There’s a national shortage of Braille teachers and the situation is dire

Braille Institute(NEW YORK) — “When my son was born, he was the first blind person I’d ever met,” Emily Coleman told ABC News’ Good Morning America.

Coleman, 40, now works as a superintendent for the Texas School for the Blind and Visually Impaired, in Austin, and is an advocate for Braille education. But before her son, now 14, was born in 2005, she didn’t realize the extent of the nation’s need for Braille educators and services for blind children.

There is a national shortage of educators who know and can teach braille, and it’s leaving children who need their services in a dire predicament.

The importance of Braille as a code to access literacy

Braille is an essential skill for those without the ability to read and write print due to visual impairment or loss and provides a way for them to access literacy. However, less than 10% of legally blind people in the U.S. read Braille, according to a 2009 report from the National Federation of the Blind.

The lack of Braille education dramatically affects a person with impaired vision’s ability to find work. Over 70% of working-age adults with significant vision loss are not employed full time, according to Cornell University’s disability statistics.

About 90% of blind or severely visually impaired people who are employed use Braille, according to the 2012 Report of the National Library Service for the Blind and Physically Handicapped.

Currently, 84% of blind children attend public school and Braille instruction can be offered as little as an hour per week, reports the The National Braille Press.

While technology is inching in the right direction by including services like speech-to-text, standard on some devices, there is still a long way to go to make all the features of the modern world accessible to those with vision impairment or loss.

And misconceptions remain about the importance of Braille.

“Sometimes it’s a misunderstanding on the part of sighted people who think why can’t some people just listen to information? We have audiobooks, we have recorded information. But until we stop teaching print reading and writing to children who are sighted, we have no justification for stopping Braille reading and writing instruction for students who are blind or visually impaired,” Cay Holbrook, a professor at the University of British Columbia who has been preparing teachers to instruct Braille for over 20 years, told GMA.

“It’s not just about creating people who can go to a book and find information — it’s about creating people who love to read, who love to read and write, who gather information as a part of their lives,” she continued. “And certainly employment is dependent on a level of reading and writing and access to information that’s only available if the child has been taught.”

To be clear, Braille is not a language, it’s described as a code to access literacy. By knowing Braille, many students can go on to achieve great things, according to Kateri Gullifor, who has been teaching Braille for a decade and recently won the 2019 Braille Teacher of The Year award from the Braille Institute.

“I have a student who is in AP chemistry and honors calculus … and legally blind,” Gullifor said, adding that another one of her former students is living in New York and studying law. “To watch someone learn to read with their fingers is one of the most fascinating things you’ll ever watch.”

Braille education across the country

There are many different ways Braille education works across the country. For Coleman, she is at a state school for the blind which is a residential program with intensive Braille learning. The goal is to integrate these students into their local school systems with the building blocks they’ll need to succeed in life.

“Some students come here for a few years, and we offer boarding — and they come home on the weekends. Other students come here for a couple weeks’ bootcamp and go back to their local schools,” she said.

Gullifor’s role includes meeting students in their local schools and giving them one-on-one instruction on Braille. Her caseload ranges but she works with approximately 15 students each year and she often helps teach the same students year after year, creating lasting bonds them.

“It’s such a creative job and it’s really all about catering to exactly what each student needs,” she told GMA.

For students with visual impairments, learning Braille is one of the first steps toward independence, and for educators, it’s a rewarding career.

“I feel like if people knew how awesome our job was, [the shortage of Braille educators] would not be the case,” Gulifor said.

“I always tell people who are coming to me to learn how to teach Braille that I can guarantee them a job — in the city, in the mountains, near the ocean,” Holbrook emphasized. “It’s just that much in demand.”

Copyright © 2019, ABC Audio. All rights reserved.

Mom competes in 140-mile race with daughter who’s unable to walk

Beth James(NEW YORK) — An Ironman triathlon is considered one of the most difficult one-day sporting events in the world.

It’s about a 17-hour competition where athletes have to complete a 2.4-mile swim, a 112-mile bike ride and then a marathon, which is a 26.2-mile run.

“Enduring 17 hours is quite a bit on the body,” Beth James said.

Beth James, 54, has not only finished one — an accomplishment by itself — but she does it with her 23-year-old daughter, Liza James, who is nonverbal and unable to walk.

They are the first mother-daughter duo to compete in the Ironman World Championship, which is, essentially, the Super Bowl of Ironman triathlons. What makes it more incredible is that there is no subdivision for disabled athletes to qualify.

“Our time is no different than the 20-year-olds or the 80-year-olds,” Beth James said.

An Ironman race starts with the swimming portion. Liza James, who weighs about 100 pounds, is strapped into a float that is attached to Beth James.

When it comes time for the 122-mile bike ride, Liza James is seated in a racing chair that weighs 21 pounds and is connected to the bike pedaled by Beth James.

Finally, for the marathon portion, Liza James sits in the racing chair that resembles a stroller as Beth James powers through.

Call her “Ironmom.”

“We really need to stop and think what humans are capable of if you can channel something like that maternal love instinct that she has for her daughter,” trainer Peter Defty said.

Beth and Liza James finished the first two portions of the race, but missed the cutoff time for the third in the Ironman World Championship. Still, Beth and Liza James have finished an Ironman race before.

Perhaps Beth James’ physical toughness stems from her mental toughness.

In 2004, Beth James and her three children were making the approximately one-mile drive home from a Fourth of July party when they got into a life-changing accident.

Beth James says she was turning left at a green light when her car got nicked from behind and spun around. Liza James’ head hit the interior of the vehicle and she suffered a severe brain injury.

