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Common questions about bacteria, viruses and vaccines during pregnancy

By Dr. Deb Krahl

Dr. Deb Krahl has been a practicing OB/GYN for 16 years. She received her medical degree from the University of Minnesota before completing her residency training at the University of California-Irvine. She has been with Aspen Medical Group for the last nine years and is currently the lead OB/GYN physician there. She is excited to be among the OB/GYN’s delivering at The Mother Baby Center.

Another glorious Minnesota winter is just around the corner – yay! Experiencing the first snowfall, sledding with hot cocoa and spending the holidays snuggled up with family are wonderful winter thoughts. Unfortunately, winter is also associated with colds, coughs, strep throat and the flu. That makes it a relevant time to go over possible viruses and infections – weather-related and otherwise – that I always like to discuss with my patients.


If you’re pregnant during the winter, the most important thing you can do is GET A FLU SHOT! Children, the elderly, people with chronic medical problems and pregnant patients are the high risk groups that should get the flu vaccine. Don’t think “I never get sick” or “I don’t want the flu shot because I might get sick from it.”  If you get the flu while pregnant, you could become extremely ill, have severe respiratory problems or even die, so please get your flu shot.


Whooping cough or pertussis has made a comeback nationally. The Tdap vaccine (tetanus/diphtheria/pertussis) is strongly recommended during pregnancy if you haven’t had this vaccine in the past 10 years. This vaccine is important for both you and your baby. It protects your baby against whooping cough from birth to 2 months when the baby gets his or her first pertussis vaccine as a newborn.

Varicella (chickenpox)

Most people have had chickenpox. But if you’re unsure, please tell your OB provider at the first visit. Blood work can be done to check your immunity. If not immune, you should get the chickenpox vaccine after delivery.

Herpes virus

Genital herpes is very common, and it’s important to discuss this with your OB provider so they know your history. Anyone with a history of herpes should be on daily medication the last month of pregnancy to prevent this infection from being passed to the baby in labor. If someone has an active herpes infection in labor, she would need a Cesarean section so the virus does not pass to the baby while going through the birth canal.


Avoid changing or touching cat litter and eating uncooked meats to avoid this infection during pregnancy.


Don’t eat any unpasteurized milks or cheeses, which could cause this infection during  pregnancy.

Parvo virus (Fifth disease)

This virus is most common in young children so teachers, daycare providers and mothers of little kids are most likely to encounter it. If you’re exposed to this in pregnancy, call your OB provider to get blood work done to check your immune status. If you are not immune, repeat blood work will be done to see if an exposure has occurred.

HIV and hepatitis B

All OB patients are encouraged to have these tests done at the first OB visit. If a patient is a hepatitis B carrier, it is crucial the baby gets the hepatitis B vaccine and immune globulin immediately after delivery. If a patient has HIV, treatment during pregnancy is essential to reduce the chances that HIV will be passed to the baby.

Common bacterial infections

Strep throat, sinus and ear infections, bronchitis and pneumonia are all common winter illnesses. Most antibiotics used to treat these conditions are safe in pregnancy, so don’t be afraid to take medication if cleared by your OB doctor.

As winter creeps up on us, get your flu shot, find a bigger winter coat to grow into and make sure to have comfortable winter boots so you don’t slip on the ice…and let the snow fall!

Check out The Mother Baby Center on Facebook and visit the website.

Four reminders to prevent the flu

Flu season. It’s that time of year when we duck for cover in Minnesota. We all know someone who has battled the flu.

The flu is a serious respiratory illness, and the symptoms can be downright nasty – sudden onset of fever, cough, congestion, sore throat, achy muscles, fatigue, occasionally pneumonia, and, in extreme cases, death.

Each year, an average of 20,000 kids under 5 are hospitalized because of flu-related complications, according to the Centers for Disease Control and Prevention. Influenza causes more hospitalizations among young children than any other vaccine-preventable illness.

“Don’t think of influenza as ‘just the flu.’  For infants and children especially, it can be a scary, very severe disease.  Prevent it,” said Patsy Stinchfield, nurse practitioner and director of infectious disease at Children’s Hospitals and Clinics of Minnesota.

Here are some easy reminders to keep your family and you healthy during flu season:

  1. Get vaccinated against the flu. All people 6 months of age and over need an annual flu vaccine.  While flu vaccines are not perfect (100 percent effective), not getting one provides zero protection.
  2. Wash your hands with soap and water. At Children’s, we wash ‘em proud. You should wash your hands before and after eating, after using the restroom, after blowing your nose and sneezing.
  3. Cover your cough and sneeze. If you’re visiting Children’s, we ask that you wear a mask if you have a cough. We ask staff and visitors to stay home if they are ill and if they have a cough to wear a mask to prevent the spread of such things as influenza and other infections to our vulnerable patients.
  4. Sick? Please, stay home from work or school. If your child is sick, keep him/her home from school and daycare, too.
Visit our flu prevention website for more information.

