Articles Posted in Obstetrics/Prenatal Care

maternal-300x170new investigation of one of the great shames of American medical care raises big questions about why labor and delivery is more dangerous to new mothers in the U.S. than just about anywhere else in the civilized world.

To their considerable credit, National Public Radio and Pro Publica, a Pulitzer Prize-winning investigative news site, have joined forces to examine why 700 to 900 American women die each year from pregnancy related causes, and 65,000 nearly die.

The news organizations say Americans are “three times more likely to die in childbirth than women in Canada, and six times more likely than Scandinavian women.” And while U.S. maternal deaths are rising, their numbers were plunging in developed countries from England to South Korea.

marijuana-smoking-131013-300x200Although marijuana is marching toward legalization across the United States, expectant moms may wish to think long and hard still about smoking or ingesting a substance that has become as ubiquitous in some households as aspirin or a bottle of chardonnay. The New York Times has delved into this discussion, even as other news outlets recently have provided parental warnings about hype over apps for baby care and tossing some toxic homeopathic teething remedies.

Pot? Not for expectant moms

Let’s turn first, and not be blue noses about it, to why moms would consider pot while pregnant. Data show that few do (an estimated 4 percent of more than 200,000 women in one 12-year sample — though the number had doubled in recent time). For younger women, the answer may be, just because. They don’t equate it with risk but with recreation. They say they try to be cautious with it, just as they might curtail their alcohol consumption but still have a rare drink. Older and expectant moms may use pot, as many women do, because they find it helps with depression, anxiety, stress, pain, nausea and vomiting.

Female_black_symbol-200x300Modern medicine isn’t addressing women’s distinctive health care needs as optimally as needed, with research further showing it may be time to dial down expectations about breast cancer screening, while heightening physicians’ awareness and best practices in eliminating gender biases.

Women also may want to keep close tabs on how changes with the Affordable Care Act affect them, and they may be well-served to remind themselves about Texas’ sudden surge in maternal deaths and one of health care’s major, gender-based debacles in hormone treatments for females.

Over-treatment tied to mammograms

Cytomegalovirus_01Although awareness has grown about viruses  like Zika that can devastate the unborn, cytomegalovirus (CMV), a much more common and equally harmful prenatal viral  infection, doesn’t get discussed with pregnant moms as much as it should. Medical counseling, testing, and administration of anti-viral medications could save more babies and their families from a lifetime of CMV woes.

More than half of adults older than 40 and one in three children by the age of 5 have been infected with CMV, a common virus in the herpes family. An estimated 1 in 150 babies gets infected at birth with CMV, with 1 in 5 of these infants sickened or harmed, including with hearing loss, microcephaly (a deformity so they have tiny heads), intellectual deficits or impaired vision.  This means CMV seriously harms as many as 8,000 youngsters annually across the United States, and it is fatal for about 400 infants.

Affected families and medical experts have told the New York Times that more needs to be done to increase CMV awareness, testing, and prevention, especially in comparison to the public health attention that has been paid to Zika and the damage it may inflict on the unborn.

skin“Skin to skin” therapy? That was the line item charge that appeared on the hospital bill for a young couple, and the dad decided to check it out. What he found has blown up across the Internet.

It turns out that the Utah parents were charged $ 39.35 by their hospital just so the new mom and dad, just after the C-section delivery of their son, could have their baby placed between her neck and chest. There, proud pops took the requisite newborn pictures.

Only later, as part of $13,280.49 tab for their son’s delivery, did the couple see the skin to skin charge. They posted the bill on a popular online site, where it drew more than 11,000 comments.

stirrupsThere’s insufficient evidence of the health benefits for millions of women who aren’t pregnant and who aren’t experiencing problems to undergo regular pelvic exams, a top federal task force on preventive care says.

Tens of millions of women get the exams each year, even though they are intrusive and uncomfortable. More important, research has failed to demonstrate that the procedure prolongs women’s lives or decreases their chances of developing illnesses like ovarian cancer, the influential U.S. Preventive Services Task Force has advised.

The group and other medical organizations in recent years have applied rigorous, evidence-based research to common, and seemingly common-sense tests and exams. They have found, as the online news site Stat says, that regular screening mammograms, annual PSA prostate tests, and yearly physicals “have little basis in science and fewer benefits that once thought.”

mergerFew states are monitoring, much less acting to protect, patient-consumers from one of the hot trends in today’s health care: the mergers, acquisitions, consolidations─and yes, closings─that are creating super-sized hospital organizations, chain-institutions that for business reasons seek greater efficiencies but also may be lessening access to care, sometimes as a result of religious reasons.

That’s the contention of a group called mergerwatch.org, which arose from a group of New York state family planning advocates who reacted when two hospitals, one Catholic and the other secular, merged, and reproductive services became a contentious issue in the new institution.

The group since has scrutinized hospital mergers, consolidations, and closings nationally, issuing a new study from its “When Hospitals Merge” project─an initiative that has been foundation supported and has published in peer-reviewed, respected medical journals like the AMA Journal of Ethics.

Of all the medical mistakes that could be made in the first hours of a newborn’s life, few lay people would think to attribute any of them to a delay in naming the infant. But neonatologists (doctors who treat ill or premature newborns) know that the unnamed wee ones under their care are more likely to be on the receiving end of a medical error.

When a baby is born and the parents are still dithering about what to call him or her, hospitals use a generic gender descriptor on the patient bracelet – Babygirl Smith, for example. Once the kid is entered into hospital records with that ID, it’s often there until the baby is discharged, even if he or she gets a real name in the meantime.

A study in Pediatrics conducted by researchers aware that such anonymity can invite problems tested a new naming method to see if it reduced potential errors.

The FDA has issued new regulations for prescription drug and medical product manufacturers to better communicate potential risks to women who are pregnant or breastfeeding, and people who are concerned about fertility.

The new rule, according to an FDA news release, “sets standards for how information about using medicines during pregnancy and breastfeeding is presented in the labeling of prescription drugs and biological products. The new content and formatting requirements will provide a more consistent way to include relevant information about the risks and benefits of prescription drugs and biological products used during pregnancy and breastfeeding.”

Lots of people have been waiting a long time for the new rules. As explained on AboutLawsuits.com, for years the feds have used a letter category system – A, B, C, D and X – to describe the risks of drugs and biological products to pregnant women and their doctors. But it was a clunky, insufficient explanation of what patients needed to know in order to make informed decisions.

No matter how hard medical experts and other promoters of good, safe health care try, it seems, there are always loud voices chiming in from the fringes of ignorance to offset their message.

A few weeks ago, in a blog about obstetricians recommending that women not be rushed into induced labor and also calling for fewer cesarean sections, we revisited the dangers of unnecessary C-sections, and noted that nearly 1 in 3 U.S. women give birth via C-section.

But when Dan Murphy, second baseman for the New York Mets, missed the first two days of the Major League Baseball season, he was berated, belittled and bullied by Mike Francesca and Boomer Esiason, two hosts on New York’s WFAN sports radio. Bad enough that these mic jocks called out Murphy because they believe it’s a higher priority to play a game than it is to attend the birth of your child and support its mother, but, worse, they promoted the idea of planning that birth – by cesarean – for the convenience of your schedule, not the baby’s.

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