November 30, 2011
On a recent Sunday in the bathroom of the Baltimore-Washington International Thurgood Marshall Airport, a baby boy made his entrance to life. His mother was approximately 28 weeks and delivered prematurely, however both baby and mother were healthy according to the media. Although the details of the delivery are sketchy, anyone involved in obstetrics can predict what occurred.
The mother might have had a previous history of a urinary tract infection, or complained of back pain. Did her ultrasound reveal a short cervix? Or perhaps she had a history of a previous early delivery. If it was her first pregnancy, did she complain of mild abdominal pressure? Premature labor is one of the most common reasons for birth defects and has a price tag of approximately 26 billion dollars per year. The signs and symptoms of preterm labor often go unnoticed or diagnosed because healthcare providers aren’t paying attention. A urine analysis report showing bacteria in the urine will not be addressed. No inquiry will be made as to whether the patient made frequent trips to the bathroom or whether she drank soda. Soda predisposes patients to urinary tract infections because of the carbonation or bubbly component of the drink irritates the bladder. Untreated urinary tract infections can cause premature labor. A complaint of lower abdominal pressure will be attributed it to “round ligament pain” even though the patient is well beyond 20 weeks when it is most likely to occur. A complaint of back pain will be blamed on the changing shape of the uterus rather than sending the patient to the hospital for further evaluation. In essence, some healthcare professionals keep missing the diagnosis or intervening too late.
According to the American College of Obstetrician/Gynecologists (ACOG) pregnant women can travel up to 32 weeks by air provided they don’t have any complications or high risk conditions. The change in altitude can sometimes cause the “water to break” or the placenta to separate too soon. All pregnant women who plan to travel (especially by air) should consult with the OB provider for advice and instructions. For pregnant women who plan to travel, here are some suggestions:
- Obtain a copy of your prenatal record prior to traveling in the event of an emergency
- Find out the name of the nearest Level 3 hospital where you will be staying
- Do not sit for more than 2 hours without standing for a few minutes to stretch your legs to prevent blood clots.
- If you are complaining of back or abdominal pain before traveling, contact your provider immediately
Fortunately the baby born in the airport bathroom appears to be fine. However not all unexpected births have a happy ending. Pregnant moms, if you have to travel, please don’t push the envelope.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
October 5, 2011
It’s a sad commentary when human beings have to be reminded how to act like human beings, especially when they’re in the helping profession. Loni Hildebrandt was a 29 year old certified nursing assistant who was pregnant with her first baby. Make that two babies because she was pregnant with twins. Hildebrandt considered her pregnancy miraculous because she had infertility and was a diabetic since the age of one. Together, she and her boyfriend saved their money and obtained fertility treatments. Her mother, Jo Novtny, a nurse of 30 years was ecstatic when she saw the ultrasound of her two grandbabies but her happiness was short-lived. One day after the procedure, Hildebrandt began to bleed so they went to Sarasota Memorial Hospital in Florida.
Sarasota Memorial Hospital has an excellent maternal fetal medicine (aka high-risk obstetrics) department but Hildebrandt never made it there. She got as far as the hospital’s emergency room where she was attended to by one of its physicians. Despite repeated requests to have her blood sugar checked, Hidebrandt had to wait six hours before it was done. An ultrasound at the hospital revealed a blood clot that was causing the contractions and the ER doctor told her that he could probably save one by “suctioning the clot so the labor would stop.” According to The Herald Tribune, the physician suctioned the clot and one of the twins as well. Hildebrandt allegedly began bleeding more, passing bright red blood clots. They called for help but no one came. According to the newspaper report, a nurse put the afterbirth in a bedpan and left it near Hildebrandt’s head where she was lying. Her mother moved it and placed it under her daughter’s bed. Novtny ultimately delivered the second twin because no one else was around. The ER doctor returned to the room saw the fetus in Novotny’s hand took it from her and put it in a bucket.
Novtny states her daughter did not receive proper treatment until her personal physician arrived and remained in a pool of blood for over 10 hours. Hildebrandt’s iron count was dangerously low because of the bleeding. Her mother’s request to speak with the hospital administrator was met with no response so she wrote a letter to the governor instead. An investigation was done, gross negligence was found, the ER doctor resigned and Hildenbrandt’s nurse was cited for “lack of critical thinking skills.” The hospital will now have unannounced federal inspections in order to keep their Medicare payments. The hospital administrator issued a public apology.
