When Downton Abbey’s Lady Sybil died of eclampsia seizures just after giving birth, many viewers wondered: Could it really happen? The answer is yes.

Lady Sybil had undiagnosed pre-eclampsia, a condition that affects as many as one in ten pregnant women. It causes high blood pressure (typically at or above 140/90) and protein in the urine from kidney malfunction. It’s also called “Pregnancy-Induced Hypertension.” That’s why blood pressure and urine are checked at every prenatal visit. Symptoms include unrelenting headaches, vision disturbances, and swelling of the hands, face and feet (although some ankle swelling is very common in pregnancy anyway).

When pre-eclampsia is severe, the flow of blood from the mother’s placenta to the baby can be impaired. That’s why these babies can be growth-restricted, just as Lady Sybil’s baby was. But even worse, if not taken seriously by obstetricians and midwives, pre-eclampsia can make a baby vulnerable to loss of oxygen during the birthing process, with brain damage as a final and terrible outcome.

Doctors still don’t know what causes many women to get high blood pressure during pregnancy. The main treatment — delivering the baby if not too premature — is the same now as it was in the Downton Abbey era of post-World War One Britain. We also have drugs that can help control the high blood pressure, and more sophisticated monitors (ultrasound and heart monitors) to check the baby’s status.

One heart-wrenching bit of Lady Sybil’s agony that wasn’t realistic is the way her doctors stood by helpless as she was having full-blown seizures from eclampsia after giving birth. Then as now, magnesium sulfate was available to help ease seizures.

But pre-eclampsia remains a scary condition that needs to be watched out for because it happens all too often, and can be devastating for mom and baby.

Here’s more on pre-eclampsia from the NIH.

Here’s a discussion on our firm’s website about medical malpractice issues relating to pre-eclampsia and other aspects of prenatal care.

Innumerable websites offer information about medicines that pregnant women can take safely. But because evidence is limited about many of the drugs listed and because the advice about them is inconsistent, the journal Pharmacoepidemiology and Drug Safety conducted a review to see if their guidance is reliable.

Guess what? In many cases, it’s not. And half of the websites examined didn’t include the key message that women should talk to their doctors about using medicine during pregnancy.

The Centers for Disease Control and Prevention (CDC) has summarized the most important elements of the study.

Half of all women of reproductive age look for health information on the Internet. More than 9 in 10 women use at least one medicine during their pregnancy, and about 7 in 10 of them use at least one prescription medicine. But almost none of the medicines had sufficient data to assess the risk for birth defects.

In the journal study, 25 active Internet websites listed medicines reported to be safe for use in pregnancy. The researchers tried to find out if there was scientific evidence to support this conclusion. Of the 245 medicines listed as pregnancy safe on these websites, about 4 in 10 didn’t have enough data to make that claim.

That doesn’t mean a medicine isn’t safe, but it might be. The point is that no pregnant woman should take any medicine, over the counter or prescription, if she doesn’t discuss it first with her doctor. That includes dietary or herbal supplements, which aren’t regulated by the FDA. If you’re planning to become pregnant, discuss the need for any medicine with your doctor before you conceive. And if you’re pregnant and taking medicine, don’t stop without first consulting your doctor.

Some medicines are notorious for causing birth defects. They include thalidomide (Thalamid) and isotretinoin (Accutane). They should be not be taken by anyone who is or might become pregnant.

Although some medications are known to be harmful when taken during pregnancy, according to the CDC, the safety of most medications taken by pregnant women has been difficult to determine because of certain variables:

• how much medication was taken;
• when during the pregnancy the medication was taken;
• other health conditions a woman might have;
• other medications a woman takes.

Some conditions must be treated even if you’re pregnant, such as asthma, epilepsy (seizures), high blood pressure and depression. If they’re not treated, the mother or the fetus could be harmed. But only your doctor can determine which medicine is appropriate, and at what dose. He or she also should discuss the possible side effects, risks and benefits of any medication being considered. That’s true, of course, whether you’re male or female, pregnant or not.

As the CDC notes, part of the problem in determining pregnancy-safe meds is the approval process. When the FDA tests medications to ensure their general safety and effectiveness, it doesn’t usually include pregnant women because of possible risks to the fetus. That’s why websites cannot make safety claims with authority for many medications.

The CDC suggests several resources where you might be able to find out more about the possible effects a medication might have when taken during pregnancy:

The Organization of Teratology Information Specialists (OTIS) has information about the risks and safety of taking medications during pregnancy and while breastfeeding. OTIS also conducts studies of pregnant women who contact them after having taken certain medications.

Drug companies sometimes conduct special studies using pregnancy registries. They enroll pregnant women who have taken a certain medication. After they give birth, the health of their babies is compared with the health of the babies of women who did not take the medication. For a list of current pregnancy registries and how to enroll, link here.

