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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 News.com 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

Posted in Childbirth & delivery, General health news, Pregnancy, Women's health issues, Women's health news, Your newborn baby | No Responses »
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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

Posted in General health news, Women's health issues, Women's health news | No Responses »
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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

Posted in General health news, Women's health issues, Women's health news | No Responses »

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

Posted in General health news, Women's health issues, Women's health news | No Responses »
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Why getting the HPV vaccine (Gardasil®) makes sense

Friday, October 30th, 2009

Too often, the Internet is filled with rumors about the dangers of vaccines. And those rumors are typically based on misinformation, disinformation and fear.

That’s been the case with Gardasil® (Quadrivalent Human Papillomavirus  (Types 6, 11, 16, 18) Recombinant Vaccine), the vaccine that protects girls and young women from the human papilloma virus (HPV).  Many people who have HPV may not show any signs or symptoms.  This means that they can pass on the virus to others and not know it. A male or female of any age who takes part in any kind of sexual activity that involves genital contact is at risk.

While all medicines carry some risk, the benefits of being vaccinated against HPV far outweigh the small potential dangers.

A large part of the backlash against this vaccine may be due to an effort by the drug’s manufacturer to make vaccination mandatory.

Do I believe that young girls and women should be forced to get the vaccine? Absolutely not. Coercion would be a mistake. And that attempt by the drug maker appeared, in this physician’s opinion, to place profits above the right to make a personal choice.

But, getting past the bad decisions of pharmaceutical companies, let’s look at the benefits for our daughters and ourselves. We know for a fact that HPV is connected to cervical cancer. And we know for a fact that cervical cancer is a horrible disease.

So, if you can get a vaccine that will largely protect you against HPV, then getting vaccinated is an absolute no-brainer. Gardasil® protects against four types of HPV: two types (Types 16, 18) that cause about 70 percent of cervical cancer cases, and two more types (Types 6, 11) that cause about 90 percent of genital warts.

The HPV vaccine is typically offered to girls and women between the ages of 9 and 26.  Given in a series of three injections (initial vaccine, another in two months and the last in six months).   For adolescents and younger, I would recommend discussing the vaccine with your gynecologist when your daughter comes in for her first gynecologic visit, which should be between 11 and 12 years of age. That first visit is only for an introduction to a gynecologist and a pelvic examination is not performed. It is a “get acquainted” visit and it is then that the benefits of the vaccine should be discussed.  Gardasil® is most effective if you can vaccinate before a woman risks being exposed to HPV … in other words, before she becomes sexually active.

As a woman gets older, her body isn’t as susceptible to the damage of HPV, so vaccinating isn’t recommended.

– Yvonne S. Thornton, MD, MPH

Posted in General health news, Women's health issues, Women's health news | No Responses »
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Should women do a breast self-exam each month?

Friday, October 9th, 2009

Most women know that mammograms save lives. A news story this week reported that three-quarters of breast cancer deaths occur among those women who did not get regular mammograms.

So, getting a mammogram is a no-brainer. It should be part of your annual exam if you’re over 50; women between 40 and 50 should get mammograms every 1-2 years. If there is a history of breast cancer in your family, you should start mammograms at age 35.

But what about breast self-exams?

Finding no evidence that breast self-examination saved lives, and “increased physician visits and higher rates of benign breast biopsies,” as a result of self-exams, the Canadian Task Force on Preventive Health Care recently recommended excluding routine self-examination from breast cancer screening.

So what do you do now? Does this mean that you can forget all those reminders your ob-gyn or family practice doc give you at each visit to check your breasts monthly?

In my view, no. Although cancer is much more likely to be discovered via mammogram, one of my patients did discover a cancerous lump through a routine self-examination. Even if she hadn’t, I’d still say, do the self-exam. However, don’t get excited and frightened because you “feel something.” Most “lumps” are totally benign (such as a fibroadenoma) or it just might be fibrocystic breast disease, which is benign and not cancerous. However, in any case, you need to be further evaluated by an experienced clinician.

Just remember, it has to be you examining your own breasts, not your boyfriend, not your husband. Because that way, you’ll get to know your own breasts and you’ll recognize if there’s some change.

– Yvonne S. Thornton, MD, MPH

Posted in General health news, Women's health issues, Women's health news | 1 Response »

Health care reform will save the U.S. $250 billion per year says Institute of Medicine

Thursday, September 17th, 2009

No one should die in America for lack of health insurance. Yet so many people do – one every thirty minutes.

We know we have to change this. It’s one of the great moral issues our country faces. Yet, there are those who say, we can’t afford to cover everyone. I can’t fathom that argument. I believe that all deserve the right to life-saving treatment.

So I was happy to learn that we will soon have an economic argument as well as a moral argument to support making health care available to all.

The Institute of Medicine is about to release a study that reportedly found that, some years after reform is instituted, we  may save up to $250 billion per year over what we’d pay if we did nothing.

