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

Policy News

The “Global Gag Rule” is a rule which prohibits international health care organizations from counseling about abortion lest they lose their aid money from the USA. More recently Title X funds are being withheld from groups in the US who perform abortion or mention it as a choice. Many feel this amounts to a domestic gag rule. However, the Trump administration is back peddling, saying it only relieves Title X recipient caregivers of the requirement to mention abortion as an option. These are two very different things. I wonder which is really the case. I wonder too, if this means the Title X grant givers will requests the medical records documenting patients' visits to see what caregivers and patients are discussing. ACOG (American College of Obstetricians and Gynecologists) has called this an “egregious intrusion” in the doctor patient relationship.  Analysts point out that, additionally, these new rules will give those “health clinics" which oppose abortion and birth control easier access to Title X funds.

Medical News 

The Chair of ACOG New York has produced a guide to the Gyn annual exam for the New York Times. In it, she has explained what to expect, including the holistic nature of the visit. Many people think of the annual Gyn exam as just a pap. However, it is wellness and preventive check that addresses the overall health of the patient. Pelvic exams are performed as indicated according to protocol. Patients are also reminded about what should not take place, such as more touching than is necessary. Patients are reassured that they are entitled to an explanation for everything that is done. 

Texas is starting to take the bull by the horns. Maternal mortality and morbidity in Texas has been egregious. Authorities are now honing in on the contributing factors, and devising strategies to address it. The Texas Medical association has drawn up a list of recommendations including statewide legislation to improve health care coverage for pregnancy women, to increase access to long acting reversible contraceptives (LARCS), and to increase the quality of record keeping on maternal complications. 

Tobacco smoke from a pregnant women damages the unborn baby’s lungs (among other things). New research indicates that vitamin C may mitigate this risk. The changes from smoking do not simply harm the baby in that time frame. In utero exposure to those chemicals induce changes in the baby's genes (epigenetic change) which may persist throughout life. 

SIDS (Sudden Infant Death Syndrome) has been a worry for some time. I remember when it was first defined. At that time, we had no clue about its cause. It remains incompletely understood. However we now understand that the odds of it are greatly reduced when the parents do not smoke, and also when the baby sleeps on their back. This knowledge has given rise to the “Back to Sleep” movement which promotes putting babies to sleep on their back. We have also since learn that avoidance of loose bedding and avoidance of co-sleeping is protective. This means newborns must not sleep in the same bed with parents, despite what may seem like convenience. Nonetheless, NPR has recently reported on the disconcerting trend of increasing co-sleeping. AAP the American Academy of Pediatrics has come out again against co-sleeping which iss highly the associated with an increased risk of sleep related deaths in babies under 4 months of age. 

The Institute of Clinical and Relational Science at UCSF (University of California San Francisco) has produced research indicating yoga may help incontinence and anxiety in older women. Findings were presented at the American Urological Association in San Francisco. 

Marijuana in pregnancy is again in the news, with yet more reports coming out about its disruption of fetal brain development. It is also linked to smaller birth weights and irritable behavior in infants. It is also linked to higher likelihood of still birth. And yet, 70% of Colorado dispensaries are recommending marijuana to pregnant women for nausea in pregnancy. Conflict of interest and flagrant irresponsibility, much ? 

Lung cancer in young women has now surpassed that in men. Lung cancer in men and women has decreased over the last two decades, however it is decreasing more rapidly in men. 

There is now good data that air pollution is related to infertility and preterm birth. A new study on the subject shows that the closure of oil and coal plants boosts fertility in nearby communities. 

There’s an app for that. Maybe. There are many apps pertaining to birth control. There may even be one that can help predict the risk of preeclampsia. However, before you go relying on one of these, Please check with your doctor about the validity of such an app. Quality varies, so buyer beware. 

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

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

Most of you know by now that the House narrowly approved the American Health Care Act (ACHA) by a vote of 217-213. No Democrats voted for the bill and 20 Republicans broke rank and voted against the bill. The bill's future is less certain in the Senate where it will almost certainly be modified. While this represents a legislative victory for the Trump administration it is by no means an indication that the bill is sure to pass.

