Archive for the ‘pregnancy’ Category

New Study Reveals Significant Increase in Pregnancy-Related Strokes

Monday, August 8th, 2011

A new study published in the Journal of the American Heart Association this month reveals that pregnant women have a significantly high risk of developing a stroke. According to the lead author of the study,  Dr. Elena V. Kuklina (senior service fellow and epidemiologist at the Center for Disease Control and Prevention (CDC)), “the overall rate of women having strokes while they are expecting a baby and in the three months after birth went up 54% in the 12 years leading up to 2006-07.”

This is a significant finding! To put it in context, consider the following facts about stroke:

  • Stroke is the third leading cause of death in the United States. Over 143,579 people die each year from stroke in the United States.
  • Stroke is the leading cause of serious, long-term disability in the United States.
  • Each year, about 795,000 people suffer a stroke. About 600,000 of these are first attacks, and 185,000 are recurrent attacks.
  • Nearly three-quarters of all strokes occur in people over the age of 65. The risk of having a stroke more than doubles each decade after the age of 55.
  • Strokes can – and do – occur at ANY age. Nearly one quarter of strokes occur in people under the age of 65.
  • Stroke death rates are higher for African Americans than for whites, even at younger ages.
  • Among adults age 20 and older, the prevalence of stroke in 2005 was 6,500,000 (about 2,600,000 males and 3,900,000 females).
  • On average, every 40 seconds someone in the United States has a stroke.
  • Each year, about 55,000 more women than men have a stroke.

“A stroke is an interruption of the blood supply to any part of the brain. A stroke is sometimes called a ‘brain attack.’” The following are well-recognized stroke risk factors: high blood pressures (hypertension), atrial fibrillation, diabetes, heart disease, high cholesterol, increasing age, and a family history of strokes.  Being pregnant is a risk factor in and of itself.

As part of the study, Dr. Kuklina and colleagues used information from 5 to 8 million discharge records from about 1000 hospitals. According to Dr. Kuklina, the increase in the stroke rate during pregnancy and in the 3 months after birth was mainly attributable to high blood pressure and obesity. The study enumerates these specific findings:

  • Pregnancy-related stroke hospitalizations went up by 54%, from 4,085 to 6,293 over the 12 years leading up to 2006- 07.
  • Strokes in pregnancy went up by 47% (from 0.15 to 0.22 per 1,000 deliveries).
  • Strokes recently after giving birth went up by 83% (from 0.12 to 0.22 per 1,000 deliveries).
  • Strokes during delivery did not change (they stayed at 0.27 per 1,000 deliveries).
  • In 2006-07, about 32% and 53% of women who were hospitalized after having strokes in pregnancy and shortly after giving birth respectively had either high blood pressure or heart disease.
  • Increased prevalence of these two conditions over the 12 years up to 2006-07 accounted for almost all the increase in stroke hospitalization after giving birth that occurred in the same period.

It appears that an increasingly larger number of women enter pregnancy with one or more stroke risk factors. This is particularly true with respect to hypertension and obesity. According to Dr. Kuklina, “[s]ince pregnancy by itself is a risk factor, if you have one of these other stroke risk factors, it doubles the risk.” For this reason, it is particularly important to enter pregnancy in relatively good cardiovascular health and to reduce other risk factors, if possible. If you are pregnant or plan on becoming pregnant, talk to your OB/GYN about your stroke risk factors. In collaboration with your physician, implement a plan to manage and reduce your stroke risks before, during, and after pregnancy.

Read these related blogs:

Stroke Warnings: Most People Who Experience Minor Strokes Do Not Recognize Its Symptoms

Strokes – Family History a Significant Risk Factor

Spinal Stroke: An atypical cause of back pain

Brother, will you help me? If you don’t this stroke might kill me.

Landmark NIH Clinical Trial Comparing Two Stroke Prevention Procedures Shows Surgery and Stenting Equally Safe and Effective

Parents – be aware and read this article: Children Don’t Have Strokes? Just Ask Jared About His, at Age 7 – NYTimes.com

To view our collection of educational videos about stroke, visit us at:

http://www.youtube.com/user/nashlawatty#g/c/BDCB5099E7C9F6C4

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

 

 

 

Milk from Mom: Effective in preventing common infant complication (NEC)

Thursday, May 19th, 2011

The debate among parents regarding the use of human milk vs. formula wages on, but according to a recent study, you can chalk one up for the human body.  That study, headed by the Johns Hopkins University in Baltimore, concluded that premature babies fed human donor milk were less likely to develop the intestinal condition necrotizing enterocolitis (NEC).  Both sides has its advocates, willing to do battle at any time. When it comes to NEC, Mom’s milk has the decided advantage.

