Mmmm…and hmmm.

The house smells good. I’m baking pies.

I thought I’d give a brief update...I’m in the middle of midterms and not happy about it. I have one left this coming Tuesday but I also have an assignment that’s due on Monday that’s been annoying. I’m almost finished with it. I feel like I’m very behind though because of all the extra time I’m taking away from homework and reading to study for the exams.

Hopefully, after I get my last midterm finished, I can get back to a more normal schedule.

I have scheduling for next semester’s classes coming up on Tuesday. It’s online sign up and I have all the classes figured out that I’m going to take already. I’ll have four classes next semester totaling 13 hours towards my degree:

SPH MC831
Integrating Developmental Science and Public Health
Mon 6:00pm – 8:45pm

SPH EH708
Intro to Environmental Health
Tue 7:30pm – 8:45pm

SPH HS755
Organization and Delivery of Acute, Long-Term, and Community-Based Care
Wed 6:00pm – 8:45pm

SPH SB721
Intro to Behavioral and Social Science
Thu 6:00pm – 8:15pm

As you can see, they’re all eveing classes again. I don’t like it but I am getting a bit better used to it now. At the pace I’m going, and including the fact that I’m planning on taking summer courses, I hope to be finished with this degree my next Christmas (won’t that be a nice Christmas present?).

I have two very strong areas of interest in the public health field. The first is nutritional eduacation for pregnant women, both about their own nutritional needs and the needs of thier babies. The second is social support networks and community based groups for mothers, first time or other. I think that both are very important for the health and well being of moms and babies (well, basically everyone if you consider the phrase “if mother isn’t happy no one is”).

I’m looking towards getting a job after my degree in one of these two areas. For nutritional education, I”m looking at trying to get a placement in the WIC program here in MA. I’m also looking at Healthy Families which provides a trained home visitor who offers information and support on a voluntary basis to all first-time parents age 20 and under. I’m leaning more towards the nutritional education right now, but I think that either one or both would be beneficial for some of my future goals.

One of the things I’m looking seriously at doing after I get my masters, pay off debt while Kyle is in school, maybe have a baby or two, etc. is becoming a midwife. I’ve always been very interested in natural healing. When I was considering going to medical school, I seriously looked at osteopathic medicine instead of allopathic medicine because it has a tendency towards more natural forms of healing and looking at the body holistically instead of as diseased parts. I have since decided that I do not want to go to medical school for several reasons, but am still very much fascinated with natural healing like midwifery. I have a real issue with some of the practices that are still going on in the field of medicine as it pertains to mother and child health. In fact I just read a wonderful article for my health services class that was written in a newslettter put out by Citizens for Midwifery. The article pointed out several rather disturbing things that are going on in obstetric medicine and that I think have sharply tipped the balance for me to want to go into midwifery after paying back some of my debt or at the very least going to a midwife or birth center when I have my own children. Here’s a few examples that I found to be quite enlightening (and a bit angry) about OB hospital care:

The more technology and the more tests and procedures that can be performed (and billed for), the greatest the differential between costs to the hospital and what the hospital charges. IN other words, as care gets more complex, the costs increase but the porfit margin goes up even faster.

Hospitals compete for patients by marketing their services, and having the “latest technology” and services available around the clock is great for marketing. However, once a hospital has invested in the technology or must pay for specialized staff, there is a strong incentive to make as much use of the technology as possible, so that the fixed costs of having the technology or staff are offset by billing, For example, hospitals want to offer epidurals anesthesia, so must incur the costs of having and anesthesiologist available around the clock, creating an incetive for the hospital and the staff to encourage “every” laboring woman to have an epidural whether or not she wants one. This also holds true for OBs who purchase expensve ultrasound equipment for their offices; the way to make that equipment pay off is to perform, and bill for, as many ultrasounds as possible, whether or not there is any medical need for them.

Now I don’t know about you, but one of the things that we’re trying to work on is to reduce the cost of health care in order to be able to serve more people. At least that’s the goal of one of my classes that I’m taking and I think it’s a pretty good goal to have. I know that you can’t fix the rising patient cost of care without looking at several underlying problems, but it has been estimated that half of the money spent of health care annually is wasted and that part of it is wasted on unecessary care…like trying to get all women to get epidurals or other ‘minor’ things like that.

