UCHealth Healthy Women by Brian Kelly

S P RING 2 015 INSIDE THIS ISSUE

Trying to Conceive, page 2 Going Skin-To-Skin, page 10 Exceptional Care for Exceptional Babies, page 14 Urgent or Emergent Care, page 18 and more.

Photo credit: Michelle Garey birthdenver.com

MEDICAL CENTER THE HE ROCKIES H e a l tVALLEY h y W oHOSPITAL men 1 UNIV ERSIT Y OF COLOROFADO A LT H | | POUDRE

Conceive

Trying to

hinking about having a baby? Wonderful! If you’re still in the considering or trying phase, you’ve got time to prepare for a healthy pregnancy.

After six months of regular and timed sex without a pregnancy, if you’re frustrated about your results, talk to your doctor. Remember, you’re still well within that one-year, 85-percent window, pointed out Rochester. But there are also simple tests “We want mom to be as healthy as possible before she conceives,” and treatments your doctor can use without going the full-blown said Dr. Natalie Rochester, an OB/GYN at UCHealth OB/GYN infertility route. who delivers babies at Medical Center of the Rockies in Loveland. “That means eating a healthy diet and exercising at least 30 “People don’t always seek care when they’ve been trying minutes a day and having all of your medical problems under unsuccessfully because they’re afraid of the costs and protocols of excellent control before trying to conceive.” infertility treatment,” said Rochester. “But the truth is, there are a number of simple next steps.” Prenatal vitamins are also “super-duper important,” said Rochester. “Starting a couple of months before you begin trying A blood test can reveal whether or not you’re ovulating each to get pregnant, women should be taking prenatal vitamins with month, for example. Medications that stimulate egg production folic acid. The vitamins lower the risk of birth defects.” You are also relatively easy to take and manage, said Rochester. can buy prenatal vitamins over-the-counter, or you can get a prescription from your doctor. The prospective mom’s age is also a fertility factor, of course. Women ages 20 to 35 have the highest chances of conceiving Finally, know what to expect when you do start trying to get quickly and delivering a healthy baby without complications. pregnant. “Many women think they’ll get pregnant quickly and “But I have many patients who are in the late thirties and early are surprised when they don’t,” said Rochester. “It often takes forties,” said Rochester. a number of months. In fact, only 85 percent of women with no infertility issues will be pregnant within a year, even if they’ve Finally, Rochester advised women to remember that each been having timed and frequent sex.” pregnancy is different. If you conceived quickly with your first baby but are having trouble conceiving your second, you’re not If you’ve been trying to conceive for a while without success, alone. It’s not uncommon for conception to take many months. Rochester suggests keeping an ovulation calendar. “A lot of And during those months, it’s essential that moms don’t neglect people don’t understand their menstrual cycles and when they their own health. can get pregnant,” said Rochester. “Keep track of your periods and have sex at the most opportune times.” “After they have one child, women tend to be so busy that they don’t take care of themselves,” said Rochester. “But it’s so important for Your ovaries release an egg about 12 to 14 days before your them to be in good health before they get pregnant again.” period starts. If you have a 28-day cycle, you’ll usually ovulate sometime between day 12 and day 16 of your cycle (with day For a list of providers who deliver babies at MCR and PVH, visit one of your cycle being the day your period starts). To conceive, uchealth.org/2pinklines. your egg needs to be fertilized within 12 to 24 hours of ovulation. Sperm live for two or three days, so if you want to get pregnant, you need to have sex a few days before you ovulate through the day of ovulation.

PRE-PREGNANCY CHECKLIST

 I’m eating a healthy diet.  I’m exercising at least 30 minutes a day, most days.  I’m taking prenatal vitamins.  I’m abstaining from alcohol, prescription and

recreational drugs and marijuana.

 I’m up-to-date on routine doctor’s check-ups,

including my annual pelvic exam and pap smear.  I’ve talked to my doctor about any pregnancy risk factors I might have.  I’m managing well any chronic health conditions (such as diabetes or high blood pressure).

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UCHealth Helps

Pregnant Women Who Use Drugs or Alcohol

ulie’s mom drank alcohol while she was pregnant with Julie and everything turned out OK, so Julie figured it would be OK for her to have a drink now and then during her own pregnancy.

Eva’s not ashamed to say that she smokes pot. It’s legal here in Colorado, and besides, cannabis is a natural substance. And now that she’s pregnant, it helps with the nausea. Ever since she was in a car accident a few years ago, Tanja has relied on prescription medication to cope with the lingering pain. She hasn’t told her OB/GYN that she still takes Tramadol sometimes, even though she’s three months pregnant.

