“It’s not good to muck around with Mother Nature.”
its,” he said. “It’ll take a while before we make that complete transition. ACOG released the recommendations because the increasing rate of C-sections unnec- essarily places women at risk. There is a hazard to the mothers having repeat cesarean sections. We always want to do the best thing for our patients.”
ment reform might be necessary to re- duce cesareans nationwide. According to the Texas Health and Human Services Commission, Medicaid pays for about 54 percent of all Texas births and spends $2.2 billion annually on birth- and delivery-related services for mothers and babies through the first year of life.
Supporting patients According to ACOG’s recommendations, increasing women’s access to continuous labor and delivery support, either from hospital staff or a doula, also has been shown to reduce cesarean birth rates. “Given that there are no associated measurable harms, this resource is prob- ably underutilized,” ACOG states. According to the American Pregnancy Association (APA), a doula is a nonmedi- cal professional who provides emotional, physical, and informational support to a mother who is expecting, is in labor, or has recently given birth. The doula’s purpose is to help women have a safe, memorable, and empowering birthing experience, APA states. According to “Continuous Support for
Women During Childbirth,” a 2012 re- view published in The Cochrane Library, Issue 10, women with continuous labor support were more likely to have spon- taneous vaginal birth and less likely to have a cesarean or instrumental vaginal birth. When the support came from a doula, the authors of the study saw a 28-percent decrease in the risk of cesar- ean section and a 12-percent increase in the likelihood of a spontaneous birth.
44 TEXAS MEDICINE June 2014
To access the review, visit http://bit .ly/ChildBirthConnection. In Dr. Ortique’s experience, patients who have the professional support of a doula through labor are more likely to deliver vaginally. Because most health insurance plans do not cover the cost of doulas, she says it is often wealthier patients who hire doulas to provide sup- port during and after childbirth. “Our hospital has trained all delivery nurses to be doulas,” she said. However, she says, most delivery nurses have more than one patient at a time and are unable to provide continu- ous support. She says increased labor times will likely mean delivery nurses will be stretched more thinly. Still, she says, women in labor need support from a professional. “Partners are wonderful support, but they do not have the training to deter- mine what’s normal and what’s not,” Dr. Ortique said.
She says at 35 percent, cesarean rates
are clearly too high, but, she notes, not every woman can deliver vaginally. Dr. Ortique points out ACOG’s recommenda- tions are not guidelines until more data exist to support them. “They are recommendations. They have not been established as best prac- tices yet,” she said. “They do provide a safe framework for implementation of education and the establishment of protocols to safely reduce the primary C-section rate.” Dr. Jennings says a reduction in cesar- ean rates might not be immediate. “It’s sometimes hard to change hab-
CDC: Prescribe pediatric antibiotics with caution
Physician-prescribed antibiotics could be putting children at risk for a common bacterial infection, a new study shows. According to “Clostridium difficile In-
fection Among Children Across Diverse U.S. Geographic Locations,” a study by the Centers for Disease Control and Prevention (CDC) published March 3 in Pediatrics, the majority of pediatric C. difficile infections occur in children who recently took antibiotics prescribed in doctors’ offices for other conditions. The study shows 71 percent of the
cases of C. difficile, a bacterial infection that causes severe diarrhea and can be life-threatening, that occurred in chil- dren aged 1 to 17 years were commu- nity-associated, or not associated with a hospital stay.
In contrast, two-thirds of C. difficile infections in adults are associated with hospital stays, CDC says. Doctors prescribed antibiotics to 73
percent of the patients with communi- ty-associated infections during the 12 weeks before their illness, usually in an outpatient facility. Taking antibiotics is the most impor- tant risk factor for developing C. difficile infections for both adults and children, CDC says. When a person takes antibi- otics, beneficial bacteria that protect against infection can be altered or elimi- nated for several weeks, during which patients can catch C. difficile from con- taminated surfaces or from a health care professional’s hands, CDC says. According to the study, doctors pre-
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60