Thursday, August 5, 2010
And finally, it’s one thing we can think about, is working to make sure that our kids get a healthy start from the beginning, by promoting breastfeeding in our communities. (Applause.) One thing we do know is that babies that are breastfed are less likely to be obese as children, but 40 percent of African American babies are never breastfed at all, not even during the first weeks of their lives.
And we know this isn’t possible or practical for some moms, but we’ve got a WIC program that’s providing new support to low-income moms who want to try so that they get the support they need.
And under the new health care legislation, businesses will now have to accommodate mothers who want to continue breastfeeding once they get back to work. (Applause.) Now, the men, you may not understand how important that is. (Laughter.) But trust me, it’s important to have a place to go.
Breastfeeding has been linked with lower risk of obesity along with several other health factors.
Wednesday, August 4, 2010
A new patient comes to my office, a healthy middle-aged woman. The medical assistant has already documented her normal blood pressure. Of our allotted 15 minutes, I spend more than two-thirds talking with her.
I press into the remaining minutes, counseling about calcium, sunscreen, seat belts. I screen for depression, domestic violence. I remind her about flu shots and colonoscopies. I pull out brochures about healthy diet and exercise, and we talk about ways to squeeze in exercise during her sedentary job.
And then I compliment myself on a job well done. I’ve covered all the relevant screening topics. I’ve touched all the bases of preventative medicine for a healthy woman. And I’ve even managed to finish on time, so I won’t have to keep the next patient waiting.
But my patient has a quizzical look on her face. Is that all there is, she seems to be asking.
In fact, through our extensive discussion (and the initial blood pressure check), we have fulfilled all of the medical interventions that scientific evidence has validated as helpful for a healthy patient. But my patient is clearly dissatisfied. A doctor’s visit is not a doctor’s visit until a stethoscope has probed the inner rhythms of the heart, and a set of medical hands has palpated the belly. Research has shown that patients expect a physical exam.
But is there any research to show that a physical exam — in a healthy person — is of any benefit? Despite a long and storied tradition, a physical exam is more a habit than a clinically proven method of picking up disease in asymptomatic people. There is scant evidence to suggest that routinely listening to every healthy person’s lungs, or pressing on every normal person’s liver, will find a disease that wasn’t suggested by the patient’s history. For a healthy person, an “abnormal finding” on physical exam is more likely to be a false positive than a real sign of illness.
Moreover, a normal physical exam cannot reassure a patient that there is no disease lurking in the shadows.
But does the physical exam serve any other purpose? The doctor-patient relationship is fundamentally different from, say, the accountant-client relationship. The laying on of hands sets medical practitioners apart from their counterparts in the business world. Despite the inroads of evidence-based medicine, M.R.I.s, angiograms and PET scanners, there is clearly something special, perhaps even healing, about touch. There is a warmth of connection that supersedes anything intellectual, and that connection goes both ways in the doctor-patient relationship.
We only have a few minutes left to our visit, but I gesture her up to the exam table. I place my hand on her shoulder and slide my stethoscope over her ribs. As I listen to the thrum of airflow that I’m 99.9 percent sure is perfectly normal, I feel both of our bodies relax ever so slightly.
I ease the bell of the stethoscope around to her heart, and though I know that there is only a small chance that I will hear anything to indicate serious illness, the familiar rhythms are comforting to my ear. As I examine her abdomen, we continue to talk, but there is a perceptible shift in the tenor of our interaction.
The polite but businesslike nature of our initial conversation has melted. No matter how we’ve come to this room, to these postures, to this connection, we are now more intimate. Even if our initial conversation had been marked by frustration or anger, the timbre of our interaction would have softened. It is almost impossible to be annoyed or curt when skin is touching skin.
Perhaps that is the crux. Touch is inherently humanizing, and for a doctor-patient relationship to have meaning beyond that of a business interaction, there needs to be trust — on both ends. As has been proved in newborn nurseries, and intuited by most doctors, nurses and patients, one of the most basic ways to establish trust is to touch.
I cringe whenever our hospital administration refers to the doctors and nurses as “health care providers.” That term always makes me feel like a soft-drink dispenser at Burger King. I’m not a “provider”; I’m a person, a doctor. And my patient is not a “customer” or a “client.” We are not transacting business.
Which is why a doctor’s visit never feels complete without a physical exam. It is a crucial part of the doctor-patient relationship that cannot be underestimated. One doesn’t need a scientific study to prove that.
Dr. Danielle Ofri is an internist in New York City. Her newest book is “Medicine in Translation: Journeys With My Patients.”
Tuesday, August 3, 2010
Gisele thinks breastfeeding should be mandatory
The genetically blessed Gisele told Harper's Bazaar it was breast-feeding that helped her maintain her super-hot post-baby figure.
"Some people [in the United States] think they don't have to breastfeed, and I think 'Are you going to give chemical food to your child when they are so little?' I think there should be a worldwide law, in my opinion, that mothers should breastfeed their babies for six months."Although she claimed her eight-hour labor “didn’t hurt in the slightest,” Gisele prepared herself for the event by meditating and adhering to a strict exercise plan.
“You want to go into the most intense physical experience of your life unprepared? That doesn't make any sense to me. I was ready and I thought OK, let's get to work'. I wasn't expecting someone else to get the baby out of me … I did kung fu up until two weeks before Benjamin was born, and yoga three days a week.'Ah, so that’s how she did it! Approach your pregnancy with a drill-sergeant-like focus, and you, too, can model swimwear six weeks after giving birth.
