women’s health

The High Cost Of Low Breastfeeding Rates

A new cost analysis of the long-term impacts of breastfeeding found that lower-than-recommended breastfeeding rates among U.S. mothers “may cause as many as 5,000 cases of breast cancer, nearly 54,000 cases of hypertension, and almost 14,000 heart attacks each year.” The study, led by a researcher at Harvard Medical School and published today in the journal Obstetrics & Gynecology also found that the economic toll associated with such “sub-optimal” breastfeeding practices reaches into the billions annually.

breastfeeding

The study’s lead author, Melissa Bartick, M.D., an assistant professor of internal medicine at Harvard Medical School and an internist at Cambridge Health Alliance says via email that the bottom line of the analysis is this: “Women need to be supported to be able to breastfeed each child for at least a year — their health, and our economy depend on it.” She adds: “The CDC has found that 60% of women do not even reach their personal breastfeeding goals. Now we know this has a real cost, with thousands of women suffering needless disease and premature death.”

(Bartick also happens to be founder of the “Ban The Bags” campaign, a pro-breastfeeding advocacy group working to stop the common hospital practice of handing over free infant formula samples, or gift bags, to new moms after they give birth.)

Here’s more detail on the breastfeeding study from the Cambridge Health Alliance news release:

The analysis used sophisticated models to compare the effect of current breastfeeding rates in a simulated group of nearly two million U.S. women who turned 15 in 2002. The authors modeled this cohort of women across their lifetimes and estimated cumulative costs. They then compared these results to what would be expected if 90% of the women followed medical recommendations to breastfeed each child for one year. Currently, only about 25% of US children are still breastfeeding at one year of age. Continue reading →

FILED UNDER: Medicine/Science, Money, Personal Health, breastfeeding, childbirth, women's health

May 23, 2013 | 12:15 PM | Rachel Zimmerman

Study: Common Surgery For Prolapse Fails Nearly 1 Out of 3 Women

We’ve written a lot about the scary complications associated with vaginal mesh, synthetic devices that are surgically implanted to treat women suffering from prolapse. This condition, which afflicts millions of women after childbirth or as they age, occurs when stretched or weakened pelvic-area tissues give way, allowing the bladder or other organs to sag or bulge into the vagina.

Now, adding to the mounting data on the potential risks of prolapse surgery in general, a new study in the Journal of the American Medical Association finds that a common surgical treatment for prolapse — one considered the “gold standard” involving abdominal surgery — fails nearly 1 out of 3 women.

So why does prolapse surgery matter? As the JAMA study authors note, nearly 1 in 4 woman have at least one pelvic floor condition and “more than 225,000 surgeries are performed annually in the United States for pelvic organ prolapse.” So, any woman considering this surgery should be aware of the “long-term risks of mesh or suture erosion.” Continue reading →

FILED UNDER: Personal Health, prolapse, surgery, vaginal mesh, women's health

May 9, 2013 | 4:38 PM | Rachel Zimmerman

Report: Many Mothers Say They’re Pressured To Have Birth Interventions

(Listening To Mothers III/Childbirth Connection)

It’s Mother’s Day Sunday — a time for high-calorie brunches and pastel-colored bath products — but an even better time to do some listening.

So, just in time, here’s a new report that does just that. “Listening to Mothers III,” produced by the nonprofit Childbirth Connection, is an in-depth look at women’s pregnancy and birth experiences that covers a huge range of topics, from pregnancy weight gain, breast-feeding and postpartum depression to use of pain medication during birth and paying for maternity care.

The report, the third of its kind, is based on online surveys of 2,400 women who gave birth to a single baby from July of 2011 through June of 2012 in a U.S. hospital. There’s a lot to digest here, but for anyone interested in birth, it’s worth spending time wading through the material.

(popularpatty/flickr)

Here, as highlighted by authors of the report, are some of the more salient findings:

–A quarter of women surveyed experienced three or more of five major medical procedures such as labor induction, drugs to speed labor, and cesarean section, while only one in eight women had none of these interventions.