A true estimate of what this bill would cost is lacking. On first glance there are some savings, but a lifecycle accounting by the Congressional Budget Office has yet to be done. For example, those that lose their insurance under this new bill will cost the government less for their insurance but perhaps more in the long run due to the uncovered care that they receive in emergency rooms.

What is this likely to mean to you? Certain people who have employer sponsored insurance could have lifetime limits on their coverage. Plans may be able to be purchased which exclude mental health or maternity care. The American Healthcare Act will cut off funding to Planned Parenthood. Planned Parenthood delivers reproductive health care and other services to 2.5 million people annually. Pre-existing conditions may come back into play. Rape and domestic violence are considered preexisting conditions and thus care for those problems may not be covered under the ACHA.

Aside from the ACHA, a new executive order allows organizations to avoid the contraceptive mandate currently in place through Obamacare. 

The legislative chair of the American College of Obstetrics and Gynecology Dr. Leah Kaufman has written that this new AHCA is a particular disaster for women, citing astronomical costs for insurance that would cover women’s concerns such as pregnancy or breast cancer. 

Trump has named Theresa Manning as deputy assistant secretary for population affairs for the Department of Health and Human services. Ms. Manning is a former anti-abortion lobbyist for the National Right to Life committee and opposed both abortion and birth control. She will be responsible for supervising the Title X program which administers contraception, paps and preventive health services for low income women. Manning is infamous for her statements that abortion causes breast cancer, and that contraception doesn’t work. 

In the medical news department, research presented at the CDC (Centers for Disease Control) indicated that babies exposed to opioids in the womb are more likely to be in need special education services. 

In the good news department, yoga appears to relieve menstrual cramps and PMS. A review analysis of 15 different studies reveals that a regular yoga practice is associated with reduced pain and PMS with periods. 

Unfortunately, troubling policy news dominated this week. But Science marches on. Stay tuned for more breaking news from the world of Obstetrics and Gynecology. And by all means, contact your elected officials with your views. 

Wellness Wednesday: Yoga

Yoga became popular when I was a child in the 1970s. Since then it has taken on more the luster of fad than fitness. Learn what the evidence says here. 

The Unexpected Benefit of Being the Worst Yogi in the Room | Greatist

This is a fantastic funny article from Greatist about beginning down the path of fitness.

" The Surprising Benefit About Being Bad at Yoga " 

I am always encouraging my patients who do not exercise to explore it. I tell them that what they do does not matter so much as just doing it. I ask them to start slowly, and to quit before they are overly tired. I have explained that their muscles, ligaments and joints need weeks to adjust to the new routine. 

Some people like to go three or four days a week for a hour or more. This can be appropriate for seasoned athletes, but for those still establishing a solid routine, I prefer 6 days a week of at least two or three different workouts, for only about 20-30 minutes. With this high of a weekly frequency, a habit can be established. With such a low duration, it won't be too hard. Nor will it be allowed to interfere with the daily schedule. In short, it should be sustainable. 

Here's a funny thing I hear at the office. " I can't go to the gym until I get in better shape. " This leads me back to the point of this article. When I was taught yoga back in my groovy Southern California high school , we were told to begin by observing and accepting our present state. In doing the poses, we were cautioned to listen to our body, and lean into them only insofar as it felt healthy. This was part of what is now called " mindfulness " or being " present". One of my best high school friends said it best : " Be here now." 

Yoga has never been about others. It is a gentle practice wherein we gain the physical skills of strength, stamina, relaxation and flexibility, and the mental skills of self calming and focus. Any exercise or sport can achieve similar goals but it must be a properly crafted regimen with a warm up, a cool down and sensible sequence. Those who are just beginning in fitness do best with some form of guidance. Ideally this is with a class and a teacher, but it can also take place with a DVD at home . That way the truly self conscious can get a taste of the benefits of yoga and similar workouts. 

I blogged about this article because I think it did a great job of showing the transformation from disliking exercise to loving it, something I wish all my patients could experience.