Tuesday, February 27, 2018
ProPublica (Feb. 22, 2018): A Larger Role for Midwives Could Improve Deficient U.S. Care for Mothers and Babies, by Nina Martin:
The results of a five-year study, conducted by researchers in both the U.S. and Canada, on the effects of midwifery on maternal and infant health are in. The study was published in the peer-reviewed journal PLOS ONE; it analyzes hundreds of laws throughout the United States that dictate what a midwife can and cannot do when it comes to prenatal care and the birthing process.
'We have been able to establish that midwifery care is strongly associated with lower interventions, cost-effectiveness and improved outcomes,' said lead researcher Saraswathi Vedam, an associate professor of midwifery who heads the Birth Place Lab at the University of British Columbia.
The midwife model emphasizes community-based maternal and infant care along with avoiding any unnecessary, and potentially dangerous, interventions. Midwives have long been widely embraced in Europe as a positive component of maternal care. In the U.S., though, midwives often represent a "culture war that encompasses gender, race, class, economic competition, professional and personal autonomy, risk versus safety, and philosophical differences."
The title "midwife" can have multiple meanings, ranging from "certified nurse-midwives," to "direct-entry midwives," to "lay midwives." Depending on the title and the state in which the midwife works, the midwife will have a different level of training and may or may not be licensed or regulated by the state.
This new study indicates, though, that midwives may be part of the answer to the U.S.'s problematic infant and maternal mortality rates. Severe maternal complications have sharply risen over the past 20 years, and maternal care is seriously sparse in certain areas of the country. "Nearly half of U.S. counties don't have a single practicing obstetrician-gynecologist."
While midwife regulations vary widely among states, the study shows that states that have more fully integrated midwifery systems within their health care have significantly better outcomes for mothers and babies. States with restrictive midwife regulations--like Alabama, Ohio, and Mississippi--regularly score much lower on tests of maternal and neonatal well-being.
Alabama, which has the worst infant mortality rate in the country, has long had strict midwife regulations, "reflecting attitudes that wiped out the state's once-rich tradition of black birth attendants." Alabama lawmakers, though, recently passed a bill legalizing certified professional midwives, taking one small step toward the process of greater midwife integration, and, hopefully, improved maternal and infant health care across racial and economic lines.
Access to midwifery is often split among racial lines, as many of the states with the worst outcomes (and higher levels of opposition to midwives), including Alabama, have large black populations. The study suggests a correlation between improved access to midwifery and reduced racial disparities in the maternal health care field.
Jennie Joseph, a British-trained midwife who runs the Florida birthing center and nonprofit Commonsense Childbirth affirms this:
“It’s a model that somewhat mitigates the impact of any systemic racial bias. You listen. You’re compassionate. There’s such a depth of racism that’s intermingled with [medical] systems. If you’re practicing in [the midwifery] model you’re mitigating this without even realizing it.”
The study, though, does not conclude that better midwife access will directly lead to better outcomes or vice versa. It acknowledges that many other factors also affect maternal and infant health among states, including access to preventative care, insurance, and rates of chronic disease.
Nonetheless, maternal health advocates have long recognized the benefits of midwifery and this is not the only study to highlight the positive effects of supporting midwives. A 2014 study found that integrating midwives into health care could prevent more than 80 percent of maternal and infant fatalities worldwide, in both low and high-resource communities. Even in the U.S., organizations such as the American Congress of Obstetricians and Gynecologists have begun embracing nurse-midwives despite lingering skepticism by many.
Tuesday, February 13, 2018
Cosmopolitan (Feb. 6, 2018): Planned Parenthood Will Launch 10 New Video Chat Abortion Locations in 2018, by Jennifer Gerson Uffalussy:
A safe, early-pregnancy abortion option has been making waves across the United States since Planned Parenthood began its telemedicine abortion pilot program in Iowa in 2008.
Telemedicine abortions enable those seeking a pregnancy termination to meet with a nurse in a local clinic where both patient and nurse loop in an abortion-providing doctor via video chat. The doctor consults with the patient to determine that they are a good candidate for early pregnancy termination and then authorizes the nurse to dispense two small pills to the patient. The patient takes the first pill in the office in the presence of the nurse and doctor and then later takes the second pill at home. The pregnancy is terminated within a day or two.