Liza James, then 6 years old, was in a coma for more than two months. Beth James said doctors had to cut part of her skull — about the size of Beth James’ palm — to allow the brain to swell.

That ended up saving her life.

“It’s truly a miracle that they kept her with us,” Beth James said.

Liza James is healthy, but she needs assistance eating and drinking.

Three months after the accident, Beth James developed a noncancerous brain tumor the size of a golf ball. She got it removed in time by the same neurosurgeon who saved Liza James’ life.

Liza James eventually woke up, and Beth James recovered from her brain issue. Beth James was a single mother with three kids. The shock and trauma of it all was hitting her.

“I thought, ‘Beth, you need to get up. You need to care for the children. You need to go for a run. You need to clear your head,’” she said.

She set a goal to run a marathon months after she and her daughter suffered brain injuries. When she finally ran the marathon, she was thinking the whole time about how to include Liza James.

So Beth James got a racing chair for Liza James to sit in while she ran. She started by running a 5-kilometer race, then a 10-kilometer race and continued to work her way up.

“Even though Liza cannot speak, she can communicate,” Beth James said. “She immediately told me, ‘Don’t stop, mom. Don’t slow down, mom. Let’s go.’”

So Beth James kept going. She says Liza James communicates to her through hand gestures and noises.

In the past four years, Beth James has worked her way up to triathlons, sometimes training for up to 10 hours a day. And even though Beth James is not new to Ironman races — she ran her first one in 1999 — with the added motivation of competing with Liza James, the race has taken on a whole new meaning.

“Life is a gift,” Beth James said. “Each and every moment of each and every day is priceless. Don’t ever take it for granted. Do not ever complain. There’s always positives surrounding you.”

Copyright © 2019, ABC Audio. All rights reserved.

Miscarriage and stillbirth: Woman details her heartbreaking experiences

Courtesy Kendal Taylor(NEW YORK) — Miscarriage is a heartbreaking reality for many women in this country, with at least 10 to 20% of pregnancies ending in loss, according to the Mayo Clinic. However, that number is likely higher, as many miscarriages occur before a woman learns she’s expecting.

Stillbirth, a term used to describe a miscarriage after 20 weeks of gestation, is less common, but is believed to impact 1 in 100 pregnancies, or 24,000 babies, each year, according to the Centers for Disease Control and Prevention.

Kendal Taylor, a Colorado native currently based in Alabama, has suffered three losses — two miscarriages and a stillbirth — and now aims to raise awareness of these issues and provide grieving parents with resources.

Taylor, who has a background in nonprofit work, maintains The Hopeful Creative, a lifestyle blog, where she’s kept readers abreast of her parenthood journey. Now pregnant for the fourth time — she’s due to give birth to a baby boy later this month — Taylor shared her story with ABC News’ Good Morning America:

Like most, our journey to starting a family began with the cheerful wonder of all the possibilities to come. So when heartbreak took over where joy was meant to be, it knocked us off our feet. We thought we would bring home babies, but instead we came home with empty arms and grieving hearts. When we found out we were expecting, we certainly weren’t expecting this.

Our first pregnancy came as a surprise because it happened quick. Nonetheless, we were thrilled. However, just as quickly as it began, it ended a couple short weeks later. It left us devastated. Nothing prepares you for working through a miscarriage, and we were faced with apprehension in our desire to get pregnant again.

A few months later, we found out we were expecting. We were excited, but with that came a new layer of anxiety that we hadn’t felt before. I was on edge at anything that seemed like it might pose a problem: a cramp here or there, a day of relief from morning sickness or getting an ultrasound and not seeing what we should.

Though it never completely left, that anxiety quieted to the background as my husband, a member of the U.S. Army, deployed to a war zone when I was in my second trimester. But before I knew it, I was about 24 weeks pregnant and realized I should start planning a registry and buying our sweet girl more than stylish outfits and matching bows for her hair.

By that time I had been feeling her kicks and movements at least a few times each day. It was exhilarating! I wished my husband could be there to participate in the excitement. Hearing about it on FaceTime just wasn’t the same as feeling a little foot kick for yourself. Despite this, being able to talk daily was a blessing.

I’ll never forget the knot in my stomach that wouldn’t untangle itself when the doctor told me it’s normal for me to have gone without feeling my baby move for an entire day at 25 weeks. Despite this, I went in to be checked anyway. The silence that signaled the absence of fetal heart tones was the loudest noise in the room. The Doppler slid over my belly, but detected nothing but my own racing heart.

The 20-foot walk down the hallway from the exam room to the ultrasound room felt like miles. My eyes brimmed with tears and dread crept into every part of my being as I avoided eye contact with the happy mamas having a normal appointment that day. All I could think of was my first loss, when the ultrasound confirmed that the bleeding was in fact caused by a miscarriage. Through my fear, I grabbed desperately at any shred of hope I could reach, thinking that maybe the Doppler had it all wrong, that we could chuckle in relief after we saw her heartbeat flickering away. Instead, I was met with a still screen and the words that broke me: “There’s no heartbeat.”

The anticipation of giving birth, knowing there would be no happy ending after the pain, was devastating.

A couple hours later I found myself in Labor and Delivery preparing to be induced for what would be a stillbirth. My husband and I were about to face the hardest moment of our lives, while nearly 8,000 miles separated us. During this time I had to work with the Red Cross to get his chain of command officially notified. This was necessary so that he could hopefully come home on emergency leave. I had already shared what was happening with him, but we still needed to get through the red tape of the Army if we wanted him home.

