Archive for the ‘Birth Injuries’ Category

Simulation Labs: Helping Teach Nurses in Baltimore

Tuesday, September 27th, 2011

From nursing.jhu.edu

Any one who has ever had a hospital stay or knows a loved one or friend who has been in the hospital knows that the nurses play a vital role in caring for patients. Nurses do many of the day-to-day activities of caring for patients in hospitals and clinics. They are also often the first ones at the bedside if a problem arises – so -isn’t it essential that nurses be well trained in all forms of emergency procedures? Even when doctors are present, nurses often play vital roles in assisting the doctors in providing life-saving care to patients.

Law and Medicine Intersect Once Again

I have recently been working on a case in which both doctors and nurses were present during an in-hospital delivery that ended with a significant injury to the child. During the delivery, a problem was encountered that has a low incidence rate during deliveries.  In considering this problem, I wondered just how frequently doctors and nurses are able to practice the skills they would need to successfully and calmly deliver a baby in a situation like this.  Faced with this “emergency” situation, how many of the doctors and nurses in the room had not experienced this problem before? For those who had –  just how much “experience” did they bring to the problem they were facing?

Simulations Rooms and Simulation Patients Provide Training Opportunities

Thankfully, technology is making it more feasible for training healthcare providers to practice handling a myriad of clinical situations during their education process that they might otherwise not experience frequently enough for their skills to develop in real world settings. In Baltimore, the Johns Hopkins University School of Nursing (JHUSON) has simulation rooms in which nursing students are able to practice a variety of procedures and techniques using simulation patients in rooms that are designed to replicate the real patient areas of the hospital. There is also a whole family of simulators to help. This “sim fam” is not like the lifeless plastic dummies you might be imagining. They are a variety of different types of “…life-like practice manikins, including Sim Man, Vital Sim Man, Noelle with newborn, and Sim Baby [that] give nursing students the hands-on experience without the anxiety of working with actual human beings.”

Harvey the Cardiac Sim, SimNewB and Sim Man 3G  - All New Additions to the “Sim Fam”

From nursing.jhu.edu

Just this year, in March, JHUSON added Harvey to its collection of simulators.  While Harvey is new to JHUSON, he is not exactly new technology:

For almost 40 years Harvey, developed in cooperation between Laerdal Medical Corporation and Miami University Miller School of Medicine, has been a proven simulation system teaching bedside cardiac assessment skills that transfer to real patients, and remains the longest continuous university-based simulation project in medical education.

Harvey’s job is to be able to simulate “nearly any cardiac disease at the touch of a button: varying blood pressure, pulses, heart sounds, and murmurs. The software installed in the simulator allows users to track history, bedside findings, lab data, medical and surgical treatment.”  He joins a collection of other sim patients that enable healthcare providers to learn and practice critical life-saving measures such as CPR, defibrillation, intubation and yes – even the proper checking of vital signs. JHSON has adult, child and baby versions of these simulators. Some of them can even “talk” to the practicing nurses. (I wonder if they are programmed to be cooperative and informative or hostile and combative – hmmm.)

New Family Members Arrived this Past August

Even newer, in August, JHUSON added SimNewB and Sim Man 3G to the family. The SimNewB is:

…a 7 pound, 21 inch female baby, with realistic newborn traits. Students will be able to simulate a wide variety of patient conditions with her, including life-threatening ones. The department’s current Sim baby is the size of a 6 month old and is not as conducive to delivery room procedures.

She is also interactive, though she is not wireless like the Sim Man 3G. Some of the new Sim Man’s traits include “…breath sounds both anteriorly and posteriorly, … pupil reactions, [and] skin temperature changes.”

What about Obstetrics Cases?

So, what about the case I was mentioning that involved obstetrical care? Well, JHUSON also has a pregnant simulator, which is can be used to practice a whole host of obstetrically related procedures. These include “Leopold maneuvers, normal vaginal and instrumented delivery, breech delivery, C-section, and postpartum hemorrhaging, among other functions.” The JHUSON sim family also has the new Sim newborn – SimNewB.

The “Jury” Is Still “Out”

Can there be any doubt that additional hands-on practice opportunities with simulators is a good idea for situations that may not come up very often in everyday practice? Won’t it help healthcare practitioners gain skills and keep those skills up-to-date? Any opinion I might have on these issues is not based on evidence….yet. Luckily, JHSON is “…among 10 nursing schools nationwide collaborating on a landmark study to find out just how well patient simulators—high-tech manikins that respond to a nurse’s care—help prepare the nurses of tomorrow.”  I – for one – will certainly be interested in the outcome of that study.

What about you? Do you think that it makes sense for nurses in training to make use of simulation rooms and simulated patients? Would it be better for them to spend more time in real world situations doing real patient care under the supervision of experienced practitioners? What about techniques that might not come up very often?

If any of the readers of this post have used these sim patients in your training and can give us firsthand information as to how, if at all, it carried-over to make you more “experienced and skilled” when facing similar clinical situations with real patients, your comments would be most welcomed as well.

Autism and Wandering – a constant struggle

Wednesday, August 3rd, 2011

I have written before in this space about special needs children, including children with autism. This week I want to turn my attention to one aspect of autism – wandering – and some of the ways parents and schools are trying to keep kids safe. Wandering is something I really had not heard of before, but I’ve since learned that it is a serious danger to children with autism or other cognitive deficits. It is also a major source of stress to parents who are constantly worried about their child wandering off.

All children have a tendency to wander away from their parents at times. When my daughter was two, I lost her at Sports Authority. I thought she was standing right next to me while I was looking at something, then I looked down and she was gone. After a few frantic minutes – and with the quick help of the store employees – we found her all the way on the opposite side of the store looking at balls. She was perfectly fine, but it was terrifying for me.

For reasons that are not well understood, children with Autism Spectrum Disorder (ASD) tend to wander more than non-autistic children. As reported by the Child Mind Institute and others, a recent study by the Interactive Autism Network has finally tried to quantify what has traditionally been more anecdotal evidence about wandering.

According to the responses from more than 800 parents, roughly 50 percent of children between the ages of 4 and 10 with an ASD wander at some point, four times more than their unaffected siblings. The behavior peaks at 4, almost four times higher than their unaffected siblings, but almost 30 percent of kids with an ASD between the ages of 7 and 10 are still eloping, eight times more than their unaffected brothers and sisters.

Autistic children seem to wander for two basic reasons. One is to find something they like, such as their favorite pond or playground; and one is to get away from something they don’t like such as a stressful school environment. It’s not really running away, at least as that term is usually used to describe a child who decides to leave home because of some real or perceived injustice at home. A majority of parents in the study described their child as happy and focused when they wandered off. It is usually a matter of the child being drawn to something that he or she likes. One child referenced in the Child Mind story had a fascination with exit signs. One day at school, the boy wandered off through the woods toward the highway to find his favorite exit sign. Thankfully, a good Samaritan picked-up the boy and returned him to where he belonged.

