Serious Childbirth Complications on the Rise in the USA: What Can You Do?

a blog by Serena H. Chen, M.D., IRMS Reproductive Medicine at Saint Barnabas,
as seen on

The Centers for Disease Control and Prevention (CDC) recently reported (Callaghan et al, Obstetrics & Gynecology, Nov 2012) that serious complications during childbirth such as heart attack, stroke, hemorrhage, and kidney failure are up 75% (yes SEVENTY FIVE PERCENT) in 2008-2009 compared to a decade ago. Post delivery complications rose 114% (one hundred fourteen percent) in the same time frame.

In one of the richest nations in the world, with ready access to prenatal and delivery care, how could this be?

Some of this may be due to advances in healthcare that allow women with serious medical conditions, such as congenital heart defects to survive long enough to have children.

However, experts believe that many of these complications may be self-inflicted. Although women are having babies at older ages and advancing age does increase the pregnancy-related risks, far greater risks result from unhealthy women having babies. One of the most prevalent health issues affecting Americans today is excess weight and obesity, which has reached epidemic proportions in almost all demographic groups, including women of child-bearing age. Over 50% of Americans are overweight and over one-third meet the medical definition for obesity. These numbers have increased dramatically – almost doubling – in the last decade.

Although some childbirth risks may be due to laudable advances in medical technology, for example, technology that helps previously infertile people to conceive, or technology that allows cancer survivors to have a family, etc, much of the increased risks may be avoided if Americans took their own health much more seriously.

The Institute of Medicine (IOM) guidelines for weight gain during pregnancy recommends no more than 25 pounds of weight gain through the entire pregnancy for women who conceive at a normal weight. On the other hand, for women who are overweight, the IOM recommends no more than 11 to 20 pounds of weight gain. In my own practice in New Jersey, the average weight gain I have seen in our patient population is approximately 40 to 50 pounds. Overweight women who become pregnant will have a significantly higher risk for miscarriage, birth defects, diabetes, high blood pressure and potentially complications of the heart and the kidneys. Hemorrhage during childbirth is significantly greater in obese women and is birth injury to the child, the rate of cesarean section and even, neonatal death.

A recent study on autism demonstrated a link between maternal obesity and autism. In addition, women with obesity have much more difficulty getting pregnant – with significantly higher rates of ovulatory infertility.

What can you do about your risks? Eat a healthy diet, get regular exercise, move closer to or maintain a normal weight. Other proactive measures – quit smoking and don’t hang out with people who smoke – second hand smoke can be deadly and is associated with infertility in both females and males. Get at least 100% of the RDA [recommended daily allowance] for folic acid is 0.4 milligrams a day or 400 micrograms a day. Taking a multivitamin is an easy way to do this. Women who are obese – a BMI over 30 – should consider taking higher doses of folic acid as their risk for a group of birth defects known as neural tube defects (spina bifida) is increased and higher doses of folic acid may lower that risk. This should be discussed with your doctor before taking higher doses.

Most women in the US have healthy pregnancies and healthy babies, but there are things that we can do to improve our chances for a healthy pregnancy and lower our risks. The good news is that improving the health of your pregnancy will improve your short- and long-term personal health as well

Gestational Carriers in NJ by William S. Singer,JD

Legislators in New Jersey are now working to update the state’s laws to legalize and regularize the use of gestational carriers. New Jersey’s laws have not kept current with the advances in the use of assisted reproductive technology (ART).  New Jersey law is still encumbered by the landmark decision in Baby M 25 years ago.  So much has changed in the interim.

The Baby M ruling concerned the use of a traditional surrogate who is the child’s genetic mother.  Now, advances in medical science have made gestational surrogacy the preferred method for creating a family.  In a gestational surrogacy, the intended parents use a donated egg or the egg of an intended parent who is unable to gestate her own child.  That fertilized egg is implanted in the gestational carrier who then has no genetic link to the child she is carrying.The proposed legislation allows for written agreements to protect all of the parties.  It sets forth the rights and obligations of the parties and allows them to obtain judicial approval of the contract before the baby is born.

Among the notable goals of the legislation is to give predictability to all parties in a gestational surrogacy so that New Jersey citizens will not need to leave the state in order to feel protected when using a  gestational surrogate.



30 Years as a Gay Lawyer

on 30-Plus Years As an Out Gay Lawyer

‎Saturday, ‎May ‎26,
‎2012, ‏‎5:12:01 AM | William S. SingerGo to full article
In January 2012 the American Civil Liberties
Union (New Jersey) announced that it is awarding me its Bill of Rights Award for
my legal work. About a month later, the Gay Lesbian Bisexual Transgender Section
of the New Jersey Bar Association unanimously awarded me its first-ever Lifetime
Achievement Award. The unexpected honor of receiving two awards for my legal
work for the LGBT community compelled me to reflect on my career as an attorney.The arc of my career in some ways reflects the evolution of the modern
LGBT movement. When I started my legal career in 1971, gay men and lesbians were
scorned and lived in the shadows. Our sexual orientation was criminalized and
pathologized. No one even discussed the existence of transgender individuals.
Aware of my same-sex attraction since childhood, I never felt that I could live
a fulfilled, happy existence as an openly gay man. As a result, I married a
woman in 1970 (just after the watershed Stonewall riot) and pursued my legal
career. In 1973 another lawyer and I opened our own law firm. With some luck and
hard work, the firm prospered and grew to eight lawyers.But by 1981 I
realized that ultimately I would regret not owning up to who I am and that I
could no longer live a fictitious life. By making a decision to “come out” as a
gay man, I understood that I would lose my marriage and possibly my position as
a partner in the law firm, as well as family and friends. Ultimately, all these
forecasts came true. When my law partners realized that I had left my wife
because I was gay, I was expelled from the law firm. At that time, unlike today,
there was no state law protecting me from such overt discrimination. Reflecting
on that event 30 years later, I can better understand the fear of my partners
and how having a gay law partner in a small law firm in a semi-rural part of New
Jersey was threatening to them. Yes, it would have been nice of them to have
been courageous, and today it might have unfolded differently. At the time,
though, I simply moved my office down the road and started building my practice
all over again, eventually working with a law partner who is generous in

