Focus on Infants During Childbirth Leaves US Moms in Danger

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yeah, it's not a focus on infants that's the problem. It's our terrible healthcare system.

I'm not so sure. They put a ton of resources into promoting breastfeeding, which has negligible if any benefits. The protocols developed by Canada to prevent pre-eclampsia wouldn't take that much money; just the organization/political will to do it.

I disagree that there are a ton of resources promoting breastfeeding. I'm a new mom struggling with breastfeeding and I'm struggling to get support. The hospital provided minimal service (and before my milk even came in with no follow up) and LCs are expensive. I went to a support group at the hospital but there were too many people there to get any specific guidance. Also, it's really tough to continue breastfeeding with a lack of paid maternity leave. Now Congress wants to get rid of the ACA mandates related to breastfeeding.

Well there's certainly been MUCH more institutional support for breastfeeding compared to maternal health. There's the whole Baby Friendly Hospital accreditation that takes money to organize, political capital to push, and then money and commitment for the hospitals to implement. Resources are also expended on reducing c-sections, which may reduce some morbidity/mortality, but fails to address the main causes of maternal death. And JAHCO's "Perinatal Core Measures" are almost exclusively focused on promoting vaginal birth and breastfeeding, not maternal health. http://www.jointcommission.org/assets/1/6/s11.pdf.

Out of curiosity PP what resources are being expended to reduce c-sections? I'm genuinely curious b/c I ended up having to have one b/c my baby was OP and didn't budge after two hours of pushing. To be honest, I was fucking furious. . .what was the point of all of those visits in the last weeks? I really don't understand why they don't do some imaging in the last week or two to determine positioning beforehand so you can try to do something about it BEFORE you go into labor.

I don't think there's really anything you can do about an OP baby to reduce c sections. If anything, maternal-health focused care would develop procedures to identify patients like you where going to c-section sooner rather htan later is the best plan to avoid injury to you. The resources I'm talking about are things like the JAHCO and California efforts to reduce c sections by encouraging operative births, longer pushing, etc (which both increase maternal pelvic injury rates, btw ...)

Bad positioning can be influenced in the weeks before the birth ... mostly through working with the mother on posture and certain techniques. It's not 100% successful but certainly more than just ignoring it. I had MWs for all 3 of mine and there was a lot of education on what I should do to improve baby's positioning. For an OP baby, there's also a lot you can do in labor to move the baby before its head is fully engaged .. after that you're kind of stuck. Regarding longer pushing, what the recent study showed is that the 1 hr cutoff was an artificial (and capriciously applied) timeline that did not improve outcomes.

Please provide research showing that there's anything that can be done through "posture" to improve positioning.

As for pushing - it's all individual. Pushing for an hour would be too much for a mother whose pelvis was the wrong shape. A prolonged second stage of labor causes pelvic floor damage. Somewhere in between (allowing variations for each individual case) is probably the right way to go.

[Anonymous]

I find this article frustrating.

It's poorly organized, with the appalling medical policy stuff buried among paragraphs of the tearjerker story. It's horrible, what happened to that family, but I think that including the whole back story of it really detracts from the substance of the article.

I think that most women receive totally inadequate postpartum care. The women who get great postpartum care seem to almost always arrange it themselves. Women hire postpartum doulas and night nurses to help them after the baby is born. Medically, we are basically on our own between discharge and a follow up appointment in 6 weeks. If something develops between discharge and 6 weeks, it's on us to notice it, and most of us do not have the medical training to do so. People spend months talking about how incoherent and exhausting the newborn phase is, and I think that most women are totally unprepared for real complications.

I wish the article had focused more on that and less on extreme medical issues in the hospital.

[Anonymous]

Anonymous wrote:I find this article frustrating.

It's poorly organized, with the appalling medical policy stuff buried among paragraphs of the tearjerker story. It's horrible, what happened to that family, but I think that including the whole back story of it really detracts from the substance of the article.

