From preconception counseling and infertility management to routine obstetric care and the availability of a Level II NICU, NewYork-Presbyterian Lawrence Hospital offers high-level care in a reassuring environment at every stage of a woman’s journey to motherhood.
Meeting maternal-fetal health needs and managing complications that may arise throughout pregnancy and delivery requires specialized expertise. The board-certified OB/GYNs, maternal-fetal medicine specialists, attending anesthesiologists and neonatologists at NewYork-Presbyterian Lawrence Hospital utilize advanced technology and provide care in a patient-centered environment, ensuring mothers and infants can receive the full spectrum of services they need locally, without having to travel significant distances to other facilities.
Optimizing Maternal Health before Pregnancy
In ideal scenarios, women visit an OB/GYN prior to becoming pregnant. These appointments enable physicians to identify health risks and address barriers to a healthy pregnancy, which may include comorbid medical conditions, obesity and tobacco use.
“It’s never too early to refer women to speak with an OB/GYN about preconception health,” says Nitasha Jain, MD, a ColumbiaDoctors OB/GYN practicing with NewYork-Presbyterian Medical Group Westchester. “Certain individualized goals, such as weight loss, take time to achieve, and it’s important to establish realistic expectations. For example, many young women believe they will get pregnant as soon as they start trying, but conception can take six to 12 months.”
(L-R) Nitasha Jain, MD, a ColumbiaDoctors OB/GYN practicing with NewYork-Presbyterian Medical Group Westchester; Rachel McConnell, MD, an OB/GYN at ColumbiaDoctors; and Pearl Lim, MD, a ColumbiaDoctors OB/GYN practicing with NewYork-Presbyterian Medical Group Westchester, consult on the unit and benefit from the collaboration of the NewYork-Presbyterian Medical Group and ColumbiaDoctors practices.
During preconception counseling, OB/GYNs review such topics as smoking cessation, alcohol use, diet and weight loss. If women are obese, losing as little as 5 to 7 percent of their body weight can make a difference in their prenatal health. Physicians also review medication that women take on a regular basis, pre-existing medical conditions that may impact maternal health during pregnancy and preconception carrier screening. In addition, Dr. Jain makes the recommendation that women begin taking 400 micrograms of folic acid — either in the form of a prenatal vitamin or folic acid supplement — at least three months prior to pregnancy to lower the risk of birth defects, such as spina bifida, and she reviews women’s medical histories to ensure they are up to date on screenings and vaccinations.
While OB/GYNs at NewYork-Presbyterian Lawrence Hospital prioritize collaboration with women’s primary care physicians and other specialists involved in their care, that partnership is especially crucial if women have pre-existing conditions, such as diabetes, high blood pressure, anxiety or depression, that require daily medication use. The goal of this collaboration is to optimize the medical condition and make medication adjustments, such as switching drugs, reducing daily dosages or, when possible, stopping use of medications for the duration of the pregnancy, prior to conception.
Rachel McConnell, MD, ColumbiaDoctors, consults with a patient to explain the various options with infertility, including IVF. She practices in the NewYork-Presbyterian Medical Group Westchester Scarsdale office location as well.
“Pregnancy changes a woman’s basic physiology, so any medical condition requires close surveillance,” Dr. Jain says. “Many times, these medical conditions affect not only maternal health, but fetal health as well.”
The collaboration between OB/GYNs and primary care physicians and specialists continues once women become pregnant. In most cases, OB/GYNs and a member of the NewYork-Presbyterian Lawrence Hospital Center for Maternal-Child Health medical team also jointly manage the pregnancies of women with comorbid medical conditions to ensure both mother and child benefit from the most comprehensive care possible.
The Role of Preconception Carrier Screening
Women, particularly those who have a genetic disorder or a strong family history of a genetic disorder, may decide to undergo preconception carrier screening. This testing enables physicians to determine if women are carriers for genetic disorders such as cystic fibrosis, spinal muscular atrophy, Tay-Sachs disease and fragile X syndrome.
“If women receive a negative result, we counsel them in the office and let them know that their chance of having a baby affected by that condition is low,” Dr. Jain says. “If results are positive, we refer them to genetic counseling.”
“Pregnancy is a window to a woman’s future health, and it can impact her health in general. Therefore, we believe in close cooperation with primary care physicians, and we are committed to providing the most comprehensive care.”
— Nitasha Jain, MD, a ColumbiaDoctors OB/GYN practicing with NewYork-Presbyterian Medical Group Westchester
Pearl Lim, MD, examines a patient in the NewYork-Presbyterian Medical Group Westchester Scarsdale office. Throughout their pregnancy, patients meet with several of the physicians so they are comfortable with all members of the practice when the important day arrives.