These medications have become known at "the abortion pill" and include both mifepristone and misoprostol, which work together first to block the hormones a woman's body needs to sustain a pregnancy and then to empty her uterus. The FDA-approved abortion pills are for ending pregnancies less than 10 weeks along. A study of Planned Parenthood's telemedicine pilot program found that access to telemedicine abortions decreased second-trimester abortions throughout the state. Second-term abortions require surgical procedures and can carry increased risks.
Although abortion is legal in all 50 states, many states have tightened their restrictions on abortion access, making it very difficult for a person facing an unwanted pregnancy to safely terminate it. Restrictions such as mandatory waiting periods and insurance limitations are compounded in states with very few clinics that can perform abortions. In fact, about 90% of counties in the U.S. do not have an abortion provider.
Telemedicine allows a patient to meet with an abortion provider even if she doesn’t live near one. Instead of driving long distances, women can go to a closer clinic or Planned Parenthood and video-chat a live, somewhere-in-state abortion provider who prescribes and (virtually, via on-site clinic staff) hands over the meds. “There is no increased risk of complications with a telemedicine visit,” says Daniel Grossman, MD, director of Advancing New Standards in Reproductive Health at the UCSF Bixby Center for Global Reproductive Health. He led a groundbreaking study published last fall that found telemedicine abortions are just as safe as those in which a woman swallows mifepristone in the same room as a physician.
While mifepristone has so far demonstrated a highly-safe success rate (its rates of complications are fewer than most common pain relievers), it cannot be obtained over-the-counter; instead a clinic, hospital, or doctor's office must dispense it.
Some states will allow a pregnant person to video chat with a doctor from her home and then receive both pills in the mail. Since 2008, though, 19 states have challenged the expansion of telemedicine abortions by passing laws that specifically require mifepristone to be dispensed "in the physical presence of the prescribing clinician."
Planned Parenthood continues to expand its telemedicine program despite the challenges. It has now established 24 telemedicine locations in the nation and plans to add at least 10 additional locations--some in new states--throughout this year.
To find out if telemedicine abortion is available in your area, call the national Planned Parenthood hotline at 800-230-PLAN.
February 13, 2018 in Abortion, Abortion Bans, Anti-Choice Movement, Current Affairs, In the Media, Medical News, Politics, Pregnancy & Childbirth, Pro-Choice Movement, Reproductive Health & Safety | Permalink | Comments (0)
Wednesday, February 7, 2018
Rewire (Jan. 25, 2018): For Nonbinary Parents, Giving Birth Can Be Especially Fraught, by S.E. Smith
Pregnancy and childbirth are vulnerable times in any parent's life. Add to that the highly gendered-status of both pregnancy and birth, and trans and non-binary parents are finding it difficult to locate an inclusive community with educated medical staff as they, too, enter childrearing chapters.
With the trans community, conversations about birth and parenting are few and far between and often fraught with discomfort. Now, though, more parents-to-be identify as trans men or somewhere else on the non-binary spectrum of gender identity. And the medical community has not yet caught up. "And, as in any area of reproductive health-care services, this isn’t simply a matter of gender: Race, class, and geography can play a huge role in whether non-binary people are able to access inclusive, affirming birth care."
Gender-affirming care--including asking for a patient's pronouns with their name, using gender-affirming language, and regularly seeking consent before performing examinations, particularly those that require a medical professional to touch the patient's genitalia--is important. When it is absent, patients report both physical and psychological trauma.
Many in the trans and non-binary communities are increasingly seeking home births with gender-affirming midwives in order to create the most comfortable environments for themselves. Midwifery can be prohibitively expensive though, and insurance rarely covers it. So for others, a hospital may be the safest or the only choice. Advocates say that hospitals and birth collectives would do well to invest in specialized training for medical providers "to ensure that everyone at a facility is trans-competent, or working on getting there."
This issue is likely to amplify in coming years with a more visible nonbinary community, as well as a more active movement to reframe the way we look at pregnancy and birthing. Trans people—binary and otherwise—are some of the biggest stakeholders in the conversation, and they’re contributing with inclusive birthing classes and provider training in addition to working as care providers themselves.
The trans and non-binary communities call on leaders within the medical community to initiate changes from the inside, including re-training initiatives and reframing core educational documents for inclusivity.