About 10 hours after the induction of labor process started, I gave birth to our sweet Paxton Grace. A fully formed little beauty, she was 12 inches long and weighed just 1 pound, 9 ounces. The labor and delivery nurses were a blessing. They helped take pictures of her for me, and even made a mold of her hands and feet. This gave us something tangible to remember our girl with. And I was able to hold her for as long as I wanted. Despite the pure exhaustion I felt, I stayed up all night holding onto my little babe and staring at the precious face I would soon have to let go of. When the funeral home came to make arrangements the next morning, it took every fiber of my being to muster up the strength I needed to set her down and let them take her. Being faced with this situation is so wrong that unfair doesn’t even begin to describe it.

A couple days later, my husband made it back to the States and was able to hold our precious Paxton Grace. It felt so wrong that saying hello and goodbye to her occupied the same moment. That day I had to say my final goodbye as well, which presented a new challenge. Leaving the hospital was hard, but I had been able to cling to the fact that I’d be able to see her again. This time though, it was final. Words will never do justice in describing the grief that comes with letting your child’s body go. No moment would ever be the right time to leave. We would never be ready. But ready or not, we couldn’t stay in that room forever.

In the days, weeks and months following Paxton’s stillbirth, I went back and forth between two extremes. I either wanted to get pregnant immediately or never wanted to conceive again. I never wanted to replace our daughter, and I knew that no baby ever would, but I also wanted to experience the joy of bringing home our children and being able to raise them.

In our situation, there are no indications as to any issues that would make carrying a pregnancy to full term impossible. Unfortunately, miscarriages just happen. And the cause of our stillbirth was due to an extremely rare condition called amniotic band syndrome. ABS is not genetic, nor is it likely to present in a subsequent pregnancy. Medical professionals don’t know what causes the amniotic bands to form, so they say there’s no indication that another pregnancy would be sure to result in loss. My husband and I started discussing the possibility of another pregnancy.

Despite my deep desire for it, the thought of another pregnancy was terrifying. I told my husband over and over that my heart couldn’t take another loss. I wish so badly that I could inform you it didn’t have to, but it did. We experienced another very early miscarriage in our third pregnancy.

There was nothing uncommon about this that would indicate fertility issues. It was just another case of “bad luck.” While it was encouraging that there were no issues present, I cringed at this statement. Luck is success or failure brought on by chance. From the medical standpoint, we had simply hit all the bad statistics. From our standpoint, we were grieving three little lives that we wouldn’t get to share in. Naturally, we began to question if trying to get pregnant again, knowing heartbreak could result, was something we were ready for.

Today, we are pregnant with our fourth baby — a boy — and are anxiously clinging to the hope that God will bless us with the opportunity to raise this sweet little one of ours. He’s due later this month. I’m working to remind myself that regardless of the outcome, this little life — just like the others — is a gift. We must cherish every precious minute that we get with him.

While we have experienced healing from our losses, we have acknowledged that this grief is just something that will always be part of us. We’re finding the beauty and joy in life, because it can still exist. But we’re also comfortable with the fact that we are always going to struggle with the pain of losing our children. And that’s OK, because they are worth remembering and longing for.

Copyright © 2019, ABC Audio. All rights reserved.

Men’s marijuana use increases miscarriage risk for women, new research finds

Tunatura/iStock(NEW YORK) — New research is highlighting the role men play in infertility and miscarriage.

When men smoke marijuana once a week or more, their partners are twice as likely to experience a miscarriage when pregnant, according to Boston University researchers who examined over 1,400 couples before they got pregnant.

The researches asked the couples about marijuana usage over the past two months and then followed them as they got pregnant and, in some cases, miscarried.

The majority of men in the study did not smoke marijuana, with only 8% smoking once a week or more. Nearly 18% of the couples in the study reported a miscarriage.

Smoking, but less frequently than once a week, did not have an association with miscarriage rate, according to the research.

One reason for the increased risk of miscarriage with male marijuana use, according to researchers, is that smoking marijuana may negatively affect sperm quality and the change in sperm quality may drive the increased occurrence of miscarriage.

The research is being presented Monday at the American Society for Reproductive Medicine Congress & Expo in Philadelphia.

“I think that’s part of the reason why this study is getting so much attention, because we’re used to putting all the focus, all the blame, all the stress on the women and the world of male fertility is really exploding,” Dr. Jennifer Ashton, ABC News chief medical correspondent and a board-certified OBGYN, said Monday on “Good Morning America.” “Forty percent of couples’ infertility is due to male factors so it bears repeating we need to focus on the men just as much as the women.”

Ashton points out two red flags in the study: its findings are based on association, not causation, so more research is needed, and there is not yet any peer-reviewed data on the study’s findings.

 The lead-author of the research, Alyssa F. Harlow, MPH from Boston University School of Public Health, told ABC News the research will be presented for peer-reviewed publication “in the near future” where it will be further scrutinized.

The research comes just days after researchers in China released a study that found a father’s alcohol intake may actually affect a future child more than a mother’s intake.

Their results, published in the European Journal of Preventive Cardiology, revealed that the risk of heart defects in infants was 44% higher if their fathers drank. They found that this risk was increased by 16% for mothers who drank.

The takeaway for men is that they, like women, need to pay attention to their health prior to conception, according to Ashton.

Ashton shared on “GMA” the following four steps men can take to improve their fertility.

1. Do not smoke.

2. Minimize exposure to high temperatures like Jacuzzis, seat warmers and laptops.

3. Do not overdo alcohol.

4. Exercise regularly.

Copyright © 2019, ABC Audio. All rights reserved.

Suicide attempts among black teenagers are rising

Moore Media/iStock(NEW YORK) —  Since the 1990s, suicide attempts among black youth have risen 73%, while attempts among white youth fell 7.5%, according to a study published Monday in the journal Pediatrics.

