Archive for the ‘childbirth’ 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

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

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

Makena: Drug to fight prematurity leads to major firestorm.

Thursday, April 7th, 2011

Last week, I started following a still emerging story about a drug that I had never heard of before called Makena. The medication is a synthetic form of progesterone that is used for women who have a high risk of prematurely delivering a baby based on having had a premature delivery in the past. The drug must be injected by these women weekly for 18-20 weeks of their pregnancy.

According to the Baltimore Sun, the controversy surrounding this drug began when the “…K-V Pharmaceutical Co. boosted the total cost of the drug during a pregnancy from about $400 to $30,000, igniting a firestorm of objections.” This was possible because originally the medication was created by a compounding pharmacy mixing it together for patient use. Then in February, the FDA granted K-V Pharmaceutical Co. the exclusive rights to manufacture the medication for seven years.

If raising the cost of the medication 75 times its original cost (from $10-20/dose to $1,500/dose) were not enough, the Baltimore Sun reports that the company then went on to “sen[d] letters to pharmacies threatening that the FDA would punish them if they compounded their own versions of the drug.”  However, the FDA, amid a loud outcry of complaints, has “…declared it would do no such thing.  In its statement, the FDA noted that the drug was important and K-V ‘received considerable assistance from the federal government in connection with the development of Makena by relying on research funded by the National Institutes of Health to demonstrate the drug’s effectiveness.’”

What has been so interesting are the implications of this story and the reactions to it. Clearly, the original decision by the pharmaceutical company to raise the cost of the drug 75 times the old cost is an attempt to make money from their exclusive rights. I can hardly imagine that there is any reason other than profit creation for this move given that they did not have costs associated with research and development or any other clearly identifiable costs. So, aside from my initial reaction of disgust that this might make it harder for women who need this medication to protect their children, I also thought about the bigger implications.

First of all, the cost issue is not so simple as it first appears.  As another article from the Baltimore Sun mentioned, “[t]he burden for many will fall on insurance companies, which may have to raise rates. The increase will also affect already strapped Medicaid programs.” The increased costs of drugs impact many Americans directly – those without insurance or those for whom even co-pays are a major budgetary struggle. However, the costs here also reach all of us. If the costs associated with the company’s increased profit are borne by the insurance companies and Medicaid, it also means that the costs are going to be felt by all of us who pay for health insurance or whose companies pay for health insurance and yes, by all of us, who pay taxes.

Secondly, for those women who do not realize that they could still go to a compounding pharmacy for this prescription and for whom it is not covered by insurance, the increased cost may mean that some woman will go without these injections. The Baltimore Sun article reports that:

About 500,000 U.S. infants are born prematurely each year. The March of Dimes estimates that about 10,000 of those premature births could be prevented if eligible women received Makena.

The implications here deal with both the health and safety of the unborn child who is now at risk of premature birth. But, unfortunately, they also have an associated monetary cost. The cost of a baby being born prematurely is also going to weigh on the insurance companies and is, therefore, going to be shared by all in the form of potentially increased premiums.

Given the intense criticism in the news, K-V Pharmaceutical Company moderately changed course in the last few days, according to Medical News Today and said they would bring the cost of Makena down to $690 per dose from the originally announced price of $1,500 per dose. While this is lower, this is hardly a significant adjustment given that the compounded version costs between $10-20 per dose. The March of Dimes, which originally backed FDA approval of the drug and was allowing the pharmaceutical company’s use of its name and logo, is apparently embarrassed by KV Pharmaceutical’s decisions. According to an article on the nonprofitquarterly.org, “…the March of Dimes is backing out of a sponsorship deal with the [pharmaceutical] company that sells [Makena]. Last Friday, the nation’s leading nonprofit focused on the health of pregnant women and babies said it would no longer allow St. Louis-based, KV Pharmaceutical Co. to use its name or logo in any of the drug company’s promotions.”

The response from the March of Dimes is not KV Pharmaceutical Co.’s only trouble as the Wall Street Journal is reporting that after the FDA announcement that it will not take action against pharmacies that compound the drug, and the company subsequently announced that it would cut the cost, the company’s shares fell 5.2%.  Reuter’s is reporting that this represents a drop of more than 20 percent.  Congress is also in an uproar about this issue.  The Reuter’s article says that elected officials are creating pressure for more to do be done on this issue.

