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Serve and Return: Deconstructing the Language of Maternal Mental Health

February 17th, 2011 by avatar

My professional curiosity lies in the power of language to limit, or liberate the lived experience of the childbearing woman—particularly those with perinatal mental health concerns.

Maternal Depression Can Undermine the Development of Young Children (2009) illustrates the positive strides being made to increase awareness of perinatal and postpartum mental health. This Harvard University working paper was a joint effort of the National Forum on Early Childhood Program Evaluation, and the National Scientific Council on the Developing Child, and published by the Center on the Developing Child at Harvard University.  As a psychologist, Ph.D. student in Transpersonal Psychology, birth doula, and mother managing the disease of major depression, I fully recognize that my personal experience influences my professional view.

Maternal Depression Can Undermine the Development of Young Children offers insights as to how childhood development experts view and describe maternal depression.  Increasing awareness of PPMAD (perinatal, postpartum mood/anxiety disorders) in all aspects of family care is crucial to making changes to prevent and treat it. However, the terminology used in the paper, and omission of the full spectrum of PPMAD demonstrate how casual use of language perpetuates stigma and stereotypes regarding maternal mental health.


Titles Are Important

The title, Maternal Depression Can Undermine the Development of Young Children reads, to me, as something I would hear on cable news, rather than a professional paper. Moreover, the term “maternal depression” is the primary descriptor used throughout the paper, rather than the more accurate “perinatal”, or even the somewhat outdated “postpartum” maternal depression.  Not using a puerperal adjective removes context of recent birth.  There is a difference.

“Because chronic and severe maternal depression has potentially far-reaching harmful effects on families and children, its widespread occurrence can undermine the future prosperity and well-being of society as a whole.” (p. 1)

Wow. Not only do depressed mothers hurt children; apparently we also have power to take down all of civilization!  I picture myself the ultimate evil villainess, “depressed mom” in my lair. In my never ending desire to undermine the future prosperity and well-being of society as a whole, I send out my far-reaching harmful effects to terrorize civilization in search for Zoloft. Children and family be damned! I have society to ruin.

The mental health of our mothers is a crucial component to healthy families and communities. But unless we unpack this kind of language, we perpetuate an unconscious belief that “mentally ill” mothers are dangerous mothers.


What is Maternal Depression?

“Characterized by a low mood and loss of interest in usually enjoyable activities, depressive symptoms include difficulty sleeping and concentrating, loss of appetite, feelings of worthlessness or guilt, and low energy. In the face of major clinical depression, the drive, energy and enjoyment needed to build and maintain positive family relationships recedes.”

Set within the prose of the article opinion, leaves symptoms in the realm of the murky. I hate to say it but for much of science, if it isn’t codified, it doesn’t exist.  If the reading audience is not medical professionals, all the more reason to be extremely clear with how medicine describes the disorder. Omitting the full DSM-IV-TR, or ICD 10 diagnostic criteria is a subtle invalidation.  It remains a “mood”/emotional/mental disorder. Furthermore, it is not an accurate representation of the actual diagnostic criteria.  There is no indication of time of onset, duration of symptoms, co-morbidities, symptoms of anxiety with depression, differential diagnosis, or how many symptoms need to present simultaneously to fit criteria.  (Go here for complete list of criteria.)

Prevalence and Effects
According to the authors, in the section subtitled: What Neuroscience and Developmental Research Tells Us, the majority of research on this subject is on maternal postpartum depression.  This is Harvard University. The power of that should not be diminished. When a group holding academic status defines something, we believe it, we repeat it to others.  Not having included all perinatal and postpartum mood/anxiety disorders (PPMAD) in the literature review missed the opportunity to recognize the research that has been done in PTSD after childbirth, and perinatal anxiety disorders.

Furthermore:

“About one in eleven infants will experience their mothers’ major depression in their first year of life”.

This wording suggests mothers doing something to the infant. It personalizes a medical condition. That the relation to the object for our attachment theory readers, WILL be negative. I doubt a public health paper would say, “About one in eleven infants will (powerful word) experience their mother’s diabetes in their first year of life”.

“When raised by a chronically depressed mother, children perform lower, on average, on cognitive, emotional, and behavioral assessments than children of non-depressed caregivers….such patterns forecast difficulties later in adult life across a variety of important domains”.

