AdSense? A Readers Poll
A couple of Nashville bloggers have posted about AdSense recently (see
Just Another Pretty Farce and 2 Retire at 50). I've considered adding
AdSense to this blog, but wonder how my readers will react. Does the
clutter bother you? Would you ever click on an ad? Do you think ads
diminish the value of the content? Although any extra income is
welcome, I'm hesitant to do it because of the lack of content control.
For example, I'm not really interested in having ads for plastic
surgeons show up when I'm talking about how ridiculous I think
labioplasty or hymen reattachment can be. I would appreciate your
thoughts in the comments.
posted by Rachel at 4/01/2006 4 comments links to this post
More Midwifery and Birth-Related Blogs
The blogger from Milliner's Dream kindly pointed me to her and other
blogs I missed in my recent roundup of midwifery and doula blogs. Her
site has a great new post, "Birth Conversations: A Doula's Version of
the Vagina Monologues, which highlights some of the different
treatment of women she has witnessed in attending births in home and
hospital settings. Among the most shocking:
"Nurse in hospital (on her knees, crying): 'Please, please, I'm
begging you please get an epidural...it's hurting my heart to watch
you suffer...'"
"Nurse in hospital: 'If your doula gets our way, just so you know,
we'll send her out.'"
More blogs:
BirthYourWay
Holistic Doula Services
Lunacy (birth, knitting, etc.)
This Path
And another women's health-related blog: The Well-Timed Period
Technorati Tags: childbirth; doula; midwife; midwifery; midwives
MeSH Tags: Midwifery; Nurse Midwives; doula* [keyword search]
posted by Rachel at 4/01/2006 1 comments links to this post
One More C-Section Post
The journal Obstetrics and Gynecology has an editorial on c-sections
in the April issue, entitled, "Can a 29% Cesarean Delivery Rate
Possibly Be Justified?" by USCD Professor of Reproductive Medicine Dr.
Robert Resnik. Free full-text is not available, but here are a few
samples of Resnik's commentary:
"The abandonment of vaginal breech delivery, concerns about operative
vaginal delivery and shoulder dystocia, and waning enthusiasm for VBAC
all contributed to the unprecedented change in obstetric practice.
Obstetricians were justifiably unwilling to challenge the
zero-tolerance legal environment and public expectation for a perfect
outcome every time, and cesarean delivery seemed to be the answer."
"Moreover, although difficult operative vaginal deliveries may be
associated with fetal intracranial trauma, the procedure and
complications are rare, reliable long-term follow-up data are hard to
find, and most children do not sustain permanent injury. The same may
be said for shoulder dystocia; it has been estimated that several
hundred cesarean deliveries would be required to prevent one case of
persistent brachial plexus injury."
"What about the maternal benefits of cesarean delivery? There is
little argument that vaginal delivery is associated with a higher
frequency of subsequent stress urinary incontinence and uterine and
vaginal prolapse. However, it is also clear that nulliparous women and
those who have had only cesarean delivery may also be symptomatic,
suggesting that the aging process, pregnancy per se, genetic factors,
and just walking upright for more than 50 years are significant
contributors to the problem. Also, although prevalence figures vary
widely, some studies suggest that the risk of symptomatic pelvic floor
dysfunction occurs in less than 50% of parous women and that only 11%
of women require surgery."
"What about the maternal benefits of cesarean delivery? There is
little argument that vaginal delivery is associated with a higher
frequency of subsequent stress urinary incontinence and uterine and
vaginal prolapse. However, it is also clear that nulliparous women
[Note: nulliparous=women who have not had children] and those who have
had only cesarean delivery may also be symptomatic, suggesting that
the aging process, pregnancy per se, genetic factors, and just walking
upright for more than 50 years are significant contributors to the
problem. Also, although prevalence figures vary widely, some studies
suggest that the risk of symptomatic pelvic floor dysfunction occurs
in less than 50% of parous women and that only 11% of women require
surgery."
Based on this commentary and responses to the NIH conference, it seems
that there is much disagreement over appropriate use of c-section, and
confusing or absent evidence regarding the topic. Why so much
confusion over a major abdominal procedure? Resnik hits some of the
high points - fear of malpractice, changing attitudes, expectations of
perfect/easy deliveries every time. In the meantime, women are left
with little recourse but to work closely with their birth attendants,
try to understand the factors affecting their individual births, and
to insist on an evidence-based rationale for their care. It's
confusing out there - good luck.
Technorati Tags: c-section; cesarean section; elective surgery
MeSH Tags: Cesarean Section/trends OR /utilization; Surgical
Procedures, Elective
posted by Rachel at 4/01/2006 0 comments links to this post
Coverage of the NIH Conference on Elective Cesarean
The American College of Nurse Midwives issued this press release, and
urges balanced coverage of the conference and appropriate attention to
the lack of evidence in this area.
