High rate of C-section births is health concern for women

By SARA L. AINSWORTH
GUEST COLUMNIST

Washington's extraordinarily high rate of Caesarean-section deliveries, reported Aug. 22 in the P-I, raises alarms for those who care about women's reproductive health and patients' rights.

Both the law and respect for women's humanity require that every pregnant woman be fully informed of the risks of all forms of labor and delivery in a language she can understand; that she be supported in her decisions about how to bring her children into the world, whether it be in a hospital, a birthing center or at home; and that she not be penalized for those decisions either medically or legally.

In addition to the potential health risks of the surgery, women who have C-sections face consequences that even conscientious health care providers may not recognize or discuss with their patients.

In many parts of this state, having one C-section delivery will require another at a subsequent birth, even over the objection of the pregnant woman and her doctor. Several Washington hospitals refuse to allow doctors to provide labor and delivery services to pregnant women who have had a previous C-section unless those women submit to a second C-section delivery.

Those hospitals claim they cannot allow those women to have the same care they provide to all other pregnant women because the small additional risk of uterine rupture requires an anesthesiologist on staff 24 hours per day. It is difficult to credit this claim, given that most if not all of those hospitals have emergency departments open 24 hours per day, and that other pregnant women are also at risk of complications during labor and delivery that may necessitate emergency surgery.

Frequently, there is no alternative hospital within a safe distance, or the pregnant woman's insurance (or lack thereof) limits her ability to seek care at another location. A pregnant woman must either submit to a subsequent C-section, whether she thinks it is a wise medical decision or not, or deliver her baby outside the hospital. For those women who do not want a home birth, or who cannot have one because of lack of health insurance coverage or lack of available midwives within a safe distance of home, this is coercion, not consent.

Insurance practices also harm women who have had C-section surgeries. The New York Times recently reported that health insurance companies have denied coverage to women who have had C-section deliveries, calling the surgery a "pre-existing condition." And here in Washington, midwives struggle to obtain insurance that will cover their care for women who have had a previous C-section.

Policies and practices that force pregnant women to submit to unnecessary surgery cannot be justified. We would never countenance that practice for any other patient. Pointing to potential risk to the baby does not justify ignoring the mother's decisions about her medical care.

Such reasoning inappropriately views a pregnant woman's decision about her and her baby's needs as suspect, and it ignores her legal rights as a patient. All pregnant women, whether they view birth as a natural event only rarely needing medical intervention, or whether they willingly accept medical assistance with the birth process, have the legal right to informed consent and to direct the experience of bringing their children into the world.

Sara L. Ainsworth is senior legal and legislative counsel at Northwest Women's Law Center.

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Amendment 48: It's dangerous to women

Imagine a law declaring that, upon becoming pregnant, a woman loses her right to bodily integrity, life and liberty. Such a law has been proposed in Colorado, a so-called "human life amendment" to the state constitution declaring that the term "person" includes "any human being from the moment of fertilization."

According to Kristi Burton, the spokeswoman for Amendment 48, it's about "the power of truth." The truth, however, is that this amendment will be devastating to pregnant women and dangerous for both maternal and fetal health.

Constitutional law ensures that people — including pregnant women — have the right to make their own health-care decisions. Yet, it is clear that if fetuses are recognized as legal persons, pregnant women could very likely lose these constitutionally protected rights. That's because laws like this one enable the state to intervene in pregnant women's lives.

For example, in Washington, D.C., doctors sought a court order to force Ayesha Madyun to have a C-section, claiming the fetus faced a 50 to 75 percent chance of infection if not delivered surgically. The court said, "All that stood between the Madyun fetus and its independent existence, separate from its mother, was — put simply — a doctor's scalpel." With that, the court granted the order. When the procedure was done, there was no evidence of infection.

In Florida, Laura Pemberton wanted to have a vaginal birth after a previous C-section. Her doctors believed that her fetus had a right to be born by a C-section. A sheriff came to her house, took her into custody while she was in active labor, strapped her legs together and forced her to go to a hospital, where they were holding a hearing about the rights of the fetus. A lawyer was appointed for her fetus but not for her. She was forced to have a C-section. Pemberton subsequently gave birth vaginally to four more children, defying the medical and court predictions of harm.

In each case, state intervention was based on the claim that fetuses had separate legal rights — exactly the ones Amendment 48 would establish in Colorado. But these forced interventions or deprivations of liberty did not actually protect mothers or babies.

If the amendment passes, Colorado's juvenile courts will have jurisdiction whenever doctors or family members disagree with a pregnant woman's medical decisions. A woman's right to bodily integrity, due process, and even life itself will disappear in the face of fetal personhood claims.

