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?
Preeclampsia is a pregnancy condition that involves high blood pressure, swelling and protein in the urine. Risk factors for developing preeclampsia include:
Age; young teens and women over 35 are at greater risk
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.
As 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.
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.
In 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:
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.
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
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.