Strollerderby : prenatal care

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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Photo: LA Times

Grieving a Lost Pregnancy? Sorry, We'd Like a Drug Test

Miriam Axel-Lute — Thu, 12 Mar 2009 22:00:00 GMT

The fight over when women lose all rights when they become pregnant continues. A bill under consideration in Tennessee would mandate drug and alcohol testing for pregnant women under several conditions:

(1) No prenatal care;
(2) Late prenatal care after twenty-four (24) weeks gestation;
(3) Incomplete prenatal care;
(4) Abruptio placentae;
(5) Intrauterine fetal death;
(6) Preterm labor of no obvious cause;
(7) Intrauterine growth retardation of no obvious cause;
(8) Previously known alcohol or drug abuse; or
(9) Unexplained congenital anomalies.

Refusal of "treatment" results in referral to child protective services. Now, there are all the usual (good) arguments to made in response against mandating drug testing and rehab for pregnant women, such as: it deters them from seeking health care in the first place; it interferes with a doctor's judgment; treatment is impossible in a state where there are aren't enough beds available and nearly all the facilities don't take pregnant women or allow women to bring their children along (see Salon for details).

But as Rachel from Women's Health News points out eloquently, the list of triggers for the testing here adds a whole extra layer of ick: Preterm labor? Intrauterine death? We don't know what causes these things most of the time—are we now going to by default blame them all on the mother's behavior? Should a woman grieving a lost pregnancy not be able to drink for while for comfort without fear of being sent to rehab or losing her other kids?

And how about "incomplete prenatal care"? So now it is not up to us to choose whether we want ultrasounds or invasive tests that tell us nothing or carry a risk of miscarriage themselves?

If you care about the effects of drug and alcohol abuse on kids, for god's sake spend your energy making the treatment system actually work.

Photo by michab37.

More by this author:

Low Birth Weight Babies, Especially Girls, Likely to Develop Autism

Cole Gamble — Thu, 05 Jun 2008 17:05:00 GMT

The possible causes for autism grew by one today as new research finds babies born before term, underweight and especially female are twice as likely to develop autism… This is according to a report by the U.S. Centers for Disease Control and Prevention. Although it is not understood what this link means, experts say it is further prompting for pregnant women to seek prenatal care. Currently one in every 150 children in the US is autistic and 1 in every 8 children is born premature.

Non-Stick Cookware Causes Low Birthweight?

Karen Murphy — Mon, 20 Aug 2007 11:27:00 GMT

Haul out your cast iron cookware if you're pregnant, or at least your stainless steel All-Clad: birth weight and size may be affected adversely by prenatal exposure to chemicals used in non-stick cookware and other things.

At least, it is in rats.

Rat research shows that exposure to the chemicals perfluorooctane sulfonate (PFOS) and perfluorooctanoate (PFOA) affects the developing wee rat fetus. And a study was made of 293 pregnant women: cord blood samples were tested for PFOA and PFOS and the levels were examined in relation to pregnancy outcomes, and it was found that cord blood levels of both chemicals were inversely related to birth weight and head circumference.

Obviously, further research is necessary to determine whether there is an actual causal relationship here, but if you're pregnant you may as well hang up your omelet pan for a few months.

It can go next to your cigarettes, deli meats, and martinis. Which will make for one hell of a party after the birth when you can have fun again.

Pregcellent: You Are Getting Sleepy...You Will Do Whatever Liz Lange Says

Jessica Ashley (Sassafrass) — Wed, 15 Aug 2007 19:55:00 GMT

Attention all pregnistas! Stop your prenataling immediately and listen to Liz Lange. Liz Lange makes maternity clothes for the stars! Liz Lange makes maternity clothes for the masses! Liz Lange has two kids! According to a recent press release, "Liz Lange is practically a maternity EXPERT!" But if you are worth your Week 28 weight in maternity info, you already knew that.

I do love Liz's take on belly clothes and I admit, I've come this close to buying some of her adorable capris with the soft elastic waist that beckons me from the Target clearance rack years after I gave birth. I'm just curious as to how her mad design skills make her an expert on all things pregnancy. Among her tips for being pregnant and pretty all at the same time are (and I quote):

1. Dress

"The best thing to do on the days you feel enormous is to actually show off your pregnancy."

Liz strongly urges all expecting mothers to find maternity clothing that fits them properly. Just as in your non-pregnancy life, clothing that is too tight or too loose can make you look and feel larger. Another quick fix for when you are feeling down about your new size? Try what Liz calls "dipping," which is dressing from top to bottom in one color such as black or dark brown.

2. Beauty

"Nothing wakes up your look like mascara, even if you can't stand makeup, invest in a good black mascara to instantly revive your appearance. It's like a cup of coffee for tired eyes."