National Birth Defects Prevention Study is sponsored by the CDC. It works to identify possible risk factors for birth defects, including the effects of taking certain medications during pregnancy. For more information, link here.

Drug companies are required to report any problems with medications to the FDA. Health-care providers, researchers and the public also may report problems directly via the FDA’s MedWatch program.

Also, visit the CDC’s site for pregnancy and medications, and our backgrounder on prenatal care.

The essence of a long and fascinating examination of a lawsuit over a newborn’s brain damage by Steve Cohen on Forbes.com was distilled nicely on PopTort.com, the civil justice site of the Center for Justice & Democracy.

It concerned tort reform, which, as regular readers of this blog know, is the misguided movement to restrict damages people who have been harmed by the actions of others may receive.

It’s misguided because it has been proved not to reduce the incidence of “defensive medicine,” in which practitioners overtreat for fear of being sued if they don’t, nor does it reduce the costs of health care, among other bogus claims.

Here are some of PopTort’s take-home messages from the Forbes piece:

1. If we change statute of limitations laws, doctors will stop complaining about being sued.

As Cohen notes, closing the window of time someone may sue for malpractice has not resulted in fewer doctors being sued, but precisely the opposite. Such limitations are objectionable on many levels, not the least of which, Cohen wrote, is that ,”Very often the clock runs out before a patient even discovers he or she is the victim of malpractice.”

So where the limits have been shortened, plaintiffs often include every conceivably liable doctor. When they realize that many named parties did nothing wrong, they drop the suit. That hurts the innocent and wastes resources.

PopTort suggests changing state statute of limitations laws to “enterprise” notification-instead of requiring a patient to file a lawsuit against every potential defendant, “the law should toll the statute of limitations against all health-care providers for injuries and damages arising from the events referred to in a complaint, save for one defendant who is initially sued. If later it is discovered that one or more others are also responsible, they can be brought into the case at that time.”

2. The “cost of defending malpractice claims and compensating victims … is 0.3% of the $2.5 trillion spent on healthcare that year.”

As PopTort has demonstrated, courtesy of the state of Texas, there’s no evidence that health-care costs decreased after medical malpractice payouts were limited in 2003. In fact, there was evidence of increased physician spending in some counties. There also was evidence that Medicare payments to doctors in Texas rose faster than elsewhere in the country.

3. Compared to the epidemic of malpractice in the country, only a “shockingly small” percentage of legitimate cases end up as claims.

Business groups, PopTort has pointed out, like to say punitive damages pose a significant threat to an enterprise’s viability. Except that they demonstrably don’t. The rate of punitive damages has remained stable, and there’s no evidence to suggest such damages are awarded systematically or inappropriately.

4. So-called “defensive medicine” is one big myth.

So say the Kaiser Family Foundation (an independent outfit that provides health policy research and information), the Congressional Budget Office and the Government Accountability Office (GAO). As we’ve explained, doctors perform tests for legitimate diagnostic reasons, or to generate extra income, not to cover their … bases.

PopTort quotes one New York doctor on this point: “The more tests doctors order – even if they are marginally necessary – the more doctors earn. … Both Medicare and private insurance companies are reimbursing us less and less for every procedure we perform. These are not ‘unnecessary’ tests, and they are certainly not harmful. I have no compunctions about ordering them and billing for them. It is part of the business.”

We have taken issue with that glib “no harm” assessment. See our blog, “Overtested, Overtreated, Overcharged.”

5. State tort laws have no impact on where doctors decide to practice.

PopTort quotes Tom Baker of the University of Pennsylvania Law School, and the author of “The Medical Malpractice Myth” about the claim that doctors abandon the profession because of the burden of medical malpractice. “Not one of the five major studies designed to rigorously track and analyze this claim have found any evidence to support the claim.”

6. State tort laws have no impact on doctors’ insurance rates.

A couple of years ago, the Robert Wood Johnson Foundation, the nation’s largest philanthropy focused exclusively on health and health care, analyzed 11 major studies on the effect of tort reforms on malpractice insurance rates. It found that despite dramatic caps on pain-and-suffering awards, much lower fees for lawyers and obstacles to bringing cases to trial, insurance premiums still increased in states that had implemented tort reform.

7. Medical societies know exactly what to do to improve patient safety.

And the right-thinking ones have done it. The American College of Obstetrics and Gynecology (ACOG) isn’t one of those, as the Forbes story and PopTort demonstrated. Said Steve Pegalis, a professor at New York Law School:

ACOG is a political organization pretending to be an educational organization. Over 10 years they’ve appointed two major committees to address the related problems of sentinel events and costly lawsuits. And twice the committee has come back with recommendations that were purposefully ambiguous. They were designed to aid in the defense of lawsuits, not help doctors identify dangerous situations during childbirth.

