Strollerderby : c-sections

Should Healthcare Reform Start in the Maternity Ward?

Madeline Holler — Tue, 19 May 2009 18:01:00 GMT

While the Obama administration tries to hammer out healthcare reform -- one based, necessarily, on reducing costs -- surely (SURELY!) they are taking a hard look at childbirth in the U.S.

According to a 2008 report from the think tank Childbirth Connections, pregnancy is the most expensive condition for private insurers and Medicaid.

A recent article in the LA Times business (!) section puts together numbers that insurance companies and some doctors are starting to look at, as the former attempts to lower its costs and the latter attempts to improve outcomes.

Ahh, but what a thorny issue for a president to become involved in!

First, the surprises:

Childbirth is the No. 1 reason for hospital admission in the U.S.

Childbirth accounts for $79 billion in hospital charges alone of the nation's $2.4 trillion annual healthcare expenditures.

Cesarean sections are the most common surgery in the U.S.

Though one-third of all U.S. births are c-sections, rates among hospitals have mind-boggling variation. Among California hospitals, the c-section rate can be anywhere from 16 percent to 62 percent.

All those surgeries cost a fortune -- at an average of $4,500 for a c-section, that's twice as much as a vaginal birth in the hospital. For the privately insured, that number reaches an average of $13,000 for uncomplicated sections.

All these c-sections haven't improved outcomes. In fact, maternal deaths have risen since 2002.

Also, 48 percent of newborns admitted to neonatal intensive care units were from scheduled deliveries -- sections or inductions -- many of them before 39 weeks.

Miscalculated dates for inductions intended for 39 weeks gestation are also sending a growing number of newborns to the NICU until they can breathe on their own.

From the LA Times:

"We're going in the wrong direction," said Dr. Roger A. Rosenblatt, a University of Washington professor of family medicine who has written about what he calls the "perinatal paradox," in which more intervention, such as cesareans, is linked with declining outcomes, such as neonatal intensive care admissions. Maternity care, he said, "is a microcosm of the entire medical enterprise."

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Woman Gives Birth to Twins Minutes After a Heart Attack

Madeline Holler — Fri, 17 Apr 2009 22:06:00 GMT

Labor is hardly a walk on the beach and maybe even doubly so when giving birth to twins. But still, having a heart attack before giving birth -- to twins -- and being told you're going to die has got to pretty much wreck the whole event to say the least.

First-time mother Nina Whear, 38, experienced all that -- including saying good-bye to her husband before her predicted death -- just before delivering Evie and Alfie, who weighed 3lb 11oz and 4lb 10oz.

Shortly after the twins' birth, doctors performed heart surgery. And get this -- mother, Evie, Alfie, daddy -- everybody's recovered nicely!

Whear suffered a massive heart attack on her due date and was rushed to the hospital, where the babies were delivered via c-section. A chaplain was dispatched to her room -- doctors had only given her a seven percent chance of surviving. She said good-bye to her husband and then was wheeled in for heart surgery.

Here's what she thought following the surgery (from the Telegraph):

"When I woke up after the operation I couldn't talk, but I tried to signal to the nurse to say that I couldn't believe I was alive, although I don't think she understood what I meant.

"I was so shocked that I didn't even think about the fact I had just had twins, I was just amazed to be alive."

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How Many of These Pregnancy Blunders Have You Made?

Jen Chaney — Wed, 25 Mar 2009 13:34:00 GMT

We all make mistakes, especially when we're pregnant and our hormones are wreaking havoc on our ability to process information. That may be why, according to an article on the Web site Divine Caroline, intelligent women often commit a few errors when they're with-child.

The site has published a list of Eight Blunders Even Smart Pregnant Women Make, which recently also was featured on the Web site Empowher. I was surprised by a few items, but also must acknowledge that I committed some of these during my nine months of fetus-carrying. Hey, I can 'fess up to my mistakes if you can 'fess up to yours'.

Of the eight errors on the list, here are the ones I made:

Eating For Two -- The Empowher list says most women only need an additional 300 hours calories per day when they're pregnant, but many consume much more than that, and not always of the healthy variety. Uh, yeah, guilty as charged on this one. I ate all kinds of things I shouldn't have when I was pregnant: burgers, hot fudge sundaes, my weight in Cheez-Its and more Christmas cookies than I can count. I was so relieved when I found out I didn't have gestational diabetes that I went on a sugar binge to celebrate. Not smart, Chaney. Not smart.

Decreasing Activity: In addition to gorging, I also was a lazy bum. I exercised a little: occasional gym visits and long walks with the dog. But not nearly as much as I should have. Although, comparatively speaking, I looked like an Olympic athlete compared to how often I hit the gym now. Apparently I am not just a stupid, unhealthy pregnant woman, I'm a stupid, unhealthy woman period. (Wow, this list is making me feel fan-TASTIC about myself.)