Often babies who’ve been exposed to drugs or alcohol in utero are born prematurely, requiring a stay in the neonatal intensive care unit before they’re well enough to go home. Some substance-exposed newborns are underweight. Still others are born with addiction symptoms, such as excessive or high-pitched crying, irritability, sleep problems, trembling, vomiting and others. While moms are laboring at the hospital, MCR and PVH nurses ask them routine questions about their smoking, alcohol and drug use during pregnancy along with other screening questions required for the Colorado Birth Certificate and Vital Statistics office.

“The screening determines if the baby will be tested,” said UCHealth and Larimer County Community Health Nurse Karen While these particular women are fictitious, their stories are Yost. “A counselor will also visit with mom to see if the family essentially true. Many women in northern Colorado continue to use could be helped by various community services.” drugs and alcohol while they’re pregnant. And in 2014 at Medical Center of the Rockies and Poudre Valley Hospital, alcohol, pot and Mothers who admit to or are suspected of use may be asked to prescription pain medications were the three substances most submit a urine sample for testing. A sample of their babies’ urine, commonly found in babies’ systems after delivery. umbilical cord or meconium (baby’s first bowel movement) may be collected and sent to the lab for drug testing. The trouble is, when a pregnant mom drinks or uses drugs, the baby drinks and uses drugs too. And while we’ve all heard stories “When the test is positive, we work with Child Protective about mothers who drank or used and their babies were born Services (CPS) to get help for the family,” said Bernatow. “We perfectly healthy, the truth is that there’s no known safe level of know that addictions are hard to overcome and that pregnancy is drugs or alcohol for developing babies. often the most successful time for recovery from substances. Our goal, always, is healthy families and a healthy community.” “There’s not enough medical research to know how much—if any— of any given substance might be OK,” said Kelly Bernatow, women Positive results are also sent to the baby’s pediatrician or family and children nurse navigator at PVH. “So, the only safe amount of care doctor. Samples that contain drugs or alcohol at levels drugs and alcohol for a pregnant mom to consume is none.” below the threshold do not trigger a call to CPS. Still, Bernatow emphasizes that she and the other nurses and doctors at UCHealth are there to help moms and babies, even when the moms are using. “We need to know what’s going on so we can take the best possible care of both mom and baby,” said Bernatow. “We want moms to be honest with us. We don’t judge them. We’re here to help them and their babies.”

IF YOU’RE USING If you’re pregnant and using drugs or alcohol (or care about someone who is), even if you think it’s a safe amount, call Connections at 970.221.5551 or visit uchealth.org/legal-not-safe for more information.

Bernatow points out that drug and alcohol use during pregnancy does not have a typical face. “Where we’re really seeing an influx is in the upper- to middle-class.”

Only very rarely does Child Protective Services separate mom and baby, said Bernatow. “That’s the last thing we want to do,” “It’s not a good idea, but it happens,” she said. “We understand she added. It’s almost always in the family’s best interest to that. We need women to be completely honest with us, because keep the family together, and with CPS involved, moms who are if we know the full story, we can get them and their babies the using drugs and alcohol have resources to get the help they need. best care possible.”

UNIV ERSIT Y OF COLOR ADO HE A LT H | H e a l t h y W o m e n

Go the

ull 40

octors used to believe that babies born at 37 or 38 “Moms who deliver early, either on their own or for medical weeks gestation were healthy and strong enough to be reasons, shouldn’t worry,” said Gustafson. “If mom goes into considered full-term. But in recent years, as more and more data spontaneous labor and gives birth early, our team of nurses, has been collected and analyzed, it’s turned out that 39 weeks is neonatal nurse practitioners and physicians will make sure that the true threshold. baby gets excellent care.”

“Babies need a full 40 weeks of pregnancy to grow and develop,” said Robyn Gustafson, clinical nurse specialist with Medical Center of the Rockies and Poudre Valley Hospital’s women and children’s services. “For most women, allowing their bodies to go into labor spontaneously is the safest and healthiest option for both mom and baby.” “Babies born before 39 weeks may experience more difficulty feeding, breathing and regulating their temperature,” Gustafson added. Gestational age at birth is now understood to be so important that it’s tracked by the Joint Commission—the organization that accredits hospitals. “MCR and PVH support the Go the Full 40 campaign created by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), and our hospitals will only schedule inductions and C-sections before 39 weeks for ‘accepted medical reasons’,” said Gustafson. The emphasis on going the full 40 at MCR and PVH means that moms and doctors are are no longer allowed to arrange elective deliveries before 39 weeks. Somewhat common in the past, early C-sections and inducing only for convenience’s sake— say, to work around a physician’s travel schedule or a mom’s discomfort—are now understood to place mom and baby at unnecessary risk. Inducing labor before mom’s body and baby are fully ready often leads to an increased chance of C-section or NICU admission for baby. Of course, some moms and babies just won’t wait. Sometimes pregnant moms develop dangerous complications like preeclampsia (high blood pressure, which can lead to serious complications for mom), and sometimes, for various reasons, unborn babies start to show signs of distress. In cases like these, pre-term or early term birth before 39 weeks is the better choice.

