Medical Monday: Breaking News from the World of Obstetrics and Gynecology

Policy News 

People across the political spectrum continue to debate the merits of Brett Kavanaugh for the Supreme Court. Since we now know that the political and judicial systems play such a large role in the health care of women, we’d all best pay close attention to this debate. 

Drug Shortages. We did not used to have them. Now it is common place on routine drugs, even IV fluids. No slight to third world countries, but sometimes it feels like we are in a third world country. The FDA is forming a new task for to more critically and quickly investigate and solve this problem. 

Companies that make formula are multinational. The Trump administration is avowedly pro business and this is particularly evident in the international sphere where of late, this had unsavory consequences. In its zeal to unfetter corporate interests, The Trump administration has taken an anti breastfeeding stance. At present advertisements of formula is limited regionally in areas where it could be misused or hazardous. The Trump administration has desired to “ reopen” these markets, under the auspices of free trade, seemingly oblivious to the perils of selling formula  in places where literacy (ability to mix correctly) and clean water is unavailable . The entire medical and public health establishment has reacted, concerned that breastfeeding continue to be encouraged as the safe and superior method that it is. Many are pointing out that formula manufacturers have no place at the health policy table. This baby feeding battle resurfaced last year when Ecuador proposed a resolution to the WHO (World health organization)  to support breastfeeding. The Trump administration through the US delegation at the World Health Assembly, tried to water down the resolution. When this did not work they threatened Ecuador with a trade war. Can you say “evil empire” ? ACOG (American College of Obstetricians and Gynecologists) and AAP (American Academy of Pediatricians) have responded formally. 

Did you know as little as two months of breastfeeding reduces risk of SIDS ? 

Did you know breastfeeding reduces mom’s risk of breast and ovary cancer, heat disease, and endometriosis ? 

Did you know the US ranks 26th among industrialized countries in breastfeeding ? 

The Trump administration seems to want people off the ACA. They have reduced the “navigators” fund from 36 to 10 million per year. Navigators are those who help people enroll in the ACA. The Trump administration says private health insurance agent and brokers do a better job. Do private brokers and agents get a fee for this ? 

Medical News 

Abortion facts were highlighted by NBC this last week: 

Death by childbirth is 14 times greater than death by abortion. 

Banning abortion does not reduce its incidence. 

Free birth control reduces abortion rates. 

Before legal abortion, 5000 women per died through complications of illegal abortion. 

Depression is not the only feature of postpartum depression. A new review has highlighted the fact that anger is often a big component of post partum depression. 

Your microbiome is the population of microorganisms that you have on your body and in your gut. This is affected greatly by what you eat. In pregnant women this microbiome is passed to the baby. Thus, what pregnant women eat can influence the microbiome of their child, for better or for worse. Newer research in multiple fields are beginning to describe the role of a healthy microbiome to overall health. 

The US birth rate is at an all time low for the second year running. Some site child care expense, wanting to spend time with existing children and concerns about the economy as chief reasons to wait. Germany and Japan have addressed their falling birth rates by putting better child care policies in place. Falling birth rates are not necessarily a bad thing, as they are associated with greater savings and higher levels of educational attainment. It is certainly an oversimplified falsehood to think that a larger population means a better economy. 

Stay tuned for more interesting news from the world of Obstetrics and Gynecology this time next week on Medical Monday. 

Medical Monday: Breaking News from the World of Obstetrics and Gynecology

POLICY 

In the good news department, the Federal Government is working toward promoting “ interoperability” which means the ability to coordinate health information technology nationally. During the Obama era, the “Meaningful Use “ program helped doctors and hospitals adopt the EMR, or electronic medical record. This new phase is meant to help all those disparate systems to be able to interact with one another. This will make authorized data sharing easier. To this end the ONC, or Office of the National Coordinator for Health Information Technology is working with innovators by giving out APIs (application programming interfaces) to encourage the making of apps which health consumers can use to control the flow of their data. Patients can choose to share their data with consultants or even with researchers who might be able to use it. 

Last week a Federal Judge in Ohio blocked the defunding of Planned Parenthood in that State. This week the same thing has happened in Washington State. Judge Rice in Spokane argued that HHS (Health and Human Services) “ arbitrarily and capriciously” blocked the funding. 

A measure on Maternal Mortality is on the Senate table for a vote in May. The bill would provide for the formation of review committees in each state which would be charged with tracking pregnancy-related deaths and thereafter to help formulate recommendations. The bill would help standardize state efforts in this regard. 

Texas has become infamous for its horrendous and still increasing rates of maternal mortality. Sweeping cuts to the primary health care system for women were made in 2011 including the defunding of Planned Parenthood. However, now that this maternal mortality crisis has come to light, Texas has formulated the Healthy Texas Women program. Usage is increasing from 70k to about 120K clients per year between 2016 and  2017. 

The USPTF, US Preventive Services Task Force, has formally recommended that all caregivers screen patients of reproductive age for abuse. It appears that there is enough evidence to support this whereas a dearth of evidence has kept them from recommending the same for people past their reproductive years. 

MEDICAL NEWS 

ACOG ( American College of Obstetricians and Gynecologists) has come out with a new Committee Opinion Document on postpartum care recommendations for clinicians. It used to be that many clinicians requested on postpartum visit at 6 weeks postpartum. However now, they are calling for at least one early checkup before 3 weeks postpartum, and a second more comprehensive visit by 12 weeks postpartum. Those with complications may need even more. I think this a great step in the right direction since many complications are already brewing within the first week alone. We conduct routine postpartum visits at 2 and 6 weeks for patients with normal clinical courses. ACOG is calling this the “ fourth trimester” and indicates it is a fundamental shift in thinking about postpartum care. Now need to get insurance companies to get on board so that more extensive postpartum care can get covered. 

ACOG has now come out saying that not only should caregivers recommend influenza vaccine to pregnant women, it is recommending that they keep the vaccine in their offices for convenient and expeditious dispensation. 

Population is a tricky thing to understand. Many of our environmental troubles stem from overpopulation. In that light, diminishing birth rates are beneficial. however, negative birth rates adversely affects economies, tooled as they currently are, on infinite growth. New data shows Kansas has reached its lowest birth rate ever. Japan, too is facing similar challenges. Economists and demographic scientists far savvier than me must put all this into context. Suffice it to say the devil is in the details. Whether or not a declining birth rate is good news or bad news depends on where you are, your perspective and your endpoints. As a physician, I know fully half of all pregnancies are unplanned. All of my studies have indicated that with women’s reproductive autonomy comes fewer children, increased educational attainment, increased savings, increased employment and widely increased affluence. But does that affluence need to be as it is in the west, at the expense of the environment? And does our affluence in the west need to stay as it is? Can we keep what’s good of western affluence and get rid of the bad? 

More good news: the number of pre-teen mothers has plunged from 8500 in the year 2000 to 2200 in the year 2016. The largest decline is among African American pre-teens. 

In the common sense department, we have research on depression. A new study published in the Journal Child Development indicates that maternal depression affects the development of children. These changes are apparent through the use of various tests including tests of verbal aptitude. A mother’s depression, in turn, is linked to the level of emotional verbal, and educational support that she has. It really does take a village. Reach out! 

Stay tuned for morebreaking news from teh world of OBstetrics and Gynecology here next week on Medical Monday.