Thursday, July 13, 2017
Vox (Jun. 29, 2017): California decided it was tired of women bleeding to death in childbirth, by Julia Belluz:
At the same time the global maternal death rate fell by nearly 44 percent, between 2000 and 2014, the United States watched its maternal mortality rate skyrocket 27 percent. Maternal mortality refers to "the death of a mother from pregnancy-related complications while she's carrying or within 42 days after birth." Childbirth is more dangerous in the U.S. than any other wealthy nation. The reason? The U.S. does not value its women.
The United States is in the company of only 12 other countries whose maternal mortality rates have actually increased in recent years, including North Korea and Zimbabwe.
Researchers and health care advocates argue that a high maternal death rate is a reflection of how that culture views its women.
[In the U.S.,] policies and funding dollars tend to focus on babies, not the women who bring them into the world. For example, Medicaid, the government health insurance program for low-income Americans, will only cover women during and shortly after pregnancy.
Texas, having rejected Medicaid expansion and closed the majority of its Planned Parenthood clinics, has the highest maternal mortality rate in the developed world. California, however, has proven to be an exception within the nation. The California maternal mortality rate has steadily decreased over the same time that the rest of the nation's has risen, thanks in large part to the California Maternal Quality Care Collaborative (CMQCC).
60% of maternal deaths are preventable and the complications that cause them should be anticipated. The CMQCC finds that even within an imperfect health care system, death from childbirth need not be an inevitability. Maternal deaths in the U.S. often result from common complications like hemorrhaging and preeclampsia. The CMQCC has enacted simple, lifesaving procedures over the last decade to reduce the number of unnecessary maternal deaths. And, they're working.
First, they aimed to lower the number of unnecessary C-sections performed. Cesarian sections are often prematurely offered by obstetricians who are short on time. The procedure can leave mothers with internal scar tissue that ultimately makes future pregnancies more dangerous by increasing the mother's risk of hemorrhaging.
As many maternal deaths are a result of hemorrhaging--a mother can bleed to death within five minutes--doctors set out to prepare every delivery room in hospitals participating in their program with a "hemorrhage cart," equipped with everything necessary to handle a bleeding problem the moment it begins.
In a recent study, researchers found a 21 percent reduction in severe complications related to hemorrhages in the hospitals participating in CMQCC's program. Hospitals not participating in the program saw only a one percent reduction.
California has demonstrated that even in our messy and imperfect health care system, progress is possible. They’ve shown the rest of the country what happens when people care about and organize around women’s health. Policymakers owe it to the 4 million babies born in the US each year, and their mothers, to figure out how to bring that success to families across the country.
How the current health care debate and the resulting volatility of the insurance market will affect the United States' maternal mortality rate going forward remains to be seen.
Thursday, April 6, 2017
New York Times (Apr. 4, 2017): Does Birth Control Cause Depression? by Aaron E. Carroll:
A study published in the Journal of the American Medical Association Psychiatry suggests that hormonal contraceptive use may trigger depression. The study examined all women and adolescent females in Denmark from 2000 through 2014. It found that those who used hormonal contraceptives "had significantly higher risks of also taking an antidepressant." The risks were higher in adolescents than in women and decreased as the subjects aged.
Placed in the context of other studies that have examined hormonal contraceptive use, the study comes up short. It's not a controlled trial and does not even remotely establish causation. It is also easy to criticize it on the basis that "anti-depressant use isn't the best measure of new-onset depression."
Data from other studies appear to contradict the JAMA study: "the data that do exist show that most women don't show any effect from hormonal birth control, or actually had their mood improve. Moreover, "women who have underlying mood disorders were more predisposed to have mood-related side effects." The JAMA introduces intriguing and "newsy" findings into the mix, but is by no means the last word on the subject. The topic of hormonal birth control and mood is best explored in the context of the patient-physician relationship. When viewed up against the fact that birth control is "[o]ne of the biggest American victories of the last decade," the fact that it may contribute to depression may be a risk worth taking.
Friday, September 23, 2016
New York Times (Sept. 19, 2016): Want a Zika Test? It's Not Easy, by Roni Caryn Rabin:
Getting a Zika test is harder than you thought, even for people who have recently traveled to areas where Zika is a big problem and who are planning to have children. People are discovering that you cannot simply show up at a public health department and be tested on demand.