Not Addressing Emotional Well-Being: I can't say I got enough sleep or perfectly managed my stress when pregnant. Then again, being aware that I needed to put "address emotional well-being" on my to-do list probably would have only added to my stress.

Now, here are the items on the list that I find understandable, even though I didn't commit these blunders myself:

Not Continuing Medications for Pre-existing Diseases: A lot of women are understandably concerned about taking any sort of medicine while pregnant, so I can see how this might be a common problem.

Skipping Breakfast: Again, when things are busy, can totally see how this happens to some moms-to-be. Me? I was too hungry to even consider it. (Please see previous reference to overeating for two.)

Installing the Car Seat at the Last Minute: It's an unpleasant task and one many of us are inclined to put off. Seems like this might be the most widespread blunder of all.

And finally, the two items on the list that I found most debatable:

Not Buckling Up: Apparently some women get all weirded out by wearing their seat belts because they are afraid it will harm their child. Okay, fine. I still find it hard to imagine taking that fear to the next level and just not bothering to wear a seat belt at all. Are many moms out there really taking this risk? You tell me.

Electing for a C-Section: This is probably the most controversial item on the list. Plenty of women undoubtedly would say that going this route isn't a blunder at all. I had a C-section, though not by choice, and I have to say that I didn't have too much trouble recovering, nor did I have any infections. This one strikes me as a matter of opinion vs. a flat-out mistake that smart pregnant women make.

Okay, I've confessed my pregnancy sins. Now it's your turn: Which of these errors did you commit? Or are you so awesome that you invented a few that Divine Caroline hasn't even heard of yet?

Image: Divine Caroline

French Politician at Work 5 Days After C-Section

Miriam Axel-Lute — Tue, 13 Jan 2009 22:31:00 GMT

Rachida Dati, French justice minister, attended a cabinet meeting last week five days after giving birth by c-section. It might not be giving a speech while leaking amniotic fluid, but the move sparked a lot of outrage across France, with a majority of the public saying it was "too soon" and she should have used more of the four months (six weeks before, ten after. swoon.) she had coming to her.

In fact, another minister has proposed a measure in response to explicitly state that expected practice is that a deputy will step in for a politician on maternity leave to increase the number of people in those kind of jobs who actually take their leave.

I'm of mixed minds on the whole reaction. Of course I would dearly love to be in a country where we are arguing over whether someone should take maternity leave that we assume is available to us, especially after the heart-wrenching stories people put in the comments to my last post on maternity leave. And the additional proposal sounds dandy.

But then we get to the whole mommy police thing. Sure, I personally cringe at the thought of anyone popping off to a meeting five days after either giving birth or having major abdominal surgery, let alone both. But is it the end of the world? Is one woman making that choice really going to constitute dangerous pressure on other women to do the same, as French women's groups are suggesting? I guess I can see it might make some employers feel more free to push for short use of leave, but I'm still inclined toward the "Lay off!" side of this one. It's just not going to work the same for everyone.

And, of course, it needs to be said that fathers don't get the same kind of treatment.

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They Say: Planning to Work Until the First Contraction? Plan for Surgery.

Miriam Axel-Lute — Thu, 08 Jan 2009 20:00:00 GMT

Women who worked up until their due date had four times the rate of c-sections as women who started their maternity leave at 35 weeks, a new study from UC Berkeley has found.

Now, I'm not sure how you can control for self-selection in that kind of study. I imagine that women starting their maternity leave early are both more likely to be placing a priority on their birth experience and better off financially, each of which could affect their outcomes. (I'm assuming they excluded people with scheduled c-sections from the study.)

On the other hand, the results were is four times as likely, not a titchy 10 to 15 percent or something. That, as Dr. Seuss might say, is a whopping number, and it makes me inclined to think there really is something going on here.

It's not really hard to imagine what either: On the one hand, there's the stress of trying to do your job with an open-ended question of whether you might have to leave at a moment's notice, trying to have things ready and yet still work, with bosses and people who are going to step into your shoes watching you anxiously. And other hand, there's the stress of trying to decide when/if you have to leave when contractions start, whether you're up for driving yourself home, when to call the family, and then changing gears in an instant from worker to woman-in-labor. Hardly optimal conditions.