What do you think should be done about KV Pharmaceutical Co.? Are they really any different from any of the other pharmaceutical companies? Is it relevant to consider that this is a so-called orphan drug and that the company has exclusive rights because of this? Do you think that allowing compounding pharmacies to create the drug for woman separate from the FDA approved drug is a sufficient solution? What about the bigger question of companies creating inflated prices for their products and having insurance (and all of us) foot the bill?

 

Having an epidural when you deliver your baby? 3 Questions to ask the doctor!

Monday, April 4th, 2011

Be your own advocate - ask questions!

Thousands of women will have an epidural today to help them through their labor, and many of them will have a running epidural after they have their baby delivered. This is especially true in the time period for those who have had a C-Section.

There’s no doubt that epidurals have been a wonderful tool for doctors to provide patients with relief from the pains of labor and the pain and discomfort following delivery – mainly after a C-Section.

Because they have become so commonplace in hospitals throughout this country – and the world – they seem to have been taken for granted as being “safe” – not just effective. For the most part – they are safe, but they clearly have significant risks associated with them.

Some reports claim that the overall complication rate for epidurals is 23%. These complications range from very minor (e.g. some nausea, vomiting, itching, headaches) to the most major of complications – death of the mother and/or her baby. In between these two extremes lie some very devastating injuries to both a mother and her baby. Just some of those reported are damage to the mother’s spinal cord leading to motor (ability to move legs) and/or sensory (ability to feel sensations) injuries, bowel and bladder dysfunction, foot drop and a host of other potential – thankfully rare – complications.

There is a popular book that many expectant mothers have considered their bible over the years – What to Expect When You’re Expecting, which is now in it’s fourth edition, according to Amazon.com. While no doubt this has been a valuable resource for many moms-to-be, one medical author takes some exception to the section on epidurals:

Epidural anesthesia has become increasingly popular for childbirth. The popular book, What to Expect when You’re Expecting, for example, portrays epidurals as perfectly safe. The risks, however, may be greatly underplayed.

It’s been many decades (four in one instance) since I personally went through the “birthing” process as a parent-in-waiting. I must admit, I have not purchased or read the latest edition of this book so I cannot vouch that this portrayal of epidurals being “perfectly safe” is still the message of this popular book. Obviously it was at the time of the quote by this Canadian medical writer.)

What expectations do YOU have for your special day?

I suspect that many of you are like I was in envisioning what your experience will be like when the day arrives. You have your bags packed, back-up coverage in place if needed, car gassed. The moment arrives and off to the hospital you go. You register, get in your room, the fetal monitor is applied, and you pass the time remembering (or trying to remember) all those things you learned in your birthing classes. Your epidural is placed and all goes smoothly. Finally, the time comes for you to deliver your new bundle of joy. You make it through some angst of birth, see your new addition through tears of joy and relief and get ready for the onslaught of family and friends, who want to see the new arrival to your family. After you and your baby are cleared for discharge, off you go to your home, ready to begin your “new life” of nurturing, educating, parenting – aglow with images of pride, joy and a world of opportunities ahead. Hopefully, that’s exactly how we all hope it works out for you and your family.

To increase your odds that this scenario plays out, I would strongly suggest that you not take for granted the part about your epidural going smoothly. While there are probably many other questions you may think to ask – or should think to ask – here are three suggestions I have for you based on my seeing (as a lawyer) what can happen when the epidural doesn’t go smoothly.

How an epidural is performed

Here is one example available on the internet (YouTube) to show you just how an epidural is done. Unfortunately, it is a bit difficult to understand the speaker (at least for me), but having looked at several videos, I think it gives you a pretty good idea of how this procedure is performed by the anesthesiologist.

httpv://www.youtube.com/watch?v=_WRccCADReY&feature=related

“Have you reviewed my medical history, Doctor? Is there anything else I can tell you?”