The danger for children is very real. While concrete statistics are difficult to come by, drowning seems to be the biggest danger (there are some who believe that autistic children are drawn to water). Children can also wander into traffic. Of course, when any small child wanders alone there is the risk of getting lost or being abducted. To further complicate matters, thirty-five percent of families in the study reported that their child is never or rarely able to communicate basic identifying information such as name, address and phone number. This obviously makes it harder for a wandering child to get back home. Even older or more high-functioning children may – due to their social anxiety – be reluctant to seek out help or cooperate with someone who is trying to intervene.

Wandering represents a challenge to schools because it can be very difficult to monitor a child all day long, especially during class changes and recess. The problem, however, also occurs at home. Wandering occurs not just during the day; night-time wandering is an especially big fear for parents of autistic children. Some children have been known to get up in the middle of the night, undo the deadbolt on the front door, and walk-off into the night. The terror of finding your child gone in the middle of the night is unimaginable. Some parents have installed deadbolts higher up on the doors, some have installed alarms that go off if the door is opened. Some parents have gone so far as to have their children wear tracking devices that send out a signal that can be pin-pointed. While all of these techniques can help, there are no sure-fire methods of preventing wandering. It is a constant worry for parents.

The autism community has taken action by getting the Center for Disease Control’s safety subcommittee to assign a specific medical code for wandering, which will be in conjunction with the diagnosis of ASD. By doing this, it is hoped that doctors will more readily recognize wandering as a legitimate diagnosis that they can address with the parents or other caregivers (the new code applies to adults with ASD as well). The American Academy of Pediatrics is also preparing a fact sheet to educate doctors on the topic so that they can better work with parents to try to reduce the incidence of wandering. The new code may also make it easier for parents to seek reimbursement from their insurance companies for alarms and tracking devices, and it may make it easier for parents to argue to their schools that a one-on-one monitor is needed as part of the child’s Individualized Education Plan (IEP). The new code takes effect in October 2011.

Lori McIlwain, Chairwoman of the National Autism Association, recently discussed how to deal with wandering:

The best overall strategy is a multi-tiered approach, which includes educating the child about safety and dangers using whatever means of communication works, including social stories, language and/or visual prompts. It’s also important that caregivers—and schools—work to understand what is causing, or contributing to, the wandering or bolting behaviors so that any triggers may be addressed or eliminated.

Have any of our readers had any experience with wandering? I’d like to hear your stories as to how you deal with it and how it affects your life.

Related Nash and Associates Links:

Dogs a Huge Help to Special Needs Kids

The Daily Struggle of Raising a Disabled Child

Many Parents Still Believe Vaccines Cause Autism

 

 

Photo courtesy of: Issueswithautism.com

Service dogs in school — a fresh look

Friday, July 22nd, 2011
Service Dog and Boy

service dogs

A while back I wrote a piece on the topic of service dogs for kids and mentioned the use of service dogs in schools. A regular reader of our blog then wrote in with a number of comments and questions about the propriety of dogs in schools. To help answer her questions, I recently spoke with Nancy Fierer, who is the Director at Susquehanna Service Dogs in Harrisburg, Pennsylvania, which is an organization that trains and places service dogs. Susquehanna is the organization that placed two of the dogs mentioned in this NPR story.

The ADA and dogs in school

I also did a little more research on the Americans with Disabilities Act (“ADA”) and its impact on the issue. The ADA requires that all public facilities allow a disabled person and his or her service dog (not pets) to enter the premises just the same as a non-disabled person. So is a school considered a public facility? It’s an interesting question. On the one hand it is accessible to the public in the sense that parents and students can freely enter a school. However, if you’re not the parent of a child at the school, can you just walk into a school and roam the halls like you might roam around a mall? I think if you tried that, you would get stopped pretty quickly and asked to leave if you had no valid business there. However, the law appears to be settled that schools are considered public facilities at least for those areas that are open to the public such as administrative offices, gymnasiums during sporting events, and auditoriums during public events. Therefore, schools must be accessible to service dogs in these public areas. For class rooms, however, it’s not so clear. While the law appears to favor allowing service dogs in class rooms, it is being decided on a case-by-case basis because there are other considerations as well – the age of the child, the disability at issue, the ability to control the dog, etc.

How much school assistance is necessary?

I have to admit that when I first wrote on this topic, I had envisioned that the dog and child were a self-contained unit that required little in the way of adult assistance. Ms. Fierer indicated that that is usually not the case. Depending on the age of the child and the level of disability, the child may be able to care for the dog independently. However, in most instances an adult (teacher’s aide or nurse perhaps) is required to pitch in with help giving the dog water and taking it out for bathroom breaks. Ms. Fierer indicated that the dog does need water breaks during the day (feeding can be done at home before and after school). This is usually accomplished by keeping a water bowl in a nearby room – perhaps a nurse’s office or a counselor’s office. Several times a day, either the child (if he/she is old enough) or an adult can take the dog for a drink. The same is true for bathroom breaks (pee only; No. 2 is usually taken care of at home). Again, service dogs do require assistance from the school but from what Ms. Fierer told me, the disruption is fairly minimal and can be worked out with proper planning.

Controlling a service dog

A larger issue is the child’s ability to control the dog. Even though service dogs are highly trained, the owner (in this case a child) must still be able to control the dog before being permitted to take a dog into school. These include such basic commands as making the dog sit, stay, come, leave it, and walk on loose leash. These are some of the common commands that all service dogs must know. In addition, a service dog also receives additional training in a particular disability and learns specific commands unique to that disability, e.g., retrieving specific items, pulling a wheelchair, responding to seizures, search and rescue. These commands must be mastered as well. For example, if an autistic child is in need of the dog to put its head in the child’s lap to help calm him/her down, the child (or a trained adult) has to be able to give the dog that command. If the child cannot give that command to the dog, then it undermines the usefulness of the dog in school.

Because of the demands that service dogs place on the child, very young children usually do not take dogs to school unescorted. Ms. Fierer said she would be surprised to see a six-year-old, for example, taking a dog to school alone. Older children can, with proper training, be permitted to take a dog to school alone. To ensure that the child is capable of caring for the dog, Susquehanna utilizes the Assistance Dogs International Public Access Test. This test requires the owner and the dog to perform multiple tests in a variety of settings to ensure that the dog is well-trained and that the owner can properly control the dog. For children, Ms. Fierer indicated that the testing is usually administered with the parent and child because she uses the team approach – the parent, child and dog are a team. For a child taking the dog to school, however, the parent is usually not there so the child must be able to control the dog independently. Only when a child is adept at controlling the dog should the child be permitted to take the dog to school. Even then, parents have to work closely with the child’s teacher and other school staff to coordinate the details of how the dog will be cared for.

