Posts Tagged ‘delivery’


I have been in the hospital since early morning, it has been very busy between the emergency room, the operating room and the delivery suite.

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What a better way to end my day!
A healthy baby boy being born breaking my personal record for the number of family members attending a delivery at a hospital!

The interactions and emotions reminded me of the strong family ties we experience back home in Lebanon.

And here is the little miracle of the day.
Happy birthday Nikhil, how special is it to be born on the birthday of your mother and the birthday of the obstetrician who cared for you while still in utero!

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Disclaimer: Both photos were taken and published here with permission of Nikhil’s parents.

Alex 2 years later

Posted: August 17, 2012 in Thought of the day
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This is Alex. I helped his mother give birth to him in June 2010. Today I run into her by chance and she shows me his recent photo. What a great feeling!

Disclaimer: This photo has been taken and shared here with permission from Alex’s mother.

Another little miracle

Posted: April 27, 2012 in Personal
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Happy birthday Zack-André and birthing day to his mother.

This photo was taken and published here with permission from Zack-André’s mother.


A new study published in The Lancet on April 3rd 2012 reveals a promising management for pregnant womyn at risk for preterm labor and delivery.

The study by Dr. Maria Goya from the Maternal Fetal Medicine Unit, Department of Obstetrics, Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Spain is the first multicenter randomized trial to test the use of a cervical pessary in womyn at high risk for preterm birth. The pessary was found to be an effective strategy to prevent preterm birth in pregnant womyn with a short cervix.

We already know that a short cervix early in pregnancy is one risk factor for preterm birth.

The Spanish study, called Pesario Cervical par Evitar Prematuridad (PECEP), randomly divided Pregnant womyn with cervical length of less than 2.5 cm into two groups: One group was treated with a cervical pessary and the other with watchful waiting. Spontaneous delivery before 34 weeks (8.5 months) was significantly lower (only 6%) in the cervical pessary group than in women assigned to expectant management (27%).

With the observed reduction in preterm birth, the pessary group of womyn was also found to give birth to larger infants with less complications as respiratory distress or sepsis.

Given the lack of cost-effective methods to prevent preterm delivery these findings offer new hope.

Hormonal treatment with progesterone is one method that was found to be effective in prevention of preterm birth. However, recent corporate greed might keep such effective medication away from the reach of many womyn. Even though progesterone has been available in an affordable form for more than a decade, now that the evidence of its benefits has solidified, it has been recently repackaged by a pharmaceutical company, given a name (Makena) and dropped in the market with a price that exceeds 1000 USD. Makena’s price has already caused much controversy especially that the FDA might prohibit pharmacies from compounding the cheap original formula.

Cervical cerclage is another method that has been studied significantly. So far the evidence of its benefit had been controversial. The process requires significant surgical skills and many gynecologists had not been adequately trained. It is also an invasive procedure that might be associated with significant risks such as rupture of membranes, infection, preterm delivery or miscarriage among others. Those risk, even though rare in well-trained hands remain significant given the little proven benefit of cervical cerclage.

In the above mentioned Spanish study, the use of a cervical pessary was found to be relatively safe and at low cost to patient. Side effects were limited to slight increase in vaginal discharge, and little discomfort.

The exact mechanism of action of the pessary is still not clear. But given its safety and low cost, it still stands as a promising option. I anticipate it will take some time before it becomes available in the American and Canadian market.

Happy birthday Akita

Posted: February 18, 2012 in Personal
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Akita just saw the light now. Yet another precious miracle delivered to life.

This photo was taken and published with permission from Akita’s mother.


A new study by Dr. Elizabeth Raynmond and Dr. David Grimes published in the Green Journal (Obstetrics & Gynecology) in Feb. 2012 concluded that:

Legal induced abortion is markedly safer than childbirth. The risk of death associated with childbirth is approximately 14 times higher than that with abortion. Similarly, the overall morbidity associated with childbirth exceeds that with abortion.

