Tuesday, June 30, 2009

Reducing Stress During Pregnancy

Researchers from Imperial College in London want to raise awareness about stress during pregnancy.

According to Professor Vivette Glover, maternal stress and anxiety can alter the development of a baby's brain. In fact, the effects of stress during pregnancy can last many years, including into adolescence.

The stress hormone cortisol one way the fetus is affected by the mother's pregnancy anxiety. Usually the placenta protects the baby from the mother's cortisol by producing an enzyme that breaks the hormone down. When the mother is very stressed, the enzyme doesn't work as well and allows the cortisol through the placenta. Researchers suggest that the higher the level of cortisol in the womb, the lower the toddler's cognitive development or IQ at 1.5 years.

Cortisol and other stress hormones also affect labor itself, by affecting the naturally occuring hormone oxytocin that stimulates contractions!

If you see your glass as half empty and stress is getting to you during pregnancy, try these helpful hints:

1) Find a massage therapist trained in pregnancy massage ~ get a massage.

2) Make sure you are eating properly and getting 8-10 glasses of water each day.

3) Reduce the level of stressful activity in your life by saying "no", either to others or to yourself.

4) Have quiet time each day ~ listen to relaxing CDs that also have relaxation exercises on them. Meditate or take a yoga class.

5) Reach a good balance of sleep and exercise.

and finally, have a good support system ~ friends, family, your childbirth care team!

Monday, June 22, 2009

New York Subway Conductor Uses Skills From Childbirth Class

Not that this is a reason to attend childbirth class, but did you happen to read the news article about the NY subway conductor who assisted a mother in labor?

The emerging newborn slid right into her (the conductor's) hands.

A concerned by-stander kept the crowd down and away from the mother, who birthed her baby in about 7 minutes after her water broke.

Oh, and the mother was sitting on the seat of the subway - naturally using the upright and gravity positive position for birth!

You can read more here.

And see the interview with the conductor, here!

Wednesday, June 17, 2009

AMA Does Not Pass Profiling Resolution This Year

A previous blog (see Sunday 6/14) post here focused on Resolution 710 for the AMA Annual Meeting this week in Chicago. The following is from their Reports/Resolutions on their website:


Mr. Speaker, your Reference Committee recommends that
Resolutions 710 not be adopted.

Resolution 710 asks that our AMA ask its CPT Editorial Panel to investigate for data collection and report back at Annual 2010 meeting:

1) developing a modifier for the E&M codes to identify non-compliant patients and/or
2) develop an add-on code to E&M codes to identify non-compliant patients.

Your Reference Committee heard limited supportive testimony on Resolution 710. The author stated that the intent of this resolution is to identify non-compliant patients, especially as there is an increasing focus on physician performance and releasing of physician data. Testimony was empathetic to the difficulty in working with non-compliant patients, but expressed concerns in labeling patients and acknowledged a desire to be sensitive to the possible mental health issues of non-compliant patients.

Testimony provided by the CPT Editorial Board stated that the appropriate forum for addressing CPT issues is through the CPT Editorial Panel process, not the House of Delegates. In addition, while there are no codes that exist to identify someone as specifically non-compliant, there are existing modifiers to identify patients who do not comply. For example, Modifier 2P (Performance Measure Exclusion Modifier Due to Patient Reasons) is available to report non-compliant patients. The list of reasons for Modifier 2P include (1) “patient declined”, (2) “economic, social, or religious reasons”, and (3) “other patient reasons”.This modifier is intended to be used with performance measure Category II codes. CPT Category II Performance Measurement codes are intended to facilitate data collection about the quality of care rendered by coding certain services and test results that support nationally established performance measures and that have an evidence base as contributing to quality patient care. These codes describe clinical components that may be typically included in evaluation and management services or clinical services and, therefore, do not have a relative value associated with them. Given that there exists an appropriate avenue to code for non-compliant patients and that this issue should be directly addressed through the CPT Editorial Panel, your Reference Committee recommends that Resolution 710 not be adopted.
Is there any person or organization watching the AMA or ACOG regarding their policies especially toward expectant/new parents? Is there a system of checks and balances?

Tuesday, June 16, 2009

Sunday, June 14, 2009

AMA Promotes Physician Profiling of Consumers

Several posts ago, I mentioned that the actions of care providers in the US appeared to be taking away the rights of consumers of medical care ~ in that post particularly, birthing women.

During the week of June 14 - 20th, delegates at the Annual Meeting of the AMA will be voting on a Michigan resolution (Resolution 710) which proposes to develop CPT (billing) codes to identify and label “non-compliant” patients. Blaming some of the hostility on the economy and increasing co-pays, the authors of the resolution state that "the stress of dealing with ungrateful patients is adding to the stress of physicians leading to decreased physician satisfaction".

The resolution goes on to say that "increasing noncompliance with treatment can reflect negatively on physicians during black box audits by insurance companies and oversight governmental agencies".

Absent from Resolution 710 is any caveat for patient/client autonomy or any suggestion that the physician is the service provider and the patient/client is the consumer. This may have very serious implications for maternity care consumers as pregnancy is a condition of normalcy and health, not one of illness or crisis.

