News & Events

Maternity Leave

It is a joy to care for you during your pregnancy. We know that as you get closer to delivery, lots of questions often come up regarding maternity leave. As your OBGYN provider, we are involved in completing paperwork for your employer about your leave. It’s important to help you understand the process and expectations regarding leave because it is often confusing or there is mixed information.

How much medical leave will I be given when I have a baby? Recovering from childbirth takes some time. Medical leave paperwork asks your provider to determine how much time your need to be medically out of work. The standard recovery time from a vaginal birth is 6 weeks and for a c-section, it’s 8 weeks. We know that you want to spend more time with your little one than 6-8 weeks which is why many employers cover additional leave time through the Family Medical Leave Act (FMLA) or Paid Family Medical Leave (PFML). However, from a disability perspective, we will complete medical forms with 6 weeks for a vaginal birth and 8 weeks for a c-section.

My employer offers up to 12 weeks of paid medical leave. Can Bedford Commons OBGYN complete my form to allow for 12 weeks of paid medical leave? Honestly, we want you to be home with your baby as long as possible. However, when we are completing these forms, we need to actively answer the question of how long do you need to be “medically incapacitated”, meaning home to recuperate from having your baby. Unless there are medical complications with your recovery after your baby is born, we need to be consistent in our medical leave requests, regardless of how much time an employer may offer. It is not uncommon that new parents are told that if the doctor allows it, additional time will be given. That is true if there is a medical indication for extended leave but that is quite uncommon.

How is bonding time different? The State of Massachusetts offers 12 weeks to bond with a child, regardless of parents’ gender. New Hampshire PFL allows for up to 8 weeks of bonding time in the first 12 months of having a child. Unlike in Massachusetts where it is a state benefit, in New Hampshire PFL is optional so you may or may not have access to the benefits. Employers can opt in for New Hampshire PFL or individual employees can opt in. In both New Hampshire and Massachusetts, bonding time is different than the medical leave discussed above. Bonding time is completed specifically by the employee (you) and does not require our office to complete any paperwork. The paperwork must be filed after the medical leave portion is filed.

Please know that we know adjusting to a new baby and sleepless nights are tricky. We also know that precious time with your little one is priceless. Talk to your employer about if you qualify for FMLA leave (up to 12 weeks total including the 6-8 weeks of medical leave) to allow for some extension of your leave.

Pregnancy

Early Pregnancy Loss – what happens to my baby after a D&C procedure

Amanda Morneau, Perinatal Loss Coordinator, Elliot Hospital

To Patients and Families Experiencing an Early Pregnancy Loss:

We understand that this is a difficult time for you and your family and that you may have some questions regarding the handling of your babies’ remains. It is our desire to care for your baby with dignity and respect; therefore, we would like you to take some time to consider two options available to you for final disposition.

Private Arrangements: You may make private arrangements for cremation or burial – regardless of the gestational age at the time of pregnancy loss. Although the cost associated with burial will vary by cemetery, many funeral homes do not charge for cremation or burial preparations for early pregnancy loss. Please make any private arrangements within two weeks and notify the funeral home of your choice. You also need to notify our staff here at the Elliot. You can email AMorneau@elliot-hs.org or RBelt@elliot-hs.org and we can help to ensure that your babies’ remains are prepared for release. Please be aware that if you do not desire a private arrangement, all remains will be placed in the Elliot Hospital Memory Garden.

Elliot Hospital Memory Garden: The Memory Garden is located on the Elliot Hospital campus and is the final resting place of stillborn and early loss babies. Remains are cremated collectively and interred in the Memory Garden at a yearly memorial service. The Memory Garden is home to the Angel of Hope Statue and is a place where families can come to remember and honor their babies privately. If you elect this option, the cremation is completed at no cost to you.

If you choose the Memory Garden, please know that we have an annual Angel of Hope Candlelight Vigil on December 6^th at 7PM in the garden. The Memory Garden Interment Ceremony and Memorial Service is on the Sunday before Memorial Day at 2PM. We would love to have you join us. For more information click here: Elliot Memory Garden information.