The difficulty stems from a Centers for Disease Control directive establishing strict guidelines for Zika testing. The guidelines give priority to pregnant women with possible exposure to Zika and to people with Zika-like symptoms. This leaves out people who have possibly been exposed to Zika and are trying to conceive. The guidance for this population is that they engage in protected sexual intercourse for at least eight weeks after their fear exposure. The World Health Organization recommends six months of protected sexual intercourse before trying to conceive. These recommendations are meant to prevent an onslaught of requests for Zika testing that would swamp local public health authorities. They also help define when insurers will cover Zika testing.
Testing for Zika is a complex process that may require three tests for a conclusive result. There is no test for detecting the infection in semen, however.
Monday, September 5, 2016
New York Magazine (August 22, 2016): How New York City Is Fighting the Growing Threat of Zika, by Charley Lanyon
With Zika on the rise in places further South like Florida, New York City is taking note of the failure of adequate preparation in other states to avoid the spread of the virus. While the common carrier of the virus, the Aedes aegypti mosquito, generally doesn't fly as far up as New York City, the related Asian Tiger mosquito does bite in New York, and some are worried that they too could become carriers of the virus. New York wants to target mosquitos in a different and more aggressive way, and intends to use a significant portion of its budget to do so:
Thus, the city is going after the Asian tiger mosquito hard, with large-scale predawn insecticide sprayings from the backs of pickup trucks and smaller more-targeted assaults from teams of exterminators with backpacks full of mosquito poison that focus on areas believed to be especially high-risk.
Even with all of the precautions, city officials are quick to reiterate that there has not been a single case of mosquito- transmitted Zika in New York City, and they are hopeful that there will never be one. The biggest danger for catching Zika in the city is through unsafe sexual contact with an individual who has been infected abroad. So at least for now, the ability to control the spread of Zika in New York lies as much with the individual as the city. Be safe.
Sunday, September 4, 2016
New York Magazine (August 12, 2016): New York City Buildings Are Now Required to Have Lactation Rooms, by Laura June
A bill requiring some New York City-run buildings to have rooms allocated specifically for lactation as of July 2017 was passed unanimously by the City Council and signed by Mayor de Blasio. There will be no restroom facilities in the rooms, but they will be equipped with electrical outlets for pumps. New York job center buildings, medical centers, and borough offices owned by the City are just some of the buildings protected by the new law.
Mayor de Blasio said in a statement, "This bill is about fairness, access, and health — no new mother should be unable to breast-feed because she can’t find a private space." He added that the "bill takes our city one step toward being a place where all women feel comfortable breast-feeding whenever they need to, wherever they need to.”
Wednesday, August 3, 2016
New York Times (July 19, 2016): I.V.F. Does Not Raise Breast Cancer Risk, Study Shows, by Catherine Saint Louis:
The use of estrogen and progesterone in in vitro fertilization has in the past stoked fears that the procedure could place patients at risk of developing breast cancer. A retrospective analysis published in 2008 found found "a potential increase in breast cancer among I.V.F. patients older than 40." But later studies, in Israel and Australia, suggested more of a danger for younger women. Some believed that infertility itself might be linked to breast cancer.
Several studies conducted in recent years, however, suggest that the fear is unfounded. The most comprehensive of these studies, published in July in the Journal of the American Medical Association, found "no increased risk among women who have undergone I.V.F." The study likewise found no increased risk among women who had less invasive treatments for infertility. Oddly, the study emphasized what appeared to be a reduced risk of breast cancer among women who have submitted to I.V.F. multiple times.
The JAMA study is not conclusive. More research needs to be conducted, including on the risk of breast cancer in postmenopausal women who have had I.V.F.
Thursday, July 21, 2016
The Guardian (July 18, 2016): Doctors urged to advise patients about risks of abstinence-centric sex education, by Molly Redden:
In a recently released report, The American Academy of Pediatrics denounced abstinence only education programs, stressing the importance of educating young people about comprehensive approaches to things like STIs and contraception. Some interviewed view this as a triumph for doctors in areas where parents may want to mitigate their children gaining access to this kind of information, viewing the report as a scientifically-sound back up against the arguments of abstinence-focused parents. The report stresses the inadequacy of abstinence-only education and highlights conversations about consent and gender identity as a few of the topics pediatricians should feel encouraged to speak with patients about.
