Taken from: http://news.yahoo.com/s/ap/20100405/ap_on_he_me/us_med_breast_feeding_savings
CHICAGO – The lives of nearly 900 babies would be saved each year, along with billions of dollars, if 90 percent of U.S. women fed their babies breast milk only for the first six months of life, a cost analysis says.
Those startling results, published online Monday in the journal Pediatrics, are only an estimate. But several experts who reviewed the analysis said the methods and conclusions seem sound.
"The health care system has got to be aware that breast-feeding makes a profound difference," said Dr. Ruth Lawrence, who heads the American Academy of Pediatrics' breast-feeding section.
The findings suggest that there are hundreds of deaths and many more costly illnesses each year from health problems that breast-feeding may help prevent. These include stomach viruses, ear infections, asthma, juvenile diabetes, Sudden Infant Death Syndrome and even childhood leukemia.
The magnitude of health benefits linked to breast-feeding is vastly underappreciated, said lead author Dr. Melissa Bartick, an internist and instructor at Harvard Medical School. Breast-feeding is sometimes considered a lifestyle choice, but Bartick calls it a public health issue.
Among the benefits: Breast milk contains antibodies that help babies fight infections; it also can affect insulin levels in the blood, which may make breast-fed babies less likely to develop diabetes and obesity.
The analysis studied the prevalence of 10 common childhood illnesses, costs of treating those diseases, including hospitalization, and the level of disease protection other studies have linked with breast-feeding.
The $13 billion in estimated losses due to the low breast-feeding rate includes an economists' calculation partly based on lost potential lifetime wages — $10.56 million per death.
The methods were similar to a widely cited 2001 government report that said $3.6 billion could be saved each year if 50 percent of mothers breast-fed their babies for six months. Medical costs have climbed since then and breast-feeding rates have increased only slightly.
About 43 percent of U.S. mothers do at least some breast-feeding for six months, but only 12 percent follow government guidelines recommending that babies receive only breast milk for six months.
Dr. Larry Gray, a University of Chicago pediatrician, called the analysis compelling and said it's reasonable to strive for 90 percent compliance.
But he also said mothers who don't breast-feed for six months shouldn't be blamed or made to feel guilty, because their jobs and other demands often make it impossible to do so.
"We'd all love as pediatricians to be able to carry this information into the boardrooms by saying we all gain by small changes at the workplace" that encourage breast-feeding, Gray said.
Bartick said there are some encouraging signs. The government's new health care overhaul requires large employers to provide private places for working mothers to pump breast milk. And under a provision enacted April 1 by the Joint Commission, a hospital accrediting agency, hospitals may be evaluated on their efforts to ensure that newborns are fed only breast milk before they're sent home.
The pediatrics academy says babies should be given a chance to start breast-feeding immediately after birth. Bartick said that often doesn't happen, and at many hospitals newborns are offered formula even when their mothers intend to breast-feed.
"Hospital practices need to change to be more in line with evidence-based care," Bartick said. "We really shouldn't be blaming mothers for this."
March 23, 2010
Article: US C-Section Rate Hits 32%
Taken From: http://www.nytimes.com/2010/03/24/health/24birth.html?src=twt&twt=nytimes
Caesarean Births Are at a High in U.S.
By DENISE GRADY
Published: March 23, 2010
The Caesarean section rate in the United States reached 32 percent in 2007, the country’s highest rate ever, health officials are reporting.
The rate has been climbing steadily since 1996, setting records year after year, and Caesarean section has become the most common operation in American hospitals. About 1.4 million Caesareans were performed in 2007, the latest year for which figures are available.
The increases — documented in a report published Tuesday — have caused debate and concern for years. When needed, a Caesarean can save the mother and her child from injury or death, but most experts doubt that one in three women need surgery to give birth. Critics say the operation is being performed too often, needlessly exposing women and babies to the risks of major surgery. The ideal rate is not known, but the World Health Organization and health agencies in the United States have suggested 15 percent.
