fetal mortality

Mamas on Bedrest: I Am in Favor of A Single Payor Health Care System for the US

March 28th, 2012

We all knew that it was coming. Following the contentious debates over the health care bill and ever since President Obama signed the bill into law, opponents have vowed to fight the individual mandate requiring Americans to buy health insurance or face a penalty and to repeal the law entirely. Cases have been heard in courts around the country and since none of them have come to consensus agreement, the arguments about constitutionality, whether or not the government can make citizens purchase health insurance, whether or not the government can impose a penalty on Americans who don’t purchase health insurance and whether or not that penalty is a tax is being argued before the justices of the supreme court.

The justices first began hearing arguments on Monday, March 26, 2012 and have continued to listen to arguments for three days. The arguments will conclude this afternoon and the justices will cloister together and later render a verdict. The final verdicts and written rationales are expected to be rendered before July of 2012.

I think that few will argue that the health care system in the United States is in trouble and in dire need of an overhaul. The problem is that we as a nation cannot reach a consensus as to what that overhaul should be and how to structure it so that the majority, if not all Americans are insured and have access to quality health care. To date proposed options have ranged from obliterating insurance all together and returning to a fee-for-services system, a national health care system that is funded with taxes but ensures that everyone has access to health care when needed like Canada or in Europe, complete privatization of health care and everyone is responsible for their own insurance or some other as yet undisclosed plan.

I’m going to go on the record and say that I am in favor of a single payer system that gets funded via taxes. Uh, Gasp, what????? Yup, I’ve said it. I believe that the United States should do away with insurance companies and should establish a single payer health care system which is funded by taxes.  Why would I take such a stand? It’s simple. The health of a nation will ultimately determine the wealth of a nation. The United States spends more of its Gross Domestic Product (GDP) on health care than most any other country in the world. Yet, we have the highest rates of preventable diseases such as heart disease and diabetes. We have the highest rates of maternal and infant mortality amongst industrialized nations (and even amongst many “developing” nations) and we have millions of citizens who don’t have access to affordable, quality health care such that when these individuals do get sick, we as a nation end up paying for them with unallocated funds. In a nutshell, we are going broke under our current health care system. Our current national health care spending cannot be sustained. As a nation, once we cannot ensure the health of our citizens, our nation’s wealth-our natural resources of people power, brain power, innovation, technology, agriculture, etc-will all dwindle away. We will dwindle away. It’s all completely preventable. We have to stop this “I’ve got mine, let the other guy get his own” mentality. We are our brothers and sisters keepers. We have to take care of one another.

When I started Mamas on Bedrest & Beyond I was quite ignorant to the plight of many women who were prescribed bed rest and the financial ruin that many families faced as a result of a high risk pregnancy, pregnancy bed rest and intensive care of premature infants. Increasingly, having a family is becoming a luxury only the wealthy can afford. If a woman works in the service industry as a teacher, a care provider, fast food restaurant manager or other such low paying, poorly compensated jobs she literally cannot afford to become pregnant-let alone have a complicated pregnancy. If she goes on bed rest for more than 12 weeks, she risks loses her job and her family is further pushed into financial constraints. Many women are having to choose between having a job and having a family while loss if either is untenable.

I could launch into a diatribe about why we need paid family leave, but I have spoken liberally about that and will continue to do so-just not in this post. In this post, I want to underscore how many women become high risk as a result of not having access to quality, affordable health care early in their pregnancies. Here, I want to underscore the hoards of women who are panicked because they are on bed rest and don’t know how they’ll make ends meet or how they’ll pay their medical bills. And I want to underscore the extraordinary costs associated with the care of premature infants and children. Oh, I could go on and on, but you get the picture. I could talk about the children who don’t receive immunizations because their parents are uninsured and can’t afford them. The women who go without pap smears and pelvic examination, mammograms or birth control because they can’t afford them and are uninsured. Yet we all pay when they become ill or pregnant and require specialized care. I would gladly pay higher taxes so women can have access to birth control pills rather than pay for unintended pregnancies. I would gladly pay higher taxes if it means that all women receive early access to prenatal care so that their pregnancies can start off well and we can potentially avoid preterm labor and prematurity and prolonged NICU stays for these infants. And with the money saved from not having to fuss with insurance claims and administration, I really think that we as a nation really can afford to provide health care to everyone.

