What Moms really want/need for Mother’s Day

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Dear Baby Daddy,

This letter applies to anyone who has fathered a child, whether they be husband, boyfriend or estranged partner. If you aren’t aware, this Sunday is Mother’s Day. You should be honoring not only the woman who gave you life but also the woman who gave life to your children. And this honor thing should not be for just one day. It should be every day.

Being in the baby business for the past 25 years, I have been present at the start of hundreds of families. This is the moment that parenting starts and some guys do it better than others. Let me give you a few clues as to what is expected of you.

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  1. Remember when this all started 9 months ago? You were there for the blessed event of conception and if you didn’t want to be a father, you should have voiced that opinion with the use of a condom. FYI – they are inexpensive, freely available and can be kept in your wallet for just such an occasion. History tells us about one immaculate conception and your partner hasn’t made history by being the second. This child is your responsibility for the remainder of your life, so stick around. And that means at the birth as well as the birthday parties. Responsibilities come in the form of monetary payments as well as emotional/physical support.
  2. Start practicing your involvement by coming to a few obstetric appointments. Hearing the heartbeat of the baby is a pretty cool trick that we doctors perform each visit. You can ask questions your partner may have forgotten. You CAN’T play video games on your phone during the entire visit – that makes you look like a child rather than a potential father.
  3. Set a good example at home with your diet and exercise habits. Eating a meal of McDonald’s on the couch while watching tv all evening doesn’t help your partner make nutritious food choices that will help her baby grow. Go for a walk and then help to cook a meal. You might even have a conversation about baby names that wouldn’t have happened in front of the tv. And if your partner is trying to give up smoking or drugs for the welfare of your child you are not allowed to offer her a cigarette, smoke in front of her or invite friends over for a night of illegal substance use.
  4. Support your partners decision to breast feed. Her breasts are not your property and will soon belong to your unborn child. Get over it!
  5. Pony up the money for a birthing class. When patients tell me they can’t afford the $80 fee, I wonder how they will afford to care for a child over the next 2 decades. I realize that you don’t need a birthing class in order to have a baby, but it makes the experience much less anxiety producing for both the mom and the doctor. Nobody would consider driving a car before taking driving lessons, but everyone thinks they are an “expert” at the birthing process because they watched someone else give birth.
  6. Your partner is in labor and you are with her at the hospital. These pointers will help you in how you are treated by the nurses and doctors. Your wife is our patient – not you. You will be required to get your own food and drink. If your partner is awake, you should be also. Sleeping on the couch in the room while your partner is trying to birth your child isn’t acceptable. Since the doctor and the nurse have been up all night helping to care for your partner, you have no excuse. And realize there will be a few sleep deprived nights ahead, so this is good practice.
  7. Labor hurts. Let me say this again; Labor hurts. Just because you and your partner decided that a natural childbirth without pain meds was a good idea last month doesn’t mean she can’t change her mind when she realizes that the horror stories she has heard are true and more. It’s her body and her decision – its your job to be supportive of her decision. Would you consider having your appendix removed without anesthesia to make it a more “natural” process? I didn’t think so.
  8. The baby has arrived and you are home. Now the hard work begins. Your partner has just pushed a volleyball out her vagina and she may be a bit sore. She is also experiencing 2 boulders sitting on her chest that leak copious amounts of milk at inopportune times. Your job is to take over the household responsibilities for at least a week. No sports on tv, no guy time, no video game marathons.
  9. For those men who are not living with the mother of their child, don’t feel that the above rules aren’t applicable to you. You are still on the hook for financial support and you should make sure that your visits aren’t disruptive but that you are helpful. Hold your child and become acquainted while mom takes a nap. Purchase a package of diapers as a gift. Offer to wash the dishes in the sink. See #1 – this is your child and your responsibility. Your parents (paternal grandparents of child) also should be holding you responsible. And if you think all this parenting work is too difficult – buy a lifelong supply of condoms.
  10.  You and your partner have made the mutual decision to stop producing more babies. She has birthed a few children as well as managed the birth control options to this point. Now it’s your turn. A vasectomy takes 10 minutes – that is the length of time for 2 contractions in a 12 hour labor – and is much less painful than one contraction. If your partner went thru childbirth without pain meds, you might want to consider a vasectomy without pain meds to make it more “natural”.  And finally, don’t forget the flowers this weekend.

