When Selam Solomon Caldwell and her husband learned she was pregnant last year, the stakes for finding the right OB-GYN felt high. Caldwell, a Black woman, had heard stories from family and friends of maternity care providers who ignored their requests or pressured them into cesarean sections without clear medical justification.

As a relative newcomer to Los Angeles, the recruiter, now 31, knew few Black people who could recommend doctors who had treated them with respect. She combed review sites, including Google reviews and Healthgrades, but couldn’t find how nearby physicians and hospitals might treat a Black woman like her.

“It’s hard to tell if it’s a fellow Black person who’s giving the review,” Caldwell said.

Consumer ratings sites rarely identify patient experiences by race or ethnicity and hospitals are under no obligation to reveal the racial and ethnic breakdowns of their patient satisfaction scores. Yet that information could be instrumental in holding maternity care providers and hospitals accountable for treating patients inequitably and could empower expectant mothers like Caldwell in finding quality obstetric care.

“You can’t change what you don’t see,” said Kimberly Seals Allers, founder of Irth, an app allowing Black and brown women to find and leave reviews of maternity care providers. She’s one of a few entrepreneurs developing new tools for collecting feedback from mothers of color.

A steady drip of new research over the past several years has spotlighted racial discrimination by maternity care providers and the role it may play in one of the country’s most vexing health disparities: Black women experience the worst birthing outcomes, a gap not explained by income or education, according to a KFF analysis. In 2021, they were nearly three times as likely to die of pregnancy-related causes as white women.

Mothers of color, especially Black women, report that they do in fact experience discrimination. They are more likely than white women to say that their care providers ignored them, scolded them, or pressured them into treatments they didn’t want. The extent to which discrimination is reported varies widely by survey, but one recently published report by the Centers for Disease Control and Prevention found roughly 30% of Black, Hispanic, and multiracial women reported mistreatment during maternity care, compared with 20% of women overall.

It’s unclear how many hospitals track survey responses by race, and, even if they do, they rarely reveal that information. And the federal government requires generic reporting on how patients say they were treated, making it difficult to pin down and address incidents of bias in maternity care.

Funding and Regulations Lag

Currently, the results of the industry’s standard patient experience survey, known as the Hospital Consumer Assessment of Healthcare Providers and Systems, are made publicly available by the federal government to help patients compare hospitals. They incentivize hospitals to improve care and are included in the rankings of many hospital ratings sites, such as U.S. News & World Report’s Best Hospitals. But it doesn’t ask about maternity care or discrimination and has low response rates, particularly among people of color.

These flaws can also make the survey inadequate for improving birth equity. “We know it’s insufficient,” said Amanda P. Williams, an OB-GYN and clinical innovation adviser to the nonprofit California Maternal Quality Care Collaborative. Hospitals, she said, could fill in the gaps by collecting feedback from maternity care surveys and breaking the results out by race and other demographic information; they could also talk to patients through forums such as town halls or focus groups.

Joy Lewis, senior vice president for health equity strategies at the American Hospital Association, said many hospitals do this work, both generally and in obstetrics.

However, Williams believes it isn’t happening enough in maternity care.

She said there are some pockets where people are doing these activities but that they are not yet widespread. At a national conference of 200 hospital executives this year, Williams said, only a few raised their hands when asked if they break out their maternity outcomes data. “If your overall C-section rate is fine, you might think everything’s hunky-dory,” she said. “But if you see that your Black people are having 50% higher C-section rates than your white and Asian patients, there’s very important work to be done.”

Then there are barriers to participation. Studies have found many in the Black community distrust the health care system.

Fearing retaliation and being seen as an “angry Black woman,” Ta-She-Ra Manning, a maternal health program coordinator in Fresno, California, said she didn’t provide any critical feedback when her OB-GYN dismissed her concerns about unusual symptoms during her 2021 pregnancy.

Meanwhile, new funding to measure disparities has been slow in coming. President Biden’s 2023 budget proposed $7.4 million to develop a supplemental survey aimed at reducing maternal health disparities, among other steps. But Congress did not fund the item. Instead, an agency in the Department of Health and Human Services is developing it with its own funding and estimates the work will take less than five years, according to a statement from Caren Ginsberg, who directs the agency’s surveys.

Still, the public likely won’t see changes anytime soon. After a survey’s measures are created, it can take several years for the results to be publicly reported or tied to payment, said Carol Sakala, senior director for maternal health at the National Partnership for Women & Families, an advocacy organization.

“This molasses level of movement contrasts acutely with all the things hitting the news about people not getting the right care and attention and respect,” Sakala said.

Amid growing interest in health equity, traditional ratings sites are grappling with how much to share with the public. For its birthing hospital ratings, U.S. News & World Report recently started assessing whether hospitals tracked racial disparities in maternity outcomes measures, but it withholds actual results. Healthgrades is taking time to think through how to collect and display sensitive information publicly, said spokesperson Sarah Javors in a statement.

Black Innovators Fight for Better Data

Some Black women are trying to fill the void by creating new feedback mechanisms that could be more trusted by the community. Allers said she created Irth after a traumatic birth experience as a Black mother at a highly rated hospital left her feeling failed by mainstream ratings. On the app, verified users answer questions, from whether they felt respected by their doctor to if they experienced certain types of mistreatment such as dismissal of pain. Irth currently has 10,000 reviews of hospitals, OB-GYNs, and pediatricians nationally, according to Allers.

“Our data is for the community,” said Allers. “They know their feedback has value to another mom or family.”

Irth also offers analysis of the reviews to hospitals and leads campaigns to collect more reviews for them. But Allers said many hospitals have expressed little interest.

Karen Scott, an OB-GYN who created PREM-OB, a scientifically validated survey that measures racism in Black birthing experiences, said she has met hospital leaders who don’t think their providers could mistreat patients or who worry that documenting responses could carry legal risk.

The American Hospital Association’s Lewis declined to comment specifically on Irth and PREM-OB but acknowledged the Black community’s long-standing mistrust of health care providers. She said hospitals want to hear more from patients in historically marginalized groups.

Early signs of progress are emerging in parts of the country.