The continuing rise “is not going to be good for anybody,” said Dr. George A. Macones, the chairman of obstetrics and gynecology at Washington University in St. Louis and a spokesman for the American College of Obstetricians and Gynecologists. “What we’re worried about is, the Caesarean section rate is going up, but we’re not improving the health of babies being delivered or of moms.”
Risks to the mother increase with each subsequent Caesarean, because the surgery raises the odds that the uterus will rupture in the next pregnancy, an event that can be life-threatening for both the mother and the baby. Caesareans also increase the risk of dangerous abnormalities in the placenta during later pregnancies, which can cause hemorrhaging and lead to a hysterectomy. Repeated Caesareans can make it risky or even impossible to have a large family.
The new report notes that Caesareans also pose a risk of surgical complications and are more likely than normal births to cause problems that put the mother back in the hospital and the infant in an intensive-care unit. The report states, “In addition to health and safety risks for mothers and newborns, hospital charges for a Caesarean delivery are almost double those for a vaginal delivery, imposing significant costs.”
Fay Menacker, an author of the report and a statistician at the National Center for Health Statistics, which published the report, said, “There’s been an increase for women of all ages and racial and ethnic groups, and all states.”
The highest rates of Caesarean births were in New Jersey (38.3 percent) and Florida (37.2 percent), and the lowest were in Utah (22.2 percent) and Alaska (22.6 percent).
The report notes that the rate in the United States is higher than those in most other industrialized countries. But rates have soared to 40 percent in some developing countries in Latin America, and the rates in Puerto Rico and China are approaching 50 percent. A report by the World Health Organization published earlier this year in The Lancet, a medical journal, said hospitals in China might be doing unnecessary operations to make money.
There is no single reason for the continuing increase in the United States. Rising multiple births because of fertility treatments have a role, because they often require Caesareans. But, the report notes, Caesarean rates for singletons increased substantially more than those for multiples. Another factor is that more older women are giving birth nowadays, and they are more likely to have Caesareans — but women under 25 had the greatest increases in Caesareans from 2000 to 2007.
Nonmedical issues are also involved. Obstetricians, fearful of being sued if there is harm to a baby after a normal labor and delivery, are quicker than they used to be to perform a Caesarean.
“The threshold for doing a Caesarean section is going down, and one of the major factors is professional liability, ending up in court,” Dr. Macones said.
In an article last month in the journal Obstetrics and Gynecology, the obstetricians’ college reported that a poll of 5,644 of its members found that 29 percent said they were performing more Caesareans because they feared lawsuits. Eight percent said they had quit delivering babies, and nearly a third of those said it was because of liability issues.
Some of the increase in Caesareans has also come from women requesting the surgery even when it is not medically necessary, Dr. Macones said. Caesareans have become so common that many people do not realize they are major abdominal surgery, with all the attendant risks.
In addition, the increased tendency to induce labor before a woman’s due date, for reasons of convenience, has helped push up the Caesarean rate, because induction is more likely than natural labor to fail and result in a Caesarean.
“We should do inductions for good solid medical reasons, not for convenience or the day of the week,” Dr. Macones said. “Sometimes patients push you.”
Another obstetrician also said patients requested what she called “social inductions,” for example, because a grandmother was visiting from out of town and hoping to see the baby before she had to leave. Another reason is the pending deployment of a husband to Iraq or Afghanistan.
Repeat Caesareans are another part of the problem. They account for about 40 percent of the total and have become increasingly common in the past 15 years as more and more hospitals have refused to allow women who have had a Caesarean to try to give birth normally. Fewer than 10 percent of women who had Caesareans now have vaginal births, compared with 28.3 percent in 1996. Many hospitals banned vaginal birth after Caesarean because of stringent guidelines set by the obstetricians’ college, which said surgery and anesthesia teams should be “immediately available” whenever a woman with a prior Caesarean was in labor.
An expert panel convened earlier this month by the National Institutes of Health said there were too many barriers to vaginal birth after a Caesarean and suggested ways to reduce them. It urged the obstetricians’ group to reassess its guidelines on “immediate availability,” and it urged hospitals to publicize their rates of vaginal birth after a Caesarean, so women could make informed choices about where to give birth. It also acknowledged the problem of malpractice suits but did not make a specific recommendation about how to solve it.