Previous research has also shown an uptick in suicide rates among elementary school black children, which have nearly doubled since the 1990s.

“I’ve been concerned for the past decade about black youth not receiving treatment for mental health disorders,” said Michael Lindsey, the lead study author and executive director at New York University’s McSilver Institute for Poverty Policy and Research.

The study, which utilized anonymous survey data from nearly 200,000 high school students and asked questions about suicidal thoughts, suicide plans and suicide attempts, found that in 1991, 5.9% of black teenagers reported attempting suicide. By 2017, more than 10% of black teenagers said they had made a suicide attempt.

While suicide rates among white teenagers are higher overall, the percentage of white teenagers reporting suicide attempts fell slightly during the study period.

According to Lindsey, part of the problem is that black youth aren’t having their mental health addressed by psychologists, psychiatrists or counselors. Instead, some teenagers act out and get involved with the criminal justice system or are suspended from school. Others try to handle unmet psychiatric needs on their own.

“That’s the population of kids we think that are engaging in higher rates of suicide attempts,” he said. “This is a form of coping. It’s pain, turned inward.”

In addition to evidence that black teenagers are under-utilizing mental health services because of the stigma associated with depression, there are a variety of structural factors that can take a toll on mental health.

On top of disproportionately higher rates of poverty and adverse childhood experiences among black youth, black American adults are more likely to report being severely psychologically distressed in the previous month than white Americans are, according to the Department of Health and Human Services Office of Minority Health.

Better access to mental health services for black teenagers is key, Lindsey pointed out, as is improving cultural competency among existing health care providers.

Lindsey said he once counseled a black adolescent who told him that when he felt depressed, he wanted to knock somebody’s head off, “so he feels the same pain I feel.”

Interpreting that aggression as a simple conduct problem would be a missed treatment opportunity, Lindsey explained, since many black teenagers express depression as a physical ailment, such as a constant stomachache or headache, or as interpersonal conflict.

“We tend to punish as opposed to treat,” he said. “Are we readily thinking that kid may be depressed?”

As it stands, suicide is the second leading cause of death among young people between the ages of 12 and 18 years old, according to Centers for Disease Control and Prevention. Non-fatal self-harm is concerning, too, since the biggest risk factor for dying by suicide is a previous suicide attempt.

In 2017, 111,000 teenagers between the ages of 12 and 18 went to the emergency room for self-harm, according to CDC data.

Copyright © 2019, ABC Audio. All rights reserved.

Breastfeeding benefits mom, baby and the environment

kate_sept2004/iStock(NEW YORK) — Breastfeeding is not only good for mothers and their babies, but it also protects the environment according to an editorial in the British Medical Journal.

“It benefits all of society,” Natalie Shenker, Ph.D., a research fellow at Imperial College, who was involved with the study, told ABC News.

“Breastfeeding does not require the energy needed to make and use formula. It doesn’t create waste or air pollution,” said Dr. Laura Teisch, a pediatrician from Las Vegas.

Formula produces significant waste during its production, distribution and use.

“As with all products, infant formula has an environmental footprint,” says Andrea Riepe, a representative for Reckitt Benckiser Group which has infant formula Enfamil in its product portfolio. The company works to minimize the waste associated with Enfamil, she added.

It’s known that breastfeeding protects both women and children. However, recent studies have highlighted that breastfeeding is also good for the Earth. Supporting mothers to breastfeed more would reduce the same amount of carbon emissions as removing nearly 77,500 cars from the United Kingdom’s roads each year, asserts the editorial’s authors.

Over 80% of U.S. children are breastfed at some point but only about 25% are exclusively breastfed until age 6 months, according to the latest National Immunization Survey by the Centers for Disease Control and Prevention.

Why should a woman breastfeed?

The American Academy of Pediatrics supports breastfeeding given its benefits to the child. It also helps prevent infection, diabetes, cancer and childhood obesity.

“Decreasing the risk for obesity is really important. Obesity is a risk factor for cancers such as breast, uterine, kidney and pancreatic,” said Dr. Vivek N. Patel, a radiation oncologist from Ft. Lauderdale, Florida.

There are benefits to the mother as well including decreased bleeding after delivery and a reduced risk of breast and ovarian cancers, the AAP also notes.

“Breast cancer is linked to exposure to estrogen,” said Patel. “When a woman breastfeeds, their menstrual cycle is delayed and therefore less estrogen is released.”

Why do some parents choose formula?

“Sometimes breastfeeding is contraindicated due to a medical condition,” said Teisch.

For example, “Breastfeeding during cancer treatment isn’t recommended as the treatment can affect your milk supply and harm the baby. If treatment is completed, a woman may breastfeed but the quantity and quality of breast milk may be affected,” said Patel.

Breastfeeding is also contraindicated when mothers have HIV and when infants have certain metabolic disorders.

Some may prefer formula for the convenience.

Formula may also supplement breast milk. Breastfed babies with significant weight loss who also received supplemental formula, had a reduced risk of hospitalization, a recent study in the American Journal of Pediatrics revealed.

Breastfeeding isn’t always an option.

“Women who try to breastfeed but are unable to do so are commonly left with ‘mom guilt.’ On top of those internal struggles, these mothers are often ‘formula-shamed’ by family, friends and even medical professionals. Parenting is hard, breastfeeding is hard and life itself can be hard,” said Teisch.

The push for “breast is best” feeding often adds pressure on women, agreed Shenker.

“I know the struggle women face when they aren’t able to breastfeed firsthand. I, too, had to rely on formula after the birth of my son. He had an extended stay in the NICU and despite my best efforts and support from family and medical professionals, I wasn’t able to produce enough milk,” Teisch shared.

