August 1, 2012
JoNel Allecia’s NBC News article, Burned Out Nurses Linked to More Infections , addresses an important issue that is often overlooked and ignored. Let’s be brutally honest, without an appropriate nursing workforce, our entire healthcare system would collapse. As our healthcare system continues to shift to a business and profit model, both nurse and physician burnout will only increase.
Decisions to “cut corners” by not providing adequate nursing staff are made on a daily basis to our detriment. There was a time when additional nurses would be brought in based on the patient census for the day or evening shift but those days are gone forever.
According to a recent medical study, for every extra patient added to a nurse’s workload, there is one hospital acquired infection for every 1,000 patients. While this may not sound significant to the uninitiated, a hospital acquired infection can wreck havoc because it is usually caused by antibiotic-resistant bacteria that are difficult to treat and Methicillin-Resistant Staph Aureus (aka flesh-eating bacteria) or MRSA is a perfect example.
The study goes on to report that when an additional patient is added to 5.7 patients per nurse, 1,351 additional hospital infections occur that are preventable. The statistics are alarming.
A few months ago I reviewed a medical ob-gyn case where the labor room nurses were short-staffed and the patient unfortunately died of complications. The physician had patients in labor but chose to finish his office hours rather than attend to a sick patient so the short-staffed labor room nurses were essentially managing his high-risk patients.
What can a patient do? Plenty.
- Ask what the patient to nurse ratio on the day of your hospital admission and if the nursing staff pattern is inappropriate, ask your insurance company if you are eligible for a private duty nurse based on the increased hazards associated with inadequate nursing staffs.
- Ask your physician to come to the hospital to closely oversee your care or make sure there’s a hospitalist on duty
- File a formal complaint with the hospital administrators, State Board of Nursing and the Joint Hospital Commission for jeopardizing your patient safety based on inadequate staffing patterns
When nurses are overloaded with work, an entire community suffers.
April 9, 2012
Introducing Guest Blogger Melis Ann: What Pregnant Moms Need to Know About Neonatal Intensive Care Units
Today I’d like to introduce our guest blogger, Melis Ann, who has written a thought-provoking and highly informative article about Neonatal Intensive Care Units and the importance of selecting the right hospital. Melis Ann is a mom and a social scientist who loves to do research to find out the how and why. Her website is http://melisann.hubpages.com
During pregnancy, there are many decisions to make. The most important decision is where to have your baby. Hospitals have different levels of qualifications to deal with life-threatening circumstances that newborn babies may face. Many infants are born premature and need help to survive in a Neonatal Intensive Care Unit (NICU). Many other babies, including full-term babies, are unexpectedly affected by breathing difficulties, heart defects and other birth defects and need emergency care. Understanding what to look for in a hospital, the neonatal nurses, and the NICU will give expectant parents the ability to make an informed decision. See the article at the following link.
March 5, 2012
Today will be a day of mourning for pregnant women who are uninsured and receiving Medicaid in Houma, Louisiana. Their local hospital closed its maternity and neonatal units because of a $2.9 million dollar budget cut. Over 100 employees will lose their jobs, many whom have held their positions for over 20 years. This closing will have a ripple effect and is an increasing phenomenon that has besieged many hospitals across our nation. Over thirteen hospitals in Philadelphia closed their labor and delivery departments and in my own backyard, South Seminole Hospital in Florida did the same. What’s going on? Hospitals claim they’re losing money and government insured and non-insured pregnant women are feeling the aftermath. These are some very scary times.
The options for Houma’s uninsured pregnant women or women who receive Medicaid are quite limited. A few years ago, they could have gone to Lafayette Hospital in Lafayette; or Earl K. Long in Baton Rouge or Charity Hospital in New Orleans. Sadly, all of those hospitals have closed their labor and delivery department. I know those hospitals well, having worked and lived in Louisiana for almost four years as a community health physician.
Although Houma is a small, close-knit community, its hospital provided hundreds of prenatal visits for pregnant women in nearby parishes. They interacted like family. The nurses at Leonard J. Chabert Medical Center are devastated and apprehensive about the future of the pregnant women knowing that most cannot afford to go to private physicians and many have high risk problems. Consequently, many of these patients will be forced to travel over 300 miles on a 5-hour trip to Shreveport, Louisiana to receive prenatal care at its charity hospital.
I strongly encourage the State of Louisiana to brace itself for an increase in infant and perhaps even maternal deaths. Many high risk patients are simply not going to be able to make that 300-mile trek to Shreveport without adverse consequences. Any perceived benefit from that $2.5 million dollar budget cut will quickly dissipate based on the spike of NICU admissions that are sure to come.