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Fake News in Medicine – or how to get your medical degree from the internet

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A 22 year woman, pregnant for the first time, informed me at her obstetrics appointment this week that she had done “all of her research on the internet” and didn’t want any vaccines for herself or her infant because she is concerned about preservatives. I had a difficult time not asking her what preservative laden food she had eaten the day before. Another patient declined the tetanus/pertussis vaccine that is recommended at 7 months of pregnancy to provide passive immunity against whooping cough to an infant before they become fully vaccinated. This has become recommended due to periodic outbreaks of whooping cough among unvaccinated children. Her reason for declining the vaccine? “My friend told me it is a bad idea”. I spent an extra five minutes explaining why the vaccine is recommended, why contracting whooping cough as a young child can be serious and potentially deadly and that the vaccine has been proven safe in pregnancy. She continued to decline and on her way out the door informed the staff that Dr Jaeger told her that her baby might die.

In the past week in Minnesota there has been an outbreak of measles – 11 children have been affected, 10 of them were not immunized and many required hospitalization. Measles is one of the most contagious of human diseases and it is expected that more cases will be identified. Fortunately, it is very unlikely that any of these cases will be fatal as the children are otherwise healthy and were identified early in the course of the infection. All of these cases occurred in the Somali community, an immigrant population that can be distrustful of western medicine. They are a cohort that is seen as an easy target by the anti-vaccine movement, which spreads its false information via social networks and word of mouth. Studies have documented that Somali parents are more likely to believe that the MMR (measles, mumps, rubella) vaccine causes autism and are more likely to refuse the vaccine than non-Somali parents.

Fake news is defined as false information or propaganda published under the guise of being authentic news. History is replete with medical snake oil remedies to cure disease. But with the widespread acceptance of the internet as a source of information – true or not – the increase in fake medical news has skyrocketed. In an attempt to research what is best for their children, parents can be susceptible to the spread of this false information. Additionally, the anti-vaccine movement is being emboldened by the current Trump administration who has appointed Robert F Kennedy Jr to a task force that purports to investigate the safety of vaccines. Mr Kennedy holds no medical degree, has done no actual research and his intent is to push forward the anti-vaccine agenda with pseudoscience that is difficult for the average American to understand. But when he has the backing of the President of the US, he is given more credibility than he deserves.

Ironically, the anti-vaccine mindset is only possible because medical research and vaccines have almost totally eradicated communicable diseases from the developed world. My patient who declined the pertussis vaccine during pregnancy has never seen a child die of whopping cough, which occurred in 1 out of 5 children in the 1920’s.  As recently as 1980, 2.8 million deaths worldwide were attributed to measles. Global measles deaths have decreased by 79% since widespread immunizations have been implemented. Do we really want to be reminded of what it feels like when you lose a child to a preventable illness?

 

 

The cost of being a woman

 

Two headlines caught my attention this week. One focused on the luxury tax for tampons that is part of the law in 46 of the 50 states. The other headline was buried in all of the news about the Republican sponsored Health Care Act.  Tom Price, head of HHS, would like to see the co-pay for contraception reinstated. As part of the ACA, contraception is free under the majority of health care plans. Both of these costs are charged to women. On a monthly basis this may not seem too costly. But let’s look at the average sum that a woman would need to pay over her lifetime for both tampons and contraception.

Tampons: an average woman uses 30 tampons for each menstruation. A box of 36 tampons costs $7 at Target. That amounts to 360 tampons per year or $70. When multiplied x 35 years that costs a woman $2450.

Contraception: Prior to the ACA, an average co-pay per month for birth control pills was $30. If a woman were to start pills at age 20 and continue to age 45 it would cost $9000 for contraception.  The average family size is 2 children, so you could subtract $1000 for the time it takes to become pregnant and the pregnancy itself. I would argue that there are other costs during that time that offset the $1000 (maternity clothes, nursing bras etc…) but those are probably considered “luxury items” by society standards.

$10,450 is the total cost of tampons and contraception for a woman during her lifetime. But some of our lawmakers want to extend this burden even further, questioning why men should have to help pay for maternity care as part of health insurance. Despite the backing of Ivanka Trump, I doubt that the current legislature will approve any bill that provides for paid maternity leave. Women caregivers are the norm for elderly parents who need assistance and many choose to decrease their paid work commitments to provide this care.

At what point will our society honestly discuss the financial inequalities that exist between men and women?  Male partners should share the finances of contraception – much cheaper than the cost of supporting  a child to age 18.  Women should not be the only members of society that are burdened with the cost of maternity care.  Removing the luxury tax on tampons is a no-brainer as I have never heard any woman describe her period with the work luxury.  And I have heard many words used to describe periods! Paid maternity leave is present in  every  country in the world other than the US and Papua New Guinea. If we want to make this country great, maybe we should start with the women.