This sounds common sense to an Obstetrician & Gynecologist regardless of their political or moral position on abortion. Now, we have it in print. In the golden era of evidence based medicine, this piece of common sense information is now supported by evidence.

Raymond & Grimes reviewed data from the CDC’s Pregnancy Mortality Surveillance System, birth certificates and Guttmacher Institute surveys to estimate mortality rates associated with live births and legal induced abortions in USA from 1998 to 2005. They also searched population-based data comparing the morbidity of abortion and childbirth.

Here are the figures they found:

  • With delivery, 8.8 womyn died per 100,000 live births
  • With legal abortion, only 0.6 womyn died per 100,000 live births

Legal abortion has been found to be safe in multiple studies. Allegations that abortion can lead to breast cancer or mental illness have been refuted.

It is true that abortion might be regretted, but so could delivery of an unwanted pregnancy. It is true that depression can be diagnosed after an abortion, but it can more so be diagnosed after a delivery.

I am not pro-choice. I am not pro-life. Actually those two terms are relatively new to me. Having studied medicine in Lebanon, the issue of abortion does not even come up in the curriculum, not even in residency training. Apparently, unwanted pregnancies do not occur in Lebanon; neither does pre-marital sex! Rape and incest in some magical way do not get womyn pregnant in the Sin City of the Middle East. Abortion is illegal in Lebanon. A woman can spend up to 5 years in prison for getting one. Abortions are being performed in Lebanon. It costs 500 to 2000 USD per abortion in a country where minimum wage is 448 USD. RU486 or mefiprostone is illegal in Lebanon but can still be found in Black Market. Read more about Lebanon’s abortion question.

After 4 years in USA, I learned all about the choice vs. life controversy. I still could not identify with either. When asked, I say I am pro-patient. As a physician, I can not and should not impose my set of moral rules on my patients. Regardless of what my personal feelings about abortion are, I am obliged to provide my patients with facts. I owe it to them. The facts as I know it stated simple and clear: Abortion is not riskier than continuing with an unwanted pregnancy, it actually appears to be safer.

So the controversy is political and not medical. I did not spend 13 years of my life studying as much as I did to allow politics to influence my medical decisions. Patient’s safety and well being should remain the focus of any health advocate. There are more serious risks to which womyn are exposed and to which governments pay less attention. Poverty should be illegal, it is a great health risk. Smoking claims 3.1 million deaths over 7-years in USA (Pregnancy claims 2856 and abortion 64 deaths).

Dr. Mitchell Creinin stated in an editorial for the Green Journal this month that:

Abortion is safer than delivery. Regardless of personal views, every woman deserves factual medical information whenever she is faced with a decision of whether or not to terminate her pregnancy. Government should be concerned about important issues that create public health hazards. With pregnancy and abortion, more laws are promoted to limit access to a safe procedure when the alternative  is riskier.

The ethical controversy will continue. We will always agree to disagree. In the meantime facts should be provided to womyn to empower them in making well-informed decisions.


I was there for the delivery of Nathan (said with a French accent).

Each baby born still has the same effect on me like that I had with the first one I ever saw. It feels miraculous.

Photo taken and published with permission from parents.


This newborn weighed 6110 gr (13.5 lbs) at birth. Another miracle saw the light. Happy birthday Stephan and birthing day to his mother.

(Photo taken and published with permission of the mother)

Baby Emily

Posted: February 18, 2011 in Personal
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(Photo published with patient's permission)

 

Another miracle saw the light.

I love it when patients bring their newborn with them to their post-partum visits. It is delightful to see those babies again and without the vernix.

Giving Birth

Posted: November 27, 2010 in Personal
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Even after “catching” hundreds of babies (“Delivering” babies in more medical terms even though all the work is done by the birthing mother), till this day, I still feel giving birth is a “miracle”.

I still experience the same overwhelming feeling I had witnessing my first delivery back in the American University of Beirut Medical Center in 2001.

I owe a lot of respect all womyn who gave birth. You are blessed with the fortune of delivering miracles.