Other concerns

Our reader also asked questions about whether service dogs are a distraction in school and whether they can pose a danger to other children. After talking to Ms. Fierer, it’s my opinion that these are not major concerns. As for being a distraction, Ms. Fierer said that is usually not the case. Service dogs are generally introduced into the school gradually, starting with maybe a half-hour per day and building from there. The children get accustomed to the dog and the novelty soon wears off. Also, the other children need to be educated that this is a service dog and not a pet to be played with. Children can easily learn this lesson. As for being a danger to other children, Ms. Fierer said she has never heard of a dangerous incident happening at school such as a dog biting a child. These dogs are amazingly well-trained and the trainers allow zero tolerance for aggressive behavior. If a dog shows any aggression, that dog does not make the cut for being a service dog. Therefore, I don’t believe this concern is a valid reason for denying a child a service dog.

Training a service dog

In terms of the actual training given to the dogs, Ms. Fierer said that when a puppy is eight weeks old, it starts living with a dedicated puppy handler who is responsible for teaching the dog basic manners.  This time includes classes at Susquehanna twice per month.  This arrangement goes on till the dog is 18 months old, at which time the dog receives about six months of intense training.  About 50-60 percent of training is the same for all service dogs. The rest is devoted to the unique needs of each disability. Before a dog is placed, Susquehanna spends about 2 and ½ weeks training the family that is receiving the dog. Even after placement, Susquehanna continues to do follow-up training – at first on a weekly basis and then gradually declining over the next six months. It even does annual re-testing.

I hope this follow-up addresses our readers’ concerns. Ms. Fierer emphasized that service dogs are not the solution for every child. Susquehanna actually does therapy sessions with families before even agreeing to place a dog to ensure that the dog and the family are a good fit. She indicated that it is a big responsibility to own a service dog and it is not a decision that is made lightly by the dog trainers. However, for the right child and the right family, a service dog can be an amazing asset.

Related Nash and Associates Links:

Service Dogs for Kids

 

photo from servicedogtraining.wordpress.com

 

 

 

 

 

 

 

 

 

 

 

Dealing with Cerebral Palsy: A Resource for Parents and Family (Part III)

Wednesday, June 22nd, 2011

In Part I of this series I provided a basic introduction to dealing with cerebral palsy.  I also provided Maryland parents with a comprehensive list of places that are able to assist parents.  In Part II I discussed educating children with cerebral palsy and provided a list of places to turn if you need help.  Today we will take a look at some of the medical treatments available for cerebral palsy.

Medical Treatment

Cerebral Palsy cannot be cured, but treatment can often improve a child’s capabilities. Progress due to medical research means that many patients can enjoy near-normal lives if their neurological problems are properly managed. There is no standard therapy that works for all patients; the physician must work with a team of other health care professionals to identify a child’s unique needs and impairments.  Typically, an individual treatment plan is created to addresses them.  As a general rule, the earlier diagnosis and treatment begins, the better chance a child has of overcoming developmental disabilities or learning new ways to accomplish difficult tasks.  The goal of treatment is to help the person be as independent as possible.

Treatment requires a team approach, including:

  • Primary care doctor
  • Dentist (dental check-ups are recommended around every 6 months)
  • Social worker
  • Nurses
  • Occupational, physical, and speech therapists
  • Other specialists, including a neurologist, rehabilitation physician, pulmonologist, and gastroenterologist

Treatment is based on the person’s symptoms and the need to prevent complications.  Self and home care include:

  • Getting enough food and nutrition
  • Keeping the home safe
  • Performing exercises recommended by the health care providers
  • Practicing proper bowel care (stool softeners, fluids, fiber, laxatives, regular bowel habits)
  • Protecting the joints from injury

Putting the child in regular schools is recommended, unless physical disabilities or mental development makes this impossible. Special education or schooling may help.

The following may help with communication and learning:

  • Glasses
  • Hearing aids
  • Muscle and bone braces
  • Walking aids
  • Wheelchairs

Physical therapy, occupational therapy, orthopedic help, or other treatments may also be needed to help with daily activities and care.

Medications may include:

  • Anticonvulsants to prevent or reduce the frequency of seizures
  • Botulinum toxin to help with spasticity and drooling
  • Muscle relaxants (baclofen) to reduce tremors and spasticity

Surgery may be needed in some cases to:

  • Control gastroesophageal reflux
  • Cut certain nerves from the spinal cord to help with pain and spasticity
  • Place feeding tubes
  • Release joint contractures

What is important, however, is that an individualized approach be taken for your child.

Query:  Does your child have cerebral palsy?  What medical treatments are you providing for your child?

 

 

Credits to http://www.nlm.nih.gov; www.nsnn.com

How Do I Choose A Lawyer? A Helpful Guide

Monday, June 20th, 2011

One of the most important things you can do if you are considering a lawsuit is to spend time doing a proper search for the lawyer, who will be handling your case.

Just because a law firm or a lawyer has a fancy webpage or an eye-catching ad in your local phone directory or even a professional looking TV commercial does not mean that this lawyer has a clue what he/she is doing in the specialized areas of medical malpractice or catastrophic personal injury.

We invite you to read and consider the issues and questions raised in our White Paper – “How to Choose a Lawyer.”

If you have other ideas or questions that you believe would be helpful to our readers in their search for a lawyer, post your reply on this topic so others may benefit by your insights.

 

Image courtesy of www.quadtechint.com

 

The death of a baby – the economic realities

Monday, June 6th, 2011

I recently wrote a blog about the grief that parents suffer when they lose an unborn child. At the risk of sounding crass, I want to now discuss the economics of lawsuits involving the death of an unborn child. For those contemplating taking legal action for the loss of their child, I hope this provides some useful information for you to consider.

Maryland courts have carved out specific rules for when an unborn child is considered a person capable of recovering damages in the event of death. The primary rule is that if a baby is actually born alive, no matter at what gestational age, that baby is considered a person with legal rights. So, if a 20-week baby is born alive and then dies one minute later, that baby is considered a “person,” and a lawsuit can be filed on behalf of the estate for that baby’s pain and suffering, otherwise known as a Survival Action.