In other words, MCR and PVH both have the expert staff, physicians, resources and technology to take excellent care of babies born too soon. But if they can help it, they’re going to support you going the full 40 weeks. Because when it comes to babies, 40 is undeniably fabulous. For more information about the Go the Full 40 campaign, visit gothefull40.com

REASONS TO GO THE FULL 40 • End right by starting right—keeping all of your prenatal appointments helps ensure a healthier ending. • Let nature take over—there are fewer complications and risks for both you and baby through natural birth. • Recover faster from a natural birth than cesarean, which is major abdominal surgery that causes more pain, requires a longer hospital stay and a longer recovery. • Birth a brainier baby—at 35 weeks your baby’s brain is only two thirds the size it will be at term. • Set her thermostat—baby will better regulate her temperature when born at term. • Boost breastfeeding—term babies more effectively suck and swallow than babies born earlier. For a full list of reason to go the full 40, visit gothefull40.com.

WHAT’S FULL-TERM? In 2013 the American College of Obstetricians and Gynecologists (ACOG) released updated definitions for what’s considered a full-term pregnancy. The new standards support the evidence-based findings that 39 weeks or more inside mom is best for baby. Late pre-term. . . . . . . . . . 34 to 36 6/7 weeks Early term. . . . . . . . . . . . . 37 to 38 6/7 weeks Full term . . . . . . . . . . . . . 39 to 40 6/7 weeks Late term . . . . . . . . . . . . . 41 to 41 6/7 weeks Post term . . . . . . . . . . . 42 weeks and beyond.

UNIV ERSIT Y OF COLOR ADO HE A LT H | H e a l t h y W o m e n

What to Expect When Youâ&#x20AC;&#x2122;re in the Hospital Photo credit: Michelle Garey birthdenver.com

ou’re in labor. Your contractions are close together. It’s time to head to the hospital!

But wait—what’s your stay at Medical Center of the Rockies or Poudre Valley Hospital going to be like? We asked labor and delivery nurse Nikky Barber and coordinator of prenatal education Carol Skeen to give us the scoop. First off, if you haven’t already, take a free Parent Preview Tour. A tour guide will take you through the hospital and show you where to park, which entrance to use when you’re in labor, what the birthing center rooms look like, etcetera. This is the perfect time to get the lay of the land and have all your logistics anxieties put to rest. Here are some other common questions: Q. Who’s allowed in the birthing rooms? A. “We allow whomever mom wants in the room,” said Barber, “as long as it’s a safe environment for mom and the care team. There is no limit to how many people, and there are no visiting hours. Children are welcome as long as there’s an adult to supervise them. Labor happens around-the-clock, and mom’s invited guests may stay the entire time. Q. Can my family sleep in the birthing room? A. Yes. There are pull-out couches or sleep chairs, and partners are encouraged to stay overnight. Q. What can I wear during my labor? A. We prefer mom to be in a hospital gown, but you can wear your own clothes if you’d like. Loose clothing with easy access to your stomach is best. Some moms wear camisoles and yoga pants. Bring a robe and slippers, too. Q. Can I be in the Jacuzzi tub during labor? A. Yes. Most birthing rooms at MCR and PVH have Jacuzzis, and you can labor in the tub until it’s time to deliver. Water births aren’t allowed.

Q. Do I have to have an IV during labor? A. Yes. Every patient has an IV cannula inserted into her hand. It’s a tiny needle covered with a small piece of plastic, held in place with medical tape. The IV port won’t necessarily get used, but it’s ready to go if you need fluids or medication delivered quickly. Q. How long will it take to deliver my baby? A. There’s a big range. Anywhere from one hour to three days. Once you’ve dilated to four centimeters, the average time is one centimeter of dilation per hour of active labor plus one to three hours of pushing. Q. After delivery, where will my baby be? A. With you! You get to room-in with your baby, which means your baby will stay with you almost every minute during your hospital stay. Q. What will I eat? A. During labor, moms who have an epidural can’t eat, though usually liquids are allowed. After delivery, moms can order room service from the cafeteria, as much as they want. Dad’s meals aren’t included—expect for the Baby Bistro celebration meal. New parents are treated to a very special “room service” breakfast, lunch or dinner. Choices include steak and lobster or eggs Benedict. Q. Can my family bring food to the hospital? A. Yes. There’s a small fridge in each birthing room. Q. Do I need to bring a car seat to the hospital? A. Yes, you’ll need a car seat for bringing baby home when you’re discharged. A certified car-seat technician can check your seat while you’re in the hospital to make sure it’s safe. (There are a limited number of appointments available.)

PARENT PREVIEW TOURS Tour the hospital and birthing center, and get all your questions answered. • Cost: Free. • Time: Takes one hour. • Dates: Varies by hospital. • Register: Go to uchealth.org/healthy-families.