Some readers may find this language suggests that depressed mothers are bad mothers, and cannot take care of children. This is myth.  Depressed women are not inherently incapable women.  Depressed mothers are not inherently incapable mothers; they are suffering a medical condition that challenges some of their current capabilities but is also completely amenable to proper treatment. I would encourage readers to read my interview with Katherine Stone at www.givingbirthwithconfidence.org for an example of resiliency.

Ping Pong and Problematic Parenting
The Paper authors acknowledge the evidence-based, substantive data demonstrating a correlation between “maternal depression” and fetal, neonatal, and early childhood development.  They are spot on to bring this data to the forefront of child development. However, word choice is extremely important when approaching an issue that has a history of stereotyping, particularly when describing it to professionals who may not be familiar with the issue. The data cited in the Harvard paper:

  • Chronic depression can manifest itself in two types of problematic parenting patterns that disrupt the “serve and return” interaction essential for healthy brain development: hostile or intrusive, and disengaged or withdrawn.
  • Children who experience maternal depression early in life may experience lasting effects on their brain architecture and persistent disruptions of their stress response systems.
  • Maternal depression may begin to affect brain development in the fetus before birth.
  • Depression often occurs in the context of other family adversities, which makes it challenging to treat successfully.

And, while not in bold-face, authors use the serve and return metaphor throughout the paper:

“When caregivers are sensitive and responsive to young child’s signals, they provide an environment rich in serve and return experiences, like a good game of tennis, or Ping-Pong.”

Sports analogies for the intimate interaction between mother and child are at best not creative, at worst insulting.  Perhaps one of the flaws of working papers is the assumption that readers can’t intellectually handle the material, and in an attempt to be understood, unfortunate metaphors are employed.


Suggestions and “Other Serious Adversities”

Hidden in all of the rhetoric, however, is good data. Shuffled off  in footnotes, there are wonderful studies referenced that offer serious contributions to what we are learning about the effects of untreated maternal mood and anxiety disorders. It is a shame in a way, as the second half of the paper offers learning opportunities around looking at program evaluation, policy, and implications for the future. But one has to weed through this kind of language to find the fruits of knowledge. A few more examples for our discussion:

Authors examine outcomes of current programs addressing “maternal depression” and conclude important issues regarding prevention and early intervention. Prevention is key. Early intervention is incredibly important. Treatment is essential and challenging. Here is their interpretation:

Prevention:Given the potential negative consequences of depression for both mothers and their children, a variety of interventions have been designed to prevent and treat it as well as to buffer children from its harmful effects.”

What is your reaction to this finding, and then to the wording?

Early intervention: “ It is not commonly understood that even young children are likely to be affected by their mother’s depression and these effects may be lasting. Moreover, ongoing depression after childbirth is linked to patterns of parenting that may disrupt the normal “serve and return” interactions between an infant and mother, thus potentially harming the child’s developing brain architecture and emerging skills.  By intervening early, before these effects can accrue, we increase the likelihood that children of depressed mothers will grow into healthy, capable, fully contributing members of society.”

Reflect on your reactions to this wording.

Treatment: “Intensive intervention efforts that focus specifically on mother-child interactions have shown promising results in several recent studies.

Wonderful information has emerged in studies showing improved cognitive behavior when mother-infant interaction is coached in brief sessions, over the first year of baby’s life.  Some of the best information the paper offers, and leaves wonderful questions about the efficacy of our current intervention paradigms.

“Research indicates that various combinations of psychotherapy and educational treatments focused exclusively on adults can be effective in reducing depressive symptoms in mothers but appear to have limited impacts on the development of their children. These findings have led several researchers to argue that therapies should not only treat the mother but should also focus on the mother-child relationship.”

I hold a deep belief in the potential of communities of women to facilitate tremendous growth through inclusive, expansive, and multiple levels of consideration and consciousness. Five studies are cited here, the most citations for any one single conclusion in the paper. Interestingly, the citations come from research in the disciplines of psychiatric, psychology, and infant mental health, in contrast to the traditional medical fields supporting first half of the paper (epidemiology, orthopsychiatry, neurobiology, biology, and immunology). The language is less of the uni-directional, mother-based disorder speak.  Traditional treatment paradigms are challenged. Here is where we can all become inclusive and expand professional and societal understanding of perinatal mood disorders. Cleaner language lends itself to learning.