Kohl’s Cares and Children’s Flu Prevention Tips from Children's of Minnesota on Vimeo.

Choosing a midwife, from her point of view

Forty years ago in her home country of Iran, Nahid Shokohi Razmpour became a midwife. She’s been delivering babies ever since.

Shokohi Razmpour, part of HealthPartners Medical Group and delivers at Abbott Northwestern Hospital and will work at The Mother Baby Center when it opens in February, loves being a midwife.

“I have a special passion to be with the woman during labor,” she said. “I love to help the woman.”

Last week was National Midwifery Week – the celebration of a profession that’s dear to her.

Nahid Shokohi Razmpour

Of the 4,000 babies born at Abbott Northwestern each year, 600 to 700 are delivered by a midwife, according to Shokohi Razmpour. And the number of women choosing a midwife is growing in Minnesota. Between 1989 and 2008, deliveries that involved a midwife increased from 3.2 percent to 7.5 percent, she said.

“Women feel more comfortable with a female provider,” she said.

Shokohi Razmpour took time recently to chat about what factors to consider when evaluating what kind of practitioner to see for prenatal care and childbirth.

So what should you consider when evaluating whether to choose an obstetrician-gynecologist (OB-GYN) versus a midwife?

From Shokohi Razmpour’s point of view:

  • Whenever possible, a midwife involves the partner on day one.
  • A midwife spends more time with the mother during labor.
  • Because a midwife spends significant time with the mother during labor, relatively few patients require intervention. The midwife encourages medication-free deliveries.
  • A midwife suggests showers, bathing, massage, homeopathy, changing positions and using a birthing ball instead of intervention like medication. However, if pain medication is needed during labor, she supports this choice, as well. She recognizes each person’s birthing experience individually.
  • A midwife counsels the mother during the pregnancy about diet, exercise and emotional support.
  • A midwife also prepares the parents for the arrival – from what to buy to what to bring to the hospital.

“I give (expectant moms) what they want – part of that is service, part of that is love,” she said.

She wants the birth experience to be what the expectant mom wants it to be – an easy and positive experience in her life.

When things don’t go as planned, Shokohi Razmpour doesn’t leave the expecting mother’s side. In the case of a Caesarean section, “I scrub in right away…I stay with my patient as a supporter.”

Post delivery, she doesn’t leave the mother’s side. She encourages breastfeeding and stays with the mother after the birth to assist.

“We take great pride in making the experience more personal,” she said.

Learn more about The Mother Baby Center by visiting its Facebook page.

A mom’s story: The power of walking

This is a guest blog post by Liz Keating. She’s a Family Advisory Council member at Children’s Hospitals and Clinics of Minnesota and a mom of three.

I had to be largely off my feet while pregnant with my first two kids. That was tough. Although I’ve never considered myself an athlete, my body and my brain had grown accustomed to an active lifestyle. Being forced to slow down was a bummer. So it was a real blessing when I was able (and encouraged) to stay active to a much greater degree while expecting our third child. Every pregnancy truly is different.

Staying active while pregnant wasn’t fancy. Our garage has accumulated quite an array of sports equipment over the years—bikes, scooters, in-line skates, ice skates, running shoes, cross county skis, snowshoes, even a four-person toboggan that doubles as a make-shift snowboard—all of which gathered dust during my pregnancy.

I had no regimented workout routine, gym membership, orspecialized equipment. Rather, the core of my daily activity was walking my eldest to and from school – about two miles in all. I added distance on some days and got outside with my family on weekends once the fatigue of the first trimester diminished. But how far I walked was never the point. The most important thing was to get outside and do SOMETHING.

I benefited a lot from staying active. I was able to face the physical and mental rigors of pregnancy with greater strength and stamina. My lower back hurt less. I slept better. Fresh air lessened my nausea somewhat. I recovered faster from delivery. Through walking, I learned to listen to my body.  I never “glowed,” but I coped better. But the greatest benefit, and the most unexpected, was the amazing connection I made with neighbors and others in my community.

Each day while walking my regular route I was greeted with smiles and waves from people passing by in cars, riding their bikes, or walking their dogs. The smiles and waves kept me going and seemed to increase as my due date approached. And now, when I am out walking the girls to school, I am stopped regularly by those same people who smiled and waved wanting to meet the baby they’d been rooting for. Having a new baby can be somewhat isolating, and making those unexpected connections helped take the edge off.