I think that most women receive totally inadequate postpartum care. The women who get great postpartum care seem to almost always arrange it themselves. Women hire postpartum doulas and night nurses to help them after the baby is born. Medically, we are basically on our own between discharge and a follow up appointment in 6 weeks. If something develops between discharge and 6 weeks, it's on us to notice it, and most of us do not have the medical training to do so. People spend months talking about how incoherent and exhausting the newborn phase is, and I think that most women are totally unprepared for real complications.

I wish the article had focused more on that and less on extreme medical issues in the hospital.

Well although I agree with you that post-partum care is terrible in general, the point of the article is to address maternal death and injury. So it's appropriate that the story focus on those cases. It's also valuable to read the stories to understand in detail how the medical errors happened.

[Anonymous]

Anonymous wrote:Just read this earlier this morning and cried. I had HELLP Syndrome and an emergency c four weeks ago. The doctors at Georgetown recognized 4 days prior that I had slightly elevated labs and slightly elevated BP and may end up in trouble. My BP was never as high as the woman in the article yet the doctors knew when I needed the c section and got my daughter out just before my platelet count dropped close to transfusion level and my liver enzymes went sky high.

I spoke to another NICU mom who had the same symptoms as me but was at another hospital in MD and they sent her to the ER instead of L&D and she was told her intense liver pain (and clear symptom of HELLP Syndrome) was just the baby kicking her ribs and to suck it up and take Tylenol. She suffered for several days before getting the help she needed. It's outrageous.

I was already feeling nervous about prior plans to move out of the region before baby #2 but this article has me terrified to consider another pregnancy at a hospital that may not be as good at recognizing signs of trouble.

I had this happen to me w/ my first pregnancy and my Dr didn't even bother to read the labs I basically forced her to order for 4 days (borderline high BP continually climbing but not yet in "high" range + URQ pain). Then, when she finally bothered to look, she called me in a panic clearly worried I would sue here (and/or was dead). Raced to the hospital and got a c-section w/ my platelets exactly on the border for needing GA. 24 hours on a mag drip, weird BP spikes for a few weeks... thankfully, everything worked out OK and my DD was fine.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I had pre-ecamplsia. While everything turned out fine in the end, I am convinced it could have and should have been found earlier.

While my BP wasn't clinically high, it was high for ME and crept up throughout my pregnancy. Also, I had a lot of swelling.

My exact experience. And I had to fight to get them to take the BP seriously because it wasn't at "crisis" levels but was creeping up starting at around 33 weeks.

I had the exact same experience with high for me but not clinically high blood pressure, along with swelling. I feel so lucky that my doctor was concerned enough to take it really seriously and even called me in on the weekend one time to come in for more labs, which showed deteriorating results and led to an immediate induction. Looking back, I'm also mad at myself for not taking things seriously enough. I had bought into the idea of "natural birth" and was so against the idea of an induction or c-section that I tried to deny to myself that things could get serious quickly. Ultimately, I would up with an induction and c-section followed by a tranfusion, but luckily baby and I both walked out unscathed.

There's certainly a variety of causes of the increasing maternal death rate, and the most significant factor is surely lack of adequate medical care/ability to afford care. My experience also makes me hope that the trend against medicalization/toward natural birth, doesn't also lead to adverse effects in some cases. If my original midwives (not known as particularly crunchy) hadn't transferred me to OBs, and the OBs hadn't been vigilant, I recognize now I could have been in a much scarier situation.

You do realize that in all of these countries with better outcomes than the U.S., mothers are primarily cared for by midwives right? In the article, the mom who died was under a doctors care in a hospital. I don't understand how you are blaming midwives for subpar health care in American hospitals.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Yeah, it's not a focus on infants that's the problem. It's our terrible healthcare system.

I'm not so sure. They put a ton of resources into promoting breastfeeding, which has negligible if any benefits. The protocols developed by Canada to prevent pre-eclampsia wouldn't take that much money; just the organization/political will to do it.

