As a follow-up to the recent court decision ordering the FDA to allow Plan B to be marketed over-the-counter to women 17 years and older, the government has stated that it will not file an appeal.
In what was a several year battle to allow over-the-counter marketing of Plan B, this is a victory for women's rights advocates and general adolescent health as a whole. Teenagers are having intercourse. Plan B will give potential teen mothers the opportunity to avert an unplanned pregnancy should she have intercourse without contraception. Finally, we're dealing with reality and not just ideals.
Friday, April 24, 2009
Thursday, April 23, 2009
When Maternal-Request Cesarean May Indicate Fewer Choices For Women
Modern obstetrics has become infested with defensive-medicine driving much of our day-to-day practice. Not only has this made the specialty of ob/gyn less desireable amongst graduating medical students, but has undoubtedly raised the cost of doing medicine and ultimately the cost of managing what would otherwise be uncomplicated pregnancies.
In her essay, An Essay On The Factory Model of Childbirth, Obstetrician/gynecologist Lauren Plante addresses the contemporary phenomenon of the "perfect" pregancy outcome expectation and how this may have resulted in actually fewer childbirth choices for women who may have thought they were being liberated. She focuses on the larger scale issues of the healthcare industry and hospital-driven infrastructure/system changes that favor cesarean delivery, for instance.
Anectodally, I've observed some of the changes in management of obstetrical patients over the last several years. It is much more difficult to have a pregnancy vaginally and without intervention now-a-days. One last thing: in 1970, the cesearean rate was about 5%; in 2009 it is approaching 30%. Meanwhile, the rate of cerebral palsy, one of the most commonly cited complications we try to avoid by doing a cesarean, has not changed.
In her essay, An Essay On The Factory Model of Childbirth, Obstetrician/gynecologist Lauren Plante addresses the contemporary phenomenon of the "perfect" pregancy outcome expectation and how this may have resulted in actually fewer childbirth choices for women who may have thought they were being liberated. She focuses on the larger scale issues of the healthcare industry and hospital-driven infrastructure/system changes that favor cesarean delivery, for instance.
Anectodally, I've observed some of the changes in management of obstetrical patients over the last several years. It is much more difficult to have a pregnancy vaginally and without intervention now-a-days. One last thing: in 1970, the cesearean rate was about 5%; in 2009 it is approaching 30%. Meanwhile, the rate of cerebral palsy, one of the most commonly cited complications we try to avoid by doing a cesarean, has not changed.
Self-Breast Exams Still Beneficial
"Breast self-exam remains the top method of breast cancer detection among young and high-risk women, according to two single-center studies reported at the American Society of Breast Surgeons meeting in San Diego, Calif. "
"Breast self-exam fell out of favor after two large longitudinal studies from China and Britain revealed no mortality advantage."
"A recent Cochrane Review also showed no reduction in breast cancer mortality rates with self-examination but almost a doubling in negative breast biopsies. (See: Breast Self-Exam Gets Thumbs Down in Systematic Review) .
The American Cancer Society and National Cancer Institute have eliminated breast self-exam from recommendations for screening in the general population. And although the ACS still calls it optional, the goal of the exam is now to make women familiar with their "breast landscape" so they know what's normal for them."
Once again, there is evidence to support doing self-breast exams. This time though, it is in so-called high-risk women. If you have any first degree relatives with breast cancer or the genetic mutations BRCA1 and/or BRCA2, then you would fall into this category. I personally recommend that all women perform self-breast exams because it is easy and can familiarize women with their own breasts so that they know what is normal for them.
"Breast self-exam fell out of favor after two large longitudinal studies from China and Britain revealed no mortality advantage."
"A recent Cochrane Review also showed no reduction in breast cancer mortality rates with self-examination but almost a doubling in negative breast biopsies. (See: Breast Self-Exam Gets Thumbs Down in Systematic Review) .
The American Cancer Society and National Cancer Institute have eliminated breast self-exam from recommendations for screening in the general population. And although the ACS still calls it optional, the goal of the exam is now to make women familiar with their "breast landscape" so they know what's normal for them."