Read more about health for expecting moms by visiting the The Mother Baby Center’s Facebook page.


Childhood cancer Twitter chat with Children’s

Join Children’s Hospitals and Clinics of Minnesota for a Twitter chat on childhood cancer on Monday, Oct. 1, at 3 p.m. CST.

We’ll talk about:

  • Childhood cancers: How does cancer impact kids differently? What is the latest in research?
  • Children’s has a unique care philosophy for treating its pediatric cancer patients. What is it and how does it impact the patient and family experience?
  • What is Children’s doing to advance cancer research?

There are a few ways you can participate:

  • On Twitter, follow the hashtag #childrenschat
  • You can also follow the chat via the live stream below, which will activate at 3 p.m. Monday.

You can submit questions in advance by:

  • Using  the hashtag #childrenschat on Twitter
  • Email your questions/comments to [email protected]
  • Entering your questions/comments in the box below when the chat starts at 3 p.m. Monday

Chat leaders include:

Dr. Kris Ann Schultz

Dr. Joanna Perkins

#childrenschat: The work continues after Childhood Cancer Awareness Month

September is National Childhood Cancer Awareness Month. Childhood cancer affects nearly one in 10,000 kids each year, and nearly 13,000 children under the age of 21 are diagnosed each year in the United States. While cancer is still the leading cause of death in children between infants and age 15, survival rates have increased significantly over the past few decades – up from 58 percent in the 1970s to nearly 80 percent in recent years.

While we’re glad there’s a month dedicated to raising awareness around childhood cancer, our work at Children’s Hospitals and Clinics of Minnesota doesn’t stop on Sept. 30. We continue working toward early detection, creating the best outcomes for our patients and advancing research.

On Monday, Oct. 1, we invite you to join Dr. Kris Ann Schultz and Dr. Joanna Perkins from our Cancer and Blood Disorders Clinic during #childrenschat to discuss what we’re doing to advance childhood cancer research.

Follow the hashtag #childrenschat on Twitter from 3 p.m. to 4 p.m. CST on Twitter. If you’re unable to participate or follow the chat, we’ll share a transcript of the chat on Tuesday, Oct. 2, right here on the Kids’ Health Blog. We can still take your questions, too. You can submit questions in advance by Tweeting them to @ChildrensMN with the #childrenschat hashtag or sending them to [email protected]

#childrenschat leaders:

Dr. Kris Ann Schultz





Dr. Joanna Perkins






• Childhood cancers: How does cancer impact kids differently? What is the latest in research?
• Children’s has a unique care philosophy for treating its pediatric cancer patients. What is it and how does it impact the patient and family experience?
• What is Children’s doing to advance cancer research?

We hope you will join us on Oct. 1. Read more about Childhood Cancer Awareness Month here.

The truth about exercise and pregnancy

Dr. Deb Krahl has been a practicing OB/GYN for 16 years. She received her medical degree from the University of Minnesota before completing her residency training at the University of California-Irvine. She has been with Aspen Medical Group for the last nine years and is currently the lead OB/GYN physician there. She is excited to be among the OB/GYN’s delivering at The Mother Baby Center.

Regular exercise is important to keep your heart, muscles and bones healthy. Exercise is just as important during your pregnancy and can have benefits during labor as well as help you get back into shape quicker after the baby is born. During pregnancy, regular exercise can help with backaches and constipation, prevent or treat gestational diabetes and improve your moods, help you sleep better and increase your overall energy level.

With the information overload in today’s world, it can be confusing for expectant moms to know which types of exercises are safe and which ones should be avoided in pregnancy. I hope this blog post will give you sound medical tips to follow as you start or continue an exercise regimen during your pregnancy.

1. Always check with your doctor first. Touch base with your doctor before beginning an exercise program to make sure you do not have an obstetric or health problem that would limit your activity.

2. Don’t overdo it. During exercise you should be able to talk normally and keep your heart rate under 140 beats per minute to avoid overexertion.

3. Be aware of the physical changes. The hormones in pregnancy cause the joints and ligaments to become more relaxed, so avoid any jerky movements that could cause injury. Also, with the added weight of the baby bump in the front, your balance and center of gravity are altered. This can cause you to be more unstable in certain positions, which can lead to falls and injury to you or your baby.

4. Don’t exercise to lose weight during pregnancy. You can exercise in pregnancy to stay in shape and feel better, but you shouldn’t try to lose weight in pregnancy by exercising or restricting calories.