“I don’t formula-shame in my own practice. I encourage breastfeeding to the mothers of my patients and inform these mothers of the benefits associated with breastfeeding, but I also recognize and acknowledge to all my families that a healthy, growing and thriving baby with a happy mother is just as important too. Bottom line, fed is best,” said Teisch.

What can we do to support breastfeeding, when possible?

There are multiple ways to support breastfeeding mothers, Shenker said. She believes that healthcare providers should be better educated on how to support mothers when they want to breastfeed. Parents should develop a birth plan and a feeding plan, she also advised.

Better access to milk banks for children who need supplementation would also help, said Shenker. In fact, Shenker founded the Human Milk Foundation which works to create awareness about, supply and raise funding for donor milk. Shenker hopes her research will shed light on the environmental impact of formula to encourage the government to step up efforts that support breastfeeding.

Why is this important now?

Breast health is always important but it’s even more in focus currently as October is Breast Cancer Awareness Month.

“Breast cancer awareness is crucial. There have been so many advances in our ability to detect and treat breast cancer in the past decade. As with any medical diagnosis, knowledge is power.” says Patel.

Copyright © 2019, ABC Audio. All rights reserved.

Miscarriage and stillbirth: Everything you need to know but were too nervous to ask

Srisakorn/iStock(NEW YORK) — Miscarriage — the loss of a pregnancy in any trimester — is a common occurrence that affects countless women but remains a taboo topic in our culture.

Statistics differ, but according to the Mayo Clinic, for women who know they’re pregnant, about 10 to 20 out of 100 will experience a first trimester loss. That number is likely considerably higher, as many women miscarry before they realize that they’re expecting. Additionally, one recent study indicated that 43% of women who had at least one successful birth reported having had one or more first trimester losses.

Stillbirth, the demise of a pregnancy after 20 weeks, affects about 1 in 100 pregnancies each year in the United States, according to the Centers for Disease Control and Prevention. This translates to about 1% of all pregnancies and about 24,000 babies.

These numbers mean that if you haven’t had a miscarriage yourself, you likely know someone who has. It’s time to talk about it.

ABC News Chief Medical Correspondent Dr. Jennifer Ashton, a board-certified obstetrician and gynecologist, demystified infant and pregnancy loss for Good Morning America:

What is a miscarriage?

A miscarriage refers to a failure or end of pregnancy in any trimester. Typically, we consider a miscarriage occurring in the first and second trimester, and a third trimester miscarriage as a stillbirth. That is the lay terminology.

How common is it?

There are a lot factors that go into determining a woman’s risk for having a miscarriage, but in general, singular miscarriage is incredibly common. Most women can or will suffer a miscarriage a lot of times even before they even know that they’re pregnant.

Is age a factor?

Age can always be a factor. In general, we have to remember that age is one very important factor when you talk about fertility.

What are the symptoms?

Sometimes a miscarriage will produce no symptoms. Sometimes they’re called “incomplete abortions,” a type of miscarriage where the cervix dilates, bleeding starts, but the cervix doesn’t close again, causing significant blood loss. This is a surgical emergency that needs to be treated with a D&C. Sometimes we refer to a “threatened miscarriage,” as a “threatened abortion,” which means there might be bleeding, but there’s still a heartbeat. We don’t totally understand what causes it, but we do know that sometimes women will have no symptoms at all. Other times there can be heavy bleeding, or cramping.

What is a “missed miscarriage”?

Usually when we use the term “missed abortion” or “missed miscarriage,” that means the pregnancy is still within the uterus and it’s just picked up that there’s no heartbeat.

What happens once the miscarriage is diagnosed?

I think the first thing for women, if they’re told they’ve had a miscarriage, is to take a minute and really kind of process that as much as possible from an emotional or psychological standpoint. There’s rarely a time pressure to act or do anything unless the woman is bleeding excessively or hemorrhaging with a miscarriage which can occasionally happen. It’s not common but it can happen. Otherwise, there is time to think, breathe, process the information initially as best as possible and then make your decision about how you want to proceed.

If we’re talking about a first trimester miscarriage, basically the options given to women are to do nothing and wait for it to pass on its own, or undergo surgical evacuation which is called a suction D&C, or dilation and curettage. Usually we don’t give medication in the first trimester to evacuate the pregnancy.

Why have a D&C?

A surgical procedure is much more controlled. It’s scheduled. The woman is under light sedation, so she doesn’t feel any pain. It takes literally minutes. There’s very minimal cramping and bleeding afterwards, so she can go about her day, go home to other children, go to work the next day. But it’s an individual choice and every woman has to decide with her physician which is right for her.

How much does a D&C cost?

The cost of a D&C is going to vary. It could be over $1,000 in some cases, it could be free in other cases.

Is the woman sedated for a D&C?

During a surgical suction D&C for a miscarriage, the woman is definitely under some type of sedation. The uterus is in the pregnant state, and we are using sharp instruments to suction out the pregnancy, so there is a risk of perforating the uterus. The woman really needs to be sedated. It’s not only more humane for the patient, but it’s definitely safer for the surgical procedure.

Does a woman always need to seek medical attention if she’s having a miscarriage?

In general if a woman is diagnosed with a miscarriage, she needs medical follow-up and likely medical management of that miscarriage. Rarely miscarriages that don’t pass on their own can become infected and the woman can develop an infection in her uterus. But whether that miscarriage is managed expectantly and the woman is given a chance to pass the pregnancy on her own at home or if it’s managed medically will differ case by case, patient by patient.

When can a woman try to conceive again after a loss?