Negligible? Ha! Keel telling yourself that if it makes you feel better that you couldn't hack it and resorted to formula.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yeah, it's not a focus on infants that's the problem. It's our terrible healthcare system.

I'm not so sure. They put a ton of resources into promoting breastfeeding, which has negligible if any benefits. The protocols developed by Canada to prevent pre-eclampsia wouldn't take that much money; just the organization/political will to do it.

I disagree that there are a ton of resources promoting breastfeeding. I'm a new mom struggling with breastfeeding and I'm struggling to get support. The hospital provided minimal service (and before my milk even came in with no follow up) and LCs are expensive. I went to a support group at the hospital but there were too many people there to get any specific guidance. Also, it's really tough to continue breastfeeding with a lack of paid maternity leave. Now Congress wants to get rid of the ACA mandates related to breastfeeding.

Well there's certainly been MUCH more institutional support for breastfeeding compared to maternal health. There's the whole Baby Friendly Hospital accreditation that takes money to organize, political capital to push, and then money and commitment for the hospitals to implement. Resources are also expended on reducing c-sections, which may reduce some morbidity/mortality, but fails to address the main causes of maternal death. And JAHCO's "Perinatal Core Measures" are almost exclusively focused on promoting vaginal birth and breastfeeding, not maternal health. http://www.jointcommission.org/assets/1/6/s11.pdf.

Out of curiosity PP what resources are being expended to reduce c-sections? I'm genuinely curious b/c I ended up having to have one b/c my baby was OP and didn't budge after two hours of pushing. To be honest, I was fucking furious. . .what was the point of all of those visits in the last weeks? I really don't understand why they don't do some imaging in the last week or two to determine positioning beforehand so you can try to do something about it BEFORE you go into labor.

I don't think there's really anything you can do about an OP baby to reduce c sections. If anything, maternal-health focused care would develop procedures to identify patients like you where going to c-section sooner rather htan later is the best plan to avoid injury to you. The resources I'm talking about are things like the JAHCO and California efforts to reduce c sections by encouraging operative births, longer pushing, etc (which both increase maternal pelvic injury rates, btw ...)

Bad positioning can be influenced in the weeks before the birth ... mostly through working with the mother on posture and certain techniques. It's not 100% successful but certainly more than just ignoring it. I had MWs for all 3 of mine and there was a lot of education on what I should do to improve baby's positioning. For an OP baby, there's also a lot you can do in labor to move the baby before its head is fully engaged .. after that you're kind of stuck. Regarding longer pushing, what the recent study showed is that the 1 hr cutoff was an artificial (and capriciously applied) timeline that did not improve outcomes.

Please provide research showing that there's anything that can be done through "posture" to improve positioning.

As for pushing - it's all individual. Pushing for an hour would be too much for a mother whose pelvis was the wrong shape. A prolonged second stage of labor causes pelvic floor damage. Somewhere in between (allowing variations for each individual case) is probably the right way to go.

This isn't true. First, there's more than two stages of labor. Second, I was in labor for 4 hours, start to finish. I only pushed for 30 minutes and I still needed PT for pelvic floor. It's not as simple as you want it to be.

Last, I'm not the PP you're responding to, but posture throughout pregnancy is important in maintaining core strength that will assist in an easier labor and delivery. A simple Google search would do you wonders.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yeah, it's not a focus on infants that's the problem. It's our terrible healthcare system.

I'm not so sure. They put a ton of resources into promoting breastfeeding, which has negligible if any benefits. The protocols developed by Canada to prevent pre-eclampsia wouldn't take that much money; just the organization/political will to do it.

Negligible? Ha! Keel telling yourself that if it makes you feel better that you couldn't hack it and resorted to formula.

Found the lactivist swine!

[Anonymous]

I read the article and I'm not sure that I follow the article's conclusion that the focus on the newborn is leading to a higher maternal mortality rate. In the case of the mother in the article who died from HELLP, that was medical negligence, in terms of not properly charting and communicating to doctors the woman's blood pressure and complaints of serious pain after birth. I'm not saying this to be obtuse or combatitive, but I don't see how that has anything to do with her newborn. But the overall point does stand that newborns receive MUCH better care, post birth, than new moms do. But then I hear all these complaints from my friends in the U.K. regarding their health visitors in their homes post-partum and that doesn't seem great either ... but maybe it's working if they have such a low maternal mortality rate?