(This leads to an interesting question – does a fetus feel pain? See Related Links below). The parents of the unborn child can also file what is known as a Wrongful Death action for their own economic and non-economic damages resulting from the death of their baby, primarily their grief and emotional loss over the death of their child. Survival actions and Wrongful Death actions are two separate claims, although they are usually pursued in the same lawsuit.

When a baby dies before birth, however, another question has to be asked: was the baby viable or not? Viability means that a baby is able to live outside the womb, even though he or she may require serious medical intervention. The current thinking is that babies are viable at around 22 weeks. The courts have made the rule that if an unborn child dies before the age of viability, that baby is not yet a “person” and has no legal rights. There can be no Survival Action and there can be no Wrongful Death action. If, however, the baby has reached the age of viability, then the baby is considered “a person” with legal rights, even if the baby was never born alive. Confusing? Yes it is.

The Maryland Courts were following the ruling in Roe v. Wade that a mother had a constitutional right to abort a non-viable baby. Therefore, a non-viable baby was not legally considered a person. If the baby was not a person, then no lawsuit could be filed on behalf of the estate of that baby, nor could the parents file a wrongful death action. So in order for a Survival Action or a Wrongful Death action to lie for an unborn baby, that baby has to have reached at least 22 weeks of gestation.

To make things even more confusing, the Maryland courts have carved out an exception to the above rules. Let’s consider the example of a non-viable baby (i.e., less than 22 weeks gestation) who dies before birth as a result of someone else’s negligence that injures the mother.

A common situation occurs when the mother (let’s say she’s 8 weeks pregnant) is injured in a car accident and suffers a miscarriage as a result. Looking at the above rules, one would think that no claim is allowed. However, the courts have said not so fast. In this circumstance, while the mother cannot recover for the grief of losing her child (because the child is non-viable and, therefore, not legally a person), she can recover for similar damages, including:

  • The depression, anguish, and grief caused by the termination of the pregnancy;
  • The manner in which the pregnancy was terminated;
  • Having to carry a baby which was killed by someone else’s tortious conduct; and
  • Having to witness the stillborn child or the fetal tissue that was to be her child.

I realize this itemization of damages sounds awfully close to the damages permitted in a Wrongful Death action – the very damages that are not allowed in the case of a non-viable baby. It is confusing, to say the least. The courts are trying to find a way to compensate a woman who is injured and loses her non-viable baby as a result of someone else’s negligence, while remaining true to prior precedent in this state that there is no Wrongful Death action allowed in the case of a non-viable baby.

Lastly, keep in mind that Maryland’s cap on non-economic damages applies to cases involving the death of an unborn baby. Economic damages (medical bills, lost wages) are usually very small in such cases. There are no lost wages because we’re talking about a baby, and the medical bills are usually small.

The value of these cases is in the emotional pain and suffering of the parents, and the physical pain and suffering of the baby (assuming a viable baby). Under Maryland law, the maximum allowable recovery for such a claim is $868,750 in a medical negligence action (assuming Mom and Dad both file a wrongful death action).

Under the hypothetical of the mother seeking recovery for the loss of a non-viable baby, the maximum allowable recovery is $695,000 if the allegation is medical negligence, and $755,000 if the allegation is non-medical negligence. (The Maryland Legislature has for some strange reason imposed different caps depending on whether the negligence is medical or non-medical, e.g., a car accident).

As for the question of whether an unborn child feels pain, please click on the link below for a blog by Brian Nash on this very issue.

Related Nash and Associates Links

Does a fetus feel pain

Hysteria over malpractice “crisis”

 

 

 

Home Births – Increasingly Popular But Are They Safe?

Saturday, June 4th, 2011

image from hobomama.com

Many little girls grow up fantasizing about what they want to be when they grow up; perhaps they want to be the President, or an artist, or a doctor, or an architect. Others might be daydreaming about being a princess or an astronaut. However, I do not know of many little girls who grow up dreaming about how they would like to bring a child into this world. Yet once these girls grow up into adults, many of them feel strongly about having a birth plan that is just as magical as all of their other dreams. Images of a comfortable labor or a display of womanly strength may play a role; perhaps they want music or a particular image available to them. Some want as few interventions as possible, while others would prefer an epidural at the hospital door. No matter what vision of childbirth a woman has, the desired end result is almost universally a healthy child.

Home Birth Rates Decreasing for Years…Now Dramatically Increase

It is no wonder that women often have strong feelings about what they want for their birth experience and how to best accomplish their goals. Historically, women gave birth at home. That practice changed and by the early 1950s, almost all women in the United States gave birth in a hospital setting. According to an NPR article about a recent study published in Birth: Issues in Perinatal Care, “the percentage of home births in the U.S. had been dropping slowly but steadily every year” from 1989 to 2004. Surprisingly, the trends reversed dramatically in the four-year period between 2004 and 2008. The study found a 20 percent increase in the number of women in the United States who gave birth at home between 2004 and 2008. Despite this increase, we are still talking about a small percentage of total births – less than 1 percent.

Increase is Mostly in Non-Hispanic White Women

A twenty percent increase is still a very large amount in a 4-year period. I was interested in the implications of this change. First, one of the most surprising (to me) findings in the study was that the change was not seen across the board. The article explained that “[m]ost of the rise was due to an increase in home births among non-Hispanic white women.” A New York Times article said that:

[t]he turnabout was driven by an increase of 28 percent in home births among non-Hispanic white women, for whom one in 100 births occurred at home in 2008. That rate was three to six times higher than for any other race or ethnic group.

I did not find any explanation or hypothesis for why this particular segment of the population was increasingly choosing home births over hospital births. Though the study does suggest that it was a change by choice as the article explained that “[r]esearchers found among the 25 states that tracked planning status in 2008, 87 percent of births that occurred at home were planned.”

Are Home Births Advisable? Are they Safe?

So, is the increase in home births a good thing? Certainly, I support a woman being comfortable and happy in her choice for a birth plan. I have given birth twice and know that it can be both one of the more uncomfortable and simultaneously one of the most overwhelmingly joyous moments of a woman’s life. A home birth affords a mother a setting that is likely more comfortable and certainly more familiar than most hospitals. And yet, as I mentioned earlier, women really just want a healthy outcome for both them and their baby. Can a home birth accomplish this goal?

Most of the medical community, certainly most associated with hospitals, say that home births are not the safest option for babies; however, neither are all hospital births.

Leading members of the medical community respond that hospitals — where 99 percent of all U.S. births take place, according to the CDC — are the safest places to have a baby, with modern medical interventions available.

The newborn death rate is two to three times higher for planned home births than for those that take place in hospitals, said George Macones, chairman of the committee on obstetrical practice at the American College of Obstetricians and Gynecologists, which has long opposed home births. Some home-birth advocates say such studies are flawed.

