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?
August 13, 2012
Journalist Nicholas Bakalar of the New York Times wrote an article that addressed a profound issue regarding pregnancy: Does Fear Make Labor Longer?
Over 2,000 pregnant women in Norway were given a questionnaire at 32 weeks to determine if they had a fear of labor. These women were then followed to determine how long they were in labor and according to the study, there was a 47 minute difference in the length of labor of 165 women who feared childbirth compared to those who don’t. Why is this important? It’s important because fear is something that we can control.
Three of the most empowering things a pregnant woman can do are request a tour of the labor room before she has a baby, take childbirth classes and request pain meds or an epidural if she experiences pain while in labor. When a pregnant woman is calm, the unborn baby is calm but if she’s writhing in pain, the adrenaline that she’s producing affects the baby and inevitably causes fetal distress. Prolonged fetal distress means emergency c. section.
One of my most memorable deliveries was as an intern during the late ‘80’s. Recording artist Anita Baker was very popular back then. I was astounded when a very “Yuppy” expectant father, pulled out a tape cassette and played Baker’s tape while his wife was in labor. He requested dim lights and held his wife’s hand as they listened to my favorite song, Sweet Love. Although I respected their privacy, I was never far from their room. His wife ultimately had a beautiful, uncomplicated delivery that left an indelible impression.
No, everyone doesn’t have to listen to Anita Baker while they’re in labor but they should do what makes them comfortable including receiving an epidural or pain meds if necessary. You don’t have to be stoic. Here’s a quote from The Smart Mother’s Guide to a Better Pregnancy that I’d like to leave you with: “The Force that moves the air within our lungs, the blood within our veins, is the same force that has created the life within your womb. The most important key to a healthy pregnancy is the consciousness that lies within. Your child will be shaped by your thoughts, your dreams, your values, your energy. You are the ship that will carry the baby to the shores of its preordained human experience. Please let the journey be smooth.”
You are smarter, stronger and more brilliant than you could ever imagine. Childbirth should not be feared. It should be celebrated.
June 18, 2012
A few years ago, a 20-something year old pregnant woman presented to her physician with complaints of a skin bump that was red and painful. She was told it was a spider bit and given antibiotics. The patient ultimately went in labor but required an emergency cesarean which went well without any complications. Four days later she developed skin lesions and 3 months later she expired after a very stormy hospital course. What did she die of? MRSA, which stands for Methicillin Resistant Staph Aureus.
Staph Aureus (Staph) is a bacteria that can be found on the skin and doesn’t usually cause problems as long as there are no breaks or cuts in the skin. However, if there are cuts and Staph gains entry into the skin, an infection can develop that if often not serious. However, Staph has a very dangerous form that is resistant to the medications that will normally treat it. The resistant form of Staph can cause havoc if unrecognized which can lead to several complications including death. In fact, 20% of people who have (MRSA) dies from this infection because the diagnosis is made too late. One of the most common complaints patients have when there is a MRSA infection is a bump or red lesion on the skin that is misdiagnosed as a spider bite. How do you avoid the misdiagnosis? By knowing who is at risk and what to look for.
MRSA tends to be found in places where there are many people living close to each other such as nursing homes, but of late, several cases are also associated with
- People who are either in a prison or an athletic facility.
- Athletes who share towels or razors
People who either work in prisons or visit relatives or friends incarcerated should always wash their hands after a visit.
If you are given a diagnosis of a “spider bite,” request that it be cultured, meaning a Q-tip is used to take a sample from the bump. Sometimes people can have the infection without having any symptoms. This is known as being a “carrier.” Again, if you are given the diagnosis of having a spider bite, ask that a culture be obtained from inside of your nose to make certain you don’t have MRSA.
MRSA can be treated appropriately with the right antibiotics. Medicines that are associated with Penicillin such as Amoxicillin and cephaplosporins will not work.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
May 2, 2012
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.
April 25, 2012
Nebraska has recently been on the radar screen for their controversy regarding public funding of “illegal” pregnant immigrants. Although Nebraska’s governor vetoed the bill that allowed funding for prenatal care, the Nebraska legislatures had the good sense to switch the benefits to a state-funded program for children which would include the unborn babies. Should the unborn be penalized because of their mothers’ immigration status?
When the general public hears the word “illegal” associated with the word immigrant, they immediately think of people who are born south of the border. But if the truth be told, there are pregnant women who enter the U.S. as tourists every day, have their babies and then return to their country. Eighteen years from now, these “babies” will be U.S. citizens although their parents never paid taxes or contributed to Social Security. Is that “illegal?”
Money is usually the deciding factor regarding political policies and these policies affect the unborn. When I worked in public health in the pre-9/11 days, there was a wealthy couple from the Middle East who sought prenatal care. The wife was very advanced in her pregnancy and her jewelry was worth more than my month’s salary. My initial impression was “How on earth did an airline allow her to board a plane and travel half-way around the world?” The administrator spoke with me personally to make certain that I would “take care of the patient.”His concern had less to do with the well-being of her baby and more to do with the cash that her husband pulled out of his pocket to pay for her care. He peeled off $2500.00 in one-hundred dollar bills as if they were one-dollar denominations. He then asked how soon could they return to their country after the birth of their child and also mentioned that they were staying at the Ritz Carlton Hotel.
