Helping nature: Inducing labor avoids cesarean for some moms
By MARILYNN MARCHIONE
AP Chief Medical Writer
Wednesday, August 8
Move over, Mother Nature. First-time moms at low risk of complications were less likely to need a cesarean delivery if labor was induced at 39 weeks instead of waiting for it to start on its own, a big study found. Their babies fared better, too.
The results overturn the longtime view that inducing labor raises the risk for a C-section, and prompted two leading OB-GYN doctor groups to say it’s now reasonable to offer women like those in the study that option.
But only certain pregnant women qualify, and the study did not track how inducing labor affected breastfeeding or other mom-baby issues later. Some groups such as Lamaze International still advocate letting nature take its course rather than giving medicines to make the womb start contracting.
“Many women don’t want all of the medical care that goes with induction” such as an IV and fetal monitoring, said Lisa Kane Low, past president of the American College of Nurse-Midwives and associate dean of the University of Michigan School of Nursing. “It can result in a very different type of experience.”
Being induced doesn’t mean moms can’t have “natural childbirth” — they can forgo pain medicine or use a hospital’s homelike birthing center rather than delivering in “an operating room in a sterile suite with a big light over your head,” said the study leader, Dr. William Grobman, an OB-GYN specialist at Northwestern University in Chicago.
“Everyone has a different definition of what a natural birth is,” said Dr. Cynthia Gyamfi-Bannerman of New York-Presbyterian/Columbia University Medical Center, which participated in the study.
“Some women feel that natural just means delivering vaginally” and more were able to do that when labor was induced, she said.
Results of the federally funded study were published Wednesday by the New England Journal of Medicine.
ABOUT THE STUDY
About 40 percent of U.S. women giving birth are first-time moms, and at least half are low risk — no problems requiring early delivery or a cesarean. Many women ask to be induced now, to let them plan delivery and ensure their doctor is available, but the risks and benefits are unclear.
Previous studies suggesting that inducing labor raises the risk for a C-section were observational and compared different types of women giving birth under different types of circumstances. This was the first very big experiment to time labor induction for 39 weeks — when a pregnancy is considered full term and complication rates are lowest.
More than 6,100 women at 41 hospitals were randomly placed in two groups: one had labor induced at 39 weeks; the other waited for labor to start on its own and were induced only if a problem developed or they hadn’t delivered by 42 weeks.
HOW MOMS AND BABIES FARED
Deaths and severe complications were fewer among babies of women who were induced — about 4 percent versus 5 percent in the other group — but the difference was so small it could have occurred by chance alone. Significantly fewer babies in the induced group needed breathing tubes or extra oxygen after birth, and they spent less time in the hospital.
Nineteen percent of induced moms had a cesarean versus 22 percent of the others. Doctors estimate that one C-section would be avoided for every 28 women induced.
Nine percent of induced women developed dangerous high blood pressure at the end of pregnancy versus 14 percent of the others. Study participants who were induced, such as Aleksa Owen, said they had less pain and felt more in control.
“I was pretty open to any kind of birth, whatever works to keep the baby safe and myself safe as well,” said Owen, a 34-year-old graduate student from the Chicago suburb of Woodridge, Illinois. Her son was born in October 2016 and “I felt like I had a sense of control throughout the process.”
It’s not clear which option costs more; researchers plan to study that. Induced women spent more time in the labor and delivery unit but went home sooner after birth. Insurers often pay a fixed rate for births, complicating cost comparisons.
The labor and delivery suite is one of the most expensive places in a hospital, said Dr. Nanette Santoro, OB-GYN chief at the University of Colorado School of Medicine. If all eligible moms decided to be induced, “I do not believe we would have the resources to accommodate them,” but may have to adapt based on this study, she said.
WHAT OTHERS THINK
Christen Sadler, a certified nurse-midwife and president-elect of Lamaze International, said other research suggests that “letting labor start on its own is almost always best for moms and babies” unless there’s a problem that requires intervening.