WHAT TO PACK FOR THE HOSPITAL • Robe. • Slippers. • Supportive bra. • Toothbrush, toothpaste and shampoo. • Loose, comfortable clothing to wear home. • Clothes for baby to wear home. • Blanket for baby. • Names for your baby. • The name of your baby’s pediatrician or family care physician. • Car seat. The hospital will provide towels, pads, lotion, soap, tissues, shower caps, a blow dryer and a hospital gown. Don’t bring candles or incense. For safety, we don’t allow anything that burns.

Q. Do I need to have a doctor for my baby picked out before I go to the hospital? A. Yes! “A lot of families don’t realize that they should have a pediatrician or family care doctor picked out by the time they’re 34 weeks pregnant,” said Barber. If you haven’t chosen a provider, an on-call physician will care for your baby. Make sure to have a provider chosen for your baby before you leave the hospital. UNIV ERSIT Y OF COLOR ADO HE A LT H | H e a l t h y W o m e n

Skin-To-Skin

We Go

Because Breast Is Best

Photo credit: Michelle Garey birthdenver.com

hen baby Micah was born at Medical Center of the Rockies sometimes called “liquid gold.” last year, his midwife, Tina Downes, gently placed him on his mother’s chest for some essential skin-to-skin time. “In the first 24 hours of life, a newborn baby’s tummy can only hold about a teaspoon at each feeding,” said Boyd. “And what do And that’s right where Micah spent the first two hours of his you know, moms provide five to seven milliliters of colostrum at precious new life. each feeding during that time. Five milliliters is a teaspoon.” “They did all the necessary baby checks on Micah while he was on me,” said his mom, Kailin Hamilton. “He latched himself within 30 minutes. It was very calm and peaceful.” Also called “kangaroo care,” skin-to-skin care is the practice of lying back and holding your newborn between your bare breasts, with a blanket draped over baby’s back to keep him warm. It’s become part of the standard practice at both MCR and Poudre Valley Hospital, because research has shown that skin-to-skin has many benefits for both mom and newborn: • • • • • • •

Maintains baby’s body warmth. Regulates baby’s heartbeat, breathing rates and blood sugar. Helps baby gain weight faster. Enables baby to spend more time in deep sleep. Soothes baby when he’s awake and fosters bonding. Fosters the natural progression of breastfeeding. Improves mom’s milk production.

“When newborn babies are placed skin-to-skin with mom, they are soothed by her familiar heartbeat, voice and the warmth of her skin,” said Becky Boyd, a nurse and certified lactation consultant at MCR’s birthing center. “After a while, they also instinctively crawl toward mom’s nipple and latch on.” “Breast milk is amazing,” said Sara Rathmell, also a nurse and certified lactation consultant at MCR. “It’s something that cannot be replicated. It’s the perfect food for babies.” When newborn babies do the breast crawl, latch on and start to suck, they’re getting colostrum, which is the thick, yellow first milk that mom’s breasts produce. It’s extremely rich in nutrients and antibodies that protect babies. That’s why colostrum is

By the third to fifth day, mom starts to produce mature breast milk—right when baby’s body is ready for it. This milk contains ample nutrients and disease-fighting antibodies, too, and is easier for baby to digest than formula. In the long run, breastfed babies have lower risks of respiratory infections, asthma, obesity and type 2 diabetes. There is also evidence that breastfeeding reduces the risk of type 1 diabetes, childhood leukemia and SIDS. For moms, breastfeeding is linked to lower risks of type 2 diabetes, breast cancer, ovarian cancer and postpartum depression. Going straight to skin-to-skin after delivery until baby has fed for the first time and allowing this natural “breast crawl” to unfold are just two of the ways that MCR and PVH birthing centers are fostering breastfeeding and, by extension, healthy babies. To safeguard skin-to-skin time, they’re also postponing baby’s first bath. “Delaying the task-focused things we used to do right away has allowed for moms and babies to remain together and in turn increased our breastfeeding rates,” said Rathmell. In fact, because he was jaundiced, baby Micah was in the hospital for three days, and he didn’t have his first bath until right before he went home. After Micah and family arrived home, though, Kailin, herself a registered dietitian and certified lactation counselor for Weld County WIC, began having breastfeeding troubles. Micah was gaining weight, but Kailin’s nipples were cracked and bleeding.

WE’RE BABY-FRIENDLY! MCR and PVH are officially designated as BabyFriendly hospitals by the World Health Organization for practices that foster breastfeeding and mother-baby bonding. They are two of only three hospitals in Colorado that have earned the Baby-Friendly status. For more information, visit babyfriendlyusa.org.

