IOM recommends women’s services, for free

The Institute of Medicine issued a report this week that added eight preventive services for women to the provisions that will be provided free of charge under the Patient Protection and Affordable Care Act.

One noteworthy recommendation calls for free contraception and counseling on how to prevent unintended pregnancy.

In addition, pregnant women would be screened for gestational diabetes and new mothers would receive counseling and equipment to support them in efforts to breastfeed their babies.

The report "provides a road map for improving the health and well-being of women," said committee chair Linda Rosenstock, dean of the School of Public Health at the University of California at Los Angeles.  Each of the eight services "stands on a foundation of evidence supporting its effectiveness," she said.

The recommendations would fill "gaps" in care that bedevil women in the present system, the report said.

The seven additional recommendations are these:

  • contraceptive methods and counseling to prevent unintended pregnancies
  • screening for gestational diabetes
  • cervical cancer screening, including human papillomavirus testing, for women over 30
  • counseling on sexually transmitted infections
  • counseling and screening for HIVAIDS
  • lactation counseling and equipment to promote breast-feeding
  • screening and counseling to detect and prevent interpersonal and domestic violence
  • yearly well-woman preventive care visits to obtain recommended preventive services

“Carmaggedon” birth story?

My daughter Nora lives in Los Angeles, Cal., so I am aware that Angelenos are so dreading the shutdown of 10 miles of the I-405 expressway there for road work this weekend they have dubbed the event "Carmageddon."

Nora is going to walk or take buses as much as she can this weekend, and being from Chicago, she is comfortable with those activities. But many Angelenos are famously more car-bound than she is.

Carmageddon

Los Angeles commuter traffic

Crosstown airline flights between the suburbs of Long Beach and Burbank are sold out this weekend and the police department is asking celebrities to urge their Twitter followers to avoid the expressway and, indeed, to drive in the city as little as possible.

But Jenny Benjamin, writing in The Stir today, brings up an interesting and, to her and other expectant moms, urgent point: What happens if your baby decides to be born in L.A. this weekend?

Pregnant with twins, less than two weeks shy of her due date, a 30-minute drive away ("without traffic") from the hospital she carefully chose for its neonatal intensive care unit, Benjamin considers the possibility of an early labor and aks, "For the love of all things good and holy, what am I going to do?!?!"

Will her husband wind up delivering the twins (one of whom is in a transverse position) on the side of the road? Should she call an ambulance? "Ambulances aren't hovercrafts -- they're going to get stuck in the same traffic!" Benjamin notes.

Her doctor lives close to the hospital. "Good to know at least one of us will be able to get there," she writes.

"Aargh, it's times like this that I really wish that Segways had caught on!" Benjamin frets.

The best solution, she notes, is not to have the babies this weekend. "I have about as much control over that as I do the traffic," Benjamin writes. "Maybe I should see how much my husband knows about home birthing."

A closer look at birth malpractice cases

Everybody knows that obstetricians are one of the most-sued medical specialties, but nailing down the details on that truism can be difficult.

CRICO Strategies, an international firm that provides risk-management software to hospitals and insurances companies, last month released a "benchmarking report" on malpractice risks in obstetrics that helps fill out that sketchy picture.

The report looked at 800 obstetrics-related medical-liability suits filed between 2005 and 2009.

Families dealing with the death of a mother or child, a severely damaged infant, or some other effect of a childbirth gone awry most commonly charged "communication failures, judgment lapses, and faulty technique as the reasons behind their injuries and their malpractice cases," the report states.

Sixty-five percent of cases involved "high-severity injuries."

Across the board, about one in 1,000 births involves a "preventable adverse outcome," the report noted.

While those can occur throughout pregnancy and birth, most suits in the study concerned allegations that birth assistants had mismanaged labor and delivery, particularly the second stage of labor — the actual birth.

"Substandard clinical judgment" was the top complaint in the suits, accounting for 77 percent of claims. Most of the suits named an attending physician.

The most common reason for suing was "birth asphyxia," a potentially injurious lack of oxygen, which accounted for 27 percent of the suits, and the most common allegation was that of a "delay in treatment of fetal distress" (25 percent of claims involving small hospitals, 19 percent involving large ones).

Independence Day weekend 2011

We here in the United States will be celebrating the birth of our country on Monday, July 4 — a different kind of birth story from the one we usually consider at Birth Story.

Given the difficult times many Americans (and others) are now experiencing, Paul Simon's wistful "American Tune," performed here during a 1981 reunion concert with Art Garfunkel, seems to me a suitably reflective way to head into the holiday weekend.

The rousing anthems and the fireworks will still be there on the holiday itself. I hope it's a happy one for you.