OBOS has received funding to make blog entries available in Spanish. We hope to expand outreach efforts in the coming year.

Hoy, el Departamento de Salud y Servicios Humanos de los Estados Unidos anunció que va a adoptar las recomendaciones del Instituto de Medicina para los servicios de cuidado preventivo para las mujeres.  Esto garantizará que las mujeres tengan acceso a los siguientes servicios bajo los planes de seguro médico, sin tener un copago, aseguro, o deducible:

• consultas para la mujer
• estudios para detectar la diabetes gestacional
• pruebas de la VPH
• asesoramiento en enfermedades de transmisión sexual
• pruebas de detección y asesoramiento de la VIH
• métodos anticonceptivos y consejería
• apoyo para el período de lactancia, provisiones y asesoramiento
• detección y asesoramiento para la violencia domestica e interpersonal

Se espera que cobertura para estos servicios empiece el 1ro de agosto del 2012.

Hay una advertencia para algunas mujeres en cuanto al acceso a los anticonceptivos sin un copago—una estipulación según la cual, “Los planes de salud de grupo que son patrocinados por ciertos empleadores religiosos, y seguros médicos de grupo que están conectados con estos planes están eximidos del requerimiento de cubrir servicios de anticonceptivos.”

OBOS has received funding to make blog entries available in Spanish. We hope to expand outreach efforts in the coming year.

La semana pasada, el Centro para el Control y la Prevención de Enfermedades dio a conocer un reporte que muestra una baja tasa de amamantamiento en los Estados Unidos, así como la importancia de tener hospitales que asuman un papel positivo en animar y apoyar esta práctica. La información del reportaje viene de una encuesta nacional sobre prácticas y políticas de maternidad.

Los investigadores encontraron que aproximadamente el 90% de los hospitales reportan que proveen educación prenatal para el amamantamiento para enseñar técnicas para amamantar, pero menos de la mitad siguen el resto de las recomendaciones de Los Diez Pasos para Amamantar con Éxito, la lista de políticas y acciones requeridas para ser un hospital o un centro de natalidad adecuado para los recién nacidos. Solo alrededor del 3.5% de los hospitales implementan al menos 9 de las 10 prácticas, las cuales son consideradas como las causantes del aumento en la tasa del amamantamiento, gracias al apoyo que reciben las madres.

Entre los pasos menos seguidos están el tener una política modelo para el amamantamiento (14.4% lo hizo); limitar el uso de formula, agua, o suplementos de glucosa en bebes saludables y apropiadamente amamantados (21.5%); y proveer apoyo adecuado de amamantamiento para madres que están dando de lactar, cuando el hospital les da de alta (26.8%).

Para más información, vea aqui.

The event begins at 8 p.m. and will take place at the Learning Center A/B on the 3rd floor of The Cambridge Hospital, 1493 Cambridge Street. Hope to see some of you there!

Parts I and II of the freely available report describe the current state of midwifery around the world, while part III outlines goals for moving forward, including growing midwifery skills and increasing their numbers, enhancing midwifery education, ensuring that proper regulation is in place to keep women safe, encouraging action from professional associations, and more.  It also outlines “Bold Steps” to be taken by governments, regulatory bodies, schools/training associations, professional associations, and international partners and organizations in order to “maximize the impact of investments, improve mutual accountability and strengthen midwifery services.”

The report includes country profiles for 58 nations on the midwifery workforce, education, and regulation, health indicators such as maternal and neonatal mortality, and where women give birth. According to the report, these countries account for 91% of global maternal mortality and 82% of global neonatal mortality, despite representing only 58% of the the world’s births, and have only 17% of the world’s trained midwives, physicians and nurses.

The report is available in English, French and Spanish – on the “Main Report” page, just choose “Change language.”

Also, check out our previous post linking to the UNFPA report from the Strengthening Midwifery conference.