To oppose the recognition of fetal personhood as a matter of state constitutional law is not to deny the value of potential life as matter of religious belief, emotional conviction or personal experience. Rather, it is to recognize that rewriting the state constitution to include human beings from the moment of fertilization is to exclude women from the moment they become pregnant.

L. Indra Lusero is LUZ Reproductive Justice Think Tank J.D. Candidate, University of Denver School of Law, and Lynn M. Paltrow is executive director of National Advocates for Pregnant Women.

New Survey Reveals Women Are Unaware of the Dangers of Surgical Adhesions

Red Bank, NJ - Although more than half of the country's women will have some type of pelvic surgery and are therefore at risk for surgical adhesions, a survey released this month by the not-for-profit National Women's Health Resource Center (NWHRC) finds that women are largely unaware of the health risks associated with adhesions.

Surgical adhesions occur when tissue in the abdominal cavity adheres, or gets stuck to other tissue. Adhesions commonly form following pelvic surgeries, such as hysterectomy, tubal ligation, cesarean section, and cyst removal. Left untreated, adhesions can cause infertility, abdominal pain, and bowel obstruction.

The survey of 1,000 women showed respondents strongly believe women should be informed about surgical adhesions prior to surgery (69%). Conversely, an overwhelming majority of women (80%) who had pelvic surgery were not informed about adhesions prior to their surgery. Of the women in the survey who suffer from adhesions, seven out of ten (70%) say they would have taken special precautions to protect themselves from getting adhesions if they had been aware of possible adhesion-related complications.

Susan Jones*, a human resources director and mother of three from McLean, Virginia, has experience with the long-term effects adhesions can have on a person's health. All of Jones's children were delivered by cesarean section. Due to adhesions caused by these three surgeries, she suffers from reoccurring abdominal pain and has been advised not to have any more children because of the increased difficulty of delivering a baby surrounded by such a large amount of scar tissue.

"My first c-section only took about 10 minutes for the doctor to get the baby out," said Jones. "My second c-section took nearly 45 minutes and my final c-section took nearly an hour and a half. My doctor had such a hard time maneuvering around the scar tissue to get to my baby."

"If I had known about adhesions," continued Jones, "I would have talked to my doctor about what can be done to reduce my risk for getting them."

Like Ms. Jones, half (51%) of survey respondents were not aware that preventative measures can be taken to lower your risk of adhesions and an even higher proportion (68%) of women that had undergone surgery did not know if their surgeon took specific steps to guard against adhesions.

"Preventive measures to reduce the incidence of adhesions are the mainstay of limiting the complications related to adhesions," stated Dr. Glenn Schattman, Associate Professor of Obstetrics and Gynecology at the Weill Medical College of Cornell University. "These include using minimally invasive surgical procedures, meticulous surgical technique, keeping tissues moist, reducing bleeding and the use of adjuvant adhesions prevention barriers to keep the tissues from sticking to each other."

"It's important to understand that once adhesions form, they are hard to get rid of," continued Dr. Schattman. "Adhesions can cause blockages of the intestines, fallopian tubes causing infertility and pain."

When faced with pelvic surgery, women said they were most concerned about short-term surgical issues such as the general recovery process (60%), immediate surgical results (59%) and post surgical pain (59%).

"Along with their immediate post-surgery concerns, women need to make adhesions part of the pre-surgery dialogue with their health care provider," stated Elizabeth Battaglino Cahill, RN, executive vice president of the NWHRC. "We hope that this adhesion awareness campaign can give women the tools they need to understand the health risks of adhesions and how to protect themselves from this life-long internal scarring."

To provide women the information they need about ways to minimize the risk of surgical adhesions, the NWHRC has developed a one-page fast facts on adhesions and an in-depth Guide to Preparing for Gynecologic Surgery. The guide includes sections entitled:

• All About Adhesions
• Preparing for Surgery Checklist
• Choosing a Surgeon
• After Your Surgery

To download your complimentary online copy of the Guide to Preparing for Gynecologic Surgery, "Fast Facts for Your Health: Pelvic Adhesions" or to learn more about the adhesion survey, please visit NWHRC's award-winning Web site, www.healthywomen.org. The survey and campaign materials were made possible through support from Ethicon Women's Health & Urology, a division of ETHICON, Inc.

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Popular Supplements Glucosamine and Chondroitin No Good for Arthritis

Popular dietary supplements – glucosamine and chondroitin sulfate – proved no better than placebos in treating people suffering from osteoarthritis, a two years study published in the journal Arthritis & Rheumatism revealed.