That was in the early 1980s, when the AIDS epidemic was emerging.
In response, I helped found the Hyacinth Foundation to assist people living with
AIDS. I started its legal committee and did deathbed wills in hospitals
throughout New Jersey and New York City. I earned the moniker “The Angel of
Death,” as my presence at a patient’s bedside meant his remaining time was

During the late 1980s, I became the General Counsel to the
fledging National LGBT Bar Association, which is now a thriving nonprofit and
affiliate of the American Bar Association. As a sole practitioner out in the
“sticks” of New Jersey, that position gave me the opportunity to connect with
other lesbian and gay attorneys around the country and not feel so isolated. I
have now served as General Counsel for 24 years.

I love being a lawyer,
much more than I ever expected. As a gay man, I have been able to use my skills
to help my community, not just in New Jersey but also in states more hostile to
our community. For example, I counsel female same-sex couples who are creating
their family and live in hostile states to come to New Jersey to deliver their
child. We can obtain a birth certificate naming them both as parents. Even more
importantly, the parents are able to complete a confirmatory adoption. As a
result, when they return to their home state, they have a judicial order
entitled to full faith and credit by the United States Constitution. One of my
clients called this process “the underground birth canal.”

I have also
assisted out-of-state couples who came to New Jersey to do civil unions. When
their relationships ended, they were unable to terminate them in their home
state. States make it easy to get married, but they have lengthy residency
requirements to obtain a judicial termination of the union. These couples become
“wedlocked.” Under the right circumstances, I have been able to convince a judge
to use his or her equitable powers to waive the residency requirement and give a
couple a termination of their New Jersey civil union.

The one achievement
of which I am the proudest is my creation of the LGBT Family Law Institute. FLI
is an annual meeting of vetted, seasoned attorneys in LGBT family law. We are
having our fourth meeting this year. FLI attracts attorneys from throughout the
United States, as well as from western Europe. The sessions are closed-door and
off-the-record. It gives us an opportunity to network and share strategies. We
also have an active listserve that helps connect attorneys, particularly those
living outside metropolitan areas, who have that same sense of isolation that I
had. I receive a great sense of gratification reading posts from attorneys in
rural areas or hostile states who express their appreciation for their ability
to use this forum to discuss issues with others and to counter their sense of

Some people think that I am special, having been an out gay
lawyer for so many years. But as I remember all my colleagues who died during
the AIDS holocaust, I know that were they still alive, my story would not be

Reflecting on these accomplishments, I realize that these awards
are not capping a lifetime of work. Rather, they are reinvigorating me and
refreshing my sense of purpose.

Law and Reproductive Medicine by William S. Singer,JD

In May, the United States Supreme Court issued a unanimous ruling in which assisted reproductive technology (ART) was a central feature. In Astrue v. Capato, the mother of two children conceived after their father’s death from frozen sperm challenged the position of the Social Security Administration (SSA) that the children were not entitled to survivor benefits.
The Court ruled that a genetic connection alone to a decedent is not sufficient to qualify for Social Security survivor benefits. Instead, the Court gave deference to the position of SSA that in order to qualify for benefits the survivor must either demonstrate that she/he is eligible to inherit from their late parent under state law or satisfy one of the other requirements under the Social Security laws.
In part the Court reasoned that the Social Security Act is meant to protect family members “against the hardship occasioned by loss of [their father’s] earnings.” The children in this case were born well after their father’s death and were never economically dependent on their father.
Similar to other issues were the law and ART intersect, there are some states which have laws which regulate whether posthumous children can inherit and many which do not.

I Just Read That IVF Has Potential Risks. Now What Do I Do?

“Now what do I do? I am just ready to commit myself to IVF and this article about a report in the New England Journal of Medicine comes out about potential risks to children and possible ill effects of ICSI and IVF. Oy Vey!”

This question was asked of me in several counseling sessions last week by women who have struggled with ramping up their treatment and finally wrapped their brains around more medical intervention to try to conceive. Now they are hit with information that makes them question the decision to go the next step.
This question addresses a necessity in participating in, not only infertility health care, but any type of medical care, and that is “trust in your doctor”. Realization that any health care carries a set of risks, as every doctor will tell you, understanding those risks and having someone who can explain them in laymen’s terms with accuracy and honesty is crucial. Whenever a patient is emotionally dealing with a medical decision, my first question is always, “what did your doctor say”? And I am surprised at the variation in the responses to this question: “well, I haven’t asked her yet”; or “he’s so busy” or “but the article says”, on and on and on. Asking your doctor is always one’s first line of defense because their explanation of a news article or internet information will provide you with what these sources aren’t saying. Your doctor should always have more information than any article can report. Clarification of the information and the spin will be helpful in making a decision that is right for you. Ask, Ask, Ask.
~Claudia Pascale, PhD