There are rarely any medical reasons for a woman to wait. Sometimes there may be, but the vast majority of women are told when they’re emotionally and physically ready. That will differ woman to woman but there usually is no reason why a woman can’t try to conceive after getting maybe one period after a miscarriage. Sometimes it happens on its own literally the following month.

Is it true that a woman is more fertile for three or so months following a miscarriage?

The data on this is not clear-cut. In general, there is approximately a 20% fecundity rate per month in young healthy women, meaning there is a 20% chance of conception in any given month.

How soon after a miscarriage would you expect a woman to get pregnant again?

It totally varies. It can happen the next month, or it may take several months or longer.

What happens if a woman has multiple miscarriages in a row?

We call multiple miscarriages in a row recurrent pregnancy loss. It used to be that a woman needed to have three miscarriages in a row before a formal or aggressive workup was done, but now we’ve kind of dialed that back to even two losses. There’s a very well-constructed, well-defined algorithm that we follow to investigate what caused those losses. It involves looking at the anatomy, looking at the genetics of both the man and the woman, doing a variety of blood tests, hormonal tests, sometimes screening for various types of infections, and in some cases, the pathology report from a previous miscarriage can show if there’s a genetic or chromosomal cause. But again, this is a very standard workup that any OB-GYN is familiar and accustomed to doing.

Is there anything a woman can do to prevent a miscarriage and/or lower her risk of having one?

For women at average risk, the best recommendation is to be in as good a state of overall health as possible before and during pregnancy. This means not smoking or drinking alcohol while pregnant, exercising regularly, having weight in healthy range, and getting 7-9 hours of sleep a night. For women with high-risk pregnancies, certain medications may help lower risk of additional miscarriage in women who have had recurrent pregnancy loss.

What is vanishing twin syndrome?

Vanishing twin syndrome refers to a pregnancy that starts with twins and then one of the twin pregnancy stops and basically that gets reabsorbed into the placenta, the amniotic sac. When the end of the pregnancy comes, there’s just one baby, a singleton that’s delivered. We don’t totally understand why this happens, so it’s hard to pinpoint how common it is.

What is an ectopic pregnancy?

Ectopic pregnancy basically refers to a pregnancy that is located anywhere other than the uterine cavity. The most common place for an ectopic to be located is actually in the Fallopian tube, but there can be ectopics that are located in the cervix, which are incredibly rare and very dangerous, because of the risk of life-threatening hemorrhage. There can occasionally be an ectopic on the outside of the ovary, where it meets the Fallopian tube, and then there can be, rarely, abdominal pregnancies where the pregnancy implants in the abdominal cavity. That is extremely rare.

How common are ectopic pregnancies and how are they diagnosed? How are they treated?

Most cited literature puts the risk of ectopic at about 1 in 50 pregnancies. To be clear, most ectopics are treated successfully but ruptured ectopic pregnancy is the number one cause of maternal death in the first trimester. We don’t know what causes ectopic pregnancy, but the vast majority of women who have an ectopic pregnancy have an anatomic problem with their Fallopian tube or evidence of infection or scar tissue in the Fallopian tube.

Usually ectopic pregnancies are diagnosed on either blood testing or with a routine ultrasound. It can be difficult. Typically we look for a doubling or at minimum about a 66% increase in HGC, which is the main pregnancy hormone, over a 48-hour period. Then we correlate that with what we see on an ultrasound which we can check roughly every week in the first trimester. Looking every day by ultrasound doesn’t really tell us anything. If it doesn’t rise appropriately or if we don’t see a confirmed pregnancy in the uterus at the time when we expect to see one, then we make the diagnosis of ectopic pregnancy.

In terms of treating an ectopic, there are basically only two options: an injection of a chemotherapy drug called methotrexate, which will stop the pregnancy because it targets rapidly dividing cells, or surgery. There are certain criteria for one versus the other, but if the ectopic is picked up after a certain point, then laparoscopic surgery is performed. Occasionally if the ectopic has caused a rupture in the Fallopian tube, the tube does need to be removed, but the woman can still get pregnant on the other side.

What is a chemical pregnancy?

We use that term when we have someone who’s had a positive pregnancy test, but we never actually see a pregnancy develop to the point of certain ultrasounds findings. We look at ultrasounds in stages in the first trimester. First we see a little sac inside the uterus. Then we see literally something that looks like a ring — we call it a yoke sac. Then we look for something that we call a fetal pole, which literally looks like a tadpole. And then we look for a heartbeat. Typically you don’t expect to see a heartbeat until about six-and-a-half or seven weeks, but that is highly dependent on the technology used, the skill of the ultrasonographer, the woman, various factors.

So if it’s a desired pregnancy, many healthcare providers will wait, as long as the woman’s not having any symptoms, until we see these signs. When we diagnose a chemical pregnancy, it’s because there’s usually a positive urine test and then the pregnancy hormones just kind of stop, so we never really see anything in the uterus. We don’t know how common this is, but everyone — midwives and obstetricians — sees it in their practice.

What is a stillbirth?

Those are oftentimes the most emotionally agonizing types of loss, but to be clear, a miscarriage or loss of a pregnancy in any trimester, they’re all upsetting. A stillbirth, generally we’re talking about third trimester loss. In terms of how common a stillbirth is — the cited statistic is 1 percent, or over 20,000 stillbirths in the country every year. Those numbers may be a little bit in question but what’s not in question is that stillbirths can and do happen. Sometimes there are known risk factors. Sometimes they happen with no known explanation or risk at all.

Most of the times third trimester fetal demise is diagnosed on a routine visit to a midwife or OB or actually in labor and delivery. At that time the management of a stillbirth is to induce labor to allow a woman to deliver the fetus.

Is anybody at fault for a miscarriage?