Even one of their own, an ACOG committee member who was frustrated about ambiguous recommendations, told a reporter, “It is intended for litigation.”

ACOG was the centerpiece of the Forbes story, and PopTort concluded its analysis with this telling passage in which Cohen quoted Tom Moore, the attorney who represented the family in a case of negligence resulting in the birth of a girl with severe brain damage:

But the most infuriating part is that they knew they were in the wrong years ago. They knew it (A) when it first happened. They knew it (B) when they first offered $8 million to settle the case. And they knew it (C) between the first and third trials when they never offered this victim a dime. And they still won’t end it.”
“… They won’t allow this poor child get the therapies she so desperately needs. She could have been getting help all this time, making even more progress.

Cohen concluded the story by asking, “What will it take to get ACOG to shift from a purposefully ambiguous mindset to one that is centered on patient safety? …Perhaps this article will be the first rumblings of an avalanche that will lead to greater patient safety in obstetrics.”

You know when a professional association recommends doing fewer procedures for which its members get paid, there’s probably a good reason. That’s the case with delivering a child by cesarean section.

The American Congress of Obstetricians and gynecologists (ACOG) recently called on its members and all medical practitioners to stop doing so many C-sections. As explained by the Associated Press (AP), new guidelines direct doctors to give otherwise healthy women more time to deliver their babies vaginally before assuming that labor has stalled.

It’s the latest news in a years-long effort to prevent unnecessary C-sections, which have become increasingly popular, often for reasons of convenience more than good medicine.

According to the Centers for Disease Control and Prevention (CDC), nearly 1 in 3 women in the U.S. gives birth by cesarean.

Sometimes, the procedure is necessary to save the life of the mother or the baby. Sometimes, it’s necessary because labor was unwisely induced with oxytocin (Pitocin), a hormone that stimulates uterine contractions. Sometimes, it’s a matter of parents trying to squeeze child birth into the schedule of life events. And sometimes, it’s about doctors fearful of being sued if someone thinks they waited too long for vaginal delivery.

In crafting the guidelines, ACOG and the Society for Maternal-Fetal Medicine found that a primary reason for a first-time C-section is labor that’s progressing too slowly. But slow is not the same as troubled, at least not always. Performing a C-section has definite risks, and the procedure greatly raises the chances of a subsequent pregnancy also ending in a C-section. Like any surgery, if it isn’t medically necessary, it’s a bad idea.

As noted in our C-section backgrounder, the risks of C-section include premature delivery (thanks to Pitocin); injury to the mother’s ureters (tubes that carry urine from the kidneys to the bladder), bowels or other pelvic organs; a higher likelihood of uterine rupture in future pregnancies.

Common sense and a reordering of priorities is the best defense against parents whose timetable is more important than good health care, but in the case of obstetricians overly concerned about making mistakes, well, these guidelines are the latest “best evidence” that labor can take longer than you want. Provided the practitioner is monitoring the mother and the fetus for serious distress resolved only by surgery, being sued for making a waiting mistake isn’t a reasonable concern.

”Labor takes a little longer than we may have thought,” Dr. Aaron Caughey told AP. He’s a co-author of the guidelines.

Caughey told AP that when it comes to labor, every woman is different. ”My patients ask this every day,” he said, and that the answer can ”run the gamut from six hours long, start to finish, to three and four days,” and any woman who endures that should win a medal.

Complicating the answer to “when is a long time too long a time?” is that the art of assessing the progress of labor might have advanced since many doctors learned about the different stages of labor in medical school.

According to the AP, a study from the National Institutes of Health in 2012 found that one stage can take 2½ hours longer now than it did in the 1960s, when many labor definitions were set.

That might be because today’s mothers are older and weigh more, but also because of changes in obstetric practice, such as more use of pain medicine, which can slow labor.

Considering these changes and the world we live in, for pregnancies that involve otherwise low-risk mothers and fetuses:

• Obstetricians should not order a C-section just because the first and longest phase of labor is prolonged. That’s when contractions are mild and far apart, and the mother’s cervix is barely dilated. Doctors used to consider it stalled if it lasted longer than 20 hours for a first-time mom, or 14 hours for returning mothers.
• Obstetricians should consider that “active labor” begins later than once thought – not until the cervix is dilated 6 centimeters instead of the outdated 4 centimeters. That’s when contractions become stronger and more frequent, and the cervix begins to dilate more rapidly until the woman eventually is ready to push.

  It’s a key change because many doctors won’t admit women to the hospital until they’re in active labor, unless they need more care for another reason.