Liz also suggests treating yourself to a facial every few weeks to really let the glow of maternity shine through. Even if you have never had a facial before in your life, starting during pregnancy is a wise time as many women undergo dramatic complexion changes and need to be re-educated on how to care for their new skin.

3. Exercise

"You're first impulse might be to veg out in front of the TV when you feel crummy, but you should do just the opposite. Don't worry, you don't need to run a marathon, but just a simple walk around the block will get your heart pumping and jumpstart your spirits."

Liz also recommends that women try to schedule some moderate exercise at least 2-3 times a week during their pregnancy. It aids in circulation and strengthens the body for labor. Liz always suggests consulting a doctor before starting any exercise routine, however.

You won't be surprised that our own Kelly said, "Liz can kiss my ass with that 'cup of coffee for tired ass bullhooey." You know what was like a cup of coffee for my tired eyes when I was pregnant? A little good morning romp with the Baby Daddy (Hello and Happy First Trimester!). After 30 weeks, I was very happy to get all dolled up in my hawt maternity clothes after I Benedryled it up through those otherwise sleepless belly-hauling nights. At 3 a.m. with a kicky fetus, swollen feet and an aching back, mascara would become more of a weapon for said Baby Daddy than a tool for rejuvenation. I'm just saying maybe Liz Lange should rethink the whole tip thing.

Liz Lange, you are not the devil, but maybe you should stick to your colored pencils and fabric swatches and let real experts like Lisa Rinna dole out the advice. (That's a joke, people. We all know Lisa Rinna should keep her expertise focused on lip inflation and dramatic soap opera facial expressions).

Pregcellent: Finally, a Tolerable Timeline

Jessica Ashley (Sassafrass) — Wed, 01 Aug 2007 14:02:00 GMT

Join me, mamas-to-be, in a collective cringe at the pregnancy newsletters that arrive right on time in your inbox every Monday and refer to your fetus in fruit terms. I shudder to think of the embryonic nectarine that blows up to a monster grapefruit in a matter of days. Would you, perhaps, just like to know the facts? Possibly skip the paragraphs on why you shouldn't snort blow while you're growing a human brain in your belly and why more than one sheer slice of deli ham will cause something freakish to happen in utero? Maybe read up on your cell-dividing wonder in swanky British terms?

This pregnancy timeline courtesy the BBC is a straight-shooting, no judgement, week-by-week peek into what's happening with your foetus and what you can expect in your many ante-natal appointments while you're cheggers. Bookmark or simply print while you're stuffing your face with lunch meat, guzzling coffee and trying to fit your feet into flip-flops. And don't forget to delete those fruit newsletters.

Ahhh, much better, right?

Eating Reasonably While Pregnant: How Novel!

Melissa Summers — Fri, 27 Jul 2007 15:27:00 GMT

Meg Hourihan of Megnut points us to this op-ed piece in the New York Times about the cultural food taboos pregnant women face while gestating. He points out in Japan eating raw fish is considered good nutrition for expecting mothers and how pregnant French women often indulge in wine and unpasteurized cheese in moderation. Shaw points out faulty logic, a lack of scientific data and a culture of fear which creates these 'rules' for women in the United States. He goes so far as to call the prohibition of sushi/raw fish consumption insulting to the Japanese culture.

Meg goes further to explain her well thought out analysis of what she would and would not eat during her pregnancy. She says she researched each food prohibition, categorizing each restriction as one which could cause illnesses which affected the fetus and those which did not. "would eating something make me any sicker because I was pregnant than if I weren't? Or would the outcome be the same?" She admits the "puritanical impulse" and the resulting guilt Shaw writes about in his piece was strong as she evaluated her need to be worked up about what she ingested for the 9 (10.5) months of her pregnancy.

I could go on and on about this issue as I've heard hushed admonitions of pregnant mothers from other women, "Is she eating a California roll? She shouldn't be giving birth if she can't give up sushi for 9 months." Gasp! A small piece of cooked crab with rice? CHILD ABUSE! But instead of listening to my anecdotal bitching, why not read something more well thought out and reasoned?

Low Cholesterol Diet Better. For the Babies, That Is.

Kelly Mills — Tue, 24 Jul 2007 12:30:00 GMT

Some Norwegian researchers found that when pregnant women consumed a low-fat, low-cholesterol diet, it seemed to improve blood flow to the fetus. More examination is needed, but so far "the authors suggest that it may involve certain anti-inflammatory effects associated with a drop in LDL cholesterol, the "bad" cholesterol, in the mother." Hmmm.