Now, back to the crazy mommy bat cave to complete my mission to undermine civilization with mood swings, crying jags, coma-like responses to my children, and bad tennis.


Posted By: Walker Karraa, MFA, MA, CD

Patient Advocacy, Perinatal Mood Disorders, Research, Science & Sensibility, Uncategorized , , , , , , , , , ,

On Our Radar: Latest Cochrane Review on Doula Care, New AWHONN Staffing Guidelines & Michelle Obama Endorses Breastfeeding!

February 16th, 2011 by avatar

Superior support in labor is the theme here and two major organizations have focused yet again on this important issue:

The research powerhouse Cochrane Collaboration has just released a systematic review of 21 RCTs involving 15,061 laboring women with the primary goal to “assess the effects of continuous, one-to-one intrapartum support compared with usual care,” and a secondary goal of determining “whether the effects of continuous support are influenced by: (1) routine practices and policies; (2) the provider’s relationship to the hospital.”
Visit Childbirth Connection’s site to review the whole report and stay tuned for further coverage from Science & Sensibility.

Next week on Tuesday, February 22 the Association of Women’s Health, Obstetric and Neonatal Nurses will host a webinar entitled, “Making the Case to Adopt AWHONN’s Staffing Guidelines.”

Promoting quality perinatal nursing care, AWHONN recently released new guidelines for perinatal nursing assignments that include 1:1 nurse-to-woman ratios for care of women receiving oxytocin in labor, and also for women who desire a low-tech birth or who have medical or obstetrical complications. A ratio of 1 nurse to 3 mother/baby couplets is recommended on postpartum units. 

The webinar is geared toward Directors of Nursing, Nurse Managers & Nurse Educators …or other champions of these guidelines who want to be better poised with “strategies for advocating the adoption of the guidelines to your organization’s leadership in order to give you the best chance for success when ‘making your pitch’.”
To register for the webinar, go here.

Also, unrelated to labor support–but certainly related to mother support in general, United States First Lady Michelle Obama is taking up the stick in terms of breastfeeding promotion.  As reported in this Politics Daily post, Mrs. Obama has begun speaking publicly about her own breastfeeding experience as well as the push which has finally secured IRS tax breaks for the financial investment associated with breastfeeding accouterments (pumps, milk storage bags, etc.).

Great things are happening for moms and babies…don’t forget to spread the word!!!

Breastfeeding, Doula Care, Evidence Based Medicine, New Research, Patient Advocacy, Practice Guidelines, Research, Systematic Review , , , ,

Pain, Suffering, and Trauma in Labor and Subsequent Post-Traumatic Stress Disorder: First of Two Posts by Penny Simkin, PT, CCE, CD(DONA)

February 15th, 2011 by avatar

Science & Sensibility welcomes new contributor, Penny Simkin, PT, CCE, CD(DONA).  Thank you for sharing your decades-long experience and expertise with us!



Introduction
After the health of mother and baby, labor pain is the greatest concern of women, their partners, and their caregivers. Nurses and doctors promise little or no pain when their medications are used, and feel frustrated and disappointed if a woman has pain. Most are also extremely uncomfortable with her expressions of pain during labor—moans, crying, tension, frustration – because they don’t know how to help her, except to give her medication.

An enormous industry exists in North America to manufacture and safely deliver pain relieving medications for labor. Hospital maternity departments are designed with elimination of pain as a primary consideration, complete with numerous interventions and protocols to keep the pain management medications from causing serious harm. When staff believe that labor pain equals suffering, they convey that belief to the woman and her partner, and, instead of offering support and guidance for comfort, they offer pain medication. If that’s the only option, women will grasp for it.

This brings me to the topic of my blog post today – Pain, Suffering, and Trauma in Labor.

Definitions of Pain and Suffering
If we check the definitions of “pain” and “suffering” in lay dictionaries, the two are often offered as synonyms of one another, which helps explain the fear of labor pain. It’s a fear of suffering. But if we consult the scientific literature, there is a distinction among pain, suffering and trauma. As described in Lowe’s fine paper on the nature of labor pain (1), pain has been defined as, “an unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” (2) The emphasis is on the physical origins of pain.