“So we went to WeeSteps,” said Kailin. Wee Steps is UCHealth’s ongoing breastfeeding support program for moms and babies at both MCR and PVH. All new moms can call and talk to a certified lactation counselor and make an appointment to be seen in person. Moms and babies are also encouraged to attend breastfeeding support groups, which meet weekly at MCR and at the Westbridge building across from PVH. Many provider offices also have lactation consultants to help support mom and baby. Also WeeSteps nurses, Boyd and Rathmell helped Kailin and Micah through the repair of a tight labial frenulum (that tissue cord under the upper lip) and tongue tie, which were the reasons why Micah was having a hard time latching well and Kailin was cracked and bleeding. They also saw Kailin through bouts of mastitis—twice—and a nasty case of thrush that lasted for months. “It took six full months before breastfeeding became easy,” said Kailin. “It was painful. It was hard. But breastfeeding was the thing I most looked forward to about having a baby, and I know that the benefits of breastfeeding are amazing. Becky and Sara gave me incredible emotional support. They were a huge part of our breastfeeding success.”

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At UCHealth, We Support Lowering the C-Section Rate

f you can safely avoid having a C-section, that’s the way to go, says Fort Collins OB/GYN Dr. J. Bradley Stern.

Why? Because while today’s cesarean sections are extremely safe, they’re still major surgery. Complication risks are higher. So are costs. And ask anyone who’s had a C-section if the recovery—measured in pain levels as well as numbers of weeks—was insignificant. (Um, no.)

Pitocin through an IV or breaking your water. Though “there are times when an induction is warranted because it is medically indicated,” said Stern. Doctors use something called a “Bishop score” to measure how “ripe” a pregnant woman’s cervix is—in other words, how ready your body is to deliver the baby. The doctor checks the position, consistency, effacement and dilation of the woman’s cervix as well as the position of the baby’s head. (The lower the baby’s head in the birth canal, the more ready the baby is to be delivered.)

Then there are the down-the-line consequences. Once a mom has a C-section, she has an increased chance of delivering via C-section for Bishop scores range from zero to 13. The higher the score, the subsequent pregnancies. While VBACs (vaginal birth after cesarean) more likely it is that mom’s induction will result in a vaginal are sometimes possible, they’re considered higher risk than first-time delivery. A low Bishop score indicate that induction may be vaginal deliveries. That’s because the incision in the uterus from the unsuccessful, leading, too often, to a C-section. first C-section can, very rarely, come open during the stress of labor, creating a life-threatening emergency for both mom and baby. “It’s important that we wait until mom’s body is ready to deliver the baby,” said Stern. In the United States today, one in three term pregnancies ends in a cesarean section. The total C-section rate in Colorado is 25.9 In addition to using induction more judiciously, ACOG and SFMM now percent. But in 1965, when C-section numbers were first measured, advise physicians to allow early labor to go on longer, allow more the national rate was just 4.5 percent. The myriad reasons for the time for labor to progress during the active phase (six centimeters to steep rise include improved technology (such as ultrasounds and fully dilated), allow laboring down, allow longer time for pushing, and fetal monitoring) that can raise questions about a baby’s health as consider the use of techniques to assist with vaginal delivery when well as increasingly casual attitudes about surgery. necessary, such as forceps. The optimal—i.e., necessary and safest—C-section rate is not known, said Dr. Stern, but “there needs to be a focus to prevent the overuse of cesarean sections.” To decrease the C-section rate, prominent physician organizations recently issued new primary (first baby) C-section guidelines. The American College of Obstetricians and Gynecologists (ACOG) and the Society for Fetal-Maternal Medicine (SFMM) are now asking physicians to be more circumspect about inducing labor and manage first-stage labor differently. “The data shows that inductions with an unfavorable cervix are more likely to lead to C-sections,” said Stern. What’s an induction? That means putting you into labor, or stimulating a stalled labor, through techniques such as giving you hormones like

MCR and PVH have been using these national recommendations to lower C-section rate. C-section rates are measured based on the NTSV (Nulliparous, Term Singleton, Vertex) measure. This measure includes the first time mom, greater than 37 weeks gestation with a singleton pregnancyone baby (not twins) in the head down position presentation.. MCR and PVH have reduced the NTSV C-section rate from 36% in 2013 to 26% in 2014. This change was made by carefully changing policies and procedures, like never inducing or scheduling C-sections for anyone without a medical need before 39 weeks gestation. By lowering the NTSV C-section rate, repeat C-sections will be prevented down the road.

This national push with local results is exciting news for moms throughout northern Colorado - it means better outcomes for moms and babies. It’s natural for women in their ninth month to grow tired of pregnancy, said Stern. But in general, what’s best is for baby to stay in utero until both baby and mom’s body are all systems go for the miraculous birth day. “Yes, we want to safely lower the C-section rate because that’s what’s best for mom and baby,” said Stern. “But the key is ‘safely.’ C-sections are still our best tool when it comes to circumstances like breech delivery and fetal distress. What’s best for any given delivery is complex because you’re always taking care of two people.”