Media Coverage:
Panel asks women to weigh pros and cons of c-section - USA Today
No clear advice on elective c-sections - AP
C-section births gaining popularity - Morning Edition, NPR
NIH panel says insufficient data available to weigh benefits, risk
of elective c-section - Kaisernetwork.org
Special deliveries: are doctors performing too many c-sections? -
Newsweek
Jury still out on c-sections on demand - ABC news
NIH panel finds no additional risk in cesarean section - Washington
Post, with a headline that seems contradictory to the story's
statement that, "Overall, the panel found that current scientific
evidence is insufficient to recommend performing or not performing
Caesareans on demand, saying the available studies suggest both risks
and benefits."
Expert panel stumped by elective cesarean delivery question -
MedPage Today
Lamaze International disputes recommendations on elective cesarean
surgery: NIH research fails to address long-term outcomes and harmful
obstetric practices during birth - Lamaze International
C-section controversy - Salon's Broadsheet
Related: DailyNightly, the blog that accompanies NBC's Nightly News,
has a thread going on pregnancy discrimination in the workplace, and
has an accompanying story, When being a mom means losing your job.
Previous related posts:
Update on NIH Elective Cesarean Conference (3/29)
Update from Childbirth Connection (3/29)
Efforts to Reduce Unnecessary C-Sections (3/25)
NIH to Hold Conference on Elective Cesarean (3/16)
Technorati Tags: c-section; cesarean section; elective surgery
MeSH Tags: Cesarean Section/trends OR /utilization; Surgical
Procedures, Elective
posted by Rachel at 4/01/2006 0 comments links to this post
April Fool's
Malcolm from Materni-Tee sent me the link to the Materni-Tee CafePress
store after seeing my previous post, Belly Ads and Sponsored Birth.
For everyone's least favorite holiday, they're offering a selection of
April Fool's Day shirts, including shirts that say "Knocked Up" on the
front and "April Fool" on the back, and "I'm Pregnant" and "I'm
Joking." My husband doesn't think this is funny at all. :)
One suggestion for Materni-Tee: offer matenity-cut shirts, instead of
just regular cut. I'm just saying.
Technorati Tags: April Fool's Day; pregnancy; t-shirts
MeSH Tags: Clothing; Pregnancy; Wit and Humor
posted by Rachel at 4/01/2006 2 comments links to this post
Health Disparities in Infertility Treatment
The April issue of the journal Fertility and Sterility has a special
section on disparities in infertility treatment, which looks at
barriers to care, disparities in treatment-seeking, the impact of
insurance, socioeconomic and racial disparities, and related issues. I
thought it was interesting that the authors chose to look at this
issue; when people talk about health disparities, it tends to be about
access to routine healthcare, cancer screening, preventive services,
nutrition, and other basic health needs - it doesn't tend to be about
issues that can be perceived as a luxury, that most people would not
consider a fundamental need. However, the editorial author states,
"...very few studies have looked at the prevalence and receipt of
infertility services by minority and low-income populations. In the
United States, the costs of infertility treatments are borne
primarily by couples, including an estimated 85% of the cost of
IVF. Emerging evidence also suggests that there might be variation
in treatment response to assisted reproductive technologies and
that causes of infertility might vary by racial or ethnic
group...nfertility-related disparities are likely to exist at
multiple levels. First, disparities in the likelihood of facing
infertility problems might be generated by disparities in age
patterns of childbearing, number of children desired, and lifetime
history of sexually transmitted infection acquisition and
treatment. Second, disparities by income and race or ethnicity
might exist in diagnosis (subfecund vs. sterile). Third,
disparities might be generated by differences in access to health
insurance with relevant benefits and income with which to purchase
treatment services. Fourth, disparities might exist in the types of
treatment available and in the response to and outcome of that
treatment."
One study in the set looked at barriers to infertility treatment for
Arab and African Americans in Detroit, and found income/economics to
be an important factor. Another survey-based piece in the issue looked
at socioeconomic and racial disparities, and again found income to be
an overriding factor, but also found racial differences in the causes
of infertility. Throughout the issue, the income factor arises over
and over as the main disparity in access to infertility treatment.
The question is, how important is this? Should anyone have access to
infertility treatment, regardless of income? Should resources be used
to address this issue when other disparities may have much broader
effect (such as lack of access to insurance or routine care)?