Lowe also points out that “suffering,” can be distinguished from pain, in that by definition, it describes negative emotional reactions, and includes any of these: perceived threat to body and/or psyche; helplessness and  loss of control; distress; inability to cope with the distressing situation; fear of death of mother or baby. If we think about it, one can have pain without suffering and suffering without pain. We can all recall times when we have been in pain, but did not fear damage or death to ourselves or others, nor did we feel unable to cope with the pain. For many people, athletic effort, recovery from planned surgery, dental work, and labor are painful but these people do not suffer with them. This is because the person has enough modifiers (knowledge, attention to other matters or goals, companionship, reassurance, touch, self-help measures, feelings of safety and other positive factors) to keep her from interpreting the experience as painful. All pain is not suffering.

By the same token, I’m sure we can recall times when we have suffered without pain. Acute worry or anguish about oneself or a loved one, death of a loved one, cruel or insensitive treatment, deep shame, extreme fear, loneliness, depression, and other negative emotions do not necessarily include real or potential physical damage, but certainly cause suffering. Therefore, all suffering is not due to pain. In fact, it is these negative modifiers that turn labor pain into suffering.

Of course, the goal of childbirth education has always been to reduce the negative modifiers, and increase the positive ones. The goal of anesthesiology has been to remove awareness of pain, in the assumption that when there is little or no pain, there will be no suffering. I’ll get back to that point later in Part 2 of this blog.

Suffering and Trauma
According to the American Psychiatric Association, the definition of trauma comes very close to the definition of suffering. “Trauma” involves experiencing or witnessing an event in which there is actual or perceived death or serious injury, or threat to the physical integrity of self or others, and/or the person’s response included fear, helplessness, or horror. (3)  Neither suffering nor trauma necessarily includes actual physical damage, although it may do so.

One’s perception of the event is what defines it as traumatic or not. As it pertains to childbirth, “Birth trauma is in the eye of the beholder” (4), and whether others would agree is irrelevant to the diagnosis.

Birth trauma and Post-Traumatic Stress Disorder (PTSD) after childbirth
A traumatic birth includes suffering and may lead to PTSD, which (according to the APA) means that the sufferer has at least 3 of the following symptoms that continue for at least one month:

  • nightmares
  • flashbacks
  • fears of recurrence
  • staying away from the people or location involved
  • avoiding circumstances in which, it can happen again
  • amnesia
  • emotional numbing
  • panic attacks
  • emotional distress

One national survey found that 18% of almost 1000 new mothers (up to 18 months after childbirth) reported traumatic births, as assessed by the PTSD Symptom Scale, a highly respected diagnostic tool. Half of these women (9% of the sample) had high enough scores to be diagnosed with PTSD after childbirth. (5)

Other smaller surveys (using women’s reports as the criteria for diagnosis) have found that between 25% and 33% of women report that their births were traumatic. Of these, between 12% and 24% developed Post-Traumatic Stress Disorder (PTSD). In other words, between 3% and 9% of all women surveyed developed PTSD after Childbirth.(6–9)

As we can see, every woman who has a traumatic birth does not go on to develop the full syndrome of PTSD. If they have fewer symptoms than the three or more required for the diagnosis, they may be described as having PTS Effects (PTSE). Though disturbing, the women are more likely to recover spontaneously over time than those with PTSD. The question of why some women get PTSD and others do not is intriguing and multifactorial: the propensity to develop post birth PTSD has to do with how they felt they were treated in labor; whether they felt in control; whether they panicked or felt angry during labor; whether they dissociated; whether they suffered “mental defeat;” (that is they gave up, feeling overwhelmed, hopeless and as if they couldn’t go on) (9, 10). Another risk factor for developing birth related PTSD  is having a history of unresolved physical, sexual and/or emotional trauma from earlier in their lives.  Even though unresolved previous trauma is unlikely to be healed during pregnancy, most of the other variables associated with PTSD can be prevented “through care in labor that enhances perceptions of control and support” (9).

In Part 2 of this blog post, I will suggest practical ways to apply what we know about the risk factors for childbirth-related PTSD, and how we can address these  before, during, and after childbirth.  I will discuss prevention and reduction strategies which can collectively reduce the likelihood of traumatic childbirth and subsequent PTSD.

This blog post series will be featured in the Fall 2011 issue of the Journal of Perinatal Education.  For references, please contact Ms. Simkin directly at: penny@pennysimkin.com or reference the JPE issue:  Summer 2011 Volume 20, Number 3.