So, which is worse? A baby born to an “undocumented” immigrant whose husband is under the radar screen and working for minimum wage or a wealthy medical tourist who has a baby that will return 18 years later to claim their rights and privileges as an American citizen? I’ll let you be the judge.
April 23, 2012
The 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.
April 11, 2012
My oldest son brought home a cabbage seedling from school to enter in a contest. If his plant grew the largest, he would win a $1,000.00 scholarship. For the first 2 weeks he faithfully nurtured the plant but then his attention span decreased as basketball and track gained more prominence on his radar screen. His father felt sorry for the abandoned plant and sat it on top of soil in a larger pot so that it could receive some sunlight. The larger pot represented a burial ground of a deceased plant that had met its untimely demise due to unintended neglect.
A few weeks passed. We assumed the plant was dead. On a lazy Sunday afternoon a hint of spring was in the air as flowers blossomed. The sun shone brightly and my spouse stepped into the backyard to get some fresh air. A few minutes later, he beckoned my son to come outside in a voiced filled with excitement. The cabbage plant was miraculously resurrected. Although still confined to its original container it had somehow dug its way into the soil of the larger pot and was now firmly attached. It was thriving with large, thick green leaves and had a significant growth spurt. What a teachable moment. Ignoring the confines of its container, the cabbage plant sensed a window of opportunity in the form of fertile soil and literally – dug in. We cut away its first container to allow it to thrive even more.
Pregnant moms, a tree is known by the fruit that it bears. The seed within you has the potential to blossom into infinite possibilities if given the proper nourishment. When the challenges of life attempt to intimidate or discourage you be like the cabbage plant and ignore the external barriers. Deflect negativity. It cannot do you harm if you ignore it. Focus instead, on the potential within.
What can we learn from the cabbage plant? We learn that the will to live is far greater than any external challenge.
March 7, 2012
March 4 – 10 is Patient Safety Awareness Week, a subject near and dear to my heart. The subject reached the radar screen after a 1999 report from the Institute of Medicine (IOM) reported that over 100,000 people in the U.S. die each year from preventable medical mistakes. Many of these mistakes were due to medication errors, hospital infections and “systems errors” which is a polite way of saying the left hand didn’t know what the right hand was doing.
The Smart Mother’s Guide to a Better Pregnancy was written as a guide to improve pregnancy outcomes. I wanted to help women take home a healthy baby by avoiding all of the preventable mistakes that are regretfully made in labor rooms and clinics. No one wants to witness or be a victim of “mistakes” that could have been avoided if people were paying attention. Imperfection is a way of life yet in healthcare it is unforgiving.
As a result of the IOM’s report, hospitals and healthcare organizations have made patient safety a national and international priority. Checklists, medication bar codes and infection control committees have emerged in many hospitals, but patients must also get involved. The federal government has a started a campaign entitled “Questions Are the Answer” that encourages patients to ask their physicians or healthcare providers questions about their healthcare. Pregnant women over 35, African Americans and Medicaid recipients face the greatest risk for medical mistakes and complications. However, there are things one can do to minimize risks.
- If your blood type is Rh Negative, make sure you are given all test results, including an antibody screen
- Ask what your vital signs are at each prenatal visit to rule out high blood pressure
- Ask for a high-risk consult with a specialist if you have diabetes, high blood pressure or asthma
- Pay attention to fetal movement
- Ask about all lab results, especially your diabetes test
- Ask whether your midwife or obstetrician knows how to manage a shoulder dystocia
- If you’re hospitalized for pre-eclampsia and someone wants to send you home before having your baby, ask for a second opinion, preferably with a high risk physician
Please be pro-active regarding your prenatal care. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
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 29, 2012
The State of Wisconsin is being challenged on their policy of requiring unmarried pregnant women to identify the father of the baby in order to receive Medicaid benefits. Once the alleged fathers are identified, the State of Wisconsin requires them to pay for the birth costs. But here’s the controversy: Wisconsin collected $19 million dollars in 2010 which is the most money earned among the 10 states that use this policy.
ABC for Health, a nonprofit Wisconsin law firm is challenging that policy stating that the longstanding practice could contribute to the state’s high black infant mortality rate. Why? Because, according to ABC, having to identify the father “may discourage unmarried pregnant mothers from getting timely prenatal care services.” The State of Wisconsin encourages collection agencies to be aggressive because it keeps 15 percent of the money.
While the altruism of ABC is admirable, its logic is completely off-base. Based on my 25 years of clinical experience working with Medicaid patients, I can assure you that late prenatal care is not based on fear of repercussions for identifying paternity. A delay in obtaining prenatal care for most women involves waiting for their insurance benefits to begin. Or not wanting to take time off from work to keep prenatal appointments. Or using poor judgment and waiting until the last possible minute to show up for prenatal care because they didn’t have any significant problems with their previous pregnancy. Please do not use infant mortality as an excuse to keep fathers for assuming their financial responsibilities. It’s like comparing apples with oranges. While it’s unfortunate that the State of Wisconsin receives what could only be described as a “commission” for obtaining payments from expectant dads, those payments provide necessary funds to a cash-strapped state funded program. Conversely, the State of Wisconsin should not abuse the system by committing extortion.
If a woman is reluctant to divulge the name of the father of her baby, please don’t eliminate her Medicaid benefit. Dig deeper and find out why.