Podcasts about gynecologists acog

*Content warning: infant loss, miscarriage, birth trauma, medical trauma, medical neglect, body image abuse, mature and stressful themes. *Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources Moms Advocating For MomsS23 survivors Markeda, Kristen and Amanda have created a nonprofit, Moms Advocating for Moms, in hopes to create a future where maternal well-being is prioritized, disparities are addressed, and every mother has the resources and support she needs to thrive: https://www.momsadvocatingformoms.org/take-actionhttps://linktr.ee/momsadvocatingformoms Please sign the survivors petitions below to improve midwifery education and regulation in Texashttps://www.change.org/p/improve-midwifery-education-and-regulation-in-texas?recruiter=1336781649&recruited_by_id=74bf3b50-fd98-11ee-9e3f-a55a14340b5a&utm_source=share_petition&utm_campaign=share_for_starters_page&utm_medium=copylink Malik's Law https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB4553 M.A.M.A. has helped file a Texas bill called Malik's Law, which is intended to implement requirements for midwives in Texas to report birth outcomes in hopes of improving transparency and data collection in the midwifery field in partnership with Senator Claudia Ordaz. *Sources:American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ Blood clots and pregnancyhttps://www.marchofdimes.org/find-support/topics/pregnancy/blood-clots-and-pregnancy#:~:text=Although%20birthing%20people%20with%20blood,both%20you%20and%20your%20baby.Chorioamnionitishttps://www.stanfordchildrens.org/en/topic/default?id=chorioamnionitis-90-P02441#:~:text=Chorioamnionitis%20is%20an%20infection%20of,smell%20from%20the%20amniotic%20fluid. Cross border reproductive care (CBRC): a growing global phenomenon with multidimensional implications (a systematic and critical review)https://pmc.ncbi.nlm.nih.gov/articles/PMC6063838/#:~:text=In%20vitro%20fertilization%20and%20intracytoplasmic,Belgium%20%5B37%E2%80%9344%5D. Detection of Proteinuria in Pregnancy: Comparison of Qualitative Tests for Proteins and Dipsticks with Urinary Protein Creatinine Indexhttps://pmc.ncbi.nlm.nih.gov/articles/PMC3809617/#:~:text=Background%20and%20Objectives%3A%20Excretion%20of,the%20patient%20or%20her%20pregnancy. Egg Donation and IVF in Czech Republichttps://www.eggdonationfriends.com/ivf-egg-donation-country-czech-republic/#:~:text=in%20Czech%20Republic-,IVF%20cost%20in%20Czech%20Republic,much%20from%20the%20European%20average.&text=It%20also%20needs%20to%20be,frozen%20embryo%20transfer Fundal Heighthttps://my.clevelandclinic.org/health/diagnostics/22294-fundal-height HELLP Syndromehttps://my.clevelandclinic.org/health/diseases/21637-hellp-syndrome High Blood Pressure–Understanding the Silent Killerhttps://www.fda.gov/drugs/special-features/high-blood-pressure-understanding-silent-killer#:~:text=Normal%20pressure%20is%20120/80,manage%20your%20high%20blood%20pressure? In vitro fertilization (IVF)https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716#:~:text=Research%20suggests%20that%20IVF%20slightly,or%20ovarian%20cancer%20after%20IVF%20. Magnesium - Uses, Side Effects, and Morehttps://www.webmd.com/vitamins/ai/ingredientmono-998/magnesium March of Dimeshttps://www.marchofdimes.org/peristats/about-us National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery North American Registry of Midwives (NARM)https://narm.org/ Placental Abruptionhttps://my.clevelandclinic.org/health/diseases/9435-placental-abruption Placenta and Heart Researchhttps://www.ohsu.edu/knight-cardiovascular-institute/placenta-and-heart-research#:~:text=By%20the%20end%20of%20pregnancy,area%20for%20uptake%20of%20nutrients. Postpartum Hemorrhagehttps://my.clevelandclinic.org/health/diseases/22228-postpartum-hemorrhage Preeclampsiahttps://my.clevelandclinic.org/health/diseases/17952-preeclampsia Preeclampsia - Signs & Symptoms https://www.preeclampsia.org/signs-and-symptoms#:~:text=Weight%20gain%20of%20more%20than,the%20kidneys%20to%20be%20excreted.&text=Do%20not%20try%20to%20lose%20weight%20during%20pregnancy%20by%20restricting%20your%20diet.Pregnancy weight gain: What's healthy?https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy-weight-gain/art-20044360 Prothrombin Gene Mutationhttps://my.clevelandclinic.org/health/diseases/21810-prothrombin-gene-mutation Prothrombin 20210 Mutation (Factor II Mutation)https://www.ahajournals.org/doi/10.1161/01.cir.0000135582.53444.87#:~:text=There%20are%20also%20implications%20of,a%20baby%20of%20small%20size. The Risks of Prothrombin Gene Mutation in Pregnancyhttps://www.healthline.com/health/pregnancy/prothrombin-gene-mutation#What-Are-the-Risks-of-Prothrombin-Mutation-in-Pregnancy State investigating Dallas birth center and midwives, following multiple complaints from patientshttps://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ Texas Health, Week by Week https://www.texashealth.org/baby-care/Week-by-Week Texas Occupations Code, Chapter 203. Midwives https://statutes.capitol.texas.gov/Docs/OC/htm/OC.203.htmWhat are high blood pressure numbers?https://www.lancastergeneralhealth.org/health-hub-home/2023/february/what-are-high-blood-pressure-numbers#:~:text=Normal:%20Less%20than%20120/80,Avoid%20secondhand%20smoke. White Coat Syndromehttps://my.clevelandclinic.org/health/diseases/23989-white-coat-syndrome Why Won't an Attorney Take My Texas Medical Malpractice Case?https://www.hastingsfirm.com/your-case-and-texas-law/ Zucker School of Medicine, Amos Grunebaum, MDhttps://faculty.medicine.hofstra.edu/13732-amos-grunebaum/publications 24-Hour Urine Collectionhttps://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/24hour-urine-collection#:~:text=A%2024%2Dhour%20urine%20collection%20is%20a%20simple%20lab%20test,is%20returned%20to%20the%20lab. 40 years later, why is IVF still not covered by insurance? Economics, ignorance and sexismhttps://www.cnn.com/2018/07/25/health/ivf-insurance-parenting-strauss/index.html *SWW S23 Theme Song & Artwork: Thank you so much to Emily Wolfe for covering Glad Rag's original song, U Think U for us this season!Hear more from Emily Wolfe:On SpotifyOn Apple Musichttps://www.emilywolfemusic.com/instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartFollow Something Was Wrong:Website: somethingwaswrong.com IG: instagram.com/somethingwaswrongpodcastTikTok: tiktok.com/@somethingwaswrongpodcast Follow Tiffany Reese:Website: tiffanyreese.me IG: instagram.com/lookiebooSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

*Content warning: birth trauma, medical trauma, medical neglect, mature and stressful themes. *Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources Moms Advocating For MomsS23 survivors Markeda, Kristen and Amanda have created a nonprofit, Moms Advocating for Moms, in hopes to create a future where maternal well-being is prioritized, disparities are addressed, and every mother has the resources and support she needs to thrive: https://www.momsadvocatingformoms.org/take-actionhttps://linktr.ee/momsadvocatingformoms Please sign the survivors petitions below to improve midwifery education and regulation in Texashttps://www.change.org/p/improve-midwifery-education-and-regulation-in-texas?recruiter=1336781649&recruited_by_id=74bf3b50-fd98-11ee-9e3f-a55a14340b5a&utm_source=share_petition&utm_campaign=share_for_starters_page&utm_medium=copylink Malik's Law https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB4553 M.A.M.A. has helped file a Texas bill called Malik's Law, which is intended to implement requirements for midwives in Texas to report birth outcomes in hopes of improving transparency and data collection in the midwifery field in partnership with Senator Claudia Ordaz. *Sources:ACTH Treatment of Infantile Spasmshttps://pmc.ncbi.nlm.nih.gov/articles/PMC3092432/ American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ Hypothermia Therapy (Neonatal Cooling)https://hiehelpcenter.org/treatment/hypothermia-therapy/#:~:text=Hypothermiatherapyinvolvescoolingthe,degreesFahrenheit Hypoxic-Ischemic Encephalopathy (HIE)https://my.clevelandclinic.org/health/diseases/hypoxic-ischemic-encephalopathy-hie Ina May's Guide to Childbirthhttps://birthworks.org/product/ina-mays-guide-to-childbirth/March of Dimeshttps://www.marchofdimes.org/peristats/about-us Meconium Aspiration Syndromehttps://www.hopkinsmedicine.org/health/conditions-and-diseases/meconium-aspiration-syndrome National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery NICU Levelshttps://www.childrenscolorado.org/doctors-and-departments/departments/neonatal-intensive-care-unit/nicu-family-resources/nicu-levels/#:~:text=WhatisaLevelIV,theirgestationalageatbirth. North American Registry of Midwives (NARM)https://narm.org/ Office for Civil Rightshttps://www.hhs.gov/ocr/index.htmlPhenobarbitalhttps://www.ncbi.nlm.nih.gov/books/NBK532277/#:~:text=Phenobarbitalsapotentcytochrome,possibleinteractionbetweenthemedications. State investigating Dallas birth center and midwives, following multiple complaints from patientshttps://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef Texas Administrative Code Rule §115.117https://texas-sos.appianportalsgov.com/rules-and-meetings?interface=LANDING_PAGE Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ Applying for a new License with TDLR:https://www.tdlr.texas.gov/midwives/apply.htmTexas Health and Human Services Birthing Centershttps://www.hhs.texas.gov/providers/health-care-facilities-regulation/birthing-centersTotal body cooling: Saving babies' lives after emergency deliveryhttps://utswmed.org/medblog/total-body-cooling-saving-babies-lives-after-emergency-delivery/ What is ACTH Therapy (Corticotropin/ACTHAR Gel) for Infantile Spasms?https://www.med.umich.edu/1libr/Pharmacy/ACTHInjections.pdf When Do Babies Start Crawling?https://www.pampers.com/en-us/baby/development/article/when-do-babies-crawl Zucker School of Medicine, Amos Grunebaum, MDhttps://faculty.medicine.hofstra.edu/13732-amos-grunebaum/publications *SWW S23 Theme Song & Artwork: Thank you so much to Emily Wolfe for covering Glad Rag's original song, U Think U for us this season!Hear more from Emily Wolfe:On SpotifyOn Apple Musichttps://www.emilywolfemusic.com/instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartFollow Something Was Wrong:Website: somethingwaswrong.com IG: instagram.com/somethingwaswrongpodcastTikTok: tiktok.com/@somethingwaswrongpodcast Follow Tiffany Reese:Website: tiffanyreese.me IG: instagram.com/lookiebooSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Joelle Taylor, MD, FACOG is a board-certified Reproductive Endocrinologist and a Diplomate of the American Board of Obstetrics and Gynecology. She is an active member of several leading scientific societies, including the American Society for Reproductive Medicine (ASRM), the Society of Reproductive Endocrinology and Infertility (SREI), the Society of Assisted Reproductive Technology (SART), and the American Congress of Obstetricians and Gynecologists (ACOG).   Dr. Taylor earned her medical degree from the University at Buffalo School of Medicine and Biomedical Sciences in 2006. As a recipient of the Howard Hughes Medical Institute Scholar Award, she dedicated a year to research at the National Institutes of Health during her medical training. She went on to complete her residency in Obstetrics and Gynecology at Wake Forest University in 2010, followed by a fellowship in Reproductive Endocrinology and Infertility at the renowned Jones Institute for Reproductive Medicine in Norfolk, Virginia—home to the first IVF baby in the United States.   Throughout her career, Dr. Taylor has been recognized with multiple research grants, has published extensively, and has presented her work at national conferences.   Outside of her professional pursuits, Dr. Taylor lives in Jupiter with her family and their Australian Labradoodle. She enjoys weightlifting, yoga, playing pickleball, and cooking for family and friends.

*Content warning: descriptions of medical trauma, death, infant loss, birthing trauma, medical trauma, medical neglect, mature and stressful themes. *Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources Moms Advocating For MomsS23 survivors Markeda, Kristen and Amanda have created a nonprofit, Moms Advocating for Moms, in hopes to create a future where maternal well-being is prioritized, disparities are addressed, and every mother has the resources and support she needs to thrive: https://www.momsadvocatingformoms.org/take-actionhttps://linktr.ee/momsadvocatingformoms Please sign the survivors petitions below to improve midwifery education and regulation in Texashttps://www.change.org/p/improve-midwifery-education-and-regulation-in-texas?recruiter=1336781649&recruited_by_id=74bf3b50-fd98-11ee-9e3f-a55a14340b5a&utm_source=share_petition&utm_campaign=share_for_starters_page&utm_medium=copylink Malik's Law https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB4553 M.A.M.A. has helped file a Texas bill called Malik's Law, which is intended to implement requirements for midwives in Texas to report birth outcomes in hopes of improving transparency and data collection in the midwifery field in partnership with Senator Claudia Ordaz. *Sources:American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ Birth Settings in America: Outcomes, Quality, Access, and Choice, Maternal and Newborn Care in the United Stateshttps://www.ncbi.nlm.nih.gov/books/NBK555484/#:~:text=Federal%20law%20requires%20that%20most%20insurance%20companies,if%20they%20and%20their%20babies%20are%20healthy.&text=Midwives7%20provide%20care%20throughout%20the%20prenatal%20period%20for%20families%20planning%20a%20home%20birth. Cooling Therapy Treatment for HIEhttps://birthinjurycenter.org/hypoxic-ischemic-encephalopathy-hie/cooling-treatment-for-hie/#:~:text=Clinical%20trials%20have%20shown%20that,of%20death%20or%20brain%20damage. March of Dimeshttps://www.marchofdimes.org/peristats/about-us National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery North American Registry of Midwives (NARM)https://narm.org/ Postpartum Hemorrhagehttps://my.clevelandclinic.org/health/diseases/22228-postpartum-hemorrhage Raynaud's diseasehttps://www.mayoclinic.org/diseases-conditions/raynauds-disease/symptoms-causes/syc-20363571 State investigating Dallas birth center and midwives, following multiple complaints from patientshttps://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ Zucker School of Medicine, Amos Grunebaum, MDhttps://faculty.medicine.hofstra.edu/13732-amos-grunebaum/publications *SWW S23 Theme Song & Artwork: Thank you so much to Emily Wolfe for covering Glad Rag's original song, U Think U for us this season!Hear more from Emily Wolfe:On SpotifyOn Apple Musichttps://www.emilywolfemusic.com/instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartFollow Something Was Wrong:Website: somethingwaswrong.com IG: instagram.com/somethingwaswrongpodcastTikTok: tiktok.com/@somethingwaswrongpodcast Follow Tiffany Reese:Website: tiffanyreese.me IG: instagram.com/lookiebooSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

*Content warning: medical trauma and neglect, threat of life, mature and stressful themes, pregnancy and infant loss. *Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources Moms Advocating For MomsS23 survivors Markeda, Kristen and Amanda have created a nonprofit, Moms Advocating for Moms, in hopes to create a future where maternal well-being is prioritized, disparities are addressed, and every mother has the resources and support she needs to thrive: https://www.momsadvocatingformoms.org/take-actionhttps://linktr.ee/momsadvocatingformoms Please sign the survivors petitions below to improve midwifery education and regulation in Texashttps://www.change.org/p/improve-midwifery-education-and-regulation-in-texas?recruiter=1336781649&recruited_by_id=74bf3b50-fd98-11ee-9e3f-a55a14340b5a&utm_source=share_petition&utm_campaign=share_for_starters_page&utm_medium=copylink Malik's Law https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB4553 M.A.M.A. has helped file a Texas bill called Malik's Law, which is intended to implement requirements for midwives in Texas to report birth outcomes in hopes of improving transparency and data collection in the midwifery field in partnership with Senator Claudia Ordaz. *Sources:American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ ACOG, Fetal Heart Rate Monitoring During Laborhttps://www.acog.org/womens-health/faqs/fetal-heart-rate-monitoring-during-labor Amniotomyhttps://www.ncbi.nlm.nih.gov/books/NBK470167/#:~:text=Amniotomy%2C%20also%20known%20as%20artificial,commonly%20performed%20during%20labor%20management. March of Dimeshttps://www.marchofdimes.org/peristats/about-us National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery North American Registry of Midwives (NARM)https://narm.org/ The Second Trimesterhttps://www.hopkinsmedicine.org/health/wellness-and-prevention/the-second-trimester#:~:text=The%20second%20trimester%20is%20the,grow%20in%20length%20and%20weight. Stages of labor and birthhttps://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/stages-of-labor/art-20046545 State investigating Dallas birth center and midwives, following multiple complaints from patientshttps://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ What to Know About Cervical Dilationhttps://www.healthline.com/health/pregnancy/cervix-dilation-chart Zucker School of Medicine, Amos Grunebaum, MDhttps://faculty.medicine.hofstra.edu/13732-amos-grunebaum/publications *SWW S23 Theme Song & Artwork: Thank you so much to Emily Wolfe for covering Glad Rag's original song, U Think U for us this season!Hear more from Emily Wolfe:On SpotifyOn Apple Musichttps://www.emilywolfemusic.com/instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartFollow Something Was Wrong:Website: somethingwaswrong.com IG: instagram.com/somethingwaswrongpodcastTikTok: tiktok.com/@somethingwaswrongpodcast Follow Tiffany Reese:Website: tiffanyreese.me IG: instagram.com/lookiebooThe Webby Awards (2025)Exciting news! Something Was Wrong is nominated for Best Crime & Justice Podcast at the 2025 Webby Awards. We'd love and appreciate your support—cast your vote today!https://vote.webbyawards.com/PublicVoting#/2025/podcasts/shows/crime-justice*Please note: the first airing of this episode stated that Rachel was a CNM, she is a CPM and LM so we corrected this error within an hour of release. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

