April 30, 2012
We 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.
January 18, 2012
Although most women will spontaneously develop labor by their due date, there are exceptions to the rule. Some women may have to be delivered earlier because of complications such as high blood pressure, pre-eclampsia, diabetes, poor fetal growth or low amniotic fluid. Other women may have to be induced because they have exceeded their due date by one to two weeks. Why are inductions of labor necessary? When the conditions within the uterus or a medical condition pose a threat to either the baby or the mother, the baby must be delivered. While most labor inductions are successful, there are some questions that pregnant moms need to ask in order to increase their chances of having favorable outcomes.
- Is my cervix favorable? The softer the cervix, the greater the chances are of having a successful vaginal delivery. If the cervix is not “favorable” or soft, medicine will be necessary to make the cervix softer, usually in the form of suppositories.
- How long will the induction take? This is a legitimate question because the longer the induction takes to occur, the greater the risk of developing complications such as infections. Most inductions of labor and delivery occur within 48 hours of admission. First-time moms dilate 1.2 centimeters per hour while moms who have had previous children dilate at 1.5 centimeters per hour. It can take up to 20 for a 1st time mom and 14 hours for a mom with previous children to develop active labor (meaning she is dilated 4 centimeters) but thereafter she should deliver within the next 12 hours. A 3-day induction of labor is a red flag that there might be potential problems that could compromise the health of the unborn baby or mom.
- If you are being induced, break your water but are not having contractions, ask your provider whether he or she will give you antibiotics to prevent infections. The longer your membranes are ruptured, the greater the risk of developing an infection.
- A multiple-day induction of labor involves many providers and nurses who will be changing shifts. Sometimes things or information gets lost in the transition. Ask who the lead person or team leader is regarding your care and make sure everyone is on the same page regarding your information. Try to obtain this information, BEFORE you are admitted to the hospital.
- Trust your instincts. If things appear complicated during your labor, ask for a maternal fetal medicine consult. These are high risk OB doctors who specialize in managing complications.
Most of the medical malpractice cases that I have reviewed as an expert have involved the issues discussed above. To be forewarned is to be forearmed.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what do to.
January 4, 2012
For years I struggled to define what I was doing as a physician regarding patient care. I finally figured it out. I was attempting to improve birth outcomes. An outcome is another way of saying end result and for most pregnant women the desired result is a healthy baby. There is an erroneous assumption that all pregnant women will have healthy babies. Unfortunately, this is not always true. Out of the 4 million babies born each year, according to the National Center for Health Statistics, 1.3 million babies require special care after they’re born. About 6 percent of newborns or 200,000 babies per year require life-saving intensive care that could have occurred before, during or after their births. What happens at the time of birth potentially depends on how much homework (aka due diligence) was done prior to going to the first prenatal appointment.
My goal for 2012 is to encourage women to become significantly more proactive regarding their healthcare, especially if they’re pregnant. Background checks of hospitals, clinics and healthcare providers should be done on a routine basis prior to making an initial appointment. Obstetrics is a specialty of the unexpected. A “normal” pregnancy could become “abnormal” in a matter of minutes in the labor room. Unwanted conditions such as diabetes, high blood pressure and premature labor rear their ugly heads. Can your healthcare provider handle these problems appropriately?
The untimely death of Hip Hop artist “Heavy D” aka Dwight Arrington Myers is a teachable moment in prevention. An autopsy confirmed that Myers had died from a blood clot to his lungs, also known as a pulmonary embolism. Myers had a previous history of obesity and heart problems. He was returning from England which is an extremely long flight. Sitting for greater than 2 hours increases the risk of developing blood clots in the legs. I wonder if anyone had advised him to stand every 2 hours for 15 minutes as a precaution. This advice also applies to pregnant women.
The story of Flight 1549, aka the “Miracle on the Hudson” is inspiring. The pilot, Captain Skully Sullenberger miraculously landed a plane in the Hudson River after the plane’s engine had been compromised by low-flying birds. His skill and proficiency saved 150 lives. Can your healthcare provider and hospital handle the unexpected? I certainly hope so.
The Smart Mother’s Guide to a Better Pregnancy was written to help pregnant women improve birth outcomes. There will also be future webinars to assist as well.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.