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Re: Lupus and pregnancy From: Sherri Holley (midwife@obii.net) Sat Jun 24 16:56:06 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Charlie Chambers: "Re: Lupus and pregnancy" Previous message: babycatchers@aol.com: "methotrexate" Maybe in reply to: Elrod, Darryl G Maj 48 MDOS/SGOBO: "Lupus and pregnancy" Next in thread: Charlie Chambers: "Re: Lupus and pregnancy" Reply: Charlie Chambers: "Re: Lupus and pregnancy" I understand your points, and I share your concerns. I take this very serious like many other conditions that arise in preg that need to be much more vigulant (sp) about. Every client of mine has to read a 10 page complication/emergency packet that I developed, and I talk in everyone depth about how at any time during their preg/ birth that I will transfer care/ or transport to hosp anything that out of my scope. I do not lead anyone on. The women who have higher risks like Lupus, come to me because they want a chance of being normal, of trying alternatives to see if they can do something different, but if they get worse or are bad to begin with know that I will transfer their care in a heart beat. I transfer care to the Dr's in town often for things that are not for me to do. With many of these women who are different, they are required to see me wkly or every 2wks throughout their preg to keep closer tabs on them and monitor baby. I do order all the apropriate (sp) testing, If things are changing to the worse they will be transfered- I get them the appointments and often go with them to their new MD appointment to make sure they follow through. I run a very large birth center with many women who are quite poor, or quite rich. Where I live their are only 5-6 Obs, and 1 Family practice MD doing births. They are up to their eyeballs in clients and have to turn down many clients. If a client does not have medicaid or insurance (that pays) the Docs won't see them. Our hosp has sent women who can't pay,away in labor. Some of these ladies have to travel 50 to 350 miles away to give birth. So sometimes if I have a woman with higher risks that cannot get into the Doctors, eithr I have to arrange for another town hosp to take them, or I if they are only moderate risk I will deliver them. I have great success with strict diets, some safe herbs or homeopathics, most of my clients are very good about doing what is recommened by me to keep themselves in a healthy condition to stay as my clients. I try to not take unnecessary risks. But my training has taught me to be prepared always, because you never know what will fall in your lap ! I have delivered over 1,500 babies in my career, and I have all sorts of situations that I have had to deal with like most of you have. Never lost mom or baby. But I know it may happen. I have to say I have been on this list for over 9 yrs, commenting occasionally. I love to see you and others ask each other for advise. I have gotten to know many of the personalities. I know Midwives and Drs. don't always agree, or think each other 's point of view are quite strange. Like mixing polar bears and moose- they don't ofter agree. But I hope all of us can agree that we are all in it to have safe outcomes. -- Sherri Holley LM, CPM > ----- Original Message ----- From: Charlie Chambers To: Multiple recipients of list OB-GYN-L Sent: Saturday, June 24, 2006 10:41 AM Subject: Re: Lupus and pregnancy I believe it to be imprudent for a pregnant patient with lupus to cared for without a physician involved in care. Sure, a number of Lupus patients can get through a pregnancy without any complications. But, a patient with Lupus can go from stable to critically ill over a very short interval of time. Someone else wiser than me on this list made the analogy before that just because you can get across the street blindfolded without getting hit, doesn't make it prudent to continue to do so. Why take an unnecessary risk? On Jun 23, 2006, at 9:32 PM, Sherri Holley wrote: I am a LM w/ 27 yrs in practice (formerly of Alaska) I have had Lupus since 15 yr old-now 50yrs. I had 2 pregnancies/births. 1st preg- totally normal except severe hyperemisis & I went very overdates- Had a home birth. 2nd child born 12 yrs later- had preterm complications, bed rest for 5 1/2 months. Went to Swedish Hsp, in Seattle several times I was also in much pain in bones and muscles. Was put on Terb. for Preterm then Penobarbital (to control the tachy in me) Was also treated by an ND. I had him at home on his due date. Baby fine, I went into a huge flair @ 6 wks postpartum however. The 27 yr old son (1st) has Lupus w/ severe Bipolar. 16yr old (2nd) has Bipolar with some slight immune problems. I due take non severe lupus in preg clients and have found that many of the natural remedies support these women, dier is extremely important and in some cases add baby aspirin. I do monitor them toxemia, preterm and kidney problems. I do do more prenatals on them, to keep closer tabs on them with emphisis (sp) on keeping them feeling non high risk. I have had very good success one the more than 25 cases. ( always explain in depth the risk and chance of hospitalization) I think I have good outcomes also be case I know personally what its like. > ----- Original Message ----- From: Elrod, Darryl G Maj 48 MDOS/SGOBO To: Multiple recipients of list OB-GYN-L Sent: Wednesday, June 21, 2006 2:21 AM Subject: Lupus and pregnancy I am seeing a 26 yo G2P1 with a known diagnosis of SLE. She recently had some bloodwork done that showed a positive lupus anticoagulant. She had previously been negative for LAC. She now is pregnant at about 5 weeks. She has no prior poor obstetrical outcomes, no prior history of DVT nor family history of DVT. Would you a) do nothing and observe b) start baby aspirin c) start baby aspirin and heparin Thanks, Glen //SIGNED// D. Glen Elrod, Maj., USAF, MC Obstetrician/Gynecologist Chief of Obstetrics 48 MDOS/SGOBO RAF Lakenheath, England Telephone DSN: 314-226-8130 Comm: +44 (0) 1638 52 8130 Notice of Confidentiality Under the Privacy Act of 1974, you must safeguard all information reflected on this e-mail and, if applicable, all attachments. Disclosure of information is IAW AFI 33-119, AFI 33-127, AFI 37-131, AFI 37-132, AFI 33-219, and PL 93-579" This e-mail message including any attachments is for the sole use of the intended recipient(s) and may contain confidential and privileged information. Any unauthorized review, use, disclosure or distribution is prohibited. If you are not the intended recipient, please contact the sender by reply e-mail and destroy all copies of the original message. Any questions pertaining to disclosure should be directed to the privacy officer. **************************************************************************** Charlie Chambers Hood River, OR cchamber@alumni.rice.edu "Almost anything you do will seem insignificant but it is very important that you do it....You must be the change you wish to see in the world" -- Mahatma Ghandi. ******************************************************************************* Next message: Charlie Chambers: "Re: Lupus and pregnancy" Previous message: babycatchers@aol.com: "methotrexate" Maybe in reply to: Elrod, Darryl G Maj 48 MDOS/SGOBO: "Lupus and pregnancy" Next in thread: Charlie Chambers: "Re: Lupus and pregnancy" Reply: Charlie Chambers: "Re: Lupus and pregnancy"

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