California hospitals will likely report disparities in birth outcomes and patient satisfaction measures. Hospitals are expected to start posting data broken out by race and other demographics on their websites in 2026, though the state hasn’t finalized the measures that will be required, said Andrew DiLuccia, a spokesperson for the state’s health data agency. At least two states, Washington and New Jersey, have disclosed rates of C-sections among low-risk patients by race for individual hospitals.

Scott founded Birthing Cultural Rigor to increase uptake of her survey. The firm has partnered with birth equity groups to recruit respondents in select counties in Georgia, Michigan, Ohio, and Tennessee. Scott said results will be used to train local health professionals on how to reduce racism in maternity care.

Separately, Irth will collect and analyze reviews for three hospitals or health systems in California, said Allers. One of them, MemorialCare Miller Children’s and Women’s Hospital Long Beach, will work with Irth to better understand the impact of birth equity efforts such as implicit bias training.

“We’ll get to see if what we’re doing is actually working,” said Sharilyn Kelly, executive director of the hospital’s perinatal services.

Caldwell, the recruiter, eventually found a doctor she trusted and went on to have a smooth pregnancy and delivery. Her son is now 8 months old. But with so little information available on how she might be treated, she said, she felt anxious until she met her doctor, when “a lot of that stress and anxiety melted away.”

Digital strategy & audience engagement editor Chaseedaw Giles contributed to this report.

[Editor’s note: California Healthline is an editorially independent service of the California Health Care Foundation, which has contributed funding to PREM-OB and the birth equity nonprofit Narrative Nation, which developed Irth.]

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

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I worked with Allison to develop an individualized treatment plan that addressed nutrition (she wanted to adopt the Mediterranean diet since it seemed sustainable), exercise (we identified several forms of physical activity she enjoyed that fit her schedule) and behavior modification (for example, we shifted her meal timing earlier and discussed techniques to avoid stress-eating). As part of this plan, we also started on metformin, a great option in cases like hers, because it can help with weight loss, it can help restore ovulation, and it is generally considered safe to take during pregnancy.

After a few months, Allison had lost 20 pounds and she began to ovulate; however, she had not yet conceived so she elected to start fertility treatment.

This meant her weight management program would be even more critical.

Weight gain associated with fertility treatment

Since hormones affect weight, hormonal therapy to enhance ovulation (whether pills or the multiple shots that the in vitro fertilization process entails) often leads to weight gain. This gain can be significant, especially for patients with insulin resistance and patients who, like Allison, have overweight or obesity.

While we don’t want to add to patients’ anxiety during the stress of fertility treatment, it is important for us as providers to be mindful of the potential for weight gain. Fertility-treatment-related weight gain can have a long-term impact because successful treatment means pregnancy — and thus pregnancy weight gain — and it’s often difficult to lose the cumulative excess pounds afterward. For women with multiple pregnancies, the extra weight can add up quickly. One of my patients, for example, gained 70 pounds with her first pregnancy and then lost only 20 pounds before conceiving again. She presented to me during her second pregnancy, and we’re working on strategies to avoid excessive weight gain this time.

Excess weight is associated with various health complications during pregnancy, including hypertension, diabetes, obstructive sleep apnea and preeclampsia, as well as an increase in the child’s risk of congenital anomalies. Women’s healthcare providers often hesitate to bring up the topic of weight, but both mother and baby could benefit significantly if more fertility specialists and OB-GYNs (nonjudgmentally) asked patients’ permission to discuss the issue — and then monitored their weight at appointments and took appropriate action as needed.

Managing weight during fertility treatment

Cases like Allison’s are extremely common, so it’s important for women’s healthcare providers of all kinds to be aware of the options and limitations of weight management during fertility treatment. Most anti-obesity medications are off the table for patients during this time, but there are still a number of steps practitioners can take to help their patients avoid excessive weight gain:

• Optimize lifestyle interventions. Dietary strategies, physical activity and recommended behavioral modifications may be more effective when tailored to the patient’s specific lifestyle. Referrals to outside resources, such as a dietitian or behavioral therapist, for instance, can be great options if additional support is needed.

• Address other contributors to weight gain. Stress, lack of sleep and many factors unrelated to the conventional diet-and-exercise combo contribute to weight gain, and all of these contributors may be in play during fertility treatment. Patients benefit from a personalized plan that addresses these as well.

• Assess for drug-induced weight gain. Many medications are known to promote weight gain, so consider pausing these medications or reducing the dose during fertility treatment, if possible, when substitution with weight-neutral agents isn’t an option. Critical medications obviously need to be maintained, but a risk-benefit analysis might suggest that others should be discontinued.

• Consider prescribing metformin. Some gynecologists and reproductive endocrinologists may be comfortable prescribing the diabetes medication, metformin, for patients with overweight, obesity or insulin resistance, or for those at high risk of weight gain. In addition to improving insulin sensitivity and helping to balance hormones, metformin is a weight-loss-promoting medication and can thus help decrease weight gain associated with fertility treatment.

• Refer to an obesity medicine specialist. While we generally can’t use anti-obesity medications during fertility treatment, patients may benefit from a comprehensive medical evaluation and a personalized treatment plan. A thorough plan is particularly important when a patient is unable to conceive quickly and undergoes fertility treatment for a prolonged period. (I currently have one patient, for example, who has gained 40 pounds over the course of seven months of fertility treatments and still isn’t pregnant.)

Supporting better outcomes for mother and child

Women with overweight or obesity who plan to become pregnant are often counseled to lose weight before trying to conceive, both to enhance fertility and to reduce the risk of health complications for themselves and their babies. This recommendation often becomes more explicit before a woman begins fertility treatment — and obesity medicine specialists like me receive many referrals at this juncture.

The more time we have to treat a patient’s obesity beforehand, the more we can do, of course, but we can still help even after treatment begins. While managing weight during fertility treatment is a challenge, it’s not a lost cause. Taking steps to counteract the potentially weight-promoting effects of hormone therapy can significantly impact the health of the woman and her future child. This is a challenge that impacts many generations to come. We can do this together!

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One of the phrases I tell myself came directly from a Maternal Fetal Medicine (MFM) attending, and anyone who trained at MSU has heard this.  “It’s better to have a living patient without a uterus than to bury them with it.”  I remember my intern year and the first time I heard this phrase.  It seemed so obvious to me.  Of course, I would do a hysterectomy to save someone’s life.  