What is NEC?

Necrotizing enterocolitis. Never heard of it?  It is a frequent cause of mortality and morbidity in very low birth weight (VLBW) infants. The condition is typically seen in premature infants, and the timing of its onset is generally inversely proportional to the gestational age of the baby at birth, i.e. the earlier a baby is born, the later the signs of NEC are typically seen.

Initial symptoms include feeding intolerance, increased gastric residuals, abdominal distension and bloody stools. Symptoms may progress rapidly to abdominal discoloration with intestinal perforation and peritonitis and systemic hypotension requiring intensive medical support.

The diagnosis is usually suspected clinically but often requires the aid of diagnostic imaging modalities. Radiographic signs of NEC include dilated bowel loops, paucity of gas, a “fixed loop” (unaltered gas-filled loop of bowel), pneumatosis intestinalis (gas cysts in the bowel wall), portal venous gas, and pneumoperitoneum (extraluminal or “free air” outside the bowel within the abdomen). The pathognomic finding on plain films is pneumatosis intestinalis . More recently ultrasonography has proven to be useful as it may detect signs and complications of NEC before they are evident on radiographs. Diagnosis is ultimately made in 5-10% of very low-birth-weight infants (<1,500g).

httpv://www.youtube.com/watch?v=ffI5UqLA_74

The role of human milk in both prevention and treatment of NEC has long been recognized. The familiar arguments, cost, inconvenience, etc., are largely inapplicable to the very low birth weight infant. Mothers of very low birth weight infants often experience insufficient milk production, resulting in mixed feedings of human milk and formula.  Moreover, medical complications often limit the volume of feeding these infants can be given.  The analysis shifts, therefore, with the new focus on the medical needs of the child and not simply on whether or not breast feeding is convenient for Mom or whether formula is too expensive for the household budget.

Human milk, whether mother’s own or from a donor, provides significant protection against many of the known risk factors of NEC as well as therapeutic protection for the infant recovering from NEC. The study shows that enteral feeding containing at least 50% human milk in the first 14 days of life was associated with a sixfold decrease in the odds of NEC.  The stark differences in the risk of NEC, its complications and the need for surgery between babies who receive human donor milk and those who get formula signal the need for a change in feeding practices across neonatal intensive care units,” said lead investigator Elizabeth Cristofalo, a neonatologist at the Johns Hopkins Children’s Center.

Those numbers are encouraging, particularly for the vulnerable very low birth weight infant. In the absence of mother’s own milk, donor human milk could be life saving for fragile preterm infants, who are at the highest risk of developing NEC.  Undoubtedly the use of non-human milk (formula) remains an option that many parents may choose to exercise. The study, however, suggests that it is the inappropriate choice for some. I have a sneaking suspicion that they are not interested in participating in the human vs. non-human milk debate.

Question:  Have you made a decision about human vs. non-human milk?  Why did you choose one over the other?

 

Image courtesy of breastfeedingtechniques.com

Laughing Gas Making Its Way Back Into The Labor And Deliver Department

Thursday, April 21st, 2011

According to a recent article published by MSNBC, laughing gas or nitrous oxide is making its way back into labor and delivery units in American hospitals. Although laughing gas has long been used as a pain relief in various countries, including Canada and the U.K., it has lost its popularity in the U.S. Well, maybe not for much longer.

It appears that a number of hospitals are now considering making laughing gas available as a pain relief measure for women in labor. A hospital in San Francisco and another in Seattle have been using laughing gas in their labor and delivery units for a while. Hospitals like Dartmouth-Hitchcock Medical Center plan to offer laughing gas to laboring mothers in the immediate future. Dartmouth-Hitchcock’s plan is currently being reviewed by the federal government, and arrangements are presently being made for the procurement of delivery equipment for laughing gas. Vanderbilt University Medical Center may begin offering laughing gas as well later this year.

