Posted On: August 28, 2010

Pediatricians repeating medical myths endanger child safety

Parents who turn to their child’s pediatrician for health and safety advice may end up hearing recycled parenting myths, a new study reports.

“In some cases, a child’s well-being may be seriously compromised if parents are given misinformation by a pediatrician based on these misconceptions and old wives’ tales,” said Andrew Adesman, M.D., lead investigator of the study and chief of developmental and behavioral pediatrics at the Steven and Alexandra Cohen Children’s Medical Center of New York.

The study was based on a questionnaire sent to a national sample of board-certified primary-care pediatricians and included a mix of 34 myths and 14 true statements. Analysis of more than 1,000 responses indicated that the majority of pediatricians (76 percent) mistakenly endorsed one or more of the parenting myths as being true, and 13 percent got three or more wrong.

Although most of the myths are benign old wives’ tales, Adesman said, there were a “dangerous dozen” health beliefs that reflected outdated parenting beliefs that could pose a risk to a child’s safety or well-being. For example:

• 33 percent said a burn can be treated with an application of ice. Risk: Ice can also cause injury to the skin.

• 33 percent said it is safe to put a baby to sleep on his or her side. Risk: Crib death -- also known as sudden infant death syndrome. (All babies need to sleep on their backs.)

• 5 percent said children can be given an ice bath to treat a fever. Risk: Hypothermia.

• 5 percent said children over age 6 can be given aspirin for a fever. Risk: Reye’s syndrome.

• 5 percent said it’s OK to place a soft object in a child’s mouth during a seizure. Risk: Dental injury to the child, hand injury to the adult.

• 3 percent said babies younger than six months can be given honey. Risk: Botulism poisoning.

Many pediatricians also endorsed less dangerous myths.. For example:

• 15 percent said children should not swim until 30 minutes after eating.

• 17 percent said vitamin C helps ward off colds.

• 16 percent said eating carrots improves a child’s vision.

• 8 percent said eating chocolate causes acne.

• 11 percent said listening to Mozart makes a baby smarter.

• 7 percent said reading in the dark causes visual problems.

• 11 percent said sugar causes hyperactivity.

• 7 percent said sitting too close to the TV damages vision.

• 9 percent said sleeping with a nightlight causes nearsightedness.

Source: Los Altos Town Crier
You can view the complete study here.

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Posted On: August 19, 2010

Maternity patient safety program improves health outcomes for newborns, mothers

A Canadian study is showing a positive way forward for making childbirth safer for mothers and babies, and reducing the devastating impact of malpractice on newborn children.

The Canadian “Managing Obstetrical Risk Efficiently” (MOREOB) patient safety program has a measurable, positive impact on the health of mothers and babies, according to a study published in the Journal of Obstetrics and Gynaecology Canada.

According to the study, the program results in a significant reduction in severe morbidity for newborns, as measured by the rate of serious complications such as respiratory distress syndrome, sepsis and severe intraventricular hemorrhage. For mothers, there was a significant reduction in third- and fourth-degree vaginal tears and length of stay in hospital.

MOREOB is a comprehensive, three-year, patient safety, professional development and performance improvement program for caregivers and administrators in hospital obstetrics units. The program structure's first priority is safety, followed by effective communication, teamwork, decreased hierarchy in emergencies, practice for emergencies, and reflective learning. It integrates evidence-based professional practice standards and guidelines with current and evolving patient safety concepts, principles and tools.

By learning and working together in their own practice environment, health-care teams use the shared knowledge, skills, attitudes and behaviors that contribute to safe, effective, patient-centered care in an efficient, collaborative, healthy practice environment.

“MOREOB is an innovative program that seeks to ensure that every pregnant woman receives optimal care. With the results of this new study, it is hoped that many other North American hospitals will emulate Alberta, and make MOREOB a key component of their hospitals’ training, standards and approach to obstetrical patient care,’ said Dr. André Lalonde, Executive Vice-President of the Society of Obstetricians and Gynaecologists of Canada.

Society of Obstetricians and Gynaecologists of Canada
You can view SOGC's press release here.

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Posted On: August 1, 2010

Protecting Babies from Hospital Malpractice in Labor and Delivery Units

Who's at fault for the high rate of Cesarean sections in the United States? If you listen to the obstetricians, it's all about lawsuits -- they are at risk of being sued for "anything short of a perfect outcome," as two doctors wrote last week in a letter to the editor in the New York Times.

But maybe the real issue is basic patient safety, and the failure of hospitals and doctors to have the right staffing necessary to make vaginal childbirth safe after a previous C-section.

If you listen to the euphemisms from the medical industry, "less than perfect outcome" sounds like parents suing over a small blemish or other trivial injury. What is really at stake, however, is permanent devastating brain injury caused by a hospital not having the resources to deliver a baby quickly enough when the vaginal birth attempt has gone south.

Three in ten American women now deliver their babies by Cesarean section, which seems like a lot. And many of those are repeat Cesareans which only happen because of the prior Cesarean, even if it might be safe to at least try normal labor and see if the baby can be delivered safely. Recent headlines suggested that hospitals were refusing to even let women try a course of normal labor after a prior Cesarean. They couldn't afford the lawsuits, it was suggested.

But here's the problem with VBAC -- vaginal birth after Cesarean. In one in 100 to one in 200 VBAC attempts, the uterus ruptures. This cuts off the baby's lifeline. The best studies show that brain damage begins in around 17 to 18 minutes, and worsens dramatically every minute after that the baby remains undelivered. After 30 minutes, most babies in ruptured uteruses are dead if not delivered.

New guidelines from the American College of Obstetricians and Gynecologists (ACOG) for VBAC have stuck to the group's 1999 recommendation that a surgical team has to be "immediately available" to deliver the baby by C-section in the event of a rupture. Immediate means right there in the hospital, ready to operate.

Hospitals don't like the "immediately available" standard, and prefer the old, looser guideline of "readily available," whatever that means. After the 1999 guidance of "immediately available" was issued, a number of hospitals, rather than having the right staffing level to ensure baby safety, simply banned VBAC procedures and said any pregnant woman with a prior C-section had to have another C-section in their hospital. This conjures up an image of tying women to hospital beds and hovering over them with scalpels, so that doesn't sound right either.

In March 2010, the National Institutes of Health convened a panel of experts who took a step backward by asking the obstetricians to consider softening the guidance back to the old "readily available" or some other mushy language.

Thankfully, ACOG didn't do that. But -- and this is a big but -- the obstetricians are now talking about pushing the risk of brain damage back onto the parents -- without giving them the full picture to make an intelligent decision.

As quoted in the New York Times, the new ACOG guideline adds the recommendation that if an immediate Caesarean is not available, it should be explained to the patient, and she should be "allowed to accept increased levels of risk." And Dr. Richard Waldman, president of the obstetricians' group, said: "What I'm hoping is that everybody will get together and do the right thing. That includes patients. If they take the risk, they have a certain responsibility not to sue the physician if there's a bad outcome, knowing that they took the risk."

You can search ACOG's statement about its new guidelines high and low, and you will never find the key facts spelled out about what this risk really means -- a child who can never walk, talk or have normal development.

ACOG and the hospitals seem more focused on the risk of lawsuits than the risk of catastrophically injured babies. It would be like talking about the danger of oil spills from deepwater drilling based on how many lawsuits would happen, not on how much damage to the environment would result.

Let's make sure our communications are very clear. We're talking about delivering babies safely. The lawsuit buzz is just a convenient whipping boy for those who want to avoid tough questions about why they're not investing in safe childbirth facilities for mothers and families.

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