Once again, there is evidence to support doing self-breast exams. This time though, it is in so-called high-risk women. If you have any first degree relatives with breast cancer or the genetic mutations BRCA1 and/or BRCA2, then you would fall into this category. I personally recommend that all women perform self-breast exams because it is easy and can familiarize women with their own breasts so that they know what is normal for them.
More Evidence That Breastfeeding Is A Good Thing
As stated in a recent article on MedicineNet.com, "Women in their 60s who had breastfed for more than 12 months over their lifespan were nearly 10% less likely to develop cardiovascular disease, and significantly less likely to develop heart disease risk factors, such as high blood pressure, diabetes and high cholesterol, researchers report." This was based on an article in the May edition of Obstetrics & Gynecology.
We've known for many years that nursing is beneficial to the infant. Here is evidence that mom benefits as well. Keep up with nursing, moms!
We've known for many years that nursing is beneficial to the infant. Here is evidence that mom benefits as well. Keep up with nursing, moms!
Monday, April 20, 2009
Politics Prevented Earlier Release of Plan B
A recent report at MedPage revealed the influence that the last administration had on the public's access to medications. Highlighted in this instance was the FDA's delayed approval of over-the-counter Plan B, otherwise known as the "morning after" pill. Often misunderstood as an "abortion pill," Plan B is a method of emergency contraception that prevents pregnancy from occuring, optimally within 72 hours of unprotected intercourse. It is considered to be a safer medication with minor side effects.
Although it isn't intended to be a form of regular contraception by itself, it is considered an excellent option for women who unintentionally had unprotected intercourse. Keep this in mind, if you're ever in this position yourself.
Although it isn't intended to be a form of regular contraception by itself, it is considered an excellent option for women who unintentionally had unprotected intercourse. Keep this in mind, if you're ever in this position yourself.
Sunday, April 19, 2009
Cesarean Delivery On Maternal Request
A study recently published in the Green Journal (Obstet Gynecol 2009;113:812-6) examined the "prognosis" for women who have spontaneous labor and what implications for maternal request cesarean delivery there might be.
"The cesarean delivery rate hit a record high in the United States in 2006, when almost one third of all births (31.1%) were cesarean deliveries. This rate equates to a 50% increase in the past 10 years, and, although the decline in vaginal births after cesarean has contributed to an increase in repeat cesareans, the primary cesarean rate is on the rise as well. The reasons for these increases are many bu most recently included the controversial use of cesarean in response to maternal request.
There are no definitive estimates on the proportion of such maternal-request cesareans, but rates as high as 6% of all births in the United States have been described.
Our most important finding in women with normal term pregnancies and spontaneous labor is the extremely high rate of safe vaginal delivery regardless of parity.
That is, parturients need to be made aware of the excellent obstetrical prognosis that they forgo when choosing elective cesarean delivery."
We're in a medical era where celebrities have put cesarean-on-request on the general public's collective radar and physician litigation risk is at an all-time high. This seeming "perfect storm" has raised concern in the obstetrical community because as this study shows, there is much to be said for allowing labor in uncomplicated pregnancies. Maybe it pays to let mother nature do its thing.
"The cesarean delivery rate hit a record high in the United States in 2006, when almost one third of all births (31.1%) were cesarean deliveries. This rate equates to a 50% increase in the past 10 years, and, although the decline in vaginal births after cesarean has contributed to an increase in repeat cesareans, the primary cesarean rate is on the rise as well. The reasons for these increases are many bu most recently included the controversial use of cesarean in response to maternal request.
There are no definitive estimates on the proportion of such maternal-request cesareans, but rates as high as 6% of all births in the United States have been described.
Our most important finding in women with normal term pregnancies and spontaneous labor is the extremely high rate of safe vaginal delivery regardless of parity.
That is, parturients need to be made aware of the excellent obstetrical prognosis that they forgo when choosing elective cesarean delivery."
We're in a medical era where celebrities have put cesarean-on-request on the general public's collective radar and physician litigation risk is at an all-time high. This seeming "perfect storm" has raised concern in the obstetrical community because as this study shows, there is much to be said for allowing labor in uncomplicated pregnancies. Maybe it pays to let mother nature do its thing.
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