You know what? I think all this is just part of a giant conspiracy to suck all the joy and pleasure out of pregnancy. In my case, we called that nine months "the time I ate like Elvis." If you can't chow down on a giant bacon cheeseburger, onion rings, and chocolate shake when you're pregnant, for god's sake, when can you? Is it just supposed to be nine months of nothing but puking and hair loss and stretch marks and feet so big you can't even find flip flops that fit? Huh? HUH?

In yer face, Norwegian researchers.

Pregcellent: (Big Old Beautiful) Belly Dancing

Jessica Ashley (Sassafrass) — Wed, 27 Jun 2007 15:36:00 GMT

Just after I had my son, I was up very late nursing and watching tribal belly dancers perform on a local access station. They were amazing and most beautiful of all was a woman with a protruding pregnant belly just between her jewelled bra and fringed hip scarf. She danced as fluidly as every other woman on stage but her belly was far more mesmerizing. The dancer's graceful fingers and hip shakes seemed to glorify this round moon in her middle. As I sat there with my jelly belly, barely able to lift my arms, let alone point my pinkies, I longed to have a little of that swelled up sense of grace and power. Sure, that bellydancer may have very well been breastfeeding her own baby at that moment with that taut skin all stretched out and lazy like mine. But somehow I doubted it.

In the sea of prenatal classes, I think belly dancing could possibly be the best choice of all for a mama-to-be. Belly dancing doesn't try to reduce your curvy, gorgeous woman figure into a boy body. It uses it all, plus bells and sheer scarves. How good must that feel? We all know that while you are growing a human in your own belly, all that puking and craving and kicking can be exhausting. And that getting big and feeling flutters can also be beyond-words amazing. It is crazy and wonderful and confusing to carry that all with you.

So maybe, just maybe, the mama-to-be in the harem pants wasn't the perfect pregnant person. But maybe she had it right. Maybe belly dancing is a great way to give yourself more than enough belly love -- to lift your spirits when you realize your boobs really might slap your knees after breastfeeing for months, to soothe your body when it's craving Guiness and mercury-laden entrees, and to put the focus back into everything near-miraculous your body can do. As a bonus, all that swaying might just rock your kicky little fetus into a slumber and all that smiling when ascend to a goddess-like state can only serve the developing person floating in there. Just watch this dazzling, painted, pregnant belly dancer on YouTube and I think you will agree: This is the good stuff. This is what pregnancy should always feel like.

Are any of you belly dancing your way through gestation? Has it given you the belly love you need to feel fabulous?

The Sad State of Infant Mortality Rates in the South

Jessica Ashley (Sassafrass) — Mon, 23 Apr 2007 14:04:00 GMT

This is what makes me tear up and scream at the monitor all at once: Many of us have iPods, strollers that cost more than our first car, food that spoils before we ever eat it and peds appointments always just around the corner. And yet, right in our own backyard, the infant mortality rate is climbing. Babies born, mostly to impoverished women of color in the South, are dying in alarming numbers of causes that should be simple to treat.

Many of these families experience a perfect storm of low birth weight, inadequate prenatal treatment, lack of information about basic baby care. As a result, 11.4 deaths per thousand infants born occurs in Mississippi alone. The U.S. average is 5.4. In this and neighboring states, mother-care is deeply embedded in this crisis, with many women who smoke, have hypertension, are diabetic or are obese having children early and without adequate support or information.

There have been hopeful and steep declines in infant mortality rates in areas where privately-funded organizations send local women door-to-door to counsel pregnant women and post-natal mothers. It is clear that racism, poverty, insurance bullshit and limited (if any) access to medical treatment is working against effective interventions.

[photo credit: Nicole Bengiveno/The New York Times]

Pregnant Women Wimps, According to Recent Study

Rachael Brownell (Redsy) — Mon, 05 Mar 2007 16:05:00 GMT

That there is a "high incidence" of back pain during pregnancy doesn't come as news to most of us who have cooked a few wee babies in our time (especially parents of multiples --ouch!!). Nor would most of us be surprised to hear about a recent study, which found that despite 85% of pregnant women reportedly experiencing back pain, only 10% received care for the pain.

The study authors conclude that in addition to a need for increased care for back pain, women may be insufficiently educated about the risks of taking pain medication during pregnancy. And in my favorite study conclusion of all time, they also express concern that pregnant women may not have sufficient ability to cope with pain, which leads them to take the ill-advised pain medication in the first place.

Ahh yes. Pregnant women are wimpy, aren't they? Always complaining and griping about the weight and the hunger and the aches and the pains. If I had a NICKEL for every wimpy pregnant lady I met, I'd be a millionaire three-times over. Seriously. Especially during labor and delivery. Have you heard them screaming out? I mean COME ON. In all seriousness, though, this study points out yet another reason that high quality prenatal care is crucial. Because that's how you get all the good pain drug hook-ups, my sister.