• Obstetricians should allow women, if they’re not too tired, to push at least two hours if they have delivered before, three hours if it’s their first baby. They may push longer if they had an epidural (pain medicine), as long as the doctor can see progress.
• Obstetricians should consider using forceps as a safe alternative to certain cesareans if they’re used by an experienced, well-trained physician. Few physicians today undergo the training.

Find out what a doctor’s cesarean rate is before choosing an obstetric practice. Discuss vaginal delivery versus C-section with your obstetrician long before your due date. Ask if he or she is familiar with the new guidelines, and what he or she considers as “normal labor.”

Long before you’re in the delivery room, you should know how the doctor supports women in labor, what he or she considers too long and agree about both. If your doctor says labor has stalled, ask if either you or the baby is in danger if you continue waiting.

No one wants to prolong labor. But neither does anyone want an adverse outcome, for this pregnancy or one you’re yet to experience.

Tragic cases of babies being born with brain damage do happen because of malpractice by either the doctor or nurses in not carefully monitoring the baby’s heartbeat and responding quickly when the baby shows signs of distress from not getting enough oxygen. These are the types of situations the Patrick Malone law firm confronts each year. Our firm website has extensive resources for parents of children with birth injuries.

Last week we blogged about the growing awareness of the wisdom of letting pregnant women take their time in labor, instead of rushing them into a cesarean section. This week, there’s more good news on the child delivery front: Hospitals are cutting down on early deliveries.

As reported in the Los Angeles Times, pressure from employers, government officials and patient-safety advocates has prompted hospitals to dissuade women from choosing to deliver early, in favor of waiting for nature to take its course. Last year, deliveries before 39 weeks without a medical reason numbered about 4.6 in 100; in 2010, the ratio was 17 in 100.

The survey of nearly 1,000 U.S. hospitals was sponsored by The Leapfrog Group, a nonprofit organization of businesses that promotes high-quality, cost-effective health care that we’ve mentioned before, primarily in blogs about hospital ratings.

Delivering a child early when there’s no medical reason to do so is a bad idea for several reasons. Potential complications for the baby include breathing and feeding problems, and infections. According to The Times, the rate of infant mortality in the first year increases by half for such early births compared with full-term babies.

Many parents, as we noted last week, schedule delivery for their convenience, which raises the probability of a cesarean section. Like all surgeries, C-sections present the risk of complications, in this case for the mother. And they’re expensive – it’s estimated that unnecessary early C-sections increase health-care costs by as much as $1 billion every year.

Leapfrog would like to see a hospital’s ratio of early deliveries at around 5 in 100; about 1 in 3 of the hospitals in its survey were above that, some by a significant margin. (Link to the Leapfrog report here to see how your hospital delivered the delivery numbers.)

But the overall result is one of what seems like few positive developments recently in health care. As The Times wrote, “[T]he swift improvement overall stands out compared to efforts to fix other long-standing quality and cost problems inside hospitals. Despite public attention and industry efforts, the incidence of medical errors, preventable infections and readmissions often remains stubbornly high.”

Leapfrog was instrumental, it seems, in prompting the change. It began publicly reporting maternity data several years ago, and now, under the patient safety promise of the Affordable Care Act (“Obamacare”), such data is being collected from hospitals nationwide.

The scrutiny, says The Times, has prompted many hospitals to adopt “hard-stop” policies that prohibit doctors from scheduling deliveries earlier than 39 weeks if there is no medical reason.

Health insurers, of course, are also players here, because it hits them in the wallet. Some insurance plans and government health programs won’t pay for early-elective deliveries.

And money is the reason why some hospitals are reluctant to adopt the best practice of full-term delivery: Leah Binder, chief executive of the nonprofit Leapfrog, said some hospitals are slow responders because admissions to the neonatal-intensive-care unit (NICU) and longer stays there boost the bottom line. (You can view data on individual hospitals on the Leapfrog website.)

The medical science is indisputable, but the cultural response lags. The Times interviewed Dr. Parissa Moradi, an ob-gyn at a Los Angeles ambulatory care center, who said that as many as 1 in 5 of her expectant mothers ask for early “social” deliveries.

“It’s mostly because they get tired of being pregnant,” Moradi told the paper. “I personally don’t like to do social deliveries before full term. I tell them all the risks involved and they can go somewhere else.”

Dignity Health, a large national hospital chain, adopted a “hard-stop” policy in 2012. Its rate of early-elective deliveries went from 7 in 100 in 2011 to less than 1 in 100 the next year. Dr. Robert Wiebe, Dignity’s chief medical officer, told The Times that because obstetricians usually aren’t involved in newborn care, many “don’t always know the consequences of early-elective delivery or they underestimate the risk.”