Here was another little fascinating tidbit that was in the article:

One way OBs can make more money…is to see more patients in the same amount of time. How to accompllish this? A planned c-section can be performed in 20 to 30 minutes, schedule conveniently around office hours. In contrast labor takes hours or days and is unpredictable. There is no question that planned c-sections are more porfitable for both the OB (they tend to get more reimbursement for a c-section than a vaginal delivery) and the hospital (more technology, drugs, lab work, etc. can all be billed for). In addition, scheduling c-sections makes it possible for the OB to have more patients, more births per month, more income per month….There is no justification for c-section rates over 10 to 15% but hte US C-section rate is 26.1%

All I got to say is wow. I had no idea that this was going on and I even shadowed in a hospital based OB clinic!

Oh it got even more interesting:

WHO (world health organization) recommends an induction rate of 10% or less, but i nthe Listening to Mothers Survey, induction was attempted 44% of the time (and worked more than 1/3 of the time). In addition to increasing the likelihood of fetal distress, inducing labor roughly doubles the chances of c-section for first time mothers.

and…

Continuous electronic fetal monitoring does not improve outcomes in either low risk or high risk births, but in the Listening to Mothers survey 93% of women had continuous EFM. Compared with intermittent listening, continuous EFM increases the likelihood of c-section and vaginal instrumental delivery.

Woah. Those are some not so nice numbers and percentages when you consider the outcomes that come from them. I had no idea that this was going on and I think that it should be stopped. We need to get the word out about these types of practices and let mothers know that they have options and that they don’t have to have all of these costly and invasive procedures. I would say go to a midwife if you can and watch your doctors like a hawk if you can’t.

Another interesting thing from the article is the list of fees and the fact that hospitals have closed nurse-midwife practices in their hospitals because they’re not big moneymakers.

Fees:
Home birth $2,300 – $5,000
Birth center $3,500 – $8,300
Hospital $4,300 – $16,000
C-section (includes 4-day hospital stay) $9,300 – $26,000

I have heard of some people taking these kinds of numbers to their insurance companies, when applicable, and arguing that the company would save a lot of money simply by letting them go to a midwife. People should not be in medicine to make money; that’s not what it’s supposed to be for. While the end of the article is not as “lay it on the line” as the rest of it, the section raises some key questions that I’ve been asking myself when it comes to mother and child health care:

Hospitals and OBs are making clinical and management decisions for economic reasons, which is neither honest nor good medical care. When a pregnant woman in labor goes to a hospital and is told she needs this procedure or that intervention, how is she to know if the treatment is actually being recommended for real medical reasons? Or for purely economic reasons? NO agency or government authority is asking any questions such as “Has the increase in c-sections resulted in better outcomes for mothers and babies?” There is an unspoken assumption that physicians’ decisions should not be questioned, so there is no regulation by disinterested parties. There is virtually no consumer pressure. There are no restraints on anti-competetive practices. There are no meaningful consumer protections. There is no accountability for the health and well-being of mothers and babies.

If there’s one thing that I’ve learned so far in my studies as a public health student, it’s that I have a duty to make sure that this type of thing no longer gets pushed under the rug. I beileve that God has put me in a very specific position as a SPH student and has led me towards concentrating in maternal and child health care. It’s not that I have a “soft spot” for this population, but that I think that something is broken and needs to be fixed. You could say that I have a compassion for moms and their babies, I have awareness of the problem and I want to be part of the solution.

I believe also that in order to start fixing these problems two things need to happen. First we all need to pay closer attention to what’s really going on, and second we need to be willing to come together as a community to work on it. The church is an interconnected body and here we are blinding ourselves to one of the most vulerable populations we have: moms and babies. If we don’t come together and produce a unified effort to give social and moral support to pregnant women and women who have given birth, how can we expect to be supported in return? If we are called to help the widows (many of whom might have been mothers like Naomi who lost all of her male support base) and the children, then we need to start doing it. One of the things I would like to personally do is start a women’s support group in my church that would include from infant to elder. We need to have cross-generational support if we want to produce a healthy community. Once we start small and strengthen our immediate community, we can expand to a larger and still larger communities. Before long, we’ll be doing what we’re called to do and that’s be constantly formed into the likeness of Christ.

I guess this really wasn’t a brief update. But I’ve been mulling over a lot of things while I’ve been steeped in homework and midterms. I do feel that this is the way the Lord is leading me and I’m very glad that I got rejected from medical school so that I could see just how deeply this problem runs. I am so thankful that he has guided Kyle and me here to MA even though it is so far away from any of our relatives. We have been blessed beyond measure with the new communities we have an opportunity to be involved with and with the very clear calling that each of us are receiving individually and as a couple.

4 thoughts on “Mmmm…and hmmm.”