“There’s no question that if you come to a hospital, there’s a one in three chance you end up with a C-section, and it’s certainly true that some of them aren’t medically indicated,” Macones said. But at home, where there is less monitoring of the baby, there is more chance of a bad outcome, he said. “Obstetrics can be a risky business. Things can go wrong.”

From a Washington Post article

Home births, even those attended by a certified nurse midwife, do not provide the medical technology and care that can be present at in a hospital setting. Perhaps this is what many women may be trying to escape when choosing to give birth at home. I know that normally I would rather stay out of a hospital at all costs since hospitals may raise the risks associated with medical interventions and infections. Additionally, the high C-section rate at hospitals may also subject women to unnecessary risks. This is one of the concerns mentioned in the New York Times article:

Other research has suggested many women choose home birth because of concern about high rates of Caesarean sections and other interventions at hospitals, said the new study’s lead author, Marian F. MacDorman, a statistician with the National Center for Health Statistics. “The two trends are not unrelated,” Dr. MacDorman said.

Additionally, the NPR article reports that the new study published in Birth: Issues in Perinatal Care found that birth outcomes are improving for babies born at home:

Researchers … found a statistically significant improvement in birth outcomes for babies born in the home. Infants who were born preterm fell by 16 percent. The percentage of home births that resulted in infants with a low birth weight also fell by 17 percent…One reason for the better outcomes could be that more women are planning to give birth at home. Researchers found among the 25 states that tracked planning status in 2008, 87 percent of births that occurred at home were planned. MacDorman also suggested that midwives could be getting better at choosing low-risk women to be candidates for home birth.

Are Birth Outcomes at Home Improving Because Lower Risk Mothers Are Delivering at Home?

Now this idea is one that resonated with me. Perhaps the key to the safety of home births is which women are giving birth at home. I remembered reading a story in the Washington Post a couple of weeks ago about a local midwife who was convicted in a baby’s death. What stuck with me about this tragic story was that the mother did not seem (at least to me) to be a good candidate for a home birth. A couple of small paragraphs late in the article explain:

It was a case most obstetricians would call high-risk: The first-time mother in Alexandria was 43, and the baby was breech, which essentially means upside-down from the normal head-first position.

The baby’s position wasn’t the problem, Carr said; the problem was that the baby’s head became stuck.

Two women who supported the mother during the September delivery said in interviews that both Carr and the mother knew the risks involved in such a delivery. They both said everything was going well, until it wasn’t.

This sounds like a horrible accident that could have happened even with the best of intentions. However, another Washington Post article explained the details surrounding how the midwife, Karen Carr, came to be working with this mother:

[Law enforcement officials] said Carr was unlicensed in Virginia, agreed to perform a high-risk breech delivery in a woman’s home after other care providers refused, and ignored warning signs that the delivery was not going well.

Ultimately, prosecutors said, Carr allowed the baby to remain with his head stuck in the birth canal for 20 minutes and then, after delivery, tried to resuscitate him for 13 minutes before calling for emergency medical help. The boy never gained consciousness or displayed brain activity, and he died two days later at Children’s National Medical Center in the District when life support was removed.

The parents sought out Carr in August after nurses at a licensed birthing center in Alexandria said they could not deliver at home because of the fetus’s position in the womb; breech births are most often delivered by Caesarean section because the risk of complications from a breech delivery — in which the baby is positioned feet-first — are high, according to medical officials.

Carr agreed to do a home delivery and, prosecutors said, declined to call for help when things got out of control. A medical examiner ruled that the death was due to complications from a breech birth at home.

While the midwife might have been performing outside the standard of care, my question in reading these articles is whether it is reasonable for a midwife to agree to a home delivery for a high risk mother, who is of advanced maternal age, whose child is breech, and who has already been turned down for delivery by a licensed birthing center based on the risks. It seems to me that the midwife and the family were taking a grave risk with this child’s life – a risk that the parents must have at least somewhat acknowledged since they sought out the home birth after being turned away by the birthing center. To what degree is it the midwife’s responsibility to assist a woman who insists on a home birth despite the risks? To what degree is it her responsibility to refuse to participate if the risks to the child are unacceptably high?

Does Insurance Matter?

Finally, I wonder what role insurance will play in the increasing number of mothers choosing to give birth at home. Vermont’s governor just signed a bill into law that will require private health insurance companies to pay for midwives during home births.  According to the Forbes article about the new bill, Vermont joins New York, New Hampshire and New Mexico in this requirement. Vermont’s rate of home birth is the highest in the country at 3 percent. The bill is expected to lower costs for low-risk births for women who choose to birth at home. I wonder, however, whether the choice to have a home birth that is reimbursed by insurance will open the door to additional mothers choosing to birth at home even if the risks are high.

What Do You Think?

At the end of the day, it seems that home births may be a good option for some low-risk women who have the support of a well trained midwife and accessible medical back-up in case of problems. That being said, for those at higher risk, perhaps there need to be other safeguards in place.

What do you think? Are you or have you been involved in home births? How are woman normally empowered to have the birth they want if they are high risk? What can be done to make the choice safer for the baby?

Related Posts:

The Grief of Losing an Unborn Child

Laughing Gas Making Its Way Back into the Labor and Delivery Department

The Grief of Losing an Unborn Child

Wednesday, June 1st, 2011

Image from HopeforParents.org

Fetal Death In Utero. It sounds so clinical, so devoid of meaning. Maybe that is by design. Medical terms have a way of masking the real human suffering that is being described.

Adenocarcinoma instead of cancer. Cerebral hemorrhage instead of stroke…and “fetal death in utero” instead of “losing an unborn child.” The medical terms are necessary, but they don’t capture the essence of the diagnosis. As one woman told me, “I didn’t lose my fetus. I lost my baby.”

For any parent, the loss of a child is the most agonizing experience imaginable. As the father of two, I can’t even imagine being told that your child has died. I can’t imagine the life-long grief that follows. I almost decided not to write about this topic for that very reason – I didn’t know the pain of losing a child so who was I to write on it? But other times I’ve waded into topics despite a lack of personal involvement because the issue has touched those whom I care about. For example, I’m not a parent of a special needs child, but I’ve written on that topic because I am close to people who are raising special needs children. Their experiences deserve to be shared.  The same is true here.

For parents who have lost an unborn child, the sense of grief is no different than if the child had been born and then died. Unfortunately, our society seems less sympathetic to the loss because there is no infant that we have seen and gotten to know. We all recognize the agony of losing an older child. Even if we haven’t experienced it ourselves, we can at least try to understand how sickeningly awful it must be. We can then offer our support and love and condolences to those who have experienced it. With an unborn child, however, it’s different. We have a tendency to minimize the grief associated with losing an unborn child, as if the fact that the child wasn’t yet born makes him or her less real. Even medical providers are guilty of this. I’ve had women tell me that their doctors tend to treat miscarriage or stillbirth as a medical condition, not the loss of a loved one. For the parents of such children, however, the loss is deep and real and long-lasting.