That seems a bit too compartmentalized, at best, and disingenuous at worst.

But Wiebe did say that sometimes doctors could be as much a part of the early-delivery problem as patients. He said it had been common for some to move up delivery dates to accommodate their travel schedules. And that their patients would be OK with that because they had developed a strong bond with that doctor.

“They are all seemingly legitimate reasons on the surface,” Wiebe told The Times, “but if you understand the risk to the baby it’s not the right thing to do.”

No, it’s not. And it’s deeply gratifying to know that more and more people understand that.

No matter how hard medical experts and other promoters of good, safe health care try, it seems, there are always loud voices chiming in from the fringes of ignorance to offset their message.

A few weeks ago, in a blog about obstetricians recommending that women not be rushed into induced labor and also calling for fewer cesarean sections, we revisited the dangers of unnecessary C-sections, and noted that nearly 1 in 3 U.S. women give birth via C-section.

But when Dan Murphy, second baseman for the New York Mets, missed the first two days of the Major League Baseball season, he was berated, belittled and bullied by Mike Francesca and Boomer Esiason, two hosts on New York’s WFAN sports radio. Bad enough that these mic jocks called out Murphy because they believe it’s a higher priority to play a game than it is to attend the birth of your child and support its mother, but, worse, they promoted the idea of planning that birth – by cesarean – for the convenience of your schedule, not the baby’s.

As recounted on, among other news sites, NYDailyNews.com, Francesca mocked MLB players’ collective bargaining agreement giving them three games off for paternity leave, calling it a “scam” and a “gimmick.”

“One day I understand,” Francesca said. “And in the old days they didn’t do that. But one day, go see the baby be born and come back. You’re a Major League Baseball player. You can hire a nurse to take care of the baby if your wife needs help. … What are you going to do? I mean you are going to sit there and look at your wife in a hospital bed for two days? Your wife doesn’t need your help the first couple of days; you know that you’re not doing much the first couple days with the baby that was just born.”

His colleague Esiason piled on the mindlessness, saying Murphy should have insisted his wife “have a C-section before the season starts. I need to be at Opening Day, I’m sorry.”

Sigh. If this was intended as a joke, it fell a bit flat.

Wiser minds have tried for years to prevent unnecessary C-sections, which often are performed purely for reasons of convenience. As we’ve noted in our C-section backgrounder, the risks include:

• injury to the mother’s ureters (tubes that carry urine from the kidneys to the bladder), bowels or other pelvic organs;
• a higher likelihood of uterine rupture in future pregnancies.

There are also risks to the baby, including:

• breathing problems;
• heart disorders;
• anemia;
• bleeding in the brain.

It’s disheartening when people blessed with a bully pulpit use it for misguided and dangerous purposes. But it’s also uplifting when others stands up. According to the Daily News story, Mets General Manager Sandy Alderson, said, “The paternity-leave policy was introduced not just for the players’ benefit, but recognition by clubs in contemporary times that this is an appropriate time for parents to be together. So I’ve got absolutely no problem whatsoever with Murph being away. I think the delivery was a little earlier than expected, but those things you don’t control.”

And Murphy apparently told ESPN that he can handle the negative blowback from the Neanderthals among us. He’s fine with his decision, and his priorities. And no one should criticize his work ethic – he missed only one game during the entire season last year.

The FDA has issued new regulations for prescription drug and medical product manufacturers to better communicate potential risks to women who are pregnant or breastfeeding, and people who are concerned about fertility.

The new rule, according to an FDA news release, “sets standards for how information about using medicines during pregnancy and breastfeeding is presented in the labeling of prescription drugs and biological products. The new content and formatting requirements will provide a more consistent way to include relevant information about the risks and benefits of prescription drugs and biological products used during pregnancy and breastfeeding.”

Lots of people have been waiting a long time for the new rules. As explained on AboutLawsuits.com, for years the feds have used a letter category system – A, B, C, D and X – to describe the risks of drugs and biological products to pregnant women and their doctors. But it was a clunky, insufficient explanation of what patients needed to know in order to make informed decisions.

So the final rule is more complete. Instead of letters, there are narrative sections covering drug and biological product labels, which are broken down into sections on pregnancy, lactation and reproductive potential for both females and males.

“Prescribing decisions during pregnancy and lactation are individualized and involve complex maternal, fetal and infant risk-benefit considerations,” said Sandra Kweder in the news release. She’s deputy director of the Office of New Drugs in the FDA’s Center for Drug Evaluation and Research. “The letter category system was overly simplistic and was misinterpreted as a grading system, which gave an over-simplified view of the product risk. The new labeling rule provides for explanations, based on available information, about the potential benefits and risks for the mother, the fetus and the breastfeeding child.”

