We came across an interesting opinion piece in the New York Times discussing the benefits of a conversation “placebo” – the evidence supports that substantial portion of “healing” comes from the communication and connection with the patient.
Under the Midwifery Model of Care, the conversation between provider and client is an essential component of partnership care. We agree that conversation is crucial, but would not characterize it as a “placebo” – still, the discussion in the context of the medical model to address this important relationship of trust between provider and client is a positive and worthwhile read.
Before we had treatments that could actually counteract the pathology of disease — antibiotics, chemotherapy, stents, organ transplants, transfusions — placebo was the mainstay of medical care, and in many cases it was remarkably effective.
A good example is patients suffering from vague diffuse pains with no discernible cause. Frequently my patients ask if a multivitamin will give them more energy. In the past I would say no, because there are no significant scientific studies to demonstrate this, and also because in the absence of a vitamin deficiency there’s not much for a basic multivitamin pill to do. Now I take a different approach. I say something along the lines of “Many of my patients find that they have more energy when they take a multivitamin.” I’m not lying, because many have indeed said so. Without fail, there are always a few patients who come back at the next visit and swear they feel much better.
There are some who argue that it is unethical to promote placebos to patients. But increasingly, many say it would be unethical not to give placebos a try in situations where patients are not getting relief from traditional means (and where it would not cause harm or replace a necessary treatment).
It’s clear that how doctors and nurses communicate their treatment can have profound effects on how patients experience the results of that treatment. Yet the conversation between doctors and patients is one of the least valued aspects of medical care. Insurance reimbursements for tests and medical procedures dwarf reimbursements for talking to patients or spending time thinking about what ails them. And the pharmaceutical industry, with its direct-to-consumer advertising, has promulgated the fallacy that every ailment must be met with a pill — brand name, of course.
As health care faces its latest overhaul, it’s crucial for the medical profession, as well as insurance companies and decision makers in government, to recognize the power of the doctor-patient conversation. It’s the most valuable diagnostic tool we have and can be remarkably effective as a treatment tool as well. Training for doctors and other medical professionals should emphasize communication skills with the same rigor that it does for other clinical skills.
Call conversation a placebo if you like, but if it helps without causing harm, then it’s legitimate medicine. Relieving suffering, after all, is what the Hippocratic oath is all about.
ACOG released new guidance advising providers to consider “low tech, high touch” approach to care for low-risk women. The Midwifery Model of Care as delivered in the birth center setting has studied this approach, and our data also supports the low-intervention approach as providing a SAFER model of care, avoiding the risk of unnecessary intervention. It is wonderful to see ACOG endorsing this evidence-based model, and also acknowledging that emotional support is an important factor in providing safe standard of maternal care. Bravo, ACOG!
From their press release:
“Practitioners always put the best interests of moms and babies at the forefront of all their medical decision-making, but in many cases those interests will be served with only limited intervention or use of technology,” said Committee Opinion author, Jeffrey L. Ecker, M.D., chief of the Obstetrics & Gynecology department at Massachusetts General Hospital. “These new recommendations offer providers an opportunity to reexamine the necessity of obstetric practices that may have uncertain benefit among low-risk women. When appropriate, providers are encouraged to consider using low-intervention approaches that have been associated with healthy outcomes and may increase a woman’s satisfaction with her birth experience.”
What constitutes “low-risk” will vary depending on a laboring woman’s condition and medical circumstances but generally involves a clinical scenario in which a woman presents at term in spontaneous labor and has had an uncomplicated course of prenatal care. For such women in the early stages of labor with reassuring maternal and fetal status, patients and providers may consider delayed hospital admission until approximately five to six centimeters dilated. Also, for women who are progressing normally and do not require internal fetal monitoring, it may not be necessary to rupture the amniotic sac. In the case where a woman at term experiences premature rupture of membranes, patients and providers may consider planning a short period of expectant management before undertaking labor induction if there are no maternal or fetal reasons to expedite delivery.
The recommendations also suggest that women benefit from continuous emotional support and the use of non-pharmacologic methods to manage pain. Support offered by trained labor coaches such as doulas has been associated with improved birth outcomes, including shortened labor and fewer operative deliveries. In addition to considering use of medications or epidural anesthesia to manage pain in labor, practitioners are encouraged to offer women coping techniques, such as massage, water immersion in the first stage of labor, or relaxation techniques. Recognizing that the complete absence and elimination of pain is not what all women value, use of a coping scale rather than pain scale is recommended to evaluate the multifactorial experience of labor.
Kangaroo care has long been used for premature babies but has become popular for full-term babies as well. Ronald Reagan UCLA Medical Center regularly practices kangaroo care, and UCLA OB-GYN Dr. Lydia Kyung-Min Lee and pediatrician Dr. Larry Gray discuss is many benefits in this NPR article.
The benefits are many, according to Dr. Lydia Kyung-Min Lee, an ob-gyn at UCLA. Not only is the baby happier, she says, but his or her vitals are more stable. Body temperature, heart and breathing rate normalize more quickly. The close contact also allows the baby to be exposed to the same bacteria as the mother, which can protect against allergies and infection in the future. Infants who receive kangaroo care breast feed more easily, Lee says, and their mothers tend to breast feed for longer periods of time, which is “all good.”
Babies also seem to suffer less pain. Almost 20 years ago, Gray studied how babies respond to a heel prick to draw blood, a procedure that screens newborns for genetic disorders. He found that when healthy newborns had kangaroo care, there was less facial grimacing and crying suggesting pain, compared to babies who had been swaddled and had the procedure in their bassinets, “sort of alone.”
Every month, members of the Nest at Babymoon Inn gather for Crafty Mamas. Coffee, crafting, cuddly babies, and chatting with other mamas… What more could you ask for?
A month ago, “Tree of Life” breastfeeding selfies went viral, and our Babymoon community quickly jumped on the trend, sharing their own gorgeous photos in our Facebook group. One Babymoon mama suggested getting together to create painted versions, and thus our January Crafty Mamas was born!
It was an overcast, chilly day today – perfect weather to meet up with friends for some painting. More than 15 mamas (and their babies) arrived at The Nest. Some chose to use graphite paper to transfer their photo to canvas and paint with acryclics. Others opted for water colors, gel pens, or sharpies on cardstock, and others used acrylic paint on a color version of the photo to add depth and texture. As usual, the array of creativity an artistic ability was quite impressive.
As with any Inn Mommies meet-up, there were babies nursing, babies sleeping, babies in slings and wraps and car seats. Some mamas painted while simultaneously wearing or feeding babies, and others painted in between tending to their little ones. The room was full of laughter and talking – a staple of any Babymoon gathering. The beauty of Crafty Mamas is that there isn’t any need to finish anything or meet an expectation. It’s about the process, not the product!
Thank you to all of the mamas who attended today! We are looking forward to next month’s Crafty Mamas. Have an idea for Crafty Mamas? Be sure to share it with us!
We are often asked for examples of positive and inspirational birth stories – because it’s sadly common to only hear negative stories about birth. Here is a beautiful example as former Bachelor contestant Desiree Hartsock shares the story of her birth center birth. (Midwives and doulas and birth centers, oh my!)
Babymoon Inn is a full-scope midwifery practice and wellness center with locations in Phoenix and Tucson. Our team is committed to improving maternal outcomes and providing personalized, evidence-based care to all people.