History

Laughing gas is not a new pain relief method. Its use had become very common in hospitals when Joseph Thomas Clover invented the gas-ether inhaler in 1876. Particularly, its use in the labor and delivery setting had been very common before the introduction of epidural and spinal anesthesia. Because laughing gas is unable to eliminate pain to the same degree as epidural or spinal anesthesia, it simply could not compete with the more sophisticated pain relief alternatives, which entered the marker in the 30s and 40s.

What is laughing gas?

Nitrous oxide, commonly known as laughing gas or sweet air, is a chemical compound with the formula N2O. It is an oxide of nitrogen. At room temperature, it is a colorless non-flammable gas, with a slightly sweet odor and taste. It is used in surgery and dentistry for its anesthetic and analgesic effects. It is known as “laughing gas” due to the euphoric effects of inhaling it, a property that has led to its recreational use as a dissociative anesthetic.

Laughing gas as an important pain relief alternative

Although laughing gas can only take the edge off pain, it just might be an important alternative to other more conventional pain relief methods. The patient does not have to rely on an anesthesiologist to administer the gas. The patient can herself choose how much gas to administer at any time. The effects of the gas are not long-lasting. Therefore, the patient does not have to recover in a post anesthesia care unit. Importantly, there is no associated loss of sensation and motor function during the delivery process. As such, the gas does not interfere with the woman’s ability to breath and push during labor. Laughing gas is also not known to have any adverse effects on the baby in utero.

The administration of laughing gas does not require any invasive medical procedures. By contrast, consider epidural anesthesia: An epidural requires that an epidural catheter be threaded into the epidural space, which is only about 2 mm wide. Any mistake and the consequences can be catastrophic. Epidurals have been known to cause spinal cord injury secondary t0 toxicity, spinal cord infarcts, severe hypotension, paraplegia, epidural bleeding, and even death. None of these complications are associated with the use of laughing gas.

: httpv://www.youtube.com/watch?v=1TO4sOgiIeU]

According to Suzanne Serat, a nurse midwife at Dartmouth-Hitchcock Medical Center:

We have a number of people who don’t want to feel the pain of labor, and nitrous oxide would not be a good option for them. They really need an epidural, and that’s perfect for them. […] Then we have a number of people who are going to wait and see what happens, and when they’re in labor, decide they’d like something and then the only option for them is an epidural but they don’t need something that strong. So they would choose to use something in the middle, but we just don’t have anything in the middle.

Nitrous oxide may just prove to be that middle option for many women who prefer to give birth without the use of powerful and potentially dangerous analgesic/anesthetic agents. If you are an expectant mother, ask your obstetrician if nitrous oxide is a pain relief option that may be available to you during labor.

Image from cartoonstock.com

For more information about epidural anesthesia and epidural complications, you may want to read these posts too:

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

5 Questions to Ask Your Obstetrician Before You Go to the Hospital

Epidural Analgesia – What Should an Expectant Mother Consider? What are the risks?

Budget Crisis Avoided, But What About the Babies? Can They Live With $504 Million Less in Funding?

Wednesday, April 20th, 2011

Let’s start here:  The Federal Government Shutdown has been avoided.  Federal workers and government contractors that depend on a functioning federal government can breathe a deep sigh of relief.  As the hysteria subsides and we return to business as usual, we should ask ourselves – “Are we really returning to business as usual?”  When it comes to your health and more specifically, the healthcare that you and your baby receive, the answer very well may be a resounding “NO.”

How It All Happened

I suppose I should set the stage for you, in case you missed the hand-wringing and other hysterics.  The two houses of Congress are divided.  As is par for the course, Democrats profess that one course of action is correct and Republicans declare that another course is more appropriate.  A budget needs to be in place for the government to function, yet the two political parties couldn’t come to an agreement.  A shutdown of the federal government was promised if a compromise was not reached.  The American public held its breath—or protested.  At the 11th hour, cuts were made, backroom deals were struck, and Washington spoke:  there will be $38 billion dollars trimmed from the federal budget.  On a positive note, federal agencies will remain operational until the end of September. Reason to cheer? Maybe. Before we break out the party hats and noise makers, let’s take a look at how healthcare fared.  The following areas are among those cut:

-         Special Supplemental Nutrition Program for Women, Infants and Children (WIC):  $504 million

-         Community Health Centers:  $600 million

-         Substantance Abuse & Mental Health Services Administration:  $45 million

-         Infectious Disease prevention:  $277 million

Total:  $1.426 Billion.  Yes, billion, with a “B”!