Donnica Moore, M.D., an Ob/Gyn and the author of a book entitled “Women’s Health for Life,” summed it up well when interviewed by the New York Times:

Couples can feel there’s no socially accepted way to grieve. If you lose a family member, people know how to do that, they know how to support you and grieve with you. But this is new territory for a lot of us. It’s a tragedy for people who have gone through it that might not be on the radar of people who have not.

I’ve recently had the pleasure (strange word, I know, given the circumstances) of representing two wonderful families who lost children. One couple lost their 9-year-old son who died of a correctible heart condition that his pediatrician failed to detect, and the other couple lost their unborn daughter when the mother was 37 weeks pregnant after being sent home from the hospital where she had gone complaining of decreased fetal movement. It’s easy to see the grief for the first couple. One day they have a little boy going to school, playing, doing homework, and the next day he’s gone. With the second couple, it’s harder to see the grief, but it’s there. I’ll share their story briefly.

This was the first child for Michelle (not her real name) and her husband. They had already decorated the nursery and picked out a name. One evening (believe it or not, Michelle had just attended a baby shower earlier in the day) she felt that the baby wasn’t moving as much as usual and called her doctor’s office. They told her to go to the hospital, which she did. At the hospital, she and her baby were evaluated and told that everything was OK. She was told to go home and keep her regularly scheduled appointment the next day. When she went to her doctor the next morning, however, the doctor could not find a heartbeat. Her daughter, unfortunately, was gone. To make things even worse, Michelle then had to carry her deceased daughter inside her for another full day before she gave birth.

Michelle did her best to move on with her life. She continued to work. She and her husband had another child. But for the entire time I represented her (to its credit, the hospital approached us about resolving the case early on) there was not a single time I talked to her that she did not start to cry in discussing her first baby – the daughter who should now be three years old. She still grieves for the loss of her daughter, wonders why it happened, wonders what her daughter went through in those final moments. She asks herself whether she did anything wrong, whether she should have been more forceful that night in the hospital. These questions don’t go away for her. They’re the same questions that any mother would ask after losing her child – whether it was an unborn child or an older child.

We all need to do a better job of recognizing that the pain of losing an unborn child – whether by miscarriage or stillbirth – is deep and long-lasting. If you know someone who has lost an unborn child, don’t shy away from him or her. A simple and genuine “I’m sorry for your loss” is a good starter. Be there to offer support and talk just like you would if the child were older. Don’t expect it to go away in a matter of weeks, and don’t assume that a subsequent pregnancy somehow erases the pain of losing the previous child; it doesn’t. Also, try to avoid clichés, e.g., “everything happens for a reason,” “I’m sure you’ll be able to have more kids.” While such sayings are meant well, clichés tend to minimize the degree of loss. If you don’t know what to say, it’s perfectly fine to say, “I don’t know what to say.”

If you yourself have lost an unborn child, you need to treat this loss like you would the death of a loved one. It is a long, slow, painful process that not everyone will fully understand. That can add to the sense of loss because you may get the feeling that people are expecting you to be over it already. Don’t let their artificial time-tables dictate your own personal grieving. You may also experience feelings of guilt, asking yourself if you did something during your pregnancy that caused this (in almost every case, the answer to that question is a resounding no). You may feel resentful toward other parents or children, or find it difficult to be around children, especially those who are the same age as your child would be. You may wonder if you will be able to have another baby. All of these feelings are completely normal, but they will take time to resolve.

Additional Links

Here are some good links to learn more about the grieving process for unborn children.

National Share

AmericanPregnancy.org

Related Nash and Associates Links

Pregnancy-related gingivitis and prematurity

 

 

 

Week in Review: (May 22 – 28, 2011) The Eye Opener Health, Law and Medicine Blog

Saturday, May 28th, 2011

From the Editor – Brian Nash

Last week’s posts by our blawgers were packed with information about a variety of topics ranging from the medicine you need to know about concussions, living with cancer, cerebral palsy resources and the potential risks of overdosing your child with medications.

On the legal front, we began a series I’m personally excited about. We call it Legal Boot Camp. It will be a series for those in our practice jurisdictions of Maryland and Washington, D.C. Our teacher’s face is on – lesson plans in place. We hope you learn some things about the laws that can affect your lives in the areas of personal injury – particularly medical malpractice law.  Our first class took place with a piece by Sarah Keogh that examines the law in Maryland on the right to claim loss/diminished earning capacity. If you’re wondering if you can have such a claim even if you weren’t working when you were injured, Sarah has some information for you. Check it out. Turn in your class card and have some fun.

We wrapped up the week with a piece by yours truly on a wonderful community outreach program by our local baseball heroes, the Baltimore Orioles. Aptly named – OriolesREACH, this initiative has a number of wonderful events, charities and missions that are worth knowing about. One in particular, Shannon’s Fund, is a great program to help those in need while dealing with the financial burdens while dealing with cancer. It is run by the University of Maryland Medical Center. Read about our challenge to our brethren before the bar in the Greater Baltimore Area.

Without further ado, here are the blogs we posted this past week …. and a sneak peak of the week ahead.

Concussions: The Message of Brian Roberts’ Injury Should Not Go Unheeded

Posted by Brian Nash

Anyone who follows sports is well aware that finally the old school mentality of “gut it out and get back in there” following blows to the head are coming (not too soon) to an end. Committees have been formed, articles written and the national spotlight of the media have finally focused on this issue. Those recommendations, debates and guidelines are beyond the scope of this post. Nevertheless, those involved in sports…Read more >

Children’s Medications: Coming Changes and Tips to Avoid Overdose

Posted by Sarah Keogh

My children are both young; the youngest is now a little past her second birthday. In the last few years, we have had both infant and children medication in the house, liquid and tablets, and I have been very careful to make sure to double-check myself if I ever have to medicate either child to make sure that I am reading the correct dosing matrix for the correct concentration and for the correct child. More often than not, I have found that children need medication when their parents are tired. As parents know – children frequently…Read more >

 

Living With Cancer: What to Expect After the Diagnosis

Posted by Jon Stefanuca

About a million and a half people will be diagnosed with cancer in the U.S. this year. The devastating truth about cancer is that about one-third of these people will die from cancer at some point. For most, the diagnosis is unexpected and completely overwhelming.The cancer does not just affect how one feels, it undermines all sense of security and stability. It changes lifestyles and redefines relationships. So often the emotional trauma is equally shared among family members and loved ones. Read more >

