December 28, 2011
It’s an obstetrician’s worst nightmare and it continues to happen on a daily basis. The story of Michal Lura Friedman brings tears to my eyes. After 7 years of trying, the 44 year old songwriter finally became pregnant –with twins. Her husband, Jay Snyder, a free-lance voice-over artist, describes the 9 months of Friedman’s pregnancy as pure bliss. However towards the end, her blood pressure became elevated so she was scheduled to have a C. Section the day after Thanksgiving.
Snyder accompanied his wife to the hospital and witnessed the birth of his babies. Then Friedman began to bleed. And bleed. And bleed. At 9:30 p.m., she became yet another U.S. maternal mortality statistic.
At least 2 women die from complications of childbirth in the US daily. Some celebrities such as Christy Turlington Burns have become a Maternal Health Advocate as a result of first-hand experience. She had a near-miss childbirth experience but lived to tell the story. Many women, including Friedman, don’t. The American Congress and College of Obstetrician-Gynecologists (ACOG), will have both Burns and Tonya Lewis Lee, the wife of renowned director, Spike Lee as spokeswomen on the topic of maternal mortality at the 2012 Annual Conference in San Diego. However, we need much more. There are obstetricians who have worked on the front-lines managing high-risk patients for years who can’t get a seat on ACOG’s policy committees and it is frustrating. Here are a few questions that should be asked at the hospital where Friedman expired:
- She had a short stature with a uterus stretched to the max with two babies. Was the possibility of hemorrhage considered?
- When her blood pressure became elevated, was it controlled prior to doing the C. Section knowing the risk of possible HELPP Syndrome that is associated with pre-eclampsia?
- Was there an OB Rapid Response Team?
- Was a Bakri balloon used once the bleeding couldn’t be controlled with uterine massage or meds?
- Was the prospect of a problem anticipated BEFORE it occurred or was there chaos trying to find appropriate meds and equipment as the tragedy unfolded?
Pregnancy is not a benign act contrary to what most people believe. Things can and do happen, most often when the hospital staff is unprepared and ill-equipped to handle an emergency. My heart bleeds for Jay Snyder. He is 41 years old, a new father and now a widow who must take care of two beautiful children, who will never know their mother. With all due respect ACOG, talk is cheap. More action must be taken to stop this.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do…
February 7, 2011
In less than six months after writing Seven Reasons Why Pregnancy Becomes a Deadly Affair , the public outrage is faint and inaudible regarding domestic violence committed against pregnant women. The subject therefore has to be revisited again.
On a college campus, less than 90 minutes away from my home, a 17 year old woman was kicked and punched in her abdomen for no apparent reason other than she carried life within her womb. The alleged father of her baby, Devin Nickels, a college student at Florida State University was apparently not happy about his new prospective role. He purportedly contacted a high school buddy, Andres Luis Marrero, who now attended the University of Tampa and asked him to beat his girlfriend until she had a miscarriage for $200.00. Marrero, instead, offered to assault the girl for free.
According to the University of Tampa’s newspaper, The Minaret, Nickels drove his girlfriend to a secluded wooded area near an apartment complex and Marrero allegedly assaulted her despite her pleas that she was pregnant. The woman was treated at a local hospital and her pregnancy was still viable. Hours later, Marrero allegedly wrote about the attack on his Facebook® wall describing it as “fun”. He was subsequently arrested for armed kidnapping and aggravated assault on a pregnant woman. His father made a statement that his son was an “outstanding kid all his life” and he had no idea “where this was coming from.”Nickels was also arrested on the FSU campus.
Unfortunately these travesties continued. A Comcast.com online newsletter reported the story of a 17- year- old Ypsilanti high school that allegedly stabbed a classmate 12 times in the back of the head, with whom he had sex because she told him she “might be pregnant.” She ultimately had surgery that resulted in an intensive care unit admission. The classmate lived because she “played dead.”
A few facts are in order for those misguided individuals who look at violence as a means of ending a pregnancy. According to a medical study, violence does not influence pregnancy loss. A 45 year old pregnant woman has an 80% chance of having a miscarriage. A 17 year old girl, despite being kicked in the stomach does not. One of the consequences of having sex is procreation. According to CDC, 49 % of all pregnancies in this country are unplanned. Teens need to be aware of the awkward fact that if they have sex, there is a near 50% chance that they will become pregnant and if their partner is not happy, they are at a greater risk of experiencing domestic violence even to the point of death.
Violence against pregnant women is becoming unparalleled in its viciousness. How many dead bodies will it take before we start doing something about it?
August 11, 2010
According to Dr. Holcomb, approximately 1 in 1500 pregnancies is affected by cancer. However as women delay childbearing to ages 30 and 40, there is an increased incidence because the peak age of cancer occurs at age 40. Cervical cancer is the most common cancer found during pregnancy and usually presents as vaginal bleeding. A Pap smear done during the first prenatal visit will reveal the diagnosis. A colposcopy procedure done during pregnancy is extremely important to detect invasive disease which would then require aggressive treatment. In my own clinical practice, I had a patient who had a low grade abnormal PAP during a previous pregnancy but unfortunately the disease has now progressed to a high-grade Pap smear three years later with her current pregnancy. She is being watched very closely with repeated colposcopy procedures and has been encouraged to stop smoking which is a risk factor for cervical cancer.