WIC, Babies, Community Health & Death

Women, Infants and Children, otherwise known as WIC, is a program that provides food for poor women and children up to the age of five.  WIC’s mission statement is “to safeguard the health of low-income women, infants, and children up to age 5, who are at nutritional risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care.” WIC gives targeted nutritional supplementation to help prevent birth defects and developmental problems caused by malnutrition.  It also provides information on healthy foods and referrals for medical care, according to the program’s website.

The WIC program gave out about $7 billion in food grants to states in 2010. There were nearly 8.9 million households receiving WIC benefits at the end of 2010, according to the Department of Agriculture. Locally, on an annual basis, Maryland WIC serves over 130,000 women, infants and children each month.  More than 151,000 pregnant and breastfeeding women, infants, and toddlers benefit from the program in Virginia.  Despite the number of women, infants and children assisted by the program, the recent budget compromise promises to slash $504 million in funding. The startling aspect is the number of women and children that are eligible but for one reason or another are not enrolled in the program. There is an estimated 43 percent of women and children, who are eligible for benefits but aren’t receiving them.  The cuts to funding will effectively foreclose their opportunity to receive benefits. At risk and in need, they will have to look elsewhere.  Sadly, many will not.

In addition to the significant cuts to WIC’s budget, the budget for community health centers would drop by about $600 million, affecting access to basic health services for approximately 5 million low-income Americans, according to the National Association for Community Health Centers. By 2015, according to NACHC, the reduction could undermine health centers’ capacity to provide services to 40 million people.

But what does it mean?

It is 2011.  My computer, cell phone and other gadgets all confirm that we are soundly within the confines of the 21st century. While we can certainly live with the fact that automobiles do not take flight a la The Jetsons, what is troubling is that we are continuing to battle fetal death in the United States.  Around 2.6 million babies are born with no signs of life after 28 weeks’ gestation – which defines a stillbirth. Undoubtedly, most of these stillbirths take place in developing countries.  Nonetheless, in the world’s wealthiest nations around 1 in every 300 babies are stillborn.  In 2005, data from the National Vital Statistics Report showed a US national average stillbirth rate of 6.2 per 1000 births. In fact, of the world’s most advanced economies, the United States has the highest infant mortality rate.  In Maryland, a preliminary report from the Department of Health and Mental Hygiene (DHMH) shows that Maryland’s infant mortality rate is 7.2 infant deaths per 1,000 live births.

The major causes of stillbirths—complications during labor, maternal infections, hypertension, diabetes, and fetal growth restriction—aren’t too different from the major causes of maternal or neonatal deaths. Among the most fundamental ways to prevent stillbirths and fetal death is to improve basic and comprehensive emergency obstetric care. Providing pregnant women folic acid supplements, preventing disease, and improved detection and management of infection during pregnancy are simple ways to ensure babies are born healthy.

According to WIC, numerous studies have shown that pregnant women who participate in WIC have longer pregnancies leading to fewer premature births; have fewer low birth-weight babies; experience fewer fetal and infant deaths; seek prenatal care earlier in pregnancy and consume more of such key nutrients as iron, protein, calcium and vitamin C. That being said, the budget negotiations resulted in drastic cuts to a program effective at reducing harm to the nation’s most vulnerable?  Oh, boy.

With the exception of a short stint as a student legislator in high school and college, I do not have meaningful experience in the political arena.  I will not pretend to have significant insight into what it takes to balance a federal budget.  As a lay person, what I can do is look at the statistics and read the reports.  The numbers and reports tell me that in the 21st century America, a scary number of its children are being harmed by the preventable.  On top of that, the funding—the lifeblood—that sustains the programs aimed at reducing the problem just took a devastating blow. Will the programs designed to help our most vulnerable continue to operate? We can only hope.   At least, for the sake of the children. So please excuse me if I don’t put on my party hat and celebrate the $38 billion in budget cuts. I haven’t found a cause for celebration just yet.