*Content warning: Pregnancy loss, miscarriage, death of a child, infant loss, death, birth trauma, medical trauma, medical neglect, racism, mature and stressful themes. *Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources Moms Advocating For MomsS23 survivors Markeda, Kristen and Amanda have created a nonprofit, Moms Advocating for Moms, in hopes to create a future where maternal well-being is prioritized, disparities are addressed, and every mother has the resources and support she needs to thrive: https://www.momsadvocatingformoms.org/take-actionhttps://linktr.ee/momsadvocatingformoms Please sign the survivors petitions below to improve midwifery education and regulation in Texashttps://www.change.org/p/improve-midwifery-education-and-regulation-in-texas?recruiter=1336781649&recruited_by_id=74bf3b50-fd98-11ee-9e3f-a55a14340b5a&utm_source=share_petition&utm_campaign=share_for_starters_page&utm_medium=copylink *Sources:American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ A Midwife's Approach to Getting Labor Startedhttps://avivaromm.com/labor-induction-low-natural-approaches-midwife-md/ Bathing Your Babyhttps://www.healthychildren.org/English/ages-stages/baby/bathing-skin-care/Pages/Bathing-Your-Newborn.aspx Fetal presentation before birthhttps://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/fetal-positions/art-20546850 Health Insurance Portability and Accountability Act of 1996 (HIPAA)https://www.cdc.gov/phlp/php/resources/health-insurance-portability-and-accountability-act-of-1996-hipaa.html#:~:text=The%20Health%20Insurance%20Portability%20and,from%20disclosure%20without%20patient's%20consent. March of Dimeshttps://www.marchofdimes.org/peristats/about-us National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery North American Registry of Midwives (NARM)https://narm.org/ Office for Civil Rightshttps://www.hhs.gov/ocr/index.html State investigating Dallas birth center and midwives, following multiple complaints from patientshttps://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef Texas Administrative Code Title 26, Chapter 503 - Birthing Centershttps://regulations.justia.com/states/texas/title-26/part-1/chapter-503/subchapter-d/section-503-34/ Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ Texas Health and Human Services Birthing Centershttps://www.hhs.texas.gov/providers/health-care-facilities-regulation/birthing-centersWhat Happens at Appointments Once My Baby is Born?https://www.communitycaremidwives.com/faq.html#:~:text=Midwives%20provide%20care%20for%20both,six%20weeks%20after%20the%20birth.&text=breastfeeding%20support.,their%20family%20doctor%20for%20care. Zucker School of Medicine, Amos Grunebaum, MDhttps://faculty.medicine.hofstra.edu/13732-amos-grunebaum/publications *SWW S23 Theme Song & Artwork: Thank you so much to Emily Wolfe for covering Glad Rag's original song, U Think U for us this season!Hear more from Emily Wolfe:On SpotifyOn Apple Musichttps://www.emilywolfemusic.com/instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartFollow Something Was Wrong:Website: somethingwaswrong.com IG: instagram.com/somethingwaswrongpodcastTikTok: tiktok.com/@somethingwaswrongpodcast Follow Tiffany Reese:Website: tiffanyreese.me IG: instagram.com/lookiebooSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

*Content warning: infant loss, death, birth trauma, medical trauma and neglect, fraud, scams. *Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources Moms Advocating For MomsMarkeda, Kristen and Amanda have created a nonprofit, Moms Advocating for Moms, in hopes to create a future where maternal well-being is prioritized, disparities are addressed, and every mother has the resources and support she needs to thrive: https://linktr.ee/momsadvocatingformoms Please sign the survivors petition below to improve midwifery education and regulation in Texas: https://tinyurl.com/SWWS23 *Sources:American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ Balance billing: Independent Dispute Resolutionhttps://www.tdi.texas.gov/medical-billing/index.html#:~:text=Texas%20and%20federal%20laws%20prohibit,with%20a%20surprise%20medical%20bill. CMS, The No Surprises Act's Prohibitions on Balancing Billinghttps://www.cms.gov/files/document/a274577-1a-training-1-balancing-billingfinal508.pdf Do Certified Professional Midwives Need Medical Malpractice Insurance? Understanding the Legal Requirementshttps://www.rcins.com/do-certified-professional-midwives-need-medical-malpractice-insurance-understanding-the-legal-requirements/#:~:text=Texas%3A%20In%20contrast%2C%20Texas%20does,to%20carry%20medical%20malpractice%20insurance. How Expanding the Role of Midwives in U.S. Health Care Could Help Address the Maternal Health Crisishttps://www.commonwealthfund.org/publications/issue-briefs/2023/may/expanding-role-midwives-address-maternal-health-crisis#:~:text=Midwives%20are%20licensed%20health%20care,women%20at%20double%20the%20rate. Implementation of 2015 Sunset Recommendationshttps://www.sunset.texas.gov/public/uploads/files/reports/Implementation%20of%202015%20Sunset%20Recommendations.pdf The Legislative Process in Texashttps://tlc.texas.gov/docs/legref/legislativeprocess.pdf National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery North American Registry of Midwives (NARM)https://narm.org/ Practicing Medicine Without a Licensehttps://www.criminaldefenselawyer.com/resources/practicing-medicine-without-a-license.htm#:~:text=Many%20states%20make%20it%20a,fine%20of%20up%20to%20%2410%2C000. Regulation of Birth Attendants in Texashttps://texashomebirth.com/regulation-2/ Texas Board of Nursing https://www.bon.texas.gov/ Texas Department of Insurance https://www.tdi.texas.gov/ Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ TDLR, Midwives Penalties and Sanctionshttps://www.tdlr.texas.gov/enforcement/midsanctions.htm Texas Health and Human Serviceshttps://www.hhs.texas.gov/ Texas Medical Board (TMB)https://www.tmb.state.tx.us/ State investigating Dallas birth center and midwives, following multiple complaints from patients, by Morgan Young for WFAA (March 29, 2024) https://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef What Do OB/GYN Nurse Practitioners Do?https://nursa.com/specialty-post/what-do-ob-gyn-nurse-practitoners-do#:~:text=OB/GYN%20nurse%20practitioners%20are,not%20licensed%20to%20deliver%20babies. What Is the Texas Medical Malpractice Statute of Limitations?https://www.nolo.com/legal-encyclopedia/what-the-texas-statute-limitations-medical-malpractice-lawsuits.html#:~:text=Like%20a%20lot%20of%20states,and%20Remedies%20Code%20section%2074.251. Which states have the highest maternal mortality rates?https://usafacts.org/articles/which-states-have-the-highest-maternal-mortality-rates/ Why Won't an Attorney Take My Texas Medical Malpractice Case?https://www.hastingsfirm.com/your-case-and-texas-law/#:~:text=Texas%20law%20has%20made%20medical,and%20many%20hours%20of%20deposition. Zucker School of Medicine, Amos Grunebaum, MDhttps://faculty.medicine.hofstra.edu/13732-amos-grunebaum/publications *SWW S23 Theme Song & Artwork: Hear more from Emily Wolfe:On Spotify // On Apple Music // https://www.emilywolfemusic.com/ // instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

*Content warning: death of an infant, infant loss, death, birth trauma, medical trauma, medical neglect, racism, mature and stressful themes. *Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources Moms Advocating For MomsS23 survivors Markeda, Kristen and Amanda have created a nonprofit, Moms Advocating for Moms, in hopes to create a future where maternal well-being is prioritized, disparities are addressed, and every mother has the resources and support she needs to thrive: https://www.momsadvocatingformoms.org/take-actionhttps://linktr.ee/momsadvocatingformoms Please sign the survivors petitions below to improve midwifery education and regulation in Texashttps://www.change.org/p/improve-midwifery-education-and-regulation-in-texas?recruiter=1336781649&recruited_by_id=74bf3b50-fd98-11ee-9e3f-a55a14340b5a&utm_source=share_petition&utm_campaign=share_for_starters_page&utm_medium=copylink Malik's Law https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB4553 M.A.M.A. has helped file a Texas bill called Malik's Law, which is intended to implement requirements for midwives in Texas to report birth outcomes in hopes of improving transparency and data collection in the midwifery field in partnership with Senator Claudia Ordaz. *Sources:American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ Electronic Records and Audit Trailshttps://www.millerweisbrod.com/docs/max/Electronic_Records_and_Audit_Trails.pdf?utm_source=chatgpt.com Intravenous nutrient therapy: the "Myers' cocktail"https://pubmed.ncbi.nlm.nih.gov/12410623/ It's dangerous for Black women to give birth in Texas, and it could be about to get worsehttps://www.theguardian.com/global-development/2023/mar/17/texas-black-women-maternal-healthcare-crisis-medicaid March of Dimeshttps://www.marchofdimes.org/peristats/about-us Meconiumhttps://my.clevelandclinic.org/health/body/24102-meconium Midwifery Education Accreditation Council (MEAC)https://www.meacschools.org/ National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery North American Registry of Midwives (NARM)https://narm.org/ Oxytocin: The love hormonehttps://www.health.harvard.edu/mind-and-mood/oxytocin-the-love-hormone Racism in the health care system is killing Black pregnant Texanshttps://www.texasstandard.org/stories/racism-in-the-health-care-system-is-killing-black-pregnant-texans/ Racism, Sexism, and the Crisis of Black Women's Healthhttps://www.bu.edu/articles/2023/racism-sexism-and-the-crisis-of-black-womens-health/ State investigating Dallas birth center and midwives, following multiple complaints from patientshttps://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ Zucker School of Medicine, Amos Grunebaum, MDhttps://faculty.medicine.hofstra.edu/13732-amos-grunebaum/publications *SWW S23 Theme Song & Artwork: Thank you so much to Emily Wolfe for covering Glad Rag's original song, U Think U for us this season!Hear more from Emily Wolfe:On SpotifyOn Apple Musichttps://www.emilywolfemusic.com/instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartFollow Something Was Wrong:Website: somethingwaswrong.com IG: instagram.com/somethingwaswrongpodcastTikTok: tiktok.com/@somethingwaswrongpodcast Follow Tiffany Reese:Website: tiffanyreese.me IG: instagram.com/lookiebooSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

A short story on a woman contemplating a VBAC after two Cesarean Deliveries.  Vaginal birth after cesarean (VBAC) after two cesarean deliveries (VBAC-2) is considered a viable option for many women, though it carries certain risks.   The success rate for VBAC-2 is approximately 71.1%, which is slightly lower than the success rate for VBAC after one cesarean (VBAC-1). The risk of uterine rupture in VBAC-2 is 1.36%, which is higher compared to VBAC-1 (0.72%). Additionally, the hysterectomy rate for VBAC-2 is 0.55%, compared to 0.19% for VBAC-1.   The American College of Obstetricians and Gynecologists (ACOG) supports offering VBAC-2 to women who are appropriate candidates, emphasizing the importance of individualized counseling regarding the risks and benefits.   A retrospective study found that VBAC-2 had a success rate of 76.1%, with no significant differences in neonatal outcomes compared to elective repeat cesarean delivery  VBAC-2 is a viable option with a success rate of around 71.1%, but it carries a higher risk of uterine rupture and other complications compared to VBAC-1. Proper counseling and careful selection of candidates are crucial to optimizing outcomes.   YouTube: https://www.youtube.com/maternalresources Instagram: https://www.instagram.com/maternalresoruces/ Facebook: https://www.facebook.com/IntegrativeOB Thank you for being part of our community, and until next time, let's continue to support, uplift, and celebrate the incredible journey of working moms and parenthood. Together, we can create a more equitable and nurturing world for all. Shop our book!  The NatureBack Method for Birth https://naturebackbook.myshopify.com/

*Content warning: death, infant loss, pregnancy and birth trauma, medical trauma, medical neglect, racism*Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources ABC's new show, Familicide: https://www.familicide.net/Melissa Espey-Mueller's North Dallas Doula Associates:Website: https://www.northdallasdoulas.com/ Instagram: https://www.instagram.com/northdallasdoulas/ Moms Advocating For MomsS23 survivors Markeda, Kristen and Amanda have created a nonprofit, Moms Advocating for Moms, in hopes to create a future where maternal well-being is prioritized, disparities are addressed, and every mother has the resources and support she needs to thrive: https://www.momsadvocatingformoms.org/take-actionhttps://linktr.ee/momsadvocatingformoms Please sign the survivors petitions below to improve midwifery education and regulation in Texas:https://www.change.org/p/improve-midwifery-education-and-regulation-in-texas?recruiter=1336781649&recruited_by_id=74bf3b50-fd98-11ee-9e3f-a55a14340b5a&utm_source=share_petition&utm_campaign=share_for_starters_page&utm_medium=copylink Malik's Law https://capitol.texas.gov/BillLookup/History.aspx?LegSess=89R&Bill=HB4553 M.A.M.A. has helped file a Texas bill called Malik's Law, which is intended to implement requirements for midwives in Texas to report birth outcomes in hopes of improving transparency and data collection in the midwifery field in partnership with Senator Claudia Ordaz. *Sources:Best Doulahttps://bestdoulatraining.com/ CAPPAhttps://cappa.net/training-certification/ DONA Internationalhttps://www.dona.org/ Madriellahttps://madriella.org/ ProDoulahttps://www.prodoula.com/ American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ A Brief History of Midwifery in Americahttps://www.ohsu.edu/womens-health/brief-history-midwifery-america CDC, Maternal Mortality Rates in the United States, 2023https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2023/maternal-mortality-rates-2023.htm CDC, Working Together to Reduce Black Maternal Mortalityhttps://www.cdc.gov/womens-health/features/maternal-mortality.html Geospatial distribution of relative cesarean section rates within the USAhttps://pmc.ncbi.nlm.nih.gov/articles/PMC9284873/ In Mexico, Midwives Offer Care Rooted In Ancestral Traditionhttps://www.pih.org/article/mexico-midwives-offer-care-rooted-ancestral-tradition Insights into the U.S. Maternal Mortality Crisis: An International Comparisonhttps://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison?utm_source=chatgpt.com March of Dimeshttps://www.marchofdimes.org/peristats/about-us Maternal Mortality and Maternity Care in the United States Compared to 10 Other Developed Countrieshttps://www.commonwealthfund.org/publications/issue-briefs/2020/nov/maternal-mortality-maternity-care-us-compared-10-countries National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery North American Registry of Midwives (NARM)https://narm.org/ Racism During Pregnancy and Birthing: Experiences from Asian and Pacific Islander, Black, Latina, and Middle Eastern Womenhttps://pmc.ncbi.nlm.nih.gov/articles/PMC9713108/ Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ US Has Highest Infant, Maternal Mortality Rates Despite the Most Health Care Spendinghttps://www.ajmc.com/view/us-has-highest-infant-maternal-mortality-rates-despite-the-most-health-care-spending What is a freebirth?https://www.pregnancybirthbaby.org.au/what-is-freebirth *SWW S23 Theme Song & Artwork: Thank you so much to Emily Wolfe for covering Glad Rag's original song, U Think U for us this season!Hear more from Emily Wolfe:On SpotifyOn Apple Musichttps://www.emilywolfemusic.com/instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

*Content warning: death of an infant, infant loss, death, birth trauma, medical trauma, medical neglect, racism, mature and stressful themes. *Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources *Sources:American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ Birth Centers Offer Potential to Transform Maternity Care Through Community-Led Approaches that Focus on Families of Colorhttps://ccf.georgetown.edu/2024/08/19/birth-centers-offer-potential-to-transform-maternity-care-through-community-led-approaches-that-focus-on-families-of-color/ CDC, Maternal Mortality Rates in the United States, 2023https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2023/maternal-mortality-rates-2023CDC, Working Together to Reduce Black Maternal Mortalityhttps://www.cdc.gov/womens-health/features/maternal-mortality.html Center for Black Maternal Health and Reproductive Justice: https://blackmaternalhealth.tufts.edu/Comparative Analysis of Therapeutic Showers and Bathtubs for Pain Management and Labor Outcomes—A Retrospective Cohort Studyhttps://pmc.ncbi.nlm.nih.gov/articles/Fetal Heart Monitoringhttps://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/fetal-heart-monitoring Fundal Heighthttps://my.clevelandclinic.org/health/diagnostics/22294-fundal-height Health Equity Among Black Women in the United Stateshttps://pmc.ncbi.nlm.nih.gov/articles/PMC8020496/ Insights into the U.S. Maternal Mortality Crisis: An International Comparisonhttps://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison March of Dimeshttps://www.marchofdimes.org/peristats/about-us March of Dimes, Data: Heath Insurance/Incomehttps://www.marchofdimes.org/peristats/data?reg=99&top=11&stop=653&lev=1&slev=4&obj=1&sreg=48https://www.marchofdimes.org/peristats/data?reg=99&top=11&stop=154&lev=1&slev=4&obj=1&sreg=48Midwifery Education Accreditation Council (MEAC)https://www.meacschools.org/ Monitoring Baby's Heart Rate During Laborhttps://familydoctor.org/monitoring-babys-heart-rate-labor/ Mucus Plughttps://my.clevelandclinic.org/health/symptoms/21606-mucus-plugNasal Cannulahttps://my.clevelandclinic.org/health/treatments/25187-nasal-cannula National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery CDC, National Vital Statistics Reportshttps://www.cdc.gov/nchs/data/nvsr/nvsr73/nvsr73-05.pdf North American Registry of Midwives (NARM)https://narm.org/ State investigating Dallas birth center and midwives, following multiple complaints from patientshttps://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ Water breaking: Understand this sign of laborhttps://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/water-breaking/art-20044142Zucker School of Medicine, Amos Grunebaum, MDhttps://faculty.medicine.hofstra.edu/13732-amos-grunebaum/publications*SWW S23 Theme Song & Artwork: Thank you so much to Emily Wolfe for covering Glad Rag's original song, U Think U for us this season!Hear more from Emily Wolfe:On SpotifyOn Apple Musichttps://www.emilywolfemusic.com/instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartFollow Something Was Wrong:Website: somethingwaswrong.com IG: instagram.com/somethingwaswrongpodcastTikTok: tiktok.com/@somethingwaswrongpodcast Follow Tiffany Reese:Website: tiffanyreese.me IG: instagram.com/lookiebooSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