The women and their unborn babies deserve better. Shame on the State of Louisiana.
February 22, 2012
To be forewarned is to be forearmed. That is the mantra that should be adopted by all potential patients who are engaged in our present healthcare system and especially pregnant women. Information is power and you can never have too much regarding your health. There is a trend for pregnant women to write a birth plan regarding their delivery but there should also be an action plan during the third trimester.
Listed below are questions taken from Harvard Medical School’s Family Health Guide. I strongly encourage you to become familiar with these questions because they could inevitably save your life or the life of your baby. Many of them address the warning signs of pre-eclampsia (swelling of the hands and face) and preterm labor (leaking fluid).
- Do you have adequate support at home from family or friends?
- How do you feel? Have you had any problems since your last visit?
- Have you had any vaginal bleeding or spotting?
- Have you had any pain or uterine cramping?
- Have you had any discharge or leakage of fluid from your vagina?
- Have you noticed swelling of your face or ankles?
- Have you had any problems with your vision?
- Are you getting frequent headaches?
- Have you noticed a change in the frequency or intensity of fetal movement?
- Are you planning to breast-feed or bottle-feed?
- Have you selected a pediatrician for your baby?
- Are you taking classes on labor and delivery?
- Have you made arrangements for your family’s health insurance to cover your baby when the baby is born?
- Have you purchased a special car seat to hold your baby when riding in your car?
- Have you decided on whether the baby will have a circumcision, if a boy?
- Have you talked with your doctor about the length of your stay in the hospital?
- Do you know the signs of going into labor so that you can call your doctor when labor begins? (These include uterine contractions and rupture of the membranes).
A good defense begins with a good offense. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
February 6, 2012
Home birth, a controversial subject in the world of maternity will gain even greater controversy based on the recent death of 36 year old Carol Lovell, an Australian home birth advocate who collapsed and died after the birth of her second daughter. Lovell was rushed to the hospital after she developed symptoms of heart failure during labor and ultimately died.
Despite warnings from the American College of Obstetricians and Gynecologists (ACOG), homebirths in the U.S. has increased by 29% from 2004 to 2009, according to Bloomberg Business Week. Caucasian women over 35 with previous children are more likely to have homebirths and over 60 percent of them are attended by midwives, 5 percent by physicians and 33 percent by “others.” Admittedly, twenty years ago, the thought of having a homebirth seemed farfetched. However, when patients lost their freedom of choice regarding hospital selections based on managed care restrictions and healthcare became more focused on profit as opposed to quality healthcare, the landscape changed dramatically.
Women opt to give birth at home for a multitude of reasons. Some want minimum interventions such as the I.V., meds and fetal monitoring. Others prefer to deliver in the comfort of their home based on its familiarity and then of course, there’s the issue of cost. It is much cheaper to deliver a baby at home rather than in a birth center or hospital. But here’s the dilemma: obstetrics is a specialty of the unexpected and a low risk pregnancy can transform into a high risk condition abruptly with little warning. Unfortunately, when a complication occurs during homebirth, the babies will die 2 to 3 times faster than if they were born in the hospital. Why? Because of the advantage of life-saving neonatal technology that is used in most hospitals. If a mother has a difficult birth in a hospital, the pediatricians and neonatal specialists are in the delivery room at the time of birth. The baby is whisked away to the neonatal intensive care unit where life-saving procedures are performed. A home birth does not offer this advantage.
Although ACOG does not support homebirth, they make the following recommendations:
- Have standard prenatal care, including Group B Strep screening
- Work with a certified midwife, certified nurse midwife or physician that practices in an integrated or regulated health system
- Be able to obtain professional consultations from obstetricians or specialists quickly
- Have a plan for safe and quick transportation to a nearby hospital in the event of an emergency
- Be a low risk patient
- Do not have a home birth if you are beyond 42 weeks
It is also time for ACOG to meet these women halfway. We know that the numbers of homebirths are steadily increasing. ACOG needs to devise new methods and innovations of improving patient safety. Homebirths are here to stay, whether we like it or not.
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.
December 5, 2011
The umbilical cord of the fetus is the lifeline to its mother. Not only does it carry nutrients from the mother, but it also removes waste products from the fetus. The cord, as it is referred to, plays a very important role in obstetrics. At birth, a sample of blood from the cord is obtained and tested to identify its blood type and make certain the baby has enough oxygen. Traditionally, the cord is clamped immediately after birth or within the first 15 seconds of life to reduce the incidence of jaundice. However, this no longer holds true. A recent article in the New York Times discussed a Swedish medical study that demonstrated waiting 3 minutes or more before clamping the cord reduced the chances of getting iron deficiency in the newborn four months later. The blood of a newborn is unique because it is in its most primitive state and has stem cells. Stem cells are important because they have the potential to grow into many different cells in the body. When clamping of the cord is delayed, the baby essentially receives a blood transfusion of its own blood.
