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Dr Karen Joash awarded the Obstetrics & Gynaecology Consultant of the Year 2019 – London

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Good day Karen

I hope you are well.

Following on from your recent nomination acceptance and our dedicated research stage, the judging panel have now made their final decisions and it brings me immense pleasure to contact you and inform you of the outcome for the 2019 Private Healthcare Awards.

To confirm, Dr Karen Joash has been awarded:
Obstetrics & Gynaecology Consultant of the Year 2019 – London
 
Every one of our award successors can be rest assured that their recognition was truly deserved, as we carefully evaluate everything from their performance over the past 12 months, their innovation, their methods and their commitment to ensure that only the most deserving names walk away with one of our prestigious accolades.

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2019 Private Healthcare Awards.

Dr Karen Joash, Consultant Obstetrician and Gynaecologist at The Portland Hospital, explains everything you need to know about gestational diabetes

Gestational diabetes is when women develop a form of diabetes when they’re pregnant. While this can be a daunting prospect, I assure my patients that the vast majority of women will return to normal after giving birth. This is aided by a careful diet and planned exercise.

Gestational diabetes can develop during pregnancy as the placenta produces hormones called human placental lactogen (HPL), which inhibits the body’s ability to produce insulin. Without enough insulin – which is the hormone responsible for helping your body absorb glucose or ‘sugar’ – glucose will accumulate in your bloodstream causing your blood sugar levels to skyrocket.

Am I at risk?

Some women are at a higher risk of developing gestational diabetes than others and if you have certain characteristics you should consult your doctor or obstetrician about it. Women who should be particularly aware include those with a high body mass index (BMI), those who have delivered babies weighing in excess of 4kg in the past, and women with immediate family members with Type 2 diabetes, or indeed those who have had gestational diabetes before. Studies have also shown that women of Asian, African-Caribbean or Middle Eastern origin can also be at higher risk.

During your ultrasound scans, if your clinician identifies a large amount of fluid around the baby, it is likely your baby will be born with a large birth weight and you may also be monitored for signs of the condition.

If your doctor suspects you might be at a high risk of developing gestational diabetes, you will be offered a glucose tolerance test to identify whether you are affected by the condition between 24 and 28 weeks gestation. This involves taking two blood tests: the first after a short period of fasting overnight and the second, around two hours later to monitor how your body reacts to glucose.

While your midwife or doctor will identify your risk of developing gestational diabetes at your first appointment, the condition does not usually manifest until about halfway through your pregnancy. Women who develop gestational diabetes might not notice any changes to their bodies, however the symptoms you might notice include fatigue, increased thirst or a repeated bout of urinary tract infections.

What does this mean for my baby?

Throughout your pregnancy you will be required to reduce your sugar consumption and eat a healthy, balanced diet to manage your blood sugar levels; although I do recommend that all mothers-to-be try to follow a healthy diet where they can to help give you and the little one the best start.

Your doctor or midwife will work with you to help explore ways to transform your diet, however if you are unable to control your blood sugar levels effectively, you may also be given insulin injections or tablets to assist.

Gestational diabetes can affect your baby by increasing her production of insulin, which can lead to an increased birth weight or a higher risk of jaundice. However you can be reassured that these conditions rarely result in serious health issues.

If your baby is large or you are on medication to control your blood sugar it may be necessary to induce labour at around 37 to 38 weeks, to avoid potential complications. Your doctor may also suggest a c-section at this stage.

Patients should also be aware of the risk of their baby developing a condition called hypoglycemia, which is when your baby is born with low blood sugar levels. You will be encouraged to feed your baby as early as possible and your baby will need a heel prick test to ensure the sugar levels are not too low. In the event where this is the case, your baby may require a formula feed to stabilise her blood sugar levels.

Should I be worried?

The large majority of women who have gestational diabetes deliver healthy, happy babies and with a healthy diet you should have no reason to worry.

Identifying the condition early and managing it throughout the pregnancy will help to reduce the risk of any problems for you and your baby during pregnancy and childbirth.

Some babies who grow very large because of high blood sugar coming from the mother are at an increased risk of a complication called shoulder dystocia where the head is delivered and the shoulders become stuck due to the size. You may be offered an induction of labour from 37 weeks or earlier if your baby is felt to be at risk. In some cases a caesarean may be offered.

What are the long-term consequences?

Those experiencing gestational diabetes are often glad to hear that it is usually a temporary condition, disappearing once you have given birth. Treatment is no longer required once you have welcomed your bundle of joy into the world.

However it is important to be aware that gestational diabetes does increase your risk of developing diabetes at a later stage of life, so women with gestational diabetes should be monitored and take simple steps to reduce their chances of developing the condition later on. This requires living a healthy lifestyle with a low sugar intake and having blood sugar checks in the weeks following your delivery, and on an annual basis with your GP from then on. Keeping fit and at the ideal weight also reduces your risk.

If you are at all worried about managing gestational diabetes, I recommend speaking with a health professional who will assess you and provide you with all the advice you need to manage the condition and welcome a healthy baby when the time comes.

What if I already suffer from diabetes?