The study is a follow-up to a large 2006 National Institutes of Health-funded study, which was designed to look whether supplements did a better job than sugar pills or the arthritis pain medication Celebrex in reducing pain in osteoarthritis patients. But the study found no improvement in those given supplements. The study was called GAIT (Glucosamine/chondroitin Arthritis Intervention Trial) and was published in the New England Journal of Medicine in 2006.

At the end of the study, the researchers continued to watch 572 volunteers for another 18 months and found the supplements did not appear to slow the loss of cartilage, taken either alone or together. More exactly, arthritis worsened in 24 percent of participants taking both, similar to those taking placebo.

“We don’t have good evidence that it (glucosamine and chondroitin sulfate combination) slows (disease) progression,” rheumatologist Allen Sawitzke, professor of internal medicine at the University of Utah and head investigator, said.

The study comes like a slap in the face of supplements’ makers. The combination glucosamine – chondroitin sulfate is the sixth-top-selling dietary supplement in the United States, with annual sales of $831 million last year, according to the “Nutrition Business Journal.”

However, Dr. Sawitzke said he would neither encourage nor discourage patients from taking the supplements.

"We didn't run into safety issues, so if a patient wants to try them, I don't see a reason to say no. But I can't recommend it; there's no supportive data that says it works," he said.

According to the most recent figures made public by the Arthritis Foundation, osteoarthritis, the most common form of arthritis, currently affects 27 million of the 46 million people in the United States with arthritis. In addition, one in two Americans are at risk for knee osteoarthritis over their lifetime.

Osteoarthritis (OA), also called osteoarthroses or degenerative joint disease, is the most common type of arthritis. OA is a chronic condition characterized by the breakdown of the joint’s cartilage. Cartilage is the part of the joint that cushions the ends of the bones and allows easy movement of joints. The breakdown of cartilage causes the bones to rub against each other, causing stiffness, pain and loss of movement in the joint. OA typically affects only certain joints, such as the hips, hands, knees, low back and neck. After the age of 50, women are more often affected by OA than men. There are not known cause of OA but certain factors such as heredity, overweight, joint injury, repeated overuse of certain joints, lack of physical activity, nerve injury and aging increase the risk of developing OA.

Arthritis and related conditions, such as OA, cost the U.S. economy nearly $128 billion per year in medical care and indirect expenses, including lost wages and productivity.

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FDA: No Lou Gehrig's disease risk with statins

An analysis of dozens of studies found the widely used statin cholesterol drugs do not increase the risk of Lou Gehrig's disease, U.S. health officials said on Monday.

The U.S. Food and Drug Administration said it reviewed 41 long-term controlled clinical trials after receiving a higher- than-expected number of reports of Lou Gehrig's disease, or amyotrophic lateral sclerosis, in patients who were treated with the cholesterol-lowering drugs.

Millions of people around the world take statins, including Pfizer Inc's Lipitor and AstraZeneca Plc's Crestor.

FDA researchers found that nine out of about 64,000 patients treated with statins were diagnosed with ALS, a fatal neurodegenerative disease, during long-term clinical trials. That compared with 10 of 56,000 patients who got placebos.

"The results show no increased incidence of the disease in patients treated with a statin compared with placebo," an FDA statement said.

Dr. Mark Avigan, director of pharmacovigilance in the FDA's drug center, said the finding was "reassuring," but added that "given the extensive use of this class of drugs and the serious nature of ALS, continued study of this issue is warranted."

Results from another study by researchers at Stanford University and the health insurer Kaiser Permanente should be available in six to nine months, the FDA said. The agency also is considering additional studies of its own.

The FDA analysis was published in the journal Pharmacoepidemiology and Drug Safety.

AstraZeneca spokeswoman Donna Huang said the company's own monitoring and reviews of medical literature "has not identified a causal relationship between ALS and the use of Crestor." More than 13 million patients worldwide have been prescribed the drug, she said.  

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Pistachios are Heart Healthy

Going green may be heart healthy if the green you choose is pistachio nuts, according to researchers at Penn State who conducted the first study to investigate the way pistachios lower cholesterol.

"We investigated mechanisms of action to explain the cholesterol-lowering effects of the pistachio diets," says Sarah K. Gebauer, recent Penn State Ph.D. recipient, currently a post-doctoral research associate, USDA Beltsville Human Nutrition Research Center.

The researchers conducted a randomized, crossover design, controlled feeding experiment to test the effects of pistachios added to a heart healthy moderate-fat diet on cardiovascular disease risk factors. Controlled feeding experiments provide all the food eaten by study subjects for the duration of the study segment.