If you have any questions about these options, please contact the bereavement line voicemail at (603)663-3396. Leave your name and number and we will return your call.

We are so sorry for your loss.

Sincerely,

Amanda Morneau, BSN, RNC-EFM, CCE
Perinatal Loss Coordinator
Elliot Hospital
AMorneau@elliot-hs.org

DaNae Belt, BSN RNC-OB, RNC-MNN, C-EFM
Clinical Nurse Manager
Labor and Delivery
Elliot Hospital
RBelt@elliot-hs.org

The following is a list of area funeral homes that provide free or low cost cremation for infants, stillborn babies and early pregnancy loss. This is not a comprehensive list. Please contact the funeral home of your choice directly to discuss options.

Phaneuf Funeral Homes & Cremation, Manchester NH (603) 625-5777
Lambert Funeral Home & Crematory, Manchester NH (603) 625-6951
Cremation Society of New Hampshire, Manchester NH (603) 622-1800
Advantage Funeral & Cremation Services, Nashua NH (603) 521-8424
Petit-Ronan Funeral Home, Pembroke NH (603) 485-9573
Still Oaks Funeral & Memorial Home, Epsom NH (603) 798-3050
Anctil-Rochette & Son Funeral Home, Nashua NH (603) 883-3041

News & Events

I just tested positive for COVID-19 and I’m pregnant! Now WHAT?!?!

Christina Haag, APRN

With rising COVID19 cases in New Hampshire, we are getting calls daily from our patients reporting a positive COVID-19 test. We are here to support you with the latest information about pregnancy and COVID19. We know that you are worried and have lot’s of questions. We are updating this information as new guidance becomes available.

If you think you may have symptoms of COVID19, you should be tested. Symptoms include: cough, fever, shortness of breath, headache, cold-like symptoms, sore throat, or loss or change to your sense of smell or taste. There are many options for testing including at-home test kits (only should be done if you are symptomatic), state test sites, and pharmacies. For a full list of testing sites, click here. New Hampshire is also offering free COVID19 test kits. To get your test kit, follow this link.

If you test positive for COVID-19, please call us during office hours at 603-668-8400 to let us know. For the safety of our patients and team members, your next visit will be scheduled at least 10 days from the date of your positive test. We are also happy to convert your scheduled visit to a telehealth visit to check-in with you. You should isolate from others and stay at home for 10 days. If you live with unvaccinated family members, try to isolate yourself from them. If you are unable to isolate yourself, those family members also need to quarantine – they will need to quarantine for 20 days. If you do need to leave your house for medical care, please be sure to wear a mask and call your healthcare provider before you arrive to notify them of your positive COVID-19 test result.

Most cases of COVID-19 are mild and can be managed at home with getting plenty of fluids and rest, as well as using medication to reduce a fever. It is safe to treat a fever in pregnancy with Tylenol (Acetaminophen) 1000mg every eight hours. In addition, make sure you’re staying hydrated by drinking a lot of water. If you are fully vaccinated for COVID-19, your risk of severe illness is significantly less than those who are not vaccinated.

Primary care providers are well versed in the symptoms of COVID-19 and recommendations for treatment. We would encourage you to reach out to your primary care provider for additional recommendations. Because pregnancy is considered to be a high risk condition for COVID-19, your primary care provider may recommend that you receive monoclonal antibodies. Monoclonal antibody treatments are recommended by the Centers for Disease Control (CDC) and the American College of Obstetricians and Gynecologists (ACOG) for treatment of pregnant people with mild to moderate COVID-19 who are at risk for complications from COVID-19. There is a limited supply of monoclonal antibodies so we are relying on insight from your primary care provider as to whether you should receive monoclonal antibodies based on your symptoms. Although monoclonal antibodies have not been specifically evaluated in pregnancy, preliminary data suggests that monoclonal antibody treatment is safe in pregnancy. Orders for monoclonal antibodies need to come from your primary care provider.

