Written by yvonnethornton on May 27th, 2010
In the richest nation on earth, with an advanced health care system, and the technology available to monitor and treat mothers and their babies, you’d expect the United States to have among the lowest rates of maternal mortality. So it’s distressing to learn that, although it’s still relatively rare for mothers to die as a result of pregnancy and childbirth, it happens here more often than it should. The U.S. is ranked 41st in maternal deaths among 171 nations analyzed by U.N. experts. That’s a worse record than virtually any other developed country — even worse than a good number of under-developed countries. What’s even more distressing: the death rate is rising.
The question is why? Why is pregnancy so risky in such a rich nation?
Often, the reason is a pre-existing disorder that complicates pregnancy, such as obesity, high blood pressure, or diabetes. The lack of access to good quality care among the uninsured also puts women at risk, leaving them without diagnosis and treatment for conditions that can cause problems until the condition gives rise to a full-blown emergency.
But there’s one contributor to maternal death that might surprise you. Our wealth, itself, could be contributing to the risk, because it encourages the prevalence of Cesarean-on-demand.
According to the CDC, in 2007, 31.8 percent of births were by Cesarean section. The rates of births by C-section have risen every year for at least eleven years.
While C-sections can be, and often are, life-saving, it’s difficult to justify that high a rate. The World Health Organization estimates that the U.S. rate is twice what would be medically necessary.
Cesarean births are now treated as routine, but major surgery is never routine. Major surgery comes with the risk of complications, including hemorrhage. And the C-section, as common as it has become, is still major surgery.
Childbirth is usually very safe, but it could be safer. Giving all women access to pre-natal care and preventive medicine is an important start. But it’s also important to remember that a woman’s body was designed to deliver babies the old-fashioned way. And choosing unnecessary surgery instead could be inviting trouble.
– Yvonne S. Thornton, MD, MPH
Posted in Childbirth & delivery, Women's health issues | 2 Responses »
Tags: c-section, cesarean on demand, increased maternal death rates, maternal mortality, obstetrician, unnecessary surgery
Written by yvonnethornton on May 21st, 2010
Most women are familiar with the term post-partum depression. Start with all the stresses of adding a new member to the family – not just the financial burden, but the schedule upheaval, the sleep deprivation, and the demands of a tiny person who can only make his or her needs known by wailing. Add the wild surge of hormones flooding a woman’s body, and is it any wonder that she might not be the picture of serenity and assurance? Estimates vary on the prevalence but as many as 25 percent of new moms may experience some level of depression either before or after delivery.
That’s bad enough, but now a study suggests that new fathers, just like new mothers, can find themselves overwhelmed when baby makes three (or more).
“The study, published in the Journal of the American Medical Assn., found that 10.4% of men experienced serious depression at some point between his partner’s first trimester and one year after childbirth, more than double the depression rate for men in general. American men were more likely to experience prenatal or postpartum depression compared with men in other countries, 14.1% in the U.S. compared with 8.2% internationally.”
What can you do when the guy you depend upon to keep you sane is going through his own blue period?
Your most important step –the one you should take if either you or your partner starts to feel sadness, agitation or hopelessness – is to talk to your doctor. Don’t try to tough it out. Reach out for help at the first signs that something isn’t quite right. It’s possible that all you need to get back to your cheery old selves is a good night’s sleep, but sometimes, you need more. The good news is that help is available. But first, you have to be aware of the signs of depression.
Post-partum depression can be debilitating if you let it go, so take steps immediately to get yourself and your new family back into the swing of enjoying things together again.
– Yvonne S. Thornton, MD, MPH
Posted in Childbirth & delivery, General health news, Pregnancy, Women's health issues, Women's health news | No Responses »
Tags: babies, infant, male post-partum depression, newborn, post-partum depression, Pregnancy
Written by yvonnethornton on May 9th, 2010
In 1997, a movie version of my memoir, The Ditchdigger’s Daughters, aired on The Family Channel. And while the film covers only a fraction of the book, it was still a thrill to see the actors playing the roles of my family members and me.
The film was never released commercially on DVD and seemed all but forgotten. Imagine my surprise when I discovered that BET network was broadcasting my story – and lots of people on Facebook are talking about it. I caught the film version last weekend as a movie premiere on BET, which makes me think that it might be broadcast again, so you should check the schedules.
Of course, Hollywood likes to focus on the conflict, so the movie was more about the struggles between my father and my older sister, Jeanette and less about what made the book a bestseller: how my father and mother overcame incredible obstacles to build a better life for their daughters.
