What Will Prenatal Care Look Like in the Future?

In today’s tough U.S. economy, healthcare is in the forefront because of the three trillion dollars spent each year. Patients are not seeing their money’s worth and neither is the U.S. government who writes the check for a large percentage of it. The cost of women having babies too early or prematurely costs our society $26 billion dollars each year. Something has to give.

Women’s health is the topic of great political debate as you may well be aware if you listen to the news or watched both political parties’ national conventions during the past two weeks. Do women control their destinies? Do we and will we continue to have control over our bodies? These are the questions at hand. While there’s great chatter about this topic as the U.S. election nears, there’s also a quiet revolution occurring in our healthcare system that will directly affect pregnant women.

Prenatal care as we know it will begin to change, especially if you receive Medicaid or government sponsored insurance. The current trend is to visit your healthcare provider’s office individually and wait to be seen. In the future, you will be seen by your healthcare provider as a member of a group, not as an individual. This is called enhanced prenatal care with group appointments and will be the wave of the future.

Groups of 10 pregnant women will be seen at the same time for approximately 10 prenatal visits that will last approximately 90 minutes. It is anticipated that 2 healthcare providers will not only take your vital signs, listen to your baby’s heartbeat, but will also allow you to interact with the other patients in this group setting to discuss prenatal issues, receive health education information and any concerns that you may have. Believe it or not, this model of care is not new.  The concept was called Centering Pregnancy and was developed by nurse midwife Sharon Shindler-Rising in 1989.

In the future, doulas and social workers along with midwives will become more prominent in terms of prenatal care as things continue to evolve. Are you ready for group prenatal visits?

Pregnancy Shouldn’t be a Deadly Affair: Critical Advice That Could Save Your Life

Dr. Linda Burke Galloway advises pregnant women about warning signs of dangerous affairs.

Why is Preeclampsia Misdiagnosed?

ImagePreeclampsia is a pregnancy condition that involves high blood pressure, swelling and protein in the urine.  Risk factors for developing preeclampsia include:

  • 1st Pregnancy
  • Age; young teens and women over 35 are at greater risk
  • Obesity
  • History of diabetes
  • History of hypertension
  • Family history (mother, sister, aunt) of preeclampsia

The typical preeclamptic patient has a blood pressure of 140/90 or greater with protein in the urine and swollen ankles in the late 3rd trimester. She may often complain about a headache. This patient is fairly straightforward, but what happens if these symptoms present in a patient who is only 31 weeks? Or 27 weeks? Some healthcare providers will try to “buy time” and “treat the patient with bed rest or blood pressure meds” and she ends up having a seizure or a stroke. The only treatment for preeclampsia is delivery of the baby because it is the placenta that’s causing the problem. There’s something in the placenta that causes the blood vessels to squeeze and increase the blood pressure. Once the placenta is delivered, the blood pressure usually comes down but a woman can have preeclampsia and the risk of having a seizure for 96 hours after birth.

A patient may have a blood pressure of 120/80 with a measurement of 3+ protein in the urine. Her normal blood pressure is usually 90/60 and she has gained 5 pounds in one week. Yet her physician or midwife thinks this is normal. It’s not. They have been lulled into a false sense of security because her blood pressure is 120/80 and not 140/90. This patient should have her blood pressure repeated 2 more times within a 6 hour period and if it remains high, the diagnosis of preeclampsia is made. She should also have her urine collected for 24 hours to determine if there’s significant protein.

Why is preeclampsia often misdiagnosed? Because healthcare providers view the abnormal signs of pregnancy as “normal” variants. They’re not. A headache that doesn’t go away, a sudden increase in weight gain, swollen feet or ankles needs further evaluation as well as significant protein in the urine. If you think you have preeclampsia but your healthcare provider disagrees, by all means, call your insurance company and request a second opinion.

Remember, a healthy pregnancy doesn’t just happen it takes a smart mother who knows what to do.

