Posts Tagged ‘newborn health’

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.

 

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?

 

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

Wednesday, March 9th, 2011

Having our baby

Once the special moment comes for you to go to the hospital to deliver your baby, there’s so much that goes on that it just may not be the best time to remember questions you wanted to ask your obstetrician. I’ve been there four times – so, as they say, been there done that! I’ve also had a number of cases that made me stop and think – “I wonder if some of the issues that my clients encountered could have been avoided if they had asked some questions before they wound-up in labor in hospital?” As you can well imagine, that is perhaps not the best time for a Q and A session.

This past weekend, I posted somewhat of a survey on our Facebook Page and Twitter asking our friends, fans and followers what questions they wished they had asked their obstetricians before they arrived at the hospital. I also have a number of moms, who work in our law office; so I put the question to them as well. The responses received provided some interesting food for thought, which I thought I might share with those about to have their baby.

Who will be delivering my baby?

This was one of the most frequent questions making the list. A number of women complained that they wish they had known that their primary obstetrician was not going to be the delivering doctor. Turns out that physician was being covered the day/night these moms delivered. While they may have met all the members of the practice (if it was a group practice), they were not particularly happy when their primary obstetrician wasn’t there for the delivery. The problem is compounded when their primary obstetrician was off and being covered by someone they had never met before. Suggestion: find out as best you can what the chances are that there will be coverage by someone you’ve never met before you arrive at the hospital. You may want to make an appointment to meet that potential covering physician if this is a concern.

When will I see my obstetrician at the hospital?

One of the cases we are handling somewhat arose from a situation that raises this as an issue. You get to the hospital, you’re admitted, you’re placed in bed, monitor attached – you’re good to go. But – where’s your doctor? Does he/she even know you’re there? When is your obstetrician coming to see you? Several of the women who responded said this was a real concern and wished they had discussed this with their doctor before they sat in bed waiting and waiting for their doctor to arrive. They also wondered – if there was no direct phone call before going to the hospital, just how could they be sure their doctor was notified that they had arrived. In one instance, one obstetrician claimed she didn’t know the patient was even in hospital for more than 4 hours! This woman had to undergo an emergency C-Section when the doctor allegedly figured out she was there. Suggestion: confirm with the hospital staff after you arrive that your doctor has been notified that you have arrived and ask when you might expect for your doctor to arrive and examine you.

Who will be doing the circumcision of my baby boy?

A number of parents indicated that while they had discussed whether their newborn son would have a circumcision, it hadn’t crossed their minds to ask – “Who will be doing the procedure?” If this is an important consideration, and you would like an answer not only as to “who” but “what experience” they have, think about covering this with your obstetrician beforehand. While some physicians are very good at performing this procedure, others are not so good. There have been a number of infant penile injuries that we have happened in the hands of – well let’s say – less than skilled physicians.

What will happen if for some reason I require general anesthesia but I’ve recently had a meal?

One of the common orders for a patient who will undergo general anesthesia is that they be NPO (nothing by mouth – liberal translation) for hours prior to surgery. While you may have planned to have an epidural or natural childbirth, some conditions involving you and/or your baby (non-reassuring fetal heart tracing, placental abruption, etc) can occur that may change the “plan” and require that you undergo a different form of anesthetic management. Suggestion: if such a situation should arise, you will be seen by an anesthesiologist first. Perhaps you will have a discussion about possible alternatives for anesthetic management, but I can virtually assure you, that will not be the best time to have a coherent, meaningful discussion. Some have suggested, based on their experience, that asking for and having a meeting with anesthesia personnel before going to the hospital for delivery is time well spent. You can usually have such appointments made through your obstetrician’s office and have a meaningful discussion of the various alternatives, risks and complications at that time.

How long will the effects of my epidural anesthetic last after delivery?

