Did you know that maternal mortality rates have more than doubled since 1990? A recent study (presented at a conference in Las Vegas and soon to be published) looks at the rates of weekend deliveries and the increased risk of maternal death. Steven Reinberg, HealthDay Reporter with US News & World Report summarizes the study:
For the study, researchers reviewed outcomes from more than 45 million pregnancies in the United States between 2004 and 2014. They found a slightly increased risk of death among mothers who delivered over the weekend — about 21 per 100,000 deliveries, compared with about 15 per 100,000 during the week.
The Baylor researchers also found that weekend deliveries were linked to the need for more maternal blood transfusions and more tearing in the area between the vagina and anus (perineum). In addition, neonatal intensive care unit admissions, neonatal seizures and antibiotic use all rose on weekends, compared with other times of the week, the study reported.
“There is clearly something different about the health care offered to women on the weekends,” Clark said.
Although the exact reasons for this weekend effect aren’t known, several factors may be in play, he speculated.
“It may be that there are less experienced people on weekend shifts,” Clark said. “That’s commonly seen in nursing and physician staffing. It may also be that people on those shifts are tired.”
Or, it may be that doctors are distracted, Clark said. “They may not be focused on patient care, but rather other things they want to do on the weekend,” he said. “Our data does not allow us to say which of these things is linked to worse care.”
Something about weekend care appears to need changing, Clark said. But because the reasons for these problems aren’t known, the changes needed aren’t clear, he said.
Dr. Mitchell Kramer, chairman of the department of obstetrics and gynecology at Northwell Health’s Huntington Hospital in Huntington, N.Y., questioned the study’s findings.
“They are grasping at straws to explain why infant and maternal mortality rates increase on weekends,” Kramer said. “I think it’s more complex than what they say.”
Kramer said he found the notion that doctors are distracted and patients fare worse over the weekend “disturbing and insulting. That comment alone makes me very dubious about the results of this study,” he said.
“In my hospital, patients get the same care on weekends that they get during the week,” he said.
Clark, however, sees the weekend effect as one possible reason for the overall higher maternal mortality in the United States, compared with other countries.
Moreover, the rate of maternal death in the United States is increasing, Clark said. It’s more than double what it was in 1990, he said.
A recent study finds that women with a low vitamin B12 are more likely to have a preterm birth. The study, published in the American Journal of Epidemiology, also found that low maternal vitamin B12 led to low birth weight in newborns as well. Low birth weight and preterm births are a leading cause of death in infants in the first 28 days of life.
Megan McNamee, Babymoon’s Registered Dietician, recommends natural sources of vitamin B12 such as:
Animal proteins, including meat, fish, pork and poultry, as well as eggs and dairy are great sources. Vegetarian sources include fortified products (like cereals and non-dairy milks) and nutritional yeast.
Most prenatal vitamins, like Thorne Basic Prenatal, will contain above-adequate amounts of B12, so additional supplementation is not necessary if women are regularly taking their prenatal vitamin. Since vitamin B12 is water soluble and is not stored in the body, it is okay for prenatal vitamins to have higher doses than the Recommended Daily Allowance of 2.6mcg for pregnant women.
What’s happened to your health insurance premiums in 2017? Are you paying more for less? Many of our clients seem to be facing this worst-of-both-worlds scenario. Would a direct pay, or cash only system provide some relief?
Sometimes called direct pay, and closely related to concierge care, this sort of business model was once seen as the perquisite of rich folks and medical tourists from foreign lands. But nowadays many of the people seeking cash-based care are middle-class Americans with high-deductible insurance plans. For a patient with an $11,000 family deductible, for example, it might make more sense to seek out a cash-based center like the Premier Medical Imaging facility in Minneapolis, which offers a basic MRI for $499, than to cough up the several thousand dollars that the same procedure generally costs at a traditional hospital. Cash payments don’t count toward a patient’s deductible, but for some it’s worth the gamble.
This trend may accelerate nationally. With the Affordable Care Act on the chopping block, many experts expect the free-market model to take off. While congressional Republicans have yet to produce a viable replacement for the Obama Administration’s health care law, almost any change is likely to result in more Americans’ choosing high-deductible insurance plans, which would help fuel the cash-based marketplace for years to come.
This case study is persuasive, especially when you review the out-of-pocket under either scenario. Read the article and let us know – what do you think?
Sure, the midwifery model of care has great outcomes and client satisfaction. Candles and tubs. But – have you heard of the VAGICIAN?!! Here’s a sample – you must read the rest
After he delivered her first baby, he said, “But wait, there’s more!!!” To the room’s amazement and especially the patient, Kendall Simpson, the vagician delivered another baby.
“At first I was really surprised to have twins,” Kendall told reporters, “but when I thought about it two for the price of one, I’ll take it. Dr. Schmidt is truly working magic over there!”
Critics argue he uses slight of hand and distraction to deliver these babies, and it really isn’t “vagic.” Dr. Schmidt, or “The Amazing Fredrick,” argues you just have to believe. In Ms. Simpson’s case there is a rumor he read the ultrasound as only one baby just to set up for the big surprise on delivery day.
“He uses things like epidurals, it’s not magic,” midwife Janet Trendall told reporters.
Weekly vaginal checks starting at 36 weeks? Frequent vaginal checks in labor? Does this policy give your provider important clinical information – or is this an obstetric ritual that exists simply because it hasn’t been questioned?
Vaginal checks in labor can be uncomfortable and intrusive. Amy Wright Glenn wrote a two-part series Dear OB: It’s Not Your Vagina and discussed this policy with our own monitrice, Rachel Leavitt. She reminds women:
Mothers-to-be, laboring women, pregnant friends – listen to me.
You have the right to determine who – if anyone – will put his or her hand in your vagina during pregnancy and birth. You have the right to inquire about any procedure that is being suggested as part of your prenatal, labor and delivery care. You have the right to consent. You have the right to request a vaginal exam. And you have the right to refuse one. Period.
But, is this an important piece of your clinical care? Does your provider NEED this information to provide safe care?
“We look at a lot of different signs to determine progression. We do very few cervical checks. We use signs such as change in contraction pattern, how the woman is coping, physical signs such as shaking, nausea, bloody show and moaning. You can see how a woman begins to turn inward and the ability to concentrate decreases. These are the typical things we will look for and chart. We only check when women first come in, and if they refuse, we don’t worry about it. We will also check if it has been a long time without any external signs of progression or if there is a clinical need. Again, a woman’s right to refuse is acknowledged.”
Rebecca Dekker of Evidence Based Birth examined two studies that looked at the effect of weekly checks at the end of pregnancy. Her conclusion:
I think in summary the evidence really shows that there is no benefit to doing the weekly exams. It may satisfy your curiosity or your doctor or midwife’s curiosity, but it doesn’t really have an effect on your health either way. You are asking me what’s the evidence, what references can I use when I go to talk with my doctor, and I would say when it comes to a situation like this you don’t have to give your reason why. If you don’t want the vaginal exams, either because they make you uncomfortable or you just simply don’t want them or you think they’re unnecessary for whatever reason, your reason is your own and you don’t have to explain it to anybody.
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.
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.