*Content warning: birth trauma, medical trauma, medical neglect, death, mature and stressful themes. *Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources *Sources:American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ CDC, Health E-Stats, Maternal Mortality Rates in the United States, 2023https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2023/Estat-maternal-mortality.pdfCDC, Maternal Mortality Rates in the United States, 2023https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2023/maternal-mortality-rates-2023CDC, Working Together to Reduce Black Maternal Mortalityhttps://www.cdc.gov/womens-health/features/maternal-mortality.html Center for Black Maternal Health and Reproductive Justice: https://blackmaternalhealth.tufts.edu/Comparative Analysis of Therapeutic Showers and Bathtubs for Pain Management and Labor Outcomes—A Retrospective Cohort Studyhttps://pmc.ncbi.nlm.nih.gov/articles/Fetal Heart Monitoringhttps://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/fetal-heart-monitoring Fundal Heighthttps://my.clevelandclinic.org/health/diagnostics/22294-fundal-height Health Equity Among Black Women in the United Stateshttps://pmc.ncbi.nlm.nih.gov/articles/PMC8020496/ Insights into the U.S. Maternal Mortality Crisis: An International Comparisonhttps://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison March of Dimeshttps://www.marchofdimes.org/peristats/about-us Midwifery Education Accreditation Council (MEAC)https://www.meacschools.org/ Monitoring Baby's Heart Rate During Laborhttps://familydoctor.org/monitoring-babys-heart-rate-labor/ Mucus Plughttps://my.clevelandclinic.org/health/symptoms/21606-mucus-plugNasal Cannulahttps://my.clevelandclinic.org/health/treatments/25187-nasal-cannula National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery CDC, National Vital Statistics Reportshttps://www.cdc.gov/nchs/data/nvsr/nvsr73/nvsr73-05.pdf North American Registry of Midwives (NARM)https://narm.org/ State investigating Dallas birth center and midwives, following multiple complaints from patientshttps://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ Water breaking: Understand this sign of laborhttps://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/in-depth/water-breaking/art-20044142Zucker School of Medicine, Amos Grunebaum, MDhttps://faculty.medicine.hofstra.edu/13732-amos-grunebaum/publications*SWW S22 Theme Song & Artwork: Thank you so much to Emily Wolfe for covering Glad Rag's original song, U Think U for us this season!Hear more from Emily Wolfe:On SpotifyOn Apple Musichttps://www.emilywolfemusic.com/instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartFollow Something Was Wrong:Website: somethingwaswrong.com IG: instagram.com/somethingwaswrongpodcastTikTok: tiktok.com/@somethingwaswrongpodcast Follow Tiffany Reese:Website: tiffanyreese.me IG: instagram.com/lookiebooSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

*Content warning: pregnancy, birth, infant & pregnancy loss, medical negligence, medical trauma. *Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources Amy Giles' Birth Center & Bio:Allen Midwifery & Family Wellness: https://allenmidwifery.com/ Amy's Bio: https://nursing.baylor.edu/person/l-amy-giles-dnp-cnm-cne-facnm *Sources:After a C-section, women who want a vaginal birth may struggle to find carehttps://www.pbs.org/newshour/health/c-section-vbac-vaginal-maternal-health American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ Cardiac conditions in pregnancy and the role of midwives: A discussion paperhttps://pmc.ncbi.nlm.nih.gov/articlesC-Section Rates By Hospitalhttps://www.leapfroggroup.org/sites/default/files/Files/C-Section-Graphic-final.pdf March of Dimeshttps://www.marchofdimes.org/peristats/about-us Midwifery Education Accreditation Council (MEAC)https://www.meacschools.org/ National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery North American Registry of Midwives (NARM)https://narm.org/ Postpartum Hemorrhagehttps://www.chop.edu/conditions-diseases/postpartum-hemorrhage Postpartum Hemorrhagehttps://my.clevelandclinic.org/health/diseases/22228-postpartum-hemorrhage Practice profile of members of the American College of Nurse-Midwives. https://pubmed.ncbi.nlm.nih.gov/9277066/ Salary and Workload of Midwives Across Birth Center Practice Types and State Regulatory Structureshttps://pubmed.ncbi.nlm.nih.gov/35191600/ State investigating Dallas birth center and midwives, following multiple complaints from patientshttps://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef Texas Administrative Codehttps://texreg.sos.state.tx.us/publicTexas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ Thyroid Disease & Pregnancyhttps://www.niddk.nih.gov/health-information/endocrine-diseases/pregnancy-thyroid-disease Zucker School of Medicine, Amos Grunebaum, MDhttps://faculty.medicine.hofstra.edu/13732-amos-grunebaum/publications *SWW S22 Theme Song & Artwork: Thank you so much to Emily Wolfe for covering Glad Rag's original song, U Think U for us this season!Hear more from Emily Wolfe:On SpotifyOn Apple Musichttps://www.emilywolfemusic.com/instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartFollow Something Was Wrong:Website: somethingwaswrong.com IG: instagram.com/somethingwaswrongpodcastTikTok: tiktok.com/@somethingwaswrongpodcast Follow Tiffany Reese:Website: tiffanyreese.me IG: instagram.com/lookiebooSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

*Content warning: birth trauma, medical trauma and neglect, death, infant loss, pregnancy loss, SIDS, postpartum depression. *Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources *Sources:American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ APGAR Scorehttps://medlineplus.gov/ency/article/003402.htm Birth Traumahttps://my.clevelandclinic.org/health/diseases/birth-trauma Breech Babyhttps://my.clevelandclinic.org/health/diseases/21848-breech-baby Intravenous nutrient therapy: the "Myers' cocktail"https://pubmed.ncbi.nlm.nih.gov/12410623/ March of Dimeshttps://www.marchofdimes.org/peristats/about-us Maternal placental abnormality and the risk of sudden infant death syndromehttps://pubmed.ncbi.nlm.nih.gov/10192307/ Midwifery Education Accreditation Council (MEAC)https://www.meacschools.org/ National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery North American Registry of Midwives (NARM)https://narm.org/ Preeclampsiahttps://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745 Pseudocholinesterase deficiencyhttps://www.mayoclinic.org/diseases-conditions/pseudocholinesterase-deficiency/symptoms-causes/syc-20354543 State investigating Dallas birth center and midwives, following multiple complaints from patientshttps://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef Succinylcholine injectionhttps://my.clevelandclinic.org/health/drugs/20755-succinylcholine-injection Sudden infant death syndrome (SIDS)https://www.mayoclinic.org/diseases-conditions/sudden-infant-death-syndrome/symptoms-causes/syc-20352800 Tawagi, George. "Compound Presentations." Oxorn-Foote Human Labor & Birth, 6e Eds. Glenn D. Posner, et al. McGraw-Hill Medical, 2014, https://obgyn.mhmedical.com/content.aspx?bookid=1247§ionid=75163840. Umbilical Cord Prolapsehttps://my.clevelandclinic.org/health/diseases/12345-umbilical-cord-prolapse Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ Zucker School of Medicine, Amos Grunebaum, MDhttps://faculty.medicine.hofstra.edu/13732-amos-grunebaum/publications *SWW S22 Theme Song & Artwork: Thank you so much to Emily Wolfe for covering Glad Rag's original song, U Think U for us this season!Hear more from Emily Wolfe:On SpotifyOn Apple Musichttps://www.emilywolfemusic.com/instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartFollow Something Was Wrong:Website: somethingwaswrong.com IG: instagram.com/somethingwaswrongpodcastTikTok: tiktok.com/@somethingwaswrongpodcast Follow Tiffany Reese:Website: tiffanyreese.me IG: instagram.com/lookieboo See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

*Content warning: infant loss, birth trauma, medical trauma and neglect, death, pregnancy loss, mature content. *Free + Confidential Resources + Safety Tips: somethingwaswrong.com/resources *Sources:American College of Nurse Midwiveshttps://midwife.org/ American College of Obstetricians and Gynecologists (ACOG)https://www.acog.org/ Gestational diabeteshttps://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-20355339 Insights into the U.S. Maternal Mortality Crisis: An International Comparisonhttps://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison March of Dimeshttps://www.marchofdimes.org/peristats/about-us Maternal Mortality, A National Institutes of Health Pathways to Prevention Panel Reporthttps://pmc.ncbi.nlm.nih.gov/articles/PMC10863655/ Maternal Mortality Rates in the United States, 2022https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2022/maternal-mortality-rates-2022.pdf Midwifery Education Accreditation Council (MEAC)https://www.meacschools.org/ National Midwifery Institutehttps://www.nationalmidwiferyinstitute.com/midwifery Neonatal mortality is more than tripled at planned out-of-hospital births attended by direct-entry midwives. Grunebaum, Amos et al. American Journal of Obstetrics & Gynecology, Volume 222, Issue 1, S45. https://www.ajog.org/article/S0002-9378(19)31440-1/fulltext North American Registry of Midwives (NARM)https://narm.org/ Placental abruptionhttps://www.mayoclinic.org/diseases-conditions/placental-abruption/symptoms-causes/syc-20376458 Preeclampsiahttps://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745 Severe Maternal Morbidity and Mortality Among Indigenous Women in the United Stateshttps://pmc.ncbi.nlm.nih.gov/articles/PMC7012336/ State investigating Dallas birth center and midwives, following multiple complaints from patientshttps://www.wfaa.com/article/news/local/investigates/state-investigating-dallas-birth-center-midwives-following-multiple-complaints-from-patients/287-ea77eb18-c637-44d4-aaa2-fe8fd7a2fcef Texas Department of Licensing and Regulation (TDLR)https://www.tdlr.texas.gov/ *SWW S22 Theme Song & Artwork: Thank you so much to Emily Wolfe for covering Glad Rag's original song, U Think U for us this season!Hear more from Emily Wolfe:On SpotifyOn Apple Musichttps://www.emilywolfemusic.com/instagram.com/emilywolfemusicGlad Rags: https://www.gladragsmusic.com/ The S23 cover art is by the Amazing Sara StewartFollow Something Was Wrong:Website: somethingwaswrong.com IG: instagram.com/somethingwaswrongpodcastTikTok: tiktok.com/@somethingwaswrongpodcast Follow Tiffany Reese:Website: tiffanyreese.me IG: instagram.com/lookieboo See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Jim manned the microphone and presented listeners worldwide with many headlines to prayerfully consider. Here's a sample of what the broadcast had to offer-----A CNN panel laughed and joked how they can now criticize Donald Trump concerning his age claiming he's -diminished-.----Congressman Jamie Raskin jumped upon his party's wild claims that Donald Trump is an insurrectionist. Now Raskin appears to be planning his own insurrection by having Congress deny Trump the presidency should he win in November. ----The campaign of Vice President Kamala Harris has attempted to moderate her image on border security. Her campaign chief suggested that she should keep in place a Biden era executive order cracking down on illegal border crossings. This is in spite of the fact that as a Senator from California she actively opposed border enforcement proposals and immigration enforcement advocates. ----The Harris campaign has altered it's biography of Minnesota Governor Tim Walz on his campaign website, making a change in its reference to his military service amid ongoing scrutiny.--The second quarter hour featured an interview with Dr. Patti Giebink, M.D., a board certified OB-GYN, a former abortion doctor, and the author of the book Unexpected Choice. A South Dakota native currently residing in Chamberlain, she has delivered hundreds of babies both domestically and in hospitals overseas. She's a Fellow at the American College of Obstetricians and Gynecologists -ACOG-, and a member of the South Dakota State Medical Association. Dr. Giebink talked about misinformation taking place in that state pertaining to Amendment G which will be coming up on their November ballot.

Jim manned the microphone and presented listeners worldwide with many headlines to prayerfully consider. Here's a sample of what the broadcast had to offer-----A CNN panel laughed and joked how they can now criticize Donald Trump concerning his age claiming he's -diminished-.----Congressman Jamie Raskin jumped upon his party's wild claims that Donald Trump is an insurrectionist. Now Raskin appears to be planning his own insurrection by having Congress deny Trump the presidency should he win in November. ----The campaign of Vice President Kamala Harris has attempted to moderate her image on border security. Her campaign chief suggested that she should keep in place a Biden era executive order cracking down on illegal border crossings. This is in spite of the fact that as a Senator from California she actively opposed border enforcement proposals and immigration enforcement advocates. ----The Harris campaign has altered it's biography of Minnesota Governor Tim Walz on his campaign website, making a change in its reference to his military service amid ongoing scrutiny.--The second quarter hour featured an interview with Dr. Patti Giebink, M.D., a board certified OB-GYN, a former abortion doctor, and the author of the book Unexpected Choice. A South Dakota native currently residing in Chamberlain, she has delivered hundreds of babies both domestically and in hospitals overseas. She's a Fellow at the American College of Obstetricians and Gynecologists -ACOG-, and a member of the South Dakota State Medical Association. Dr. Giebink talked about misinformation taking place in that state pertaining to Amendment G which will be coming up on their November ballot.

Jim manned the microphone and presented listeners worldwide with many headlines to prayerfully consider. Here's a sample of what the broadcast had to offer:--A CNN panel laughed and joked how they can now criticize Donald Trump concerning his age claiming he's "diminished".--Congressman Jamie Raskin jumped upon his party's wild claims that Donald Trump is an insurrectionist. Now Raskin appears to be planning his own insurrection by having Congress deny Trump the presidency should he win in November. --The campaign of Vice President Kamala Harris has attempted to moderate her image on border security. Her campaign chief suggested that she should keep in place a Biden era executive order cracking down on illegal border crossings. This is in spite of the fact that as a Senator from California she actively opposed border enforcement proposals and immigration enforcement advocates. --The Harris campaign has altered it's biography of Minnesota Governor Tim Walz on his campaign website, making a change in its reference to his military service amid ongoing scrutiny.The second quarter hour featured an interview with Dr. Patti Giebink, M.D., a board certified OB/GYN, a former abortion doctor, and the author of the book Unexpected Choice. A South Dakota native currently residing in Chamberlain, she has delivered hundreds of babies both domestically and in hospitals overseas. She's a Fellow at the American College of Obstetricians and Gynecologists (ACOG), and a member of the South Dakota State Medical Association. Dr. Giebink talked about misinformation taking place in that state pertaining to Amendment G which will be coming up on their November ballot.

Jim manned the microphone and presented listeners worldwide with many headlines to prayerfully consider. Here's a sample of what the broadcast had to offer-----A CNN panel laughed and joked how they can now criticize Donald Trump concerning his age claiming he's -diminished-.----Congressman Jamie Raskin jumped upon his party's wild claims that Donald Trump is an insurrectionist. Now Raskin appears to be planning his own insurrection by having Congress deny Trump the presidency should he win in November. ----The campaign of Vice President Kamala Harris has attempted to moderate her image on border security. Her campaign chief suggested that she should keep in place a Biden era executive order cracking down on illegal border crossings. This is in spite of the fact that as a Senator from California she actively opposed border enforcement proposals and immigration enforcement advocates. ----The Harris campaign has altered it's biography of Minnesota Governor Tim Walz on his campaign website, making a change in its reference to his military service amid ongoing scrutiny.--The second quarter hour featured an interview with Dr. Patti Giebink, M.D., a board certified OB-GYN, a former abortion doctor, and the author of the book Unexpected Choice. A South Dakota native currently residing in Chamberlain, she has delivered hundreds of babies both domestically and in hospitals overseas. She's a Fellow at the American College of Obstetricians and Gynecologists -ACOG-, and a member of the South Dakota State Medical Association. Dr. Giebink talked about misinformation taking place in that state pertaining to Amendment G which will be coming up on their November ballot.

Jim manned the microphone and presented listeners worldwide with many headlines to prayerfully consider. Here's a sample of what the broadcast had to offer-----A CNN panel laughed and joked how they can now criticize Donald Trump concerning his age claiming he's -diminished-.----Congressman Jamie Raskin jumped upon his party's wild claims that Donald Trump is an insurrectionist. Now Raskin appears to be planning his own insurrection by having Congress deny Trump the presidency should he win in November. ----The campaign of Vice President Kamala Harris has attempted to moderate her image on border security. Her campaign chief suggested that she should keep in place a Biden era executive order cracking down on illegal border crossings. This is in spite of the fact that as a Senator from California she actively opposed border enforcement proposals and immigration enforcement advocates. ----The Harris campaign has altered it's biography of Minnesota Governor Tim Walz on his campaign website, making a change in its reference to his military service amid ongoing scrutiny.--The second quarter hour featured an interview with Dr. Patti Giebink, M.D., a board certified OB-GYN, a former abortion doctor, and the author of the book Unexpected Choice. A South Dakota native currently residing in Chamberlain, she has delivered hundreds of babies both domestically and in hospitals overseas. She's a Fellow at the American College of Obstetricians and Gynecologists -ACOG-, and a member of the South Dakota State Medical Association. Dr. Giebink talked about misinformation taking place in that state pertaining to Amendment G which will be coming up on their November ballot.

Jim manned the microphone and presented listeners worldwide with many headlines to prayerfully consider. Here's a sample of what the broadcast had to offer:--A CNN panel laughed and joked how they can now criticize Donald Trump concerning his age claiming he's "diminished".--Congressman Jamie Raskin jumped upon his party's wild claims that Donald Trump is an insurrectionist. Now Raskin appears to be planning his own insurrection by having Congress deny Trump the presidency should he win in November. --The campaign of Vice President Kamala Harris has attempted to moderate her image on border security. Her campaign chief suggested that she should keep in place a Biden era executive order cracking down on illegal border crossings. This is in spite of the fact that as a Senator from California she actively opposed border enforcement proposals and immigration enforcement advocates. --The Harris campaign has altered it's biography of Minnesota Governor Tim Walz on his campaign website, making a change in its reference to his military service amid ongoing scrutiny.The second quarter hour featured an interview with Dr. Patti Giebink, M.D., a board certified OB/GYN, a former abortion doctor, and the author of the book Unexpected Choice. A South Dakota native currently residing in Chamberlain, she has delivered hundreds of babies both domestically and in hospitals overseas. She's a Fellow at the American College of Obstetricians and Gynecologists (ACOG), and a member of the South Dakota State Medical Association. Dr. Giebink talked about misinformation taking place in that state pertaining to Amendment G which will be coming up on their November ballot.

Christie Allen, Senior Director of Quality Improvement and Programs at the American College of Obstetricians and Gynecologists (ACOG), and Dr. Veronica Gillispie-Bell are back to explore the complexities of sustaining momentum in maternal health quality. After reflecting on last season, they discuss the concept of "health equity tourism" and the importance of true community integration. Dr. Gillispie-Bell shares her insights on embedding sustainable, equitable practices in healthcare beyond initial surges of interest.  This show is brought to you by the Alliance for Innovation on Maternal Health (AIM). Join us in the journey toward safer, more equitable maternal care and learn more about AIM at saferbirth.org.This podcast is supported by the Health Resources and Services Administration, HRSA, of the United States Department of Health and Human Services, HHS, as part of an initiative to improve maternal health outcomes.

