April, 2010

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Babies I’ve delivered, all grown up

Friday, April 30th, 2010

Other doctors deal mostly with unhappy occasions, from a sniffle to serious illness, but obstetricians are there for the happiest times – the birth of a child – which is why I always say I have the best job ever.

I was reminded of just how wonderful my specialty has been to me by an e-mail from a patient transferred to my care 16 years ago, who eventually had to undergo a complicated cesarean delivery. As a maternal-fetal medicine specialist, I was called in by her obstetrician for difficult cases like hers.

She was carrying twins and had been in the hospital for a week. The night before the delivery, she’d had a very rough time. To help get through it, she’d watched “The Sound of Music” on TV.

The next day, in the delivery room, I delivered her babies by cesarean, fraternal twins, one boy, one girl. As I sent the babies off to the nursery, I noticed that her ovaries were very large and purple and asked if she’d been on fertility drugs. She hadn’t been but I called in two more specialists to consult and chatted with her as we reviewed the situation. Despite their enormous size and color, the ovaries did not pose a threat to her health and I decided to leave them where they were and just watch the situation.

We got to know each other better as I visited each day. When she mentioned the movie she’d seen the night before the delivery, I told her that it was one of my favorites and that I’d copied Maria’s wedding veil for my own wedding. After she and her babies went home, we stayed in touch and I sent her a copy of my first memoir, THE DITCHDIGGER’S DAUGHTERS.

Just last week, those twin babies turned 16 and my patient sent me some photographs of them looking all grown up.  It brightened up my day to see them, and to know that I had a hand in bringing them into the world. She also spoke of how she loved my book. So I can’t wait until my new memoir, SOMETHING TO PROVE, is published this fall. She’s going to be one of the first people I send a copy to.

– Yvonne S. Thornton, MD, MPH

Why do black women wait longer for breast cancer diagnosis and treatment than white women?

Wednesday, April 28th, 2010

Among pundits, there is a tendency to proclaim that we live in a post-racial society. We’ve had laws on the books banning racial discrimination for decades now. In 2008, we elected our first African-American president. Perhaps the most popular talk show host of our time is a black woman.

While all these signs of progress are encouraging, they are still only steps along the road to equality; we haven’t yet reached our destination. That reality becomes painfully evident in the results of a recent study about the disparities in diagnosis and treatment of breast cancer between white and black women.

In a five-year study, using initial screening data that reached back 12 years, researchers at The GW Cancer Institute examined the effect of race and health insurance status on the diagnosis and treatment of breast cancer. What they found was startling:

• insured black women and uninsured white women waited more than twice as long to reach their definitive diagnosis than insured white women;

• lack of health insurance decreased the speed of diagnosis in white women, but having insurance did not increase the speed of diagnosis in black women; and

• overall, black women waited twice as long as white women for treatment initiation following definitive diagnosis.

The researchers had, quite reasonably, expected to find that any insured woman, of any color, would get diagnosed and treated earlier than any woman of any color without insurance.

What do we make of the data that suggest that being black is as great a barrier to treatment as being uninsured?

It’s a question without an answer but it shows that we have a long way to go on this journey. For those quick to proclaim the “post-racial” era has arrived, this is a call, first for introspection but most urgently, for action. Neither insurance status nor race should get in the way of life-saving treatment.

– Yvonne S. Thornton, MD, MPH

How late can you wait to have a baby?

Tuesday, April 13th, 2010

Today, many women are delaying starting families, most likely due to career and  economic concerns. Pregnancy rates are down in all age groups except for those 40 to 44 years of age, says the CDC, where pregnancy rates are up by 4 percent.

With all those over-40 women having babies, does this mean you can wait indefinitely if you hope to get pregnant? Not really.  A woman’s peak of fertility is about 25 years of age.  After that, “it’s all downhill.”  The likelihood of becoming pregnant drops dramatically well before you reach menopause, which is what many women think of as the end of their fertile years. A great number of those after-40 pregnancies are the results of medical interventions such as in vitro fertilization and donor eggs from 25 year olds.  Unlike our male counterparts who keep producing new sperm every 74 days, women are given their complement of eggs way before they are even born and there are no more new eggs to be produced.   Therefore, at 36 years of age, a woman’s eggs are 36+ years old with all the attendant risks that accompany any aging process.  According to the March of Dimes:

“At age 25, a woman has about a 1-in-1,250 chance of having a baby with Down syndrome; at age 40, the risk increases to 1-in-100 chance; and at 45, the risk  of carrying a child with a chromosomal anomaly such as Down syndrome, continues to rise to 1-in-30 chance.”

The advent of artificial reproductive technologies virtually transforms a woman’s “biological clock” into a perpetual calendar, but not without risks.  In studies, babies born via in vitro fertilization have been shown to have a higher risk of birth defects.

If an older woman doesn’t mind having a baby who carries none of her DNA, she may opt for a donor egg from a younger woman, which is then fertilized by her husband and the embryo transferred into her uterus.  Many of the older celebrities have chosen this route for their family planning.

Medical interventions, while they seem miraculous when they work, aren’t guaranteed to be successful. Just as in getting pregnant the old-fashioned way, your chances of success drop the older you are.  In vitro fertilization will result in a live birth among women past 40 only 6 to 10 percent of the time versus a 30 to 35 percent success rate among women younger than 35.

Nature’s message is clear, and unfortunately, it doesn’t offer any leeway in difficult economic times or while you are working your way up the corporate ladder: if you want to start a family, you’re more likely to be successful if you begin well before you turn 40.

– Yvonne S. Thornton, MD, MPH