I was lucky: Since I was leaving my job instead of taking maternity leave, it was easier for me to choose to set my last day at 35 weeks. And I have to say, since my daughter came early (37 weeks and 2 days), I'm extremely glad I did. Even though you never exactly feel prepared, having tied up loose ends, cleared out my desk and said my goodbyes and then taking those two weeks free of deadline pressure and office details to sleep/nest/prepare felt wonderful. It may be the closest thing to taking a complete vacation without traveling I've ever done. Can I prove that that helped with my fairly uncomplicated birth? Of course not, but I wouldn't be surprised.

I know how much of a luxury that sounds like to so many people. I sure as hell couldn't blithely skip five (or even two) weeks of work now. In general, it's hard enough to get maternity or paternity leave at all, and the UC Berkeley researchers, while advocating strongly that maternity leave start earlier, note that people who choose to work up to their due date (or up to their labor as the case often is) are usually doing so because they can't afford maternity leave after the birth otherwise, and clearly that trumps.

I guess for now we can add the health advantages they've identified to the list of casualties of our work-over-family culture.

Image from Take Back Your Time.

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They Say: Moms Shut Down Infant Brains During Birth (It's a Good Thing)

Miriam Axel-Lute — Tue, 07 Oct 2008 17:17:00 GMT

Ah, oxytocin, how we love you. Or how you make us love others. Or something. But that's not all. Oxytocin, the hormone associated with social relationships, including maternal-infant bonding, lust, and trust, now has a different kind of role to add to its resume:

Science blogger Ed Yong explains that apparently the flush of oxytocin that is released when a fetus's head starts pushing on the inside of the cervix in labor sends a "chill-out" message to the newborn brain, causing it to not respond for a while to the neurotransmitter known as GABA, which pre- and post-birth usually keeps all those nerve cells firing away at rapid pace, learning and growing.

My first reaction to this was wonder if this was a way of softening the psychological drama of leaving the warm, soft, wet womb and its constant heartbeat and heading out into this big bad world.

That may be a side effect, but the researchers seem to think it's a little more pragmatic than that: When a baby brain is all zen on oxytocin, it needs a lot less oxygen, which means it's at much less risk of damage from a temporary oxygen deprivation, one of the most common dangers of birth. Handy.

It's cool to know your hormones are that on the ball. It also seems like oxytocin is powerful enough on so many fronts that even if you do need to plan a c-section for some reason you might want to wait until labor starts to give you and your kid that hormone hit. (Waiting for labor, as I learned from my friend who recently insisted on it, is apparently exceedingly rare. Perhaps that's a post for another time.)

In the meantime, I wonder if large enough doses of oxytocin would chill out my brain for a while?

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Two women found guilty of illegal midwifery

Brett Singer — Sat, 06 Sep 2008 21:00:00 GMT

This is a serious issue, but I have to say that the term "illegal midwifery" sounds like something out of a bad Shakespeare parody.

Now that I've gotten that out of the way, here's the story:

"Tonya McGlade was found guilty of Attempting Midwifery Without a License. Linda McGlade was found guilty of Principal to Practice Midwifery Without a License.

"Prosecutors say the women helped Linda McGlade's other daughter-in-law deliver her baby boy. She died of internal bleeding two days after giving birth back in 2004."

In other words, they attempted to deliver a baby without having a license to do so. Sadly, the mother died; the baby survived. This site has a lot more detail if you're interested (fair warning: it's very sad).

What I'm wondering is, just how prevalent is this practice? If someone decides to give birth at home without a trained person present (midwife, doctor, nurse, whatever) and nothing goes wrong, would they be prosecuted as well? Judging by what I've seen on Babble, home births are far more common than I realized. If I had to guess, I would say that a large percentage of these births are against the law. And something else: isn't the problem that the patient died and received poor treatment, rather than the midwife's lack of license? I mean, you can get a midwife license online. (CORRECTION: according to a commenter, that web site only offers the coursework; to get licensed you have to complete your training under supervision.)

Image/source: mysuncoast.com

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New Mom Sues After No-Meds C-Section

Madeline Holler — Sat, 06 Sep 2008 15:36:00 GMT

There's unmedicated birth, and then there's unmedicated birth. It sparks much discussion, passionate arguments on all sides. But I think there's one thing everybody agrees on: anesthesia and c-sections were kind of made for each other.

Just as this mom in the U.K. who had to endure her daughter's surgical birth without a working epidural. She'll tell you the pain is so great, the situation so totally terrifying that it has quelched her dream of having more children.

Here's what happened:

Sarah Carberry, 27, was 38 weeks pregnant when her water broke. Doctors said she could not be induced and that she would have to give birth to her daughter via c-section. She agreed, changed into her gown, got the epidural. They wheeled her in for the surgery.

She said she knew right away that the epidural hadn't worked and told doctors she would feel the knife. They told her that was nonsense and that she was just stressed. They started to cut. She felt the knife.