Remembering my Soror Dawn: A Preeclampsia Victim

ImageAs a young girl growing up in a small Long Island town called Amityville, Memorial Day was a huge holiday filled with parades and barbeques. I would inevitably end up at my friend Diane’s backyard eating a hotdog along with the rest of the kids on our block. It was also a day when we made our annual trip to the cemetery to place American flags on the graves of veterans and flowers on the graves of the deceased. Well, today, in honor of both Memorial Day and Preeclampsia Awareness Week, I’d like to take time to remember all mothers and their babies who died during childbirth, especially from preeclampsia.

What is preeclampsia and why is it so deadly? Preeclampsia is a condition of pregnancy in which there is high blood pressure; swelling of the ankles, feet, or face; protein in the urine; and abnormal kidney function. This condition requires the delivery of the baby in order to preserve the mother’s life and prevent seizures and strokes. The old fashioned term for preeclampsia was toxemia and it affects 1 out of 12 pregnancies each year. Approximately 76,000 women die annually from this disease and most people know of at least someone that it has affected during pregnancy.

When I think about preeclampsia, a woman name Dawn Fleming comes to mind. Dawn was 31 years old, a member of my sorority, Delta Sigma Theta and a popular radio personality in Orlando. Although I did not know her personally, she was from my former hometown of Queens. She was gregarious, a community activist who died unexpectedly from a preeclampsia related stroke. She had recently married and delivered a baby girl 6 days before her untimely birth. Her daughter is now approximately 8 years old and will never know her mother. When I attended Dawn’s wake, I was both angry and sad. I suspected someone had inevitably missed the diagnosis and by the time she was given treatment, it was too late. Such is the case of the vast majority of preeclampsia victims. By the time a diagnosis is made, the damage is already done. In her book, You Have No Idea, celebrity Vanessa Williams and her mother, Helen, discusses preeclampsia as the reason for her paternal grandmother’s death.

In my next blog, I will describe the signs, symptoms and treatment for preeclampsia that is also described in The Smart Mother’s Guide to a Better Pregnancy. But in the meantime, I urge all of us to take a few moments to remember all the moms and babies who are no longer with us and pray that a cure for preeclampsia will one day be found.

Is He the Daddy? Now you’ll know at Eight Weeks

The subject of paternity has always been a source of controversy and brings to mind an old adage my late aunt used to say: “Mama’s baby. Daddy’s maybe.” Because 50 percent of pregnancies in the U.S. are unplanned, paternity becomes a huge issue when there are multiple partners involved.

What haven’t I seen as an obstetrician? There was the patient who wanted me to change her due date and induce her 2 months early to correspond with her male partner of choice, rather than the baby’s biological father. Of course, the answer was no. It’s also difficult to explain how two parents of one race can produce a baby of another. And then there’s always the pregnant teen whose boyfriend’s mother is demanding a paternity test.

In 2009, an article in the Sunday New York Times Magazine published a story that nearly brought me to tears. Ruth Padawer wrote a story about fathers who had been “duped” regarding their children’s paternity. Who Knew I was Not the Father, is a cautionary tale of men who raised children, paid child support only to discover that they are not the biological father.  It was disheartening to read about the profound betrayal these men felt upon discovering the truth.

Traditionally, mothers and fathers would have to wait until after the birth of the baby to determine paternity or have an invasive procedure called an amniocentesis that took a sample of fluid around the baby and tested it against the father’s DNA.  Now, things have changed, thanks to modern genetics and Ravinder Dhallan, MD, PhD, who discovered the test through his research. Although fetal cells are present in a mother’s blood, it was difficult to isolate them based on technical difficulties. Dhallan discovered that if he mixed the mother’s blood with a fixative, the fetal blood cells could be obtained. Therefore, rather than have an invasive test that runs the risk of causing a miscarriage or waiting until after the baby is born, the paternity of a baby can be established as early as 8 weeks gestation.

This new DNA tests is a game-changer. It allows women to make informed choices and empowers men to prove or disprove paternity much earlier in the pregnancy. Would you use this test if it were available? Please share your thoughts.

