miscarriage can be devastating, "Some women actually we suggest counseling; not that day but if it's sort of still lingering. Spoke to someone just the other day who it's been four weeks and she's having a very tough time with it and so we have some mental health professionals who are very helpful and trying to figure out why, why it was so difficult for this person. Obviously it's a sad event but there may have been some underlying issues with the family or the patient that people don't know about. Some women may require medication if they really get to the point where they need medication for depression after a miscarriage then it's my preference to send them to a mental health professional."

Now some women want to try again right away, Dr. Swaim says that might be okay. "I think it's a myth that you have to wait this three month period, we usually advise that you just have one period but there are some people maybe who need some further evaluation. If it was your third miscarriage, for example, then you might not want to get pregnant right away until there are some laboratory studies done. If there was something that happened in DNC that precludes you getting pregnant for a little while. But for otherwise healthy women who had an uncomplicated miscarriage, I just have them wait a month, keep taking their vitamins and go for it. And specifically women who are older, they just have a limited number of eggs left; you want to use them." But it's highly likely your cramping is just the normal uterine growth that's accompanying your thickening waistline. Now your jeans may feel a little snug now and more than a little snug if this is your second baby or beyond but you're still not showing really and your snug jeans can just be your little happy secret if that's what you want.

Now if you're on regular medication, hopefully you've already talked to your doctor about it but there are ailments that will come up during pregnancy and you'll probably wonder if you can take something for it. Many moms to be think you can't take anything, that's not true. Dr. Swaim says medications are divided into categories to help you understand what's safe for your baby and what's not. The first category is category A. "Category A is safe. It's your prenatal vitamin (which is safe only at the dose you are taking, extra is not better necessarily in pregnancy). So vitamins, Tylenol that kind of stuff." So category A drugs have undergone several well controlled studies that found no harmful effects or increase in birth defects. "So category A would be those drugs that have had extensive testing with no adverse effects on a human fetus, period. Category B comes close." Now the difference between drugs assigned category A and category B status are B drugs are not likely to pose a threat to the fetus from the evidence in animal studies but unlike A drugs no well controlled studies have been performed in pregnant women. Now the next category is, surprise, category C, "Category C are drugs that may have some risk in pregnancy but in general, depending on the disease, the benefits of taking it out weigh the risks. Every single antibiotic for example, not every single but the ones that are commonly used during pregnancy, are likely category C drugs: penicillin, gentamicin, those kinds of antibiotics." Now category D medications are drugs which have caused, are suspected to have caused, or may be expected to cause an increased incidence of malformations, defects, or irreversible damage in a baby but a doctor may still encourage you to take one depending on your specific situation. It's a benefit/risk assessment. Say for example a mom has cancer and needs her chemotherapeutic agents. Well the benefit of taking the drug will probably outweigh the risk to the baby, that's something that you and your doctor need to sort out. Now there's one group of drugs that many women at reproductive age are taking and their status right now is changing, they're SSRIs, antidepressant drugs like paxil, "Paxil recently changed to category D which means you cannot use it and we'll see what happens with the others. And the reason for this is risk of anomalies but also third hemisphere exposures are associated with fetal withdrawal syndrome. That sometimes just means the baby's a little jittery but let's say that's fairly easy to overcome, but there have been some babies that have had frank seizures."

Now there are reports of birth defects with these drugs as well so if you take an antidepressant you need to talk to your doctor. Dr. Swaim says together you can do that risk and benefit analysis, "You know some women take this because they have real depression and they cannot function throughout the day without taking a medication. Those women, we know we'll discuss this with their physicians and their psychiatrist, need to continue taking it. But there are some women who quite frankly take it because they feel better and if that's the case then it's not the best time in their life to necessarily take it." Dr. Swaim says there are moms-to-be who are very uncomfortable going off antidepressants, "I think this is where it's also important to involve mental health professionals because as OBGYNs we don't have the training to decide who has true depression and who doesn't. For individuals who really feel like they need to be treated during pregnancy it may be a good idea to have them evaluated by a psychiatrist as well." And after that evaluation despite the risks now associated with this group of antidepressants some moms will need to take their medicine throughout pregnancy. "Depression and anxiety are real diseases and real disorders just like diabetes and hypertension and if they are significant then it is always better to treat the mom. You know if mom can't take care of herself then the baby's not going to do well."

The uncertainties surrounding SSRIs is presenting challenges for both moms-to-be and the doctors trying to give them the best care possible before and after the baby comes. "It's sort of a double edged sword because some of those women who have depression will be at the greatest risk for postpartum depression. These medicines do not work over night so we used to think we were smart and we'd give them to women when they're 36, 37 weeks: 'start taking them, they'll be working by the time you deliver' and now that's something we're mostly avoiding: to give it to someone the second they deliver since it's not going to work reliably for a couple of weeks." So if this is you, this is something you'll probably talk to your doctor about several times during your pregnancy.

Oh there's one more drug category beyond category D, it's category X. With category X drugs, the risks of taking them almost certainly outweigh the benefits. You will not be taking any of these drugs during your pregnancy. For a link for more information on the FDA drug safety for pregnancy category chart, go to our website Peainthepodcast.com.

Well here you are, eight weeks pregnant, you have 32 weeks to go until week 40.

That's your Pea in the Podcast for week eight of your pregnancy. Dr. Swaim and I look forward to talking to you again next week. Enjoy this week and we'll talk to you again. I'm Bonnie Petrie, thanks for listening.