Perhaps one day hospitals will do the right thing, even when no one is watching. Hopefully, Hildebrandt will become pregnant again and have a better outcome.
September 5, 2011
It seems that Matthew Scheidt, had a summer job working part-time for a surgical supply company. He allegedly went to the Human Resources Department of the Osceola Regional Medical Center (ORMC) and convinced them that he was a Physician Assistant student at Nova Southeastern University and lost his identification badge. This is the hospital where many of my former patients were forced to go for medical care because they were either uninsured or received Medicaid. My former employer had a fiscal relationship with them. The use of the word “forced” is quite appropriate because my uninsured patients had no options. When those who had Medicaid requested to deliver at a women’s hospital in another county they were discouraged to do so by the powers that be. I recall with great pain the memos, reprimands and threats I received from my former employer because I wanted to give my patients the freedom of choice. Oh, the stories I could tell about the numerous altercations I had with certain staff members regarding patient management issues. So the fact that this hospital is now on local and national radar screen does not surprise me at all. The hospital was formerly owned by the organization that Florida’s incumbent governor once worked for and eventually paid fines because of fiscal improprieties. The hospital’s long-standing former administrator resigned once the governor ran for office. Yes, politics indeed can affect patient management. But let us return to the story of Scheidt.
Scheidt allegedly performed CPR, changed IVs, cleaned wounds, performed interviews and physical exams on male patients who were disrobed. He was also in the operating room. He only got caught when he asked permission to go to “restrictive areas” of the hospital and I pray it wasn’t the labor and delivery suite. How did this happen? Because our healthcare system is presently on automatic pilot. There are no checks and balances. No accountability. A 17 year old can show up in the human resources department of the hospital and no one does a background check to verify his credentials. Pity the poor patients. This is one of many reasons why The Smart Mother’s Guide to a Better Pregnancy (TSMG) was written. Patients need to be protected.
Could this happen to you? In a heartbeat if you’re not astute and aware. There is a chapter in TSMG, called Investigating the Places Where You Will Receive Care. I strongly encourage everyone to read it.
March 30, 2011
I read an article in my local newspaper the other day that gave me reason to pause. The State of Florida intends to hand over 3 million Medicaid patients to managed care companies who will reduce payments to physicians and hospitals. In exchange for accepting these low payments for professional services, doctors are guaranteed through pending legislation that no matter what egregious errors they make, the patient will only receive a maximum of $250,000 in a medical malpractice lawsuit. This is definitely a “lose-lose” situation for patients.
Managed care is bad news for pregnant women. Extremely bad news. Every ultrasound, lab test and hospital admission that your physician or midwife orders on your behalf will have to be pre-approved by a gatekeeper who is on a mission to increase the profits of their company by reducing the amount of money that is spent on you. So you must therefore be on a mission to keep both you and your unborn baby out of harm’s way. How do you do that? Here are a few suggestions that are taken from The Smart Mothers Guide to a Better Pregnancy:
- Research your prospective healthcare provider through your State Board of Medicine’s licensing department to make certain they do not have any 7-figure malpractice suits settled or pending
- If you’ve had a previous high-risk pregnancy, request a referral to a Maternal Fetal Medicine high-risk specialist for your prenatal care
- If you delivered a preterm baby in the past, chances are likely you will do it again. Ask to have your cervix measured when you have an ultrasound and if it’s short , request a referral to a high-risk specialist
- If you have vaginal bleeding and are pregnant, do not leave a doctor’s office or an emergency room without someone doing an ultrasound to confirm that (a) the fetus is alive and (b) the pregnancy is not in the fallopian tubes (aka) ectopic pregnancy. An undiagnosed ectopic pregnancy could rupture and cause havoc.
- If you complain of a vaginal discharge, do not leave your healthcare provider until someone gives you a diagnosis and treatment. Untreated vaginal infections can lead to preterm labor. Bacteria is not your friend when you’re pregnant
- Back and lower abdominal pain should not be ignored, especially if you are less than 36 weeks. It could represent signs of premature labor
- Become familiar with fetal tracings. Flat lines and “u-shaped” curves during labor could mean your baby is in trouble and needs to be delivered quickly
- Try to deliver in a hospital that has a level 3 nursery and/or a NICU (neonatal intensive care unit)
- If a hospital mistreats you, contact its administrator. If you’re still not satisfied, file a complaint with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) http://www.jointcommission.org/
- Trust your instincts. I can’t emphasize this enough.