Genetic counseling is available to women and their partners through the NewYork-Presbyterian Lawrence Hospital Center for Maternal-Child Health and is especially vital for families in which both women and their partners screen positively as carriers. In these cases, infants have a 25 percent likelihood of receiving two sets of the abnormal gene and developing the condition. Conversely, if only the female patient or her partner is a carrier for the disorder, infants have no chance of developing the disease but a 50 percent risk of also being carriers for that gene.
Evaluating Causes of Infertility
Couples under age 35 who have been unable to conceive after one year or couples over 35 who have been unable to conceive after six months are candidates for referral to an infertility specialist. In 33 percent of these cases, infertility is linked to a maternal health issue.
“The most common cause of maternal infertility is some type of ovulatory dysfunction,” says Rachel McConnell, MD, a subspecialist in reproductive endocrinology and fertility, and OB/GYN at ColumbiaDoctors. “We also see tubal factor infertility, which results from impaired function or blockage of the fallopian tubes, and cervical or uterine causes that interfere with implantation.”
Ovulatory dysfunction can arise from a number of sources. Polycystic ovarian syndrome (PCOS), in which imbalances of androgen and estrogen interfere with ovulation, is one of the most common causes of ovulatory dysfunction. Other contributors include primary ovarian insufficiency, which occurs when ovulation stops before age 40.
Nitasha Jain, MD, NewYork-Presbyterian Medical Group Westchester, stops to check in on a new mother and baby boy. All of the OB/GYN physicians at NewYork-Presbyterian Medical Group Westchester encourage patients to ask questions in the hospital and beyond to feel as comfortable as possible with the life change of childbirth.
In addition to medical conditions, such as PCOS, which may interfere with ovulation, and endometriosis and pelvic inflammatory disease that may increase the likelihood of tubal factor infertility, maternal age plays a substantial role in infertility. The likelihood of conception decreases rapidly every year after age 30, according to the U.S. Department of Health and Human Services Office on Women’s Health, which estimates that one-third of couples in which the woman is over age 35 have difficulty conceiving.
“In terms of fertility, women are in their prime in their mid-20s,” Dr. McConnell says. “As women age, so do their oocytes. In women age 35 and older, we see a decrease in the quantity and quality of eggs.”
Male factor infertility, which may result from an anatomical irregularity such as a varicocele, plays a role in 33 percent of infertility cases. The remainder of cases are idiopathic.
Dr. McConnell evaluates patients who are experiencing infertility at the ColumbiaDoctors’ Center for Women’s Reproductive Care in Scarsdale. At this location, couples can receive education about infertility, as well as a wide range of treatments. If women need a hysterosalpingogram (HSG) — an X-ray evaluation used to diagnose tubal factor infertility — or other diagnostic testing, that can be performed at NewYork-Presbyterian Lawrence Hospital.
Couples who wish to delay pregnancy but worry about advanced maternal age have multiple options, including oocyte, sperm and embryo cryopreservation. Oocyte and sperm cryopreservation may also be options for women and men facing chemotherapy or radiation therapy for cancer treatment that may impact fertility.
“Prior to 2012, egg freezing was considered experimental,” Dr. McConnell says. “With older freezing techniques, it was difficult for eggs to survive the freezing process. Using the newest freezing technique, vitrification, eggs as well as embryos are able to be frozen and thawed with a high rate of success, so egg freezing is becoming a standard treatment option for many women.”
The preparation process for egg retrieval prior to oocyte and embryo cryopreservation or in vitro fertilization (IVF) is similar and takes 10 to 14 days. During this time, women self-administer daily injections of hormone solutions, which may contain follicle-stimulating and/or luteinizing hormones. Physicians also perform daily blood tests and vaginal ultrasounds to determine when the eggs are ready for collection. Women can receive all of the preparation services in Scarsdale. Egg retrieval takes place at the Center for Women’s Reproductive Care main office in Manhattan.
Orphia Blake, RN, and Natalie Ruiz, RN, utilize the latest wireless monitoring technology at NewYork-Presbyterian Lawrence Hospital. The maternity unit recently acquired the new monitors, which allow laboring patients to move around as needed during the process.
Other infertility procedures performed at the Scarsdale location include intrauterine insemination, a technique in which physicians introduce sperm into the woman’s uterus during ovulation. This therapy may be used to treat male or female factor infertility. Reasons physicians may utilize intrauterine insemination include erectile dysfunction, low sperm production or cervical scarring.
“Our goal is to accommodate women by keeping them close to home and making care as convenient as possible,” Dr. McConnell says. “We’ve made it easy for women to access academic-level fertility services in their local community.”
The Basics of Prenatal Care
If women have not established a relationship with an OB/GYN prior to their first prenatal appointment, physicians take a detailed medical history. During the initial appointment, physicians also confirm the pregnancy via ultrasound and determine a woman’s due date. While the timing and frequency of ultrasounds can vary between practices, the first ultrasound is usually performed before the 10th week of pregnancy to make sure there is a heartbeat, according to Pearl Lim, MD, a ColumbiaDoctors OB/GYN practicing with NewYork-Presbyterian Medical Group Westchester.