Nan Strauss, policy chief for the advocacy group Every Mother Counts, agreed: “Inducing labor disrupts the complex hormonal processes that help labor progress, prepare the baby for birth, and promote successful breastfeeding and bonding.”
The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine says it’s reasonable for doctors to offer labor induction “after discussing the options thoroughly” with first-time moms at low risk who had an ultrasound early in pregnancy to verify when they will reach 39 weeks.
Dr. Michael Greene of Massachusetts General Hospital noted that women in the study were younger than U.S. mothers on average and fewer were over 35, calling into question how generalizable the results are.
Still, the study “should reassure women that elective induction of labor at 39 weeks is a reasonable choice” that’s unlikely to harm moms or babies, he wrote in a commentary in the journal.
Marilynn Marchione can be followed on Twitter at http://twitter.com/MMarchioneAP
The Associated Press Health & Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.
Opinion: The Unintended Elitism of Health Care Policy
By Robert Graboyes
The biggest problem with health care policy may be that those who design health care policy mostly design it for people who design health care policy.
We policy folk reside in a variety of institutions: medical facilities, corporations, universities, think tanks, legislative offices, regulatory agencies and advocacy groups. But we broadly share certain characteristics. We’re well educated. We possess deep knowledge of health-related matters. We’re analytical. Our thoughts and passion focus on health.
Our lives and careers follow similar patterns. We have white-collar jobs. We either pursue healthy lifestyles — exercise, diet, medical care — or at least feel guilty when we don’t. Our schedules theoretically leave us time to exercise or obtain healthy meals. Our friends, co-workers and families share many of these characteristics.
Most of our employers provide generous formal and informal health-related benefits. If we’re sick, they let us take time off to visit the doctor, usually with no loss of wages. Our employment is relatively stable and our hours regular and predictable.
While many of us, particularly in medical institutions, interact with those in less rarified circumstances, we have the luxury of retreating into our fortunate bubble when we leave the office.
This bright, monochromatic life skews our thinking about public policy. When we ask ourselves, “What can the government or employers do to improve people’s health?” we tend to conjure up solutions we imagine would work on ourselves or the half-marathon runner in the adjacent office or the overweight colleague across the hall.
For years, I’ve asked roomfuls of doctors and nurses how employers might help stanch Americans’ rapid increase in obesity. Their answers fit the stereotype. “My office had a walkathon competition.” “My company opened a gymnasium for employees.” “My employer pays 50 percent of gym membership costs.” “We have twice-weekly yoga classes in the boardroom.” “Human Resources offers wellness classes.” “Our cafeteria offers healthy options.”
Ask the same medical professionals what the government ought to do to fight obesity, and the answers reflexively veer toward “encourage or require employers to do all those things my employer does.”
The problem is that many of America’s most serious health problems reside in people whose lives and jobs do not remotely resemble those of policy-shapers.
7-11 isn’t going to build a gymnasium for the guy working the night shift. The long-haul trucker won’t be participating in an office walkathon. The fast-food restaurant can’t give a complimentary Planet Fitness membership to the burger flipper who only brings in a few hundred dollars in extra profits annually — and whose stay is likely short-term.
The single mother working three part-time jobs probably won’t fit the yoga class into her schedule. When she or her children are sick, a doctor’s visit likely means a difficult-to-afford loss of wages and perhaps a disgruntled boss. The dayworker outside The Home Depot won’t be taking HR’s wellness classes.
At Reason.com, Peter Suderman notes a congressional proposal — popular with Republicans and Democrats alike — to create a medical tax deduction for gym memberships and fitness classes (“Republicans Want a Tax Break For Gym Memberships. That’s a Terrible Idea.”). He astutely argues that the primary beneficiaries would be the fitness industry and people who already have gym memberships. Plus, it would only matter for people who itemize tax deductions, with the largest breaks accruing to those in the highest tax brackets.