Are you noticing changes in your body that feel like uncharted territory? You're not alone, and we're here to illuminate the path through one of motherhood's less talked about chapters: perimenopause. It knocks quietly but changes everything. Today I'm sharing personal experiences and vital information that every mom should have as they approach this life stage.   I share: The ins and outs of perimenopause and why it's more than just irregular periods How hormone replacement therapy turned the tide for me Practical strategies for managing symptoms from weight gain to mood swings Navigating intimate changes and reclaiming your sexual health with confidence The emotional rollercoaster and the power of open conversations Lifestyle tips to stay on top of your game   Resource Recommendations:   * The North American Menopause Society [NAMS]: https://www.menopause.org/ (Provides educational resources and healthcare professional directories)   * The American College of Obstetricians and Gynecologists [ACOG]: https://www.acog.org/ (Offers patient education resources on perimenopause)   Need more support? Let's chat! https://scottiedurrett.com/contact   INSTAGRAM SOURCES:   https://www.instagram.com/menopause.nutritionist/   https://www.instagram.com/drshahzadiharper/   Drop me a DM: @scottiedurrett on IG

This episode is sponsored by HCA Midwest Health. One of the first of many decisions you'll have to make once you find out you're having a baby is choosing a healthcare practitioner. Some women choose an obstetrician, while others opt for a midwife. Today we are chatting with Kim Boote, a Certified Nurse Midwife with Kansas City Women's Clinic, part of HCA Midwest Health, to learn about the benefits of choosing a midwife. Meet Kim Boote Kim Boote, CNM, MSN, C-EFM is a Certified Nurse Midwife with Kansas City Women's Clinic seeing patients in Kansas City, Olathe, and Lansing, KS. She is affiliated with Overland Park Regional Medical Center. Kim is a member of the American College of Nurse-Midwives (ACNM), the American College of Obstetricians and Gynecologists (ACOG), and the American Society for Colposcopy and Cervical Pathology (ASCCP). She received her Bachelor of Science in Nursing (BSN) from the University of Iowa, her Master of Science in Nursing (MSN) from Case Western Reserve University, and her Nurse-Midwifery certificate from Frontier Nursing University. Kim and her family enjoy vacationing in warm climates where they can hike, snorkel, or just enjoy the ocean. She loves learning where all her patients have traveled to update her bucket list for new destinations. Kim has four kids that keep her busy! Connect with Megan and Sarah We would love to hear from you! Send us an e-mail or find us on Instagram or Facebook!        

Episode 162: Early-Onset Sepsis      Dr. Kooner explains how to diagnose early-onset sepsis by using clinical evaluation and clinical tools. Dr. Schlaerths describes the signs and symptoms of sepsis in neonates, and Dr. Arreaza adds comments about GBS bacteriuria.  Written by Lovedip Kooner, MD, editing Hector Arreaza, MD, and comments by Katherine Schlaerth, MD. Rio Bravo Family Medicine Residency Program.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Introduction:Neonatal sepsis is defined as pathogenic bacterial growth from blood or cerebral spinal fluid culture within the first 28 days of life. Neonatal sepsis can be divided into two categories: early-onset sepsis (EOS) and late-onset.  EOS is neonatal sepsis within 72 hours or 7 days after birth, depending on the specialist. How common is early-onset sepsis (EOS)?According to the CDC, the infant mortality rate rose for the first time in 20 years in the USA. In the U.S., the incidence of EOS is 0.5 in 1,000 live births and carries a mortality rate of about 3%. What causes EOS?Most infections are due to ascending lower vaginal tract flora. Other causes include intra-amniotic infections and maternal hematogenous spread of systemic infections. Group B streptococcus (S. agalactiae) accounts for about 1/3 of the infectious organisms, followed by E. coli which accounts for about 1/4, and Viridans streptococci account for about 1/5 of infections. Cases of E. coli are seen more often with prolonged rupture of membranes and intrapartum antibiotic exposure. Other notable infections are Listeria monocytogenes, coagulase-negative staphylococci (CoNS), herpes simplex virus, and enteroviruses. The role of GBS.Approximately 30% of women have vaginal and rectal GBS colonization and 50% will transmit it to the newborn. Without maternal antibiotic treatment, 1-2% of those infants will develop EOS. The American College of Obstetricians and Gynecologists (ACOG) recommends universal culture-based screening for GBS at 36-37 weeks and 6 days regardless of mode of delivery. GBS bacteriuria: Treat it (symptomatic and asymptomatic) if >105 CFU/mL. Do not treat it in asymptomatic patients if GBS 18 hours, intrapartum fever, or GBS positive in previous pregnancy.Nucleic acid amplification test: NAAT in pregnancy is not recommended to determine colonization status. However, if NAAT is obtained in the intrapartum period, give IAP if positive. But, you must also give IAP if negative + mentioned risk factors (18h, Maternal fever >100.4F)What is considered adequate intrapartum antibiotic prophylaxis? Penicillin and ampicillin are the recommended antibiotics for prophylaxis. Cefazolin can be given if there is a penicillin-allergy with a low risk for anaphylaxis. Clindamycin and vancomycin are reserved for cases of maternal penicillin allergy. Specifically, clindamycin can be used only if GBS is known to be sensitive to clindamycin. Vancomycin must be used if GBS is resistant to clindamycin. Do not use erythromycin. You will Administered at least 4 hours before delivery.IAP is believed to reduce neonatal GBS disease by: (1) temporarily reducing maternal vaginal GBS colonization; (2) preventing colonization of the fetus or newborn's surfaces and mucous membranes; and (3) achieving antibiotic levels in the newborn's bloodstream sufficient to surpass the minimum inhibitory concentration (MIC) for eliminating group B streptococci.Diagnosis of EOS:Clinical presentation: Tachycardia, tachypnea, temperature instability, supplemental oxygen requirement, and lethargy. Hypoglycemia should not be considered a sign of EOS.Diagnosing early-onset sepsis is achieved through blood or cerebrospinal fluid (CSF) cultures. Not effective methods for diagnosing EOS include laboratory tests, such as a complete blood cell count or C-reactive protein (CRP), as well as surface cultures, gastric aspirate analysis, or urine culture.Most infants will generally show signs of EOS GBS infection within the initial 24 hours of birth, with approximately 85% exhibiting symptoms during this timeframe.Waiting for cultures and/or signs can delay lifesaving treatment.Management:According to the American Academy of Pediatrics (AAP), the management of term and late-term infants is undertaken via the clinical condition assessment, the categorical risk factor assessment, and the multivariate risk assessment. As a part of the 2015 AAP guidelines, the Categorical Risk Factor Assessment is more of an algorithmic approach based on the presence or absence of specific risk factor threshold values such as:Ill-appearing infant. Mother diagnosed with chorioamnionitis.Mother GBS positive with inadequate intrapartum prophylaxis.ROM >18 hours.Birth before 37 weeks of gestation.Antibiotics are not always needed, and they can even cause damage. Information taken from the American Academy of Pediatrics, “Management of Neonates Born at ≥35 0/7 Weeks' Gestation With Suspected or Proven Early-Onset Bacterial Sepsis,” published on December 1, 2018:(1) Any newborn infant who is ill-appearing or (2) when the mother has a clinical diagnosis of chorioamnionitis -> laboratory testing must be ordered, and empirical antibiotic therapy should be started.(3) A mother who is colonized with GBS and who received inadequate intrapartum antibiotic prophylaxis, with a duration of ROM being >18 hours or birth before 37 weeks' gestation -> laboratory testing should be ordered.(4) A mother who is colonized with GBS who received inadequate IAP but with no additional risk factors -> observation in the hospital for ≥48 hours.______________________________Conclusion: Now we conclude episode number 162, “Early-onset Sepsis Introduction.” Dr Kooner explained the role of GBS in the pathophysiology of EOS, Dr. Schlaerth discussed the importance of clinical evaluation and Dr. Arreaza explained that GBS screening in the third trimester is not needed when there is a GBS positive urine culture early in pregnancy. Don't miss part 2 of this discussion. By the way, we do not recommend using feces to prevent or treat sepsis, we just shared anecdotal information to end with a funny note.This week we thank Hector Arreaza, Lovedip Kooner, and Katherine Schlaerth. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Neonatal Early-Onset Sepsis Calculator by Kaiser Permanente, available at: https://neonatalsepsiscalculator.kaiserpermanente.org/.Espinosa K, Brown SR. Neonatal Early-Onset Sepsis Calculator. Am Fam Physician. 2021;104(6):636-637.https://www.aafp.org/pubs/afp/issues/2021/1200/p636.html.Puopolo KM, Benitz WE, Zaoutis TE; COMMITTEE ON FETUS AND NEWBORN; COMMITTEE ON INFECTIOUS DISEASES. Management of Neonates Born at ≥35 0/7 Weeks' Gestation With Suspected or Proven Early-Onset Bacterial Sepsis. Pediatrics. 2018 Dec;142(6):e20182894. doi: 10.1542/peds.2018-2894. PMID: 30455342. https://pubmed.ncbi.nlm.nih.gov/30455342/.Briggs-Steinberg C, Roth P. Early-Onset Sepsis in Newborns. Pediatr Rev. 2023 Jan 1;44(1):14-22. doi: 10.1542/pir.2020-001164. PMID: 36587021. https://pubmed.ncbi.nlm.nih.gov/36587021/.Flannery DD, Puopolo KM. Neonatal Early-Onset Sepsis. Neoreviews. 2022 Nov 1;23(11):756-770. doi: 10.1542/neo.23-10-e756. PMID: 36316253. https://pubmed.ncbi.nlm.nih.gov/36316253/.Polin RA; Committee on Fetus and Newborn. Management of neonates with suspected or proven early-onset bacterial sepsis. Pediatrics. 2012 May;129(5):1006-15. doi: 10.1542/peds.2012-0541. Epub 2012 Apr 30. PMID: 22547779. https://pubmed.ncbi.nlm.nih.gov/22547779/.Royalty-free music used for this episode: Good Vibes_Adventure Time by Simon Pettersson, downloaded on July 20, 2023, from https://www.videvo.net/  

Episode 156: Obesity, Fertility, and PregnancyFuture Dr. Hamilton defines obesity and explains the pathophysiology of obesity and its effects on fertility and pregnancy. Dr. Arreaza adds some input about the impact of epigenetics on newborn babies.  Written by Shelby Hamilton, MS3, American University of the Caribbean School of Medicine. Editing by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Definition of obesityObesity is a multifactorial chronic disease that is increasing in prevalence across the globe. It can be defined as a body mass index (or BMI) greater than 30 kg/m2. According to the CDC from 2017-March 2020, the prevalence of obesity in United States adults was 41.9%.Classification of obesity by BMI.Obesity can further be divided into three classes: class I which is a BMI between 30-34.9; class II which is a BMI between 35-39.5; and class III which is a BMI greater than 40. We recommend avoiding the term “morbid obesity” because of the negative connotation of the word “morbid.” Class III or severe are better terms in those cases. This classification is based on the individual risk of cardiovascular disease. One of the greatest health consequences affecting individuals with obesity is the cardiovascular effects including hypertension, dyslipidemia, and coronary artery disease. Other effects include insulin resistance and diabetes, cholelithiasis, non-alcoholic fatty liver disease, osteoarthritis, and even depression.How Does Obesity Affect Fertility?Obesity can have an extensive effect on the overall health of an individual. In addition to these commonly discussed effects, obesity can also influence a person's fertility. This is especially observed in women with polycystic Ovary Syndrome (PCOS) who have a greater BMI and also have symptoms of anovulation. Excess adipose tissue plays a role in the effects that obesity has on fertility. White adipose tissue can secrete a specific group of cytokines known as ‘adipokines'. These adipokines include leptin, ghrelin, resistin, visfatin, chemerin, omentin, and adiponectin. With a greater percentage of adipose tissue, there are higher rates of hypothalamic gonadotropin hormonal dysregulation, which can be combined with insulin-related disorders, low sex hormone binding proteins, and high levels of androgens. The combination of these factors can result in decreased ovarian follicle development and decreased progesterone levels.Hormonal changesObesity is an endocrine disorder. One specific adipokine that affects the hypothalamic-gonadotropin axis is chemerin. Chemerin impairs the release of follicle-stimulating hormone (FSH) from the pituitary gland. This reduction in FSH release consequently leads to anovulation, meaning that no egg will be released from an ovarian follicle, contributing to infertility. Shelby: Another adipokine affecting fertility is adiponectin. The receptors of adiponectin are predominantly expressed in reproductive tissues, including the ovaries and endometrium. In individuals with a greater BMI, a decrease in adiponectin secretion has been observed, resulting in decreased stimulation of its receptors, especially in the endometrium, which has been linked to recurrent implantation failure. Adiponectin has also been shown to affect glucose uptake in the liver. With reduced adiponectin levels, there is reduced hepatic glucose uptake, leading to insulin resistance. As tissues become less sensitive to insulin, the body compensates by secreting higher amounts of insulin, leading to hyperinsulinemia. Higher levels of circulating insulin have also been proven to cause hyperandrogenemia in women by blocking the hepatic production of sex hormone-binding globulin. Insulin can also act on the IGF-1 receptors in the theca cells, increasing steroidogenesis, and thus, increasing androgens. With hyperandrogenemia, there is also increased granulosa cell apoptosis as well as increased peripheral conversion of androgens into estrogen. This creates negative feedback to the hypothalamic-pituitary axis to decrease the release of gonadotropins such as FSH which are critical in ovulation.Leptin is another adipokine that is shown to be increased in obesity. Studies on mice have shown that leptin impairs the development of ovarian follicles, resulting in a decrease in ovulation. In these studies, it was also observed that leptin reduces the production of estriol by the granulosa cells in the ovarian follicles as well as increases the rate of apoptosis in granulosa cells, both of which affect ovulation. Leptin decreases hunger, but persons with obesity may be resistant to its effects and that's why they have higher levels than a person with normal weight. They have high levels of leptin but are still hungry because they have leptin resistance.Studies have also shown that the fatty acid composition of follicular fluid found in ovarian follicles also plays a role in fertility. In individuals with a high BMI, this fluid contains high levels of oleic acid, which can cause embryo fragmentation after fertilization occurs. Stearic acid is another fatty acid found in elevated levels in the follicular fluid of women with a greater BMI, which can also affect the quality of the embryo while in the blastomere stage.The bottom line is obesity decreases fertility. It does not mean that patients with obesity will not get pregnant, but it can make it harder to get pregnant. Female patients who are losing weight must be warned about their improved fertility once they start to lose weight.What effect does obesity have on pregnancy?While obesity may make it more difficult for a woman to get pregnant, it is not impossible. However, there are potential risks both to the mother's health as well as the baby's health. Therefore, it is very important to monitor these patients even more carefully.Women who have a greater BMI pre-pregnancy are at a greater risk of developing gestational hypertension. Gestational hypertension is defined as blood pressure greater than 140/90 on more than one reading in the second half of pregnancy. Hypertension during pregnancy can also have serious complications such as kidney failure, stroke, myocardial infarction, or even heart failure. Gestational hypertension can also result in preterm birth or low birth weight.Treatment of mild hypertension in pregnancyRecent studies published in the AFP Journal support the treatment of mild hypertension in pregnancy. It states that “evidence and expert opinion support treating mild chronic hypertension in pregnancy with approved antihypertensives, with a strength of recommendation: B”. There was a randomized control trial with about 2,000 women who were randomized to receive antihypertensive treatment vs no treatment. The treatment group had a lower incidence of preeclampsia with severe features, preterm birth, placental abruption, and neonatal or fetal death. There was not an increase in fetal growth restriction or maternal or neonatal complications. So, it is advisable to treat chronic, mild hypertension in pregnancy, according to the AFP Journal.PreeclampsiaPreeclampsia is another condition that is at a higher risk in women with obesity, which is a more serious manifestation of hypertension in the second half of pregnancy. Along with high blood pressure, there are also effects on the kidneys and liver. Hypertension accompanied by proteinuria is indicative of preeclampsia and should be taken seriously. Preeclampsia can become eclampsia, where the patient also experiences seizures. There is also the risk for stroke, HELLP syndrome, placenta abruption, preterm birth, and fetal growth restriction.Gestational diabetesAnother risk is gestational diabetes. Elevated blood glucose during pregnancy can result in a larger baby and delivery by cesarean. There may also be a greater risk of the mother and child developing diabetes mellitus later on in life.OSAWomen with a greater BMI may also be at risk of developing obstructive sleep apnea during pregnancy. Not only can this result in fatigue but can also contribute to the development of gestational hypertension and preeclampsia.Effect of obesity on the fetusAs mentioned, there are some risks to the fetus in women with a greater pre-pregnancy BMI. There is a greater risk for these babies to be born with birth defects such as congenital heart defects and neural tube defects. Another risk previously discussed is macrosomia, or large for gestational age. Larger babies are also at increased risk for shoulder dystocia during delivery as well as resulting clavicle fractures, brachial plexus injuries, and nerve palsies. Preterm birth is another risk, which also increases the risk of short-term and long-term health complications. Lastly, a higher BMI is directly correlated with the risk of spontaneous abortion or stillbirth.SummaryAs the prevalence of obesity increases, it is important to discuss the health risks that are associated with this disease. In our patients of childbearing age and who may be hoping to conceive, it is even more important to discuss how a higher BMI may affect fertility and pregnancy. While discussing these topics with patients, it is important to try our best to build rapport with the patient so that the discussion is seen more as one of concern and support rather than one of criticism regarding their weight. We may want to help by not only telling patients to “lose weight” or “diet”, but we can also provide them with resources regarding dietary adjustments and ways they can incorporate physical activity into their lives without just telling them to eat less and move more. Stay tuned for our episode on the management of obesity in pregnancy.ConclusionNow we conclude episode number 156, “Obesity, fertility, and pregnancy.” Future Dr. Hamilton explained how obesity affects the hormonal regulation of fertility. She also explained the obstetrical risks associated with obesity. Primary care professionals need to educate our patients about the benefits of preconception weight control. Dr. Arreaza explained that hypertension is a common condition in pregnant patients with obesity and mentioned the benefits of treating mild hypertension in pregnancy. We hope to bring you an episode on the management of obesity in pregnancy soon, so stay tuned! This week we thank Hector Arreaza and Shelby Hamilton. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Gautam, D., Purandare, N., Maxwell, C., Rosser, M., O'Brien, P., Mocanu, E., McKeown, C., Malhotra, J., & McAuliffe, F. (2023) The challenges of obesity for fertility: A FIGO literature review. International Journal of Gynecology & Obstetrics, 160(S1), 50-55. https://doi.org/10.1002/ijgo.14538Pandey, S., Pandey, S., Maheshwari, A., & Bhattacharya, S. (2010). The impact of female obesity on the outcome of fertility treatment. Journal of Human Reproductive Science, 3(2), 62-67. https://doi.org/10.4103/0974-1208.69332.Perreault L. Obesity in adults: Prevalence, screening, and evaluation. In: UpToDate, Pi Sunyer FX (Ed) Wolters Kluwer. https://www.uptodate.com (Accessed on October 6, 2023).Obesity and Pregnancy FAQ, The American College of Obstetricians and Gynecologists (ACOG), https://www.acog.org/womens-health/faqs/obesity-and-pregnancy, Accessed on October 10, 2023.Adult Obesity Facts, Centers for Disease Control and Prevention (CDC), https://www.cdc.gov/obesity/data/adult.html, Accessed on October 7, 2023. Dresang L, Vellardita L. Should Medication Be Prescribed for Mild Chronic Hypertension in Pregnancy?. Am Fam Physician. 2023;108(4):411-412. Royalty-free music used for this episode: "I Think We Have a Chance."  downloaded on November 11, 2023,  from https://www.videvo.net/.

