December 28, 2011
An OB Nightmare: Mom Dies after Giving Birth to Twins
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…
October 10, 2011
Dilemma: Hospital Says Leave When You Think You Should Stay
The story of Tanya* is compelling. She was 24 weeks pregnant with her third child and the hospital was threatening to send her home. Two years ago, she faced similar circumstances and delivered a baby at 23 weeks. Luckily, the baby is now two years old but the one before that was not so lucky. Tanya presented to a local hospital during her first pregnancy because of complaints of abdominal pain. She was sent home because her contractions “weren’t regular.” Ten hours later, Tanya returned to the hospital because of a “nagging feeling that something was wrong” although her contractions were still not regular. Unfortunately, her cervix was dilated and the contractions could not be stopped. Her son was born alive but died one hour later because the hospital was not equipped to deal with premature newborns. Tanya’s second pregnancy was similar to her first because she developed premature contractions again, at 23 weeks. As with the first pregnancy, her contractions were not strong and regular so she was discharged home from the hospital with a monitor that was supposed to help. It didn’t. Luckily, she had an appointment with her high risk physician the next day who informed her that she was dilated although she did not have regular contractions. Her preterm labor could not be stopped but this time, her baby did not die.
Tanya contacted her Bedrest Coach, DarlineTurner-Lee, owner of Mamas On Bedrest that provides support to high risk pregnant moms and Lee contacted me. She asked for advice regarding Tanya who was 24 weeks and about to be inappropriately discharged home from a specialized teaching hospital. I offered strategies on Tanya’s behalf but there weren’t necessary. One of the physicians at the hospital convinced the staff to allow Tanya to remain in the hospital until 28 weeks. There are lessons to be learned from her case
- Trust your instincts. Tanya was correct in not wanting to be discharged home because of her previous history. Women who delivery preterm babies (especially at 23 weeks) are bound to do it again. The chances of survival are far greater at 28 weeks than at 24 weeks
- She obtained an advocate and sought a second opinion. 2 heads are always better than 1 especially when there is doubt about a diagnosis or treatment
- If you have a high risk problem, always attempt to be admitted to a Level 3 hospital where they have specialized care for newborns
Tanya expressed her gratitude by saying “. . . I thank God for people like you and the staff who fight for our little miracles.”
1 out of 8 pregnant women will deliver a premature baby in the US each year. Hopefully, this time, Tanya will not be one of them.
*Name changed.
July 4, 2011
A Journey to Motherhood via Ethiopia (Part 1)
Independence Day always reminds me of my mother whose birthday fell two days prior to the holiday. My mom made her transition almost ten years ago but in her honor, I’d like to share a page or two from my journal that describes my own experience of becoming a mother.
I’m presently flying on Ethiopian Air across the Atlantic Ocean. The plane dropped 10 to 20 feet because of turbulence and my husband became embarrassed because I started calling on Jesus; loud and in living color. He tried to force me to listen to some Ethiopian music via red, antiquated looking head phones but I emphatically say no, I prefer to have a conversation with God instead. I’ve never been one who suffered in silence and when it appears like we’re headed straight for the ocean, of course I’m going to pray. I’m not a religious zealot but calling out God’s name in the time of trouble is like using a password to enter a safe haven in the midst of a chaotic world.
The pilot lowers the altitude and the plane is peaceful again. Back to the boys. I often wonder how did I arrive at this junction called international adoption? Twenty years from now when my sons are in their late twenties, I’ll be a three-quarter of a century. How will they respond to me when we finally meet? We appear to be getting closer to Ireland and Paris.
August 24, 2008. Seven whole days after my birthday and my life has changed dramatically. We stopped in Rome for fuel and a change of airline crew. The new crew was tougher, a little more no-nonsense but still professional and polite. I looked out the window and saw the demarcation between night and day; the dark, black sky giving way to a pale blue sky with orange hues. It was beautiful. I look at the flight monitor and watched our plane fly over exotic places such as Khartoum and Sudan. My former life seemed millions of miles away as the plane ventured towards my unknown future.
We finally approach Addis Ababa and as the plane was descending into the city, I observed the beautiful mountains and virgin landscape. It was breathtaking and of course, I cried. We had to obtain an entry visa that proved to be painless. They didn’t ask us to declare money nor the prerequisite pictures we were so careful to remember to bring. They only seemed concerned about the $40 visa fee and quickly snatched the two crisp $20 bills out of my hands and stuffed it into their pockets. Most of the immigration workers were 20-something year olds whose families probably bought their positions through backdoor deals and old political ties.
(To be continued. Please see Part 2 on Wednesday.)