If you feel like your symptoms are worsening, please reach out to your primary care provider for additional recommendations. Watch for emergency warning signs for COVID-19 which may indicate more severe illness including difficulty breathing, confusion, persistent pain or pressure in the chest, or pale, gray, or blue-colored skin, lips or nail beds. If you have any of these signs, seek emergency medical care immediately.

According to the data available from the CDC and ACOG, people with COVID-19 during pregnancy are more likely to experience preterm birth (delivering the baby earlier than 37 weeks) and stillbirth and might be more likely to have other pregnancy complications compared to people without COVID-19 during pregnancy. Unfortunately, there are not any specific ways to prevent these risks once someone tests positive for COVID-19 other than monitoring for symptoms. Due to a risk of pre-eclampsia (high blood pressures in pregnancy), if you are less than 28 weeks pregnant, you should begin taking low dose aspirin (81mg) daily starting at 12 weeks of pregnancy, if you have not already been instructed to take aspirin. If you’re more than 28 weeks pregnant, you do not need to start aspirin. If you’ve already been on it, continue taking your aspirin until you deliver.

If you were hospitalized with COVID-19, we will schedule non-stress tests to monitor your baby’s well-being twice weekly starting at 32 weeks (and at least 14 days after you were diagnosed with COVID-19) and an ultrasound to check your baby’s growth. Please reach out to our office with any symptoms of preterm labor which include: Regular, frequent contractions or tightening of your belly, leaking fluid like your water might have broke, worsening lower back pain, and a sensation of significant lower pelvic pressure.

If you have not already received your COVID-19 vaccine or booster, once you are feeling better and it’s been at least 14 days since you were diagnosed with COVID-19, please get vaccinated. Even if you have already had COVID-19, vaccination is still the best way to protect you and your baby.

We hope you feel better soon. Again, please be sure to seek emergency medical help if you are having any severe symptoms of COVID-19.

For more information, please visit: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnant-people.html

Gynecology

What is a DO?

Throughout my training and career, this question has certainly come up more than once. Now, more than ever, with the topic of DO physicians making news and headlines (all press is good press, right? Not necessarily…) are we presented with the opportunity to educate and share exactly what “DOing” is.

DO stands for Doctor of Osteopathic Medicine whereas MD stands for Doctor of Medicine. Like MDs, Doctors of Osteopathic Medicine are fully licensed physicians who can practice in all areas and specialties of medicine. We practice evidence-based medicine, using the latest science and technology. During our medical school training, like MD students, the first two years are centered around classroom learning, and the last two gaining clinical experience in various specialties during clinical rotations.

Many DOs sit for the same licensing exams as MDs (USMLE) during medical school in addition to their osteopathic licensing exams (COMLEX). The field has grown 300% (wow!) in the last three decades, currently making up 11% of the physician population. In addition, 42% of actively practicing DOs are female!

In many circumstances, patients may not even notice a difference between their DO or MD physicians. Where DOs differ is the underlying philosophy that is incorporated in our medical school training.

The hallmark of Osteopathy emphasizes a “whole person” approach (a person is a unit of “body, mind and spirit”). We are trained that the person and body is whole and interconnected, and each body system affects the other. DOs have an additional 200 hours on top of general medical school curriculum that focuses on Osteopathic Manipulative Treatment (OMT). OMT is a hands-on approach, where we learn in depth musculoskeletal exam and treatment of musculoskeletal dysfunction, which may be related to visceral (other body systems/organs) or somatic (musculoskeletal) causes. While not every DO uses OMT in their day to day practice, this inherent philosophy of treating the person as a whole is how osteopaths are trained to approach each and every patient. Many of my MD colleagues approach their patients with a similar view due to their compassionate personality, but this philosophy is not part a focus their medical school curriculum.

One of the best parts of being a DO, like all differences, is being able to bring a different perspective to the table. I am proud of my training and where it has led me (here at BCOG!)!

Gynecology

Flu Vaccine – coming to Bedford Commons OBGYN October 1, 2020!

Christina Haag, APRN

“Ouch, that hurt! Why did you do that?!?” — that’s what my 5 year old daughter yelled at the nurse giving her the flu vaccine last year.