Safe exercises for everyone during pregnancy:

Walking and swimming are great ways to start an exercise program. Cycling is a very good aerobic activity but after the first trimester, you should only cycle on a stationary bike to prevent falling off a road bicycle as your belly grows. Low impact and water aerobics, as well as strength training, are also terrific ways to get or stay in shape during your pregnancy. For any exercise activity, you should avoid lying on your back or standing still for prolonged periods of time after the first trimester.

Safe exercises for individuals in good shape prior to pregnancy:

If you’re a runner, you can continue running in pregnancy but may need to modify your routine or total distance, especially in the third trimester. Talk to your doctor to get specific questions answered.

Exercises and sports to avoid during pregnancy:

Any activities where you could lose your balance and fall should be avoided in pregnancy. This includes waterskiing, downhill snow skiing, horseback riding, gymnastics, tennis and racquetball. Any contact sports such as soccer, basketball and ice hockey should be avoided. Lastly, no scuba diving or using water slides in pregnancy.

Exercise tips:

Always warm up before and cool down after you exercise. Drink plenty of water and avoid exercising in hot, humid weather. Make sure you wear comfortable clothing and a supportive bra.

What to watch for during exercise:

If you experience any of these symptoms while exercising, you need to stop and call your doctor immediately: vaginal bleeding, dizziness, chest pain, uterine contractions, leakage of fluid from the vagina or decreased fetal movement.

Exercise during pregnancy has many benefits both during the pregnancy and after delivery. Even just a brisk walk every day can make a difference. All you need is the motivation to get out there and do it.

Visit The Mother Baby Center’s Facebook page for updates on its anticipated arrival. Due date: February 2013.

First-time moms-to-be: What to expect during the last three months

Dr. Deb Krahl has been a practicing OB/GYN for 16 years. She received her medical degree from University of Minnesota before completing her residency training at the University of California-Irvine. She has been with Aspen Medical Group for the last nine years and is currently the lead OB/GYN physician there. She is excited to be among the OB/GYN’s delivering at The Mother Baby Center.

For most first-time moms-to-be, the last three months of their pregnancy are a mixture of excitement, joy and anticipation, but there are also concerns about labor and becoming a parent in general. Some moms-to-be are energized and relish each and every day of their pregnancy wishing it could last 50 weeks instead of 40 weeks. Other expecting moms are exhausted due to lack of sleep and low back pain, have extremely puffy feet and are counting the days and hours until they can go more than two hours in between bathroom breaks. No matter what experience you’re having as a first-time mom-to-be, here are some practical tips to consider during the last three months of your pregnancy:

Maximize your sleep. Take advantage of sleeping in on weekends and naps when you can. Once the baby is born, you won’t have this luxury!

Keep busy. If you work, keep working your normal schedule as long as possible (assuming you are physically able and there are no restrictions from your doctor). If you exercise, continue your low impact routine to stay in shape for labor and delivery and your overall health.

Spend more time with your partner. Go see a movie, out to dinner, or on walks. Once you become parents, your time alone as a couple is significantly decreased and will be influenced by who you trust to watch the baby if you do want couple time together.

Learn more about the labor and delivery process. The most comprehensive way is to take a Labor and Delivery class offered through the hospital or your doctor’s office. These classes usually cost $100 and include a tour of the hospital. If you don’t want to spend money on these classes, I strongly recommend doing the FREE TOUR of the Labor and Delivery area that all hospitals offer. It would also be helpful to read about the stages of labor and pain relief options available. The more familiar you are with your surroundings and what to expect for each stage in labor, the more relaxed you will be when it happens.

Learn more about newborn care and breastfeeding. First-time moms-to-be are often caught up thinking about Labor and Delivery and forget to learn about basic newborn care and techniques for breastfeeding. There are many books on these two topics, so find ones that appeal to you. If you don’t have time to read up before the birth, don’t worry! Hospitals have great videos to watch after the baby is born in the postpartum rooms, and your pediatrician will be another wonderful source for years to come regarding questions about your baby.

Take your DHA. DHA is proven to help with baby brain development. You need to take DHA in addition to your prenatal vitamins every day after 28 weeks. Check your prenatal vitamins as some already have the DHA in them.

Don’t worry about how your labor will go. It’s normal for expecting moms to be nervous about labor (even OB/GYN doctors don’t know how their labors are going to go when they’re pregnant!), but don’t let it consume your thoughts. Your Labor and Delivery nurses and your doctor will be there to help guide and support you through the process. Be an active participant in your labor and be open to options for pain relief. It doesn’t matter if you get an epidural or if you have a vaginal delivery or Cesarean section; the important part is to have a healthy mom and baby! Your labor team will do everything in their power to accommodate your wishes in labor and make it a wonderful experience as you bring your new child into the world.