In a recent article, it was revealed that the interim head of the American College of Obstetricians and Gynecologists (ACOG) is a proponent of unrestricted access to abortion. Christopher M. Zahn and Jenni Villavicencio, leaders within ACOG, jointly authored an op-ed in The Washington Post, wherein they voiced their support for unrestricted abortion access. This response came in the wake of an op-ed authored by Susan B. Anthony Pro-Life America President Marjorie Dannenfelser and former senior counselor to the president Kellyanne Conway.The ACOG leaders argue that abortion is not only safe but also plays a role in improving and saving lives. They firmly believe that it should be available without any restrictions, positioning it as an essential component of healthcare.This article underscores the ongoing debate surrounding abortion rights, with ACOG advocating for a comprehensive approach to access, while other voices in the public discourse are pushing for limitations and restrictions on abortion.Read here: https://www.christianpost.com/news/ob-gyn-group-head-calls-for-unrestricted-abortion-access.htmlJoin us for an engaging episode of I Am Refocused Radio, as your host Shemaiah chats with Chelsey Youman, Texas State Director and National Legislative Advisor for Human Coalition. In this conversation, we delve into the ongoing discussions around abortion rights, where medical professionals have recently called for extending abortion access, and some Democrats remain steadfast supporters.Chelsey offers a warm and informative perspective on the dedicated work of Human Coalition. Their mission is to ensure that every woman has access to the care, resources, and support needed to make choices about their preborn child's future.Discover the compassionate initiatives Human Coalition is spearheading to create a more understanding and supportive environment for women facing these challenging decisions. Learn about the importance of rallying pro-life advocates to appreciate the complexity of these situations and the urgency of the need for change.In this episode, we aim to provide valuable insights into the ongoing dialogue surrounding abortion and efforts to promote alternatives that empower women and honor the sanctity of life. So, tune in and join us as we explore these essential topics with Chelsey Youman.Chelsey Youman Texas State Director and National Legislative AdvisorChelsey Youman, Esq., serves the pro-life coalition, as well as women and their preborn children, by advocating for pro-life policies and jurisprudence; mobilizing and unifying local grassroots to strengthen the pro-life movement and its footprint; and engaging with the public to ultimately strengthen our community's desire to enable women and protect preborn children.Chelsey's professional experience includes working as senior counsel and chief of staff for First Liberty Institute, concentrating on religious liberty matters and First Amendment rights. At First Liberty Institute, she litigated on behalf of and advised hundreds of clients regarding conscience rights nationwide. Chelsey has also worked in private practice, where she successfully litigated corporate fraud matters, complex commercial litigation, and consumer rights issues in both federal and state jurisdictions.Chelsey holds a Bachelor of Arts degree in Political Science from Texas A&M, and a J.D. from Southern Methodist University.Chelsey is happily married with two children. Her family is active in their church, serving in the premarital and pro-life ministries there. They enjoy traveling, adventuring, and eating good food.https://hucoaction.org/https://www.humancoalition.org/bios/chelsey-youman/For more interviews visit: www.iamrefocusedradio.com

A viral video is making the rounds, which shows an enraged husband's mission of vengeance storming the stage during a medical conference to slap the hell out of the gynecologist he alleges committed sexual assault on his wife. The dramatic scene played out right in the middle of the annual American College of Obstetricians and Gynecologists (ACOG), last month in Baltimore and the furious man confronted the physician while he was standing at a podium delivering a speech. The man grabbed the doctor by his shirt and b-slapped him across the face multiple times, yelling, "You know what you did!" You touched my wife 7 years ago in New York. Don't be an ass****, bitch!" Surprisingly, the doctor did not press charges against the man. And here to talk about the importance of trust between a gynecologist and his patients, is our resident physician. Listen to Lamont & Tonelli Monday through Friday, 6-10am, on 107.7 The Bone in the San Francisco Bay Area. Follow Lamont & Tonelli:Website: http://www.landtradio.com/Facebook: http://www.facebook.com/lamontandtonelliTwitter: http://www.twitter.com/landtshowInstagram: http://www.instagram.com/landtshowSee omnystudio.com/listener for privacy information.

A viral video is making the rounds, which shows an enraged husband's mission of vengeance storming the stage during a medical conference to slap the hell out of the gynecologist he alleges committed sexual assault on his wife. The dramatic scene played out right in the middle of the annual American College of Obstetricians and Gynecologists (ACOG), last month in Baltimore and the furious man confronted the physician while he was standing at a podium delivering a speech. The man grabbed the doctor by his shirt and b-slapped him across the face multiple times, yelling, "You know what you did!" You touched my wife 7 years ago in New York. Don't be an ass****, bitch!" Surprisingly, the doctor did not press charges against the man. And here to talk about the importance of trust between a gynecologist and his patients, is our resident physician. Listen to Lamont & Tonelli Monday through Friday, 6-10am, on 107.7 The Bone in the San Francisco Bay Area. Follow Lamont & Tonelli:Website: http://www.landtradio.com/Facebook: http://www.facebook.com/lamontandtonelliTwitter: http://www.twitter.com/landtshowInstagram: http://www.instagram.com/landtshowSee omnystudio.com/listener for privacy information.

No episódio de hoje, você ficará por dentro das principais temáticas abordadas no American College of Obstetricians and Gynecologists – ACOG 2023, que ocorreu dos dias 19 a 21 de maio de 2023, em Baltimore. Entre elas: saúde mental da mulher; novo dispositivo para a hemorragia pós-parto; Espectro da Placenta Acreta, Fezolinetante e mais! Confira esse e outros posts no Portal PEBMED e siga nossas redes sociais! Facebook Instagram Linkedin Twitter

Dr. Christina Francis, CEO of the American Association of Pro-Life OB/Gyns (AAPLOG), discusses the cancellation of a pro-life booth at a recent American Congress of Obstetricians and Gynecologists (ACOG) conference.  What does this mean for the medical community and culture? Make A Gift To The LoveX2 Project Music Title: Children of the Son Author: Pipe Choir Souce: www.pipechoir.com Licenses: Creative Commons Attribution 4.0 International  

A scar pregnancy is a rare type of ectopic pregnancy where the fertilized egg implants in the scar tissue of a previous cesarean section or other surgical procedure in the uterus, rather than in the lining of the uterus where a normal pregnancy should occur. This can occur when the scar tissue is not fully healed or is weakened, allowing the fertilized egg to implant and grow in the scar tissue where the uterine muscle can be weakened. Scar pregnancy can be dangerous, as the scar tissue may not be able to support the growing embryo and can rupture or cause other complications, but it is not always associated with miscarriage or loss of the pregnancy. A scar pregnnacy can actually produce a live. birth. In addition, scar pregnancy can be difficult to diagnose, as it may not produce typical pregnancy symptoms and may not be visible on a standard ultrasound. A highly trained expert sonographer is generally what is needed for diagnosis.  Dr. Ilan Timor is an expert OB/GYN with extensive years in scanning for these types of pregnancies and is world-renown in how to treat and diagnosis these types of pregnancies.  Fortunate of us a Maternal Resources, he has recenlty joined our team and can assist us in the diagnosis, treatment and managment of different types of pregnancies.  From Dr. Timor's perspective he doesn't alwasy consider a scar pregnancy an ectopic pregnancy. It is generally accepted in the medical community that a scar pregnancy is a type of ectopic pregnancy, despite the fact that the gestational sac is located within the uterus. This is because the fertilized egg has implanted in scar tissue outside of the normal location in the endometrial lining of the uterus. In fact, the American College of Obstetricians and Gynecologists (ACOG) defines an ectopic pregnancy as "any gestation that implants outside the endometrial lining of the uterine cavity." This includes implantation in the fallopian tube (the most common location for ectopic pregnancy), as well as other locations outside the uterus, such as the cervix, ovaries, and abdominal cavity. While scar pregnancy is a relatively rare type of ectopic pregnancy, it can still pose serious health risks and requires prompt medical attention and treatment. Treatment for scar pregnancy typically involves surgical removal of the ectopic pregnancy and the scar tissue, in order to prevent further complications and preserve the health of the uterus.   Maintaining the integrity of the uterus is very important in scar pregnancies. When a fertilized egg implants in the scar tissue of a previous cesarean section or other surgical procedure, it can weaken the scar tissue and put the integrity of the uterus at risk. Scar tissue may be thinner and more prone to tearing, which can lead to bleeding and other complications. If a scar pregnancy is not treated promptly, it can result in further damage to the uterus and potentially require more extensive surgical intervention, such as a hysterectomy. Therefore, early detection and prompt treatment of scar pregnancy is important to preserve the health and integrity of the uterus. Treatment typically involves the removal of the ectopic pregnancy and scar tissue, which may be done through surgery or medication depending on the severity of the case. If you suspect you may have a scar pregnancy, it is important to seek medical attention right away. Your healthcare provider can perform an ultrasound and other diagnostic tests to determine the best course of treatment for your individual situation.   Dr. Timor can be found in our practice at www.maternalresources.org He is currently accepting patients and consults in our New York City office to reach us call (201) 487-8600   As always, we'd love to hear from you! Connect with us on our website at www.truebirthpodcast.com or send us an email at info@maternalresources.org     Remember to subscribe wherever you listen and considering leaving us some feedback at info@maternalresoruces.org or writieng a review.  Our Social Channels are as follows Twitter: https://twitter.com/integrativeobYouTube: https://www.youtube.com/maternalresources IG: https://www.instagram.com/integrativeobgyn/ Facebook: https://www.facebook.com/IntegrativeOB

VBAC stands for Vaginal Birth After Cesarean, which is a delivery method chosen by women who have previously had a c-section but want to deliver vaginally for their next birth. VBAC2, on the other hand, refers to the second or subsequent vaginal birth after a c-section. VBAC and VBAC2 are two different terms that can be confusing for new parents. Women who have had a previous c-section may be wondering about their options for future deliveries. So, let's break down the difference between these two terms. VBAC: Vaginal Birth After Cesarean, or VBAC, is a safe and successful option for many women who have previously delivered by c-section. The American College of Obstetricians and Gynecologists (ACOG) states that women who have had one prior low transverse uterine incision are candidates for VBAC. The success rate for VBAC is high, around 60-80%, and it has several benefits over repeat c-section, including a shorter recovery time, a reduced risk of surgical complications, and a lower risk of infections. However, VBAC is not recommended for all women, as it carries a small risk of uterine rupture, which can be life-threatening for both mother and baby. Other factors, such as the reason for the previous c-section, may also play a role in determining whether VBAC is a safe option for a woman. However, just like with VBAC, there are factors to consider when deciding whether VBAC2 is a safe option. Women who have had multiple c-sections or a previous uterine rupture may not be good candidates for VBAC or VBAC2, yet VBAC2 may still be safe and recommended or some women. VBAC and VBAC2 are both viable options for women who have previously had a c-section and want to deliver vaginally in the future. VBAC is a safe option for most women with one or two prior low transverse uterine incisions. It is important to discuss your options with your healthcare provider, who can help you make an informed decision based on your medical history and individual circumstances. As always, we'd love to hear from you! Connect with us on our website at www.truebirthpodcast.com or send us an email at info@maternalresources.org   Maternal Resources' website is:  https://www.maternalresources.org/   Remember to subscribe wherever you listen, and leave us a review!   Our Social Channels are as follows Twitter: https://twitter.com/integrativeobYouTube: https://www.youtube.com/maternalresources IG: https://www.instagram.com/integrativeobgyn/ Facebook: https://www.facebook.com/IntegrativeOB

What causes headaches and migraines? How can you avoid them naturally? What about trigger foods for headaches? Headaches and migraines can severely impact your life and make you lose out on important things. If you're like a lot of people, you might get frequent headaches and migraines. Maybe all the over the counter medications aren't working so well for you. But there are plenty of natural ways to manage these pesky developments that nature can throw your way and it's all explained in this podcast. We also share my discovery on how a common household product could be linked to autism. Migraines and headaches can be managed using natural methods. Many of the over-the-counter medications on the market are loaded with chemicals that can be harmful for your health. In this podcast, Dr. Thom gives tips on how to avoid some of these products. He also tells about a surprising discovery with Autism and why you need to STOP taking this specific OTC if you are under the age of 30. In this episode, we go over the different types of headaches (and migraines) the natural ways to treat them, and a little known secret that can help with immune function. In the 2022 review, led by Jasmine Cendejas-Hernandez of Duke University states that a 2008 case-controlled study led by Stephen Schulz was the first to indicate acetaminophen's adverse effect on neurodevelopment. Through parental survey research they found that children with autistic disorder (n=83) were far more likely to have received acetaminophen after MMR vaccination than healthy control children (n=80). Ibuprophen use was not associated with an increase rate of autism. According to Cendejas-Hernandez et al, the American College of Obstetritions and Gynecologists (ACOG) has refused to caution against acetaminophen use during pregnancy. ACOGS clinical guidance for physicians is not to change clinical practice until prospective studies are done. The Duke researchers respond: “it is difficult to rationalize the need for such a high level of certainty regarding a drug never demonstrated to be safe or life-saving, where judgement should presumably err on the side of caution and avoidance of harm… the drug would not meet current safety standards during preclinical testing due to adverse, long-term neurological effects in laboratory animals, and thus would never reach phase 1 testing under the current regulatory system.” If you're interested in learning more and reading the research here are some pubmed articles. PMID: 35175416 PMID: 27585674 PMID: 27353198 Let's connect beyond the podcast: Julie's Info: Website: https://fitomize.ca YouTube: https://www.youtube.com/fitomizefitness Instagram: http://instagram.com/fitomizefitness Facebook: https://www.facebook.com/fitomize/ Online Community (Mighty Network): https://community.fitomize.ca/ LinkedIn for Julie - https://www.linkedin.com/in/julie-thom-b133881a0 Join Julie's email list: https://forms.aweber.com/form/51/1973490451.htm Dr. Thom's Info: Website: https://drdicksonthom.com/ LinkedIn for Dr. Thom - https://www.linkedin.com/in/dick-thom-7a36163/ Purchase the book: https://drdicksonthom.com/product/the-brain-protocol-book/

Episode 126: Caffeine and AKI.  January 20, 2023. Olivia and Janelli explain that caffeine intake during pregnancy may cause short height in babies, and Anthony discusses the definition, evaluation, and management of AKI with Dr. Kooner. Introduction: Caffeine consumption during pregnancy. Written by Olivia Weller, MS3, American University of the Caribbean School of Medicine; and Janelli Mendoza, MS3, Ross University School of Medicine.Current Guidelines about caffeine during pregnancy: The American College of Obstetricians and Gynecologists (ACOG) current recommendations are to limit caffeine consumption during pregnancy to 200 mg of caffeine per day. Anything exceeding a moderate level of caffeine intake has been linked to an increased risk for preterm birth and miscarriage. [8 oz of brewed coffee has approximately 137mg of caffeine. Other drinks and foods contain caffeine: Brewed tea 48mg; Decaf coffee (12 oz), 9-15 mg; caffeinated soft drink (12 oz) 37mg, Dark chocolate (1.45 oz) 30mg] New Evidence: More recent data disclosed that moderate levels of caffeine consumed during pregnancy led to newborns being small for gestation age (SGA). This information was taken further, and scientists began to monitor these children as they aged. Researchers studied newborns born to mothers who consumed zero caffeine during pregnancy versus women who consumed moderate levels of caffeine. They tracked height, weight, BMI, and obesity risk but only found statistical differences in height. So far, they have only investigated children up to the age of 8 and found that the variance in height increased as the children got older. Therefore, even consuming a moderate level of caffeine during pregnancy can have lasting effects on a child's height, which likely persists into adulthood. Some professionals are now saying there may be no amount of caffeine that is safe to consume during pregnancy. American Family Physician Journal, 2009: “Caffeine intake is directly correlated with small but notable fetal growth restriction. Although a safe threshold cannot be determined, maternal caffeine intake of less than 100 mg per day minimizes the risk of fetal growth restriction.”Why does smaller birth size matter? Caffeine crosses the placenta and acts as a vasoconstrictor which reduces the blood supply to the fetus and thus hinders proper growth. It is a sympathomimetic agent that can affect fetal stress hormones and increase the risk for rapid weight gain after birth. Although height is not a pressing issue, children are potentially more susceptible to increased risk for certain conditions later in life, such as obesity, heart disease, and diabetes. More research is needed on this front to make the conclusion that these differences do in fact persist into adulthood and lead to adverse health outcomes. Conclusions and limitations. Pregnant women and children remain as a group with the least amount of research due to the potential adverse life outcomes. For this reason, the studies that have been done on caffeine consumption during pregnancy are comprised of self-reported data. Due to the association between high caffeine consumption and smoking, it is difficult to distinguish the two. Therefore, there is no clear cause-and-effect relationship between caffeine and intrauterine growth restriction (IUGR), leading to shorter stature later in life. However, the potential adverse health outcomes outweigh the psychological benefits of caffeine during the gestational period. If mothers can give up alcohol, drugs, smoking, raw fish, and so much more during pregnancy, why not caffeine too? With the emergence of this new information, perhaps it is time for a review of those guidelines. Welcome: You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Acute Kidney Injury. January 20, 2023. Written by Anthony Floresca, MS4, American University of the Caribbean School of Medicine; edited by Hector Arreaza, MD; recording done with Gagan Kooner, MD.Definition of Acute Kidney Injury (AKI): Acute kidney injury is a clinically relevant disease process that often occurs during hospitalizations but can also occur as a result of pre-existing diseases such as diabetes mellitus, hypertension, and congestive heart failure, usually referred to as “AKI on CKD,” i.e., acute kidney injury can present as a worsening of renal function in a patient who already has decreased renal function at baseline. AKI is defined as a sudden onset decrease in renal function that can be diagnosed as early as 6 hours from disease onset. To diagnose AKI, specific parameters to consider are creatinine and urine output. Kidney Disease: Improving Global Outcomes or KDIGO established criteria in 2012 for diagnosing AKI:An increase in serum creatinine of ≥ 0.3 mg/dL within 48 hours, [for example, a serum creatinine increasing from 1.3 (baseline) to 1.6]An increase in serum creatinine ≥ 1.5 times baseline within the past week, [for example, an increase in serum creatinine from 1.3 (baseline) to 1.95]A decrease in urine output < 0.5 mL/kg/hr within 6 hours, [for example, a man who weighs 70 kg and is urinating less than 35mL of urine per hour]Classification:The severity of AKI is defined under the 2012 KDIGO guidelines: Stage ICreatinine 1.5-1.9 times greater than baseline or  ≥ 0.3 mg/dL increase in serum creatinine.Urine volume < 0.5 mL/kg/hr for ≥ 6-12 hoursStage IICreatinine 1.5-1.9 times greater than baseline or  ≥ 0.3 mg/dL increase in serum creatinine.Urine volume < 0.5 mL/kg/hr for ≥ 6-12 hoursStage IIICreatinine 3 times higher than baseline OR ≥ 4.0 mg/dL increase in serum creatinine(Kooner: For example, if a creatinine at baseline is 0.8 and it increases to 2.4, it is stage III)Anthony: Yes, it is stage III if the patient initiates renal replacement therapy (hemodialysis), OR a decrease in GFR to < 35 mL/min per 1.73 m^2 in patients