It’s been pointed out to me that while some hospitals have discontinued the practice of providing pain relief (analgesia) post-partum by use of PCA (patient controlled analgesia) pumps, some hospitals still continue that practice. Regardless of what the hospital’s practice may be, there is usually a very consistent practice/protocol for when a woman who has had an epidural should be discharged from a recovery room/area. This is when she is able to bend her knees, move her hips and flex her feet in both directions. Suggestion: ask your obstetrician what his/her practice is for providing you pain management/relief after you deliver your baby. Will you have an epidural running to provide that relief? When should you expect to get return of your ability to use and feel your legs? Don’t guess – you could suffer what is known as a prolonged block, where the anesthetic, for various reasons, is taking too long to wear-off and affecting your neurological functioning. If your obstetrician doesn’t know, then consider talking to specialist in such pain relief techniques – the anesthesiologist at the hospital where you will be delivering your baby. While you’re there, you may also want to discuss what the risks, benefits and complications of epidural, spinal and general anesthesia are so that you are aware of these issues in advance.

What suggestions do you have?

This is only a partial list of a number of suggestions made by our readers and staff. What suggestions do you have? If you have already been through childbirth, are these matters or issues you wish you had discussed before you went to the hospital? If you are about to have your first child, are these issues, concerns or questions you might share? We – and our readers – would really like to hear from you. There is no substitute for experience – or so they say.

Image by corbisimages.com


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Pregnancy Gingivitis: Simple ways to avoid risk for you and your baby.

Friday, February 25th, 2011

I recently came across a website that offers a lot of really good advice for parents-to-be, and I’m happy to promote it on our blog. You may want to visit The Pregnancy Zone and bookmark it for future good reads. If you are a long-time reader of our blogs, you know by now we are really into sharing health and safety information with our readers. As we say on our Twitter page, we are lawyers trying to get the word out so you never need people like us

A recent post on The Pregnancy Zone brought to my attention a condition that, quite frankly, I was not all that familiar with - pregnancy gingivitis. Gingivitis is probably a condition that you are already familiar with. Simply put, it is a form of periodontal disease, which involves inflammation and infection that destroys the tissues that support the teeth, including the gums, the periodontal ligaments, and the tooth sockets. What I didn’t realize is that it has a real potential risk for moms-to-be and their babies. Watch this video by Dr. Jaimie Johnson for a better understanding of why it is important to not overlook this basic element of your prenatal care.

httpv://www.youtube.com/watch?v=c8Uip6hr3vM

So why is this so important? Premature delivery is the primary reason.

At least a couple of major studies have shown that there is a link between gum disease and premature birth. Researchers of one study who published their results in The Journal of the American Dental Association found that pregnant women with chronic gum disease were four to seven times more likely to deliver prematurely (before gestational week 37) than mothers with healthy gums.

Mothers with the most severe periodontal disease delivered the most prematurely at 32 weeks. The researchers’ study did not address if treating gum disease would reduce the risk of preterm birth, adding that more studies need to be conducted to answer this question. Their main findings, however, support the results of another study that also showed that premature, underweight babies were born more often to mothers with gum disease.

Source: WebMD:

What also drew my attention to this topic was a story of a mom, who suffered a stillbirth at full term. The best cause for how this could have happened, according to her doctors, was that the bacteria from her dental condition had directly affected the placenta, leading to the death of her fetus in utero.

What is a bit disturbing about the WebMD post is the statement that the study “did not address if treating gum disease would reduce the risk of preterm birth, adding that more studies need to be conducted to answer this question.” Clearly, some blogs and videos on this topic indicate that there is a treatment-risk reduction benefit. It does seem to make common sense, doesn’t it?

Would love to know if you have any information to share about any other studies, ongoing research and the like on this topic. Sure seems that – at a minimum – getting good dental care during your pregnancy is sound advice and surely worth the effort in case there is a direct cause-effect-treatment relationship perhaps is the case.


Newborn Mortality Rate Significantly Higher in Home Births – Are Home Births Worth the Risk?

Friday, July 16th, 2010

A recent study published by the American Journal of Obstetrics & Gynecology suggests that there is a significant increase in the newborn mortality rate in cases of planned home births when compared to hospital deliveries. The study conducted by Joseph R. Wax. M.D. included data from 342,056 planned home births and 207,511 planned hospital deliveries. The data was collected from a number of industrialized Western nations. Researchers found that:

Although rare, newborn deaths occurred in 0.2% of the total planned home births included in the analysis, compared with 0.09% of the total planned hospital births. Among infants born without any birth defects, the rates were 0.15% vs. 0.04%, respectively.

These findings suggest that, in cases of home birth, the newborn mortality rate was almost twice as high when compared to hospital deliveries and almost tripled in cases involving newborns with congenital abnormalities. One explanation for these findings is that newborns have less medical intervention, which can result in respiratory distress and failed resuscitation.