It’s fun to watch but if you really want the whole story, I hope you’ll read the book.
And if you want to know what happens after that book ends, please keep an eye out for my next memoir, Something to Prove, scheduled to be published in December.
– Yvonne S. Thornton, MD, MPH
Posted in Something To Prove: A Daughter’s Journey to Fulfill a Father’s Legacy, The Ditchdigger's Daughters | 40 Responses »
Tags: BET network, Donald Thornton, film based on Yvonne Thornton's The Ditchdigger's Daughters, Something To Prove, The Ditchdigger's Daughters, Yvonne S. Thornton, Yvonne Thornton memoir
Written by yvonnethornton on 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
Posted in Childbirth & delivery, Something To Prove: A Daughter’s Journey to Fulfill a Father’s Legacy, The Ditchdigger's Daughters | No Responses »
Tags: babies, obstetrician, Something To Prove, The Ditchdigger's Daughters, Yvonne S. Thornton
Written by yvonnethornton on 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
Posted in General health news, Women's health issues, Women's health news | No Responses »
Tags: Breast cancer, breast cancer diagnosis, racial disparities
Written by yvonnethornton on 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
Posted in Childbirth & delivery, Fertility & Infertility, Pregnancy, Women's health issues, Your newborn baby | 1 Response »
Tags: Childbirth & delivery, egg donor, in vitro fertilization, pregnancy after 40, risks of delaying pregnancy
Written by yvonnethornton on March 31st, 2010
For many years, corporations have been filing patents to claim ownership of the genes that researchers have discovered. Nevermind that these genes exist in our bodies and were designed, not by scientists, but by nature. Once a corporation or other institution gets a gene patent, that gene becomes its property.
Those who control the genes get to decide whether to allow other researchers to use the gene in further research. The gene’s “owners” also get to corner the market in potentially life-saving tests involving the gene.
That’s led to some pretty significant price-gouging of women whose genetics put them at risk for certain breast and ovarian cancers. Myriad Genetics controls the patents for the genes that are associated with about 10 percent of breast and ovarian cancers. So if your doctor told you that you needed a test to see whether you carry a gene that makes you more susceptible to these cancers, you could get hit with a bill from Myriad for a whopping $3,000.
But that’s about to change.
This week, a federal court ruled, in a lawsuit against Myriad Genetics, that its gene patents were invalid because genes occur naturally. From an article about the court’s ruling that appeared in The New York Times:
Judge Sweet… said that many critics of gene patents considered the idea that isolating a gene made it patentable “a ‘lawyer’s trick’ that circumvents the prohibition on the direct patenting of the DNA in our bodies but which, in practice, reaches the same result.”
The case could have far-reaching implications. About 20 percent of human genes have been patented, and multibillion-dollar industries have been built atop the intellectual property rights that the patents grant.
“If a decision like this were upheld, it would have a pretty significant impact on the future of medicine,” said Kenneth Chahine, a visiting law professor at the University of Utah who filed an amicus brief on the side of Myriad. He said that medicine was becoming more personalized, with genetic tests used not only to diagnose diseases but to determine which medicine was best for which patient.
Mr. Chahine, who once ran a biotechnology company, said the decision could also make it harder for young companies to raise money from investors. “The industry is going to have to get more creative about how to retain exclusivity and attract capital in the face of potentially weaker patent protection,” he said.
I take issue with anyone who claims that denying patents on what nature creates will thwart research. And I am in total agreement with the court’s decision to invalidate these patents on genes. Patenting genes invites a type of commercial perversion of what is a natural occurrence. As a researcher myself, I disagree that invalidating gene patents removes incentives for future research. There will always be research. However, the results of that research will have checks and balances rather than the current focus on the “bottom line” of profit, that takes advantage of patients and the medical community.
– Yvonne S. Thornton, MD, MPH
Posted in General health news, Women's health issues, Women's health news | No Responses »
Tags: Breast cancer, genes, genetic testing, judge invalidates gene patent, ovarian cancer
Written by yvonnethornton on March 9th, 2010
Pregnancy and childbirth alter the hormonal balance, which may explain why depression is so common at this stage of women’s lives. Up to 23 percent of pregnant women experience symptoms of depression and that figure rises to up to 25 percent among new mothers.
Many women decide to simply suffer through it without seeking help, but that could be a big mistake. According to the American College of Obstetricians and Gynecologists:
“… untreated maternal depression negatively affects an infant’s cognitive, neurologic, and motor skill development. A mother’s untreated depression can also negatively impact older children’s mental health and behavior.”