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PVH NICU

Provides Exceptional Care for Exceptional Babies

t was the Friday before Christmas, 2012, and Nicole Wright had just had her 20-week ultrasound. She and her husband, Casey, were expecting their first baby.

But instead of enjoying the holidays, they suddenly found themselves meeting with specialists, doing medical research, and making some very hard decisions. The ultrasound had revealed a problem. Their baby, a girl, had spina bifida. “We were seeing the midwives at the Women’s Clinic of Northern Colorado,” said Nicole. “I was in the ultrasound room, and the midwives called in Dr. Kozak. She began to explain what we could do—places where we could look into surgery. They told us not to go home and Google it. But of course, we did.” Spina bifida—which literally means “cleft spine”—is a condition in which the brain, spinal cord, and/or the protective covering around a fetus’ brain and spinal cord don’t develop completely. According to the National Institute of Neurological Disorders and Stroke, it affects about 2,000 of the four million babies born in the U.S. each year.

“So we decided to go through with the surgery,” said Nicole. “Our baby—we named her Piper—was 24 weeks gestation. They only do the surgery between 21 and 26 weeks, and we thought it would give her the best chance.” Piper’s surgery went well, but the incision in Nicole’s uterus didn’t heal completely. She was leaking amniotic fluid.

The PVH NICU is level III, staffed and equipped to routinely care for babies as young as 8 weeks gestation and as small as two pounds. It’s the highest-level NICU between Denver and Billings, Montana.

Back in Fort Collins now, Nicole was admitted to PVH and put on bed rest. The goal: to make it to 37 weeks. But at 30 weeks, despite a long stretch off her feet and doctors’ best efforts to stop her contractions, Nicole went into labor. Because of the risks of vaginal delivery for both mother and baby, Piper was delivered by C-section.

“We have five neonatologists on staff at PVH,” said Dr. MacRitchie, “as well as 14 neonatal nurse practitioners and Dr. Schneider, the perinatologist. Our NICU is so closely affiliated with Children’s Hospital, the University of Colorado Hospital, and Medical Center of the Rockies that it’s easy for us to all work together and collaborate on a patient’s care. We also have a really great multidisciplinary approach that includes pediatricians, occupational therapy, physical therapy and other aspects of care.”

“She spent a few days in the neonatal intensive care unit (NICU) at PVH, then she was moved to Children’s Hospital in Denver,” said Nicole. “She was just over three pounds when she was born, and she needed to be on oxygen.”

In fact, the PVH NICU is in such demand that a remodel in early 2016 will nearly triple its size, from its current 7,000 square feet to almost 20,000. The NICU can now accommodate 19 critically ill babies, but it will soon be able to care for 32.

Nicole stayed with Piper in Denver during her month at Children’s Hospital, while Casey continued to work in Fort Collins and visit when he could. The separation and travel wore thin.

Dr. Dan Satterwhite, PVH NICU Medical Director, said, “This expansion is needed not just to provide the most technologically advanced care to babies, but also to allow families to be more involved in their babies’ recovery.” In the revamped NICU, individual patient rooms will replace the current open floor plan. Much like private hospital rooms for adults, the new NICU rooms will have ample space for families to spend time with their babies as well as sleep overnight.

“It was really taxing on us,” said Nicole. “So we fought to get her Fortuitously, Dr. Michael Schneider had just open the first fullback to PVH.” time perinatology clinic in northern Colorado. Dr. Schneider is an obstetrics physician who specializes in complicated, high-risk “We really like to be able to have northern Colorado babies come pregnancies. He contacted the Wrights and helped them consider back to PVH if they’ve had to be in Denver at Children’s at first,” their options. said Dr. Amy MacRitchie, a PVH neonatologist who also practices at the University of Colorado Hospital and Children’s Hospital. “We were his first patients in Fort Collins,” said Nicole. “He told “It’s a huge help to families to stay in their own communities.” us about the possibility of in utero surgery.” In late April, the Wrights got their wish and Piper was transferred Dr. Schneider set up a February appointment for the Wrights at back to the PVH NICU, where she stayed until the end of May. University of California-San Francisco hospital, which is where Because Nicole had spent so much time at PVH during her the first human fetal surgery was performed more than 30 years pregnancy, she felt at home there. ago and the nearest hospital offering the procedure. Doctors there explained the results of a study proving that babies who “I knew the nurses at PVH, and we loved being back there,” she undergo an operation to repair the spina bifida defect while they said. “We knew all the doctors. We loved the attention we got. I are still in the womb develop better and have better neurologic felt like I was more involved with Piper’s care at PVH. And I could outcomes than babies who have corrective surgery after birth. go home for lunch.”