Prevention is the key to reducing medical injury, not taking away someone’s right to sue.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do. Check out the video below for my information and pick up a copy of The Smart Mother’s Guide
March 9, 2011
Did you ever love something or someone so much that you had to walk away because it hurt too much to stay? That’s how I feel about medicine. From the moment I saw my first delivery, I was hooked and there was no turning back. Perhaps I’m highly offended at our present state of affairs because I had to work so hard to gain acceptance into med school. I spent countless nights in the library at Columbia School of Physicians and Surgeons studying for the MCATs. Endured physiology, histology, biochemistry, gross anatomy (included the dreaded head and neck) and microbiology so that I could eventually diagnose clinical problems. I walked through the fire of residency training and came out whole on the other side. Yet, despite all of these humble achievements, I couldn’t see the destruction of healthcare coming. And neither did many of my colleagues. However, instead of banning together to save our profession, some of us allowed ourselves to be fiscally co-opted giving rise to the birth of “volume oriented medicine.”
Healthcare is now a business and quality of patient care has flown out the window. Billable procedures with diagnostic codes are the order of the day. “Productivity” is a buzz word, a euphemism for volume. The insurance companies are paying less, yet the healthcare providers are expected to do more. The number of patients on schedules increases and it has become “normal” for some of my colleagues to see 48 pregnant women in a day. A former medical director decided that he wanted to increase “productivity” even more so he paid physicians on a per-patient-basis and of course, his theory worked. When one of his cronies had 80 pregnant women scheduled in 5 minute intervals for one day, I had seen enough. I wrote a letter of complaint to the Florida Board of Medicine and was informed that there was no law that prohibited the number of patients a healthcare provider could see in a day. I then contacted the American College of Obstetrician-Gynecologists (ACOG) and they too, had no protocol or rule about volume. So, it was the wild, wild, west regarding patient care. No rules. No boundaries. And certainly no patient protection. Regime changes occurred, but the “numbers” game continued. I had had enough. So after 15 years of attempting to administer quality care in the midst of chaos and strife, I have tendered my resignation. There is nothing more that I can do except put it in the hands of God.
August 23, 2010
Pretty is as pretty does. It’s an old adage my mom used to say but still holds true. An article in the Orlando Sentinel discussed how hospitals have deep pockets regarding providing amenities for maternity patients as a means of soliciting “business.” One hospital spent $112 million dollars on its new all women’s facilities. Its competitor than felt compelled to spend $16 million to refurbish its maternity floors. While flat TV screens, wood floors, granite paneled bathrooms and a masseuse are nice, do these perks add to the quality of obstetrical care?
Make no mistake, ladies, the cost of these amenities will somehow show up on your hospital bill. Elizabeth Cohen, of CNN’s show, The Empowered Patient discussed toothbrushes that cost over $100. And ironically, I ended up on her show discussing my dissatisfaction of having to pay over $800 for a $167 disposable pair of forceps during my own surgical procedure.
While it is nice to give birth in a comfortable atmosphere, the quality of care is equally important. One of my patients was pregnant with her first baby and wanted to deliver at an upscale hospital. I supported her decision because the hospital provides excellent obstetrical care and it also happens to be aesthetically beautiful. My patient worked as a manager, had a picture-perfect prenatal course and had third-party insurance. What could possibly go wrong? The lack of compassion from the admitting physician.
Although she was in the early stages of labor at 3 centimeters and extremely uncomfortable, the physician refused to admit her. His attitude was both condescending and demeaning. My patient was close to tears and her nurse was livid. When she presented to my office, it was obvious that she was uncomfortable. I offered to call the hospital and advocate on her behalf but she wanted no part of them. She requested to be delivered at a less upscale hospital where she was subsequently admitted and treated like a queen. So much for the “resort” environment.
Hospital perks might be great for marketing but they need to be accompanied with quality care and good old-fashioned courtesy.
A healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
March 10, 2010
Electronic fetal monitoring was first used at Yale University in the 1950s and is a great asset in terms of checking fetal well being. Unless a woman delivers at home, most pregnant women will have fetal monitoring during the time that they’re in labor. The fetal monitor measures both the baby’s heart rate and the mother’s uterine contractions. Why is this important? Because the vein in the baby’s umbilical cord receives oxygen which is necessary for growth and development, especially in the brain. When the uterus contracts, the blood flow to the baby is reduced, then increases once the contraction is over. The fetal monitor essentially tells us two important things: (1) whether the baby is tolerating labor and (2) whether it’s receiving enough oxygen.