The following was excerpted from the International Cesarean Awareness Network's response to this Resolution:

A recent report by Childbirth Connection and The Milbank Memorial Fund, called “Evidence-Based Maternity Care: What It Is and What It Can Achieve,” shows that the state of maternity care in the U.S. is worrisome, driven largely by a failure of care providers to heed evidence-based care practices. For most women in the U.S., care practices that have been proven to make childbirth easier and safer are underused, and interventions that may increase risks to mothers and babies are routinely overused. The authors of the report point to the “perinatal paradox” of doing more, but accomplishing less.

The resolution proposed by the Michigan delegation of the AMA could threaten patient care and patient autonomy for several reasons:

• Billing codes that would categorize any disagreement and exercise of autonomy on the part of the patient as “non-compliance” “abuse” or “hostility” could create a pathway for insurance companies to deny coverage to patients

• Use of these labels fails to recognize patients as competent partners with physicians in their own care

• Tagging patients as “non-compliant” fails to recognize that there is not a “one size fits all” approach to care, that different opinions among physicians abound, and that patients are entitled to these very same differences of opinion

• Labeling patients as “non-compliant” may, in fact, be punitive, jeopardizing a patient’s ability to seek out other care providers.

If you believe in a Patient's Bill of Rights, please blog or use any social media to inform expectant parents about this tipping of the balance of ....power.

Thursday, June 11, 2009

Yeah, we are finalists in the BirthMatters VA contest!

Here is the YouTube version ~ vote for this one :)

Scooping a mouthful of breast!

In haunting YouTube again, I found a series of nice breastfeeding videos. How lucky we are to have this education literally at our fingertips!

HIPAA & Social Media

One of the newest and most exciting (but most unexplored) areas of the birth profession is the use of social media (Facebook, Twitter, Blogs, etc) to market your small business and getting the news out and into the hands of expectant parents and other professionals ~ whether you are a private practice pregnancy massage therapist, lactation consultant, childbirth educator, doula, nurse consultant or whatever.

And I say unexplored in regards to HIPAA, the Health Insurance Portability and Accountability Act of 1996. The Privacy Rule standards address the use and disclosure of individuals’ health information—called “protected health information” by organizations subject to the Privacy Rule — called “covered entities,” as well as standards for individuals' privacy rights to understand and control how their health information is used.

The Privacy Rule protects all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. The Privacy Rule calls this information "protected health information (PHI)."

“Individually identifiable health information” is information, including demographic data, that relates to:
the individual’s past, present or future physical or mental health or condition, the provision of health care to the individual, or the past, present, or future payment for the provision of health care to the individual,
and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual.13 Individually identifiable health information includes many common identifiers (e.g., name, address, birth date, Social Security Number). The Privacy Rule excludes from protected health information employment records that a covered entity maintains in its capacity as an employer and education and certain other records subject to, or defined in, the Family Educational Rights and Privacy Act, 20 U.S.C. §1232g.

Please be careful when FBing, Tweeting or Blogging about certain situations. If you need to check the stipulations of the HIPAA, go to http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html.

I will have more about this in my upcoming book on creating/marketing your birth business AND my presentation at the Lamaze Conference in Orlando!

Wednesday, June 10, 2009

Take Childbirth Class ~ Avoid Misinformation

American Baby Magazine editor Judith Nolte, a long time friend & supporter of childbirth education, speaks out on why she believes women are choosing not to attend childbirth education classes today and what that might mean long term.

Tuesday, June 09, 2009

Mass Media Childbirth vs. The Real Thing!

Lately, my world has been full of video trailers. Here is the latest one, a video I previewed the other night. The work was done by a childbirth anthropologist, Vicki Elson. Her DVD, Mass Media Childbirth vs. The Real Thing is very thought provoking. Let me know what you think!

Monday, June 08, 2009

OB Not Specialist In L & D

A colleague sent to me a link from an article that came out April 14 (close, but not a full moon then) extolling the benefits of walking during labor. The executive editor of Medpage Today wrote about the tremendous benefits of walking in labor ~ a significant shortened length of labor AND a reduced need for pain medication such as epidural anesthesia. There is even a colorful sidebar that was titled "Action Point": Explain to interested patients that this study suggests that an upright position may be an effective way to shorten the first stage of labor, but the authors note that women may seek several different positions as labor progresses."

Well, at least the word is getting out even though it took many of us 3 decades or more to see it printed where physicians could also see it.

But wait, there's more......

A Florida Chief of OB/GYN stated (and I quote): "The C-section rate is three times higher [than 20 years ago], yet babies are not healthier. It's not helping. I think it's because we are still generalists. We don't have doctors who specialize completely in labor and delivery. They would have more experience with every situation that can arise. They wouldn't resort to C-sections as fast."

All along I thought an OB was, in fact, the labor and birth specialist in the physician world.

What is he saying?

Is he saying that physicians don't know about normal birth?

Is he saying that midwives know more about normal birth?

Does anyone know what he is saying?


Saturday, June 06, 2009

A Video Double Header!

Third year nursing students created this amazing video about the "Fear of Childbirth". This should be shown in every childbirth education class ~ and at only 4 minutes and 14 seconds ~ why not????

Laboring With A Birthing Ball

This is a really nice view of how to use the Birthing Ball during labor.