A lot of people feel shame and stigma and don’t want to talk about it or feel they can’t talk about it openly, and I think, unfortunately, a major reason for that is that a lot of women in particular feel that something is wrong with them or they did something wrong or it’s their fault in some way. That is rarely, if ever, the case. The reality is, miscarriage happens. And that is incredibly painful and upsetting for the couple. It’s no one’s fault. I think it’s one of the many topics in medicine that we need to de-stigmatize and we need to bring out of the shadows and make it more acceptable to discuss because it’s so common and so many people, unfortunately, experience it.

What would you say to a woman who blames herself?

For some women who have suffered a miscarriage who on some level blame themselves or feel that it makes them less of a woman or that it’s a fault or flaw in them, all I can say as an OB-GYN is that’s not true. It’s not your fault. It doesn’t make you flawed. And it certainly doesn’t make you less of a woman. I think it’s also important to remember that a miscarriage is a painful loss for the other partner in that couple, and that that partner can grieve the loss of a pregnancy even if he or she wasn’t carrying the pregnancy. So I think that we need to start expanding our sensitivity when it comes to this and a big part of that is how we look at pregnancy in this country — that it’s always the “Hollywood pregnancy,” and it’s so easy and then couples get this perfect baby and that’s not reality. For most people who suffer miscarriage, it seems that everywhere they turn, they’re looking at that Hollywood pregnancy, or they’re seeing women who have seemingly no issue with fertility. But it’s important to remember that optics are rarely reality.

What should and shouldn’t I say to a friend who’s suffered a miscarriage?

You don’t really have to say anything. You can just be with the person. You can offer them emotional support with just a gesture like a hug. What not to say? “You can always try again.” Or, “There will be other pregnancies.” I think it’s really important to understand that a miscarriage in any trimester is a loss, and that is incredibly emotional and painful for the woman who was pregnant and for her partner. So saying things like, “You can always try again” or “You can always have another baby” doesn’t help. It does a lot of damage.

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New opioid prescribing guidelines reverse course on strict restrictions

iStock/Eugeneonline(WASHINGTON) — The Department of Health and Human Services reversed course on its opioid guidelines this week and advised doctors that cutting off pain patients’ prescriptions suddenly could do more harm than good.

The new guidance, published Thursday, stressed that that abrupt changes to long-term pain patients’ medication regimens could “put the patient at risk of harm,” because of the significant chance that a sudden switch could throw the patient into opioid withdrawal.

In addition to withdrawal, the guide lists anxiety, depression, self-harm, suicidal ideation, ruptured trust and pain exacerbation as side effects of sudden prescription changes.

“We need to treat people with compassion,” Adm. Dr. Brett Giroir, assistant secretary for health at HHS, said in a statement. Giroir noted that clinicians were tasked with the dual goals: effective pain management and reducing addiction risk. Outside of life-threatening situations, HHS does not recommend that clinicians rapidly taper or suddenly discontinue patients’ prescriptions.

The new recommendations stand in contrast to those issued to primary care providers by the Centers for Disease Control and Prevention in 2016, which focused on judicious prescribing and emphasized that opioids were not a first-line treatment, nor were they an appropriate routine therapy. Many clinicians thought the guidelines went too far and resulted in unintended consequences.

In a letter to the agency earlier this year, doctors described patients in pain who were cut off from opioids and not offered alternative pain care. Some suffered. Others turned to illicit drugs for relief.

“These actions have led many health care providers to perceive a significant category of vulnerable patients as institutional and professional liabilities to be contained or eliminated, rather than as people needing care,” the doctors wrote.

More than 68,000 people died of drug overdoses in 2018, according to preliminary estimates from the CDC, a count that’s down slightly from 2017, when overdose deaths topped 70,000. It’s the first drop in deaths since 1990, a drop that’s partially attributed to doctors prescribing fewer opioids in recent years.

By 2017, prescriptions for opioids fell to 191 million prescriptions dispensed, down from a peak of 225 million prescriptions in 2012.

“What’s good about this guidance is that it calls for care to be individualized and tailored for the patient,” said Dr. Stefan Kertesz, lead author of the letter to the CDC and a professor of preventive medicine at the University of Alabama at Birmingham.

Doctors escalated opioid doses too quickly in years past, Kertesz said. Once prescribing opioids became frowned upon, they similarly de-escalated doses too aggressively, often without patient consent. The new guidelines move in the right direction “by demanding that care be individualized,” Kertesz added.

Moving to less aggressive tapering practices won’t necessarily be easy for doctors. “There is a tremendous amount of pressure on doctors from every possible agency, including the federal government itself,” Kertesz explained.

That pressure can take the form of limits on opioids prescribing, or evaluating providers’ quality of care based on the number of patients they treat with high opioid doses.

“The effect of all these pressures is to force doctors to reduce doses or to get rid of the patients altogether,” Kertesz said.

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STD cases hit record high for fifth year running, as prevention efforts hit by budget cuts

jarun011/iStock(NEW YORK) — Sexually transmitted infections hit a record high 2.4 million cases in 2018, making it the fifth year in a row that cases of chlamydia, gonorrhea and syphilis have spiked, according to new numbers from the Centers for Disease Control and Prevention.

The agency pointed to the budget cuts that have hit sexually transmitted disease programs in recent years as a driving factor behind the disease spike. Cuts to state and local programs have translated into clinic closures, decreased staffing and ultimately fewer patient screenings and follow-ups.

Over the last five years, chlamydia cases increased 19%, gonorrhea cases increased 63% and syphilis cases increased 71%.

Human papillomavirus virus, which 79 million Americans are infected with, remains the most common sexually transmitted disease.