Dr. Macones said the panel’s advice made sense, but he added: “The first thing we should be trying to do is lower the primary C-section rate. Then we wouldn’t get into this trouble.”
Dr. Menacker said: “It looks as if this is a trend that is continuing. I don’t know what the future will hold.”
Caesarean Births Are at a High in U.S.
By DENISE GRADY
Published: March 23, 2010
The Caesarean section rate in the United States reached 32 percent in 2007, the country’s highest rate ever, health officials are reporting.
The rate has been climbing steadily since 1996, setting records year after year, and Caesarean section has become the most common operation in American hospitals. About 1.4 million Caesareans were performed in 2007, the latest year for which figures are available.
The increases — documented in a report published Tuesday — have caused debate and concern for years. When needed, a Caesarean can save the mother and her child from injury or death, but most experts doubt that one in three women need surgery to give birth. Critics say the operation is being performed too often, needlessly exposing women and babies to the risks of major surgery. The ideal rate is not known, but the World Health Organization and health agencies in the United States have suggested 15 percent.
The continuing rise “is not going to be good for anybody,” said Dr. George A. Macones, the chairman of obstetrics and gynecology at Washington University in St. Louis and a spokesman for the American College of Obstetricians and Gynecologists. “What we’re worried about is, the Caesarean section rate is going up, but we’re not improving the health of babies being delivered or of moms.”
Risks to the mother increase with each subsequent Caesarean, because the surgery raises the odds that the uterus will rupture in the next pregnancy, an event that can be life-threatening for both the mother and the baby. Caesareans also increase the risk of dangerous abnormalities in the placenta during later pregnancies, which can cause hemorrhaging and lead to a hysterectomy. Repeated Caesareans can make it risky or even impossible to have a large family.
The new report notes that Caesareans also pose a risk of surgical complications and are more likely than normal births to cause problems that put the mother back in the hospital and the infant in an intensive-care unit. The report states, “In addition to health and safety risks for mothers and newborns, hospital charges for a Caesarean delivery are almost double those for a vaginal delivery, imposing significant costs.”
Fay Menacker, an author of the report and a statistician at the National Center for Health Statistics, which published the report, said, “There’s been an increase for women of all ages and racial and ethnic groups, and all states.”
The highest rates of Caesarean births were in New Jersey (38.3 percent) and Florida (37.2 percent), and the lowest were in Utah (22.2 percent) and Alaska (22.6 percent).
The report notes that the rate in the United States is higher than those in most other industrialized countries. But rates have soared to 40 percent in some developing countries in Latin America, and the rates in Puerto Rico and China are approaching 50 percent. A report by the World Health Organization published earlier this year in The Lancet, a medical journal, said hospitals in China might be doing unnecessary operations to make money.
There is no single reason for the continuing increase in the United States. Rising multiple births because of fertility treatments have a role, because they often require Caesareans. But, the report notes, Caesarean rates for singletons increased substantially more than those for multiples. Another factor is that more older women are giving birth nowadays, and they are more likely to have Caesareans — but women under 25 had the greatest increases in Caesareans from 2000 to 2007.
Nonmedical issues are also involved. Obstetricians, fearful of being sued if there is harm to a baby after a normal labor and delivery, are quicker than they used to be to perform a Caesarean.
“The threshold for doing a Caesarean section is going down, and one of the major factors is professional liability, ending up in court,” Dr. Macones said.
In an article last month in the journal Obstetrics and Gynecology, the obstetricians’ college reported that a poll of 5,644 of its members found that 29 percent said they were performing more Caesareans because they feared lawsuits. Eight percent said they had quit delivering babies, and nearly a third of those said it was because of liability issues.
Some of the increase in Caesareans has also come from women requesting the surgery even when it is not medically necessary, Dr. Macones said. Caesareans have become so common that many people do not realize they are major abdominal surgery, with all the attendant risks.
In addition, the increased tendency to induce labor before a woman’s due date, for reasons of convenience, has helped push up the Caesarean rate, because induction is more likely than natural labor to fail and result in a Caesarean.