The subsection on pregnancy provides information about potential risks to a developing fetus, dosing information and information about pregnancy registries that might gather information on how the drug has affected pregnant women in the past.

Under lactation, there’s information about a drug’s potential effects on breast milk and children who drink it.

The fertility section concerns how a drug might affect contraception, fertility and pregnancy testing.

According to the FDA, there are more than 6 million pregnancies in the U.S. every year, and pregnant women take an average of three to five prescription drugs during pregnancy. Women who have asthma, high blood pressure or other conditions before they get pregnant might need to continue using prescription drugs to treat those conditions, so they need to know the risks.

Women also might need medicine to treat new or acute conditions that occur during pregnancy or breastfeeding.

As explained on AboutLawsuits, the new rule will affect many drug labels, some of which the FDA and scientists have struggled to classify in terms of their potential pregnancy risks. In many cases, the risks are inconclusive, or yet to be determined. One goal of the new regulation is to illuminate the state of this research.

According to AboutLawsuits, pregnant women and their doctors have been concerned primarily with two classes of drugs – antidepressants, and epilepsy drugs.

Many antidepressants are in a class of medications called selective serotonin reuptake inhibitors (SSRIs). They include Zoloft, Paxil, Prozac, Celexa, and Lexapro. Antidepressant side effects have been associated with an increased risk of birth defects, miscarriage and problems in the children, such as asthma and autism.

But if a woman is depressed and pregnant, and doesn’t treat her mental disorder, the fetus can be at risk as well as the woman.

Antiseizure meds like Depakote and Topamax also might pose a risk of birth defects and developmental problems. But not taking those drugs if you need them puts both mother and developing fetus at physical risk if epilepsy is uncontrolled during pregnancy.

So doctors and patients must figure out whether or not to use these drugs, and if so, how much and for how long. Letter designations aren’t helpful in this analysis, but a summary of the current data or research might be.

One supporter of the new rule is the nonprofit organization MotherToBaby.org. It provides evidence-based information to mothers, health-care professionals and the public about medications and other exposures during pregnancy and while breastfeeding.

“There will be a steep learning curve for clinicians and patients to feel comfortable with more detailed information as opposed to the simple letter category,” said Christina Chambers, director of UC San Diego’s Center for the Promotion of Maternal Health and Infant Development, where the organization conducts pregnancy studies. “The MotherToBaby toll-free service can help.”

You can receive a personalized risk assessment of drugs or other exposures from MotherToBaby’s expert phone counseling service at (866) 626-6847. The organization also is conducting pregnancy research studies about asthma, autoimmune diseases and vaccines. To learn more or to volunteer for a study, call the number above or link to MotherToBaby.org and click on the “Research” tab.

Of all the medical mistakes that could be made in the first hours of a newborn’s life, few lay people would think to attribute any of them to a delay in naming the infant. But neonatologists (doctors who treat ill or premature newborns) know that the unnamed wee ones under their care are more likely to be on the receiving end of a medical error.

When a baby is born and the parents are still dithering about what to call him or her, hospitals use a generic gender descriptor on the patient bracelet – Babygirl Smith, for example. Once the kid is entered into hospital records with that ID, it’s often there until the baby is discharged, even if he or she gets a real name in the meantime.

A study in Pediatrics conducted by researchers aware that such anonymity can invite problems tested a new naming method to see if it reduced potential errors.

As reported on NPR, it’s believed that generic baby names increase the risk of the wrong treatment being given to the wrong patient, especially if the baby is in the neonatal intensive care unit, where about 12 in 100 newborns land.

The neonatal ICU, or NICU, is filled with tiny, often fragile beings requiring complicated care. According to the study’s lead author, Dr. Jason Adelman, an internist and patient safety officer at Montefiore Health System in New York, “All neonatologists know [generic naming] is a problem, but weren’t able to quantify it.”

His team changed naming convention by using a real first name – the mother’s. Instead of Babygirl Smith, that baby would get the ID Donnasgirl Smith. Twins would be 1Donnasgirl Smith and 2Donnasgirl Smith instead of the standard BabygirlA and BabygirlB.

Researchers compared the rate of so-called retract-and-reorder (RAR) events in the years before and after implementing the new ID system. “Retract-and-reorder,” NPR explained, “is a tool that uses the hospital’s computer system to flag medical orders retracted by a health-care worker and then placed by the same worker on a different patient within a short time period.”

The study showed that RAR events declined by more than one-third in the year after the intervention compared with the earlier period.

That doesn’t prove that the new ID system is superior to the old one, but it’s food for hospital thought to consider revising clinical practice.

Keep in mind that the RAR tool does not track medical errors, just close calls. As Dr. Gautham Suresh, a neonatologist not involved in the study explained to NPR, “Say I’m driving down the highway and I almost take the wrong exit but then swing back into the right lane and take the correct exit later. RAR is catching those times when I almost took the wrong exit.”