I was chief rotating on the MFM service during my third year of residency.  We arrived early to conduct medical rounds, check patient vitals, ensure fetal status was stable, and plan for the day ahead.  We had been watching a patient for premature rupture of membranes (PPROM).  She had a very desired pregnancy and was seven weeks away from the fetus being able to survive outside of the uterus.  I was rounding with an amazing attending, and she was precise, detail-oriented, and focused on doing the right thing.  She spoke about all the pregnancy options with the family daily.  

She was keenly aware of the risks of continuing a pregnancy with PPROM.  One of the risks of this pregnancy is infection.  If the bag of water, the amniotic sac, is broken, then there is an open area where bacteria can take hold.  Unfortunately, this infection can become significant and risk the mother’s life.  

One day, this very thing happened to our patient.  Once an infection starts, patients often have more pain, uterine tenderness, and vaginal discharge.  Sometimes people will begin bleeding and can hemorrhage.  The uterus is a muscle; if infected, you can imagine, it will respond with contractions.  

At the same time, the infection could spread through the patient’s body.  This is something called sepsis.  A patient’s heart rate goes up, blood pressure can go down, and chills, dizziness, and a loss of consciousness can occur.  People can develop shortness of breath, nausea and vomiting, diarrhea, and other dangerous symptoms.  As sepsis progresses, organs can start shutting down.  When septic shock appears, mortality is between 30-50 percent.  

Physicians need to be trained to notice when someone is becoming sick and developing an infection.  The concern is the progression of the infection to shock and death.  In some states, the legislation is so vague that physicians wait for patient instability to act.  In Missouri, an ectopic pregnancy was being observed, and physicians felt like they couldn’t legally act until someone showed changes in their vital signs and hgb dropping, which means bleeding internally.

Now, imagine the physician unable to act to save a life – confused – confused by the ambiguity of state law – not medical best practice.  Imagine years of training and oversight; the patient must be shunted aside for procedures and policies. Will the residents of the future be trained to turn an eye to a primary medical credo written millennia ago and guiding skill and mission? “Do no harm.” 

These pregnancies aren’t viable, meaning the fetus will not survive outside the patient’s body.  If the patient dies, the fetus dies.  We are handicapping physicians from practicing evidence-based medicine.  We are putting people at risk, even in our hospital systems.  Who is going to be held accountable for this? Who will take responsibility for the impossible position healthcare workers are in?  

We should be acting in the best interest of our patients, always. 

Physicians specializing in women’s health should be part of critical policy conversations.  We are endangering the lives of the American people.  Laws created in 1849, like in Wisconsin, have no business regulating what a physician can and can’t do in modern-day healthcare.  Let healthcare be provided by the people who trained their whole lives to provide it.  Hospitals, administrators, nursing staff, and physicians need to meet and develop ongoing policies to handle things in a timely fashion instead of waiting for life-threatening events to happen.  

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The past week has been difficult for liberally-minded individuals in the United States. Through a series of Supreme Court rulings, citizens lost several fundamental rights. Miranda rights, mandating that those arrested are informed of their rights, and Roe v Wade, giving women freedom in their reproductive health choices, were both repealed. The latter is particularly troubling for me as a physician, given the substantial evidence of harm when women’s bodies are under the state’s control rather than a woman’s (read a detailed statement by the Journal of the American Medical Association here). Why would someone ignore clear evidence that something can overall improve the lives of citizens?

These next few years will see an increase in women dying from complications of forced pregnancies and poverty. Pregnancy can be hazardous for some women, such as those at risk of blood clots. Being prevented from having an abortion can leave a woman (and her fetus) vulnerable to permanent disability from a stroke and blood clot, even if put on anticoagulants. Women with chronic conditions could be required to stop their medications if they accidentally become pregnant due to known toxicity against the fetus, exacerbating health crises that could harm both the woman and her fetus. Finally, women without the financial resources to support the medical appointments required for a healthy pregnancy, not to mention helping a born child and subsequently affording pediatrician appointments, will often have to take on debt, limiting their and their child’s lifetime achievement. Why restrict family planning methods while at the same time opposing funding towards supporting those with less financial resources?

This article is not about showcasing this decision placing discriminatory burdens overwhelmingly on the poor and people of colour. It is about finding peace today, so together, we can maintain a state of mind needed to ensure women regain the rights they lost and gain even more, given that women were not treated as equals to men even before this decision. Read on to learn how you can find peace in our more troubled world.

There are many ways that one can respond to life stressors. In psychiatry, they are classified as mature and immature ego defences, briefly summarized by Psychology Today here. Mature defences typically lead to more lasting relief of suffering, whereas immature ones can propagate it. Examples of mature defences include using humour, converting one’s suffering into doing good (altruism), and converting one’s suffering into a passion for one’s work or hobbies. Examples of immature defences include passive aggression that can harm one’s interpersonal relationships, acting out where one may seek peace through purchasing copious amounts of financial goods or excess consumption of alcohol, or denial where one cannot acknowledge the reality of a given situation.

Fortunately, through mindfulness and practice, one can learn to replace immature ego defences with mature ones, as I have done throughout my adult life. While it took effort, feeling at greater peace with myself and my life choices affords me more energy to invest in others and my hobbies. It has helped me pursue advocacy work with global health and challenge COVID-19 misinformation. But how does one foster these mature ego defences?

Altruism:

Altruism is where one challenges their suffering by doing kind things for others. So when one is perhaps facing guilt over harmful comments said to a romantic partner or friend during a disagreement, one could challenge this by doing something nice for them or simply apologizing. In another scenario, when one is worried about their parents getting older or an illness in the family, one could pursue volunteer work at their local hospital or homeless shelter. Lastly, if one is feeling hopeless, given the recent Supreme Court rulings, one could become an advocate for those seeking to exercise autonomy over their reproductive choices. There is much one could do towards this principle, with one simply needing to feel like they are improving another person’s life. Tell me in a comment the ways you like to help others.