–Unnecessary interventions — such as inducing labor for convenience or routine repeat cesareans — exposed women and their babies to avoidable risk.

–Most of the women could not correctly identify risks of labor induction or cesarean section, revealing problems with prenatal education.

–One in four who had these procedures reported experiencing pressure from a care provider to do so.

–Mothers expressed a high degree of trust in maternity care providers, with nearly half rating them as “completely trustworthy.”

Maureen Corry, Executive Director of New York-based Childbirth Connection, said in an interview that a perfect storm of forces — including pressure on women and complete trust in their provider — could lead to unwanted outcomes.

“The pressure to have an induction or c-section, a lack of awareness about the risks of those interventions and an unqualified trust in their health care providers is a potent combination that could result in women and their babies being exposed to unnecessary risk and receiving care that isn’t based upon the evidence,” Corry said. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, childbirth, mother's health, pregnancy, women's health

April 30, 2013 | 3:27 PM | Rachel Zimmerman

Pediatricians’ New Guidelines On Home Birth Rekindle Old Debate

Yesterday, the influential American Academy of Pediatrics issued, for the first time, a set of guidelines related to planned home births, a hotly debated practice (though not so much among women who do it) that has increased slightly in the past few years, mainly among highly educated white women.

(meme_mutation/flickr)

Specifically, the guidelines are on caring for infants born via planned delivery at home. The first line of the guidelines underscores the fact that the new statement is hardly radical:

The American Academy of Pediatrics concurs with the recent statement of the American College of Obstetricians and Gynecologists affirming that hospitals and birthing centers are the safest settings for birth in the United States while respecting the right of women to make a medically informed decision about delivery.

Time Healthland reiterates that the guidelines, published in the journal Pediatrics yesterday, are pretty straightforward, including these recommendations:

“…at least one person at the birth should be responsible for tending to the newborn infant; that person should also be trained in infant CPR. Medical equipment should be tested before the delivery. A phone line should be available; while you’re at it, check the weather forecast too, in case complications arise and a trip to the hospital is necessary. In case of emergency, have a plan to transfer the laboring mom to a hospital. And do all the stuff that nurses do in the hospital to brand-new babies: monitor their temperature and heart rates, keep them warm and cozy, administer vitamin K and heel-prick newborn screening tests that are sent to outside labs for processing, among other things.

Still, Time says:

More controversial is the academy’s advice that pediatricians endorse only midwives who are trained and cleared by the American Midwifery Certification Board. Midwives accredited by this board typically attend deliveries at hospitals and birthing centers. That position has upset certified professional midwives, who deliver the majority of babies born at home in this country but are accredited by a different body — the North American Registry of Midwives (NARM).

Robin Hutson, executive director of the nonprofit Foundation for the Advancement of Midwifery, based in Boston, says these guidelines are only useful if consumers also have access to data on the risks of giving birth in other settings. In a hospital, for instance, Hutson notes there’s a higher likelihood of infections, unnecessary use of medical interventions and prolonged separation of mother and baby which can deter breast-feeding. “No method of birth is risk free,” Hutson says.

One local doula told me that even though the statement is certainly not a full-blown endorsement of home birth, just the fact that the AAP put it out somehow offers the practice added legitimacy in mainstream circles.

Of course it’s also pragmatic for the AAP to acknowledge that all babies, regardless of where they’re born, deserve the same level of care, particularly since home birth has been undergoing a mini-resurgence. (It ticked up a bit after actress and home-birth advocate Ricki Lake gave birth in a bathtub and then produced the film, The Business of Being Born.)

As we reported in 2011:

After a 15-year decline, home births in the U.S. rose 20 percent between 2004-2008. Though the actual numbers remain tiny — out of about 4 million births, 28,357 happened at home in 2008 — the reversal of the long downward trend is notable. So are the demographics: much of the increase was driven by highly educated white women.

Continue reading →

FILED UNDER: Medicine/Science, Personal Health, home birth, pediatrics, women's health

April 23, 2013 | 10:19 AM |

Doctor: Possible Links Between Antidepressants, Pregnancy And Autism

By Dr. Adam Urato
Guest Contributor

On Friday, a new study was released in the British Medical Journal showing that antidepressant use during pregnancy is associated with autism in the exposed children. This is now the second study within the last two years showing this link and it adds to the accumulating evidence of potential harm associated with the use of antidepressants during pregnancy.