If microinvasive cervical cancer is detected, the pregnancy may continue to term and a c. section is only necessary for obstetrical reasons. A post-partum hysterectomy is not necessary if the patient desires to have more children. If invasive cervical cancer is detected before 24-weeks, radiation therapy will cause a miscarriage 35 days after treatment in the first trimester and 45 days after treatment in the second trimester. If invasive cervical cancer is detected after 24-weeks, delivery is done by a cesarean section at term, and the patient then receives radiation therapy. The lower the stage of cervical cancer detected during pregnancy, the higher the survival rate. PAP smears save lives.
Breast cancer is the second most common malignancy detected during pregnancy and affects 1 in 3,000 women. Twenty percent of women will have breast cancer before age 35 and 1-2 percent are pregnant at the time of diagnosis. The later the diagnosis, the worse the prognosis. A modified radical mastectomy is well tolerated during pregnancy. If the patient has a lumpectomy, therapeutic abortions do not improve the prognosis. Chemotherapy is used in advanced cases after the first trimester. If future children are desired, a 2-3 year waiting period is recommended. Actress Christine Applegate is an example of a breast cancer survivor who is now pregnant with her first child.
Melanoma is the third most common cancer diagnosed during pregnancy and ovarian cancer is the fourth. Ovarian cancer presents more danger to the mother than the fetus. An ovarian cyst greater than 5 centimeters detected during pregnancy requires surgery to rule out cancer, preferably done at 18 weeks. Most ovarian cancers found during pregnancy are stage 1 which has a good prognosis.
Although rare, cancer can occur during pregnancy. Early detection can save lives. A healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
August 26, 2009
Quality healthcare is dead. And it was murdered by penny-pinching administrators.
An ultrasound report came across my desk the other day that made me scratch my head. On the first page, the fetus was listed as head down and on the second page it was listed as breech (feet first). Well, what was it? The patient was almost ready to have her baby and I needed accurate information in order to make a clinical decision. It wasn’t the first time I had received a conflicting report of that nature and I was becoming highly annoyed.
A few days later I received two PAP reports printed in large font that included an apology for the “discrepancy” of the original reports. A technician had originally read them as “normal”, but after they were re-read by a physician, they were in fact, abnormal. I had the unpleasant duty of reporting to my patients that they were now at risk for developing cancer.
In an effort to “cut costs”, professional standards are cast to the wind. The radiology department in question reverted to a voice-recognition system, eliminating transcriptionist jobs. Because the computer can’t recognize certain words the ultrasound reports are often riddled with mistakes. The problem is further compounded by a revolving door of radiologists who are hired as temps and read the reports remotely (outside of the hospital). As a result of an absence of physician leadership, the radiology technicians have inadvertently “taken over.”
Yes, you can nickel-and-dime health care services, but you will also get what you pay for. Voice-recognition software can never replace qualified human beings and neither can improperly trained technicians replace pathologists. Physicians love to scream about tort reform, however how about putting some of these hospitals in check? I wish my colleagues would get their complacent heads out of the sand and DO SOMETHING to promote patient safety.
I’m tired of fighting this battle alone.
June 4, 2009
And there it was on the front page of the New York Times for the whole world to see. Where Life Starts Is a Deadly Risk, by Denise Grady, described a harsh reality that is often mentioned as a mere footnote. More than half a million pregnant women die from preventable deaths and over a quarter million occur in Africa. Of course there are not enough financial and human resources available and their stories are disheartening. For each woman who dies, 20 more encounter serious complications. Physicians state that more deaths occur outside the hospital because many try to give birth at home. This leads to my next point.
There are a growing number of women who want to give birth at home alone, without a midwife or birth attendant. I posted a blog about this “unassisted” phenomena a few weeks ago after one of their advocates’ baby ended up dead. I subsequently received a comment from a woman who discussed how “tribal” women would rather deliver without intervention and their biggest obstacle was poverty. Not so. There are millions of African women who would love to trade places with the “unassisted” crowd in a heartbeat. Yes, childbirth is a natural act but it is not exempt from danger.
Grady’s article reads like a litany of horror. A mother of six bled to death because the nurses did not know how to remove the placenta. A mother of quadruplets died leaving four beautiful babies in an orphanage. Two and three laboring women sharing one cot. America, we are so blessed. The cost to run a hospital in Tanzania costs $200,000 a year. I challenge the American College of Obstetricians-Gynecologists (ACOG), the American Board of Obstetrician-Gynecologists (ABOG) and all the rest of the deep-pocket women’s organizations to step up to the plate. We are our sisters’ keepers. When a mother and baby die, the whole world mourns.
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