Some of the known risks of having epidural anesthesia are connected to your medical history. Sure, you’re assuming that the medical history you gave to your OB during the prenatal visits and to the intake nurse when you arrived at the hospital has found it’s way to your medical record. You’re also assuming that your medical history has been carefully reviewed by the anesthesiologist whose about to put the epidural in your back. Is it there? Has it been carefully reviewed? Ask! There are conditions (e.g. spina bifida, scoliosis, certain heart valve problems, sickle cell anemia, etc.) that can increase your risk of a complication from an epidural.  Are you taking or have you recently taken any type of anti-coagulant such as heparin or coumadin? Make sure your anesthesiologist is aware if this is the case since these drugs can increase the risk of a bleeding complication. You don’t want to have a collection of blood around your spinal cord – believe me!

“When should I expect to move my legs or bend my knees? How long will I feel numb?”

In most instances, epidural are given to provide analgesia – pain relief (sensory block) during labor and at times for post-delivery (C-Section) pain relief. They are not intended to block your motor function – that is, your ability to move your legs, flex your ankles, wiggle your toes, flex your hips or bend your knees. During a C-Section the drugs being used for delivery are many times different drugs from the ones you are getting via your epidural infusion. You will have a different block so that surgery can be performed safely. You will likely have both a sensory and a motor block! You need to understand the difference.

These anesthesia drugs (the ones given during your surgery) will usually wear-off (varies depending on the drugs and from patient to patient) in a period of 1 to 4 hours. You will typically be in a post anesthesia care unit (PACU) during your recovery phase from anesthesia.

Key: you should not be discharged from the PACU if you are unable to at least bend your knees. There is a scoring system (Bromage) that the nurses and personnel in the PACU will typically use after examining your ability to move your legs, bend your knees, wiggle your toes, flex your hips, etc. to determine if you can safely be discharged from the PACU or if you need to be seen by a specialist in anesthesia to determine if you have a potentially significant complication.

“What exactly should I expect to feel like if I have an epidural running after I deliver my baby?”

I simply cannot stress enough how important it is for you to understand exactly how you should be feeling after you have been discharged from the PACU to your room. Don’t ask your family or friends; they don’t know – unless they are anesthesiologists. There are so many free, uneducated opinions out there that are simply wrong!

One further piece of advice: do not ask the nurse what you should expect to feel like. There is absolutely no doubt that there are many  very experienced and highly capable nurses out there taking care of moms. Unless you intend to ask for and analyze your nurse’s background, training and experience in anesthesia, don’t do it. The drugs used in administering epidural analgesia can vary significantly. The dosing (concentration, volume per hour, etc.) can also vary. Only a specialist in anesthesia can answer your questions correctly!

Know what to look for so that if there is some change in your condition or you start to encounter a feeling or loss of function or sensation, you can tell your nurse or doctor immediately so that you can be examined right away!

I suspect many parents are so caught up in the labor process, or are so exhausted after the delivery or so caught up in the wonderment of having their baby that these issues relating to an epidural may not be very important. If you are in your 20′s, 30′s or 40′s, how important is it to you that may not be able to walk for the rest of your life? It can happen – rarely, thank goodness, but it can happen. I have been involved in cases in which this is exactly what happened! Frankly – I don’t want to see it happen to anyone else. It is incredibly tragic for a mom, a dad and their child – trust me!

One last point before we leave this discussion on post-delivery (post-operative) analgesia. Some hospitals (the number appears to be declining due to concerns about the inadequacy of monitoring) use what is known as Patient Controlled Anesthesia epidural analgesia. Simply put, this is a device (they vary depending on the manufacturer) permits the patient to push a button a infuse a pre-determined dose of drugs (e.g. bupivacaine and fentanyl) into the epidural space for additional pain relief. A patient is actually limited as to how much drug can be used in the course of an hour (determined by what in called a lock-out interval and maximum dosing parameters per hour). While a fixed lower amount of drug flows each hour (known as the basal rate), many patients may require more relief than the basal rate provides.

That being said, if you find yourself pushing the PCA button numerous times during the course of an hour, you should bring this to the attention of your nurse or doctor. Don’t wait for them to hopefully check the machine to see how many times you pushed in the last hour (many forget to do this!). Be pro-active. If you are pushing your PCA button a number of times in the course of an hour, even though you can’t really overdose yourself because of pre-set limits by the anesthesiologist, this may be an indication that something needs to be checked. For instance, the catheter may have become displaced; the drugs may not be distributing equally; you may be having some problem that someone needs to investigate. Don’t keep hitting the PCA pump; hit the call button!

