Worthy Global Human Endeavors

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There are only two tru­ly wor­thy glob­al human endeav­ors:

1. Humane Birthing. Find out more from the White Rib­bon Alliance for Safe Moth­er­hood.

2. Space Explo­ration. Find out more from the Augus­tine Com­mis­sion.

Pass it on.

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.

Rant: Health Care Reform/Pregnancy

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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.

Pregnancy Pathway, Pregnancy — Maternal Immunological Response

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Today: Mater­nal Immuno­log­i­cal Response…or…the Mother/Fetus Dance!

Maternal Immune Response During Pregnancy

Mater­nal Immune Response Dur­ing Preg­nan­cy

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.

The maternal/fetal dance goes on.…

Be Prepared for Birth!

Be Pre­pared for Birth!