That gives us every reason to reform health care and no excuses not to. The moral imperative is obvious, at least to me, as a doctor who has treated both the very poor and the very wealthy. The economic argument should counter those who want to do less or nothing at all.

To save lives (and even, we now learn, to save money), it’s time to provide no loopholes, no fine print, real, affordable health care coverage for all.

– Yvonne  S. Thornton, MD, MPH

UPDATE: The above figures, showing that one person dies every 30 minutes due to lack of health insurance, are from The Institute of Medicine statistics of 2002. A new study, just released today by Harvard Medical School researchers, shows that it’s even worse than that: today, one person dies every 12 minutes due to lack of health insurance.

Posted in General health news, Health care policy, Women's health issues, Women's health news | No Responses »
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White House lists the benefits of proposed health care reforms

Friday, August 14th, 2009

I’m glad the government has spelled out what Americans can expect from a health care reform bill. Here’s what the White House says will be in the final bill:

  • No Discrimination for Pre-Existing Conditions
  • Insurance companies will be prohibited from refusing you coverage because of your medical history.
  • No Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays
  • Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.
  • No Cost-Sharing for Preventive Care
  • Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.
  • No Dropping of Coverage for Seriously Ill
  • Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.
  • No Gender Discrimination
  • Insurance companies will be prohibited from charging you more because of your gender.
  • No Annual or Lifetime Caps on Coverage
  • Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.
  • Extended Coverage for Young Adults
  • Children would continue to be eligible for family coverage through the age of 26.
  • Guaranteed Insurance Renewal
  • Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won’t be allowed to refuse renewal because someone became sick.

And here is a link to answers to Frequently Asked Questions that I hope will dispel fears and refute the misinformation.

– Yvonne S. Thornton, MD, MPH

Posted in General health news, Health care policy, Women's health issues, Women's health news | No Responses »
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Should schools provide voluntary testing for STDs?

Friday, August 7th, 2009

Yesterday, I was on Dr. Nancy’s noontime show on MSNBC, as one of two medical expert guests, to discuss whether schools should be permitted to offer voluntary testing for sexually transmitted diseases (STDs) to their students.

As you’ll see from the video, we three physicians (who are also all mothers) — Dr. Nancy, myself, and a doctor from the Medical Institute for Sexual Health in Austin, Texas — agreed that this is a no-brainer. Of course, we should allow schools to offer voluntary testing for STDs.

Why should we test? Because, in a pilot program at eight high schools in the Washington, D.C. area, 13 percent of the teens who took advantage of voluntary testing were found to be infected, most often with chlamydia and gonorrhea. Chlamydia often causes no symptoms but, if left untreated, can lead to chronic pelvic pain due to pelvic inflammatory disease, an increase in ectopic (abnormal) pregnancy and infertility. Only by testing can we be certain to discover and treat it.

This does not mean we want our teens to be intimate at such a young age. But we must face the fact that, despite our best efforts, some are becoming intimate. And, because of this, some teens face the risk of sexually transmitted diseases that, if left untreated, can cause lifelong damage.

No one would be forced to get a test and no one is suggesting anything but that we make the tests available to kids who wish to know whether they’ve been exposed. If they fear that they are infected, we must give them a way to find out for sure so that they can get treatment.

– Yvonne S. Thornton, MD, MPH

Posted in Fertility & Infertility, General health news, Health care policy, Media appearances, The Ditchdigger's Daughters, Women's health issues, Women's health news | No Responses »
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Lawmakers: direct-to-consumer ads for prescription drugs are a problem

Friday, July 31st, 2009

As I’ve written before, I am troubled by direct-to-consumer advertising of prescription drugs. Only a doctor who knows your medical history and has done and interpreted any necessary tests can determine whether you need a prescription drug and which one you should be taking.

Now, a few lawmakers have proposed bills that would help limit this practice. Here is an excerpt from a New York Times article about the legislative proposals:

“For some legislators and consumer advocates, the ads are a daily reminder of a health care system run amok. Critics contend that drug ads are intended to prompt people to diagnose themselves with chronic quality-of-life problems like insomnia or restless leg syndrome; lead people to pressure their doctors for prescriptions for expensive brand-name drugs to treat these conditions; and steer people away from cheaper generic pills.


“And, critics say, such ads may overstate benefits and understate risks of drugs, or by drumming up audiences for the latest pills at a time when the side effects of such drugs may not yet be fully known.”

I agree with all the above and hope that Congress will act. One suggested bill would deny pharmaceutical companies a tax break for the cost of creating and running such ads. That sounds like a good start. The rest of us shouldn’t subsidize these direct-to-consumer ads through our tax dollars.

– Yvonne S. Thornton, MD, MPH

Posted in General health news, Health care policy, Women's health issues, Women's health news | 1 Response »
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