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 NEWS

As reported last week, many States are starting to push back against the defunding of teen pregnancy prevention programs in their states. The latest such example is Minnesota, where in Hennepin County, HHS (Department of Health and Human Services) terminated a $214 million teen pregnancy prevention program. The grant had originally been obtained to last through 2020 and was cut as of 2018, and the suit filed asks that it be reinstated until 2020 again. Texas’ Teen Pregnancy Prevention Program is called Healthy Futures of Texas, and its Title X funds are slated to be cut. However, This organization and other Texas grant recipients are filing lawsuits to discontinue the termination of their grants. 

Title X is a federal grant program dedicated solely to providing funds for birth control and family planning. The Trump administration governs the awarding of such grant money. Of late, they have shifted their funding criteria to favor those organizations which promote abstinence rather than evidence based birth control. Several chapters of Planned Parenthood and the National Family Planning and Reproductive Health Association have filed suit against the Trump administration alleging that this strategy violates the mission statement of Title X. 

During the recent years of the Trump administration, the number of uninsured Americans rose by 4 million. These are those who slip through the cracks between the Affordable Care Act plans and private insurance, with a single income of $30,000 and a joint family income of about $61,000. The data comes from the Commonwealth Fund who warned that this trend is likely to continue. 

MEDICAL NEWS

We have known for some time now that women have been concerned about contraceptive access ever since Trump was elected. Long acting reversible contraceptives (LARCs) have been the strategy for many women. In one particular study out of UCLA David Geffen School of Medicine, uptake of LARCs nearly doubled in the two weeks following the election. 

All kinds of stereotypes exist about older people. Some have to do with sexual activity. A new study has shown that 40% of people ages 65-80 are sexually active, and of those, 73% are satisfied with their sex lives. In the subgroup of those with spouses or partners, a little over half are sexually active. Caregivers need to continue to bear all this in mind. 

ACOG (American College of Obstetricians and Gynecologists) recently held its annual meeting. One presenter there highlighted the medical benefits of vibrators, and called upon Gynecologists to identify patients who might benefit from them, and initiate discussions which normalize their use. 

ACOG president Dr. Hal Lawrence has termed the current health care climate a “battle” and “ one that is not going to end anytime soon”. They have called it a “fight to protect women’s health care”. The ACOG president has highlight the advocacy efforts of the organization this past year, along with like minded others, the “Gang of Six” consisting of  internists, pediatricians, family doctors, psychiatrists, ob/gyns, and osteopaths. 

Menopause. It is the cessation of ovarian function and all that results from that. We cease to ovulate and become infertile. Then our hormone production quits, and we may have symptoms of estrogen deprivation, like hot flashes and vaginal dryness. The average age of menopause is 51, but the range is considerable and it takes about two years to get completely through. A new study has highlighted a little know fact, that women with a poor diet, i.e. diets high in refined carbohydrates, get menopause much sooner than those with high quality diets, such as those with lots of whole foods and fish. 

The postpartum period or so called fourth trimester, is getting some much needed attention. A new study has illuminated the prevalence of perinatal depression. Turns out it affects 1 in 7 women. Indeed, a related study found that maternal suicide takes more women than hemorrhage and hypertensive disorders combined, and accounts for 1 in 5 postpartum deaths. The study has also shown that only about a fourth of postpartum moms suffering from depression get treatment. Both the US Preventive Services Task Force and ACOG recommend mental health screening during pregnancy. Pregnant moms take note: Your postpartum visit should cover mood, emotions, infant care, sexuality , contraception, sleep, and health maintenance, to name a few. 

The opioid crisis has brought many problems for pregnant women and their children. However, one such problem can go under the radar: Hepatitis C.The opioid epidemic is driving an increase in Hepatitis C among mothers and children and neither the screening protocols for mothers or infants has kept up. Hepatitis C is transmitted by blood, and thus by needles, and infrequently, from mother to child. There is no vaccine, but just recently, there is a fairly good treatment. 