[Anonymous]

Anonymous wrote:I read the article and I'm not sure that I follow the article's conclusion that the focus on the newborn is leading to a higher maternal mortality rate. In the case of the mother in the article who died from HELLP, that was medical negligence, in terms of not properly charting and communicating to doctors the woman's blood pressure and complaints of serious pain after birth. I'm not saying this to be obtuse or combatitive, but I don't see how that has anything to do with her newborn. But the overall point does stand that newborns receive MUCH better care, post birth, than new moms do. But then I hear all these complaints from my friends in the U.K. regarding their health visitors in their homes post-partum and that doesn't seem great either ... but maybe it's working if they have such a low maternal mortality rate?

What complaints are you hearing? My friends in the U.K. think it's amazing and can't understand why we don't do the same here.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I read the article and I'm not sure that I follow the article's conclusion that the focus on the newborn is leading to a higher maternal mortality rate. In the case of the mother in the article who died from HELLP, that was medical negligence, in terms of not properly charting and communicating to doctors the woman's blood pressure and complaints of serious pain after birth. I'm not saying this to be obtuse or combatitive, but I don't see how that has anything to do with her newborn. But the overall point does stand that newborns receive MUCH better care, post birth, than new moms do. But then I hear all these complaints from my friends in the U.K. regarding their health visitors in their homes post-partum and that doesn't seem great either ... but maybe it's working if they have such a low maternal mortality rate?

What complaints are you hearing? My friends in the U.K. think it's amazing and can't understand why we don't do the same here.

Oh yes, it sounds terrible to have regularly scheduled lactation consultants and nurses check on you after the birth.

I paid $300/hour for the privilege in the U.S.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I read the article and I'm not sure that I follow the article's conclusion that the focus on the newborn is leading to a higher maternal mortality rate. In the case of the mother in the article who died from HELLP, that was medical negligence, in terms of not properly charting and communicating to doctors the woman's blood pressure and complaints of serious pain after birth. I'm not saying this to be obtuse or combatitive, but I don't see how that has anything to do with her newborn. But the overall point does stand that newborns receive MUCH better care, post birth, than new moms do. But then I hear all these complaints from my friends in the U.K. regarding their health visitors in their homes post-partum and that doesn't seem great either ... but maybe it's working if they have such a low maternal mortality rate?

What complaints are you hearing? My friends in the U.K. think it's amazing and can't understand why we don't do the same here.

Just that the quality of the health visitors really varies - some are great and some are poor and have poor bedside manner. It also sounds like they focus more on the baby than the mother, especially with pushing breastfeeding at all costs, and ignoring postpartum mood disorders. But they also can't fathom why we don't have anything like that in the US, so it sounds like something where people try to take the good with the bad.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yeah, it's not a focus on infants that's the problem. It's our terrible healthcare system.

I'm not so sure. They put a ton of resources into promoting breastfeeding, which has negligible if any benefits. The protocols developed by Canada to prevent pre-eclampsia wouldn't take that much money; just the organization/political will to do it.

I disagree that there are a ton of resources promoting breastfeeding. I'm a new mom struggling with breastfeeding and I'm struggling to get support. The hospital provided minimal service (and before my milk even came in with no follow up) and LCs are expensive. I went to a support group at the hospital but there were too many people there to get any specific guidance. Also, it's really tough to continue breastfeeding with a lack of paid maternity leave. Now Congress wants to get rid of the ACA mandates related to breastfeeding.