 

Post By: Penny Simkin, PT, CCE, CD(DONA)

Doula Care, Healthy Birth Practices, Healthy Care Practices, Patient Advocacy, Perinatal Mood Disorders, PTSD, Science & Sensibility, Uncategorized , , , , ,

Listening to the Voice of the Customer: Patient Satisfaction and the HCAHPS Survey

February 11th, 2011 by avatar

“Right or wrong, the customer is always right.”—Marshall Field

“Customers don’t expect you to be perfect. They do expect you to fix things when they go wrong.” –Donald Porter, British Airways

“If the shopper feels like it was poor service, then it was poor service.” –Mark Perrault, Rally Stores


I’ve often wondered how these popular corporate slogans of customer satisfaction get translated into the world of health care. In our industry, who is the customer? What defines customer service? What does it mean to have a satisfied or dissatisfied customer?

In a 2009 survey of more than 200 top-level healthcare executives, nearly 90 percent ranked patient experience as either their top priority or among their top five priorities. The growing consciousness about the importance of patient satisfaction with the health care experience stems at least in part from increased use of the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey. Developed by a partnership of public and private organizations and funded by the Federal government through the Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality, HCAHPS (pronounced “H-caps”) is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care. The survey reports are being used to help patients make fair and objective comparisons between hospitals, allow individual hospitals to compare themselves to state and national benchmarks, and inform health care providers, accrediting and regulatory bodies, lawmakers, purchasers, and researchers about health care quality.

From the latest data reporting period between April 2009 and March 2010, over 8.8 million medical, surgical, and maternity care patients from 3,798 hospitals participated in the HCAHPS survey. HCAHPS asks a random sample of recently discharged patients 27 questions about their recent hospital stay.  An integral part of this survey are 18 core questions about critical aspects of patients’ hospital experiences such as communication with nurses and doctors, the responsiveness of hospital staff, the cleanliness and quiet nature of the hospital environment, pain management, communication about medicines, discharge information, overall rating of the hospital, and whether or not the respondent would recommend the hospital. The answers are then consolidated into ten quality measures that are publicly reported on the Hospital Compare Web site. Although the latest mandate does not yet include maternity care patients, HCAHPS performance will be a condition for value-based incentive payments to hospitals providing inpatient services to Medicare beneficiaries beginning in FY2013 (money talks!).

One of the most striking features of HCAHPS, and what differentiates it from previous patient satisfaction surveys, is not the questions that are asked, but those that are not asked. For example, HCAHPS asks patients:

  • How often did doctors/nurses communicate well with you?
  • How often was your pain well-controlled?
  • Would you recommend this hospital to your friends and family?

And not:

  • Did you sign an informed consent document? [Because a signed informed consent form does not always mean a patient was necessarily informed or fully consenting]
  • Did you receive written discharge instructions? [Because giving out discharge instructions may not mean a patient understands them].
  • Did you receive an epidural or medication for pain? [Because the administration of anesthesia and drugs does not always mean that pain has been adequately assessed or managed]

Do you see the difference? The uniqueness of HCAHPS is the emphasis placed on the patient’s perspective and satisfaction as a valid outcome measure of quality. Although accurate documentation, appropriate use of medical intervention, and timeliness of care are all important quality goals, it is not the focus of this survey. This represents a seismic shift away from other surveys that use provider-centric metrics driven by concerns for regulatory compliance. HCAHPS is an important first step towards acknowledging that there is more to the patient care experience than simply whether or not mother and baby make it out alive, and that patients themselves are capable of evaluating the quality of the care they receive.

The general public has seized the idea of using HCAHPS as a hospital report card, thanks in part to patient and family advocates like Regina Holliday, a gifted muralist who wields “paint and brushes to promote health reform and patients’ rights.” Here is a three-minute video of Regina painting the HCAHPS visualization “Apples to Apples” and interacting with curious passers-by on the sidewalk outside a major hospital in Washington D.C.:

Apples to Apples by Regina Holliday (used with permission by the artist)

Some birthing advocates have questioned the validity of HCAHPS, pointing out that the survey is not maternity-care specific and has severe limitations for capturing the experiences of childbearing women and newborns. With mothers and children accounting for 25 percent of all hospital discharges, it is indeed critical to ensure that the questions are relevant to the particular needs and sensitivities of maternity care patients in order to maintain the instrument’s validity and utility. Our colleagues at Childbirth Connection have introduced legislation to include provisions to adapt the survey for use in maternity care (see Congressman Engel’s bill H.R. 6437 – Partnering to Improve Maternity Care Quality Act of 2010 and Kimmelin Hull recently wrote an excellent post in December that reviewed several large scale maternity-focused satisfaction surveys conducted in the U.S. and abroad.