Stay tuned for more news from the intense world of Obstetrics and Gynecology, here, next week, on Medical Monday. 

Medical Monday: Delayed Edition

Policy has marched on, despite my delay. Last week, the Graham Cassidy Bill to replace the Medicaid Expansion with State Block grants fell with a thud without even being brought to a vote. This is because it did not even have enough Republican support. 

Early in the week, the Secretary of the Department of Health and Human Services resigned amidst constroversy. He was criticized for his extensive use of taxpayer funded charter flights. He was, by those in the medical community, not considered to be a friend of health care. He was viewed as a political appointee there to tow the party line. 

Most recently, Senator Bernie Sanders has revealed that this administration has been giving consideration to cutting Medicare as well as Medicaid. Medicare is the Federal Health Insurance Program for the elderly and the disabled, which Medicaid is the health insurance program for the poorest sector. Democrats allege these cuts in health care for vulnerable populations would be used to finance tax cuts “for the rich”. 

Premium prices for those purchasing health insurance through the ACA will most assuredly increase. Some increases will be more than 50%. This increase in cost of insurance premiums is NOT based on any definite information of federal subsidies reductions. Instead it is based on the THREAT of reduced or eliminated subsidy payments. Uncertainty and instability from the Federal government is causing insurers to raise prices, and is causing in insurance commissioners to allow them to do so. All premiums for all insurance plans are likely to rise. 

Prescription drug prices are likely to rise. The FDA (Food and Drug Administration) Commissioner Dr. Scott Gottleib, has declared that these high prices are a public health concern. In response, he has indicated a commitment to “more efficient generic drug development, review and approval”. 

Such uncertainty means hospitals and insurers will be unable to predict their income. This is causing them to take conservative positions across the board. This has also resulted in the closure of many rural hospitals, and the closure of maternity units within otherwise operational hospitals. More than half of all rural counties to not have a a prenatal clinic or Ob care facility. 

As discussed previously, several states have taken matters into their own hands. A red state, Utah, is fielding a proposal to expand access to birth control for low income women. Utah State Representative Ward has cited patient autonomy and cost savings as the driving benefits behind the bill. 

The morning after pill, widely considered in medical circles to be utterly safe, is now being dispensed from vending machines on certain college campuses. 

Massachusetts is considering a bill ensuring the provision of free birth control. This bill required the input of the third party payers, the insurance companies, as well as reproductive health advocates. It is expected to pass. 

In medical news, I am happy to announce the official eradication of infant and maternal tetanus. This infection once killed 10,000 newborns per year in the Western hemisphere. This has been at least in part due to the successful vaccination program using DPT in the past, and TDAP more recently. 

TDAP stands for tetanus, diphtheria, and acellular pertussis. Pertussis, also known as whooping cough, is a bad nuisance for healthy adults. However, it can be fatal in infants. All pregnant women are encouraged to get a TDAP booster in the third trimester. This turns out to confer 90% pertussis protection to the newborn. However, only half of all pregnant women got the vaccine. 

Confirmed: hormone containing IUDs do not adversely impact breastfeeding. A new study confirms what we would already expect. We expect this because hormone containing IUDs do not send hormone into the greater circulation; only to the lining of the uterus itself.  This is also the reason why they do not confer systemic side effects. 

In the bad news department, the CDC (Centers for Disease Control) report that sexually transmitted diseases are at record highs, for a second year in a row. This includes Chlamydia, gonorrhea, and syphilis. This is attributed to budget cuts impacting screening and treatment clinics but also to better testing methods. Chladmydia is soaring in women, while syphilis is most prominently increasing in gay and bisexual men. 

Much needed increased attention is being paid to post partum depression. I attended a conference today where it was highlighted that depression in this case is really a misnomer. The most common presentation of postpartum depression is anger or anxiety. A new study highlights that post partum depression is 27-47 times more likely to recur in a patient who has had it once. Postpartum depression has good treatments. More awareness and aggressive screening in the early post partum period is our best defense. 