New Blog Series: Legal Boot Camp

Posted by Brian Nash

I’m really pleased to announce a new series we’re starting today. If you’re a reader of our blog, you know that we post numerous times a week on health, safety, medicine and related law topics. That’s what we do in our firm – we represent people who are injured by the negligence of health care providers and those who suffer catastrophic injuries in non-medical settings as well. So, sharing what we believe is some good information about medical, health and safety issues is our mission. We strongly believe that our social networking should be about giving good information, engaging in dialogue about relevant issues – just plain good, old sharing. Read more >

Legal Boot Camp (First Class): The Story of Pam – Maryland’s Law on Loss of Earning Capacity

Posted by Sarah Keogh

A 41-year-old woman, Pam, who was laid off from her job as a swimming instructor and swim coach in December of 2009, has been struggling to find a new position for the last few years. Even though Pam had been working as a swimming instructor full-time for the past 18 years, she felt that she needed to jump into a new career while waiting to find a new position as a swimming instructor and coach. Starting in October of 2010, her father died leaving her a rundown home that he had recently purchased with the intent of renovating it. Pam felt that she could put her physical fitness and knowledge of home aesthetics to work, not to mention the ideas she picked up watching renovations shows while unemployed, by renovating the home her father left… Read more >

Dealing with Cerebral Palsy: A Resource for Parents and Family

Posted by Jason Penn

Today’s society has become increasingly dependent on aggregators. We use a variety of methods to assemble and sort information so that we can easily consume it.  Mint.com and Quicken help with our finances and Google Reader helps to manage our online content. A quick search of the internet suggests that the parents of children withcerebral palsy do not yet have an objective aggregator of information to turn to.  Let’s consider this our attempt to provide parents in the Baltimore and Washington D.C. areas with a place to turn. Read more >

Charity Begins at Home: OriolesREACH Program Hits a Grand Slam with Us!

Posted by Brian Nash

I recently wrote a post about our local area charities and civic organizations who do so much for so many in our community. With that in mind, as I was happily reading the sports page in the warm glow of the Orioles’ 12th inning victory yesterday (5 in a row – Go O’s), I came across a piece about a new initiative for our military personnel by the Birds. While looking at the details of this worthy program, I noticed (ashamedly for the first time, I admit) a host of community programs being run by the Orioles. The team uses the name OriolesREACH for the community programs they sponsor, promote or fund. Read more >

Sneak Peak of the Week Ahead

Here’s a sampling of what’s coming next week on The Eye Opener: Views and Opinions from the Nash Community:

  • As families prepare for the upcoming holidays and summer vacation, Theresa Neumann has some important medical advice about what else needs to be included in your travel plans.
  • Legal Boot Camp: Prepare for our second class – get those pencils, pens, iPads and whatever else you need out and ready – there could be a pop quiz on next week’s primary on law.
  • What rights do babies-before-birth (fetal rights) have in our legal system? Do parents who lose a child just before birth have any rights of recovery? You’ll find out next week.
  • Home births are on the rise. Is that a good or a bad thing? Sarah Keogh weighs in on that issue in the coming edition of The Eye Opener

And….maybe even more to come…you can never tell….

Have a wonderful and safe Memorial Day Weekend. Best to All of You and Your Families and Friends from All of Us at Nash & Associates

Dealing with Cerebral Palsy: A Resource for Parents and Family

Thursday, May 26th, 2011

Today’s society has become increasingly dependent on aggregators. We use a variety of methods to assemble and sort information so that we can easily consume it.  Mint.com and Quicken help with our finances and Google Reader helps to manage our online content. A quick search of the internet suggests that the parents of children with cerebral palsy do not yet have an objective aggregator of information to turn to.  Let’s consider this our attempt to provide parents in the Baltimore and Washington D.C. areas with a place to turn.

This is Part I of a several part series.  As we continue to provide you – our readers—with information, if there is anything that would prove helpful, please do not hesitate to let us know.

Here is the roadmap for our journey:

Part I:  Introduction:  You are not alone

Part II:  Education for your child.

Part III:  Medical Information for Parents

Part IV:  Cerebral Palsy Treatments and Therapies

Part V:  Legal Rights & Help

What is Cerebral Palsy?

httpv://www.youtube.com/watch?v=KRljnQTEBMo

Cerebral Palsy is a broad term used to describe a group of chronic movement or posture disorders. “Cerebral” refers to the brain, while “Palsy” refers to a physical disorder, such as a lack of muscle control. Cerebral Palsy is not caused by problems with the muscles or nerves, but rather with the brain’s ability to adequately control the body. Cerebral Palsy can be caused by injury during birth, although sometimes it is the result of later damage to the brain. Symptoms usually appear in the first few years of life and once they appear, they generally do not worsen over time. Disorders are classified into four categories:

  • Spastic (difficult or stiff movement)
  • Ataxic (loss of depth perception and balance)
  • Athetoid/Dyskinetic (uncontrolled or involuntary movements)
  • Mixed (a mix of two or more of the above)

If you are the parent of a child with cerebral palsy the most important thing that you need to know is that you are not alone. Mike Sanders recently addressed this issue in his blog entitled The Daily Struggle of Raising a Disable Child. In addition to the private resources available to you (these resources will be covered in the upcoming segments), there are significant government resources available to Maryland area parents.  Here is a quick breakdown, courtesy of cerebralpalsy.org (please feel free to bookmark this page for easy access to these valuable contacts:

GOVERNOR’S OFFICE FOR INDIVIDUALS WITH DISABILITIES

Beatrice Rodgers, Director

Governor’s Office for Individuals with Disabilities
One Market Center, Box 10
300 West Lexington Street
Baltimore, MD 21201-3435
(410) 333-3098 (V/TTY)
E-mail: oid@clark.nett

Department of Education, Division of Special Education
Early Intervention Services
200 West Baltimore Street
Baltimore, MD 21201-2595
(410) 767-0238
E-mail: cbaglin@msde.state.md.us

Web: www.msde.state.md.us

PROGRAMS FOR INFANTS AND TODDLERS WITH DISABILITIES:
AGES BIRTH THROUGH 3
Deborah Metzger, Program Manager
Program Development and Assistance Branch
Division of Special Education
Early Intervention Services
200 West Baltimore Street
Baltimore, MD 21201
(410) 767-0237; (800) 535-0182 (in MD)

PROGRAMS FOR CHILDREN WITH DISABILITIES:
AGES 3-21
Jerry F. White, Program Manager
Department of Education
Division of Special Education
Early Intervention Services
200 West Baltimore Street
Baltimore, MD 21201
(410) 767-0249
E-mail: jwhite@msde.state.md.us