 

Dear Kellyanne Conway – This is what feminism looks like

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Ms Conway spoke at the CPAC convention last week on the contemporary definition of feminism as anti-male and pro-abortion. I consider myself a feminist and don’t identify with either of these definitions. I heard about her commentary as I was driving between appointments and reflected on my “feminist” activities on the same day as she was speaking at the convention. Following is the run-down of what a feminist does on her day off from her usual job as a physician serving women – the ultimate feminist job.

  1. Awake at 6 am to make breakfast for daughters as they head out to high school.
  2. Text with 26 year old son about upcoming interview for nursing school.
  3. Spend 2 hours on Haiti non-profit, Helping Haiti Work, that grants microloans to women and operates a sewing center that constructs reusable menstrual pads for sale in the community. Women that participate in this program are empowered to be leaders in their families and communities.
  4. Volunteer at a local public elementary school tutoring first graders in reading and math. 90% of the students in this school are children of color. The teachers are dedicated and constantly working to involve each child in the curriculum.
  5. Grocery shopping for the week. My husband and I split this task, but he often does more than 50%. Arrive home and start dinner in crockpot for husband and daughters as we will be eating at different times. I cook because I love to and not because I am the mother. Husband also does his share of meal prep.
  6. Drive across town to the MN legislature. I have volunteered to speak before the Health and Human Services Committee in opposition to 2 bills that are being introduced to restrict access to abortion. I am NOT pro-abortion, but rather pro-choice and pro-contraception. Along with many of my colleagues, I feel that government should stay out of the room when a physician is counseling a patient.
  7. Attend a year-end meeting of our independent medical clinic, one of the few non-hospital owned clinics left in our area. I am a board member of this clinic and up for re-election so give a 5 minute speech about the value of independence and what measures we need to take in the future to stay that way. My value as a board member is based on experience, working hard and ability to appreciate other’s opinions. Being the only female board member is a responsibility I do not take lightly.
  8. Head back to St Paul to attend a visit to an Eastern Orthodox church, arranged thru Tapestry, an interfaith group of women that works to break down religious and cultural barriers thru education and service. I am proud to be one of the 3 founders of this growing organization but saddened to know that our existence is needed now more than ever. It was interesting to hear the stories behind the iconography that is so much a part of the Eastern Orthodox religion, but also to reflect on the similarities between the Jewish faith and to view the women in the pictures as wearing the traditional head coverings or hijab. During the social hour following the church tour, I lamented with my Muslim friends about the difficulties of encouraging our teens to stay involved in their respective religions. We found that we shared many of the same difficulties as well as joys.
  9. Arrived home around 9:30 and discussed husband’s experience at local town hall political meeting that was attended by 1000 constituents but not our legislator. We made plans for future involvement in politics and discussed our shared values with our daughters.
  10. Crawled into bed around 11 pm as I had an early morning surgery and clinic the next day. This is where the real feminist is unleashed – advocating for free birth control, vaccinations, knowledge about our bodies and how they work and access to health care as a human right and not a privilege.

Feminism is the right to be treated as an equal human being and to be able to make our own choices. That is not anti-male or pro-abortion. That is human decency and what I teach both my sons and my daughters.

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Breast Feeding, Jade Eggs and the Gspot

This post combines two of my favorite topics: international mission work and working to dispel rumors. You may wonder how the topics above have any relationship to each other. Stay with me for a few paragraphs and I think you will better understand.

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When we are in Haiti for a medical mission week we try to listen as well as teach. This trip we became aware of the tendency for Haitian women to quit breast-feeding their children after 1-2 months so that their breasts can retain their “sexy” look. Powdered milk is now more available but still expensive. Thus, women use the powdered milk as a substitute for breast milk and dilute the milk to make it last longer. Water in Haiti is often contaminated with bacteria, leading to an increase in diarrhea diseases in children. Diarrhea in combination with poor nutrition from diluted milk causes chronic malnutrition. Parents aren’t able to purchase the medications or medical care and frequently abandon these malnourished children in orphanages. An entire cascade of problems that all started with a “sexy breast”.

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Another story. Gwyneth Paltrow recently advocated the use of jade eggs for women to stick inside their vaginas to maximize their “feminine appeal” while increasing vaginal muscle tone and orgasms. Not coincidentally, she sold the jade eggs on her website for a mere $66!  The tragic part of this story is not that Gwyneth purports pseudoscience on her lifestyle website. The internet is full of more inaccurate medical theories than accurate. The crazy part is that the jade eggs sold out!! Women were willing to put their health at risk for a ridiculous theory that was backed by an attractive Hollywood star with no medical background. The benefit of this monetary and health risk was to improve their attractiveness to men. Are you starting to understand where I might be heading on this topic?