Understanding differing causes of infertility in different populations
may be important, but how does that relate to the importance of access
to treatment? Is the ability to bear children a basic healthcare need
and right, or is infertility treatment an elective luxury akin to
cosmetic surgery? I think this is a touchy issue, and would be
interested in your thoughts.
Technorati Tags: fertility; health disparities; infertility
MeSH Tags: Infertility; Reproductive Techniques, Assisted;
Socioeconomic Factors
posted by Rachel at 4/01/2006 0 comments links to this post
Global Unsafe Abortion Resources
An article from Reuters entitled "Desperate Kenyan women risk
last-resort abortions" covers the women's health consequences of
unsafe and illegal abortions in Kenya and other parts of Africa.
According to the article, "Across sub-Saharan Africa, more than 30,000
women die each year from unsafe abortions and many more suffer
lifelong consequences. In Africa, the rate of deaths from abortions is
one per 150 procedures, compared with one in 3,700 in rich countries,
according to the World Health Organization... Despite the dangers, a
recent study estimated that more than 300,000 abortions are carried
out in Kenya each year, and that the annual cost of treating the
resulting complications exceeds 90 million Kenyan shillings ($1.2
million)."
Until reading this article, I was not aware of the World Health
Organization's resources on this topic (such as this website), and
hadn't thought much about the problem. When most people think of
health problems in Africa, I'd wager they think of AIDS, vaccines,
water-borne disease, and hunger. This 2000 report (PDF), "Unsafe
Abortion: Global and regional estimates of the incidence of unsafe
abortion and associated mortality in 2000, 4th edition," attempts to
quantify the problem. In assessing unplanned pregnancy, it states:
It has been estimated that almost two in every five pregnancies
worldwide are unplanned-- the result of non-use of contraception or
of ineffective contraceptive use or method failure. The 1994 ICPD
Programme of Action emphasizes that expanding and improving family
planning services can help reduce unintended pregnancy and induced
abortion. However, family planning services are frequently unable
to meet the demand, or may be inaccessible or unaffordable, or
there may be a range of social barriers that prevent women and
couples from using them. Studies show that many married women in
developing countries do not have access to the contraceptive
methods they would prefer to use in order to space pregnancies or
limit family size. The situation is worse for unmarried women,
particularly adolescents, who rarely have access to reproductive
information and counselling, and are frequently excluded from
contraceptive services."
It also addresses how legal restrictions affect safety, reporting, "In
the case of Romania, for example, the number of abortion-related
deaths increased sharply after November 1966, when the government
tightened a previously liberal abortion law (Figure 2). The figure
rose from 20 to 100,000 live births in 1965 to almost 100 in 1974 and
150 in 1983.14 Abortions were legalized again in December 1989 and, by
the end of 1990, maternal deaths caused by abortion dropped to around
60 to 100,000 live births."
Table 2 of the report emphasizes the stark difference in mortality
rates for obstetric procedures between the United States and
developing countries. (Click to view a larger version)
The report goes on to analyze patterns of unsafe abortion and
mortality by age and region, and concludes, "Although the evidence
remains incomplete, there are increasing indications that both
incidence of unsafe abortion and resulting mortality are rising among
unmarried adolescent women in urban areas, particularly where abortion
is illegal and fertility regulation services are inadequate or
inappropriate. A variety of demographic and socioeconomic developments
- earlier menarche, rising age at marriage, and the influence of the
media - can contribute to increasing the likelihood of premarital
sexual activity and early pregnancy. Where information about
sexuality, safe sexual practices and contraception is either lacking
or of insufficient quality to respond to the needs of the young, there
are likely to be many unintended pregnancies, a proportion of which
will be terminated by safe or unsafe abortion. Young women may undergo
an unsafe abortion even when abortion is legally permitted, because of
lack of information and skills to make informed decisions and seek
assistance. Where abortion is strictly illegal, they have no other
option than to seek an unsafe abortion or continue the pregnancy -
with all the attendant social and educational consequences."
Related Resources: (from a pro-choice perspective, and addressing how
U.S. policy impacts global women's health)
Breaking the Silence: The Global Gag Rule's Impact on Unsafe
Abortion - Center for Reproductive Rights
Global Illegal Abortion and Preventing Unsafe Abortion - Planned
Parenthood
Opinion piece - Against the Gran: U.S. Abortion Policy from a Global
Perspective - Center for American Progress
Global Gag Rule - International Women's Health Coalition
Unsafe Abortion - Family Care International
Why the Global Gag Rule Undermines U.S. Foreign Policy and Harms
Women's Health and Access Denied- Population Action International
Issue in Focuse: Global Gag Rule - Feminist Majority Foundation
Technorati Tags: abortion; family planning; global gag rule; safety;
world health
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