December 30, 2009
Every Eight Seconds a Baby is Born: A Love Letter to Pregnant Moms
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 7, 2009
Health Care Reform: An Unkept Promise
When I heard the final Senate version of the healthcare reform bill, I had a complete meltdown (please see An Open Letter to President Obama). I had been sucker-punched by people who I thought I could believe in and it was clear that the democratic process had been replaced by corporate agendas.
Louisiana Senator Mary Landrieu received an additional 100 to 300 million dollars for Medicaid, Nebraska Senator Ben Nelson cut a deal that guaranteed federal Medicaid payment for life (although this is now being challenged by several State Attorney Generals) and Connecticut Senator Joe Lieberman killed a public option because of his wife’s affiliation as a consultant and lobbyist to pharmaceutical and insurance companies. Hadassah Lieberman was a consultant for Pfizer, who is one of the largest U.S. pharmaceutical companies and recently ordered by the U.S. Department of Justice to pay a $2.3 billion dollar lawsuit for healthcare fraud. Government lawyers settle $2.3 billion dollar Pfizer fraud lawsuit.
On Christmas Eve, the US Senate’s version of HR 3200, aka America’s Affordable Health Choices Act of 2009 passed. The House of Representative and Senate bills must now converge into one bill. The dynamics of that process will be interesting and we will need to watch our backs.
I challenged Doctors for America, an organization of approximately 16,000 physicians to answer the following questions regarding HR3200:
- Will the premiums for people with pre-existing conditions be higher and by how much?
- Will there be some outside regulatory agency to govern the insurance companies in the event of misdeeds?
- Will there by co-pays and deductibles and by how much?
- Will there be a limit of services provided by these so-called state regulated insurance plans, i.e., will the poor receive less services based on the type of insurance they have?
- How much assistance will poor people receive regarding insurance premium payments? 10%, 20%, or 30%?
- Is there a cap on how much an insurance CEO can earn?
- Will there be reductions in payments of Medicare and Medicaid to physicians?
- Will these plans be taxed to people who earn above a predetermined income?
To the organization’s credit, they provided the following answers:
1. Older people will have to pay higher premiums at a ratio of 2:1 in the House bill and 3:1 in the Senate bill. This means that as an “older” person, my premiums will either double or triple based on the new “reform”. If you are a smoker, be prepared to pay higher premiums as well and no, you can’t conceal your habits because they can do urine and blood tests in search of nicotine.
2. Insurance companies will be required to report to the government on their performance, profits, etc. A health insurance’s ability to participate in the Exchanges will depend on its performance. If an insurance company increases its premiums prior to the Bill’s final approval, they will be excluded as a candidate for the exchange.
3. Yes, there WILL be co-pays but there will allegedly be no more lifetime or annual limits on how much an insurance company can pay on your behalf.
4. Allegedly, there’s a minimum benefits plan on the Exchanges, and then several levels of plans above that. The minimum benefits plan provides “significantly” more benefits than the average individual plan today.
5. People earning 400% below the poverty line will have their insurance premiums subsidized. Who are these people? Any individual who earns $43,000 or less and families of four who earn less than $88,000. The table listed below illustrates provides an example of a subsidy.
6. At present there is no cap on the earnings of insurance CEOs but allegedly companies must spend between 80 to 85% of their revenues on medical care. They are also required to report profits annually and pay dividends to their customers if their profits exceed the cap.
7. Allegedly, there will be no cuts to either Medicare or Medicaid physician payments.
8. There is allegedly going to be an “excise” tax on “Cadillac” plans described as plans that cost individuals more than $8500 per year or families more than $23,000 per year. Individuals earning more than $200,000 and families earning more than $250,000 per year will pay 2.35% more in Medicare payroll tax.
What does HR 3200 offer small business owners? Small business, with payrolls less than $250,000 per year will be exempt from the employer responsibility requirement. Allegedly, new small business tax credit will be available for companies who want, but can’t afford to provide their employees with healthcare insurance.
As a physician, my main concern is patient care and safety both which have declined under an insurance-driven market. Have no doubt about it folks, the insurance companies are running the show and “old-school” physicians like me are growing weary of fighting near-impossible battles. With the demise of the public option, who’s going to ensure that insurance companies play by the rules? Proposing that states assume that responsibility as suggested by the Senate Bill is unrealistic. The federal government had to enforce the Civil Rights Act back in 1964 and the same principle applies now. Without federal intervention, state governments will do nothing and insurance companies will conduct business as usual.
President Obama admitted that members of the US Senate and Congress have the best health insurance plans in our country. Why should WE settle for anything less?