If you already suffer from Type 1 or Type 2 diabetes, it is advised that you visit a specialist health professional and work with them to ensure your blood sugar levels are controlled before you conceive and during pregnancy. While the symptoms and management techniques are relatively similar to those of gestational diabetes, you will be at a higher
risk of experiencing complications during your pregnancy and should be monitored more closely.

Irregular bleeding is common in the time when women are coming up to the menopause due to cycles which occur when no egg is released, which are called anovulatory. This leads a change in progesterone and oestradiol levels and women can bleed for longer and more frequently. They can also have progressively larger gaps between periods.

For some women they need to be seen by a gynaecologist as periods become troublesome and very heavy. All women would be advised to have a gynaecology ultrasound scan to assess for any problems. There are different treatments which can improve this bleeding such as medicines to help thin the lining of the womb. However it is always important to exclude more serious reasons for abnormal bleeding such as endometrial hyperplasia (overgrowth of the lining of the womb).

Risk factors for endometrial hyperplasia and cancer  include-

• Polycystic ovarian syndrome
• Obesity
• Nulliparity ( never pregnant)
• Diabetes
• Tamoxifen therapy
• Family history of endometrial cancer
• Exposure to unopposed oestrogeng. HRT with oestrogen alone

A simple test can be performed called a hysteroscopy, where the lining of the womb is directly visualised and any abnormal areas are a biopsied or removed. This can be performed under local anaesthetic or general anaesthetic. Never ignore irregular bleeding. It is always important to seek advice and get help early. Most conditions are easily treatable and can change your life.

Dr Karen Joash, obstetrician and gynaecologist at The Portland Hospital, explains the benefits of opting for a water birth

The decision to have a water birth is becoming increasingly popular amongst expectant mothers.

Water labour is often used as a tool to cope with pain, while some mothers will choose to deliver in the water, either by entering the pool from the early stages of labour and throughout, or right at the end of their labour, just before their baby is born.

Water labours are renowned for the effect they can have on relaxation during the most painful parts of giving birth.

The pool promotes the release of hormones called endorphins which are our bodies’ natural painkillers, helping us to manage pain, in turn, this can also lead to a slightly shorter first stage of labour.

It also has the added benefit of lowering the mother’s blood pressure without reducing placental blood flow.

The buoyancy effect also means women feel more mobile in water, and find it easier to get into good positions for labour.

Women that opt for a water birth are often less likely to need an epidural. For this reason, NHS UK guidance recommends water birth as a natural way of coping with labour pains.

A 2017 Care Quality Commission survey showed that 18 per cent of women are likely to use water as a form of pain relief in labour, with 10 per cent of women giving birth in the pool.

Is a water birth right for me?

Traditionally this was a birth choice mainly reserved for low-risk pregnancy, but increasingly women with other conditions, such as previous caesarean, are being allowed to go through labour in water with careful monitoring of both mum and baby.

The best time to enter the water is usually after 5cm, when the contractions are coming every three minutes: this is when labour is established.

In some cases, water immersion may slow down the contractions; in these cases, the women are encouraged to leave the pool and mobilise to encourage the contraction frequency to increase.

Once in the pool, the temperature should be keep between 35-37˚C in the first stage of labour and 37-37.5˚C in the second stage. If women become overheated, it can effect the baby’s heartbeat.

If there are any concerns about the mother’s observations or the baby’s heartbeat, she may be asked to leave the pool. If any excessive bleeding occurs or meconium is passed from the baby, she’ll be asked to leave the pool so the baby can be more closely monitored.

What happens during a water birth?

In the pool, the baby is monitored with an underwater doppler device every five to 15 minutes, depending on the phase of labour. The mother may be checked with a vaginal exam or the practitioner may use an underwater mirror to check if the head is visible. When the time is right, she’ll be asked to push.

The head will deliver, and shortly afterwards the shoulders, which may be with the next contraction. The practitioner will lift the baby out of the water on to her chest.

Some women may be asked to leave the pool for delivery of the placenta, particularly if they plan to keep it or extract stem cells.

Does a water birth reduce tearing?

The studies around water births are mixed. Some groups cite that the risk of tearing is reduced. Another study showed that the risk of third-degree tear was higher; however, this was related to a very fast pushing stage.

The birth attendant can’t support the perineal area to offer tear protection during the birth, due to the risk of stimulating the baby before it’s out of the water.

The woman should thus be encouraged to breathe slowly as the head is crowning. Techniques such as antenatal perineal massage may also be used to try and reduce the risk of tearing in the second stage of labour.

There have been some concerns about the baby inhaling water into its lungs, but the lungs aren’t inflated until the first breath is taken, and studies have shown little difference in the health of babies born in water in comparison to those in air.

The rates of infection are also similar, and there’s no increase in the rates of those requiring special baby unit care.

Current NICE guidelines are that water immersion is a safe and useful tool in labour and should be offered to all women without contraindications, such as breech babies, multiple births, herpes, pre-term delivery and some chronic medical conditions.

Recovery after a natural birth is usually quicker, due to the relaxing effects of water which promote energy conservation during labour.

Original article at https://www.baby-magazine.co.uk/water-birth-advice/