The practice of delayed clamping of the cord is not new but it is usually done after premature births to reduce complications. Delayed clamping of the cord of preemies by 30 to 120 seconds reduced the need for blood transfusions and reduced brain hemorrhages. These benefits were seen immediately. However, in the Swedish study, the benefits of delayed cord clamping were seen at a much later time interval of 4 months. This is was very significant and paves the way for further studies to determine if this benefit will still prevail months or even years later. Should all babies have delayed cord clamping? No not all. Newborns who had fetal distress during labor should not have delayed clamping because there is a greater transfer of blood from the placenta to the baby during this type of crisis. Also, babies who were growth restricted during pregnancy and babies of diabetic moms should not have delayed cord clamping as well.
Delayed cord clamping might play a significant role in the prevention of newborn and infant anemia. It certainly deserves a discussion with your healthcare provider at your next prenatal appointment.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
November 7, 2011
A recent article about the shameful infant mortality rate in the U.S. caught my attention. Certainly the statistics quoted are nothing new but still remains alarming. However, the Op Ed by CNN contributor Deborah Klein Walker gave the subject matter a new spin. Walker wrote “This is one of the greatest injustices in our country: that a baby’s chance of having a healthy life is largely dependent on where he or she is born. States and local communities vary widely in what care their leaders choose to provide to women and children.” If Dr. Walker were present, I’d give her a great big hug for her courage to say what no one else dared. A baby can die based on a hospital zip code.
Every pregnant mother needs to take a mini course in hospital politics because they are directly affected. A hospital is no longer a place of healing. It is a business and at times, ruthless. I have witnessed a colleague forced out of business because she said no when a hospital wanted to buy her practice so they withdrew her admitting privileges instead. I recall bitter battles with my former employer because I would not encourage my patients to deliver at a hospital that was notorious for being under staffed, overworked and a haven for medical errors, simply because of a business relationship that my employer had with thatehospital.
I commend our federal government for initiating programs such as Healthy Start and the new home visiting program, but dependence on government assistance alone cannot guarantee a healthy baby. A pregnant mom must do her due diligence. She must investigate the credentials of the provider and hospital where she intends to give birth. What should a pregnant mom do if she lives in a community or state that has a high infant mortality rate? Give birth at a teaching hospital that’s affiliated with a university or medical school. Most of these institutions receive federal and state financial support and are obligated to provide care to patients.
Can a baby die based on the zip code where it’s born? Unfortunately, yes unless the mother is willing to do her homework and take the necessary precautions to avoid that from happening. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
October 17, 2011
It is said that when one wants to learn the mysteries of life, observe Nature. To everything there is a season, but what are the chances that twin sisters would give birth on the same day? Alicia Teepler and Ari Ostler are identical twins . Their own births were miraculous when you consider that there was one fertilized egg that split into two during their conception. They shared one amniotic sac, one placental connection with their mother and one common birth date. Now, their children do as well. Ostler gave birth to a baby boy on October 7th and 43 minutes later Teepler gave birth to a baby girl. Both sisters had exceeded their due dates and were induced. Ostler requested an epidural for pain management while Teepler opted for natural childbirth. Both moms’ deliveries had an abnormal amount of amniotic fluid and their babies had nuchal cords, meaning the umbilical cord was wrapped around their necks but they were easily removed at birth. Surprisingly, both labors progressed at the same pace.
Sometimes miracles are in plain view and we discount them as mere coincidences. I recall the time when I had a patient who was in labor and ultimately delivered a baby girl on her daughter’s birthday. She now had two daughters born on the same day. Or the patient who had a miscarriage with a twin pregnancy after she had relocated to another state. She returned pregnant again and an ultrasound was ordered to confirm her dates. When I initially reviewed the ultrasound report, I thought there had been a mistake. The ultrasound report’s findings indicated twins. However, I quickly discovered there had not been a mistake. The patient was pregnant with twins – again. She went on to have a successful delivery. Then there was the patient who had lost her daughter to undiagnosed heart failure at the age of four and was understandably anxious when she became pregnant again. She ultimately delivered a baby girl on her deceased daughter’s birthday. As an obstetrician, these experiences have made me both happy humbled.
“Life is not measured by the number of breaths we take, but by the moments that take our breath away.” The births of these twin sisters, Teepler and Ostler’s babies can certainly be counted as one of them.