Abstinence-only groups have already taken issue with the report, but many are heralding this as an important step in the right direction for doctors and patients alike:
“This is the mothership telling pediatricians that talking about sex is part of your charge to keep children and adolescents safe,” said Dr Cora Breuner, a professor and pediatrician at Seattle Children’s research hospital and the report’s lead author.
Monday, July 18, 2016
The Atlantic (July 13, 2016): Why the Male Pill Still Doesn't Exist, by Andy Extance
While America was introduced to the female birth control pill, and the first tests in hopes of creating a pill for men were conducted as early as 1957, many lament the fact that a male 'pill' equivalent to that of female hormonal contraception still does not exist. There are a variety of issues that have delayed the development of a male pill - there is a lack of commitment to contraception; pharmaceutical companies are less interested in making a product for men; and dangerous side effects documented from previous drug trials. But studies show that the interest, across gender identities, for a male pill is there. The article highlights the social acceptance of women bearing the responsibility of taking contraception, and researchers' worry that they may not be able to create a product that would be as easy as to administer as the female pill. Over the years, researchers have explored various hormonal and non-hormonal methods. One of the researches believes that the answer is probably out there and the work just needs to be completed:
[Elaine] Lissner is adamant that the ideas that seem to have faltered are not dead, they’re just resting. “We keep collecting new methods and never finish the ones we have,” she fumes. “Pick one and make something! Finish the job!”
Monday, June 6, 2016
New York Times (May 30, 2016): Triplet and Higher-Order Births in U.S. Down 41%, by Nicholas Bakalar:
Women 25 and older and in particular women 45 and older are giving birth to fewer higher-order births, 90 percent of which have been triplets in recent years. The sharpest drop occurred among non-Hispanic white women, though the rate in this group is still 57 percent higher than for non-Hispanic black women and twice as high as the rate for Hispanic women. The increase in higher-order births prior to 1998 was attributed to the rising average maternal age. This average has continued to rise; the decline in higher-order births, then, is thought to be the result of the practices of infertility centers, namely, not implanting multiple embryos in women seeking treatment.
Wednesday, June 1, 2016
Human Reproduction (May 21, 2016): Santa Claus in the Fertility Clinic, by Hans Evers:
The editor-in-chief of this premier medical journal criticizes infertility physicians for creating therapeutic illusions with misdiagnoses, useless medications, and unnecessary treatment. Evers is referring specifically to the unnecessary use of intra-cytoplasmic sperm injection (ICSI) in cases where in vitro fertilization (IVF) by itself would be sufficient to create a viable pregnancy. ICSI is indicated in cases of male-factor infertility, but such cases do not comprise the majority of infertility cases. Evers bases his evaluation on data covering 2008 through 2010 and gathered by the International Committee Monitoring Assisted Reproductive Technology (ICMART). The data show that the ICSI-to-IVF ratio varies from 1.4 in Asia to a staggering 60.3 in the Middle East. Studies show that the use of ICSI in non-male-factor infertility cases results in fewer lives births than the use of IVF alone. It does not improve the chances of a successful fertilization in such cases. Evers calls for the end of this costly and ineffective therapeutic illusion.
Wednesday, May 11, 2016
New York Times (May 3, 2016): Silence Order on Abortions Violates Law, Doctor Says, by Erik Eckholm:
Diane J. Horvath-Cosper, an obstetrician and gynecologist at Med-Star Washington Hospital Center has filed a federal civil rights complaint against Med-Star in the wake of the hospital's order that she cease speaking out in favor of abortion liberty. The hospital has required Dr. Horvath-Cosper to turn down "several requests for interviews or articles or risk losing her job." The hospital says that the order is a "sensible precaution" because it fears violence in the current fraught climate. Dr. Horvath-Cosper and some of her colleagues believe that staying silent about abortion "feeds the drive to stigmatize and restrict abortion." "'I don't think the way to deal with bullies is to cower and pull back," she said.'" The chair of Physicians for Reproductive Health, a national advocacy group, commented that physicians who speak out about abortion are making a personal decision based on privacy and risk. If the complaint moves forward, the hospital risks losing its federal funding.