Everyone feels sad some of the time. It’s normal to have a bad day. But if your bad day stretches into weeks, for your own sake and the sake of your baby, you need to get help. If you don’t have a therapist, ask your ob-gyn for a referral if you experience feelings of hopelessness, sadness or despair. Don’t suffer needlessly. Help is available.
– Yvonne S. Thornton, MD, MPH
Posted in Childbirth & delivery, General health news, Women's health issues, Women's health news, Your newborn baby | No Responses »
Tags: ACOG, American College of Obstetricians and Gynecologists, depression during pregnancy, depression in women, hormonal changes during pregnancy, post-partum depression, Pregnancy
Written by yvonnethornton on March 1st, 2010
For parents of baby boys, the question of whether to circumcise is likely to come up. You might make the decision to circumcise or not, depending on your religious, family, or cultural traditions. Or your decision might involve considerations about your newborn’s health. Hygiene is easier and urinary infections are less prevalent among boys and men who have been circumcised. Circumcised men are less prone to cancer of the penis. And there is some evidence that circumcised men are at slightly less risk of sexually transmitted diseases, including HIV/AIDS.
Still, you may not wish to have a surgical procedure that isn’t absolutely necessary performed on your baby.
Whatever you decide, that decision should be based on the facts and not the false controversies that have been swirling around the Internet.
Contrary to some inflammatory claims that have appeared on popular websites, there is no similarity whatsoever between male circumcision and the disfiguring procedure done on girls in some Third World countries that’s referred to as female circumcision. Male circumcision is a generally safe, simple procedure that removes only the foreskin of the penis. Female circumcision, by contrast, removes the entire clitoris and sometimes parts of the labia.
Female circumcision is a brutal, abusive act that has a negative lifelong effect on sexual function and pleasure in adulthood. Male circumcision has no effect on sexuality.
So don’t be swayed by false claims, even those made by experts. And, if you’re undecided, discuss the pros and cons of circumcision with your doctor.
– Yvonne S. Thornton, MD, MPH
Posted in Childbirth & delivery, General health news, Your newborn baby | No Responses »
Tags: false controversy over circumcision, newborn, newborn circumcision
Written by yvonnethornton on February 16th, 2010
You may have heard that Anthem-Blue Cross proposed raising its rates for individual health insurance policies by as much as 39 percent in California. President Obama and Secretary of Health and Human Services Kathleen Sebelius have both decried this outrageous hike. A recent report from the Associated Press shows that similarly huge rate hikes are coming to individual policies in many states including Maine, Kansas, Oregon and Indiana.
“You’re going to see rate increases of 20, 25, 30 percent” for individual health policies in the near term, Sandy Praeger, chairwoman of the health insurance and managed care committee for the National Association of Insurance Commissioners, predicted Friday.
But you might think that this has nothing to do with you if you’re employed by a company that provides you with health insurance. Unfortunately, all of us are affected, no matter where we get our insurance.
The Anthem-Blue Cross increase is the harbinger of things to come in employer-provided policies as well.
Last week, I heard from someone whose employer had to switch from a comprehensive policy to bare bones insurance because the insurer raised the company’s group rate by about 30 percent. So now, instead of offering employees a policy that covers just about anything, from a broken ankle to a liver transplant, the company will offer its employees a policy with an annual cap of just $25,000.
That’s employer-provided insurance that’s in danger now. And that means that more Americans are at risk of having either no insurance or inadequate insurance when a medical emergency strikes.
As a doctor, I am well aware of the high cost of medical care and can assure you that a policy with a $25,000 annual cap won’t cover much if you need hospitalization. I’ve dealt with that reality, not just as a physician, but as a mother. As I wrote on this blog before, when my daughter had to be hospitalized a few years ago, we learned too late that her school-provided policy had a $25,000 annual cap. Lucky for Kimmie that her parents are both doctors and could afford to pay the tens of thousands of dollars in hospital and medical bills that her insurance didn’t cover.
What would you do if one of your loved ones needed medical care and your insurance was inadequate?
This is no longer an issue for the uninsured. It’s an issue for us all. Please tell your Senators and Congressional representatives that you support health care reform. The life of someone you know, maybe someone you love, maybe your own, may depend on what happens next in Washington, DC.
– Yvonne S. Thornton, MD, MPH
Posted in General health news, Women's health issues, Women's health news | No Responses »
Tags: health care reform, health insurance, healthcare legislation, healthcare reform, Uninsured Americans