After some backlash for the previous comments, this was posted on Gisele's blog:
Since Gisele became mother, the Top model has been outspoken when expressing her feelings about motherhood and life. In a recent interview for the September issue of Harper’s Bazaar UK, Gisele talked about the importance of breastfeeding in the first months of a child’s life. Now, Gisele writes first-hand on the impact caused by the comment.
My intention in making a comment about the importance of breastfeeding has nothing to do with the law. It comes from my passion and beliefs about children. Becoming a new mom has brought a lot of questions, I feel like I am in a constant search for answers on what might be the best for my child. It’s unfortunate that in an interview sometimes things can seem so black and white. I am sure if I would just be sitting talking about my experiences with other mothers, we would just be sharing opinions. I understand that everyone has their own experience and opinions and I am not here to judge. I believe that bringing a life into this world is the single most important thing a person can undertake and it can also be the most challenging. I think as mothers we are all just trying our best.
In respiratory distress syndrome, the tiny air sacs of the infant’s lungs do not fully open because of a lack of surface lubricant, making breathing difficult. It is one of the most common complications of late preterm deliveries, defined as those that take place after 34 weeks and before 37 weeks of gestation.
The risk of respiratory problems decreased with each additional week of pregnancy, the researchers also found.
Babies born after 36 weeks were only nine times as likely as full-term babies to develop the syndrome, while those born at 37 weeks were at three times the risk. The study, published in The Journal of the American Medical Association last week, is one of the largest and most current to examine respiratory problems associated with late preterm births.
“The pulmonary system is the last system to develop in the fetus,” said Dr. Judith U. Hibbard of the University of Illinois and the paper’s lead author. “Obstetricians need to make every effort not to deliver a baby until 39 weeks unless there is a good medical reason.”
Researchers at the University of California, Davis are studying the individual components of breastmilk to determine their specific functions. They have found that the sugars in human milk contain a specific microbe that helps line the intestinal walls of an infant and help ward off disease.
This particular strain of bacterium, a subspecies of Bifidobacterium longum, protects infants from others strains of bacteria that would make an infant ill. Humans do not naturally process the sugars, which make up about 21% of breastmilk, but the bacteria is specially designed to do just that.
They have also found that harmful bacteria will bind to the sugars in breastmilk and will then be flushed out of the baby's system as waste.
“Everything in milk costs the mother — she is literally dissolving her own tissues to make it,” said Dr. Bruce German, “Finding that [milk] selectively stimulates the growth of specific bacteria, which are in turn protective of the infant, let us see the genius of the strategy — mothers are recruiting another life-form to baby-sit their baby.”
The research also suggests what breastfeeding advocates have been striving toward for decades, that mother's milk could be extremely beneficial to premature babies. They also suggest it may be good for the elderly.
Dr. David Mills noted that each component of breastmilk may hold biological significance, updating the previous notion that some elements just pass through with no effect. His quote finishes the article: “So for God’s sake, please breast-feed.”
"Tuba City ...with about 500 births a year, could probably teach the rest of the country a few things about obstetrical care. But matching its success would require sweeping, fundamental changes in medical practice, like allowing midwives to handle more deliveries and removing the profit motive for performing surgery," the Times writes.
Doctors and midwives have salaried pay, stripping the incentive to cram more patients in and perform more unnecessary and costly procedures. The hospital receives its insurance coverage from the federal government and as such is more likely to opt for less expensive, and less invasive techniques. At least in terms of birth, those simple and inexpensive methods--massage, words of encouragement, staying at the woman's side for the entirety of labor, encouraging a woman to move, having a tub available in birthing rooms--return significantly better outcomes for the majority of women.
Read the full Times article here.
Monday, August 2, 2010
The Midwifery Modernization Act passed unanimously in the New York State Congress and received Gov. Patterson's signature.
The bill was quickly pushed through the New York State Assembly following the recent near demise of midwifery and homebirth in New York City. The previous piece of legislation concerning midwifery required certified midwives to have the written practice agreements (WPA) with an obstetrician in order to practice in the state. In New York City, the only OBs willing to enter into this agreement were to be found at St. Vincent's Hospital, which shut its doors this past March.
The Midwifery Modernization Act removes the need for a WPA, allowing midwives to practice independently as primary care providers. It recognizes them as the qualified care providers they are and not just as second rate specialists for a fringe movement.
Under the new law, midwives may continue to refer women to obstetricians, gynecologist, or physicians when necessary, but this is on a as-needed basis--just the same as your regular physician refers you to any other specialist. This is the standard of care in countries where midwifery care is the norm for pregnancy and birth related matters and has a record of being a safe and cost-effective means of care. In fact, under this model, countries such as The Netherlands, Sweden, and Norway have better maternal and fetal outcomes than the United States where only 1% of births are attended by midwives.
This is also a victory for mothers in New York who now have more options in deciding where and with whom to give birth, an option that should be available to all women without political barriers.
This article is not meant to scare any woman out of having an induction, or to judge anyone for having chosen to have one. Instead, this article is meant to be informative, and to urge women to educate themselves on the benefits and risks of non-medically indicated inductions in addition to other options and alternatives in childbirth. If your primary care provider is urging you to induce, make sure to ask him or her what indicators for needing an induction are present and what your options are. Make sure to inform yourself the risks and benefits of induction from more than one reliable source before making a decision. The following may be a useful place to start...
Read the rest of the article here.