Humour:

Humour is when one can attempt to make light of difficult situations to ease the felt burden. For students or working professionals, one could make jokes about how a pressing deadline was good for their skin because they did not have much time for showering. However, one should be careful about humour because it can be easy to tell a “joke” that hurts someone’s feelings or propagates harmful ideas, which could lead to a disagreement and more suffering. Making jokes about your boss due to an increased workload or being required to work on weekends could easily strain that relationship, potentially leading to one becoming unemployed. Suggesting calls for violence are “jokes” can make others feel unsafe, causing others to suffer and fear for their lives. Such logic was used by individuals who stormed the Capital on January 6, 2021.

Sublimation and Suppression:

Sublimation is where one converts the energy or suffering from an “unacceptable action” into an action that is more acceptable. So instead of shouting at a driver who cut you off in traffic, you put those feelings on hold (suppression) and bring all that energy out in your video game or gym/sports session later that day. Rather than sending a passive-aggressive message to a friend who you feel did not return your call or text message fast enough, you can take care of chores in your apartment or house instead. Rather than telling people on the internet who do not share your views that they and their opinions are worthless, regardless of the topic, one can volunteer with organizations that advance the issue you care about. Clearly, these mature defences can overlap.

Sometimes it can feel like the world is collapsing around us. There is a certain amount of truth to this as the status quo seemingly continues with the rich getting richer, the poor getting poorer, and inequality becoming more of a norm than the exception. Like Siddhartha Gautama, I too find it startling, for example, that wealth can be juxtaposed on the same street with poverty. In Montreal, I see beggars looking for donations on the side of the road as Ferraris drive by. That suggests that something is not right with our society as it stands. Feeling frustration is a perfectly acceptable reaction. What is important is what we do with those feelings. We can react to our world in a way that harms us and others, or we can face our challenges in a way that motivates equality and prosperity. We can wallow in fear and misery, or we can take those feelings and make something better of them. It is not always easy to do the latter. We can get stuck with the former. What is important is that we ultimately find the strength inside ourselves to overcome our limitations and create a more equal world collectively.

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Monoclonal antibody therapy reduces the risk of hospitalization and severe disease. Pregnant people qualify for treatment, but they need to get the treatment as early as possible.

Our company, MacArthur Medical Center’s core values include INNOVATION and EXCELLENCE. We stay at the cutting edge to promote the best care possible to our patients.

Our company has started offering monoclonal antibody treatments to any pregnant patient who tests positive for Covid-19. We also refer gynecologic patients who meet the criteria. 

We share this protocol to help other practices learn of this treatment’s value and to provide a roadmap to integrate a similar option inside of their own practice

Here is what all Obgyn practices need to know.

Regneron is a medication approved by the FDA under emergency use authorization for the treatment of Covid-19 for those early in the infection and at high risk of developing severe disease.

All pregnant people diagnosed with Covid-19 are considered high risk. Pregnancy naturally suppresses the immune system which predisposes pregnant people for worse outcomes when they are infected with a viral illness. 

Regeneron is a combination of two medications, Casirivimab and Imdevimab. Regeneronmakes use of monoclonal antibodies to fight the disease. These antibodies are similar to the ones our body would naturally produce in response to infection.

Monoclonal antibodies are mass-produced in a laboratory and are designed to recognize a specific component of the Covid-19 virus — the spike protein on its outer shell. These specific antibodies interfere with the virus’s ability to attach and gain entry into human cells by targeting the spike protein. 

Monoclonal antibodies give the immune system a leg up until it can mount its response.

Most pregnant people who contract Covid-19 do well. But the studies are clear that Covid-19 increases the risk of preterm labor, ICU admission, intubation, and death.

For a practice to successfully integrate monoclonal antibody therapy into practice, we must focus on teamwork. Everyone in the practice should have some basic knowledge of this treatment option to make certain cases are identified and referred early in the infection when the treatment is most effective. 

We must work together to give our patients to best chance possible to stay healthy after being diagnosed with Covid-19. 

Remember: Getting vaccinated against Covid is the best approach. All medical providers and teammates should encourage every patient to protect themself and others. Protect our moms, babies, and children. 

Covid vaccination in pregnancy is safe and effective. There is zero credible evidence linking Covid-19 vaccines to infertility or miscarriage.

Who qualifies for monoclonal antibody therapy? 

Patients must meet at least ONE of the following criteria:

• Pregnancy
• High-risk Ethnicity Groups (Latin X or Black)
• Older age (for example, age ≥ 65)
• Obesity or being overweight (for example, BMI > 25 kg/m2)
• Chronic kidney disease, diabetes, or
• Immunosuppressive disease
• Currently receiving immunosuppressive treatment
• Heart disease 
• High Blood pressure 
• Chronic lung diseases
• Sickle cell disease
• Neurodevelopmental disorders

Additionally, patients must meet ALL the following criteria:

• 12 years of age or older
• The patient is symptomatic (not asymptomatic) and has mild to moderate illness.
• Day 10 or less since symptom onset or testing positive.
• Documented positive COVID test performed
• Not requiring Oxygen therapy 

Where is monoclonal antibody therapy done?

The State of Texas has placed The Regional Infusion Center 8th Avenue in Fort Worth near Cooks Children’s Medical Center. A physician must refer patients. Patients cannot refer themselves, and all treatments must be scheduled in advance.

Monoclonal antibody treatment is free. It is funded by the state of Texas. There is no cost to the patient.

The RIC (Regional infusion Center operates seven days a week from 8:00 AM — 6:00 PM. 

How can a practice refer a patient for monoclonal Antibody Therapy? 

1. Confirm the patient has a positive Covid test. 
2. Confirm the patient meets the eligibility criteria listed above. 
3. Fill out the Statewide RIC Infusion Referral Form. We recommend placing a copy of this required form inside of the practice’s electronic health record to help medical assistants and referral coordinators have easy access. 
4. Fax the RIC Infusion Referral Form to 210–208–5295 or send it by email to InfusionReferral@bcfs.net
5. An Infusion Center Representative will reach out to the patient to schedule an appointment.

The post North Texas Obgyns Need to Know About Monoclonal Antibodies for Covid-19 appeared first on Medika Life.

Before I review the common methods of inducing labor, let me first explain that these methods are used by licensed medical professionals. If you came here for “natural” induction techniques, then you clicked on the wrong article.