Get information about the risks, benefits and alternative to an epidural!

Having been there (i.e. childbirth) as a father four times, I know – at least from my perspective – how difficult it is to concentrate on issues such as risks, benefits and alternatives involving an epidural. Common sense tell me the ideal time to have this discussion simply cannot be while mom is in labor. If that’s the only chance you have, then fine – take the time and make the effort and have a real discussion with the anesthesiologist. Even if you just cover the 3 items I have suggested above, that will take you a long way.

I have made this suggestion before, but I’ll make it again: make arrangements to meet with someone from the anesthesia department before you get to the hospital to delivery your baby. Don’t be shy or concerned that you don’t want to bother anybody. Bother somebody! There really are an awful lot of wonderful doctors and CRNA’s, who would be willing to meet with you, educate you and answer your questions.  It’s your health,  your body, your future – so protect it!

There clearly are more than “3 questions” you should ask. Many of you have been through this. Many of you have medical training and experience. What questions do YOU think a mom-to-be should ask about their epidural.

 


 

Birth Defect Updates: Warnings about opioid use before and during pregnancy

Monday, March 21st, 2011

Photo credit: Getty Images

Recently, I wrote about studies concerning the increased risk of birth defects caused by smoking.  A recent press release from the CDC draws attention to a newly discovered link between the use of certainly prescription opioid pain relievers by a woman shortly before conception or in the first trimester of pregnancy to an increase in birth defects.  Similar to the evidence about smoke exposure, the research identifies the period before conception and during early pregnancy as critical.  I think that these findings raise questions about the use of these drugs by woman of child-bearing age as the critical time period may be one when a woman is not aware that she is pregnant or going to become pregnant.

Use of these opioid pain relievers, such as codeine and oxycodone, “was linked to several types of congenital heart defects as well as spina bifida, hydrocephaly, congenital glaucoma and gastroschisis.”  According to the press release, the study, which was published in the American Journal of Obstetrics and Gynecology, “found that women who took prescription opioid medications just before or during early pregnancy had about two times the risk for having a baby with hypoplastic left heart syndrome (one of the most critical heart defects) as women who were not treated with these opioid medications.”   Overall the CDC statement suggests that the risk of these defects is not that large for any individual woman given the rarity of these conditions, but that it is important information nonetheless since the defects are very significant.

Cerebral Palsy rates dropping in U.S.

In happier news, overall rates of cerebral palsy are dropping in the United States.  The cause of the decline is linked to improved care during pregnancy and at birth.  According to Medical News Today, a new “…article published in The Journal of Pediatrics indicates that the rates of cerebral palsy have declined dramatically in the past 15 years.” This is exciting news not just because it means that many fewer children are born with a devastating injury but also because it is an indicator of a general improvement in the care provided to mothers and babies before, during and immediately following birth.

 

 

Smoking and Secondhand Smoke Increase Risk for Birth Defects and Stillbirth – Even before pregancy

Thursday, March 17th, 2011

Photo courtesy of Impact Lab

Recently, I came across several news articles regarding risks that can lead to birth defects.  While it has long been known that smoking during pregnancy is not healthy for the mom or her developing baby, a new study is showing that a mom who smokes during pregnancy creates a huge risk of heart defects in her baby.  A Reuters article explains that the potential for harm caused by smoking during the first trimester of pregnancy, a time when many women may not even realize they are pregnant, is significant:

Specifically, women who smoked early in pregnancy were 30 percent more likely to give birth to babies with obstructions in the flow of blood from the heart to the lungs, and nearly 40 percent more likely to have babies with openings in the upper chambers of their hearts.

While smoking later in pregnancy can also cause birth defects, it is the critical period in early pregnancy when organ development occurs that causes the risk to be so significant at that time.

The Reuters article goes on to explain that the new study, in the journal Pediatrics, does not explain precisely why smoking so dramatically increases the risk of heart defects. However, given the risk, women not smoking before or during early pregnancy could decrease the number of children born with these defects.