Now we are up to date ! Stay tuned for more exciting news from the world of Obstetrics and Gynecology , here, next week, on Medical Monday.

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

The Graham-Cassidy Bill leads the policy news this week. This is the GOP's last ditch attempt to repeal the ACA (Affordable Care Act). It has been simplified down to one key point : redistributing Federal funds for Medicaid expansion and insurance subsidies as State block grants. The bill was introduced by two GOP Senators, Lindsey Graham of South Carolina, and Bill Cassidy of Louisiana, and with support from others. 

During the week that the Graham Cassidy bill has been around, it has been scrutinized. The Kaiser Foundation has determined that the redistribution of funds in those plan would be quite unequal between States. Consider that different States expanded Medicaid more than others, and some did not expand it at all. What States would stand to have taken away would therefore vary. Overall Federal spending on health care would drop by more than 100 billion dollars between 2020-2026 under this plan. Many physician groups have also criticized the plan. Most notably, ACOG (the American College of Obstetricians and Gynecologists). Eleven Governors including some from the GOP have come out against the bill as well. 

It is unclear if there will be enough votes to pass this bill. More than 50 are needed. Toward the end of the week Senator John McCain has stated he will not support it, and that alone may doom it. Remember that Senator McCain was recently diagnosed with brain cancer this last year, and is therefore deeply involved in the health care world. 

The deadline to pass this bill is September 30th. But it will only be brought to the floor if it is determined beforehand that it will pass. This deadline is needed in part because insurance companies and insurance commissioners need to settle on rates which the commissioners will approve and that will keep the insurers solvent. 

The Iowa legislature voted to forego Federal Funding just so they could deny funding to Planned Parenthood. Now the Iowa Department of Health and Human Services is beginning a collection of data about the effects that this is having. They are trying to determine if defunding Planned Parenthood has reduced access to reproductive health services for Iowans. Seems bass ackward to me. 

In a interesting and positive turn, State Senator Ray Ward, a Republican out of Bountiful, Utah  has proposed a bill that would allow Utah Medicaid recipients to have a postpartum IUD placed while they are still at the hospital. This would bring the red state in line with all but 6 other states which lack this law. 

On to the medical news. 

How bad is the opioid crisis ? It is so bad that death from opioid overdoses is skewing our life expectancy gains statistics. 

Women and opioids are a special case. It turns out opioid addiction and sexual violence are closely linked. In these cases, police are seldom called due to the presence of the drugs and fear or retaliation. 

Speaking of drugs, ACOG has come out with a new Committee Opinion. In this latest document, they have stated clearly that pregnant and breastfeeding women should not use marijuana. 

In the this-makes-perfect-sense department, a new study out of Harvard has shown that adequate sleep and adequate support protect against postpartum depression. That said, even those with high levels of support can get postpartum depression. For example, Ivanka Trump has recently shared her story of postpartum depression. 

An insulin pump may give better control to pregnant diabetics than conventional prick and inject methods.We currently use insulin pumps in non-pregnant diabetics, but have not until now, seen evidence about their use in pregnancy. 

There was a recent Apple event with new product announcements. In it, mention was made of the Apple watch, and the app called Health Kit, and their potential for ultimately helping patients like diabetics. Fast forward only a few days later when I attended Stanford MedX conference. We heard from a young diabetic woman who solved her own problem. Using small cheap components and a little home built computer set up called raspberry pi, she combined a blood glucose sensor with some dosing software and an insulin pump to create her own “ artificial pancreas”. We heard her presentation as an example of what an empowered patient could do. Empowerment plays a huge role in healing. 

The opposite of empowerment is psychological trauma, with resultant PTSD. It turns out that this sort of thing significantly increases one’s risk of being diagnosed with lupus. Lupus is a serious autoimmune disorder characterized by inflammation of the joints and many other tissues. According to a study published in the Journal Arthritis and Rheumatology, trauma even without PTSD are than doubles the risk of getting the disease. Those with PTSD are three times more likely than their peers to get lupus. Nearly 55,000 women’s questionnaires were examined over a 24 year period. This news reinforces the already widespread advice that stress management is important. 

