November, 2009 browsing by month


Labor & Delivery: Don’t try this at home

Monday, November 30th, 2009

Most women today have no idea how dangerous it once was for a woman to give birth. The maternal death rate today is about eight per 100,000 births.  When home births were in style, the maternal death rate was 83 per 100,000 births – 10 times the number of deaths.

Women today almost never die in childbirth because, when things go wrong during labor and delivery, medical professionals can step in and prevent emergencies from becoming tragedies.

Which is why I want to scream when I read nonsense like the following, from a website calling itself “Born Free.”

“Welcome to Bornfree! This site is based on the belief that childbirth is inherently safe and relatively painless provided we don’t live in poverty, and do not interfere either physically or psychologically. Drugs, machinery, and medical personnel are not only unnecessary in most cases, they are also no match for a woman’s own intellect and intuition.”

The site quoted above advocates for unassisted childbirth at home. No doctor. No midwife. And no professional help at the ready if something goes wrong.

Ordinarily, I wouldn’t get too exercised over an obscure website. But, it’s how I found this website that has me troubled. It was featured in an article on ABC in the “Entertainment” section. The article mostly extolled the concept of women giving birth at home, with neither a midwife nor a doctor present, giving only the briefest nod to the caveats from an ob-gyn.

In the age of reality TV, maybe a piece about women risking their lives to experience “freebirth” makes good copy. Maybe, because it was in the Entertainment section, this quote from a mother who recently gave birth on her own didn’t raise any eyebrows: “…it is not risky if you do your homework.”

But ask an ob-gyn and you’ll get a much different albeit less entertaining quote.

Yes, so-called “freebirth” is risky. And no, you can’t mitigate the risk by doing “homework.” Approximately 40 percent of high-risk patients appear to be low-risk before labor and delivery. No amount of “homework” can prepare a woman for suddenly finding herself among those 40 percent. If she’s at home, without medical attention, she and her baby could be in serious danger.

Most certified nurse midwives are affiliated with hospitals today precisely because the unexpected can and does happen during childbirth and having medical and surgical teams within shouting distance can mean the difference between life and death. The birthing process is still the 11th leading cause of death in women between 15 and 44 years of age.

When I was in the military, we received a stat call about a home birth gone wrong. The woman lost all muscle tone in her uterus after the birth of her child. By the time the ambulance got her to Bethesda, she had bled to death.

So I’ve seen firsthand how “freebirth” can be a recipe for disaster.

– Yvonne S. Thornton, MD, MPH

Why you MUST get a gynecological exam every year. Period.

Monday, November 23rd, 2009

You may have heard that the American Congress of Obstetricians and Gynecologists (ACOG) has just come out with new guidelines for how often women should get Pap smears. Rather than discussing the details of the guidelines, I want to stress one essential fact:

A Pap smear is not an annual pelvic exam. It’s just one small segment. If you’re over 21, you must still get a pelvic examination each year, every year, for as long as you live. Some years the Pap test will be part of the examination and some years, it may not be. Whether you get a Pap has nothing to do with whether you need to be examined.

You do. Here’s why.

During your annual pelvic exam, your physician evaluates you for many diseases and disorders that have nothing to do with Pap smears or cervical cancer. Among the most critical that your doctor checks for are ovarian cancer, uterine cancer, and vulvar cancer.

If caught early, such cancers are highly treatable. If left undetected for years, as I fear might happen should women skip pelvic exams in years when they don’t get Pap tests, such cancers can be killers.

So, no matter what you’ve heard about the change in the guidelines for Pap smears, the take-away is that this change should not affect your behavior in any way; it’s merely guidance for your doctor.

Get your annual pelvic exam as you have in the past. Let your doctor decide whether the Pap should be part of it every two years or three years or if that particular test is necessary after age 70.

Remember that you’re not going to the doctor for just one test that detects just one type of cancer. You’re going to ensure that you’re in good gynecological health, and to get treated promptly if your doctor finds anything wrong.

– Yvonne S. Thornton, MD, MPH

Confused about mammograms? Here’s what you need to know

Wednesday, November 18th, 2009

You’ve probably heard the news that the U.S. Preventive Services Task Force has changed its recommendations about who should get mammograms, and how often. And you may be wondering what this means for you. If you’re 50 or older, should you only get mammograms once every two years as the new guidelines recommend? If you’re under 50, should you get a mammogram at all?