A news release from the CDC adds that this study and other research suggest that if women quit smoking before or very early in pregnancy, they could avoid as many as 100 cases of the obstruction type of heart defect and 700 cases of abnormal openings in the upper heart chambers each year in the United States.

This is yet another great reason for woman to quit smoking as soon as possible and certainly before trying to get pregnant.

Secondhand Smoke Risks to Your Baby

We cannot let spouses, partners or other people in the mothers’ lives off the hook when it comes to smoking cessation.  A blog article on The Chart from CNN discusses a new study, also from the journal Pediatrics, which gives a convincing argument why woman must avoid secondhand smoke during and even before pregnancy.  The “[r]esearchers found exposure to secondhand smoke increased a non-smoking pregnant woman’s [chances] of having a stillborn by 23 percent, and increased the risk of delivering a baby with birth defects by 13 percent.”  The article went on to explain that the risk of having a stillborn or delivering a baby with birth defects is almost as large for a woman who does not smoke but is exposed to secondhand smoke as for a woman who smoked herself.  The risks of having a stillborn are increased 20-34% when the mother herself is the smoker and the risks of birth defects are increased by 10-34%.

Aren’t these compelling reasons to continue to work hard as a society on prevention and smoking cessation for the young?  It is too late to wait until child-bearing age when women may already be causing unnecessary harm to their unborn children before they know they are pregnant or by sharing their lives with individuals, who are not able to quit smoking fast enough to prevent harm before conception or during early pregnancy.

Nationwide Push to Curb Elective Early Deliveries

Wednesday, March 16th, 2011

Image by SoulPrintsPhotography

I recently overheard a mother talking about her child’s upcoming birth.  She was pregnant with her fourth child and was a few days away from her due date.  Another mother was asking her about whether she was concerned about when she would go into labor.  The pregnant mother explained that she was scheduled to have a planned caesarean section, since for medical reasons her prior three children had already been born via caesarean section.  What was interesting and surprising about this conversation was that the mother went on to explain that she was scheduled to give birth to the baby a week later, four days after her due date.

The mother clearly stated that she specifically requested a delivery date after her due date.  I was surprised and impressed by this mother’s decision and the explanation that she gave to the other mother about her choice.  She said that her first child was born by unscheduled caesarean section following an attempted induction two weeks after her due date.  She then had each of her subsequent children by planned caesareans – the next on the due date, the third a few days after the due date and this one planned for 4 days after the due date.  She explained that she liked to wait as long as possible before having the caesarean sections for each of her children.  I don’t know if this mom was up to date on the recent research in this area or if she had other reasons that she chose to delay delivery.  However, her choices seem very sound based on current research that shows that too many moms are having elective deliveries before their due dates.  These deliveries before a baby is full term can increase the risk of complications to mother and baby and lead to longer hospital stays.

A recent article on a Wall Street Journal Health Blog discusses the current nationwide push to inform mothers about the risks of elective delivery before 39 weeks of gestation.  Another Wall Street Journal article highlights what a large number of births this might impact as “’early term’ elective inductions…[now] account for about a quarter of births, up from less than 10% in 1990.”  The number of elective deliveries is large and so are the complications:

Now, a growing body of medical evidence indicates that gestation even a few days short of a full 39 weeks can lead to short- and long-term health risks. Public health officials, safety advocates, private insurers and employer groups are stepping up pressure to sharply reduce early term deliveries. The practice drives up costs of neonatal intensive care and leads to a higher rate of caesarean sections. C-sections are more expensive than natural deliveries and result in longer hospital stays and more risks for the mother, including infection. A study last year estimated that reducing early term births to 1.7% could save close to $1 billion annually.

The current research, including a study published in the Journal of Reproductive Medicine, is influencing a campaign to stop doctors and hospitals from allowing elective deliveries before 39 weeks to better protect mothers and babies, as well as to cut unnecessary costs.

What do you think?  I can certainly sympathize with mothers who are uncomfortable at the end of a pregnancy and are ready for delivery.  However, I cannot imagine that many mothers, faced with the information about risks to themselves and their babies, would not be willing to stay pregnant for another week or two.  I wonder if a clear and widespread public education campaign targeted at mothers would not dramatically decrease the number of elective early deliveries?