If you are not yet convinced about the global need for humane care for pregnant and birthing women, google (or bing, or yahoo…) “fistula.” If you want more first world information, compare medical birth with what’s on YouTube; while these two approaches to birth are at odds in contemporary medicine, in a humane setting they are both necessary.
As for space, let me paraphrase Craig Nelson’s notion: In time, the Earth will perish. This is nothing you need to lose sleep over. It will be a long, long time before this happens. But, we need to start now to prepare. In time, the Earth will perish, and we will need to be somewhere else when that happens.
These two things will reap all the rewards that need be reaped. The enabling of safe motherhood and our movement into space are the only things that ensure human survival.
Since Health Care Reform is a hot topic, let’s look at it from the perspective of pregnancy and birth.
What revisions would most benefit pregnant women, their offspring, families and communities?
1. Reward healthy behaviors. A system that provides reduced premiums for health care for women who exercise, eat well, do not smoke and are in a normal weight range is evidence-based.
Yes! We could provide financial incentives for being healthy during pregnancy. Why? Healthy moms have healthy babies; healthy babies cost the payer less money.
2. Review best practices. Is a 40 or 50% cesarean rate the best practice? Accompanying the rise in cesarean births is growing information that babies born by cesarean are at increased risk for a number of immune disorders. But the business model of medicine rewards cesarean because it both pays the provider more and is defensive medical practice.
Fetal monitoring to determine if a cesarean may be necessary, is wrong 3/4 of the time. In an effort to change this, guidelines are changing for the use of monitors during labor. What is the evidence that this change of practice is beneficial? Will it lead to more or less monitoring, which may itself be an intervention that can disrupt normal labor?
3. Change the business model for health care. When we make financial incentives for care providers, base them on best practice, not on enriching the middle man. Currently the payers (insurance companies) are middle men, making money (i.e., conducting business) by charging fees. They ration payments for services in order to pay their own salaries and overhead. They do not actually do anything productive. This is why single payer, government, and health care coop options have been proposed. They eliminate most of the cumbersome middle layer.
Why does insurance pay for cesareans? Well, they will do it once. After all, the care providers have to practice defensive medicine. But, once you have a cesarean, you become a risk for the insurance company (they know what the research says about cesareans and offspring health problems) and may be denied insurance. They can no longer afford you.
Because care providers are paid fee for service and must practice defensive medicine, pregnancy and birth have become increasingly burdened with intervening procedures that do not necessarily promote a healthy pregnancy or birth process. How is this playing out? Increasingly, we see women giving birth in what they perceive as a more supportive and health-inducing setting: their own homes. Think of it this way: many women now believe that it is safer to stay home than go to a hospital to give birth.
Unless health care becomes about best practices and healthy outcomes — not price, size, and getting paid for passing money back and forth — the U.S. will continue to have some of the worst maternal/infant outcomes in the developed world.
Back to work! Thank you for your forebearance while we wrote a chapter for a nursing textbook!
During the course of pregnancy, the mother/fetus dance is ongoing. The maternal immune system and the trophoblast cells continue to influence each other even beyond the implantation.
Because the mother’s immune response modulates near the start of each trimester, the fetus is affected to some degree and mounts a response, as well. For a long time it was thought that maternal and fetal DNA material was not exchanged across the placental membrane, however recent findings indicate that there is some exchange of material. Thus, we all carry some portion of our mother’s DNA and our mother carries some of ours.
What is the impact of this chimeric effect? It depends on how well our DNA gets along!
How does this affect the fetus in utero? The fetus may be affected by clotting issues. Depending on maternal health status s/he may be subject to a stronger or weaker immune system.
How does this affect the mother? Women are more likely than men to develop autoimmune disorders (pregnancy playing a role here), and those who bear male offspring are more likely than those who only have girls to have these disorders.