So where do we go from here? Some of you may remember my last post in December about a root cause analysis (RCA) of a maternal death. We talked about use of RCA as an essential tool in quality improvement, the difference between “deep” and “shallow” RCA, and the importance of serially asking “Why?” as we drill down the chain of events to uncover the fundamental and systemic root causes that contribute to an adverse outcome. Although RCA is typically performed in cases of serious or fatal harm, these approaches and tools can be applied to any situation in which there is a gap between expected and actual outcomes. Patient dissatisfaction with a negative birth experience is one such gap. As the use of surveys like HCAHPS continues to spread, the survey instruments become more refined to maternity care, and detailed follow-up surveys are developed, we can expect to see patient-centered RCA emerge as the next frontier in quality improvement. In my next post, I will do just that. Do you think the root causes of a patient death and a dissatisfactory patient experience will be the same or different? Stay tuned and find out! Until then,

“If the patient feels like it was poor care, then it was poor care.”—Tricia Pil, MD

Thank you to Regina Holliday for sharing her inspiring work with Science & Sensibility

Posted by:  Tricia Pil, MD

Healthcare Reform, Patient Advocacy, Uncategorized , , , , , , ,

Recent Journal and Media Information Round-Up

February 10th, 2011 by avatar

I’d like to take a few moments today to share with you some interesting articles and blog posts which have floated over the air waves in the recent past:

OTIS (Organization of Teratology Information Specialists) recently posted a great piece on their blog about caffeine intake during pregnancy.  With Valentine’s Day approaching and heart-shaped, chocolate-filled boxes flying off stores shelves, pregnant women may be wondering whether the amount of caffeine contained in chocolate can harm baby, or increase the risk of miscarriage or preterm birth.  OTIS’ blog post does a nice job discussing this concern(see article for details), ending with the following guide:

Dark Chocolate 1.45 oz = 30mg
Milk Chocolate 1.55 oz = 11mg
Coffee 8oz = 137mg
Tea 8oz = 48mg
Soda 12oz = 37mg
Hot Cocoa 12oz = 8-12mg

This recent article from the LA Times discusses the record low rates of teen pregnancies in the state of California—(2009 rate was less than half that of the 1991 teen mother birth rate.)

This study from The British Journal of Obstetrics and Gynecology looked at outcomes of attempting “early” versus “late” external cephalic version (ECV) for breech presentation in 1543 women from 68 centers in 21 countries.  “Early” was defined as 34-35 weeks.  “Late” was defined as 37-38 weeks. The general results suggest that early vs. late ECV “increases the likelihood of cephalic presentation at birth but does not reduce the rate of caesarean section and may increase the rate of preterm birth.”  Interestingly, hospital, birth center and home births were represented in the study.  ECVs were performed by both obstetricians and midwives (approximately 98 vs. 2 % in each group, respectively).

I remember attending a March of Dimes continuing education seminar a couple years ago here in Montana, in which illicit drug use during pregnancy was the primary topic of discussion.  Several L&D nurses stood before the audience, describing women they’d attended in labor who had taken their last hit of their chosen drug in the parking lot of the hospital minutes before being admitted to birth their babies.  Here is an interesting article which recently appeared in Reuters, and is based on a study from the American Journal of Obstetrics and Gynecology.

This article on the Medical News Today website discusses a hugely successful study undertaken at the University of California -San Francisco in which in utero surgery to address spina bifida results in far better outcomes for the child later in life.  In fact, fetal surgery is nothing new—the first “open fetal surgery” was performed by Dr. Michael Harrison at UCSF 30 years ago.  To find out more about the risks and benefits of this type of surgery, you can find the actual study, as published in the New England Journal of Medicine here.

Also, check out Childbirth Connection’s resource What You Need to Know about Induction of Labor which pairs nicely with Amy Romano’s recent post here on Science & Sensibility.

Have you recently read something in the media you’d like to see highlighted on Science & Sensibility?  If so, drop me a line.

Posted by:  Kimmelin Hull, PA, LCCE

New Research, News about Pregnancy, Research , , , , ,