Preconception Care

Mamas on Bedrest: Take a Look at the HealthTap App

June 5th, 2013

It’s Video Wednesday!

This week, I am taking a look at the HealthTap App. As you will recall from the last blog entry, HealthTap is a health information website that provides health information, tips and breaking health information. The site boasts some 40,000 physician experts from all 50 states and 128 specialties. HealthTap has just rolled out its new App and now consumers can have the convenience of health information at their fingertips.

The App is more than just an encyclopedia of health information. It is a way for consumers to store and track their own health information. This morning, I downloaded the app onto my iPad. The App then guided me through the registration process and enabled me to input personal information and preferences. I was able to “follow” doctors whose work I highly respect and often cite in my blogs and other educational information. I can contact my own gynecologist (who is a participating physician), ask questions of other physicians and get feedback on lab information, tests and other health inquiries.

I have to say that I barely scratched the surface of the HealthTap App. I am sure that it has many more functions that I have yet to discover. But I found it really easy to use, easy to read and easy to input and save my information. I think that this app may be a handy way for Mamas on Bedrest to chart their bed rest progress. In particular, when I think of mamas with cervical insufficiency, each time you go to the OB, you can chart your cervical measurements and keep track. If you have pregnancy induced hypertension or pre-eclampsia, you can track your blood pressures and/or urine proteins (if your OB has you doing urine dip sticks). And this tool is useful after your pregnancy as well; helping you to chart breastfeeding, weight loss, exercise, sleep, and other health indices.

Give it a shot. It’s free and fun (The Geek in Me was quite giddy playing with this!!).

 

Mamas on Bedrest: Research and Practical Efforts Aimed At Improving Maternity Care!

April 12th, 2013

Hello Mamas,

I have to confess, I’m having a moment of Geek. I received an article link from a former Mama on Bedrest and the Geek in me has been jumping up and down as I am reading it. Finally, researchers here in the United States are taking notice of the fact that intra partum maternal mortality rates are atrocious and they are doing something about it!

Now you are probably saying, “What has that got to do with me, a Mama on Bedrest?” Well, it has everything to do with you! It means that physicians, researchers and hospitals around the country are making changes to ensure that if you have a complication during your labor and delivery, you don’t die from it. In my book, that’s a pretty big deal!

Okay, this is not exactly a sexy topic. It’s not, “4 Ways to better prop yourself up on pillows while on bed rest,” or some other topic that is immediately associated with your current situation. It’s not soothing, it’s not comforting. Yet it’s extremely important. It’s the nuts and bolts of maternity care. Its looking at a grave situation-maternal mortality in the United States (which is worse than any other industrialized nation by the way  and 3-4 times worse in African American women!)-and saying, “We’re going to fix this!!” The good thing is that when American physicians and researchers put their minds and energy into improving outcomes, things typically do improve! (Look at how care of preterm infants has vastly improved, assisted reproductive technology allows women to become pregnant in the first place, and all the advances in perinatal care if you want examples!)

So what is the article saying-Exactly?

The article is from the St. Louis Post Dispatch and asked the question, “Why are so many US women dying during childbirth?” The doctors and researchers in this article, all from the St. Louis Missouri area, began looking closely at cases of maternal intra partum death and came up with the following reasons and solutions:

  • Preconception counseling or at least very early prenatal counseling is important-especially in women with pre-existing conditions and/or riskfactors for complications.
  • Pregnancy has become increasingly risky because of  the prevalence of obesity, Type 2 diabetes, hypertension and cardiovascular disease; more older women having children; advancements in fertility treatments resulting in twin births; and the high rate of C-sections. All of these issues must be addressed early and aggressively, from start to finish during pregnancy.
  • Researchers and high-risk pregnancy specialists say an important step is stratifying maternity care, parallel to what has been adopted in the care of high-risk newborns. Higher-level hospitals would have the specialists and infrastructure needed to take care of complex (maternal health) cases, help institute guidelines to improve care, and consult with lower-level hospitals on complex cases. They note that often a mama and her baby are transferred to another hospital to care for a sick, fragile infant, forgetting that the infant is ill because the mama is also in poorer health. Care must start with mama!!
  • Physicians and hospitals must be continually evaluating their outcomes and making adjustments to improve care. Complication protocols must be instituted and everyone must be trained in these protocols. Doctors and staff who fail to comply must be “reined in.”
  • What hospitals can also do, many say, is promote spontaneous, vaginal births — the safest for mothers and babies. One procedure or drug increases the risk for another, often causing a cascade of interventions that ends with a C-section. In the U.S., the C-section rate has skyrocketed to 33 percent of all births. The World Health Organization says it should be closer to 15 percent.
  • Consider using more Midwives and for uncomplicated births. Their low-tech approach has been shown to reduce C-section rates and improve other health outcomes.
  • More research and study needed to understand the causes and treatments of potentially catastrophic maternal conditions. Even if a complication is rare, there should be protocols in place  every part of the health care team should be educated on the condition and the protocol and know what to do in the event of a catastrophic event.
  • Statewide maternal mortality review committees (and a national registry??) made up of key players in prenatal, childbirth and postpartum care are being instituted. Committees regularly review deaths to gain insight on warning signs, prevention and treatments. Such committees exist in Illinois and Missouri and the Illinois committee is the model for several other committees forming around the country. Federal legislation proposed two years ago to beef up state maternal mortality committees stalled, but nationally, there is a bigger effort around improving care than there ever has been before by government, doctors groups and researchers.