This data is particularly surprising considering that most women, who participated in home births, had fewer overall obstetrical risk factors (e.g., obesity, previous pregnancy/delivery complications, c- sections). Additionally, the study also suggests that while the newborn mortality rate increased in cases of home births, the mothers were less likely to develop a number of complications, including infections, perineal/vaginal lacerations, bleeding, and retained placentas.

For many women, the decision to proceed with a home birth vs. a hospital delivery is not an easy one. It is usually motivated by a number of factors, such as preconceived notions about medical care, family history, and opinions regarding c-sections, among many other things. If you are expecting, whatever you do, make an educated decision about your delivery.

Child Safety Tips: As mercury goes up, so do safety risks for kids!

Wednesday, June 2nd, 2010

By picpoke.com

Yes, it is really getting hot out there this week!!!  Coming from Florida to DC last year, I thought “OK, so it will not get nearly as hot up here, or at least not as early in the summer.”  Yes, I was wrong.  This thought brought me to thinking about some of the fun things to do in the summer, but also the dangers for our little ones during this time if we are not extra careful.  Lo and behold, I found this article today, courtesy of the Dallas Morning News and reprinted by the Kansas City Star:

Emergency-room professionals have their own name for the long, lovely, lazy days that kids look forward to in summer: trauma season. Because that’s when hospitals see a spike in drownings and heat-related accidents.

The article discusses several myths and related facts associated with those myths.  Here are a few samples from the article:

MYTH: Pool parties are safe as long as adults are around.

FACT: Many drownings happen when adults are close by. The problem is too much commotion. The key is to have a designated adult watching the water because that is where the danger is. The pool should be free of excess toys that can block the view of the water.

MYTH: Floaties keep little ones safe in the water.

FACT: Floaties are designed for fun, not safety. They give a false sense of security, can deflate and can slip off.

MYTH: The kids will be fine in the pool for the short time it takes to answer the phone or get a cold drink.

FACT: In a minute, a child can go under water. In two or three minutes, the child can lose consciousness. In four or five, the child could suffer irreversible brain damage or die. According to the Centers for Disease Control and Prevention, drowning is the second-leading cause of unintentional, injury-related death for children 1 to 14 years old, second only to car and transportation-related accidents.

The article states several other myths and facts, which include the hazards of leaving children unattended in cars and car seats, as well as sun exposure and dehydration.  We encourage you to read the article in its entirety.  Let’s all have a safe summer out there, please!!

Use Of Acetaminophen In Pregnancy Associated With Increased Asthma Symptoms In Children

Saturday, February 6th, 2010

Medical News Today recently issued a report on a study, done by the Columbia Center for Children’s Environmental Health at Columbia University’s Mailman School of Public Health, in which children who were exposed to acetominophen (Tylenol) prenatally were at increased risk to have asthma symptoms by age 5.  Use Of Acetaminophen In Pregnancy Associated With Increased Asthma Symptoms In Children.

While the study involved 300 African-American and Dominican Republic children living in New York City, the potential relevance for broader concern for African-American and Hispanic children  is evident.

[The study] found that the relationship was stronger in children with a variant of a gene, glutathione S transferase, involved in detoxification of foreign substances. The variant is common among African-American and Hispanic populations. The results suggest that less efficient detoxification is a mechanism in the association between acetaminophen and asthma.

“These findings might provide an explanation for some of the increased asthma risk in minority communities and suggest caution in the use of acetaminophen in pregnancy,” says Matthew S. Perzanowski, PhD, assistant professor of Environmental Health Sciences at the Mailman School of Public Health.

What is of some related interest is the fact that online postings regarding acetaminophen suggest that this may be the drug of choice for conditions as short-term fever and minor pain during surgery.

For example, Medicinenet.com’s posting, (which certainly predates this study) states in pertinent part:

SIDE EFFECTS: When used appropriately, side effects with acetaminophen are rare.

This most recent study appears to have some similarity to a prior study, at least according to the article on Medical News Today:

In a similar study conducted in the UK, the frequency of acetaminophen use during pregnancy and the magnitude of association in the UK study were similar to that in New York City.

So – Moms-To-Be, consider discussing this study with your OB before reaching for that bottle of Tylenol.