When Doctors Won’t Listen (Part 2)

ImageIn Part 1 of Monday’s blog, we learned about Angela Burgin Login, a first-time pregnant mom who was developing pre-eclampsia but the signs were ignored by her physician.  Angela almost lost her life because the recognition of her diagnosis was delayed.  While most pregnancies are uneventful, a “normal” pregnancy will not always mean a “normal” birth. Things can change quickly, especially in the labor room. In order to have a favorable outcome at the end of a pregnancy, the healthcare provider and the patient must be in total agreement regarding expectations and treatment. Sometimes that may not happen. The most important task of a pregnant mother is to select the right provider and Chapter 1 of The Smart Mother’s Guide to a Better Pregnancy addresses this issue in detail. What then should a patient do if her physician is not responsive to her concerns? Here are a few strategies:

  1. Ask that your concerns be documented in your chart and then ask to receive a copy of the chart. If your concerns are still present and not addressed to your satisfaction, call your insurance company, explain the situation and request approval to change providers.
  2. If for some reason, you are not able to change physicians or providers, contact your insurance company, explain yours concerns and dissatisfaction, then ask for approval to obtain a consultation with a high-risk specialist (aka maternal fetal medicine) so that he or she can evaluate your condition to make certain that it’s not high-risk
  3. If you are in labor and are not satisfied with your progress, have a family member or your support person request to speak to the nursing supervisor. When he or she arrives, inform them of your concerns and that you want it documented in your chart. Ask her who is the on-call or consulting maternal fetal medicine specialist and then request an in-house consultation. Simultaneously contact your insurance company, explain your concerns and ask for approval for the consultation advising them that if anything happens to you or your baby, they have been duly notified in advance. Also ask to speak to the hospital’s risk management office as well.

By implementing these strategies, you improve your chances of having a favorable outcome because you are formally documenting your concerns and holding people accountable for your patient care. Your proactive role will protect both you and your child.

Most physicians are compassionate, competent and caring. On rare occasion, you might unfortunately encounter one who needs to be “brought back down to Earth.” If that happens, you now know what to do.

Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.

http://youtu.be/rySO6jqj0ik

When Doctors Won’t Listen (Part 1)

ImageWe recently celebrated the arrival of a new addition in our family and it was a delivery made in Heaven. Our relative’s membranes ruptured, contractions started and she delivered a healthy baby 45 minutes after her arrival to the hospital. The doctor came 10 minutes before the baby was born and all she had to do was basically “catch the baby.”

Sadly, everyone is not as fortunate. Each month I review medical malpractice cases and shake my head in frustration because many of them could have been avoided if only someone had listened to the patient or paid attention in the labor room. Last week, the listeners of a popular morning radio show listened in horror to Angela Burgin Logan’s interview about her missed diagnosis of pre-eclampsia that almost killed both her and her unborn daughter. Fortunately she lived to tell the story which is now a movie entitled Breathe. Although Angela and her daughter are well, other women have not been as lucky.

Pregnant women need to start thinking in terms of “outcomes” regarding their pregnancy. As the healthcare “industry” moves deeper into the 21st century, healthcare providers and hospitals will be measured and paid according to the outcomes of the patient. You will hear terms such as “pay for performance” and “performance measures” used more frequently. A “normal” pregnancy does not necessarily mean a “normal” outcome at birth (aka healthy baby) if someone misses a sign or a signal of a potential life-threatening problem. Why does this happen? For reasons too numerous to count but the main culprit is lack of communication. A lab report with important results was not reviewed or signed. High-volume practices leave little time to provide quality care for patients and then of course, there is arrogance.

Two of the most empowering things a pregnant woman can do in order to improve her chances of having a healthy baby is to (1) select the right healthcare provider and (2) have strategies at hand in the event that she encounters administrative or clinical complications. In Part 2 of this discussion, I will provide some of those strategies in the event that you have a healthcare provider who will not listen to your concerns. Until then, remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.

http://youtu.be/rySO6jqj0ik

Top 4 Ways Pregnant Women Can Avoid Food Poisoning

ImageThe U.S. Department of Agriculture (USDA) and Food Drug Administration (FDA) are on a mission. One in six Americans become sick each year from food poisoning (aka foodborne illness) and pregnant women are quite susceptible of becoming victims. Why? Because the immune system of pregnant women is lowered thereby making them at risk for developing infections. Specifically, they are at risk for developing illnesses that are associated with Listeria Monocytogenes and Toxoplasma gondii.

