Sarah Boden’s story for Spotlight PA
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One of the most significant experiences in a person’s life can be giving birth. It can also be risky at times, particularly in America.
Perhaps the deadliest high-income country to give birth is the United States. The Commonwealth Fund has reported that the maternal death rate in the United States is at least four times higher than that of the United Kingdom, Australia, and Japan, and more than twice as high as that of Canada, France, and Korea. Maternal deaths are almost nonexistent in Norway.
This imbalance is caused by a number of complex circumstances, such as racial injustices that place Black patients at the highest risk of dying, but according to a 2022 CDC review, 80% of maternal fatalities are avoidable.
Expanding access to high-quality maternity care before to, during, and following delivery is one strategy to address this issue. The Health Resources and Services Administration claims that in order to do this, the United States must strengthen its personnel in maternity medicine.
This guide summarizes their diverse skill sets and the assistance they offer, based on interviews with members of that workforce.
An obstetrician is a medical professional who focuses on giving birth and treating patients during and after pregnancy. The majority of obstetricians also treat the female reproductive system as gynecologists. An OB-GYN is a typical abbreviation for an obstetrician-gynecologist.
The Health Resources and Services Administration predicts that the OB-GYN shortage will worsen by the end of the decade. This is a threat to further deteriorate the standard of maternity care in the United States.
Meanwhile, OB-GYNs are dealing with new issues. According to doctor Keith Williams, pregnant patients appear to be more susceptible to chronic conditions like diabetes and hypertension than they were a few decades ago.
Higher obesity rates are also making care more difficult, according to Williams, division chief of obstetrics and gynecology at the flagship hospital of Geisinger Medical Center in Danville. Additionally, those who previously struggled with infertility as a result of severe medical disorders are now discovering that they are able to conceive.
“But having a baby can be a wonderful experience and can be unlike anything else a patient has ever encountered,” he told Spotlight PA.
A doctor who minimizes pain during operations and other medical treatments is known as an anesthesiologist.
The most popular way to manage pain during labor is with an epidural. A catheter is placed along the spine in the lower back for this surgery. The lower body is then rendered numb by injecting a local anesthetic and an opioid, like fentanyl. The medicine is safe for both parents and children because just a small quantity enters the bloodstream.
available is no right way to give birth, according to Richard C. Month, an obstetric anesthesiologist at Temple University’s Lewis Katz School of Medicine, who told Spotlight PA that he always stresses to his patients that he is available to customize their care to their preferences.
if you’ve known from the start that you want an epidural? Fantastic! When you’re ready, we’ll be there. Uncertain? Fantastic! In an email, he responded, “I’ll sit down with you and discuss the pros and cons as best I can.”
Would you like to try without? Fantastic! I’m here to help in any way I can. Are you positive you don’t want one? That’s okay too! I will be available to assist you in any way I can, including in the event of an emergency or if you decide to change your mind.
Patients frequently worry that an error during their epidural could cause paralysis. According to Month, the chance of this happening is comparable to the danger of getting struck by lightning.
However, those with blood coagulation or spinal disorders may not benefit from an epidural. In those situations, doctors may administer laughing gas or intravenous drugs to assist patients feel less pain. Alternatives include non-medical methods like breathing exercises or giving birth in water.
A nurse is a certified healthcare professional who has received basic patient care training. Like physicians, nurses have different specialties and carry out a variety of duties, but their fundamental responsibility is to ensure patients’ well-being. Among other things, this may entail conducting exams, giving prescriptions, and keeping an eye on vital signs.
At UPMC Magee-Womens Hospital, nurses who work in the birth center assist with critical care, surgeries, and labor and delivery.
According to Magee’s Birth Center’s unit head, Rebecca Lavezoli, labor and delivery nursing is the perfect example of collaboration. According to Lavezoli, these nurses are the first people patients turn to while they are in labor for information, explanations of delivery alternatives, and reviews of birth plans.
At Magee, doctors deliver the majority of newborns. However, Lavezoli stated that a nurse must intervene when labor advances quickly.
According to Lavozoli, working as a labor and delivery nurse is a true calling because the field exposes nurses to a wide range of emotional extremes.
Midwives are non-physicians who provide reproductive health care and give birth. Registered nurses with extra training, such as from the American College of Nurse-Midwives, make up the majority of midwives.
While midwives and obstetricians offer comparable services, midwives give patients’ social and emotional well-being more attention. Only doctors are able to do surgery, however midwives assist with deliveries both inside and outside of hospitals. Consequently, midwives mostly deal with low-risk pregnancies.
According to Christine Haas, executive director of the Midwife Center in Pittsburgh, midwife care is also excellent for those who prefer to be actively involved in their care and who do not want medical interventions unless absolutely required by their doctor.
According to a research published earlier this year by March of Dimes, a nonprofit organization dedicated to enhancing mother and baby health, midwives might expand maternal care to areas with fewer hospitals and clinics and help the shrinking OB-GYN staff.
The decreased prevalence of medical procedures, such as cesarean sections, is another advantage of midwifery care. Compared to vaginal births, individuals who undergo a C-section have increased rates of infection and uterine tears, among other complications. A C-section is a serious surgery.
A doula is a non-medical practitioner who helps patients before, during, and after childbirth by offering them emotional, physical, and informational support.
According to research, doulas diminish racial inequities in maternal health and enhance delivery outcomes.
According to Gerria Coffee, president of the Pennsylvania Doula Commission, a doula’s patient advocacy can go beyond perinatal responsibilities. Doulas may help clients enroll in state-funded nutrition assistance programs or make connections to mental health or domestic violence services.
“Regardless of the result, everyone deserves to have a beautiful, safe experience,” Coffee added.
To practice, doulas do not require a certification. Recent modifications to Pennsylvania’s Medicaid program, however, let doulas to receive payment for their services as long as they hold a state-issued certified perinatal doula license.
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