Families and individuals visiting Woodstock Funeral Home who are grieving the loss of a loved one will find that there is a kind and calming presence there with them to show support. Ginger, an 8-year-old red standard poodle, was adopted in February 2020 by Paige Fowler-Ogle from Georgia Poodle Rescue, a nonprofit in Alpharetta run by Deborah Blatchley. Fowler-Ogle is the location manager at Woodstock Funeral Home, where Ginger is a regular. The first thing Ginger does is greet the individual or family at the door. Ginger then walks with them to the office, where she usually sits with Fowler-Ogle and the individual or family who are setting up the funeral arrangements. During this time, she will show her support by letting the person or family pet her, hold her, sit with her — any way she can help, Fowler-Ogle said. Sometimes, Ginger will also walk and sit with families at the viewing, giving emotional support to children and adults. Ginger is not the first poodle in the Fowler-Ogle household, though she is the first to show this level of understanding and support, her owner said. Since Fowler-Ogle became the location manager a little over a year ago, Ginger has been by her side every day at the office. Ginger often wears a bow that matches her owner's outfit for the day, which is always a topic of conversation with  visitors and adds to the welcoming feel of the funeral home, Fowler-Ogle said. Fowler-Ogle also paints her dog's nails. Fowler-Ogle said she knew Ginger would be perfect in this type of environment after seeing her dog's kindness to her young son. The duo recently visited Manor Lake assisted living in BridgeMill in Canton, where Fowler-Ogle said Ginger was “a big hit.” A Marietta man has been indicted after authorities say he drowned a cat in Cherokee County this summer. Austin Hedgeman is charged with one felony count of aggravated cruelty to animals, according to an indictment filed December 12. The indictment charges Hedgeman with causing a cat's death by drowning around July 6. In an arrest warrant filed July 6 by the Cherokee Marshal's Office, officers say Hedgeman caused “physical pain, suffering or death to an animal” July 3 and could be heard on a recording saying he held the cat down “until he stopped moving.” Authorities say the drowning was at a southwest Cherokee County home, near Woodstock. Court records show the marshal's office originally charged Hedgeman with a misdemeanor count of animal cruelty but the charge was upgraded to a felony. Hedgeman was arrested July 6 and released July 8 on a $1,000 bond, according to the Cherokee Sheriff's Office. He has a hearing scheduled for January 11, according to court documents. An indictment is a formal charge of felony offenses, and defendants are assumed innocent until proven guilty. Northside Hospital is the first hospital system in the United States to receive Maternal Levels of Care Verification from The Joint Commission, the commission and the Georgia Department of Public Health announced. Northside Hospital also is the first in the state to receive a Level IV Maternal Center Designation from DPH. The United States has a higher maternal mortality rate than many other developed countries. Georgia is taking action to help improve care for women and newborns. It is one of a handful of states to review risk-appropriate care and the first to collaborate on a program with an accreditation organization. In 2022, DPH announced a partnership with The Joint Commission, recognizing its MLC Verification program. The program, offered in collaboration with the American College of Obstetricians and Gynecologists (ACOG), is a verification process that involves an on-site comprehensive review of a hospital's maternal capabilities and policies, as well as a level of maternal care determination. Through the partnership, hospitals may seek the optional Maternal Center Designation with The Joint Commission's MLC Verification program. For details on the designation process, visit dph dot Georgia dot gov. Most bills the General Assembly passes each year take effect on July 1. But a smattering of new laws enacted during the 2022 legislative session will kick in this Sunday, Jan. 1, including a bill making it easier for food trucks to do business and several new or expanded tax credits. The food truck legislation does away with a current requirement in Georgia law that food truck operators obtain a permit and inspection in every county where they do business. While the tax credit bills technically became effective last summer, they don't really become reality until New Year's Day, the beginning of the tax year. Three of the measures create new income tax credits. House Bill 424 will provide a tax credit to Georgia taxpayers who contribute to nonprofit organizations that help foster children about to age out of the foster care system. More than 700 young men and women age out of the system each year. Senate Bill 361, which was championed by Lieutenant Governor Geoff Duncan, will provide a dollar-for-dollar income tax credit on contributions to public safety initiatives in the taxpayer's community. Law enforcement agencies will be able to use the money for police officer salary supplements, to purchase or maintain department equipment and/or to establish or maintain a co-responder program.  Senate Bill 87, the Jack Hill Veterans' Act, honors the late state Sen. Jack Hill of Reidsville, who died in 2020. It provides income tax credits in exchange for contributions to scholarships for service-disabled veterans through the Technical College System of Georgia Foundation. Another bill that will take effect on Sunday, Senate Bill 332, also known as the Inform Consumers Act, is aimed at preventing criminals from selling goods stolen from retail stores on any online marketing platform. It establishes financial and contact information requirements for high-volume sellers to online marketplaces and requires such platforms to establish an option for consumers to report suspicious activity A Canton pediatrician's office is closed after a burst pipe damaged the building December 24. A major sprinkler pipe burst in the ceiling of the office of DV Pediatrics on the morning of December 24, resulting in major damage to the entire building. Although firefighters quickly responded and turned the water off around noon to limit the damage, the damage has prompted a long-term closure for repairs, DV Pediatrics announced. Repairs are estimated to take four to six months. Until they have a working office space, DV Pediatrics will provide home visits, or house calls, phone consultations and telemedicine appointments for sick patients. The pediatric office said the staff are doing everything possible to provide the same level of healthcare services for the families they care for. #CherokeeCounty #Georgia #LocalNews           -          -          -          -          -          -          The Cherokee Tribune Ledger Podcast is local news for Woodstock, Canton, and all of Cherokee County. Register Here for your essential digital news.             This podcast was produced and published for the Cherokee Tribune-Ledger and TribuneLedgerNews.com by BG Ad Group     For more information be sure to visit https://www.bgpodcastnetwork.com/    https://cuofga.org/   https://www.drakerealty.com/   https://www.esogrepair.com/                         See omnystudio.com/listener for privacy information.

Catherine Dezynski is a licensed certified nurse midwife and women's health nurse practitioner. Her clinical areas of expertise include family planning, colposcopy, office-based gynecology, and labor management. Catherine is a member of the American College of Obstetricians and Gynecologists (ACOG), Nurse Practitioners in Women's Health (NPWH), and the American Society for Colposcopy and Cervical Pathology (ASCCP). Catherine is also a medical science liaison for BD, a global medical technology company and the creator of advanced cervical cancer screening tests.   In this episode, we talk about why cervical cancer is underdiagnosed, shocking statistics on the rates of diagnosis and death, how the testing innovations at BD help women prevent cervical cancer before it starts, why HPV testing is recommended alongside Pap smears, what you need to know about the HPV vaccine, and so much more! To learn more, visit https://nicolejardim.com/podcasts/advanced-cervical-cancer-testing-that-could-save-your-life-catherine-dezynski/. This episode is brought to you by Knix. Visit Knix.com to shop for period underwear and more. Podcast Production Support: Amazing Gains | https://listenerstoclients.com

On this episode, BackTable VI host Dr. Christopher Beck shares the mic with two Maternal Fetal Medicine (MFM) specialists, Drs. Roxane Rampersad at Washington University and Tony Shanks at Indiana University, to discuss cross-specialty management of postpartum hemorrhage (PPH) between OBGYN and interventional radiology (IR). --- EARN CME Reflect on how this Podcast applies to your day-to-day and earn AMA PRA Category 1 CMEs: https://earnc.me/ASxPdP --- SHOW NOTES To set the stage, Drs. Rampersad and Shanks explain the definition of PPH based on the American College of Obstetricians and Gynecologists (ACOG) guidelines. They further describe the differences between early / acute versus late blood loss, in addition to the most common etiologies using the “Four T's” pneumonic: tone, trauma, tissue, thrombin. Drs. Rampersad and Shanks then describe their approach to the workup and management of PPH. The group discusses topics such as uterine massage, oxytocin, hemabate / methergine, tamponade (e.g. Bakri balloon, the JADA System), embolization, and hysterectomy. The physicians then describe the role of cross-specialty collaboration between OBGYN and IR, specifically in the management of PPH. When highlighting the role of IR, Dr. Beck describes how he counsels patients for uterine artery embolization (UAE), and he provides an anecdote regarding a repeat UAE. He also shares his perspective with utilization of gel foam versus coils. The group then transitions to describe diagnosis and management of placenta accreta spectrum (PAS), its association with PPH, and the role of radiology in this disease process. Lastly, Drs. Rampersad and Shanks allude to what the future may hold for PPH, including more personalized medicine and potential technologies to prevent PAS. The group ends the episode by providing IR colleagues with insight to what may strengthen the collaboration between OBGYN and IR in order to provide optimal care for patients with PPH. --- RESOURCES Silver RM, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006 Jun;107(6):1226-32. doi: 10.1097/01.AOG.0000219750.79480.84. PMID: 16738145. Bienstock RM, Eke AC and Hueppchen NA; Postpartum Hemorrhage. New England Journal of Medicine 2021 Vol. 384 Issue 17 Pages 1635-1645. Accession Number: 33913640 DOI: 10.1056/NEJMra1513247. https://www.nejm.org/doi/full/10.1056/NEJMra1513247 ACOG Postpartum Hemorrhage: https://www.acog.org/en/clinical/clinical-guidance/practice-bulletin/articles/2017/10/postpartum-hemorrhage

With Blyss busy on Halloween doing birthing stuff, Dr. Stu cleans out his mental attic and finds some scary stuff. Today, he's unpacking recent updates from The American College of Obstetricians and Gynecologists (ACOG) on vaccine recommendations and how hospitals should navigate the current “oxytocin” shortage, along with a breakdown of why some vaccine studies and articles need to be questioned.In this episode of Birthing Instincts:ACOG updates: jab recommendations & “oxytocin” shortageQuestionable studies: C*VID jab during pregnancyCDC recommendations, FDA approval, & vaccine safetyBreech babies & bodily autonomySelf-advocacy for hospital birthsThis show is supported by:LMNT | Go to drinklmnt.com/birthinginstincts to get a free sample pack!Resources:Article: FDA Approves…FAQ on Oxytocin ShortageResearch on Peripartum Outcomes…Book: Male Practice: How Doctors Manipulate WomenConnect with Dr. Stu:Instagram: @birthinginstinctsWebsite: birthinginstincts.comConnect with Blyss:Instagram: @birthingblyssWebsite: birthingblyss.comThis show is produced by Soulfire Productions

Michele Bratcher Goodwin, JD (Center for Biotechnology and Global Health Policy, University of California, Irvine), Molly Meegan, JD (American College of Obstetricians and Gynecologists), and Lisa Harris, MD, PhD (University of Michigan) discuss how new abortion bans in the US are creating serious legal and ethical dilemmas for clinicians. Hosted by JAMA Legal and Global Health Correspondent Lawrence O. Gostin, JD (Georgetown University). Related Content: Legal Risks and Ethical Dilemmas for Clinicians in the Aftermath of Dobbs The Future of Ob-Gyn Training in the US Post-Dobbs Medical Indications for Abortion   Conflict of Interest Disclosures: Lawrence O. Gostin, JD, is the Legal and Global Health Correspondent for JAMA and Faculty Director of the O'Neill Institute for National and Global Health Law at Georgetown University.  No other disclosures were reported. Michele Bratcher Goodwin, JD, LLM, SJD is Director of the Center for Biotechnology and Global Health Policy at University of California, Irvine.  No other disclosures were reported.  Lisa Harris, MD, PhD, is the F. Wallace and Janet Jeffries Collegiate Professor of Reproductive Health, and Professor and Associate Chair in the Department of Obstetrics and Gynecology at University of Michigan. She is also a Professor in the Department of Women's Studies.  No other disclosures reported.  Molly Meegan is the Chief Legal Officer and General Counsel for the American College of Obstetricians and Gynecologists (ACOG).  No other disclosures reported.

We love bringing you guests who are not only doing impactful work in Women's Health but also have interesting stories to share. This episode with LaToshia Rouse delivers in both areas. LaToshia is a certified DONA International doula and owner of Birth Sisters Doula Services. She has a passion for helping parents develop their voice in the care of their children and helping medical staff learn from and make improvements in care based on the parent perspective. She also strives to find ways for clinicians and patients to have a true partnership and improve outcomes. LaToshia has served as a subject matter expert and expert team member for the Perinatal Quality Collaboratives across the country, American Board of Pediatrics (ABP), American College of Obstetricians and Gynecologists (ACOG), Center for Medicare and Medicaid Services (CMS), National Quality Forum (NQF) and several other organizations. Her work as an advisor, speaker, facilitator and doula all began after having triplets at 26 weeks gestation via an emergency vaginal delivery. Our discussion today included: Latoshia's birth story of her triplets and emergency vaginal delivery. Motherhood advice from a mom of four. Her findings while working with NICU's, including her discoveries, improvements needed and what they are doing right. LaToshia's suggestions on how to best advocate for your children. The definition of who a doula is, what they do, and how LaToshia explains her role as a doula. Changing how birth doula's are accepted in the birthing community and how she knew being a doula was her calling. Working with highly reputable organizations and whether she gets intimidated. LaToshia's story of how she was a victim of not receiving equal access to care. From her perspective, LaToshia discusses whether she truly believes that we can create a healthcare system where clinicians and patients have a true partnership and improve outcomes. Ideas on how to make this partnership happen so it is inclusive of all socioeconomic platforms and accessible to all. Sponsorship: Davis Family Chiropractic: www.Davischironc.com and @davischironc Dr. Charryse Johnson: https://www.charrysejohnson.com Expired Mindsets by Dr. Charryse Johnson --- Support this podcast: https://anchor.fm/herhealthcollective/support

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Are c-sections underrated?, published by braces on October 1, 2022 on LessWrong. Summary I think so. Correlations tend to show worse outcomes for c-sections, but the guidelines take this evidence too literally. Careful causal evidence finds that it's more of a mixed bag. Moderate negative effects on subsequent births seem more robust. An elective c-section might be the defensible choice for someone's final pregnancy. Disclaimer: Not a doctor. The official guidelines C-sections cost about twice as much as vaginal delivery and are associated with worse health outcomes for infants and moms. These facts are concerning enough to the US Medicaid system that one of their “Improvement Initiatives” is reducing low-risk cesarean delivery. They write: “Cesarean delivery poses a greater risk of maternal morbidity and mortality for low-risk pregnancies when compared to vaginal births, a risk that ideally should be avoided.” They lead seminars with slides like this, highlighting that everything bad is correlated with c-sections: Hospitals have been falling in line. UCSF boasts: “Our view of labor and childbirth as a natural process has helped keep our overall Cesarean rate at 20 percent, among the lowest rates in California.Our threshold for making the decision to recommend a C-section is a lot higher than in other places.” The American College of Obstetricians and Gynecologists (ACOG) has similar advice, and to their credit they spell out the evidence and their reasoning. The main paper they cite is this Canadian study of 2.3m vaginal and 46k c-section deliveries. “A large population-based study from Canada found that the risk of severe maternal morbidities.was increased threefold for cesarean delivery as compared with vaginal delivery.” But what really should we make of the association between c-sections and bad outcomes? The observed correlation is ripe for reverse causality, for the same reason that going to the hospital is correlated with dying: c-sections are often performed because of some dangerous condition (e.g., preeclampsia). In the Canadian study, the treatment group was mothers who had scheduled a c-section due to breech position, and breech is correlated with other negative outcomes. In other studies, the c-sections could happen for reasons that are never recorded in hospital data, so even lots of control variables should make you worried about selection effects. The causal effect of a c-section A new paper by Card, Fenizia, and Silver, using data from California births, takes the question of causality seriously. It appears to be the only careful attempt at separating correlation and causation. C-sections are not randomly assigned. How can we use observational data to arrive at a causal estimate? Their approach combines the facts that hospitals exhibit stable differences in their (risk-adjusted) c-section rates and that moms often give birth at the hospital closest to them. Together, these mean that some moms will have c-sections by virtue of living close to a hospital that performs more of them. In essence, a causal estimate can be derived by comparing the outcomes of mothers who live near vs. far from high c-section hospitals. You might be concerned that certain kinds of moms live next to certain kinds of hospitals. But in detailed tests, the authors find no signs of problematic selection along this distance-to-hospital dimension (although with these kinds of designs it's reasonable to worry that something not measured could still bias the estimates). And they show that the distance measure does have a large effect on c-sections for the group they study: low-risk first births. (Why restrict to this sample? High-risk births are often defaulted to c-sections, and a c-section in a first birth means you should probably only get c-sections in subsequent births—so this ...