One concern has been that cheaper versions of the drug compounded by pharmacies would no longer be available to patients. The company making Makena, KV Pharmaceuticals, previously sent letters to compounding pharmacies instructing them to stop compounding the drug lest they run afowl of FDA regulations. The FDA has now issued a statement in response indicating that the agency:

does not intend to take enforcement action against pharmacies that compound hydroxyprogesterone caproate based on a valid prescription for an individually identified patient unless the compounded products are unsafe, of substandard quality, or are not being compounded in accordance with appropriate standards for compounding sterile products.

The FDA also says the letters send out by KV Pharmaceuticals to pharmacies are “not correct” when they suggest that the agency plans to take action against compounding pharmacies.

The Council for Responsible Genetics has created an online “Consumer Genetic Privacy Manual” to help people understand this relatively new technology and its implications, providing information for the public about the basic science of genetics, genetic discrimination (including existing nondiscrimination acts related to health insurance), current privacy concerns, gene-associated diseases, genetic tests, informed consent, and other issues. The material seems intended for a U.S. audience, and much of it is somewhat technical, but it may be a good starting point for individuals seeking to understand these issues.

For those interested in policy, Genome.gov has more information on genetic discrimination, including legislation, White House statements, and reports. For those who would like to learn more about genes and associated conditions, Genetics Home Reference is a good resource, and the Talking Glossary of Genetic Terms may be a useful reference for understanding and pronouncing the relevant terminology.

The report provides accounts of coerced and forced sterilization of HIV-positive women, negative attitudes from care providers, including pressure not to have children, and structural barriers to care.

The organizations had previously filed a case before the Inter-American Commission on Human Rights, an international human rights body, on behalf of a Chilean woman who was sterilized without her consent during a cesarean. More information on her story is provided here; she explains:

I was in the recovery room of the Hospital of Curicó when [the nurse] entered and… told me that I was sterilized… It was not my decision to end my fertility; they took it away from me.

Unfortunately her story is not uncommon. For more information, check out the full report.

Perhaps most likely to cause feminist double-takes was the following comment:

Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk.

New letters to the editor in the October 16 issue take on this comment (alongside other letter-writers who describe their perspectives on the Wax methods and conclusions). Susan Bewley et al respond:

Why does The Lancet perpetuate the misuse of language, irresponsible reporting, and paternalism that dog the home birth debate? “Women have the right to choose how and where to give birth, but they do not have the right to put their baby at risk:” what humbug! There is no risk-free birth. Life and parenting consist of complex choices and tradeoffs, preferably made with impartial information. “Rights-talk”…becomes a stick to beat “non-compliant” women.

They go on to ask, “Even if home birth was objectively inadvisable, what remedy is proposed-barring the familiar guilt trip and cultural misogyny?”

Another writer comments that if improvements in home birth safety is desired,

The most effective solution would be a call to action for professional organizations and health-care institutions to remedy the problems for both hospital and home births, although it is not as headline-catching as a solution that suggests that women’s informed decision making, and indeed their rights, be curtailed.

For more information about the problems with the Wax meta-analysis, see Planned home birth and neonatal death: Who do we believe?, a post by Science and Sensibility’s Amy Romano.

The authors of the paper, which consists of a review of 12 previous studies, acknowledged significant benefits associated with home birth: fewer maternal interventions, including epidurals, episiotomies and C-sections; and fewer cases of premature birth and low birth weight.

But the finding that made headlines was that planned home births led to a two-to-three-times higher risk of neonatal death than planned hospital deliveries among healthy, low-risk women.

Time reporter Catherine Elton notes that the study’s lead author Dr. Joseph Wax “cautions against alarm,” quoting him as stating: “Home birth is quite safe for the baby. But not as safe as a hospital birth.”

Below is an unpublished letter to the editor of Time coordinated by OBOS’s Judy Norsigian:

Catherine Elton’s recent article is a thoughtful analysis of the the fragmented and sometimes underground system of home birth care in the United States, and the reasons women access it in spite of these shortcomings. However, in her discussion of the recent high-profile meta-analysis showing a significantly higher neonatal death rate in home birth compared with hospital birth, Elton states that the meta-analysis included hundreds of thousands of births, but fails to make it clear that the researchers’ calculation of neonatal mortality risk was not based on hundreds of thousands of births…not by a long shot. For reasons that are unclear, the researchers excluded from their neonatal mortality analysis a study that included over a half-million births, leaving fewer than 10,000 planned home births in their calculations of newborn death rates. The large Dutch study that was excluded found identical, very low rates of newborn deaths in the first week of life in both the planned home birth and planned hospital birth groups, and these data come from much more reliable databases than the Washington study, which the meta-analysis researchers included and which Elton acknowledged was flawed. All reliable data on home birth midwifery in regulated and integrated systems like the Netherlands and Canada suggest that home birth is safe for the baby and associated with significant health benefits for the mother.