Stay tuned for more exciting news from the world of Obstetrics and Gynecology, next week, on Medical Monday. 

Medical Monday, Labor Day Version: Breaking News from the World of Obstetrics and Gynecology

The current administration continues to try to whittle away at the ACA (Affordable Care Act). This week, funding for the "advertising” for the ACA was cut. In particular, programs for health care enrollment were cut from 100 million to 10 million. 

At the same time, a bipartisan group of Governors has stepped up to craft and submit a proposal to stabilize existing insurance markets under the ACA. Their plan maintains several original ACA features, including the individual mandate, guaranteed subsidies payments, and funding to promote ACA enrollment. New features would include a 15 billion dollar fund to supplement the subsidies, as well as tax credits for insurance companies willing to enter markets with only one insurer. The bill also favors more State flexibility in the spending of their respective subsidies. 

The most interesting news in policy is the Love Ernst Bill, also known as the “Allowing Greater Access to Safe and Effective Contraception Act” . It has been introduced by two Senators and two Representatives, all Republican, and all women. They are  Congresswomen Barbara Comstock (R-VA) and Mia Love (R-UT), U.S. House of Representatives to Senators Joni Ernst (R-IA) and Cory Gardner's (R-CO), in case you want to give them a shout out. 

• It incentivizes oral contraceptives (OCPS) to be sold over the counter (OTC) in several ways. 1. It hastens the FDA approval process and waives the fees to do so. It would then provide for OTC OCPS for women 18 and older. 
• It has also repealed the ACA’s provisions on using health medical and flex savings accounts (FSAs) on OTC medications. 
• Finally it has repealed the ACA’s annual limits on flex contributions. 

This represents great progress in the national conversation, and I applaud these forward thinking brave Republican lawmakers. At the same time, I fully understand the position of ACOG, the American College of Obstetricians and Gynecologists, of which I am a card carrying member. ACOG does not support the Love Ernst Bill. That is not because it is wrong, but rather because it does not go far enough. 

ACOG has stated that the available evidence shows that cost is a significant barrier to contraception. They state that the ACA’s strategy of birth control without copay is therefore the best strategy. ACOG also objects to the artificial age restriction of 18, and rightly points to the need to continue to curb the teen pregnancy rate, especially among those under the age of 18. Finally ACOG supports the provision of all forms of birth control, not just the birth control pill. 

At the present time, the use of IUDs ( intrauterine devices) is on the upswing. The developers of IUDs have come out with more brands and more sizes to meet the current demand and the particular needs of those who have not yet borne children. Nonetheless IUD use in the US lags behind our cohorts globally at 8% prevalence, while Belgium,for example is at 20% and South Korea at 70%. 

Egypt’s government is taking steps which show understanding of the relationship of contraception to prosperity. The government would like to employ contraception to control overpopulation, which they consider a threat to national development. They are deploying 12,000 family planning advocates to 18 rural provinces to address conservative beliefs on the matter. Perhaps they can also visit the United States as well. 

It is once again time to highlight the significant prevalence of post partum mood disorders. Time with a new baby is hard. Moreover, immense hormone changes are not always well tolerated. A new study published in the Maternal and Child Health Journal has shown that 21% of new mothers who have post partum mood disorders do NOT tell their physician. 

It should not be surprising then that a 14 year study out of Ontario has revealed that suicide is one of the leading causes of death in the pregnant and recently pregnant women. The study revealed that 5 % of deaths in pregnancy or the first year of motherhood were due to suicide. The study shows a clear need for comprehensive prenatal and post natal care with assessment for mood disorders and suicide prevention included. 