Most worrying of all was a spike in syphilis transmission from mothers to newborns during pregnancy, which skyrocketed 185% — to 1,306 cases — in 2018.

Congenital syphilis, which can lead to miscarriage, stillbirth and severe neurological problems for babies, resulted in 94 newborn deaths last year, a number Dr. Gail Bolan, director of the CDC’s Division of STD Prevention called “startling” in a statement.

The rise in congenital syphilis is especially worrisome because it indicates a breakdown in the health care system, explained Holly Hagan, director of the NYU College of Global Public Health Center for Drug Use and HIV/HCV Infection.

“Where there is good access to regular health care, screening for infectious disease and access to family planning, congenital syphilis should not occur,” Hagan added.

Decreased condom use could also be contributing to the increases, experts say, a practice that might be fueled in part by advances in the prevention of HIV transmission.

Pre-exposure prophylaxis, or PrEP, for example, the once-daily pill that prevents HIV transmission, does not offer protection against the spread of other sexually transmitted diseases. In 2016, roughly 80,000 Americans filled prescriptions for the medication.

People on PrEP may take the calculated risk of contracting gonorrhea, chlamydia and syphilis when they have sex without using a condom, because they know those diseases are curable, explained Dr. David Bell, an associate professor of population and family health at Columbia University Irving Medical Center.

“They obviously don’t want those infections,” he added. “But they do end up taking the risk, to some degree.”

The protocol for providers who have patients taking PrEP is to screen those individuals for sexually transmitted disease much more frequently than they would otherwise, at least once every three months. There’s a possibility that increased screening could be capturing more individuals with sexually transmitted diseases than screenings did when PrEP use was less prevalent.

Bell pointed to the importance of treating chlamydia, gonorrhea and syphilis, in order to decrease their overall prevalence in the U.S. population, particularly in areas of the county with pockets of high STI rates, like parts of the South.

“We have put most of our eggs in the basket around the personal responsibility and personal morality of using condoms. But a major part of prevention should be testing for sexually transmitted infections and curing them,” he said. “If we had decreased prevalence our rates wouldn’t be going up.”

Chlamydia, gonorrhea and syphilis, which can all be treated with antibiotics, can lead to infertility, ectopic pregnancy and increased HIV risk if left untreated. The CDC recommends that boys and girls between the ages of 11 and 12 get vaccinated against HPV, which can lead to cervical, vulvar, vaginal, penile and anal cancers.

Risk factors for sexually transmitted diseases include having unprotected sex, sex with multiple partners and having a previous history of STI infection, according to the Mayo Clinic.

Half of the infections occur in people between the ages of 15 and 24, although men treated for erectile dysfunction medication are also at a higher risk for STIs than the general population.

Copyright © 2019, ABC Audio. All rights reserved.

‘Weed moms’ are the new ‘wine moms’

Nastasic/iStock(NEW YORK) — Are weed moms the new wine moms?

Though “wine mom” culture has long been the source of many a mommy meme and largely socially acceptable, marijuana-using moms are stepping out of the shadows and proudly extolling the virtues of cannabis.

In a recent essay for Parents magazine, writer Leah Campbell claimed micro-dosing marijuana makes her a better mom.

“A small amount of pot administered as an edible allows me to be present and functional for my daughter,” the article reads. “It makes me the best version of myself and I have no shame at all in admitting that it makes me a better parent.”

Julia Dennison, executive editor of told ABC News’ Good Morning America that more moms are opening up about their marijuana use than ever before.

“We see mom influencers on Instagram posting about it,” she said. “In line with the legalization of marijuana has come a lessening of the stigma surrounding it.”

Dr. Edith Bracho-Sanchez, a primary care pediatrician and assistant professor of Pediatrics at Columbia University, agreed.

“As more states have moved to legalize cannabis for both medicinal and recreational use in recent years, there certainly has been a rise in the amount of parents who are using them to cope with the stress of parenting and daily life,” she told GMA. “I’m hearing from more and more adults who use these products to ‘take the edge off,’ relax or ease pain.”

In her piece, Campbell writes she started micro-dosing to avoid period pain. She soon discovered it also eased her anxiety.

“When I started to feel that increase in my heart rate, I found that just one 2.5mg dose of THC was typically enough to stabilize my breathing and bring me back to a steady state. Quick, easy, and effective,” she wrote.

Campbell wrote she does this 5 – 10 days each month and “every once in a while, I take higher doses recreationally.”

Campbell is far from an outlier. In a 2016 report from the Centers for Disease Control and Prevention, the organization found the highest usage of marijuana was among 26-34 years olds.

Despite this, Dennison said there is still some taboo tied to marijuana use among moms.

“They get flack in mom groups in a way they don’t when the topic is wine,” she said.

Marijuana is fully legal in at least 11 states, including Alaska where Campbell lives.

Moms who may not have a marijuana community around them can find support online.

On Facebook, The Cannavist Mom, a group for “cannabis choosing moms” has almost 35,0000 members. It’s tagline: “Mommy needs a joint should be just as socially acceptable as Mommy needs a glass of wine!” There’s also Moms for Marijuana International with half a million followers.

And while “wine mom” may be tempted to turn “weed mom” if only to save herself the hangover, Bracho-Sanchez warns to proceed carefully.

“Just because these products are now legal, it does not mean that they’re always safe,” she said. “We have no standards or process for ensuring their quality, we don’t know the appropriate dosing for different conditions and we ultimately can’t guarantee their safety.”

“I do believe the use of these products is a valid strategy to cope with certain medical conditions and I encourage people to partner with their physicians to decide whether they can be safely introduced into the treatment plan,” she said.

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