STATE VOCATIONAL REHABILITATION AGENCY
Robert Burns, Assistant State Superintendent
Division of Rehabilitation Services
Department of Education, Maryland Rehabilitation Center
2301 Argonne Drive
Baltimore, MD 21218-1696
(410) 554-9385
E-mail: dors@state.md.us
Web: www.dors.state.md.us/

OFFICE OF STATE COORDINATOR OF VOCATIONAL EDUCATION FOR STUDENTS WITH DISABILITIES
Mary Ann Marvil, Equity Specialist
Division of Career Technology and Adult Learning
200 West Baltimore Street
Baltimore, MD 21201
(410) 767-0536
E-mail: mmarvil@msde.state.md.us

STATE MENTAL HEALTH AGENCY
Oscar Morgan, Director
Mental Hygiene Admin.
Department of Health & Mental Hygiene
201 West Preston Street, Suite 416A
Baltimore, MD 21201
(410) 767-6655
E-mail: morgano@dhmh.state.md.us

STATE MENTAL HEALTH REPRESENTATIVE FOR CHILDREN AND YOUTH
Albert Zachik, Assistant Director
Mental Hygiene Administration
Child & Adolescent Services
Department of Health & Mental Hygiene
201 West Preston Street
Baltimore, MD 21201
(410) 767-6649

STATE MENTAL RETARDATION PROGRAM
Diane Coughlin, Director
Developmental Disabilities Administration
Department of Health & Mental Hygiene
201 West Preston Street, Room 422C
Baltimore, MD 21201
(410) 767-5600
E-mail: coughlind@dhmh.state.md.us

STATE DEVELOPMENTAL DISABILITIES PLANNING COUNCIL
Mindy Morrell, Executive Director
MD Developmental Disabilities Council
300 West Lexington Street, Box 10
Baltimore, MD 21201-2323
(410) 333-3688
E-mail: MDDC@erols.com

PROTECTION AND ADVOCACY AGENCY
Philip Fornaci, Executive Director
Maryland Disability Law Center
1800 N. Charles, Suite 204
Baltimore, MD 21201
(410) 727-6352; (800) 233-7201
E-mail: philf@MDLCBALTO.org

CLIENT ASSISTANCE PROGRAM
Peggy Dew, Director
Client Assistance Program
Department of Education
Division of Rehabilitation Services
2301 Argonne Drive
Baltimore, MD 21218
(410) 554-9358; (800) 638-6243
Web: www.dors.state.md.us/cap.html

PROGRAMS FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS
Sandra J. Malone, Chief
Department of Health & Mental Hygiene
Children’s Medical Services Program- Unit 50
20l West Preston Street
Baltimore, MD 21201
(410) 225-5580; (800) 638-8864
E-mail: Malones@DHMH.state.md.us

STATE EDUCATION AGENCY RURAL REPRESENTATIVE
Jerry White, Program Manager
Program Administration & Support
Division of Special Education/Department of Education
200 West Baltimore Street, 4th floor
Baltimore, MD 21201
(410) 767-0249
E-mail: jwhite@msde.state.md.us

REGIONAL ADA TECHNICAL ASSISTANCE AGENCY
ADA Information Center for Mid-Atlantic Region
TransCen, Inc.
451 Hungerford Drive, Suite 607
Rockville, MD 20850
(301) 217-0124 (V/TTY); (800) 949-4232 (V/TTY)
E-mail: adainfo@transcen.org
Web: www.adainfo.org

DISABILITY ORGANIZATIONS
Attention Deficit Disorder
To identify an ADD group in your state or locality, contact either:
Children and Adults with Attention-Deficit/Hyperactivity Disorder (CH.A.D.D)
8181 Professional Place, Suite 201
Landover, MD 20785
(301) 306-7070
(800) 233-4050 (Voice mail to request information packet)
E-mail: national@chadd.org
Web: www.chadd.org

National Attention Deficit Disorder Association (ADDA)
P.O. Box 1303
Northbrook, IL 60065-1303
E-mail: mail@add.org
Web: www.add.org

Autism Society of America
7910 Woodmont Avenue, Suite 300
Bethesda, MD 20814
(301) 657-0881; (800) 3-AUTISM
Web: www.autism-society.org

Alicia Brain Injury
Brain Injury Association of Maryland
Kernan Hospital
2200 Kernan Drive
Baltimore, MD 21207
(410) 448-2924;
(800) 221-6443 (in MD)
Website: http://www.biamd.org
E-mail: info@biamd.org

Cerebral Palsy
Mitzi Bernard, Executive Director
United Cerebral Palsy of Southern MD
49 Old Solomons Island Rd., Suite 301
Annapolis, MD 21401
(410) 897-9545
E-mail: somducp@earthlink.net
Web: www.sitestar.com/ucp/

Lee Kingham, Executive Director
Epilepsy Association of MD
Hampton Plaza, Suite 1103
300 East Joppa Road
Towson, MD 21286
(410) 828-7700; (800) 492-2523 (in MD only)

Learning Disabilities Association of MD
76 Cranbrook Road, Suite 300
Cockeysville, MD 21030
(800) 673-6777

Linda Raines, Executive Director
Mental Health Association of Maryland
711 West 40th Street, Suite 428
Baltimore, MD 21211
(410) 235-1178

NAMI MD
711 W. 40th St., Suite 451
Baltimore, MD 21211
(410) 467-7100; (800) 467-0075
E-mail: amimd@AOL.com
Web: amimd.nami.org/amimd/

Cristine Boswell Marchand, Executive Director
The Arc of Maryland
49 Old Solomons Island Road, Suite 205
Annapolis, MD 21401
(410) 571-9320; (410) 974-6139 (In Balt.)
E-mail: cmarchand@thearcmd.org

Speech and Hearing
Rosalie Nabors, President
MD Speech-Language-Hearing Association
P.O. Box 31
Manchester, MD 21102
(800) 622-6742

Division of Special Education, Early Intervention Services
Department of Education
200 West Baltimore Street, 4th floor
Baltimore, MD 21201
(410) 767-0652; (800) 535-0182 (in MD only)

Parents of children in Washington D.C., part II of this series will provide you with a comprehensive list of the government-based agencies available to support your needs.   Additionally, we will take a look at the challenges faced by parents that are looking for educational resources–of all varieties– for their children.

For a primer for part II of this series, see our prior piece entitled IEP’s: Stand Up for Your Child’s rights – Be Their Best Advocate.

 

Related Posts:

CDC Features – Date Show 1 in 303 Children Have Cerebral Palsy

 

Image from hear-it.org