Let us not forget that Houston after Hurricane Harvey is a medical disaster. Several hospitals were just lost, and many had to be evacuated for repairs.  Beyond that, ambulances could scarcely travel, and caregivers had trouble getting to work at all. Much of the floodwater is polluted and the water supply is unsafe. All this spells a second wave of potential disaster from the threat of infectious disease. 

Polycystic Ovarian syndrome (PCOS) is a actually a cluster of conditions that involve problem with ovulation (egg production) and with carbohydrate metabolism. It turns out that those with PCOS not only have trouble getting pregnant, they have a higher complication rates in pregnancy, especially for gestational diabetes. 

A new global study has shown that perhaps we should all be eating fewer carbohydrates. The PURE study, which was published in the Lancet and presented at the European Society of Cardiology, showed that people who eat a high quantity of carbohydrates have a 30% higher change of dying compared to those eating a low carb diet. 

And in the truly awesome department, we look to the FDA approval of Kymriah, a new therapy for childhood leukemia. This is not actually a drug, per se. It is a technique, whereby the patient’s own white cells are extracted, genetically modified to kill cancer cells, then re-injected to do their job. It is being called a “living drug”. It produces remission in 83 % of cases. 

Gentle readers, you have work to do. Keep giving feedback to your elected officials, and even to those exceptional ones outside your district. 

And consider doing what you can for the those affected by Hurricane Harvey. Click on the satellite photo of the hurricane to donate via the Red Cross. 

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

In policy news we find more of the same. Texas again figures prominently, so much so that I have decided to create a new category: Texas news. Texas is an unmitigated perinatal disaster and is an embarrassment to this country, particularly to its medical establishment. But make no mistake, if current trends in law and politics are any indication, women's healthcare in every state will be like Texas.

To wit: a new study through the Commonwealth Fund has shown that one quarter of working age Texas women still lack insurance of any kind. A significant percentage of those who are insured struggle to pay medical bills and admit to having skipped needed care because of cost. Texas did chose not to expand its Medicaid, and this is believed to be one of the causes for these phenomena.

Also in Texas, ordinary standard insurance does not cover abortion. A new bill passing the Texas House will require women to buy supplemental insurance coverage for this procedure. It also increases reporting on complications after abortion and on the incidence of minors receiving the procedure. 

Finally in the Texas news, the Texas physician Dr. Brett Giroir, a Pediatrician, has been nominated for assistant Secretary of Health at the Department of Health and Human Services. However, Democratic Senators have delayed his confirmation on concerns that he would not support women's health programs. And they wonder why Texas is in the state it's in.

The Trump administration has cut funding for the Texas Teen Pregnancy and Prevention Program. Now it proposes eliminating funding for all such programs across the country. Moreover the fundamental research for the Teen Pregnancy Prevention Project is situated at Texas A&M University and theses researchers have recently been notified that their funding has been cut.

In Texas, Planned Parenthood has been barred from receiving Medicaid reimbursement. As a result the number of comments coming in to the Center for Medicaid Services (CMS) have doubled from 9,000 per week to 18,000 per week. According to the Center for Public Policy Priorities this will remove healthcare access from 45,000 people.

In the good news department, a bipartisan group of high ranking Senators are trying to strengthen existing law regarding health care. They are recommending that the Federal government continue paying subsidies, and that all Americans enroll in coverage. They also recommend renewal of the Children’s Health Insurance Program. Even Senate Majority Leader Mitch McConnell has said that he would consider such a bipartisan effort to shore up subsidy payments to insurers to stabilize current insurance markets.

In the medical news, one is seven women experience anxiety or depression in the first year after giving birth. This remains vastly under-diagnosed untreated with only 15% of those affected seeking help. Obstetricians have been alerted to increase screening for these debilitating conditions. 

In other concerning news, the team suicide rate among girls has reached a 40 year high. This is according to a new report from the Centers for Disease Control and Prevention published this last week in the Morbidity and Mortality Weekly Report. As of 2015 it sits at about 5 per 100,000. 