Adam Urato, M.D., a maternal-fetal medicine specialist says evidence is growing on the harms of taking antidepressants during pregnancy.

Adam Urato, M.D., a maternal-fetal medicine specialist says evidence is growing on the potential harms of taking antidepressants during pregnancy.

The study was a case-control study from Sweden, which was fairly large: it looked at 4,429 cases of autism spectrum disorder and compared these cases to 43,277 matched controls. The researchers found that antidepressant use during pregnancy, with either SSRIs or nonselective monoamine reuptake inhibitors (another type of antidepressant) was associated with an increased rate of autism spectrum disorders in the offspring. The odds ratio was high at 3.34, which roughly means that antidepressant use was associated with more than a tripling of risk of autism in the children.

The study concludes:

In utero exposure to both SSRIs and non-selective monoamine reuptake inhibitors (tricyclic antidepressants) was associated with an increased risk of autism spectrum disorders, particularly without intellectual disability. Whether this association is causal or reflects the risk of autism with severe depression during pregnancy requires further research. However, assuming causality, antidepressant use during pregnancy is unlikely to have contributed significantly towards the dramatic increase in observed prevalence of autism spectrum disorders as it explained less than 1% of cases.

These results do not surprise those of us who have been following the scientific studies in this area over the past two decades. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, antidepressants, autism, pregnancy, women's health

March 15, 2013 | 7:58 AM | Rachel Zimmerman

OB-GYNs: Beware Marketing Hype On Robotic Hysterectomy

The influential American College of Obstetricians and Gynecologists (ACOG) is warning women that despite an aggressive marketing campaign to promote pricey robotic surgery for hysterectomies, that approach may not be the best choice available for patients.

Citing a recent JAMA study that found robotic hysterectomies cost more but aren’t really better, ACOG president, James T. Breeden, MD, in a statement said it’s “important to separate the hype from reality” when considering this type of robotic surgery.

Here’s the full ACOG statement:

Many women today are hearing about the claimed advantages of robotic surgery for hysterectomy, thanks to widespread marketing and advertising. Robotic surgery is not the only or the best minimally invasive approach for hysterectomy. Nor is it the most cost-efficient. It is important to separate the marketing hype from the reality when considering the best surgical approach for hysterectomies.

The outcome of any surgery is directly associated with the surgeon’s skill. Highly skilled surgeons attain expertise through years of training and experience. Studies show there is a learning curve with new surgical technologies, during which there is an increased complication rate. Expertise with robotic hysterectomy is limited and varies widely among both hospitals and surgeons. While there may be some advantages to the use of robotics in complex hysterectomies, especially for cancer operations that require extensive surgery and removal of lymph nodes, studies have shown that adding this expensive technology for routine surgical care does not improve patient outcomes. Consequently, there is no good data proving that robotic hysterectomy is even as good as—let alone better—than existing, and far less costly, minimally invasive alternatives. Continue reading →

FILED UNDER: Medicine/Science, Money, Personal Health, hysterectomy, marketing, robotic surgery, women's health

March 2, 2013 | 11:24 AM | Rachel Zimmerman

FDA Approves New Pill To Alleviate Pain During Sex

As we’ve reported, about one-third of women in the U.S. say they experience pain during sex.

There a number of non-medical interventions that can help fix the problem, such as pelvic floor physical therapy, which we’ve also written about here. Still, for some, medication may be called for, so it looks like a positive development that the FDA earlier this week approved a new drug to alleviate the pain that many post-menopausal women experience during intercourse.