Link to original articleWelcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Are c-sections underrated?, published by braces on October 1, 2022 on LessWrong. Summary I think so. Correlations tend to show worse outcomes for c-sections, but the guidelines take this evidence too literally. Careful causal evidence finds that it's more of a mixed bag. Moderate negative effects on subsequent births seem more robust. An elective c-section might be the defensible choice for someone's final pregnancy. Disclaimer: Not a doctor. The official guidelines C-sections cost about twice as much as vaginal delivery and are associated with worse health outcomes for infants and moms. These facts are concerning enough to the US Medicaid system that one of their “Improvement Initiatives” is reducing low-risk cesarean delivery. They write: “Cesarean delivery poses a greater risk of maternal morbidity and mortality for low-risk pregnancies when compared to vaginal births, a risk that ideally should be avoided.” They lead seminars with slides like this, highlighting that everything bad is correlated with c-sections: Hospitals have been falling in line. UCSF boasts: “Our view of labor and childbirth as a natural process has helped keep our overall Cesarean rate at 20 percent, among the lowest rates in California.Our threshold for making the decision to recommend a C-section is a lot higher than in other places.” The American College of Obstetricians and Gynecologists (ACOG) has similar advice, and to their credit they spell out the evidence and their reasoning. The main paper they cite is this Canadian study of 2.3m vaginal and 46k c-section deliveries. “A large population-based study from Canada found that the risk of severe maternal morbidities.was increased threefold for cesarean delivery as compared with vaginal delivery.” But what really should we make of the association between c-sections and bad outcomes? The observed correlation is ripe for reverse causality, for the same reason that going to the hospital is correlated with dying: c-sections are often performed because of some dangerous condition (e.g., preeclampsia). In the Canadian study, the treatment group was mothers who had scheduled a c-section due to breech position, and breech is correlated with other negative outcomes. In other studies, the c-sections could happen for reasons that are never recorded in hospital data, so even lots of control variables should make you worried about selection effects. The causal effect of a c-section A new paper by Card, Fenizia, and Silver, using data from California births, takes the question of causality seriously. It appears to be the only careful attempt at separating correlation and causation. C-sections are not randomly assigned. How can we use observational data to arrive at a causal estimate? Their approach combines the facts that hospitals exhibit stable differences in their (risk-adjusted) c-section rates and that moms often give birth at the hospital closest to them. Together, these mean that some moms will have c-sections by virtue of living close to a hospital that performs more of them. In essence, a causal estimate can be derived by comparing the outcomes of mothers who live near vs. far from high c-section hospitals. You might be concerned that certain kinds of moms live next to certain kinds of hospitals. But in detailed tests, the authors find no signs of problematic selection along this distance-to-hospital dimension (although with these kinds of designs it's reasonable to worry that something not measured could still bias the estimates). And they show that the distance measure does have a large effect on c-sections for the group they study: low-risk first births. (Why restrict to this sample? High-risk births are often defaulted to c-sections, and a c-section in a first birth means you should probably only get c-sections in subsequent births—so this ...

Episode 111: Pregnancy FAQ  Dr. Urso answers commonly asked questions during pregnancy.  You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Written by Carmen Urso, MD. Edited by Hector Arreaza, MD.Pregnancy is one of the most exciting moments of a woman's life, but at the same time, it could be a little scary because whatever the mother does may affect the baby. This is why it is so important to make sure about general recommendations during pregnancy. The information I present here is evidence-based. 1. Should I take prenatal vitamins?The goal of prenatal supplements is to provide the vitamins and minerals needed to promote normal fetal development. Some studies have shown that in high-income countries where the food is vitamin-fortified, and typically people are well-nourished, vitamin supplementation has not proved to improve maternal and neonatal outcomes. However, a Cochrane review of randomized trials in low- and middle-income countries with vitamin and mineral diet deficiency found that supplementation reduces the risk of low birth weight and small for gestational age. Because you don't always know the nutritional status of a patient, it is advised to use a standard prenatal vitamin. What are the most important vitamins in the prenatal period? The 2 most important elements are folic acid and iron, which can be found in regular prenatal vitamins. The American College of Obstetrics and Gynecology (ACOG) recommends multivitamins with: -Folic acid: 400mcg to 800mcg daily to reduce the risk of neural tube defects. It is recommended to start before pregnancy until the end of the first trimester (12 weeks). Patients with a history of fetal neural tubal defect should take 4000 mcg (4mg) daily. The USPSTF recommends (Grade A, 2017) to supplement with folic acid for all women of childbearing before pregnancy. Supplementation should start at least one month before pregnancy, according to CDC. -Iron: 30 mg/day to prevent maternal anemia. The formulation should contain 15-30 mg/dl. Most prenatal contain about 30 mg, which is considered a “low” dose, and 65 mg of elemental iron is equivalent to 325 mg of ferrous sulfate, which is a common supplement given to patients in our clinics. So, patients could take one tablet of 325 mg of ferrous sulfate daily and have enough for their pregnancy, or take it every other day if they are intolerant to iron]-Vitamin D: Vitamin D deficiency is associated with preterm birth and preeclampsia. 200-600 international units are recommended. ACOG does not recommend screening for vitamin D deficiency before or during pregnancy. The USPSTF concluded there is insufficient evidence to recommend for or against Vitamin D deficiency screening in asymptomatic adults. This is a Grade I recommendation.-Calcium: Supplements should contain 1000 mg/dL. Most multivitamins have 200-300mg; the rest of the daily calcium should come from dietary sources. Foods rich in calcium include dairy products such as milk, yogurt, cheese, soybeans, seeds, beans, lentils, and dark-green leafy vegetables like kale, spinach, and collard greens. Another source of vitamin D is sun exposure. We do not recommend sun exposure as a source of vitamin D, but there are benefits to sun exposure for other reasons, for example, mood.2. Should I be eating for 2 while I am pregnant?It is a misconception. Pregnant women do not have to eat for 2. Caloric intake will depend on the number of fetuses (single or multiple), the trimester, and the pre-pregnancy weight. During the first trimester, no extra daily calories are needed. In the second trimester, a pregnant person will need 340 extra calories/day, and in the third, 450 extra calories/day for a total of 2200 to 2900 kcal/day. The weight gain will be based on pre-pregnancy BMI (body mass index). For example, a patient who is overweight (BMI 20-29) should gain 15-25 lbs. in the whole pregnancy, but a patient with obesity (BMI above 30) should gain 11-20 lbs. only. These are the recommendations by the National Academy of Medicine.Interestingly, if you are underweight before pregnancy, you can gain 30-40 pounds.National Academy of Medicine Recommendations for Weight Gain in Pregnancy:Pre-pregnancy BMI Category (kg/m2)                  Recommended Weight Gain (lbs.) Underweight (less than 18.5)                                                       28–40 Normal weight (18.5-24.9)                                                              25-30Overweight (25.0-29.9)                                                                    15-25Obese (30 or greater)                                                                         11-203. Can I drink alcohol?There is not a safe level of alcohol during pregnancy. Alcohol can cause life-long birth defects. Even little amounts can cause problems to the baby, such as coordination, behavior, attention, and learning disability. Heavy drinking can cause fetal alcohol syndrome, characterized by developmental delay, short stature, abnormal facial features, small head size, vision impairments, and hearing difficulty. It is recommended to avoid alcohol at all costs during pregnancy. 4. Can I drink coffee? Caffeine increases catecholamine levels in the maternal blood, and it crosses the placenta. Caffeine was thought to increase the risk of spontaneous miscarriage, but recent studies showed that moderate caffeine intake was not related to miscarriage or preterm birth. ACOG states that low to moderate intake, less than 200mg (6 oz per day), does not appear to be associated with adverse effects. The amount of caffeine varies in different foods. For example, 8 oz of brewed coffee has approximately 137mg of caffeine. Also, we must remember that caffeine is in other drinks like soda and tea.Content of caffeine in different drinks: -Instant Coffee 76mg -Tea, Brewed 48mg; Instant 26-36mg-Caffeinated soft drink (12 oz) 37mg-Hot cocoa (12oz) 8-12mg-Chocolate milk (8oz) 5-8mg-Dark chocolate (1.45 oz) 30mg -Milk chocolate (1.55oz) 11mg -Semi-sweet chocolate (1/4 cup) 26-28mg -Chocolate syrup (tbsp) 3 mg-Coffee ice cream or frozen yogurt 2mg 5. Can I eat fish?Fish is an excellent source of omega 3, which is associated with improved neurodevelopment in children, decreased risk of preterm birth, and reduced allergy and atopic disease. Fish also contains mercury which can cause fetal neurologic damage. All fish contain mercury, but some have more than others. This is why it is so important to know what fish has more mercury content.ACOG recommends 2 to 3 servings per week. Pregnant women can have fish high in omega 3 and low in mercury. Some examples of fish that are high in omega 3 and low in mercury are anchovies, Atlantic herring, Atlantic mackerel, mussels, oysters, farmed and wild salmon, sardines, snapper, and trout. Seafood that is low in mercury and low in omega 3 includes shrimp, pollock, tilapia, cod, and catfish. Fish high in mercury include king mackerel, marlin, orange roughy, shark, swordfish, tilefish, and tuna bigeye. 6. Can I eat sushi?Raw fish can carry bacteria or parasites. Therefore, it is recommended not to have raw fish, but you can have cooked options like tempura sushi. For example, all ingredients are cooked in the California roll except the cucumber and avocado.7. Can I exercise?Yes. If you do not have any complications (healthy pregnancy), it is recommended that you have moderate-intensity aerobic exercise for 30 minutes, 5-7 days a week. Moderate exercise means you can carry on a normal conversation during exercise. For example, brisk walking, gardening, and dancing. The benefits of exercising during pregnancy go beyond maintaining a good weight. Exercise also decreases muscle discomfort (back pain, pelvic pain), makes the pelvic floor strong, and decreases the risk of urinary incontinence. Avoid exercises with a higher risk of injuries, such as skiing, horseback riding, scuba diving, hot yoga o hot Pilates (for the risk of overheating), and skydiving. 8. Hot tubs and swimmingHot tubs are not recommended during pregnancy, especially in the first trimester, because higher body temperature has been associated with neural tube defects and miscarriage. Swimming does not appear to have any teratogenic effect because pools are typically cooler than body temperature. 9. Can I dye my hair? There is limited data on the safety of cosmetics. Because it is a topical product, systemic absorption is supposed to be low unless the skin is compromised. However, it is recommended to avoid ammonia-based products. Plant-based hair dyes are probably safe. Also, using these products in a well-ventilated area is recommended to avoid allergies. 10.  Is it safe to have sex during pregnancy?Sex is safe if you do not have any complications such as placenta previa, vaginal bleeding, cervical incompetence, preterm labor, risk of preterm labor, or leaking of amniotic fluid. Sex does not increase the risk of complications during pregnancy, but like in the general population, there is a risk of sexually transmitted diseases during pregnancy. During pregnancy, the vaginal circulation is increased, and the cervix is more sensitive, so may have scant vaginal bleeding during intercourse but if the bleeding is heavy, patients should be evaluated.Conclusion: Now we conclude our episode number 111 “Pregnancy FAQ.” Dr. Urso explained that pregnancy is one of the most exciting moments in a woman's life. Special care is needed to make sure both mother and baby are healthy and safe during this special time. Appropriate vitamin supplementation, a nutritious diet, adequate exercise, and avoiding alcohol are key elements of prenatal care. We were reminded that sex is generally safe in uncomplicated pregnancies. This week we thank Hector Arreaza, Carmen Urso, Gagan Kooner, and Arianna Lundquist. Audio by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Fox, N.S. “Do and Don'ts in pregnancy, truths and myths”. Obstetrics & Gynecology, vol 131, issue 4, 2018, pp.713–21. DOI:10.1097/AOG.0000000000002517. https://journals.lww.com/greenjournal/Fulltext/2018/04000/Dos_and_Don_ts_in_Pregnancy__Truths_and_Myths.16.aspx. Accessed 7 July. 2022.Advice about eating fish. For those who might become or are pregnant or breastfeeding and children ages 1- 11 years. https://www.fda.gov/food/consumers/advice-about-eating-fish. Accessed 1 August 2022.Garner C.D. Nutrition in pregnancy: Dietary requirements and supplements. Up to Date, last updated April 14, 2022. https://www.uptodate.com/contents/nutrition-in-pregnancy-dietary-requirements-and-supplements. Accessed 4 August 2022.Lockwood, C.J. Prenatal care: Patient education, health promotion, and safety of commonly used drugs. Up to Date, last updated August 16, 2022.https://www.uptodate.com/contents/prenatal-care-patient-education-health-promotion-and-safety-of-commonly-used-drugs. Accessed 1 August 2022.Goetzl, L.M. Folic acid supplementation in pregnancy. Up to Date, Last Updated Jun 16, 2022. https://www.uptodate.com/contents/folic-acid-supplementation-in-pregnancy. Accessed 2 August 2022.Haider BA, Bhutta ZA. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst Rev. 2017 Apr 13;4(4):CD004905. doi: 10.1002/14651858.CD004905.pub5. Update in: Cochrane Database Syst Rev. 2019 Mar 14;3:CD004905. PMID: 28407219; PMCID: PMC6478115. https://pubmed.ncbi.nlm.nih.gov/28407219/. Accessed 2 August 2022.“Moderate Caffeine Consumption During Pregnancy”, The American College of Obstetrics and Gynecologists (ACOG). Committee Opinion, Number 462, August 2010. (Reaffirmed 2020). https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2010/08/moderate-caffeine-consumption-during-pregnancy. Accessed 1 August 2022.Royalty-free music used for this episode: Good Vibes Alt Mix by Videvo, downloaded on May 06, 2022 from https://www.videvo.net/royalty-free-music-track/good-vibes-alt-mix/1017292/

This is not the first time I've discussed Tylenol in pregnancy. It's not the second time either! But the topic keeps coming up. The latest iteration was a series of scary Instagram posts, some of which reference a possible class-action lawsuit. Yet advisory bodies like the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine state that Tylenol is safe during pregnancy. So what's going on? Want more on pregnancy and parenting? Subscribe to the ParentData newsletter for free at ParentData.org. You can also become a paid subscriber for access to the full ParentData archive (searchable by topic) and an extra newsletter every week.

Molly Broache serves as Associate Director, US Region, Medical Affairs for BD Integrated Diagnostic Solutions (IDS) and is also licensed as a women's health nurse practitioner in both Maryland and Virginia. Molly manages a team of medical science liaisons responsible for specimen management, microbiology, and women's health & cancer. Molly's clinical areas of expertise include women's healthcare, gynecology, infectious disease diagnostic tests, and women's health screening guidelines. Molly is a member of the American College of Obstetricians and Gynecologists (ACOG), Nurse Practitioners in Women's Health (NPWH), American Society for Colposcopy and Cervical Pathology (ASCCP), and the Medical Science Liaison Society (MSLS). She serves on the membership committee for ASCCP and the Cervical Cancer Screening Initiative – Provider Workgroup for the American Cancer Society. Molly holds two Bachelor's degrees from Johns Hopkins University, in both molecular biology and nursing. She also holds a master's degree in nursing from Georgetown University, where she received her training as a nurse practitioner. Molly is currently completing her Doctor of Nursing Practice degree at the University of Maryland, Baltimore.BD is one of the largest global medical technology companies in the world and is advancing the world of health by improving medical discovery, diagnostics and the delivery of care. The company supports the heroes on the frontlines of health care by developing innovative technology, services and solutions that help advance both clinical therapy for patients and clinical process for health care providers. BD and its 75,000 employees have a passion and commitment to help enhance the safety and efficiency of clinicians' care delivery process, enable laboratory scientists to accurately detect disease and advance researchers' capabilities to develop the next generation of diagnostics and therapeutics. BD has a presence in virtually every country and partners with organizations around the world to address some of the most challenging global health issues. By working in close collaboration with customers, BD can help enhance outcomes, lower costs, increase efficiencies, improve safety and expand access to health care.LinkedIn: www.linkedin.com/company/bd1/ | Twitter @BDandCo | Instagram: @becton_dickinson

Doctors are worried gray areas in new abortion bans force a choice between breaking their oath and breaking the law. Today on “Post Reports,” we talk to an OB/GYN about what those decisions are like. Plus, how to cover your digital trail if you seek an abortion.Read more:Health and science reporter Ariana Eunjung Cha recently wrote about the fear and confusion many doctors are facing since Roe was overturned.. The American College of Obstetricians and Gynecologists (ACOG) joined numerous other professional organizations and medical journals over the past few days in warning that the ruling will affect health care beyond abortion, creating new risks for patients and potentially increasing maternal mortality. We interviewed Nisha Verma, an OB/GYN in Atlanta who is also a fellow at ACOG. She talked about the gray areas these laws and restrictions don't cover. “These laws don't make any sense,” Verma told Elahe Izadi. While lawmakers point out that there are exceptions for the life of the pregnant person, Verma says it's very unclear what that means. “There's not a moment in time. This line where someone goes from being completely fine to dying. It's a continuum. People get sicker and sicker. And so we have to be able to make decisions in that continuum with all of the training that we have without having to worry about whether the person was sick enough or whether we're going to get in trouble under the law,” Verma said. Also on the show, tech reporter Heather Kelly explains how to protect your privacy if you're seeking abortion care — and why period-tracking apps are best avoided.