Agree or disagree? That’s why the comment section is below. Let me know if you have your party shoes on.

 

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.

 


 

The Week in Review: did you miss last week’s posts on health, safety, medicine, law and healthcare? A sneak preview of the week ahead.

Saturday, March 26th, 2011

Eye Opener - Nash & Associates Blog

This week we are starting a weekly posting of our blogs of this past week, some key blogs of interest to our more than 6,500 monthly readers, and a sneak preview of what’s coming next week. We would really like for you to join our community of readers, so don’t forget to hit the RSS Feedburner button or subscribe to our blog, Eye Opener. We share with you our thoughts, insights and analysis of what’s new in the law, the world of law and medicine, health, patient and consumer safety as well as a host of other topics that we deal with as lawyers on a daily basis in trying to serve the needs of our clients.

For those of you on Twitter, Facebook and LinkedIn, we have a vibrant presence on those social networks as well. Hit the icon(s) of your choice and become part of our ever-growing social network community. Share your thoughts, share our posts, give us your feedback on what YOU would like to hear about.

This Past Week

Birth Defect Updates: Warnings About Opioid Use Before and During Pregnancy In this post, Sarah Keogh, explored a new report which is vital information for women who are pregnant or thinking about becoming pregnant. Opiods, narcotic pain killers such as morphine, codeine, hydrocodone and oxycodone, are a valuable part of a physician’s drug armamentarium, but they can have significant implications for a fetus if taken during pregnancy or even just before a woman become pregnant. Read Sarah’s important piece, be informed and learn why you should discuss the use of any such drugs with your obstetrician/gynecologist before taking them.

 

Doctors Disciplined by Their Own Hospitals Escape Actions by Licensing Boards. Who’s at Fault? Brian Nash, founder of the firm, writes about a serious problem with this country’s medical licensing boards, who have failed, at an alarming rate, to take disciplinary action against physicians, who have had their hospital privileges revoked, suspended or curtailed for issues such as sub-standard care, moral transgressions and the like. Public Citizen brought this story to light; we analyze the issue and share our thoughts on this serious patient health and safety issue.

Decreasing Obesity Risks in Children: Another Benefit of Breastfeeding A mom herself and an advocate for public health childhood obesityand safety throughout her legal career, Sarah Keogh reports on a recent study covered by the Baltimore Sun about the long-term benefits of breastfeeding for at least six months. The issue for many, however, is – how can a family of two income earners afford to do this? Does our society and the workplace really lend itself to this practice? Read Sarah’s compelling piece and share your experience and thoughts.

The Week Ahead

Sneak preview of what’s ahead during the week of March 28, 2011:

medical technology

Brian Nash begins a series on the issue of medical technology and patient health/safety. Is the medical community being properly trained in the proper and safe use of all the new medical devices that are hitting our hospitals, clinics and medical offices? Is the rush to have the newest, shiniest and “best” new medical device really advancing the safe and effective delivery of healthcare in our country? Here’s a sneak preview…

Dr. Roper and so many other dedicated healthcare professionals are faced daily with the same issue – “…challenged by the task of putting lofty ideas into practice at the local level. I remain very committed to the effort, but we are daily challenged to put the best ideas into practice.” Put another way – at least for me – taking public healthcare policy and practices and making a much better widget.

As these lofty concepts were debated, published and analyzed, technology streaked along with its new bells and whistles at what some might call an amazing – almost mystifying – pace. Did you really envision yourself 25 years ago sitting with your iPhone or iPad and scouring the world’s news, chatting with your friends and followers on the other side of the planet, watching the latest streaming video of March Madness or sharing every random thought you have on Twitter or Facebook?

Some top posts you may have missed

What happens when your surgeon has been up all night and you are being wheeled into the operating room to be his or her next surgical case? We looked at an article from The New England Journal of Medicine that addressed this patient safety issue and made recommendations for change.  See our posting entitled A Surgeon’s Sleep Deprivation and Elective Surgery-Not a good (or safe) combination.