The wheels of change are slowly turning and finally there is emphasis on the health of mamas! I’ve said my goal is to put myself out of business. Hopefully with these changes in maternity care, that desire is not long off!

Mamas on Bedrest: Did any of you undergo “preconception” counseling before becoming pregnant?

March 18th, 2013

Good Morning Mamas!!

Question: Did any of you undergo “preconception” counseling before becoming pregnant? 

I ask this question because a couple of days ago, I was trolling twitter and inserted myself into the #acogchat. The topic of discussion was preconception evaluations. When I entered the discussion, I’m thinking a good 20-30 minutes into the chat, the group was discussing how more women need to be aware of their health histories and essentially should have all their “medical ducks in a row” prior to becoming pregnant to avoid complications. Well you all know me. The statements were making my neck hairs stand on end because they seemed to be saying that when pregnancy complications arise, it’s because of something mamas haven’t addressed prior to getting pregnant, a sort of negligence. In my experience with Mamas on Bedrest that simply isn’t true. For many mamas, there is no rhyme or reason that they have the complications they have. And on that note, I jumped into the conversation.

Let me begin by saying that the moderators and participants of the chat were very gracious and receptive to me and my views. I didn’t exactly “tip toe” my way into the chat, I went in full throttle in defense of mamas! But as the chat progressed, we all reached a really good consensus about preconception health care and health care in general. With a candid discussion about the limitations of our current health care climate as well as cultural and societal opinions, we all left the chat with the following “agreement” regarding preconception evaluations/examinations/counseling:

A Preconception Exam/Evaluation is really preventive maintenance. As the chat progressed, we all realized that if health care providers ask, AT EACH AND EVERY VISIT, about a person’s medical history; if any new complications have arisen, if the patient has any new concerns, is there any change in family history…Then we are doing preconception counseling-the way that it should be done. A woman’s health (or anyone’s health) should always be optimized at any doctor/patient interaction. When we providers don’t ask these questions and update a patient’s record each and ever visit, we drop the ball not the patient.

Preconception Exams/Evaluations must be done for men as well as women! Conception takes 2 PEOPLE!! We focus so much on women (as the carriers) but we cannot forget the fact that the sperm quality will also affect whether or not conception takes place and has just as significant an impact on the health of the baby as the quality of the egg and mama’s health. Just as it’s important for mamas not to smoke or drink if they are trying to get pregnant, fathers who smoke, drink or have other health issues won’t impart healthy genes to their offspring and may also be impeding the conception process.

Preconception Exams/Evaluations must begin in pediatrics. This is one area in which there was some controversy. We all know that teen pregnancy is an issue in the United States. Yet, there is no consensus on when/how to teach sex education in schools. What we as a group came up with is that if we teach children to always take exemplary care of their bodies; stressing the importance of not smoking, not drinking alcohol in excess, avoiding recreational drugs, maintaining a healthy weight for height, getting regular exercise, avoiding risky sexual behavior, etc…We are teaching not only good health habits, but imparting good preconception habits.  By focusing on good health, we can reduce the stress many parents feel regarding “sex education” and not step on toes. For example, talking to a teenager about how condoms work and how they prevent the spread of disease is a different conversation than, “You should use condoms at every sexual encounter. ” We impart the medical information and allow parents to speak to the moral implications as they see fit. (And while we know that many parents won’t speak with their children about sex, it is still the parents’ right to impart their moral code on children, not ours-no matter how much we feel it is needed. We can suggest to parents that they discuss certain issues with their children, but in the end, as it was brought up by a parent on the chat, it’s the parent’s obligation, responsibility and right to educate their children (or not) about sex.)

Do discuss medical costs. I brought this to the attention of the group that many insurance companies don’t cover maternity care and require a separate rider on policies. So many woman have been caught by this. Who wouldn’t? It’s natural to assume that if you have insurance, it will cover you if you become pregnant. This just isn’t the case! So as clinicians, we must ask our patients at each and every visit if their insurance has changed, and to give them a simple “heads up” that many treatments and procedures aren’t covered and they should review their insurance policies annually (and most especially if they are planning to become pregnant).

Make Sure Pre-Existing Conditions are Well Controlled Prior to Conception. Again, this was a topic that got us wound up for a minute. But as we discussed it, we all realized, that if health care providers are truly monitoring their patients’ medical conditions, say diabetes, then the goal should always be tight control. At each office visit the importance of blood sugar control should be discussed and emphasized-whether the patient is trying to become pregnant or not. So again, it’s not a question of preparing the patient for pregnancy, it’s about making sure the patient is in optimum health always.

 

I really am glad that I “crashed the chat”. I had the opportunity to speak on behalf of Mamas on Bedrest and to contribute to a really great discussion on patient care. The one area we were not able to address is the notion that all of this can be done in 8-12 minutes. But I am confident that given the passion and dedication to this group of health care professionals, even that “obstacle” will soon be eliminated.