For the past 3 days the justices of the US Supreme Court have been listening to arguments as to whether or not the Affordable Care Act and its individual mandate are constitutional and should be upheld. Many Americans want the law repealed and cite “Don’t tell me how to spend my money”. To that I say, don’t ask me for mine or anyone else’s once you get sick. As I see it, we can all pay into the health care pot and share the burden (and actually lower costs). But if you would rather not to contribute to the health care pot, go it alone, have at it. But don’t ask for “your portion” when you’re in need.

Mamas on Bedrest: Who is Ban Ki-Moon?

March 9th, 2012

International Women’s Day was yesterday, March 8, 2012. International Women’s Day, helps to culminate The United Nation’s Commission on the Status of Women (CSW), 2 weeks of meetings during which world leaders come together to discuss the status of women and girls around the world. The meetings are wrapping up this week.

The head of the UN is Secretary General, Ban Ki-moon. To mark the occasion of International Women’s Day, the Secretary General noted gender equality and the empowerment of women are gaining ground worldwide, but urged governments, civil society and the private sector to continue to commit to gender equality and the empowerment of women as a fundamental human right and a force for the benefit of all in his statement to the UN counsel and partners.

I have only recently began to study Mr. Ban and I am heartily impressed. This man is a staunch advocate for women’s rights and well being. One of his primary initiatives as Secretary General is empowering women. Here is what he has done during his tenure as Secretary General:

The Secretary-General pressed successfully for the creation of UN Women, a major new agency that consolidates the UN’s work in this area. His advocacy for women’s rights and gender equality has also included the “Unite to End Violence against Women” campaign, the “Stop Rape Now” initiative, the creation of a “Network of Men Leaders” and the establishment of a new Special Representative on Sexual Violence in Conflict. Within the UN itself, the Secretary-General has increased the number of women in senior management positions by more than 40 per cent, reaching the highest level in the Organization’s history.

How fantastic is it that a man with such global power has such a heart for the health and well being of the world’s women? One could argue that Mr. Ban is inspired by his wife, Madam Yoo (Ban) Soon-taek. Since 2007, Mrs. Ban has devoted her attention to women’s and children’s health, including autism, the elimination of violence against women, and the campaign to prevent mother-to-child transmission of HIV/AIDS.  So maybe his interest stems from her interest, her “whispering sweet nothings in his ear”?

That is not the impression that I get. In his own words, Mr. Ban says, “I grew up in war” (Mr. Ban was born in the Republic of Korea (South Korea)) and he knows first hand the destruction and hardship people often endure. He also knows the importance of global help in order to rebuild a nation and its people. But even more key, Mr. Ban recognizes that for a nation to be strong  a nation must tend to the care of all of its people and when one or more segments of the population are not thriving, the nation and subsequently the world, cannot thrive.

I am thrilled that I am learning about his plans for global women’s empowerment. I think that it behooves all of us to learn more about the United Nations’ initiatives on women’s empowerment and to see what we each can do to help move these initiatives forward-after all, they will impact us all in one way or another. There is something for everyone to do. For some of us, it will be making financial donations. For others, it may mean becoming involved with one of the many partnering organizations. I think most of us will work in our immediate neighborhoods, towns, cities, states and nations to effect change. There is nothing wrong with that. We are not all called to perform on the global stage as Mr. Ban does, but we are all called to serve.

Mamas on Bedrest: Soothing Belly Itches During Pregnancy

February 27th, 2012

As your pregnancy progresses, your belly will begin to itch. This is really no surprise. As your belly expands, your skin stretches and it is this stretching that causes the itching.

There are a variety of salves, lotions and antihistamine creams available on the market to relieve belly itching, many touting that they are “specifically formulated” to relieve the itching associated with pregnancy. Don’t be fooled. Most of the belly itching associated with pregnancy is not so specific that it requires any specialized type of cream or salve. Many products, readily available on the general retail market are sufficient to provide relief. Emollient creams, creams containing shea butter, cocoa butter, aloe vera or oatmeal and sometimes creams or lotions containing 0.5% or 1.0% hydrocortisone cream are effective in providing relief. Typically, keeping the skin on you belly well moisturized (applying creams or lotions 2-3 times daily or more as needed for itching. Be sure to consult with your health care provider if you are using cortisone creams and do not apply more frequently than the manufacturer or your health care provider recommends. ) and avoiding harsh chemicals, constricting clothing or clothing that rubs against your belly will provide relief. There are a few skin eruptions that cause itching specifically during pregnancy that may require more specific care and attention. They are described below.

Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPPs)

Pruritic Urticarial Papules and Plaques of Pregnancy or PUPPPs is a common, intensely itchy skin condition that occurs typically late in the third trimester of pregnancy. PUPPP’s is characterized by red papular (bumpy) lesions on the belly, often around stretchmarks, that become so widespread that the bumps become grouped into large red patches on the belly, usually centered around the belly button. The patches often spread to include the thighs and buttocks and will occasionally spread to the arms and legs but this is less common. Seeing PUPPPs on or above the breasts is rare. The patches are extremely itchy and many women report that they can’t sleep due to the itching.

PUPPPs typically spontaneously resolves within days after delivery. For the intense itching, many health care providers prescribe low dose corticosteroid creams (0.5-1.0% hydrocortisone cream) to be applied 5-6 times daily. In some cases, patients are prescribed mild oral antihistamines for relief and to allow them to sleep. In rare cases, patients have to be prescribed a short taper of oral corticosteroids, but again, this is extremely rare.

Impetigo Herpetiformis

Impetigo Herpetiformis is a rare  form of pustular psoriasis which occurs during pregnancy and may be life threatening. While it has been documented in all trimesters, Impetigo Herpetiformis usually occurs during the last trimester and resolves shortly after delivery. However, it is crucial the impetigo herpetiformis be accurately diagnosed and treated as it can lead to placental insufficiency, stillbirth and increases in complications and even death for mothers and babies. Impetigo Herpetiformis is associated with low levels of calcium and women with hypoparathyroidism are at particular risk for developing the disorder.

Impetigo Herpetiformis begins as pus-filled bumps on reddened skin of the inner thighs and groin. The pustules join and spread to the trunk and extremities. The rash typically spares the face, hands, and feet but can spread to inside the mouth and into the nail beds.  Interestingly, the pustules are not filled with bacteria, but can become infected as the rash progresses. Some women will also experience generalized viral symptoms such as fatigue, nausea, vomiting, diarrhea, fever and chills. Treatment for Impetigo Herpetiformis is oral corticosteroids such as prednisone.

Intrahepatic Cholestasis of Pregnancy (ICP)

Intrahepatic Cholestasis of Pregnancy occurs when bile secretion in the liver is impaired. As the bile backs up in the liver, the level of bile acids increases in the bloodstream. These “backed up” bile acids are then deposited in the skin causing the intense itching.  The itching ranges from annoying to severe and tends to be worse at night. The itching typically begins on the palms of the hands and soles of the feet and them spreads to the rest of the body. Rash develops as a result of scratching. Jaundice occurs in 10% to 15% of cases and typically develops 2 to 4 weeks after the itching starts. All symptoms spontaneously resolve shortly after delivery.

Intrahepatic Cholestasis is rare and occurs in 0.3-5% of pregnancies overall. It is more common in women who have a family history of ICP,  and women who develop the disorder in a first pregnancy tend to develop it in subsequent pregnancies.  While the exact etiology of ICP is unknown, it has been determined that the increase in estrogen and progesterone during pregnancy play a major role. Estrogen interferes with bile clearance from the liver and progesterone interferes with estrogen removal from the liver.

The most important side effects of ICP on infants are preterm delivery, meconium staining (stool changes) at birth and still birth because the fetal liver cannot manage the additional bile salts from the maternal circulation. Treatment of ICP is aimed at lowering the bile salt levels and preserving the livers and health of both mother and baby.

ICP is diagnosed based on history and  blood tests showing elevated levels of bile acids and certain liver enzymes. There is rarely a need for a liver biopsy. Treatment consists of ursodeoxycholic acid (10–20 mg/kg/d) as well as antihistamines, Questran for elevated cholesterol and in severe cases of itching, phenobarbital. In some cases, high doses of oral steroids are needed to relieve the itching. Most mothers with ICP are delivered between 37 and 38 weeks once fetal lung maturity has been established.

Resources

Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPPs)

MedScape

About.com

BabyCenter.com

Impetigo Herpetiformis

About.com

Intrahepatic Cholestasis of Pregnancy

Dr. Mona Ridgeway, MD The Austin Gastroenterology Clinic, Austin, TX

Itchy Moms

About.com

MedScape

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