September 10, 2012
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?
March 15, 2010
A blue-ribbon panel of physicians, midwives and other healthcare providers convened at the National Institute of Health to discuss the dilemma of vaginal birth after cesarean (VBAC). At the end of the three-day-conference, they issued a statement that read: “Given the available evidence, TOL (trial of labor) is a reasonable option for many pregnant women with a prior low transverse uterine incision.” Most obstetricians know that, however convincing the hospitals is another matter.
The vacillation of VBAC policies makes me dizzy. In the late eighties and early nineties there was a tremendous effort to promote VBACs and dispel the myth of “once a cesarean section, always a cesarean section.” I recall the days of my residency training when we would call hospitals in foreign countries in an attempt to document a uterine incision of a pregnant patient who had one previous cesarean section and had presented to our hospital in labor. To section or not to section, was the issue at hand. If a woman had a vertical uterine incision, then she must have a repeat cesarean section to avoid the possibility of rupturing the uterus. However, is she had a low transverse or horizontal incision, than ideally, she was a VBAC candidate, barring any other issues such as more than two cesarean sections, fibroid surgery (aka myomectomy) and other uterine procedures that are too complicated to mention.
I blissfully remember taking care of a patient with two previous c. sections who presented in labor at 8 centimeters. She ultimately had a successful VBAC and I was greatly relieved. I dreaded doing repeat c. sections. Fighting layers of scar tissue (adhesions) from previous surgery is not a pretty sight when you’re attempting to reach the uterus and deliver a healthy baby.
Today, most hospitals will not allow VBACs unless the physician remains in the hospital during the patient’s entire course of labor. Since most physicians refuse to do so, a patient is forced to have a repeat c. section. When you deny a woman’s freedom of choice, please be prepared for the consequences. VBAC activism is on the rise and I hope it continues to spread.
March 10, 2010
Electronic fetal monitoring was first used at Yale University in the 1950s and is a great asset in terms of checking fetal well being. Unless a woman delivers at home, most pregnant women will have fetal monitoring during the time that they’re in labor. The fetal monitor measures both the baby’s heart rate and the mother’s uterine contractions. Why is this important? Because the vein in the baby’s umbilical cord receives oxygen which is necessary for growth and development, especially in the brain. When the uterus contracts, the blood flow to the baby is reduced, then increases once the contraction is over. The fetal monitor essentially tells us two important things: (1) whether the baby is tolerating labor and (2) whether it’s receiving enough oxygen.
Of four million babies born in the US each year, approximately 875,000 will experience birth injuries. What is a birth injury? It’s any type of injury suffered by an infant as a result of the birthing process. Most birth injuries can be avoided if someone is paying attention. Babies can’t tell us when they’re in trouble with their mouths, but they can certainly do so with their hearts. The signs of normal and abnormal fetal heart tracings are included in The Smart Mother’s Guide to a Better Pregnancy. Fetal tracings are either reassuring (meaning good) or nonreassuring (not good). If the fetal tracing is nonreassuring, then the baby needs to be delivered as quickly as possible.
Despite our current healthcare challenges, babies will continue to be born. I therefore encourage all pregnant women, childbirth educators and doulas to take these bold new steps:
- Become familiar with fetal tracings and the distinction between reassuring and nonreassuring traces (pages 201 and 202 of The Smart Mothers Guide®)
- Doulas should become Labor Room Advocates who can be another set of eyes and ears that can address any issues during labor and make certain that appropriate communication of hospital staff (including the status of the fetal tracing) is known during a shift change
- Become familiar with a high-risk specialist who can offer a second opinion in case there is a disagreement regarding labor room management
When your baby’s fetal monitor attempts to “talk” to you, everyone should understand what it’s saying.