“We should do inductions for good solid medical reasons, not for convenience or the day of the week,” Dr. Macones said. “Sometimes patients push you.”
Another obstetrician also said patients requested what she called “social inductions,” for example, because a grandmother was visiting from out of town and hoping to see the baby before she had to leave. Another reason is the pending deployment of a husband to Iraq or Afghanistan.
Repeat Caesareans are another part of the problem. They account for about 40 percent of the total and have become increasingly common in the past 15 years as more and more hospitals have refused to allow women who have had a Caesarean to try to give birth normally. Fewer than 10 percent of women who had Caesareans now have vaginal births, compared with 28.3 percent in 1996. Many hospitals banned vaginal birth after Caesarean because of stringent guidelines set by the obstetricians’ college, which said surgery and anesthesia teams should be “immediately available” whenever a woman with a prior Caesarean was in labor.
An expert panel convened earlier this month by the National Institutes of Health said there were too many barriers to vaginal birth after a Caesarean and suggested ways to reduce them. It urged the obstetricians’ group to reassess its guidelines on “immediate availability,” and it urged hospitals to publicize their rates of vaginal birth after a Caesarean, so women could make informed choices about where to give birth. It also acknowledged the problem of malpractice suits but did not make a specific recommendation about how to solve it.
Dr. Macones said the panel’s advice made sense, but he added: “The first thing we should be trying to do is lower the primary C-section rate. Then we wouldn’t get into this trouble.”
Dr. Menacker said: “It looks as if this is a trend that is continuing. I don’t know what the future will hold.”
March 12, 2010
Article: Too Many Women Dying While Having Babies
Taken From: http://www.time.com/time/health/article/0,8599,1971633,00.html
Amnesty International may be best known to American audiences for bringing to light horror stories overseas such as the disappearance of political activists in Argentina or the abysmal conditions inside South African prisons under apartheid. But in a new report on pregnancy and childbirth care in the U.S., Amnesty details the maternal health care crisis in this country as part of a systemic violation of women's rights.
The report, titled "Deadly Delivery," notes that the likelihood of a woman dying in childbirth in the U.S. is five times greater than in Greece, four times greater than in Germany, and three times greater than in Spain. Every day in the U.S., more than two women die of pregnancy-related causes, with the maternal mortality ratio doubling from 6.6 deaths per 100,000 births in 1987 to 13.3 deaths per 100,000 births in 2006. (And as shocking as these figures are, Amnesty notes that the actual number of maternal deaths in the U.S. may be a lot higher since there are no federal requirements to report these outcomes and since data collection at the state and local levels needs to be improved.) "In the U.S., we spend more than any country on health care, yet American women are at greater risk of dying from pregnancy-related causes than in 40 other countries," says Nan Strauss, the report's co-author, who spent two years investigating the issue of maternal mortality worldwide. "We thought that was scandalous." (See the most common hospital mishaps.)
According to Amnesty, which gathered data from many sources including the CDC, approximately half of the pregnancy-related deaths in the U.S. are preventable, the result of systemic failures including barriers to accessing care; inadequate, neglectful, or discriminatory care; and overuse of risky interventions like inducing labor and delivering via cesarean section. "Women are not dying from complex, mysterious causes that we don't know how to treat," says Strauss. "Women are dying because it's a fragmented system, and they are not getting the comprehensive services that they need."
The report notes that black women in the U.S. are nearly four times more likely to die from pregnancy-related causes than white women, although they are no more likely to suffer certain complications like hemorrhage.
The Amnesty report comes on the heels of an investigation in California that found maternal deaths have tripled there in recent years as well as a maternal-mortality alert issued in January by the Joint Commission, a group that accredits hospitals and other medical organizations, which noted that common preventable errors included failure to control blood pressure in hypertensive women and failure to pay attention to vital signs following c-sections. And just this week, a panel of medical experts at a conference held by the National Institutes of Health recommended that physicians' organizations revisit policies that prevent women from having vaginal births after having had a cesarean. Such policies, designed in part to protect against litigation, have contributed to the U.S. cesarean rate rising to nearly 32% in 2007, the most recent year for which data is available.