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Third story. A patient in our clinic this past month had been paying to have Gspot amplification done in a clinic that advertises cosmetic gynecological procedures, such as labiaplasty and vaginal rejuvenation. Gspot amplification is a procedure that has no medical evidence to support it and is advertised as a procedure that needs to be continuously repeated. The benefit is that it improves vaginal tightness and restores appearance and function. Appearance and function for whom? Do you finally get it?

Women in Haiti and the US are not so very different. Each are willing to sacrifice their health, the health of their children and their money to appeal more sexual to men. Equally at fault are the men who help to perpetuate these myths for their own benefit. I don’t think you would see many men paying $66 for a jade egg to put in their rectum so that they would appear more masculine to women. Men wouldn’t allow an injection in their private parts to restore appearance and sexual function. Heck – they won’t even agree to a vasectomy after their partners have pushed out 2-3 basketball sized infants thru their vaginas. Vaginas that now need jade eggs and Gspot amplification to become restored. Sure hope that Gwyneth has a second shipment of those jade eggs arriving soon from Asia.

How the Birth Plan can destroy the Birth Experience

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It happened again last week. I shredded my patients carefully thought out birth plan. I didn’t literally shred the two page birth plan, but rather destroyed what she had planned for her birth experience. And at the end we had a healthy baby and healthy mom, which is an Obstetrician’s ideal birth plan. But it was the in-between that mattered for her and that is what I mangled. She didn’t want to be induced but yet had dangerously low amniotic fluid levels at 8 days past her due date, requiring induction to prevent a stillborn. She wanted a short labor, ideally less than 8 hours. With an unfavorable cervix and need for induction, her labor duration was just short of 24 hours. She wanted to experience labor without pain medication but requested an epidural when in active labor. She wanted to freely move about the room during labor and baby to be monitored intermittently rather than continuously. Due to the low-level of amniotic fluid and concern for fetal distress with contractions, she needed continuous monitoring. She wanted a vaginal delivery but needed a cesarean due to fetal distress and failure to progress. She wanted skin to skin bonding time with baby for the first hour after delivery but due to breathing difficulties, baby was moved to Special Care Nursery 10 minutes after birth. Her perception in the days following birth was that the medical community had failed her in that she didn’t have the “experience” that she had anticipated.

Although birth plans can be helpful as a starting point to discuss expectations, I find that too many women focus on their WANTS during labor and not the needs of their unborn child. If a physician is telling you that the health of your child is in danger and you need to be delivered, should we be arguing about the fact that you didn’t WANT an induction? If the physician is telling you that your baby is in danger of suffering long-term brain injury due to lack of oxygen and that you need a cesarean, should we be discussing that you did everything possible to have a vaginal delivery and don’t WANT a cesarean.

With women having fewer children and childbirth becoming an increasingly safe experience, women seem to set themselves up for unrealistic expectations of an event that will only occur once or twice in their lives. That experience needs to be near perfect with pictures/video extensively documenting the event. Each month hospitals review scorecards detailing pain management expectations, whether medical personal adequately explained procedures, the quality of the food etc. While this is important information that medical providers need to reflect on, I also think there needs to be a recognition on the patients end that a failure to meet their expectations is not necessarily anyone’s fault. If the pain of childbirth is too unbearable and you ask for the epidural that you didn’t want when you walked in the door, it is not the fault of the physician for starting Pitocin because you were not making progress in labor.  If the epidural didn’t relieve 100% of your pain, it is not the anesthesiologist fault for faulty placement. In emergent situations, there may not be time to explain all of the risks and benefits of a certain procedure. Hospital food is designed to be healthy and in adequate proportions. If you are used to the taste and proportions of fast food, you will be disappointed in what is served.

Reduction in the risk of childbirth has decreased tremendously in the last 100 years. In the early 1900’s, 1 out of 90 women died of childbirth complications. 200/1000 babies died before their first birthday. Instead of fearing childbirth as in the past, women now enter the labor room with expectations of a perfect outcome, both for themselves and their unborn child. The overwhelming majority of the time we are able to meet these expectations. But due to the increasing epidemic of obesity, hypertension and diabetes, coupled with delayed childbearing, the maternal mortality and complication rate is sharply increasing. A complication such as postpartum hemorrhage related to maternal obesity, hypertension and prolonged labor is something we cannot prevent but can only manage once it occurs.