Friday, May 8, 2015
TIME: How a New Study on Premature Babies Could Influence the Abortion Debate, by Eliza Gray:
A new study showing that a tiny percentage of extremely premature babies born at 22 weeks can survive with extensive medical intervention could change the national conversation about abortion, though the research is unlikely to have a major effect on women’s access to abortions in the short term.
Pro-life advocates said the study—which was published by theNew England Journal of Medicine on Wednesday and found that 3.5% percent of 357 infants born at 22 weeks could survive without severe health problems if hospitals treated them—could benefit the pro-life movement by sparking discussion about the viability of premature babies. . . .
This article correctly points out that the study in no way contradicts or forces reconsideration of Supreme Court precedent governing pre- and post-viability abortions. Unlike what some articles suggest, the Supreme Court has never set viability at a specific point in pregnancy (even in Roe), but rather has left the determination of viability to the provider to determine based on the individual facts surrounding each pregnancy. Viability depends on many factors, including the type of medical facilities available.
Monday, December 8, 2014
Bustle: An Anti-Choice Group Is Pushing "Abortion Reversal" Treatment, And It's Alarming To Say The Least, by Jessica Blankenship:
In Bettendorf, Iowa, an anti-choice advocacy group is offering women an “abortion reversal” using an experimental treatment about which little is known, and it’s all decidedly suspect and troubling. The Women’s Choice Center (which is, to reiterate, is run by a pro-life/anti-choice group) is now promoting what they’re touting as a chance for women who are in the middle of a medical abortion the chance to “unabort” their pregnancies. The major problem with this is that the therapy hasn’t really been tested, and the entire procedure just generally feels problematic all around: imploring women to undergo experimental-at-best, hormone-altering treatments, underscored, obviously, by an anti-choice agenda.
Here’s how this whole thing, more or less, supposedly works . . . .
Saturday, March 1, 2014
Study Finds that Men's "Biological Clock" Means Higher Risk of Mental Illness in Children Born to Older Fathers
The New York Times: Mental Illness Risk Higher for Children of Older Fathers, Study Finds, by Benedict Carey:
Children born to middle-aged men are more likely than those born to younger fathers to develop any of a range of mental difficulties, including attention deficits, bipolar disorder, autism and schizophrenia, according to the most comprehensive study to date of paternal age and offspring mental health. . . .
. . . Men have a biological clock of sorts because of random mutations in sperm over time, the report suggests, and the risks associated with later fatherhood may be higher than previously thought. The findings were published on Wednesday in the journal JAMA Psychiatry. . . .
The Los Angeles Times: Study calls DNA test reliable in discovering fetal disorders, by Monte Morin:
The screening more accurately identifies likely cases of genetic disorders caused by extra chromosomes, like Down syndrome, in a study of low-risk pregnant women.
It's billed as a faster, safer and more accurate way of screening expectant mothers for fetal abnormalities like Down syndrome, and proponents say it has already become the standard for prenatal care.
But as a handful of California companies market their DNA-testing services to a growing number of pregnant women, some experts complain that the tests have not been proven effective in the kind of rigorous clinical trials that are required of new drugs.
Now, a study published Wednesday by the prestigious New England Journal of Medicine has verified that one of the tests can identify likely cases of Down syndrome and other genetic disorders caused by extra chromosomes in low-risk women with greater reliability than traditional noninvasive screening methods. . . .
Saturday, February 1, 2014
The New York Times: Responding to Critics, Gynecology Board Reverses Ban on Treating Male Patients, by Denise Grady:
After months of protest from doctors and patients, a professional group that certifies obstetrician-gynecologists has lifted a ban it imposed in September and now says its members are free to treat men.
The decision, announced Thursday by theAmerican Board of Obstetrics and Gynecology, was a reversal of its September directive, and followed partial concessions the group had made in November and December in an effort to mollify critics. . . .
Saturday, January 25, 2014
TIME: Effectiveness of Emergency Contraception for Overweight Women Reviewed in Europe, by Alexandra Sifferlin:
The European Medicines Agency (EMA) — the European version of the U.S. Food and Drug Administration (FDA) — launched a broad review of whether body weight influences the ability of emergency contraceptives to prevent unintended pregnancies.
The agency recently required makers of the European version of Plan B, called Norlevo, to add an alert that the product may be less effective for overweight women. . . .