Well there's certainly been MUCH more institutional support for breastfeeding compared to maternal health. There's the whole Baby Friendly Hospital accreditation that takes money to organize, political capital to push, and then money and commitment for the hospitals to implement. Resources are also expended on reducing c-sections, which may reduce some morbidity/mortality, but fails to address the main causes of maternal death. And JAHCO's "Perinatal Core Measures" are almost exclusively focused on promoting vaginal birth and breastfeeding, not maternal health. http://www.jointcommission.org/assets/1/6/s11.pdf.

Out of curiosity PP what resources are being expended to reduce c-sections? I'm genuinely curious b/c I ended up having to have one b/c my baby was OP and didn't budge after two hours of pushing. To be honest, I was fucking furious. . .what was the point of all of those visits in the last weeks? I really don't understand why they don't do some imaging in the last week or two to determine positioning beforehand so you can try to do something about it BEFORE you go into labor.

I don't think there's really anything you can do about an OP baby to reduce c sections. If anything, maternal-health focused care would develop procedures to identify patients like you where going to c-section sooner rather htan later is the best plan to avoid injury to you. The resources I'm talking about are things like the JAHCO and California efforts to reduce c sections by encouraging operative births, longer pushing, etc (which both increase maternal pelvic injury rates, btw ...)

Bad positioning can be influenced in the weeks before the birth ... mostly through working with the mother on posture and certain techniques. It's not 100% successful but certainly more than just ignoring it. I had MWs for all 3 of mine and there was a lot of education on what I should do to improve baby's positioning. For an OP baby, there's also a lot you can do in labor to move the baby before its head is fully engaged .. after that you're kind of stuck. Regarding longer pushing, what the recent study showed is that the 1 hr cutoff was an artificial (and capriciously applied) timeline that did not improve outcomes.

Please provide research showing that there's anything that can be done through "posture" to improve positioning.

As for pushing - it's all individual. Pushing for an hour would be too much for a mother whose pelvis was the wrong shape. A prolonged second stage of labor causes pelvic floor damage. Somewhere in between (allowing variations for each individual case) is probably the right way to go.

This isn't true. First, there's more than two stages of labor. Second, I was in labor for 4 hours, start to finish. I only pushed for 30 minutes and I still needed PT for pelvic floor. It's not as simple as you want it to be.

Last, I'm not the PP you're responding to, but posture throughout pregnancy is important in maintaining core strength that will assist in an easier labor and delivery. A simple Google search would do you wonders.

Right, show me the well designed clinical trial showing that better POSTURE will reduce maternal mortality.

Also the second stage of labor is the stage you push, so that's where pelvic injury would happen. And obviously there can still be damage in a short labor. If you really want to avoid it, get a c section.

[Anonymous]

This is so sad. An ex-colleague of mine just passed away after having a baby too, but in her case it was sepsis (they think). She left behind a 4yo, 2yo and a newborn. Devastating.

https://www.google.com/amp/nypost.com/2017/04/22/death-of-tv-producer-five-days-after-childbirth-still-a-mystery/amp/

[Anonymous]

Anonymous wrote:

Anonymous wrote:Just read this earlier this morning and cried. I had HELLP Syndrome and an emergency c four weeks ago. The doctors at Georgetown recognized 4 days prior that I had slightly elevated labs and slightly elevated BP and may end up in trouble. My BP was never as high as the woman in the article yet the doctors knew when I needed the c section and got my daughter out just before my platelet count dropped close to transfusion level and my liver enzymes went sky high.

I spoke to another NICU mom who had the same symptoms as me but was at another hospital in MD and they sent her to the ER instead of L&D and she was told her intense liver pain (and clear symptom of HELLP Syndrome) was just the baby kicking her ribs and to suck it up and take Tylenol. She suffered for several days before getting the help she needed. It's outrageous.

I was already feeling nervous about prior plans to move out of the region before baby #2 but this article has me terrified to consider another pregnancy at a hospital that may not be as good at recognizing signs of trouble.

Georgetown caught my pre-e and HELLP too and kept my baby cooking for an extra three weeks under close care. They are a really great practice.

I delivered at Georgetown in 2013 and they were very aggressive in monitoring my increasing BP and subsequent pre-e, as well.