The first thing to understand is that the guidelines are general and may not apply to your situation. Only your own physician can say whether you should still get mammograms and whether you should get one on an annual or bi-annual basis.

The second thing to understand is that the new guidelines have not yet been endorsed by the American College of Obstetricians and Gynecologists (ACOG).

The American College of Obstetricians and Gynecologists continues to recommend:

* Screening mammography every 1-2 years for women aged 40-49 years

* Screening mammography every year for women aged 50 years or older.

So why don’t the two authorities agree? There is evidence that supports both points of view. The American College of Obstetricians and Gynecologists appears to be relying on the ability of mammograms to detect cancer at an earlier age, allowing for early treatment. The U.S. Preventive Services Task Force considered evidence that early detection didn’t necessarily result in fewer breast cancer deaths and could lead to women experiencing unnecessary fear and anxiety when mammograms detect benign lumps.

My personal recommendation as a physician? I believe that early detection is the way to go. All of the actuarial tables relied upon by the U. S. Preventive Services Task Force do not put me at ease when I am recommending a certain course of management for my patients. Therefore, I would recommend continuing to have a screening mammography every two years, if you are younger than 50 years of age and every year for women 50 and older. I don’t believe that the endpoint should just be breast cancer deaths. One needs to take into consideration the quality of life regarding the different treatment modalities and the psychological toll of being diagnosed with breast cancer, whether you die from the disease or not. Early detection will minimize that risk. So, I would recommend what the National Cancer Institute and ACOG now recommend, and that is the regimen presently being used for screening. However, discuss this important and potentially life-saving test with your own doctor. Only your personal physician knows your history and your risk factors. Only your personal physician can determine what’s best for you.

– Yvonne S. Thornton, MD, MPH

Halfway to realizing real health care reform

Wednesday, November 11th, 2009

This past weekend, in the House of Representatives, our congressmen and congresswomen came together to pass a bi-partisan bill. In doing so, they took the first step toward ensuring that all Americans have access to health care when they need it.

If a final bill passes that includes the provisions of this bill, here’s what we can all look forward to:

* No more lifetime or annual caps on how much treatment health insurance will pay for. This is so very important for men, women and children with chronic illnesses, who often see their claims for care denied, just when they need it most.

* No more denial of insurance coverage for pre-existing conditions. As of right now, some health insurers consider having had a cesarean section a “pre-existing condition.” They deny claims to victims of domestic violence, calling it a “pre-existing condition.” Even perfectly healthy babies who are a bit chubby have been turned down by health insurers who claim their weight is a “pre-existing condition.”

* Adult children would be allowed to remain on their parents’ policies until age 27.

* Seniors on Medicare would pay less for prescriptions.

* And all would get a genuine choice of health insurance options, available from both health insurance companies and a government-administered plan (the public option).

None of us should have any illusions that this first step toward making health care affordable and available to all will make the next steps any easier. Powerful interests, particularly those of health insurance companies, will fight all that much more aggressively to prevent the senate from passing its own version of reform. Health insurers’ profits are as high as they are because they get to cherry-pick who they will and won’t cover; because they can refuse to provide care after someone has reached the annual or lifetime coverage cap; because they can call almost anything a “pre-existing condition.”

Through misinformation campaigns, spread by surrogates, these powerful special interests have done all they can to frighten Americans into believing that health care reform will be bad for them and for America. The misinformation often mirrors that which was spread back in the 1960s in an attempt to prevent Congress from passing Medicare.

As a physician who has seen, firsthand, how the lack of health insurance can devastate families, I know that we must fight back aggressively against the special interests. We must become informed about the realities of health care reform and help our friends and families understand the difference between information and misinformation.

This opportunity to provide health care for all may not come again for many years if it doesn’t succeed now. And if it fails today, next time, the fight will be even harder and will stand less chance of success.

As a doctor, a woman, and a mother, I urge our senators, no matter their party affiliation, to stand with our families and help us protect them when they are most vulnerable. And I urge my readers to contact their senators and tell them that nothing is more precious than health – and nothing more important than passing reform so that families can get the help they need when they need it.

– Yvonne S. Thornton, MD, MPH