Preterm birth has continued to be a significant perinatal problem and one that has been resistant to explanation and treatment. However, new research published in Obstetrics and Gynecology has indicated that sleep disorders may play a role in some cases. Data from over three million birth was studied, with conditions like apnea and insomnia being tied to preterm birth. 

New research indicates that risk of stroke is decreasing for men but not women. Stroke risk is related to the incidence of several medical conditions, including obesity, smoking, high blood pressure, diabetes, and high cholesterol. These conditions are on the rise among women. 

Physicians and patients, listen up: Physicians are doing a BAD Job at educating patients about marijuana use in pregnancy. Increasing State legalization has led many to believe marijuana is entirely safe under varied conditions. (Since when do we believe what politicians have to say about science and medical care ? ) This has not been substantiated. According to researchers at the University of Colorado in Denver, the data available is limited, and sometimes flawed. However, there is “ moderate evidence that the use of marijuana in pregnancy is associated with increased risk of reduced fetal growth, lower IQ scores in young children, adverse effects on a child's cognitive functioning and academic ability, an increase in attention problems” There may also be associations with low birth weight and preterm birth. Patients need to be honest with their caregivers, and caregivers have to help patients to meet their needs some other way than to use marijuana.

Stay tuned form more fascinating and important news from the word of Obstetrics and Gynecology, next week, on Medical Monday. 

Medical Monday: Medical Portion

Maternal mortality rates are once again in the headlines, although this time the focus is on Virginia and not Texas. Virginia has 38.2 point two deaths per 100,000 live births. The Virginia Medical Examiner's Office investigated, finding that, "Women who die pregnancy related deaths in Virginia more often die from not having health care than from hemorrhaging, cesarean section complications or other maladies linked to birth." Virginia is not isolated in this regard as the American College of Obstetricians and Gynecologists has reported that there has been a 26% increase in maternal mortality in the United States from the years 2000 to 2014.

In the good news department, we have evidence for a common sense phenomenon. Data reported this month in the Journal Birth has demonstrated that "Physical activity during and after pregnancy improves psychological well-being and may protect against postpartum depression”

A new report in the American Journal of Clinical Nutrition has found that women with gestational diabetes who consume a high proportion of refined grains may give birth to children with a higher risk of obesity by age 7.

A study was performed using a federal nutrition program and an Internet-based program for weight loss. Results on 371 women indicated that this Internet-based weight loss intervention helped women shed their baby weight, i.e.their postpartum pounds. This study was funded by the National Institutes of Health and was published in the Journal of the American Medical Association. 

More data has come in against the practice of water birth. The Arizona Department of Health has identified two cases of Legionnaire's disease which occurred in newborns following water birth.  In both these cases the babies had been born at home in hot tubs. The Department noted that tapwater is not sterile and that legionella bacteria can grow in plumbing systems. While ACOG supports water labor it does not support water birth, citing a lack of definitive evidence showing safety and benefit.

Breast-feeding has numerous benefits for the baby and some obvious ones from mom. However it is somewhat counterintuitive that breast feeding should protect a woman against heart attack and stroke. Nonetheless new study has shown that “ breast-feeding may help mothers lower the risk of heart attack and stroke even decades after giving birth".  Breast-feeding for any amount of time confers a 9% reduction in the risk of coronary artery disease and reduces risk of stroke by 8%.These findings are published in the Journal of the American Heart Association.

A report produced from the Population Reference Bureau calls attention to the difficulties that young women face. The report is called "Losing ground: Young women's well-being across generations in United States". It has quantitatively documented that women in the US are”…poorer than their mothers and grandmothers when they were young, more likely to commit suicide and to be shut out of high tech jobs .” It concludes that ”social and structural barriers continue to obstruct the advancement of female members of generation X and millennials."

In-line with the last report, it's been determined that" opioid related hospitalizations among women in the United States have increased far faster than among men between 2005 and 2014." This has been determined by looking at data from the US agency for healthcare research and quality. Such hospitalizations have risen by 75% during this time interval. 