Let me just say that if you want to try at-home techniques, please talk to your healthcare provider. We are not opposed to natural methods, but there are side effects/risks that may put certain pregnancies at increased risk. Also, I never, ever recommend castor oil to induce labor. Diarrhea-induced contractions are not the type of contractions you want to suffer through.

Inducing labor can take several hours, if not days, and you may need multiple methods throughout the induction process. Please note the time limits posted for each method to prevent complications. These methods have been studied and proven safe for most pregnant people.

1. Nipple Stimulation: This isn’t as fun as it sounds! Nipple stimulation releases endogenous oxytocin which causes contractions. Nipple stimulation is best accomplished by applying a mechanical breast pump to both breasts. One problem with this method is once the stimulation is stopped, the oxytocin level drops, and contractions can also stop if labor wasn’t fully established. Time limit: 20 minutes on, 20 minutes off, for up to 2 hours

2. Foley Balloon: Mechanical dilators, like the foley balloon or Cook cervical balloon, put pressure on the cervix, stretch the lower segment of the uterus, and indirectly release cervical softening hormones called prostaglandins. The end of the balloon can be attached to traction to aid in cervical dilation. Once the balloon comes out, the cervix is usually 3–5 centimeters dilated, though contractions will usually need to be stimulated to induce labor. Time limit: 12–24 hours

3. Cervidil or Cytotec: These prostaglandin medications are placed directly behind your cervix to soften the cervix and help thin it out. Cytotec can be taken orally, which is great if the amniotic membranes are ruptured. Though the goal of these medications is to ripen a cervix for labor. Both are capable of producing contractions. Labor is more likely if you have had more than one baby. Time limit: 12 hours for Cervidil; Cytotec is given every 3–4 hours for up to 3–4 doses

4. Pitocin: Pitocin is the synthetic version of oxytocin. It is given through an IV and can be titrated to achieve an adequate contraction pattern. Pitocin is the most common method of induction or augmentation of labor and is rapidly cleared by the body once it is turned off. Pitocin can be given after delivery to prevent uterine atony and postpartum hemorrhage. While in labor, your nurse or healthcare provider will carefully monitor the fetal heart rate and contraction pattern to prevent complications. Time limit: No time limit; postpartum complication risks increase with prolonged exposure (>24 hours) for some people.

Your provider should explain the risks, benefits, and alternatives for any induction process. Each pregnancy is different so the method that worked for your first pregnancy may not be an option for future pregnancies.

Also, unless you have a medical condition validating an induction prior to 39 weeks gestation, your provider cannot induce labor. No matter how bad your back hurts or if your mom is coming in from out of town.

Trust the process and be patient!

This article was contributed by MacArthur Medical Center’s Certified Nurse Midwife Jen Rockhold

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Two Texas residents, who reside in long-term care facilities, contracted Listeriosis. The infections were traced back to contaminated chicken products from Tyson Food Inc, prompting a Food Safety Alert.

Listeria monocytogenes is a bacteria found in soil and water. Cattle and poultry can carry the bacteria, which causes a severe type of food poisoning in humans. Listeria accounts for only 1 percent of reported bacterial food-borne infections, but these cases can be fatal when not treated with appropriate antibiotics.

The CDC reports approximately 1,600 people contract Listeriosis each year in the United States, leading to 260 deaths.

The US Department of Agriculture Food Safety and Inspection Service compared samples from Tyson Food Inc with those of the infected Texas patients. The bacterial strains from the two patients were a match indicating a shared original source.

Public health agencies traced their exposure to chicken products stating “two precooked chicken samples from two establishments that are closely related genetically to Listeria monocytogenes from ill people.”

Listeriosis was found in fully cooked chicken products marketed under brands such as Tyson, Jet’s Pizza, Casey’s General Store, Marco’s Pizza, and Little Caesars.

The CDC and public health agencies can respond quickly to listeriosis outbreaks because of the Whole Genome Sequencing Project. This early detection tool helps identify infectious disease public health threats before they can spread. When someone tests positive for Listeriosis, scientists genetically sequence the entire strain of bacteria. When two patients test positive for the same strain, public health officials can search for the source causing the infections. According to the CDC, the Whole Genome Sequencing Project allows scientists to:

• Detect early clusters of Listeria infections
• Link cases of Listeria to a likely source
• Identify unrecognized sources of Listeria
• Stop Listeria outbreaks while they are still small

Listeriosis is a potentially life-threatening infection when people eat food contaminated by the bacteria Listeria monocytogenes. Most people who contract Listeriosis have a mild illness, but those with suppressed immune systems or over age 65 can become very sick.

Patients with autoimmune diseases, HIV, cancer, or transplants are at increased risk. The infection can spread to the bloodstream causing sepsis or to the brain, causing meningitis or encephalitis.

The symptoms of Listeria can arise days to weeks after exposure. Common symptoms are similar to the flu, including fever, chills, muscle aches, and diarrhea. Some may develop more concerning symptoms such as headaches, a stiff neck, or confusion.

Listeriosis is especially concerning during pregnancy. Pregnant women are at a much higher risk of getting sick from Listeriosis. Pregnant women who contract Listeriosis generally have a mild illness, but the disease has been linked to miscarriage, stillbirth, and preterm labor.

Listeriosis can be transmitted from a pregnant woman to her baby through the placenta. The placenta is the organ inside the uterus that keeps the baby alive. Maternal blood circulates through this internal filtration system. The growing baby receives oxygen and nutrients from the mother, and the placenta removes carbon dioxide and waste products. 

The placenta is also the defense system against invading infections like bacteria and viruses. Placental immune system cells called trophoblasts are the first line of defense against any invading organisms.

Most infectious invaders do not make it across the placental defense system. Trophoblasts stop them in their tracks. Listeriosis can cross the placental barrier leading to infections in the baby.

Listeriosis can cause intellectual disability, paralysis, seizures, and blindness. Infected babies may develop problems in the brain, kidneys, and heart.

The CDC Food Safety Alert linked this listeria outbreak to fully cooked chicken supplied by Tyson Food Inc recalling products “shipped nationwide to retailers and institutions including hospitals, nursing facilities, restaurants, schools and Department of Defense locations.”The products affected include:

• Fully cooked chicken strips
• Diced chicken,
• Chicken wing sections
• Fully cooked pizza with chicken.