  1. Freeze dry and ship me a pie. No gravy.

    Complete agreement on OBs making money decisions. My friend had her baby in July (day before Josiah’s birthday) and ended up having an emergency (so they say) c-section. Her baby was posterior, automatically making it a longer labor. The reason the dr gave her for the c/s was that her baby was too big for her. I know it is a possible scenario, but from my reading, the excuse is more common than the scenario. Her baby was 7lb9oz. She’s about my size. Personally, I think her dr got tired of waiting.

    Then, this girl in my educational psychology class Wednesday was talking about how she was induced a week before her due date with her baby, and saying the reason was that her baby was too big for her because she only gained 12 lbs and the baby was 5 (7? don’t remember exactly which she said). Right after that she said that her OB regularly induces a week or two before the due date because he’s so busy from so many patients. I wouldn’t even bother with a dr like that, it increases my own risks.

    With everything we’re having to deal with over Adam, can you imagine what would be hitting the fan if I had been induced instead of going into labor on my own?

    “When a pregnant woman in labor goes to a hospital and is told she needs this procedure or that intervention, how is she to know if the treatment is actually being recommended for real medical reasons?”
    That’s what I still have to deal with about Josiah’s birth. My water broke, ok. They checked for infection, none. I wasn’t in labor so they scared me into being induced, with the “you might have to have a c/s if you don’t have him in 24 hours” card. Arbitrary number. I just didn’t know as much then as I do now.

    From talking with a lot of natural birth moms, if there’s no infection – they generally have nothing to worry about. If they wanted to keep me in the hospital to keep an eye on it, fine, whatever. But until they show me an actual need for a c/s, they’re not coming anywhere near me for one.

    Hurry it up with that pie..

    Like

  2. Your anger concerns me.

    In the technology market early adopters of technology pay more than those who wait. In fact the premium that early adopters can be charged and for how long is determined even before the technology product is developed. This determines the return on investment (ROI) for those investing in the risky business of developing technology. This is true for computer, Ipods, phones, as well as medical equipment, tests and medications.

    In countries with socialized medicine the risk to develop medical technology is low because the medical system will integrate/buy technology at a rate equal to what they can tax for it. Besides lowering the risk to develop medical technology socialized medicine also lowers the ROI. As a consequence investment money will tend to go to other investments that will provide a greater ROI. The United States has as free and open market medical system as you find in the industrialized world. I like having all the medical choices at my income level. I support charities that bring choices to those that cannot afford them. I also support government efforts to bring up the level of basic health care choices especially for those concerning children.

    The efficient use and of any resource (people, supplies or facilities) in any for profit organization will have a positive effect on the bottom line for that organization. Even in not for profit organizations efficiency is encouraged. All other factors being equal, organizations that are more efficient compared to their completers or their alternatives survive. I admit this is Darwinism applied to social organizations so you may take issue with it but I believe there is enough evidence to support it. Organizations are made up of people, some motivated by greed admittedly but also some motivated by an altruistic sense of community. There is all the other motivations in-between both good and bad but most want their organization to survive. It is therefore inaccurate to characterize efficiency incentives as inherently bad or good.

    If you look at you statistics without with a predisposition that people in the medical field are more motivated in helping people that making money you might come up with some different reasons for them. For example 93% of women had continuous EFM and that practice increases the likelihood of c-section and vaginal instrumental delivery. EFM provides real-time risk information to the medical staff, which they use to assess the risk to the patents in the near term delivery procedure options. Risks are a funny human inventions dealing with consequences and probabilities, and all humans weigh them differently. It is true that without information people will tend to stay the course and do nothing and given risk information people will take a more active role in mitigating risks. Mitigating risks is a far cry for looking out for the money you can put in your pocket. You said you shadowed in a hospital base OB clinic. What were the motivations that you perceived?

    I would say you are beginning to get an awareness of the problem. Like most problems it is bigger than you realize at first nor is it black and white. Put yourself in other people shoes with love and you may see other aspects of the problem you have not considered. If you become a midwife you will offer an important choice to many women. It would be a good way to demonstrate your compassion for moms and their babies. I think it would be a mistake to do so to show your distain for the hospital medical system. Look closer with a different paradigm and you might find other choices to demonstrate your compassion.

    As a post script: Fourteen years ago, Judy’s water broke at 2AM. She went to the hospital and was put on EFM. After many hours of labor and some minor pain medication the delivery cease to progress so it was decide to induce. It continued to progress until near crowning where it was noted Julie was in distress because of inadequate opening in the pelvis. Judy went in for a c-section with the epidural. Julie was born at 2:00 PM. Just one persons story, someone with no regrets and happy to have had the choices.

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s