Today Piper is a happy two-year-old. She loves slides, climbing up onto couches, and giving hugs and kisses. She can walk assisted by braces and a walker. Nicole and Casey like to put her in a backpack and take her hiking and camping. Nicole Wright is thankful for the PVH NICU. “I had a voice there,” she said. To learn more about premature birth, hear another family’s NICU story or to share your own, visit care.uchealth.org/love.

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Don’t Procrastinate – Vaccinate! Immunization Q&A

ave questions about your children’s immunizations? Fort Collins pediatricians Dr. Beth Ballard and Dr. Mark Simmons have the answers!

Q. I’ve been hearing lots of stories in the media warning that immunizations are dangerous. Are they? A. No, said Ballard. “Billions of dollars have been spent researching the possible links between vaccines and autism, SIDS and other problems,” said Ballard. “The research has shown no connection.” Ballard also points out that the Centers for Disease Control and the American Academy of Pediatrics stand firmly behind comprehensive immunization. Very rarely, it turns out that a child is allergic to a vaccine, added Ballard. This can cause anaphylaxis, which is a dangerous, whole-body allergic reaction. Anaphylaxis occurs in about one case per 1.5 million doses of vaccine, according to a study in the journal Pediatrics. More commonly, vaccinated children may develop a fever and soreness at the injection site—side effects that can be managed with over-the-counter medication.

Q. Isn’t it dangerous to give kids so many vaccines at the same time? A. Vaccines are made from killed or weakened viruses and bacteria, which trigger newborns’ immune systems but can’t make them sick, explained Simmons. Q. What about postponing some of the vaccines? “A delayed immunization schedule just delays the child’s protection,” said Ballard. Q. Are preservatives like thimerosol/mercury still used in vaccines? A. With the exception of the flu vaccine, thimerosol has been removed from, or reduced to trace amounts in, all routine vaccines for kids six and under, said Simmons. Vaccines may still contain small amounts of additives or preservatives, such as aluminum and formaldehyde, because they help the vaccine work better or prevent the virus from replicating.

Q. Isn’t it really unlikely that my child would get a disease like diphtheria or measles anyway? “The risk of contracting the diseases we can immunize against A. It’s true that many of the diseases we immunize against is much greater than the risk of the immunizations themselves,” are becoming more and more rare—a testament to the emphasized Ballard. effectiveness of vaccines, said Ballard. “But if you’re the parent of a child suffering from pertussis or bacterial Q. But don’t we give newborns too many vaccinations too meningitis, the fact that these illnesses are uncommon doesn’t soon? Isn’t their immune system too immature? matter to you. A. “Newborns need protection right away,” said Ballard. “When itty-bitty babies get pertussis (whooping cough), it can kill them.” “Think of it like putting on your seatbelt,” she added. “You don’t get in the car and buckle your seatbelt because you’re “Newborns have strong immune systems from day one,” planning to get into an accident. You buckle up because you’ll added Simmons, “but they have to build up antibodies to the be safer if you do get into an accident.” deadliest diseases. That’s where the vaccinations come in.” Q. Are your own kids fully immunized? A. “Absolutely!” said both Ballard and Simmons.

BUT I’VE READ ABOUT KIDS GETTING SICK FROM VACCINES Stories you hear on popular and social media are often not reliable. If you’re not sure whether to believe a children’s health story or not, here are some questions that the American Academy of Pediatrics recommends asking: Who is providing the information? The source of the information should be clearly stated. You should be able to read more about the organization’s or individual’s credentials and motives. Is the information based on sound research? Research published in peer-reviewed medical journals has been scrutinized for accuracy and possible bias and has been found to have integrity. Is the information up-to-date? Medical knowledge and practices change quickly. Make sure the information you’re reading was updated recently. Does the information make sense? If the information you found sounds unreasonably positive or negative, it probably is. Can I find out more? Reliable medical sites post contact information. They also include links or references to additional reading on others’ websites.

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ER or Urgent Care?

f you’re a parent, you’ve experienced the Murphy’s law of childhood illness: Kids always seem to get sick after 5 p.m. or on the weekend.

