I recently found this article about prenatal genetic testing. I feel everyone should know about prenatal tests, risks and benefits, and who the tests are recommended for. Your prenatal care provider can help you with this, and there are really good books available that will help you educate yourself to make an informed choice. Some of my favorite books on the subject include "The Thinking Woman's Guide to a Better Birth" by Henci Goer and "Pregnancy, Childbirth, and the Newborn" by Simkin, Whalley and Keppler."Whether this is their first pregnancy, or their fifth, women often worry about the health of their unborn baby.Doctors have a range of genetic tests available to make sure the fetus is healthy.Cristina Flores sat down with Annette Crowley, a registered nurse with Selecthealth, who is the Perinatal Care Manager.Cristina: We should start by saying most babies and most pregnancies turn out just fine, right?Annette: Absolutely, the majority of women who get pregnant, the pregnancies go along perfectly, and the baby is lovely, everything is fine. Only about 3% of all pregnancies have a birth defect associated with it. It's a very small percentage of all pregnancies.Cristina: On that note, who needs to have these genetic tests while they're pregnant?Annette: That's a good question. For the majority of women they are already seeking prenatal care, and that's great to be seeing their doctor. But for women who have had a baby who had some sort of birth defect or genetic problem, women who have a family history who have some sort of genetic problem, or women who are over age 35 are encouraged to look into genetic testing, or prenatal testing.Cristina: And, to get these test, just talk to your doctor, right?Annette: Yes, the nurse practitioner or doctor that you are working with has the information available and they can certainly walk women through what their risks are, and if they need to look into these tests.For more information, head to www.babyyourbaby.org."Originally published at: Genetic Testing During Pregnancy
I just came across this article regarding a proposed AMA medical billing change that could affect expectant parents' rights to take charge of their prenatal care by jeopardizing their ability to get insurance coverage or seek other care givers by labeling them as "non-complaint". Under this proposed change, I could be labeled as non-compliant by my obstetrician's office simply for not subscribing to the suggested routine of prenatal visits (because I've been doing those with my midwife instead) and choosing not to participate in certain prenatal tests and screens. I would hate for my personal choices in managing my prenatal care to impact my future care options. I've posted the article in its entirety.
AMA Resolution Would Seek to Label “Ungrateful” Patients Redondo Beach, CA, June 11, 2009 - At the American Medical Association’s (AMA) Annual Meeting next week, delegates will vote on a resolution which proposes to develop CPT (billing) codes to identify and label “non-compliant” patients (1)
The resolution complains:
“The stress of dealing with ungrateful patients is adding to the stress of physicians leading to decreased physician satisfaction.”
“This resolution is alarming in its arrogance and its failure to recognize, or even pay lip service to, patient autonomy,” said Desirre Andrews, the newly elected president of the International Cesarean Awareness Network (ICAN).
If approved, the resolution could hold implications for women receiving maternity care. For pregnant women seeking quality care and good outcomes, “non-compliance” is often their only alternative to accepting sub-standard care. Physicians routinely order interventions like induction, episiotomy, or cesarean section unnecessarily.
Liz Dutzy, a mother from Olathe, Kansas, delivered her first two babies by cesarean and was told by her obstetrician that she needed another surgical delivery. “My doctor told me that I needed to have a cesarean delivery at 39 weeks, or my uterus would rupture and my baby would die.” She sought out another care provider and had a healthy and safe intervention-free {home} birth at 41 weeks and 3 days gestation.
A recent report by Childbirth Connection and The Milbank Memorial Fund, called “Evidence-Based Maternity Care: What It Is and What It Can Achieve ,” (2) shows that the state of maternity care in the U.S. is worrisome, driven largely by a failure of care providers to heed evidence-based care practices. For most women in the U.S., care practices that have been proven to make childbirth easier and safer are underused, and interventions that may increase risks to mothers and babies are routinely overused. The authors of the report point to the “perinatal paradox” of doing more, but accomplishing less.
The resolution proposed by the Michigan delegation of the AMA could threaten patient care and patient autonomy for several reasons: - Billing codes that would categorize any disagreement and exercise of autonomy on the part of the patient as “non-compliance” “abuse” or “hostility” could create a pathway for insurance companies to deny coverage to patients
- Use of these labels fails to recognize patients as competent partners with physicians in their own care
- Tagging patients as “non-compliant” fails to recognize that there is not a “one size fits all” approach to care, that different opinions among physicians abound, and that patients are entitled to these very same differences of opinion
- Labeling patients as “non-compliant” may, in fact, be punitive, jeopardizing a patient’s ability to seek out other care providers
The resolution also fails to address how it would implicate patients navigating controversial issues in medical care, like vaginal birth after cesarean (VBAC). While a substantive body of medical research demonstrates that VBAC is reasonably safe, if not safer, than repeat cesareans, most physicians and hospitals refuse to support VBAC. (3) The language in the resolution suggests that patients who assert their right to opt for VBAC could be tagged as non-compliant, even though their choice would be consistent with the medical research.“The reality is that the balance of power in the physician-patient relationship is decidedly tipped towards physicians. The least patients should have is the right to disagree with their doctors and not be labeled a ‘naughty’ patient,” said Andrews.
About Cesareans: When a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies from cesareans include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death.Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. ICAN has 110 chapters in North America and Europe, which hold educational and support meetings for people interested in cesarean prevention and recovery.