MedPage Today reports that the newly approved “selective estrogen receptor modulator (SERM)” called ospemifene (Osphena) is taken as an oral tablet and “targets vulvar and vaginal atrophy resulting from menopause, which is the underlying cause of dyspareunia, or pain during sex.” There are risks, however:

The treatment, however, will come with a boxed warning stating that it may thicken the uterine lining, with the concern that unusual bleeding may be a sign of endometrial cancer or a condition that can lead to it. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, menopause, pain during sex, sex, women's health

January 24, 2013 | 3:07 PM | Rachel Zimmerman

ACOG: Screen for Lesser-Known Abuse, ‘Contraception Sabotage’

According to the nation’s leading obstetricians and gynecologists, “reproductive and sexual coercion” — behavior intended to maintain power and control in a sexual relationship — is, sadly, not uncommon.

While homicide is one of the leading causes of death for pregnant women, The American College of Obstetricians and Gynecologists (ACOG) reports that many abused adolescent girls and women are also the subject of another, lesser-known form of abuse: “contraception sabotage,” the most common form of reproductive coercion.

In a just-released committee opinion ACOG notes that victims of such abuse have “male partners who intentionally sabotage their contraception, deliberately give them sexually transmitted infections, or force them into having unwanted pregnancies or abortions.” This type of “reproductive coercion” says ACOG, can even go as far as male partners “forcefully remove intrauterine devices (IUDs) and vaginal rings, poke holes in condoms, or destroy birth control pills.”

(zeevveez/flickr)

ACOG reports:

Sexual coercion includes a range of behavior that a partner may use related to sexual decision making to pressure or coerce a person to have sex without using physical force. This behavior includes repeatedly pressuring a partner to have sex, threatening to end a relationship if the person does not have sex, forcing sex without a condom or not allowing other prophylaxis use, intentionally exposing a partner to a sexually transmitted infection, including human immunodeficiency virus (HIV), or threatening retaliation if notified of a positive STI test result. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, contraception, domestic violence, women's health

January 8, 2013 | 12:01 PM | Rachel Zimmerman

CDC: Binge Drinking A Serious Problem Among Women, Girls

The CDC reports that binge drinking among women and girls is a dangerous, often under-recognized problem, with nearly 14 million U.S. women binge drinking about three times a month, consuming an average six drinks per “binge.”

According to the CDC news release:

…binge drinking puts women at increased risk for many health problems such as breast cancer, sexually transmitted diseases, heart disease, and unintended pregnancy. Pregnant women who binge drink expose a developing baby to high levels of alcohol, which can lead to fetal alcohol spectrum disorders and sudden infant death syndrome.

In addition, the report finds that about 1 in 8 women and 1 in 5 high school girls report binge drinking. Binge drinking was most common among women aged 18-34 and high school girls, whites and Hispanics, and women with household incomes of $75,000 or more. Half of all high school girls who drink alcohol report binge drinking.

Binge drinking is defined as consuming four or more drinks on an occasion for women and girls. Drinking too much, including binge drinking, causes about 23,000 deaths among women and girls in the United States each year.

FILED UNDER: Medicine/Science, Personal Health, adolescent health, binge drinking, CDC, public health, women's health

December 3, 2012 | 10:51 AM | Carey Goldberg

Pregnancy Prevention Progress: Easier Pills, Plan B At Teen Check-Ups

Birth control pills

This looks like quite a convergence. In a country where roughly half of conceptions are still accidental, we’ve just seen two significant steps toward helping women avoid unwanted pregnancy, both coming from groups of doctors who can rule on safety as well as urgent need.

On WBUR’s Cognoscenti, writer Judy Foreman posts here today:

Earlier this month, the American College of Obstetricians and Gynecologists, the country’s leading professional group for ob/gyn physicians, recommended that oral contraceptives — on the market for more than half a century now — finally be available over-the-counter.
It’s about time.

And also last week, the American Academy of Pediatrics recommended that doctors routinely counsel teenagers about emergency contraception — better known as Plan B or the morning-after pill — and prescribe it in advance, even if the teen is not sexually active. Currently, girls under 17 need prescriptions for the pills.

WBUR’s Here & Now discusses the issue here, and the segment elicited this cogent comment:

Well how about the boys? Isn’t it time we gave them a script for the morning-after-pill to give to their partners?

Readers? Interesting scenario, isn’t it? How might that dialogue in the steamed-up car go?