The participants began the study by eating a typical American diet consisting of 35 percent total fat and 11 percent saturated fat for two weeks. They then tested three diets for four weeks each with about a two-week break between each diet. All three diets were variations on the Step I Diet, a cholesterol-lowering diet in general use. The diets included, as a control, a Step I Diet with no pistachios and about 25 percent total fat and 8 percent saturated fat. The pistachio enhanced diets were Step I Diets with 10 and 20 percent of the energy supplied by pistachio nuts, respectively. The 10 percent pistachio diet had 30 percent total fat and 8 percent saturated fat and the 20 percent pistachio diet had 34 percent total fat and 8 percent saturated fat.

The participants ate half their pistachios as a snack and the rest incorporated into meals.

The researchers report in the most recent issue of the American Journal of Clinical Nutrition that "Inclusion of pistachios in a healthy diet beneficially affects cardiovascular disease risk factors in a dose-dependent manner, which may reflect effects on Stearoyl CoA Desaturase (SCD). " The researchers used the ratio of two fatty acids, 16:1 and 16:0 in plasma as a marker for SCD, an enzyme that is involved in the body's synthesis of fatty acids.

"SCD is an important enzyme involved in cholesterol metabolism," says Gebauer.

They found the ratio of 16:1/16:0 was significantly lower, suggesting a decrease in SCD activity, after eating the 20 percent energy pistachio diet compared to the control diet which had no pistachios. Also, the change in the 16:1/16:0 ratio was correlated with the change in cholesterol, suggesting that SCD activity may contribute to the lipid-lowering effects of pistachios. That, accompanied by the dose-dependent effects of the pistachios, begins to unravel the way in which pistachios improve cardiovascular health.

Compared to the control diet, the 20 percent pistachio diet lowered LDL cholesterol -- bad cholesterol -- about 12 percent and the 10 percent energy pistachio diet lowered LDL cholesterol by 9 percent that suggests a 9 to 12 percent decrease in coronary heart disease risk. The relationships of total cholesterol to HDL cholesterol and LDL cholesterol to HDL cholesterol may be more powerful predictors of cardiovascular risk. The effects of the 10 and 20 percent energy diets showed a dose dependent effect on these ratios.

However, the researchers note that the reduction in LDL cholesterol observed was seven times greater than would be expected from only the fatty acid profile of pistachios. They suggest that the lipid lowering effects not only reflect the fatty acid profile of the diet, but also are the result of other bioactive substances in pistachios, perhaps phytosterols and fiber.

"Our study has shown that pistachios, eaten with a heart healthy diet, may decrease a person's CVD risk profile, says Penny Kris-Etherton, distinguished professor of nutrition and primary investigator of the study."

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Melamine found in sauce packets from Taiwan's Pizza Hut

Taipei - Pizza Hut restaurants in Taiwan stopped giving away cheese sauce packets Thursday night after the toxic chemical melamine was found in them, the Central New Agency (CNA) reportedMore...

Statins Harm Skeletal Muscles

A new study confirms that cholesterol-lowering drugs (statins) have adverse effects on skeletal muscles, which are the muscles that allow the body to move. The study, conducted by the University of Alabama at Birmingham, found that statin drugs cause muscle cramping, fatigue, and potential myopathy (weakness).More..

Brits Say No Ritalin for Tots

Parents should be taught how to cope with hyperactive youngsters and Ritalin should only be prescribed as a last resort and never given to the under-fives, a health watchdog said Wednesday.

The National Institute for Health and Clinical Excellence (NICE) has issued new guidelines on how to cope with unruly youngsters suffering from attention deficit hyperactivity disorder (ADHD).

The disorder affects 365,000 children in Britain, and youngsters with ADHD are easily distracted, forgetful and have difficulty keeping still.

Doctors have prescribed Ritalin -- which can cause insomnia, weight loss, nausea and an erratic heartbeat -- to 37,000 children, but NICE says parents should instead be taught how to create a structured home environment, encourage attentiveness and deal properly with misbehaviour.

NICE -- which examines the cost-effectiveness of particular treatments by the NHS -- said drugs still remain the first option for children over five with severe ADHD, but only as part of a broad treatment plan.

"Quite commonly, people tend to revert to offering methylphenidate or atomoxetene...because the child has got what appears to be ADHD and that's what's available," said Tim Kendall -- the joint director of the National Collaborating Centre for Mental Health which assisted NICE in framing the new guidelines.

"Its easier to prescribe a drug when other options like parent training programmes are not available," he added.

The ADHD charity ADDISS questioned the new guidelines.

"Parenting programmes are extremely important, but they need to be specific for ADHD. The ones that NICE are recommending were designed for the parents of children with conduct disorder, which is completely different from ADHD," said ADDISS chief executive Andrea Bilbow.

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Chlorinated Pools Boost Asthma Risk 5 Times

Swimming in outdoor chlorinated pools appears to increase the odds a child will develop asthma, Belgian researchers said on Thursday. ..more...