“There’s an art to caring for pregnant women — it’s definitely not just a science. Our physicians and nursing team have the resources and education necessary to deliver safe, up-to-date care, which helps ensure good outcomes.”
— Pearl Lim, MD, a ColumbiaDoctors OB/GYN practicing with NewYork-Presbyterian Medical Group Westchester
Judy McArdle, Lactation Counselor at NewYork-Presbyterian Lawrence Hospital, helps a new mother with proper technique. She is available for all patients on the post-partum unit to answer questions, demonstrate best practices and offer support.
At the beginning of pregnancy, physicians heavily emphasize educating women about pregnancy and the importance of a healthy lifestyle. For example, as the number of women who are overweight or obese grows, physicians initiate conversations about weight with their patients at the beginning of pregnancy. Handling those conversations sensitively is a priority.
“Obesity is an issue of health, not appearance,” Dr. Lim says. “Weight can be a major factor in a healthy pregnancy. Weight is an emotional topic for many women, however, so you must be sensitive and respectful. If you keep the focus on the poor health effects of obesity, you can have productive discussions.”
Women who are obese have a greater risk of miscarriage than those whose body mass index (BMI) falls within normal ranges at the beginning of pregnancy. The risks of stillbirth, preterm delivery, gestational diabetes and pre-eclampsia, and fetal anatomical malformations, such as heart and neural tube birth defects, are also higher in obese women.
“It is uncertain why obesity impacts fetal health,” Dr. Lim says. “One hypothesis is that adipose tissue causes chronic inflammation within the body, which affects the growing fetus.”
The amount of weight women should gain during pregnancy depends largely on their pre-pregnancy BMI. According to the CDC, women who are:
- Underweight (BMI under 18.5) should gain 28 to 40 pounds
- Normal weight (BMI between 18.5 and 24.9) should gain 25 to 35 pounds
- Overweight (BMI between 25 and 29.9) should gain 15 to 25 pounds
- Obese (BMI over 30) should gain 11 to 20 pounds
The American Congress of Obstetricians and Gynecologists (ACOG) recommends women consume no more than 300 extra calories per day during their second and third trimesters. During office appointments with a NewYork-Presbyterian Medical Group Westchester or ColumbiaDoctors OB/GYN, an OB nurse provides women with nutritional education, including a daily caloric breakdown of fruits, vegetables, meats and grains. The Outpatient Nutrition Program at NewYork-Presbyterian Lawrence Hospital also offers nutritional counseling for women who are pregnant or nursing.
“An easy rule of thumb that I pass along to my patients is, ‘If you’re pregnant, eat the way you want your 5-year-old child to eat,’” Dr. Lim says. “Moms aren’t going to want to give their children soda and chips; they’ll opt for water and fruit. When it comes to food habits, it makes sense to make healthy eating changes before children are born because if parents eat healthfully, their children are more likely to do so.”
From left, additional members of the OB/GYN team include Lilah Oasman, front-desk secretary; Kathryn McCormack, medical secretary; Blanca Baizan, CMA; Yokasta Lopez, CMA; Brenda Cotroneo, CMA; Barbara Crowley, Site Operations Manager; Brenda Jimenez, RN; and Camille Taylor, Practice Coordinator.
Maintaining a regular exercise program is another important component of physical health and preventing excess weight gain before, during and after pregnancy. Most women with uncomplicated pregnancies can exercise safely as long as they are not at risk of injuring their abdomen or experiencing bleeding. Exceptions include women who are experiencing complications, such as pre-eclampsia, cervical insufficiency or premature membrane rupture, according to ACOG.
As pregnancy progresses, the length of time between office visits becomes shorter. Until the 24th week of pregnancy, women come into the office every four weeks for an evaluation. From weeks 24 to 35, however, women begin visiting their physician every two or three weeks. When women reach the 35th week of their pregnancy, they start seeing their physician weekly for prenatal care.
“The rationale is that in the beginning, babies simply need to grow,” Dr. Lim says. “There also aren’t many interventions beyond blood tests and ultrasound that we perform during early pregnancy. Prior to 20 weeks, if there’s a miscarriage, there’s no proven intervention to prevent it. After 24 weeks, we want women to come in sooner because we start to see complications develop and need to screen for problems with blood pressure and blood sugar.”
To help women prepare for delivery, the NewYork-Presbyterian Lawrence Hospital Center for Maternal-Child Health offers an array of educational services. Tours of the hospital are available, as are breastfeeding and childbirth classes conducted by members of the nursing team. Following delivery, breastfeeding support is available both during women’s inpatient recoveries and on an outpatient basis through the Breastfeeding Support Group.
For more information about the services available to women at all stages of pregnancy, visit nyp.org/lawrence and click on Programs/Services/Maternity Program.