The researchers also noted that RAR slightly over-reports wrong-patient errors because it includes some false positives. That’s when a test indicates something amiss that leads to more tests and the possibility of complications (such as infection) when, if nothing had been done in the first place, no harm would have occurred.

Although his study analyzed only computerized orders, Adelman said the new naming system has the potential to lower the rate of other kinds of errors, some as simple as taking the wrong container of pumped breast milk from the refrigerator.

Suresh said the study advanced the body of knowledge, but he didn’t go as far as to advise that the new ID system be widely implemented. But he did advocate for further attention to the traditional way babies are named in the hospital, and noted that other factors contribute to wrong-patient mistakes, such as human distraction or poor lighting. “Patient identification errors are complex, and the name is only part of the puzzle,” he says.

The simplest way to avoid them, of course, is to figure out what to call your kid before he or she arrives. Come on, mom and dad … it’s not as if Baby has a vote.

Few states are monitoring, much less acting to protect, patient-consumers from one of the hot trends in today’s health care: the mergers, acquisitions, consolidations─and yes, closings─that are creating super-sized hospital organizations, chain-institutions that for business reasons seek greater efficiencies but also may be lessening access to care, sometimes as a result of religious reasons.

That’s the contention of a group called mergerwatch.org, which arose from a group of New York state family planning advocates who reacted when two hospitals, one Catholic and the other secular, merged, and reproductive services became a contentious issue in the new institution.

The group since has scrutinized hospital mergers, consolidations, and closings nationally, issuing a new study from its “When Hospitals Merge” project─an initiative that has been foundation supported and has published in peer-reviewed, respected medical journals like the AMA Journal of Ethics.

There’s insufficient evidence of the health benefits for millions of women who aren’t pregnant and who aren’t experiencing problems to undergo regular pelvic exams, a top federal task force on preventive care says.

Tens of millions of women get the exams each year, even though they are intrusive and uncomfortable. More important, research has failed to demonstrate that the procedure prolongs women’s lives or decreases their chances of developing illnesses like ovarian cancer, the influential U.S. Preventive Services Task Force has advised.

The group and other medical organizations in recent years have applied rigorous, evidence-based research to common, and seemingly common-sense tests and exams. They have found, as the online news site Stat says, that regular screening mammograms, annual PSA prostate tests, and yearly physicals “have little basis in science and fewer benefits that once thought.”

“Skin to skin” therapy? That was the line item charge that appeared on the hospital bill for a young couple, and the dad decided to check it out. What he found has blown up across the Internet.

It turns out that the Utah parents were charged $ 39.35 by their hospital just so the new mom and dad, just after the C-section delivery of their son, could have their baby placed between her neck and chest. There, proud pops took the requisite newborn pictures.

Only later, as part of $13,280.49 tab for their son’s delivery, did the couple see the skin to skin charge. They posted the bill on a popular online site, where it drew more than 11,000 comments.

Although awareness has grown about viruses  like Zika that can devastate the unborn, cytomegalovirus (CMV), a much more common and equally harmful prenatal viral  infection, doesn’t get discussed with pregnant moms as much as it should. Medical counseling, testing, and administration of anti-viral medications could save more babies and their families from a lifetime of CMV woes.

More than half of adults older than 40 and one in three children by the age of 5 have been infected with CMV, a common virus in the herpes family. An estimated 1 in 150 babies gets infected at birth with CMV, with 1 in 5 of these infants sickened or harmed, including with hearing loss, microcephaly (a deformity so they have tiny heads), intellectual deficits or impaired vision.  This means CMV seriously harms as many as 8,000 youngsters annually across the United States, and it is fatal for about 400 infants.

Affected families and medical experts have told the New York Times that more needs to be done to increase CMV awareness, testing, and prevention, especially in comparison to the public health attention that has been paid to Zika and the damage it may inflict on the unborn.

Modern medicine isn’t addressing women’s distinctive health care needs as optimally as needed, with research further showing it may be time to dial down expectations about breast cancer screening, while heightening physicians’ awareness and best practices in eliminating gender biases.

Women also may want to keep close tabs on how changes with the Affordable Care Act affect them, and they may be well-served to remind themselves about Texas’ sudden surge in maternal deaths and one of health care’s major, gender-based debacles in hormone treatments for females.

Over-treatment tied to mammograms

Although marijuana is marching toward legalization across the United States, expectant moms may wish to think long and hard still about smoking or ingesting a substance that has become as ubiquitous in some households as aspirin or a bottle of chardonnay. The New York Times has delved into this discussion, even as other news outlets recently have provided parental warnings about hype over apps for baby care and tossing some toxic homeopathic teething remedies.