- Resolution 710 “Identifying Abusive, Hostile or Non-Compliant Patients”
- Evidence-Based Maternity Care: What It Is and What It Can Achieve
- http://www.ican-online.org/ican-in-the-news/trouble-repeat-cesareans
Prenatal health care is very important. I found an article in my local news that talks about this: I'd like to point out that an expectant mother has the option of going to an obstetrician or a midwife, and the medical care should be adequate from both sources. Both obstetricians and midwives do a urinalysis at each prenatal visit to screen for possible health concerns or complications, as well as check the mother's blood pressure, fundal height measurement, weight gain or loss, and check the baby's heartbeat.
A good obstetrician or midwife will also take time at each visit to talk with the expectant mother about her feelings, her life situation and stressors which might impact her well-being during her pregnancy.
Health care may differ from one care giver to another depending on that caregiver's approach to pregnancy and birth. Obstetricians and Certified Nurse Midwives who practice under the supervision of an OB may be more likely to take a very medical approach by suggesting more screenings and tests than a Certified Professional Midwife or Direct Entry Midwife would. Doctors approach pregnancy and birth as a problem waiting to happen. They spend more time looking for problems, because they are trained to handle emergencies and complications. Midwives generally approach pregnancy and birth by looking at the woman as a whole being and trusting in her body's ability to do what it's designed to do, and less time looking for problems. With this being said, midwives are trained to watch for potential problems and how to handle them if they do come up.Whether you choose a doctor or a midwife for your prenatal care, and whether you choose to birth in a hospital, birth center or at home, please get the prenatal health care that you need. Learn about the screenings and tests and procedures so that you can make educated decisions about your health care. Remember that the doctor or midwife works for you, and not the other way around.
What is obstetric cholestasis (intrahepatic cholestasis of pregnancy – ICP)?
Obstetric cholestasis (sometimes called "cholestasis of pregnancy", "OC", "intrahepatic cholestasis of pregnancy", "ICP") affects the liver, which in some women seems to be oversensitive to pregnancy hormones. Bile is produced in the liver and normally it flows down the bile ducts into the intestines where it helps with the digestion of food. If you have OC, the flow of bile into the intestines is reduced and so bile salts build up in your blood.
What are the symptoms of Cholestasis of pregnancy?
- Itching, particularly on the hands and feet (often is the only symptom noticed)
- Dark urine color
- Light coloring of bowel movements
- Fatigue or exhaustion
- Loss of appetite
- Depression
Less common symptoms include:
- Jaundice (yellow coloring of skin, eyes, and mucous membranes)
- Upper-Right Quadrant Pain
- Nausea
Who is at risk for Cholestasis of pregnancy?
1 to 2 pregnancies in 1000 are affected by cholestasis. The following women have a higher risk of getting cholestasis during pregnancy:
- Women carrying multiples
- Women who have previous liver damage
- Women whose mother or sisters had Cholestasis
How is OC identified?
A diagnosis of cholestasis can be made by doing a complete medical history, physical examination, and blood tests that evaluate liver function, bile acids, and bilirubin.
Will OC harm my baby?
The risk of having a stillborn baby is 15 per cent greater for women who have OC than for other women. Nobody is quite sure why. The baby may die because of the bile acids, which are known to cross the placenta, or as a result of being suddenly deprived of oxygen, perhaps because of placental problems.
ICP/OC has been reported to be associated with an increased risk of spontaneous premature birth, fetal distress and stillbirth. With active management (which usually means treatment and choosing to deliver early) the risk of stillbirth in an ICP/OC pregnancy is believed to be the same as that for a normal pregnancy (1%). Most hospitals chose to monitor women with ICP/OC more closely and to deliver the babies early in order to minimize any risk to your baby.
How is OC managed?
The treatment goals for cholestasis of pregnancy are to relieve itching. Some treatment options include:
- Topical anti-itch medications or medication with corticosteroids
- Medication to decrease the concentration of bile acids such as ursodeoxycholic acid
- Cold baths and ice water slow down the flow of blood in the body by decreasing it’s temperature
- Dexamethansone is a steroid that increases the maturity of the baby’s lungs
- Vitamin K supplements administered to the mother before delivery and again once the baby is born to prevent intracranial hemorrhaging
- Dandelion Root and Milk Thistle are natural substances that are beneficial to the liver
- Bi-weekly non-stress tests which involve fetal heart monitoring and contraction recordings
- Regular blood tests monitoring both bile serum levels and liver function
Treatment for cholestasis of pregnancy needs to be determined by your physician who will take the following criteria into consideration:
- Your pregnancy, overall health, and medical history
- The extent of the disease
- Your tolerance of specific medications, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
Treatments that should not be used for Cholestasis include:
- Antihistamines
- Aveeno and Oatmeal Bath
*There are conflicting views on using the medication Cholestyramine for treatment of cholestasis. In the past, this medication was readily used to treat this condition, but some studies have shown that Cholestyramine may not be as effective as other treatments and potentially has some adverse side effects such as blocking essential vitamins like Vitamin K (a vitamin that is already deficient in women with cholestasis).
Will the itching go away after delivery?
ICP is believed to be a condition caused by a gene mutation resulting in the liver's inability to cope with high levels of estrogen present in the body. However, ICP is sometimes a result of an underlying liver disorder. It is normal for patients to continue itching for some time after delivery, particularly with cases that have been prolonged or in cases where a patient has had several pregnancies in a short time frame, but special attention should be given to patients whose itching intensifies after delivery or does not go away at all. Postpartum Serum Bile Acid testing and Liver Function testing are suggested for ICP patients to ensure overall health. A differential diagnosis may include Primary Bilary Cirrhosis, Hepatitis, AIDS, anemia, Benign Recurrent Intra-hepatic Cholestasis, and bile duct obstruction.
I found this information posted by Full Circle Doulas on Facebook and americanpregnancy.org.