The US Food and Drug Administration offers this helpful video to help families learn about preventing foodborne illnesses.

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What can I do before getting pregnant to lower my risk of passing HIV to my baby?

If you plan to become pregnant, talk to your doctor right away. Your doctor can talk with you about how HIV can affect your health during pregnancy and your unborn baby’s health. Your doctor can work with you to prepare for a healthy pregnancy before you start trying to become pregnant.

Everyone living with HIV should take HIV medicines to stay healthy. If you are thinking about becoming pregnant and are not taking HIV treatment, it is important that you begin, because this will lower your chances of passing the virus to your baby when you become pregnant.

There are ways for you to get pregnant that will limit your partner’s risk of HIV infection. You can ask your doctor about ways to get pregnant and still protect your partner.

I do not have HIV, but my partner does. Can I get pregnant without getting HIV?

Women have a higher risk of HIV infection during vaginal sex than men. If you do not have HIV but your male partner does, the risk of getting HIV while trying to get pregnant can be reduced but not totally eliminated.

Talk to your doctor about HIV medicine you can take (called pre-exposure prophylaxis or PrEP) to help protect you and your baby from HIV.

You may also want to consider donor sperm or assisted reproductive technology, such as semen washing or in vitro fertilization, to get pregnant. These options can be expensive and may not be covered by your health insurance.

I’m pregnant. Will my baby have HIV?

If you just found out you are pregnant, see your doctor right away. Find out what you can do to take care of yourself and to give your baby a healthy start to life.

With your doctor’s help, you can decide on the best treatment for you and your baby before, during, and after the pregnancy. You should also take these steps below before and during your pregnancy to help you and your baby stay healthy.

Just because you have HIV doesn’t mean your child will get HIV. In the United States, before effective treatment was available, about 25% of pregnant mothers with HIV passed the virus to their babies. Today, if you take HIV treatment and have an undetectable viral load, your risk of passing HIV to your baby is less than 1%.¹

What can I do to lower my risk of passing HIV to my baby?

Thanks to more HIV testing and new medicines, the number of children infected with HIV during pregnancy, labor and childbirth, and breastfeeding has decreased by 90% since the mid-1990s. The steps below can lower the risk of giving HIV to your baby:

Step 1

Tell your doctor you want to get pregnant. Your doctor can help you decide if you need to change your treatments to lower your viral load, to help you get pregnant without passing HIV to your partner, and to prevent you from passing the virus to your baby. He or she will also help you get as healthy as possible before you get pregnant to improve your chances of a healthy pregnancy and baby. Don’t stop using condoms for STI prevention and another method of birth control for pregnancy prevention until your doctor says you are healthy enough to start trying.

Step 2

Get prenatal care. Prenatal care is the care you receive from your doctor while you are pregnant. You need to work closely with your doctor throughout your pregnancy to monitor your treatment, your health, and your baby’s health.

Step 3

Start HIV treatment. You can start treatment before pregnancy to lower the risk of passing HIV to your baby. If you are already on treatment, do not stop, but do see your doctor right away. Some HIV drugs should not be used while you’re pregnant. For other drugs, you may need a different dosage.

Step 4

Manage side effects. Side effects from HIV medicines can be especially challenging during pregnancy, but it is still important that you take your medicine as directed by your doctor. Talk to your doctor about any side effects you have and about ways to manage them.

Step 5

Do not breastfeed. You can pass the virus to your baby through your breastmilk even if you are taking medicine. The best way to avoid passing HIV to your baby is to feed your infant formula instead of breastfeeding.

Step 6

Make sure your baby is tested for HIV right after birth. You should choose a doctor or clinic experienced in caring for babies exposed to HIV. They will tell you what follow-up tests your baby will need and when. Talk to your doctor about whether your baby may benefit from starting treatment right away.

Step 7

Ask your pediatric HIV specialist if your baby might benefit from anti-HIV medicines before you know if your baby is HIV-positive or HIV-negative. Research has shown that giving combination HIV drugs to newborns is better at preventing HIV than taking AZT (azidothymidine, an antiretroviral medicine) alone.

Can I take HIV medicine during pregnancy?

HIV-infected pregnant women should take HIV medicines. These medicines can lower the risk of passing HIV to a baby and improve the mother’s health.

If you haven’t used any HIV drugs before pregnancy and are in your first trimester, your doctor will help you decide if you should start treatment. Here are some things to consider:

• Nausea and vomiting may make it hard to take the HIV medicine early during pregnancy.
• It is possible the medicine may affect your baby. Your doctor will prescribe medicine that is safe to use during pregnancy.
• HIV is more commonly passed to a baby late in pregnancy or during delivery. HIV can be passed early in pregnancy if your viral load is detectable.
• Studies show treatment works best at preventing HIV in a baby if it is started before pregnancy or as early as possible during pregnancy.

If you are taking HIV drugs and find out you’re pregnant in the first trimester, talk to your doctor about sticking with your current treatment plan. Some things you can talk about with your doctor include:

• Whether to continue or stop HIV treatment in the first trimester. Stopping HIV medicine could cause your viral load to go up. If your viral load goes up, the risk of infection also goes up. Your disease also could get worse and cause problems for your baby. So this is a serious decision to make with your doctor.
• What effects your HIV medicines may have on the baby
• Whether you are at risk for drug resistance. This means the HIV medicine you take no longer works against HIV. Never stop taking your HIV medicine without first talking to your doctor.

Can I get help paying for care during pregnancy?

If you are pregnant, Medicaid may pay for your prenatal care. If you are pregnant and living with HIV, Medicaid might pay for counseling, medicine to lower the risk of passing HIV to your baby, and treatment for HIV. Each state makes its own rules regarding Medicaid. Contact your local or county medical assistance, welfare, or social services office to learn more. If you are unable to find that number, search your state’s department of health.

If you don’t think you qualify for assistance, check again. Sometimes states change their Medicaid rules. Under the Affordable Care Act, Medicaid eligibility expanded to cover many more people. Also, you may be newly eligible for Medicaid because of increased income limits for prenatal care and HIV treatment for pregnant women.

