A fascinating case study and exploration of the WHY behind the delay in evidence to implementation in health care. Although the article does not address maternal health care, the philosophy is clear – does this sound familiar?
David Epstein/ProPublica writes:
“Most of my colleagues,” Christoforetti says, “will say: ‘Look, save yourself the headache, just do the surgery. None of us are going to be upset with you for doing the surgery. Your bank account’s not going to be upset with you for doing the surgery. Just do the surgery.’”
The first case study in the article looked at two patients with very different outcomes. Neither one needed a stent. The patient who got one did not survive. The article explains:
Stents for stable patients prevent zero heart attacks and extend the lives of patients a grand total of not at all.What the patients in both stories had in common was that neither needed a stent. By dint of an inquiring mind and a smartphone, one escaped with his life intact. The greater concern is: How can a procedure so contraindicated by research be so common?
When you visit a doctor, you probably assume the treatment you receive is backed by evidence from medical research. Surely, the drug you’re prescribed or the surgery you’ll undergo wouldn’t be so common if it didn’t work, right?
For all the truly wondrous developments of modern medicine—imaging technologies that enable precision surgery, routine organ transplants, care that transforms premature infants into perfectly healthy kids, and remarkable chemotherapy treatments, to name a few—it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable—or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades.
The entire article contains several case studies and a thorough look at the research. It is a great read! What are your thoughts relating to maternal health care?
From time to time, we have lab companies come in and present information about new testing and technology available to offer our clients. As we sat in the presentation, the complex ethical questions were apparent – especially as we started to consider the future application of the developing technology. With the availability of more information comes the ultimate question – what do you DO with that information? A recent article explores the potential available in the very testing we were discussing:
Secrets of Life in a Spoonful of Blood: The intricate development of the fetus is yielding its long-held secrets to state-of-the-art molecular technologies that can make use of the mother’s blood. By Claire Ainsworth, Nature.com
Now, a crop of molecular technologies is giving scientists tantalizing hints about how to fill in those gaps. Improved ways of reading and interpreting the information in fetal genetic material are uncovering a raft of genes involved in human development, and letting researchers eavesdrop on the hum of gene activity before birth. They can see which genes turn on or off at pivotal moments, and sense how the environment nurtures or intrudes on this.
Even the vital life-support system that we jettison at birth — the placenta — is laying bare its secrets. “It really is this great mystery in reproduction,” says Zev Williams, a reproductive endocrinologist and infertility specialist at the Albert Einstein College of Medicine in New York City. “It’s obviously such a critical part of human development, but it’s been so understudied.”
Until now, much of the work has relied on amniotic or placental samples obtained during routine invasive tests such as amniocentesis. But scientists are eyeing the next step: studies that are non-invasive for the fetus and are done on a teaspoonful of blood drawn from a pregnant woman’s arm. In this way, researchers could monitor fetuses as they develop and, down the line, develop non-invasive tests for a broad range of conditions, in both fetus and mother.
It is always hard to balance the right to know against the potential harm of revealing the presence of a DNA variant — especially if scientists can’t be sure what the effect of that variant will be, says Shendure. “It’s just going to get really tricky.”
Have you noticed dramatic hair loss during your postpartum “fourth trimester” – and the regrowth of fun little baby hairs along your forehead? Women’s Health Magazine has a Q & A about this condition that can be scary until you look at the facts (ps – it’s normal).
What it is: During pregnancy, you get a surge in estrogen, which can cause your hair to grow like a weed. But about three to four months after giving birth, the hormone plummets, which helps send many follicles from the growth (anagen) phase to the resting (telogen) phase at the same time—doctors refer to this condition as telogen effluvium. This shedding can last anywhere from four to seven months, says Fusco. And it’s not always a zero-sum game: You can end up losing more hair than you gained during pregnancy.
So, it’s a real thing – you aren’t imagining it! But what can you do about it?
What helps: If you’re breast-feeding, your options are limited, says dermatologist Kathie P. Huang, M.D., codirector of Brigham and Women’s Hospital Hair Loss Clinic in Boston. Anything that gets in your system could potentially be transferred to your baby (and many treatments aren’t safety-tested on nursing mothers or babies for good reason). A healthy diet goes a long way, as do prenatal vitamins if you have any pregnancy-related deficiencies, like iron, that could hinder healthy hair growth. (Try adding these foods high in iron too your diet.)
For more information, read the entire article here.
“And then, a few hours later,” he says, lowering his voice as if he is about to impart the answer to all the secret mysteries of the universe, “they sent us home. And Clare just walked out. Like a normal person. She just got up and walked out. But she’d just had a baby! I offered to carry her, but she just looked at me as if I was insane. As if I was insane! As if what she’d just done wasn’t insane! They should carry you all out on golden sedan chairs through streets lined with cheering crowds.”
“And cushions,” I say. “We want cushions on the sedan chair. We want it to be mostly cushions.”
“Whatever you say,” he says, earnestly. “Whatever you say.”
The Charleston Birth Place is an accredited birth center in South Caroline, owned and operated by Certified Nurse Midwife and former AABC President, Lesley Rathbun. Ms. Rathbun fears impending legislative process will greatly impact her ability to provide safe and appropriate clinical care. The new regulations would require a doctor to visit the birth center when an emergency takes place in order to decide if the mother and child need to be taken to the hospital. The Post and Courier explains:
Four years ago, state lawmakers passed a temporary fix that allowed birth centers to sidestep the regulations and remain open. That proviso, which has been renewed each year and will remain valid through June, allows birth centers to consult with a physician on-site or “by telecommunications or other electronic means.” It also requires the contracting physician to “be within a thirty minute drive of the birthing center or hospital.”
But a health care subcommittee of state lawmakers recently indicated it will not likely renew the proviso for another year. Rep. Murrell Smith, a Sumter Republican who chairs that subcommittee, did not return a message Friday.
Meanwhile, two bills have been introduced to permanently update the DHEC regulations, but similar laws have failed to gain traction in the past.
We need our supporters to click on the links, and make comments. Engaging the media helps us get H3133/S242 the legislative support needed to put all this behind us.
NORTH CHARLESTON, SC (WCSC) – A local birth center is in jeopardy of ending its services. This after a state committee deleted a temporary law this week that enables the local center to carry out natural births. Charleston Birth Place an accredited birth center provides natural births for women.
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.