For first-time moms-to-be, the last three months of pregnancy are usually a mixture of physical and emotional changes. Hopefully, the above tips will help guide you in your preparation for labor and becoming a parent!

Like The Mother Baby Center on Facebook and visit the website.

Recognizing National Childhood Cancer Awareness Month

September is National Childhood Cancer Awareness Month, and no one is more aware of childhood cancer than the families affected by it. If your family should be affected by a cancer diagnosis, you can find some comfort in knowing that the best care available is here at Children’s Hospitals and Clinics of Minnesota. That’s because we have the largest pediatric cancer and blood disorders program in the Upper Midwest.

Childhood cancer affects nearly one in 10,000 kids each year, and nearly 13,000 children under the age of 21 are diagnosed each year in the United States. The most common childhood cancers are leukemias (blood cancers) and brain or nervous system tumors.

While cancer is still the leading cause of death in children between infants and age 15, survival rates have increased significantly over the past few decades – up from 58 percent in the 1970s to nearly 80 percent in recent years.

Children’s takes a unique approach by focusing not only on the patient, but the whole family. We look at the entire picture – the clinical care, emotional well-being, sibling support and more – because we believe that better journeys lead to better outcomes.

There are even more reasons why Children’s is the best place for childhood cancer and blood disorder treatment. Here are just a few:

Children’s treats the most kids – in fact, we care for more than 55 percent of children diagnosed with cancer in Minnesota and more than 60 percent of Minnesota children and teens with blood disorders each year, says Dr. Susan Sencer.

Our outcomes are among the best in the nation. Children’s ranks in the top 10 programs in the U.S. in both medical and surgical cancer outcomes according to the Pediatric Health Information Systems (PHIS) database. Our program delivers some of the highest survival rates among leading U.S. children’s hospitals treating patients with cancer and blood disorders.

We believe no child should suffer needless pain. It’s for that reason why we’re known for our aggressive management of pain and side effects. Our nationally recognized Pain and Palliative Care Program is one of the largest and longest running in the nation and is led by our world-renowned pediatric pain management specialist.

Our patients have access to the most advanced treatments. Our state-of-the-art technologies – including special high-tech MRI capabilities that help doctors map tumors with precision – help yield remarkable outcomes. Our participation in cancer research –nearly 90 percent of our patients take part in clinical trials – place us in the top 5 percent of Children’s Oncology Group institutions for number of patients enrolled in clinical trials.

And, our physicians communicate and consult with colleagues from around the country, ensuring that every child receives the care they need, even if not at Children’s.

Our goal always is no matter what the condition, whether cancer or a chronic blood disorder, that we make that journey for the family and the child as positive as possible, given the rather hard circumstances of the disease itself. We believe, better journeys, better outcomes.

Throughout September, we’ll recognize in Childhood Cancer Awareness Month several different ways. Follow us here and on Facebook for updates throughout the month.

Learn more about Children’s Cancer and Blood Disorders program.

Teen patients welcome new space in Minneapolis

The teen lounge is open for fun.

Until last week, teen patients visiting our Minneapolis campus didn’t have a special space where they could escape the beeps of machines and stuffiness of a hospital room.

The Youth Advisory Council spoke, and we listened thanks to help from Magnolia/Best Buy. Now, patients and their siblings and friends are able to enjoy a space that feels more like a state-of-the-art basement and less like a hospital.

“Being out of my room just makes me feel better,” said Olivia, a YAC member who spends most of her time in St. Paul, which has had a space for teens called the Minnesota Wild Teen Room.

The new space features a 65-inch flat panel TV, several gaming systems, leather theater chairs, a computer desk, gaming table, and many DVDs and games.

“We’re excited to be able to offer a space specifically designed for teens. The teen room will be a fun and unique space for our adolescent patients to gather with family and friends beyond the hospital patient room,” said Christi Dady, a Children’s Child Life Specialist who works with the YAC. “The interesting design and the electronic equipment create a more home-like and comfortable environment where our teen patients can relax.”

The YAC collaborated with the Magnolia team at Best Buy to plan the lounge. Mason, a YAC member, said helping design the space has been his favorite projects at Children’s.

“I would always come here (to the lounge),” Mason said.

Daniela, also a YAC member, said being confined to her hospital room gets depressing. She hopes she can spend time in the lounge, where she hopes to make new friends.