Pot? Not for expectant moms

Let’s turn first, and not be blue noses about it, to why moms would consider pot while pregnant. Data show that few do (an estimated 4 percent of more than 200,000 women in one 12-year sample — though the number had doubled in recent time). For younger women, the answer may be, just because. They don’t equate it with risk but with recreation. They say they try to be cautious with it, just as they might curtail their alcohol consumption but still have a rare drink. Older and expectant moms may use pot, as many women do, because they find it helps with depression, anxiety, stress, pain, nausea and vomiting.

A new investigation of one of the great shames of American medical care raises big questions about why labor and delivery is more dangerous to new mothers in the U.S. than just about anywhere else in the civilized world.

To their considerable credit, National Public Radio and Pro Publica, a Pulitzer Prize-winning investigative news site, have joined forces to examine why 700 to 900 American women die each year from pregnancy related causes, and 65,000 nearly die.

The news organizations say Americans are “three times more likely to die in childbirth than women in Canada, and six times more likely than Scandinavian women.” And while U.S. maternal deaths are rising, their numbers were plunging in developed countries from England to South Korea.

Health officials caught expectant mothers, local politicians, and the D.C. community off guard by ordering the only full-service hospital in the southeast part of the District of Columbia to stop delivering babies and to shut its nursery for 90 days.

Details weren’t provided as to why D.C. regulators slapped restrictions on United Medical Center’s obstetrics and nursery care license. The hospital itself has acknowledged that at least three incidents, which it says it cannot discuss due to rigorous federal patient privacy rules, prompted the official rebuke.

This shutdown provides a harsh reminder just how little the public gets to know about important issues affecting doctors, hospitals, and patient safety and quality care.

It can be too easy to forget the unfortunate, inequitable legacy of the Old South, especially how racist Dixie created stark racial health disparities. But sometimes a foreigner’s jab in the ribs can remind us how making America great again could mean tending much better to our collective p’s and q’s in public health, especially so poor, rural people of color don’t get tropical parasite infections and they do get reasonable access to critical maternal care.

The Guardian, a British news outlet, has pointed out that new, published research shows a disgusting resurgence in Americans, notably in Alabama, testing positive for hookworms, a debilitating “gastrointestinal parasite that was thought to have been eradicated from the U.S. decades ago.”

As the Guardian reports:

Elmo and the Colonials won’t make it as a new Saturday morning hit cartoon show. But the colorful characters might play a tangential part in some important lessons for consumers and some supposedly serious institutions on preserving the public trust in published, medical-scientific research.

Healthnewsreview.org, a nonprofit and independent watchdog of health information, rightly has taken George Washington University to task for issuing a Pollyannaish, inaccurate news release on a Colonials’ study on whether text messages could help curb expectant moms’ smoking. The hype from the school, about research from GWU’s Milken Institute School of Public Health, first proclaimed:

Text messaging program may help pregnant women kick the smoking habit

Even as District of Columbia officials struggle with deepening woes at the United Medical Center (UMC), advocates from a national, independent, and nonprofit group have offered a dim review of hospitals in the DC area.

The bad news keeps piling on at UMC, a leading provider of medical care for communities of color in the District’s Southeast area and in Prince George’s County, Md.

To its credit, the sometimes locally slumbering Washington Post has put out a disturbing, well-documented report about the death of a 47-year-old HIV-AIDS patient in UMC’s nursing home care. As others witnessing the scene clamored for them to help, UMC nurses, the Post says, let the patient fall to the floor, where he sprawled in his own waste for 20 minutes while his caregivers argued with a security guard. When the patient finally was returned to his bed, he was dead.

The bad news for expectant black moms isn’t confined to those living in the nation’s capital: A new investigation has found higher risks of harm for women in New York, Florida, and Illinois when they deliver at hospitals that disproportionately serve black mothers.

ProPublica, a Pulitzer Prize-winning investigative site, analyzed two years of hospital inpatient discharge data from the three states to “look in-depth at how well different facilities treat women who experience one particular problem — hemorrhages — while giving birth.” Reporters found negative patterns that underscored big woes identified by other research before:

[B]lack women … fare worse in pregnancy and childbirth, dying at a rate more than triple that of white mothers. And while part of the disparity can be attributed to factors like poverty and inadequate access to health care, there is growing evidence that points to the quality of care at hospitals where a disproportionate number of black women deliver, which are often in neighborhoods disadvantaged by segregation. Researchers have found that women who deliver at these so-called ‘black-serving’ hospitals are more likely to have serious complications — from infections to birth-related embolisms to emergency hysterectomies — than mothers who deliver at institutions that serve fewer black women.