Listeria causes a form of food illness called Listeriosis that can cause a miscarriage, premature deliveries, serious illness or death of a newborn. Each year, 2,500 Americans become ill from listeriosis and one out of five cases result in death. Unfortunately one-third of listeriosis occurs during pregnancy. Foods associated with listeriosis can grow slowly at refrigerator temperatures. Such foods include: improperly cooked hot dogs, luncheon meats, cold cuts, fermented or dry sausages and other deli-style meat and poultry.  Raw (unpasteurized) milk and soft cheeses made with unpasteurized milk are also culprits as well as smoked seafood and salads made in the store such as ham, chicken or seafood salads as well as raw vegetables. Symptoms of listeriosis include fever, chills, headache, backache, occasional upset stomach, abdominal pain and diarrhea. It may take up to 2 months to become ill.

Toxoplasmosis is a parasite found in raw or undercooked meat as well as cat litter boxes and other areas where cat feces can be found. It can cause hearing loss, mental retardation and blindness in babies. It can also cause miscarriages and birth defects. Its symptoms include flu-like symptoms that usually appear 10 to 13 days after eating and may last for months.

How can pregnant women avoid getting these foodborne illnesses? By following the four basic steps to food safety: clean, separate, cook and chill food during and after preparation. Wash hands and surfaces often. Use paper towels to clean kitchen surfaces. Rinse fruits and vegetables. Clean lids before opening cans. Separate raw meat, poultry, seafood and eggs from other foods in your grocery shopping cart, grocery bags and in your refrigerator. Never place cooked food on a plate that previously held raw meat. Use a food thermometer when cooking meat and refrigerate or freeze meat, poultry, eggs seafood and other perishables within 2 hours of cooking or purchasing. Refrigerate within 1 hour if the temperature outside ifs above 90°F.

For further information, please contact AskKaren.gov that is a virtual assistant funded by the FDA. www.fda.gov/Food/ResourcesForYou/HealthEducators/ucm081785.htm is another great resource regarding food safety for pregnant moms.

Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.

http://youtu.be/rySO6jqj0ik

Baby Pronounced Dead but Awakens in a Morgue 12 Hours Later

Anyone who has ever witnessed the birth of a baby knows that they have truly witnessed a miracle. However, it’s stories like Analia Bouter from Buenos Aires, Argentina that keeps us humble.

Imagine that you delivered a premature baby at 26 weeks, was informed that it was a stillbirth and then 12 hours later, you discover that it is alive. That is exactly what happened to Bouter, after delivering a baby girl via a C. Section. Bouter’s daughter was pronounced dead at the time of birth and quickly whisked away to the morgue where it remained in a refrigerated room. Twelve hours later, Bouter and her husband visited the morgue to say a final farewell and take pictures to be sent to the funeral home. Bouter’s husband attempted to open the coffin with great difficulty and once opened, he stepped aside so that Bouter could see the baby. She moved the coverings aside, touched the baby’s hand and then uncovered her face.  She then heard a cry and at first thought she was imaging things. As she stepped back, the baby woke up and let out a weak cry. Bouter fell to her knees crying and laughing simultaneously. The baby was quickly taken to the neonatal intensive care unit and is presently on a ventilator.  A news conference was held and five healthcare workers were suspended pending an investigation. Bouter plans to sue.

How could this possibly be, one might ask? There are a few possibilities. Perhaps the baby had a weak heartbeat that went undetected or it was the cold temperature that kept it alive. Almost 2 years ago to the exact date, I wrote a blog about hypothermia, (see 5 “Cool” Ways to Save a Newborn’s Life), an innovative way to keep critically ill newborns alive. This process was initiated at the University of California in San Francisco, had specific protocols that were used on babies greater than 36 weeks and must be implemented within the newborn’s first 6 hours of life. Bouter’s baby was only 26 weeks but the process still worked.

In 2005, there was a case of tourist Dan O’Rielly who drowned in Mexico and was airlifted to Houston where he was given a cooling blanket with a temperature of 90 and the man came back to life 12 hours later. He went without oxygen for 45 minutes before he was intubated. There IS something to this freezing stuff and I hope medical science will research the matter further. In the meantime, may the story of Luz Milagros (Little Miracle) continue to inspire us all. Obviously she was meant to be here.