In the midst of the current COVID-19 pandemic, it’s easy to forget the flu season is just around the corner. Or maybe you haven’t forgotten because you have seen signs advertising the flu vaccine at many national pharmacy chains. I think I saw my first flu vaccine advertisement at the end of July, more than 2 months before the onset of the flu season!

The Center for Disease Control (CDC) recommends the flu vaccine every year for everyone 6 months of age and older. It is especially important this year given the overlap of symptoms caused by COVID-19 and the flu. Getting your flu vaccine is one of the best ways to protect against the flu. Although the flu vaccine is currently available at many pharmacies, the CDC recommends waiting until late September to get vaccinated because getting the vaccine too early may cause reduced protection against the flu later in the flu season.

As we have been so focused on COVID-19, I think it is important to remember that last year, more than 410,000 Americans were hospitalized due to the flu and more than 24,000 people died from the flu. Although wearing a mask can help prevent the flu, the best way to protect yourself is to get the vaccine.

At Bedford Commons OB-GYN, we will begin to offer the flu vaccine to our pregnant patients starting October 1, 2020. We recommend the vaccine for all of our patients but due to a limited supply, we are only able to offer the vaccine in our office to our obstetric patients. For our non-obstetric patients, we would recommend heading to your primary care or a local pharmacy to get vaccinated.

Click here for more information from the CDC about this year’s flu vaccine.

Pregnancy

Trial of Labor after Cesarean (TOLAC)

Dr. Kristen Bannister

So you had a cesarean for your first delivery and now you are pregnant again. One of the major questions you will make with your OB is what type of delivery, vaginal birth after cesarean (VBAC) or repeat cesarean, is most reasonable. How do you make that decision? If we had crystal ball it would be so easy, but we don’t, so let’s look at all the factors that influence the decision.

Risks to consider

After a cesarean there is a scar on the uterus. That area is just a little weaker than the rest of the uterus. As the uterus grows and stretches this area gets thinned out and even weaker. Labor contractions put even more stress on the scar. All this increases the risk that the scar can break open, or what we term “uterine rupture”. If the scar ruptures, the blood flow to the baby can be compromised and sometimes cause permanent neurologic problems for the baby, or even death. The risk of these are extremely low. Only half of a percent of women laboring after a previous cesarean will have rupture. Of those that rupture approximately 3 percent (and remember this is 3% of 0.5% total ruptures) will have complications or fetal death. Because this number is so low, it is reasonable to consider a trial of labor in appropriate patients.

So what makes a patient appropriate?

Things your provider is considering when they are counseling you about a TOLAC include the reason for your cesarean, baby’s weight as well as your height and weight, whether or not have you had a vaginal delivery, and your ethnicity. All of these can affect the potential success of a TOLAC. There are online calculators that will give you the chance of a successful vaginal delivery. Additionally we factor in how many more pregnancies you are considering. The final factor is what do YOU want. Sometimes in your gut you know how you want to deliver. Realize there is no wrong or right. Your provider will always guide you away from a overly risky option.

Recovery

Many women fear the recovery with another baby at home. Surprisingly most women do really well after a repeat cesarean. Certainly if you labored last time, then had a c-section while you were both mentally and physically exhausted, the recovery of a repeat may seem easier even if you have other children at home.

It’s a big decision and no gut instinct, physician or VBAC calculator can always predict a successful vaginal delivery, all of these tools will guide you into a decision that makes you and you provider are comfortable. End of the day the goal is a healthy baby and a healthy mom!!

Pregnancy

Pregnancy Loss and Miscarriage

Dr. Samantha Pawlowski

Miscarriage is sadly incredibly common, occurring in approximately 10% of all pregnancies in the first trimester. It most often occurs due to an abnormal number of chromosomes in the developing embryo. In healthy women, there is little that can be done to prevent miscarriage from happening.

Symptoms of pregnancy loss

At the start of a miscarriage, many women will have bleeding and cramping, however, some women have no symptoms at all, and the miscarriage will be diagnosed on an ultrasound exam.

Treatment options

Miscarriages can be treated in three ways.