Of four million babies born in the US each year, approximately 875,000 will experience birth injuries. What is a birth injury? It’s any type of injury suffered by an infant as a result of the birthing process. Most birth injuries can be avoided if someone is paying attention. Babies can’t tell us when they’re in trouble with their mouths, but they can certainly do so with their hearts. The signs of normal and abnormal fetal heart tracings are included in The Smart Mother’s Guide to a Better Pregnancy. Fetal tracings are either reassuring (meaning good) or nonreassuring (not good). If the fetal tracing is nonreassuring, then the baby needs to be delivered as quickly as possible.
Despite our current healthcare challenges, babies will continue to be born. I therefore encourage all pregnant women, childbirth educators and doulas to take these bold new steps:
- Become familiar with fetal tracings and the distinction between reassuring and nonreassuring traces (pages 201 and 202 of The Smart Mothers Guide®)
- Doulas should become Labor Room Advocates who can be another set of eyes and ears that can address any issues during labor and make certain that appropriate communication of hospital staff (including the status of the fetal tracing) is known during a shift change
- Become familiar with a high-risk specialist who can offer a second opinion in case there is a disagreement regarding labor room management
When your baby’s fetal monitor attempts to “talk” to you, everyone should understand what it’s saying.
December 30, 2009
According to Answers.com, there is a baby born in the U.S. every 8 seconds, a figure that is both staggering and exhilarating. As an obstetrician, my greatest desires is for all 11,803 babies born each day to arrive healthy and safely. I would like to dedicate my last blog post of 2009 to all the beautiful moms-in-waiting and share some pearls from my 22-year professional journey.
The force that moves the air within our lungs, the blood within our veins, is the same force that has created the life within your womb. The most important key to a healthy pregnancy is the consciousness that lies within. Your child will be shaped by your thoughts, your dreams, your values, your energy. You are the ship that will carry the baby to the shores of its pre-ordained human experience. Please let the journey be smooth. Do not create a storm from worry, a tornado from doubt, a cloud from fear, a disaster from envy. The majority of patients who end up with emergency cesarean sections are those with “fetal distress.” What was causing the distress? Who was causing the distress? Let it not be you, its mother.
Because of the advent of 4-D ultrasound technology, we can actually observe fetal behavior in the womb. We can see babies yawning, sucking their thumbs, stretching their arms and legs, even playing with their umbilical cords. They respond to music, the rhythm of your heartbeat, a touch from your partner, the sound of your voice. You are literally filled with the miracle of life. There is no gift on Earth more precious than that.
You are smarter, stronger, and more brilliant that you can ever imagine. You have been selected, yes, selected, to be this child’s mother. That is the Divine Connection.
I wish you a healthy, joyous pregnancy and a prosperous and blessed New Year.
This excerpt is taken from The Smart Mother’s Guide® to a Better Pregnancy. All Rights Reserved.
December 28, 2009
“A newborn baby abandoned in a Kenyan forest was saved by a stray dog who apparently carried her across a busy road and through a barbed wire fence to a shed where the infant was discovered nestled with a litter of puppies.” CBS News covered this story as well.
This baby girl was dressed in a torn shirt and wrapped in a plastic bag when the dog found her in a poor neighborhood near a forest in Nairobi. She was approximately two days old. “When the dog picked up the baby in a dirty bag, it came and dropped her behind the wooden building where the dog has its puppies,” stated an eyewitness. The baby was found by children who had heard her cry and was eventually taken to the hospital where, with the exception of an infected umbilical cord, was doing well. This story gave me reason to pause. Obviously, the act of abandonment was superseded by the will of a higher power who proclaimed that this baby would live. What amazed me the most was the compassion and bravery of the dog. It had risked its own life by crossing a busy street while holding on to the baby, faced physical harm as it crawled underneath a barbed wired fence and shared its resources by placing the baby alongside its own litter of puppies. Perhaps the dog understood how miraculous this newborn baby was even if its own mother didn’t.
In a world of infinite possibilities, miracles can occur under the most unusual circumstances. And yes, we can gain profound insight, even from a dog.
This excerpt is taken from The Smart Mother’s Guide® to a Better Pregnancy. All Rights Reserved.