Dr. Kevin Pho, who is the well known editor and contributor of KevinMD.com, wrote a piece in which he espoused his belief that medical malpractice cases really do not improve patient safety. Having read this piece and finding that this was just too much to digest, Brian Nash wrote a counter-piece entitled Malpractice System Doesn’t Improve Patient Safety – Oh Really? What this led to was cross-posting by Dr. Kevin Pho on our blog, Eye Opener, and our posting on his blog. Our blog post (as best I can tell) led to one of the all-time highest postings of comments by readers of KevinMD. One thing all participants in the “debate” learned – we are both passionate about our positions. Read what led to this firestorm.

 

Decreasing Obesity Risks in Children: Another Benefit of Breastfeeding

Friday, March 25th, 2011

Image from fooducate.com

In the United States today, one of the major health problems is obesity. The CDC reports that “[i]n 2009, only Colorado and the District of Columbia had a prevalence of obesity less than 20%.”  The number of both adults and children who are obese is huge and continues to rise dramatically.  The CDC website provides maps that show just how prevalent this problem is in our country. Particularly troubling is that “[t]hirty-three states had a prevalence equal to or greater than 25%; nine of these states (Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee, and West Virginia) had a prevalence of obesity equal to or greater than 30%).  This represents an enormous number of people in our country who are at risk for major health complications, such as “cardiovascular disease, certain types of cancer, and type 2 diabetes.”

While there has been an emphasis in our country on various ways to decrease these obesity statistics (including improving nutrition and increasing exercise), I wonder whether additional emphasis should be paid to children being given a great start to health. A recent article in the Baltimore Sun caught my attention. The article explains how diabetic moms, including those who had gestational diabetes during pregnancy but are not otherwise diabetic, are both more likely to give birth to a larger than average baby and also how their child is “more likely to become obese in childhood.”  The good news, the article explains, is that:

…a new study says that if you breastfeed your baby for at least six months, your child will be no more likely to put on weight than those whose moms are not diabetic.

This is just one more example of how breastfeeding for at least six months can dramatically improve your child’s chances of lifelong health.  Through breastfeeding alone, these moms can erase the increased risk that these children will become obese.

What they found appears to be a real advantage for breastfeeding: If the babies had been breastfed for six months or more, children born to diabetic moms looked nearly the same as the children of non-diabetic moms. And they were no more likely to be obese.

On the other hand, children who were breastfed for less than six months — and who had been exposed to diabetes in the womb — had significantly higher BMIs, thicker waists and stored more fat around their midsections than the other children in the study.

While I was excited to read about one more reason to support breastfeeding, I was concerned about whether this is a realistic choice for many families in our country.  Many moms who are committed to breastfeeding their children and who are successful at the start, do not continue breastfeeding for at least six months. The CDC Breastfeeding Report Card for 2010 says that “…3 out of every 4 new mothers in the United States now starts out breastfeeding… However, rates of breastfeeding at 6 and 12 months as well as rates of exclusive breastfeeding at 3 and 6 months remain stagnant and low.”  The national average is that while 75% of moms have breastfed, only 43% are breastfeeding at all at 6 months and only a mere 13.3% are exclusively breastfeeding at 6 months.  At 3 months, a time when infants would not have started solid food, only 33% of moms are still exclusively breastfeeding.  This means that there is a large drop off from what moms do when their babies are born and what they are doing by the time their babies reach 3 months.

However, the study about diabetes found that at least six months of breastfeeding was essential in protecting these kids from the increased risks of obesity. From both personal experience and anecdotal evidence, I suspect that many families are facing hard decisions about employment and breastfeeding. I suspect that a significant part of the large drop off between the numbers of moms’ breastfeeding at birth and those breastfeeding exclusively at 3 months has to do with employment. Given that the US lags so far behind other countries in paid parental leave, most moms have no choice but to go back to work full-time by the time their infants are 3 months (if not earlier).  Many moms face no choice at that point but to stop or severely limit breastfeeding, as few employers offer the time, space or scheduling to truly make moms successful at the difficult job of trying to pump while working.

I believe that the health care costs of treating individuals with obesity and all of the associated health problems should be examined against the costs of providing more complete support to new families.  What do you think?  Could employers better support breastfeeding in an attempt to increase the number of healthy children whose risks of obesity are lowered? Do you think that lack of paid leave or increased support in the workplace for breastfeeding is really the reason for decreased breastfeeding or are there other factors at play?