One is to wait for the pregnancy tissue to pass on its own. While this has the benefit of not having any medical intervention, it can take up to four to eight weeks to occur, so many women prefer not to have the uncertainty of waiting that long.

The second option is to take a medication called misoprostol that causes the uterus to contract and expel the pregnancy tissue. This usually happens within 24 hours of taking the medication, but can take up to several days. The medication can be repeated if it does not work after the first dose. This is effective 70-90% of the time. Management with medication has the advantage of being able to control the timing of miscarrying while still being able to be in the comfort of your own home, however, there is typically a several hour window of time that is very uncomfortable with heavy bleeding and cramping.

The third option is to have the pregnancy tissue removed surgically through a procedure called a dilation and curettage (D&C). This allows for the most control of timing and least amount of pain, however, does mean receiving anesthesia and undergoing a surgical procedure.

Follow-up

After a miscarriage, you will be seen in the office to confirm that all the pregnancy tissue has been passed and to discuss any questions you might have about the process. Your bleeding will typically taper down and eventually stop after one to two weeks. Your periods will typically resume four to six weeks later.

Planning for another pregnancy

Many women who are trying to get pregnant wonder when they can begin trying again after a miscarriage. While women used to be advised to wait a couple cycles before trying, newer data shows that there is no advantage to waiting and that there may be some advantage to attempting in the first three months after a miscarriage. The bottom line: when you feel physically and emotionally ready to try again, it is safe to do so

Pregnancy

Prenatal Vitamins Made Simple – What should you be looking for?

Dr. Danielle Albushies

A balanced diet is the best way to get the vitamins and minerals you need for a healthy pregnancy. However, it is easy to fall short on key nutrients during a pregnancy. A prenatal vitamin can fill in the gaps.

Here are a few key rules to consider when thinking about prenatal vitamins:

Rule #1: Start the prenatal vitamin before you try to conceive.

Many pregnancies are unexpected some it’s reasonable to consider taking a prenatal vitamin daily even if you aren’t actively trying for pregnancy. Important events are happening in an early pregnancy before a woman even misses her period and knows she is pregnant.

Rule #2: Find a prenatal vitamin that is cost effective.

It will need to be taken for a year or more as it is also recommended to continue a vitamin while breastfeeding. Prescription prenatal vitamins are no better than over the counter prenatal vitamins.

Rule #3: Make sure your prenatal vitamin has these critical components:

Iron, 27 mg. In the United States approximately 20% of pregnant women are iron deficient. During pregnancy, the body needs to make extra blood to support the health of the mother and fetus. It takes iron to make this extra blood. Iron is also needed for fetal brain development. Although gummy prenatal vitamins tend to be easier to tolerate, they do not contain iron. A separate iron supplement would be needed if you are using gummy prenatal vitamins.
Folic Acid, at least 400 micrograms. Low folic acid levels are directly linked to neural tube defects or spina bifida. The adequate amount of folic acid needs to be present from conception which is why prenatal vitamins should be started before a woman knows she is pregnant. It can be challenging to consistently get the adequate amount of folic acid in the food we eat.
Iodine, 150 mcg . Many prenatal vitamins do not contain iodine. Iodine is needed for normal maternal and fetal thyroid function as well as fetal brain and central nervous system development.
Other important ingredients in your prenatal vitamin that are important for fetal bone, central nervous system and overall growth include:
- Calcium 1,000 mg
- Choline 450 mg
- Vitamin D 600 IU
- Vitamin A 770 mcg
- Vitamin C 85 mg
- Vitamin B6
- Vitamin B12 2.6mcg
- Zinc
- DHA: 200 mg There’s evidence indicating that omega-3 fatty acids (particularly DHA)–a fat found in some types of fish–may play an important role in the development of your baby’s brain and nervous system.

There are many medical conditions where the amounts recommended above would need to be adjusted. For example, taking the prenatal vitamin depends on adequate absorption through your gastrointestinal tract. If you have certain gastrointestinal conditions or have had gastric bypass surgery, speak with your ob/gyn. In general, a preconception counseling visit is always a wonderful idea to discuss any woman’s history and unique needs.