The Amnesty report spotlights numerous barriers women face in accessing care, even among those who are insured or qualify for Medicaid. Poverty is a major factor, but all women are put at risk by overuse of obstetrical intervention and barriers in access to more woman-centered, physiologic care provided by family-practice physicians and midwives.
Amnesty is calling on Obama to create an Office of Maternal Health within the Department of Health and Human Services to improve outcomes and reduce disparities, among other recommendations. The report also calls on the government to address the shortage of maternal-care providers.
"Access is only one factor," cautions Maureen Corry, executive director of Childbirth Connection, a research and advocacy organziation that recently convened more than 100 stakeholders, including members of the American College of Obstetricians and Gynecologists and the NIH, in a large symposium on transforming maternity care. "We need to make sure that we reduce the overuse of interventions that are not always necessary, like C-sections, and increase access to the care that we know is good for mothers and babies, like labor support."
FREE Web Discussion on Fertility and Early Pregnancy
Hi everyone!
I will be hosting a web discussion on fertility and early pregnancy and you are all welcome to join! Just e-mail me at TheCrunchyChristian@live.com and express your interest.
The first discussion will be hosted on March 22 at 8:30 PM. I plan on scheduling more later on for people who cannot attend the first one.
Here are some of the topics being covered:
-Charting: How-to, Technical Setup for Fertility Friend, Trying to Avoid Pregnancy, Trying to Conceive, Implantation Dips, thermometer questions.
-Hormones: FSH, LH, Estridol, Progesterone, TSH, Testosterone. Progesterone discussion into the first trimester.
-Cervix: Where is it, what is it, and what does it do? Detecting cervical cysts. What happens during pregnancy?
-Cervical Fluid: Normal vs. Abnormal
-Fertility Supplements: Dong Quai, Soy Isoflavones, Evening Primrose Oil, Parsley, B6, Wild Yam, pineapple core, etc.
-Fertility Drugs: Mucinex, Clomid, Prometrium, Injectibles, baby asprin, birth control pills.
-Fertility Testing: Blood tests, HSG, ultrasound
-The phases of your cycle: Menses, Follicular Phase, "Ovulation Phase", and Luteal Phase.
-The Two Waiting Weeks: Early pregnancy symptoms, Early fetal development
-"BFP" and Beyond: Common early pregnancy symptoms, causes, and how to ease them. Choosing a medical professional. Miscarriages and rates.
Please feel free to expound on the topics listed here if you have any other questions you think of.
In the future, I hope to offer more information on pregnancy, labor, and delivery.
I will be hosting a web discussion on fertility and early pregnancy and you are all welcome to join! Just e-mail me at TheCrunchyChristian@live.com and express your interest.
The first discussion will be hosted on March 22 at 8:30 PM. I plan on scheduling more later on for people who cannot attend the first one.
Here are some of the topics being covered:
-Charting: How-to, Technical Setup for Fertility Friend, Trying to Avoid Pregnancy, Trying to Conceive, Implantation Dips, thermometer questions.
-Hormones: FSH, LH, Estridol, Progesterone, TSH, Testosterone. Progesterone discussion into the first trimester.
-Cervix: Where is it, what is it, and what does it do? Detecting cervical cysts. What happens during pregnancy?
-Cervical Fluid: Normal vs. Abnormal
-Fertility Supplements: Dong Quai, Soy Isoflavones, Evening Primrose Oil, Parsley, B6, Wild Yam, pineapple core, etc.
-Fertility Drugs: Mucinex, Clomid, Prometrium, Injectibles, baby asprin, birth control pills.
-Fertility Testing: Blood tests, HSG, ultrasound
-The phases of your cycle: Menses, Follicular Phase, "Ovulation Phase", and Luteal Phase.
-The Two Waiting Weeks: Early pregnancy symptoms, Early fetal development
-"BFP" and Beyond: Common early pregnancy symptoms, causes, and how to ease them. Choosing a medical professional. Miscarriages and rates.
Please feel free to expound on the topics listed here if you have any other questions you think of.
In the future, I hope to offer more information on pregnancy, labor, and delivery.
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