You may also access care through the Ryan White HIV/AIDS Program. Find a Ryan White HIV/AIDS Program medical care provider near you. 

Offsite Resources

For more information about HIV and pregnancy, check out the following resources from other organizations:

• HIV Among Pregnant Women, Infants, and Children — Fact sheet from the Centers for Disease Control and Prevention (CDC).
• HIV and Pregnancy — Information from AIDSinfo.
• Infant feeding and HIV — Publication from UNICEF.
• Elimination of Mother-to-Child HIV Transmission (EMCT) in the United States — Fact sheet from CDC.
• One Test. Two Lives. — Campaign information from the CDC.

The post Pregnancy and HIV; Here is What We Need to Know appeared first on Medika Life.

After Texas passes the heartbeat bill limiting abortion access, Representative Rose hopes to prove Texans care about women and children after pregnancy ends.

Dallas Representative Toni Rose sponsored House Bill 133. She proposed extending Medicaid benefits to low-income women after they have a baby. Rose told The Austin Statesman, “For the past few years, I’ve heard from families across the state who have lost loved ones due to complications of childbirth. Believe me when I say that this issue knows no political or geographical boundaries.”

Under current guidelines, pregnant people qualify for Medicaid for sixty days after delivery. During the Covid-19 pandemic, Texas extended postpartum Medicaid coverage for one year. Some women qualify for a Healthy Texas Women program that provides contraception access and basic primary care coverage.

House Bill 133 is titled “Relating to the provision of certain benefits under Medicaid and the Healthy Texas Women program, including the transition of case management for children and pregnant women program services and Healthy Texas Women program services to a managed care program.”

The bill would allow pregnant people who qualify for Medicaid to continue their health coverage for twelve months after having a baby. The bill passed the Texas House in bipartisan fashion 121-24. The Texas Senate amended the bill reducing the coverage from twelve to six months. The Texas Medical Association is lobbying to extend health coverage back to one year.

Preexisting medical conditions cause many pregnancy complications. To address preexisting conditions, patients need access to medical providers. Primary care, Obgyn, and specialist care before, during, and after pregnancy reduce the risk of maternal deaths.

Many Americans access the US Health system through the Medicaid program. Medicaid covers almost half of the births in our country. In Texas, 54% of pregnant women qualify for Medicaid. But many states, like Texas, chose not to expand Medicaid under the provisions of the Affordable Care Act.

Federal law dictates states must provide prenatal coverage through the Medicaid program. Pregnant women with family incomes up to 138% of the federal poverty level qualify for mandatory prenatal coverage.

Medicaid coverage does not begin until the pregnant woman completes the pregnancy verification process. For many women, this process is slow and arduous. Federally mandated prenatal coverage also ends sixty days postpartum.

In Texas, we provide Medicaid AFTER patients get pregnant and take it away when they deliver. Women gain temporary access to the US health system once they become pregnant and lose access once they deliver their baby. Health providers lose many opportunities to address health needs and prevent complications.

Pregnant people qualify for free health coverage through Medicaid for Pregnant Women, which makes Medicaid available during pregnancy and for two months after birth if they fall under certain monthly income thresholds based on family size ($2,126 or less for a single woman or $3,624 for a family of three).

But to qualify after the two-month postpartum period, the income threshold is significantly lower: $196 a month for a mother with one child or $230 for a mother with two children ($285 a month for a two-parent household with two children).

The maternal mortality rate in Texas is above the national average. According to 2018 data from the U.S. Centers for Disease Control and Prevention, the estimated maternal mortality rate (women who died while pregnant or within 42 days of delivery) was 17.4 deaths per 100,000 live births. In Texas, the maternal mortality rate was 18.5 deaths — that’s nearly 700 deaths nationally and about 70 in Texas each year.

Black and other women of color are two to three times more likely to die from pregnancy-related causes than white women. This risk increases with age. For women over the age of 30, the risk of dying during or after pregnancy is the risk dying before or after pregnancy is four to five times higher than white women.

The 2010 Affordable Care Act (ACA) increased coverage in our country, but millions of Americans are still without health insurance.

The lack of access to high-quality, affordable healthcare increases poor health outcomes and widens the racial disparities.

Why do pregnant women die?

1. Cardiomyopathy and another cardiac disease
2. Thrombotic pulmonary embolism
3. Preeclampsia and hypertensive disorders of pregnancy
4. Hemorrhage
5. Cerebrovascular accidents (strokes)
6. Infections

Representative Toni Rose proposed House Bill 133 to bridge the gap, ensuring Texas provides care for pregnant people after they give birth. This legislation will save lives.

Representative Toni Rose is serving her fourth term in the Texas House of Representatives. District 10 covers the diverse communities of Oak Cliff, Highland Hills, Pleasant Grove, Balch Springs, and Mesquite.

Representative Rose was born and raised in Dallas. Her passions are mental health, social justice, and criminal justice. Her biography states she works on legislation to help “mental health reform, access to affordable healthcare, improving the quality of life for our aging population and underserved communities.”

Mental health access is a key component of her legislation. One in seven women suffers from postpartum depression. Perinatal mood and anxiety disorders can occur anytime from conception to one year after the delivery of a baby.

Perinatal depression is darker and debilitating. A mom feels unable to function for an extended period. Women need access to mental health care to address their needs when certain symptoms are present.

Postpartum depression symptoms include crying spells, feeling sad, feelings of hopelessness, and feeling guilty. Some may express a lack of happiness or feel the absence of bonding with the baby. Some may have feelings of hurt themselves or their baby. All of these symptoms indicate it is time to seek medical attention.

A study written by Mathematica in collaboration with St. David’s Foundation and Texans Care for Children examined the economic impact on Texas for failing to provide postpartum mental health care. Texas loses 2.2 billion dollars each year by not providing access to care for people after having a baby.

HB 133 is an opportunity for Texas to show we care about pregnant during and after delivery. A bipartisan group of Dallas leaders in the Texas House of representatives is working together on prison reform. Let’s hope more leaders come together to support Representative Rose’s common-sense legislation to save tax-payer money and save the lives of new Texas mothers.

The post Dallas Representative Toni Rose Fighting for Medicaid Extension for Women After Having a Baby appeared first on Medika Life.