It was only when they cut my womb open and I was screaming in agony that they finally took me seriously.

'I was shaking in pain. I was convinced I would die, but no one would listen to me. They continued until my husband said, "Stop the operation".'

The doctors suspect there was a kink in the tube that delivered the anesthesia. So the anesthesiologist decided to top off her epidural. ... but Mrs Carberry said the glass container which holds the liquid shattered, and he said: 'There's nothing else we can do for you.'

She refused general anesthetic since she had lost all trust in her doctors and didn't want to be knocked out for the baby's birth.

'The female surgeon said she could see the baby and needed to get it out. I told them just to get the baby out.

'I gripped a medic's hand throughout the operation and did breathing exercises, all the time asking them how long the operation was going to take, to focus my mind on the end. It was excruciating.

'They had to stitch up muscle, tissue, layers of fat and the skin. I felt it all. It was awful.

... Mrs Carberry was allowed home with Ruby after four days but had to be readmitted a week later as the caesarean scar was infected. She spent a week in hospital while her husband looked after Ruby at home.

The baby is fine and the mother is also, though she still hasn't heard from the hospital regarding an investigation into her case.

Ouch. Ouch, ouch, ouch. I've heard of epidurals not working, but never during a c-section? Anybody else endure a meds-free surgery?

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Photo: The Daily Mail

Is Home Birth a Civil Right?

Hannah Tennant-Moore — Sat, 09 Aug 2008 19:00:00 GMT

Most people agree that where and how to give birth is a personal choice. But what if your choice is one that many doctors feel is dangerous for you and your baby?

A resurgence in the home birthing movement has doctors and midwives grappling with this question, and Babble’s own Ada Calhoun has researched the heck out of the issue for Time.

Women who opt for home births argue that this method allows them more control over their birthing experience, making it unlikely that they will undergo interventions, such as C-sections or episiotomies, that they don’t feel are necessary. Midwives only assist at home births for low risk patients, and are trained not only to deal with emergencies themselves—often in the exact same way an obstetric nurse would—but they also know when it’s necessary to bring a patient to the hospital as quickly as possible.

But many doctors argue that the best medical care can only be accessed in the hospital—period. The American Medical Association is urging lawmakers to restrict the home birthing movement, in part by making it more difficult for direct-entry midwives (who don’t have nursing degrees) to get licensed.

Currently, only 1 percent of U.S. births occur in the home. So midwife Joan Bryson seems justified in defending home birth’s safety in these terms: “We [the U.S.] rank 42nd in the world in live births, and we spend more money than anyone else. You can’t blame it on home birth.”

My personal experience makes me naturally inclined to side with Bryson. Both my sister and I were born at home with a midwife, and my parents describe the experience in near ecstatic terms (honestly, their extreme enthusiasm when recounting my mother's 12-hour labor can be a bit disconcerting). Also, my older sister never exhibited the jealousy and sense of displacement that many older children feel after the birth of a sibling. I believe this was in part because she was present in the house while my mother was in labor, and was able to see my mother and me almost as soon as I was born. There was no sense that her mother had disappeared, and then returned carrying the reason for her disappearance.

It goes without saying that giving birth at home is not for everyone—but neither is giving birth at a hospital. Competent midwives should not be subject to prosecution for allowing women to opt out of a traditional hospital birthing experience.

Photo: Time

Have a C-Section? Pay Higher Insurance Premiums

Rachael Brownell (Redsy) — Sun, 01 Jun 2008 00:10:00 GMT

To add insult to injury, some women have to pay higher health insurance premiums after having c-sections, according to a report in today's New York Times.

As more and more people are no longer covered by employer-covered group health insurance, they might be surprised to find that finding individual coverage is more of a challenge.

And apparently, this is especially so if you've had a c-section.

Coverage rules vary from state to state, but the Times article highlights one company (Golden Rule) who when they receive an insurance application from a woman who has had a c-section who is under 40, rejects her outright if she lives in a state that disallows c-section exclusions.

In other words, health companies suck even more than they ever did!

[Photo Credit: Consumerist]

Nation's Largest Hospital to Ban Vaginal Deliveries

Rachael Brownell (Redsy) — Tue, 01 Apr 2008 20:32:00 GMT

New York's Sister of Mercy Hospital announced today that it would cease allowing vaginal births immediately due to the high costs associated with non-c-section births.

Despite the bad press c-sections unfairly receive, they are by far preferable to their vaginal counterpart...

According to hospital administrators, women just aren't as capable of delivering vaginally as they were 20 years ago. And with the clean predictable schedules c-sections allowed, maternity leaves (unpaid) can be shortened from 4-6 weeks to just one week (with the proper medications).

Here's hoping other hospitals follow suit..