Sincerely,

Marjorie Greenfield MD, FACOG
Professor, Obstetrics and Gynecology
Division Director, General Obstetrics and Gynecology MacDonald Hospital for Women University
Hospitals Case Medical Center Case Western Reserve University School of Medicine, Cleveland Ohio

Mark Nichols, MD, FACOG, Professor, Chief of General Gynecology & Obstetrics, Oregon Health and
Science University

Elizabeth Allemann, MD, Family Physician, Columbia, MO

Lucy Candib, MD, Professor, Department of Family Medicine and Community Health, University of
Massachusetts Medical School, and Family Health Center of Worcester, MA.

Eugene Declercq, PhD, Professor of Maternal and Child Health, Boston University School
of Public Health Daniel Grossman, MD, FACOG Senior Associate, Ibis Reproductive Health

Michael C. Klein, MD, CCFP, FAAP (Neonatal-Perinatal), FCFP, ABFP, FCPS, Emeritus Professor
Family Practice & Pediatrics, University British Columbia, Sr. Scientist Emeritus, Child and Family
Research Institute, BC Children’s & Women’s Health Centre Vancouver, BC Canada

Michael C. Lu, MD, MPH, Associate Professor of Obstetrics, Gynecology and Public Health, UCLA (Los
Angeles, CA).

Lauren Plante, MD, MPH, FACOG, Associate Professor, Obstetrics & Gynecology, Thomas Jefferson
University (Philadelphia, PA)

Amy Romano, MSN, CNM Author, Science and Sensibility blog: www.scienceandsensibility.org/

Judith Rooks, CNM, MS, MPH, midwife and epidemiologist, Portland, OR

Sara G. Shields, M.D., M.S., FAAFP
Clinical Associate Professor of Family Medicine and Community Health University of Massachusetts
Family Health Center of Worcester, Worcester, MA 01610

Mark Sloan, MD, pediatrician and author of Birth Day: A Pediatrician Explores the Science, the History,
and the Wonder of Childbirth,

Naomi E. Stotland MD, FACOG
Associate Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences University of
California, San Francisco, San Francisco General Hospital

Cornelia van der Ziel, MD, FACOG, obstetrician, Harvard Vanguard Medical Associates, Cambridge,
MA

OBOS urges all readers to share this letter with maternity care providers who may not have had time to fully read or consider potential limitations of the Wax study.

First, some good resources for keeping up with product recalls in general:

• From the FDA: Recalls, Market Withdrawals, & Safety Alerts (you can sign up for email alerts)
• Recalls.gov: news about and links to recalls of food, medicines, cosmetics, and other consumer products (you can also sign up for alerts from various government agencies through this site)
• USDA: news on food-related recalls from the USDA’s Food Safety & Inspection Service
• FoodSafety.gov – food safety information and recall news
• Consumer Product Safety Commission – recall and product safety news (non-food items, like child, household, and recreational products)

If you have access to a mobile device, there are also apps for tracking recalls, such as these from the U.S. government.

Now, some egg recall-specific resources:

• URGENT Nationwide Egg Recall; Eggs in Their Shells May Put Consumers at Risk for Salmonella – main alert page from the FDA
• Also from the FDA: Salmonella Enteritidis Outbreak in Shell Eggs
• How can I tell if my eggs have been recalled? – a guide to finding the relevant carton codes, from the FDA, with a list of recalled brands and relevant dates
• Tips to Reduce Your Risk of Salmonella from Eggs – egg safety information from the CDC
• FoodSafety.gov: Eggs & Egg Products – basic overview and links to additional recall and egg safety information