Breast cancer is in the news. It turns out that a low dose of aspirin i.e. baby aspirin taken daily may reduce the risk of breast cancer in women who have type II diabetes. This is preliminary research published in the Journal of Women's Health.

The National Institutes of Health has recently reported good news regarding breast cancer. Apparently breast cancer rates have been steadily declining since 2005 at a rate of 1.8 % per year.

ACOG has maintained their position that women should be offered mammograms beginning at age 40. Thereafter they should be given every one or two years through a joint determination by the patient and her physician.

Stay tuned for more breaking news from the exciting world of Obstetrics and Gynecology next week on Medical Monday. 

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

After a season of crisis with the Zika virus, the director of the CDC, (Centers for Disease Control) Dr. Thomas Frieden, has stated that the Zika virus is not “ controllable with current technologies.”. He has also indicated that he believes Zika "will become endemic in this hemisphere.” He states a Zika vaccine is probably 2-3 years away. 

Delays in public funding to combat the Zika virus in Florida have motivated private and corporate donors to step up. Pfizer, contributed $4.1 million, and Community Health Charities and March of Dimes will contribute and fund raise. 

The CDC (Centers for Disease Control) and ACOG (The American College of Obstetricians and Gynecologists) have identified use of long acting lot reversible contraceptive, or LARCs, inserted in the immediate postpartum period as key in curbing unintended pregnancy. Happily, many states are changing Medicaid regulations to cover IUDs inserted immediately after delivery. LARCs are highly effective safe methods of birth control which require little in the way of maintenance or remembering on behalf of the patient. The complication rate is low but not zero. Complications that do exist are well described and manageable.

At my institution, we practice evidence-based medicine. Moreover, Obstetrics and Gynecology is a very highly studied and regulated field. Because of all of this, many of our practices for example on the labor unit our policy driven. For example, we permit and encourage laboring in water because the literature shows that has clear benefits and no known side effects.. Others have also advocated, In the absence of any supporting data, for birth in water as well mistakingly assuming that amniotic fluid is similar to water. Indeed, as regular water is irritating to your respiratory passageways, so it is as well to the respiratory passageways of a newborn. Based on this,we do not endorse water birth. Updated guidelines from ACOG indicate that the first stage of labor may take place in water but when it comes time to push women should get out.

American College of Obstetricians and Gynecologists sponsored a special briefing last week in Washington DC on the subject of us maternal mortality rates. United States overall maternal mortality rates are actually increasing in contradistinction to the rest of the world. They are increasing disproportionately among minority women particularly African American women.

A recent study by Harvard researcher Dr. Julie Silver indicates that female physicians are still chronically underrepresented as healthcare leaders. She indicates that this may contribute to the persistent salary gap that exists between male and female physicians.

While women and men are still not equal in many ways, equality has been gained in one category. The British Medical Journal recently presented research which indicated women are now drinking as much alcohol has men. The differences between men and women in three categories, any alcohol use, problematic alcohol use, and alcohol-related harms, are diminishing.

We have two items in the "We are already knew this” department. First, education and support may help women stick with breast-feeding. This groundbreaking research was supported by your tax dollars through the Department of Health and Human Services Agency for healthcare research and Quality through the US Preventive Services Task Force. Were we unwilling to provide education and support to potentially breast-feeding mothers before the dawn of this research conclusion? I think not.

Secondly, scintillating new conclusions published in the Journal Menopause indicate that women experiencing menopause symptoms may do better in a comfortable workplace. They break this down and indicate that the workplace should be comfortable. Moreover the patient’s boss should be supportive. Another victory for common sense and human decency !

In the possibly actionable department, a new study finds that good pain relief during labor may be associated with lower postpartum depression scores. An observational study presented at the annual meeting of the American Society of Anesthesiologists has found this result after evaluating 201 postpartum women. Studies of this nature are suggestive but not conclusive.

Here are a couple Halloween party food pictures that I promised. Have a happy and safe Halloween.