A year or so back, I had a heated discussion with a physician who thought the key to better health lay in more intimate involvement of doctors in the lives of their patients — the doctor as life guide. I argued that her aspiration was noble but that in a country of 200,000 primary care doctors treating 320,000,000 patients — many transient and most outside the elite bubble — her idea, while noble and great when it works, would mostly serve the fortunate few.
This bias — focusing on what motivates ourselves and our similar acquaintances — permeates health care policy with an unintended and sometimes destructive elitism. In a rare act of bipartisanship, we squander scarce resources where they add little to health.
ABOUT THE WRITER
Robert Graboyes is a senior research fellow with the Mercatus Center at George Mason University, where he focuses on technological innovation in health care. He is the author of “Fortress and Frontier in American Health Care” and has taught health economics at five universities. He wrote this for InsideSources.com.
AUG. 10, 2018 CHIPOTLE UPDATE
The Ohio Department of Health returned all food sample test results. According to ODH, all food samples tested negative for: “B. cereus, C. perfringens, Staphylococcal enterotoxin, Salmonella, Shigella and Shiga-like toxin-producing E.coli.”
ODH sent stool samples for further testing to the Centers for Disease Control and Prevention. Those results are still pending.
After completing all follow-up calls this week, Health District staff have identified 644 people who self-reported gastrointestinal symptoms after consuming food from the Chipotle on Sawmill Parkway between Thursday July 26 – Monday July 30, 2018.
New information will be released when it becomes available on both the Delaware General Health District Facebook page and Twitter account (@DelawareHealth).
How Illnesses Could Predict the Stock Market
Sickweather data shows correlation between predicted illness trends and stock performance
Kansas City, MO – Aug 10, 2018 – Can illness trends predict a company’s revenue or profit margin? Yes. In fact, the correlation with flu data can be as strong as -1.0r (out of a perfect 1.0r or -1.0r) for some healthcare businesses and their financial performance according to a recent Sickweather study.
Sickweather, the world’s first real-time map of human health, collects and processes millions of illness reports each month to deliver a hyper-local view of what’s going around in a specific area. Flu, allergies and 35 other illnesses are tracked across the country and around the world.
To conduct the study, 855 publicly traded healthcare companies whose bottom line could potentially be affected by flu and allergy seasons were selected. Three years’ worth of information regarding each company’s quarterly earnings was gathered from US Securities and Exchange Commission (SEC). Sickweather flu and allergy data for the same period was overlaid with variations of Basic Earnings per Share (EPS), Total Revenue, Profit Margin, Price to Earnings Ratio (P/E ratio), and Return on Equity.
Study outcomes showed there were correlations > 0.50r or < -0.50r between both illnesses and the financial metrics for 16% of the companies sampled.
“Given Sickweather’s ability to forecast flu & allergy seasons up to 15 weeks in advance, this would provide a predictive and potentially prescriptive model for a wide range of healthcare organizations” said Graham Dodge, CEO, Sickweather.
While this was a limited study, the idea of using illness forecast data to develop more in-depth financial correlations could be extremely valuable for companies and stock traders. The information could be used to adjust their business model to account for illnesses affecting their sales, workforce or supply chain activities.
Additional details about these findings will be shared at Sickweather’s upcoming Cold Cough Flu Conference in Kansas City on October 15th, along with their forecast and outlook of the upcoming flu season. The published results of the study are available here: http://sick.io/stocks
To learn more about Sickweather’s illness forecasting capabilities and Cold Cough Flu Conference, visit www.sickweather.com.
About Sickweather: Sickweather is the world’s first real-time map of sickness and the largest crowdsourcing community of its kind – processing millions of illness reports each month. The company has been recognized for accurately forecasting outbreaks up to 15 weeks in advance. Sickweather is committed to providing consumers and businesses the most accurate, predictive and meaningful sickness forecasts in the world – for reducing healthcare costs and saving lives.