“99 percent of kids’ emergencies are breathing-related,” Ballard added. If your child’s breathing is really labored—her voice has changed significantly, she’s having to pause to breathe between words—or, for babies, breathing faster than one breath a second, During regular office hours, you can call your child’s doctor or an ER visit is warranted. Go to urgent care if the breathing healthcare provider and get answers—and maybe an appointment— problem seems less serious but you don’t want to wait until your right away. But what do you do outside office hours? Do you go to doctor’s office opens.” urgent care? Should you take your child to the ER? After breathing concerns, hydration problems are next on the list “My first piece of advice to parents is to call your child’s primary of common emergencies. “Is your child producing tears when he care provider,” said pediatrician Beth Ballard of the Youth Clinic. is crying?” asked Ballard. “Is he so listless that he can’t even get “Call the main practice phone number, and if it’s after hours, the upset or pitch a fit?” Lack of tears, listlessness and infrequent answering service will page the doctor for you.” urination (fewer than three times in 24 hours) are all signs of dehydration. And in kids, especially, dehydration can be an But, Ballard cautioned, if you feel like you just can’t wait about emergency. Outside office hours, choose urgent care if your child 30 minutes for a return call, trust your instincts and go to the is responsive and urinating but you’re worried about dehydration. emergency room or call 911. “Parents know their children,” she said. “Do a gut check. If your child isn’t breathing well or is Pain that you can’t control with ibuprofen, acetaminophen, and unresponsive, it’s an emergency.” heat/cold packs is another reason to go to urgent care or the ER, said Ballard. “If you’ve treated your child with home remedies That’s where emergency rooms come in. They’re for lifeand she’s still in too much pain to fall asleep, take her to urgent threatening illnesses and injuries. Urgent care clinics are for care if it’s open or the ER if it’s not.” more routine illnesses and injuries—just like doctors’ offices but with the important difference that they’re open evenings and Note that high fever by itself isn’t on the list of emergency weekends. In the late night and early morning hours when urgent symptoms in children. “I’m not so worried about the number on cares are closed, however, emergency rooms are for any illness the thermometer,” said Ballard. “If your child is hydrated, acting or injury that you think shouldn’t wait until the doctor’s office or in an age-appropriate manner and breathing fine, a fever is OK. urgent care opens in the morning. On the other hand, if your child is extremely listless but has a low fever, I want him to be seen right away.” Regardless of time of day, Ballard said, go to the ER if your child has: If your child needs to be admitted to the hospital for care, • Very labored breathing or shortness of breath. both MCR and PVH have pediatric units with a team specially • A change in level of consciousness, e.g., sudden sleepiness, trained to care for your child. PVH also has pediatric ICU care hard to wake, confused or disoriented. and specially trained pediatric anesthesiologists. When illness • A cut that won’t stop bleeding. strikes, northern Colorado is lucky to have this incredible team of • A stiff neck with fever. pediatric specialists to care for your children. • A rapid heartbeat that doesn’t slow. • Eaten or drunk something you think might be dangerous. • A head injury more serious than a minor bump.

URGENT AND EMERGENT CARE LOCATIONS Emergency Care Medical Center of the Rockies 2500 Rocky Mountain Ave., Loveland Poudre Valley Hospital 1024 S. Lemay Ave., Fort Collins Greeley Emergency and Surgery Center 6906 10th St., Greeley Urgent Care Associates in Family Medicine Urgent Care 3519 Richmond Drive, Fort Collins | afmfc.com Pediatric Urgent Care of Northern Colorado 1214 Oak Park Drive, Fort Collins pediatricurgentcareofnortherncolorado.com UCHealth Urgent Care 2121 E. Harmony Road, Fort Collins UCHealth Urgent Care 1900 16th St., Greeley UCHealth Urgent Care 3850 N. Grant Ave., Ste. 200, Loveland Walk-In Care Family Medicine Center Walk-in 1025 Pennock Place, Suite 121, Fort Collins uchealth.org/JustWalkIn

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2315 E. Harmony Road Suite 200 Fort Collins, CO 80528-8620

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Come learn the techniques for successful breastfeeding. This class reviews the process of breastfeeding and how to prevent common challenges. LABOR SKILLS

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Take a one-day or two-day Fast Track or a five-week series childbirth class. We also have a natural childbirth class option. These interactive classes prepare mom and her labor coach for the birth experience.

For a complete description of hospital tours, classes and dates, times and location please visit uchealth.org/healthy-families or call 970.495.7500. Classes and tours may also be offered by your provider.

Blueberry whole wheat pancakes Servings: 4

Ingredients ¾ cup whole wheat flour ¾ cup all-purpose flour 2 teaspoons baking powder 4 teaspoons sugar 2 large egg whites 1 ¼ cup fat-free milk 1 ½ tbsp. canola oil ¼ cup blueberries

Directions In a small bowl, mix together both flours, baking powder, and sugar. In a large bowl, beat egg whites, milk and oil until smoothly blended. Add flour mixture to milk mixture and stir just until dry ingredients are evenly moistened. (Batter will be lumpy.) Stir in blueberries. Heat a nonstick frying pan on medium heat. Spray with cooking spray if necessary. For each pancake, spoon about 3 tablespoons batter into the hot pan. Spread to make a 4-inch circle. Cook until bubbly on top and browned on bottom; then turn and cook other side (about 2 more minutes). Also great without blueberries! Serve with light maple syrup or top with yogurt and fruit for a great snack!

Nutrition per serving (3 to 4 pancakes) 264 calories, 6 g fat, 1 g saturated fat, 44 g carbohydrate, 10 g protein Recipe adapted from The Best of Sunset Low-Fat Cook Book by University of Colorado Health wellness team.