As often as reasonably possible, I try to honor my patients wishes in labor if those wishes do not interfere with the health of the baby or the mother. I have allowed a woman to cook a pot roast in a slow cooker in the labor room because she thought the fragrance would help with pain control. Intermittent monitoring of the infant while moving freely about the room and shower/bath is fine. Eating snacks during labor is fine as long as you realize that you may see them in another form if you are prone to throwing up.  I allow women to take their placenta home to be dried and eaten. However, there are times that a doctor may know more about the correct course of action than a patient. And that is when the patient needs to trust that we are doing what is best for both their health and the health of their child. As I often tell patients, “The childbirth experience is just the first part of parenting where things may not go as expected. If you are going to enjoy the journey, you can’t get too caught up in the particulars!”

 

 

How Roe v Wade is affecting the upcoming election – and how we can change the discussion.

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Life must be interesting for Ruth Bader Ginsburg. As the oldest member of the Supreme Court, she is the most likely to retire/pass away in the next 4 years, allowing the next President to change the dynamics of the Supreme Court. Either it remains with a conservative majority or changes to a more liberal bench. The SCOTUS (Supreme Court of the United Sates) appointment is the reason many conservatives still back Mr Trump, even though they confess  they don’t believe he is Presidential material.  With a conservative majority, their hope in the future involves the defeat of Roe v Wade and the outlawing of abortion.

One of the frequent arguments against abortion involves the practice of partial birth abortion. In fact, in the third presidential debate Mr Trump described partial birth abortion as “ripping a baby out of the womb only days before birth”. As an obstetrics doctor, I routinely do this. I refer to it as a cesarean and would use the nomenclature cutting rather than ripping. Spreading false rhetoric only works to push people apart. We need to look at how we can find common ground in this debate.

These are the facts. 91% of abortions are performed before 13 weeks of pregnancy and only 1.3% occur after 21 weeks of pregnancy. The majority of these later terminations are due to fetal anomalies that are not diagnosed until the 5 month ultrasound. Heart-wrenching decisions need to be made by parents in a short time frame, as most states outlaw terminations beyond 23 weeks, only 3 weeks after a diagnosis is made. In the past few years, I have been involved in 2 of these scenarios that resulted in different decisions. One child was diagnosed with a lethal heart defect that would require multiple heart surgeries to allow the child to become old enough so that she would be a potential candidate for a heart transplant. Years of surgeries, hospitalizations, medications for at best a 20% chance of life. The other mother was diagnosed with rupture of the amniotic sac at 20 weeks of pregnancy, preventing full and complete development of the baby’s lungs. One couple chose to continue the pregnancy, the other to terminate. The important point is not which option these couples chose, but that these parents were able to make a CHOICE. A decision that made sense for their family now and in the future.

Rather than focusing on the 1.3% of abortions that are classified as late-term, why not focus on the 91% that are performed prior to 13 weeks. The number of these abortions can be dramatically reduced by reliable contraception. For example, use of long acting reversible contraception (IUDs and implants) by teens has been shown to reduce the pregnancy rate by 50%.  It is always amazing to me the number of women I see for a pregnancy confirmation that have not been using birth control because they are worried about all the “bad side effects”,  but yet didn’t want to become pregnant. Do they understand that an unwanted child is a “bad side effect”. An educational campaign focused on contraception,  healthy pregnancy and involving men in contraceptive decision-making would pay back large dividends in reducing health care dollars spent on unwanted pregnancies that are often high risk.

An unwanted pregnancy that may end in abortion was not created by just one person. But it is the woman who is blamed for the decision to terminate the pregnancy. Why don’t we hold the male partner accountable? They could have used a condom if they didn’t want their partner to become pregnant.

Overturning Roe v Wade and outlawing abortion is not the answer. I have worked in many developing world countries where abortion is illegal. This does not mean that abortion does not happen, only that it becomes expensive and dangerous. Unlicensed and unqualified practitioners put women’s lives at risk in order to make money. These are some of the same countries where birth control is difficult to obtain and rape of women, both by their spouses and others, is common. During one of my trips to Haiti, I was able to save a woman’s life (the mother of 4 children) when she suffered a perforation of the uterus and horrific bowel injury by an unqualified physician. If our surgical team had not been operating that week, she would have died and left 4 children orphans. Her response when I told her that we had to remove her uterus in order to save her life was a grateful thank you because she would not have to worry any further about pregnancy. One ward of a hospital in Port-au-Prince is devoted to women who have suffered complications of abortions. Many of these women die due to lack of antibiotics and the funds to pay for adequate care.

If you are against abortion, work to increase education and access to contraception. Educate men and boys about their responsibilities. This will work to reduce 91% of abortions; those that occur prior to 13 weeks and are often due to lack or failure of contraception. Leave late-term abortion decisions to women and their families. This is a personal decision that is different for every woman. We as physicians are able to provide factual information and support women in their decisions. This should not be decided as a one size fits all policy.