A friend of mine also read the article, he is an OBGYN and his response bothered me. “Yes, we know about this, I just have no idea if we can fix it.”

So is it fixable? The research I referenced above was only looking for very specific contaminants, namely PFA’s. There are more, quite a lot more, as it turns out and I’m not even going to go down the route of listing these additional environmental toxins and I’ll explain why.

It’s pointless. As hard as it to acknowledge this fact, it’s the truth. While legislation lags about twenty years behind the industries that poison us, even if we were to pass a blanket ban today on everything we know to be harmful, contamination of our environment and us is complete and absolute. 

It would take two or three generations, perhaps longer, to cleanse ourselves and the planet of the poisons we have been spreading and consuming for decades.

That’s assuming a complete and immediate cessation of all manufacturing of plastics etc and harmful chemicals, pesticides, veterinary antibiotics (fed to our food), and a host of other materials. Never happening, so discussing it is moot. We need to accept the situation and deal with it. 

So do I breastfeed?

Yes is the answer to the question asked by moms either breastfeeding now or considering it. Breastfeed, please. I’ll explain why and the answers, which may appear simplistic on the surface are based on common sense and risk management. 

1. The Immunity Issue

This is a biggie and for a good reason. Your newborn is delivered into a world it’s completely unprepared for. The baby’s immune system is not functioning yet and it will take months and years to mature into a properly functioning system. Your milk contains your baby’s first-ever “vaccination”, courtesy of nature.

While it adapts, your bundle of joy is going to need a little help from mom. You can provide this via your breast milk, particularly for the first few days after birth, even if you decide later to switch to formula. Your initial supply of milk is loaded with extra colostrum, a sticky substance that is loaded with your antibodies and sIgA. Nature knows it needs to help the newborn and colostrum is how it achieves that. 

Colostrum is also called beestings or first milk and to understand just how magical it is, refer to this article. Please also read the note in the footer of this article on colostrum supplements.

By sharing your immunity with your baby you’re providing an invisible shield that will help the child ward off diseases and other nasties floating about. You’re providing your child’s throat and nasal passages extra protection and helping to populate the child’s gut biome. Your colostrum gives the baby’s own immune system a helping hand, in effect kick starting it with a helpful supply of data. 

Incidentally, natural birth also boosts a child’s immunity as they are exposed to a whole host of bacteria on their trip out the womb that stimulate their immune systems. Babies born by Caesarian Section (CS) lack this added boost, so the argument for breastfeeding CS babies is possibly even stronger.

2. Breast milk versus formula

Yes I know there are some fantastic products out there and for mothers that cannot breastfeed, out of choice, or because of issues like lactose intolerant infants or supply issues, these are a godsend. 

They aren’t however breast milk. It’s very rare to see an obese baby if it’s breastfed. Formula babies tend to pack on the pounds and regulating the baby’s weight is an important part of forming a healthy adult. Many parents don’t. A lot of this has to do with supply and demand. It’s hard work breastfeeding for a little mouth, whereas with a teat-and-bottle, supply often exceeds demand.

Also, formulas cannot provide antibodies. That’s a job for breast milk and only breast milk. Depending on where you live and the quality controls put in place by regulators, you also have to rely on manufacturers ensuring their products don’t contain anything that impacts your child’s health, both now and in later life. Breastmilk doesn’t suffer from this issue.

3. Futility

Yes, there’s that reason again and this is why it is futile. Whatever toxins your breast milk contains I can assure you that the benefits of your milk To the child far outweigh the risks it carries. 

There are risks. Anyone who says otherwise is lying to you. We know they exist, but if science is honest about it, it’s just not a field anyone is interested in. Short-sighted? Yes, horribly so, and sadly unlikely to change in the near future. 

Many of our adult diseases may and probably do stem from childhood exposure to environmental toxins. There is money to be made in treating the sick adult, while very little profit exists in keeping the child healthy. 

Another reason linked to futility is this. If you don’t poison your child with your breast milk, you’re sure to get him as soon as he starts eating. 

The plastic bottles and teats used for their formula contain contaminants, the utensils and pans you cook with are loaded with plasticizers that leech into everything. The food you buy is contaminated and even produce marked as organic is tainted. There is no escaping this, which is why your breast milk really matters to your child.

You want to give them the best start you can in life. A real fighting chance to equip them for what lies ahead and the best way you can do this is with your breastmilk Breast really is best.

Don’t Stress it

If you want your milk to dry up or for supply to become erratic, try stressing. You’ve got more than enough to worry about over the next few months as the baby grows and breastfeeding honestly shouldn’t be on this list. Yes, you may be imparting toxins and chemicals to your baby via your breastmilk, but the baby will be exposed to these in their very near future in any case. 

As we’ve pointed out, unless you’re going to move in with Heidi in some remote hut in the Alps, drinking from underground streams, and churning yak milk for cheese, you’re going to be contaminated with these pollutants.

By offering your child your breastmilk you’re actually enabling an incredibly adaptable little system with the best possible chance it may have to combat these pollutants later in life. So hand out that free shield mom, you’ve been given the amazing ability for a reason. Don’t ever doubt it.

Colostrum Supplements

Medika Life isn’t here to sell you anything, our only concern is your health and your ability to make informed choices about it. Colostrum supplements are a huge waste of money. There is no real documented science to suggest drinking cow-derived (bovine) colostrum later in life is of any real and lasting benefit. In fact, it may even be harmful. You’re consuming antibody proteins derived from a non-human source.

Questions exist as to your body’s ability to be able to actually absorb these ingredients at all and if you manage that, what the outcomes will be. Colostrum supplements are also very pricey, so not only are you wasting your money, you may be exposing your health to indeterminate risks. Every other mammal on the planet enjoys a limited supply of colostrum at the point in their lives when they need it, and never again.

Once this time has passed, your body arguably may not tolerate or absorb the ingredient or may in fact perceive the foreign proteins as a threat. We are not, after all, cows. Please don’t bother replying to this with links to colostrum research, we’ve seen it and none of it proves anything.

The post Is it Safe to Breastfeed my Baby? Breastmilk and Environmental Toxins appeared first on Medika Life.