In today's episode of the VBAC podcast, we're going to answer questions like "What is ACOG?" "What are ACOG Guidelines" and what does ACOG say about vaginal birth after cesarean? When you meet with an OBGYN about you VBAC birth plans, he or she is likely to refer to the American College of Obstetricians and Gynecologists (ACOG) guidelines for VBAC management. However, women frequently find themselves in a situation where their OBGYN is making VBAC recommendations that do not follow ACOG guidelines. While guidelines are not rules, and it is up to each provider and patient to consider benefits and risks TOGETHER, too often, ACOG's guidelines are being misapplied or blatantly ignored and warped. Mothers planning a Vaginal Birth After Cesarean should take the time to get to know the ACOG VBAC Guidelines published in the ACOG VBAC Practice Bulletin. In this episode of the VBAC podcast, we will explore what exactly ACOG says about vaginal birth after cesarean, the risks, the benefits, and the birth plan options available to VBAC candidates.  This episode of theVBACpodcast will discuss benefits of VBAC, risks of VBAC, the option of repeat cesarean, and who is a good candidate for VBAC: including more information on special scars and VBAC, Due Dates and VBAC, recommendations for Vaginal Birth After Multiple Cesareans (VBAMC), planning a VBAC with a 'Large for Gestational Age" (LGA) baby (also called macrosomia), and many more VBAC candidacy variables.    Be on theVBACpodcast or submit an ASK JAIMIE question: www.littlebearlactation.com/podcast FREE Combatting Fear During VBAC Class: https://view.flodesk.com/pages/627c013046c9ddac8218a3a0 VBAC With Confidence Complete Birth Prep Program: https://www.littlebearlactation.com/vbacwithconfidence247 VBAC Consulting With Jaimie: www.littlebearlactation.com/consulting Social Media: instagram.com/thevbacpodcast

Stacy Brooks Whatley is director of marketing and communications at the American Physiological Society (APS). As a director since 2019, she oversees media relations, social media, website content strategy, the award-winning I Spy Physiology blog, and overall communications outreach for APS. She is also editor-in-chief of the award-winning The Physiologist Magazine, APS' member-focused publication that relaunched in 2019. Stacy devotes much of her time at work helping APS members—primarily biomedical researchers with PhDs—learn how to better communicate their research to the media, the general public and other researchers.  This podcast host, Melanie Padgett Powers, works with Stacy as managing editor of The Physiologist Magazine. The two have known each other since 2005 when they became communications co-workers—and fast friends—at the American College of Obstetricians and Gynecologists (ACOG). Stacy is also the new president of AM&P Network's Associations Council (formerly Association Media and Publishing or AM&P), as of June 21, 2022.   Topics covered: Engaging and featuring more than just the super volunteers in your content. Using a “Let us get to know you” form. Using member photos rather than stock photos. Sending birthday emails to members. Deciding what to cover and through which vehicle—while not getting distracted by the shiny object. Creating a web presence or content hub for a print-first magazine.  The life-changing flexibility of working from home since the pandemic started. Creating “collective” work-life boundaries as a staff. Analyzing what would make your work life better. Lessons from Tonya Mosely: “rest as a radical concept for women of color.” Lessons from trauma therapist Resmaa Menakem. Becoming AM&P Network's Associations Council new president in June 2022.  The community, education and support Stacy has received from AM&P Network over the years.  Associations Council's vibrant freelance community, including the sole proprietor membership category and Freelance Connections Committee.  Resources: www.physiology.org  The Physiologist Magazine Podcast Truth Be Told with Tonya Mosely Resmaa Menakem AM&P Network's AMPLIFY Summit, June 22–23, 2022 Stacy on LinkedIn Stacy's email address: SBrooks@physiology.org

Did you know that those first moments after the birth of your baby offer incredible opportunities to promote health and long-term development? In this episode, Shazi discusses the birth of her daughter Asha with her OBGYN, Dr. Katherine Kohari – and why she made the decision to bank Asha's cord blood privately. She also speaks with midwife McKenna Eldh, who explains the benefits of delayed cord clamping – which midwives have always traditionally practiced and The American College of Obstetricians and Gynecologists (ACOG) now also recommends. We also hear from biomedical engineer and CEO of Epibone, Nina Tandon, on the incredible ways that stem cells are being used to repair diseased or damaged tissue later in life. See omnystudio.com/listener for privacy information.

Dr. Kimberly Durant (e-mail) of Leadbetter Rehabilitation and Dr. Meghan Musick (e-mail, LinkedIn, Twitter, Instagram) of Jefferson Physical Therapy are interviewed by Antigone Vesci regarding a presentation they gave at the 2021 AAOMPT Conference titled, “Fourth Trimester and Beyond - Where is the Treatment? What is the Evidence?” This episode contains information that will be interesting for practitioners who want to learn more about pelvic health as it relates to orthopaedic clinical practice and the postpartum population. Additionally, to find the resources mentioned during this interview use the following links: Podschun et al  2013 (the hamstring/pelvic floor case study), McArthur et al 2016 (urinary incontinence does not go away), Moore et al 2021 (BJSM and JOSPT systematic review about factors contributing to return to running), Dakic et al 2021 (effect of pelvic floor symptoms on women's participation in exercise), Cozen Screening Tool (for pelvic floor dysfunction), AAOMPT Pelvic Health Special Interest Group's Decision Tree, Brown et al 2006 (3 question incontinence screening tool), Talasz et al 2011 (phase-locked parallel movement of diaphragm and pelvic floor during breathing and coughing), the American College of Obstetricians and Gynecologists (ACOG) recommendation for postpartum exercise, Donnelly et al 2020 (return to running), Cassidy et al 2017 (Canadian pelvic health survey), Julie Wiebe courses (including external only techniques), Antony Lo (Physio detective), Evidence in Motion's Pelvic Health I course, Kelli Wilson of Alcove Education, Tough to Treat Podcast by Susan Clinton and Erica Meloe, Herman & Wallace Pelvic Floor Level 1 (internal course), and APTA Pelvic Health Pelvic Health Physical Therapy (Level 1 or PH1 is an internal course). Listeners may also find the BJSM Return to Running Blog to be useful.Find out more about the American Academy of Orthopaedic Manual Physical Therapists at the following links:Academy website: www.aaompt.orgTwitter: @AAOMPTFacebook: https://www.facebook.com/aaompt/Instagram: https://www.instagram.com/officialaaompt/?hl=enPodcast e-mail: aaomptpodcast@gmail.comPodcast website: https://aaomptpodcast.simplecast.fm

George Thomas, CBN's senior international correspondent, talks about the latest on Ukraine and Russia. Mary Szoch, FRC's Director of the Center for Human Dignity, unpacks the American College of Obstetricians and Gynecologists (ACOG)'s latest “Guide to Language and Abortion.” Aaron Baer, President of the Center for Christian Virtue, talks about the opening of a Christian school in Ohio that is expected to be a model for similar schools across the state. Dr. Andrew Bostom, academic clinical trialist and epidemiologist, comments on the insistence of COVID mandates despite what data is telling us. Blaine Conzatti, President of Idaho Family Policy Center, unpacks Idaho's Texas-inspired abortion bill. --- Support this podcast: https://anchor.fm/loving-liberty/support

VBAC, or vaginal birth after cesarean, is becoming a more desired option verses simply having a repeat c-section. Unfortunately, many care providers still do NOT support VBAC and will tell women their only option is a repeat cesarean birth. Many women simply do not know they have alternative options, either. In this episode, the founder of VBACFacts.com, Jen Kamel, talks with me about VBAC options and how to navigate getting the VBAC you desire!VBAC and VBA2C are both supported by evidence!VBAC after 3 or more cesareans is not studied enough to state if it is supported by evidence or not; Mom should get to make the final choiceThe American College of Obstetrics and Gynecologists (ACOG) states that informed consent & refusal is vital to healthcare, even during birthHow do you deal with an unsupportive care provider?! We cover that, too!Buy Me a Coffee- DONATION PAGEResources Mentioned:Jen Kamel- VBAC FactsVaginal Birth After 2 Cesareans- Fact SheetVBAC Facts Parent Courses & Free HandoutVBAC Facts Professional MembershipACOG's Committee Opinion on Informed RefusalDoula MatchNOW IT'S YOUR TURN!The NaturalBirth Site Read *natural birth stories*- and submit your ownSign up for the NaturalBirth Education course to best prepare your body & mind for natural birthShare with anyone interested in natural birthShare my podcast with anyone you know who is interested in natural birth!"Like" my Facebook and Instagram pagesSubscribe to my YouTube Channel  

Let's talk about sex, baby! Yes, you read that right. We're talking all about sex in this episode of UNprivate Parts because the American College of Obstetricians and Gynecologists (ACOG) reports about 4 in 10 women have problems with sex at some point in their lives, yet it's something women rarely talk about. In honor of Valentine's Day, we sat down with Dr. Renee Cowan, a GYN Oncologist at Woman's Hospital, for a raw, open discussion on the universal love language to help more women feel comfortable talking about sex and get the help they need to address any problems getting in the way of a healthy sex life.

On today's podcast, we're going to talk with Jen Kamel of VBAC Facts® about VBAC or vaginal birth after cesarean.  As the founder and CEO of VBAC Facts®, Jen Kamel is an internationally recognized consumer advocate, whose mission is to increase feedback access through education, legislation changes, and amplifying the consumer's voice. Jen travels throughout the United States training perinatal professionals, presents grand rounds at hospitals, and works as a legislative consultant throughout the US, focusing on midwifery legislation and regulations that threaten VBAC, or vaginal birth after cesarean, access. Jen envisions a time when every pregnant person seeking VBAC has access to unbiased information, respectful providers, and a community where they can plan the birth of their choice in the setting they desire. We talk about the statistics on VBAC access, as well as the difference between VBAC rates and VBAC success rates. We also talk about the misinformation about VBAC and the unbiased evidence based research that helps to support a person's right to choose to have a VBAC.  Content Warning: We will mention cesarean, uterine rupture, placental abnormalities, and birth trauma.  RESOURCES:  Learn more about Jen Kamel here. Follow VBAC Facts® on Facebook and Instagram. Learn more about the American College of Obstetricians and Gynecologists (ACOG) here and ACOG's information on VBAC here.   Lundgren I, van Limbeek E, Vehvilainen-Julkunen K, Nilsson C. Clinicians' views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a qualitative study from countries with high VBAC rates. BMC Pregnancy Childbirth. 2015 Aug 28;15:196. doi: 10.1186/s12884-015-0629-6. PMID: 26314295; PMCID: PMC4552403.   For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on Facebook (https://www.facebook.com/EvidenceBasedBirth/), Instagram (https://www.instagram.com/ebbirth/), and Pinterest (https://www.pinterest.com/ebbirth/). Ready to get involved? Check out our Professional membership (including scholarship options) (https://evidencebasedbirth.com/become-pro-member/). Find an EBB Instructor here (https://evidencebasedbirth.com/find-an-instructor-parents/), and click here (https://evidencebasedbirth.com/childbirth-class/) to learn more about the Evidence Based Birth® Childbirth Class.

When the Food and Drug Administration (FDA) approved mifepristone--the first of two drugs used in a medication abortion-- in 2000, the approval process came with a myriad of restrictions. Kirsten Moore, creator and director of the Expanding Medication Abortion Access (EMAA) Project, sits down to talk with us about the evolution of restrictions on medication abortion over the past 22 years, as well as the future of medication abortion access. In the mid-2000s, these restrictions were folded into an FDA program called Risk Evaluation and Mitigation Strategies (REMS). These restrictions included a certification process for the clinician, requires that the medication be dispensed in person in the clinic, hospital, or medical office, and patients must fill out a consent form. During the pandemic, the FDA issued guidance for medications subject to REMS, easing restrictions on providers and patients—but medications requiring in-person dispersal was not included. The American College of Obstetricians and Gynecologists (ACOG) sued the FDA, leading to a short period of time in 2020 when providers were able to consult with patients and prescribe medication abortion care through telemedicine and the mail. In January of 2021, the Supreme Court shut these abilities down. Still, in spring of 2021, the FDA announced that they would re-consider the current REMS restrictions. In December of 2021, the FDA announced the removal of the in-person distribution requirement for mifepristone and allowing in-person and mail-order pharmacy distribution. Unfortunately, expanded medication abortion access will, like many reproductive health services, be dependent on where you live. At this moment, 19 states prohibit the use of telehealth for abortion care (the number of states may rise to 26 depending on the future of Roe v. Wade). Many patients who are seeking an abortion are already facing structural, financial, and logistical barriers that make accessing this care extremely difficult to begin with. Even so, the FDA's lifting of unnecessary restrictions on medication abortion dismantles one less barrier to care for many. LinksThe EMAA Project on FacebookThe EMAA Project on TwitterBlog post- Supporting a Friend's Abortion At Home Take Action Follow the EMAA project on Facebook and Twitter here. Stay engaged in the fight to reduce barriers to medication abortion in individual states, and continue to talk about medication abortion as an option! Many people aren't aware of it or know little about it, despite the fact that it's an extremely safe and effective way of ending a pregnancy.  You can also support friends, family members, or loved ones during their medication abortion by bringing them a care basket, joining them to watch movies while they complete their abortion, or simply validating their experiences. Learn more in Caitlin Blunnie's blog post here!Support the show (https://www.reprosfightback.com/take-action#donate)

Dr. Christina Francis is the chairman of the board for the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG). A group of board certified, professional medical experts who believe that the Hippocratic Oath is something to be honored and not crapped on. Dr. Francis joins us today for a wide-ranging conversation on the breaking edges of the culture of death. We discuss the history of the fraudulent organization known as the American College of Obstetricians and Gynecologists (ACOG), how AAPLOG was birthed as a response to ACOG, how the abortion industry is sacrificing pregnant women in order to sell more abortion pills, the horrors of mail-order abortions, the miracle of the abortion-pill reversal and how pro-life OB/GYN's can use this to help us save more lives. Lastly, we discuss the dire fate for pro-life doctors, and why pro-life doctors need to STAND NOW before its too late! To learn more or join AAPLOG: https://aaplog.org AAPLOG's myth buster video on the abortion-pill reversal: https://tinyurl.com/5an36vaj Date: 12/21/21 To help UnAborted create more pro-life content and take our content to the streets, become a Patron of the show at https://www.patreon.com/unaborted To help Seth reach more high school and college students through pro-life presentations around the country, become a monthly supporter at https://prolifetraining.com/donate/

On today's podcast, we're going to talk with board certified physician Dr. Stacy De-Lin about the spread of misinformation online about COVID, particularly COVID and pregnancy.  Dr. Stacy De-Lin MD (she/her), is a board certified physician whose specialty and area of practice is gynecology and family planning. Dr. De-Lin is an Associate Medical Director at Planned Parenthood and works to provide access to full-spectrum reproductive healthcare no matter what. In addition to her busy practice, Dr. De-Lin works to combat online misinformation through her Instagram account @stacydelin_md.  We talk about the rise of misinformation online about COVID regarding pregnancy. We also talk about how evidence based research about COVID can assist pregnant people and their families to make informed decisions about their health.  Content Warning: We mention COVID, COVID-related deaths, abortion, and miscarriage. RESOURCES: Learn more about Dr. Stacy De-Lin and follow her Instagram here. Learn more about Planned Parenthood here.  Learn more about the Centers for Disease Control and Prevention (CDC) here.  Learn more about the American Academy of Pediatrics here. Learn more about EBB COVID resource page here. Learn more about the American College of Obstetricians and Gynecologists (ACOG) here. For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on Facebook (https://www.facebook.com/EvidenceBasedBirth/), Instagram (https://www.instagram.com/ebbirth/), and Pinterest (https://www.pinterest.com/ebbirth/). Ready to get involved? Check out our Professional membership (including scholarship options) (https://evidencebasedbirth.com/become-pro-member/). Find an EBB Instructor here (https://evidencebasedbirth.com/find-an-instructor-parents/), and click here (https://evidencebasedbirth.com/childbirth-class/) to learn more about the Evidence Based Birth® Childbirth Class.

The American College of Obstetricians and Gynecologists (ACOG) recommends ultrasound for all pregnant patients and we too are big fans of ultrasound.  If there is one tool that we have that is essential to understanding the well being of a a developing fetus it is an ultrasound.  Listen in as Dr. Abdelahk explains everything you need to know about ultrasound in pregnancy. We'd love to hear from you! Please get in touch with us on our website at TrueBirthPodcast.com or reach out on any of our social channels.  Integrative OBSTETRICS Social Facebook https://www.facebook.com/IntegrativeOB Instagram @integrativeobgyn Maternal Resources Social Facebook: https://www.facebook.com/maternalresourceshackensack |nstagram: @maternalresources Subscribe to the podcast on Apple Podcasts, Spotify, Google Podcasts, & Stitcher and leave a review!

Today I dive into unexplained infertility while comparing recommendations from the American Society of Reproductive Medicine (ASRM), the American College of Obstetricians & Gynecologists (ACOG), and the American Academy of Family Physicians (AAFP).    Top 10 Questions to Ask Your Reproductive Doctor Mira Ovulation Kit Second Opinions and IUI Statistics FREEBIES! Grab your freebies, new one every month!        Tara's Instagram for all things FREE infertility education Private Facebook Group for support and FREE education     *Information provided on this podcast provides general health information for educational purposes only. The information provided by me as a fertility coach is not to be used as a substitute for medical advice, cannot diagnose or treat any health condition and does not substitute for care from your healthcare provider.   

Dr. Florencia Greer Polite is an Associate Professor of Clinical Obstetrics & Gynecology and Chief of the Division of General OBGYN at University of Pennsylvania Perelman School of Medicine.  Dr. Polite is a native of Philadelphia and a graduate of Harvard College and the University of Pennsylvania School of Medicine. She completed her residency training in Obstetrics and Gynecology at NYU & Bellevue hospitals, where she served as the Administrative Chief Resident and received the Lyman Barton Memorial Chief Resident award.  Upon graduation, Dr. Polite joined the faculty at NYU and served as the Associate Residency Program Director for the Department of Obstetrics and Gynecology.   In August 2010, Dr. Polite joined the LSU faculty as an attending in the Generalist Division of OBGYN, becoming Director of the Residency Program in 2012, Director of the Generalist Division in 2014, and the Director of Faculty and Resident Development in 2017.  In September of 2018, Dr. Polite returned to the University of Pennsylvania as the Chief of the Division of General Obstetrics and Gynecology.  In this capacity, Dr. Polite is responsible for the largest division in the department of Obstetrics and Gynecology including four clinical practice sites. Dr. Polite is board certified by the American Board of Obstetrics and Gynecology. She is a Fellow of the American College of Obstetricians and Gynecologists (ACOG), a member of the Association of Professors of Gynecology and Obstetrics (APGO), and a member of the Society for Academic Specialists in General Obstetrics and Gynecology (SASCOG).  She serves on the National Board of Medical Examiners (NBME) Executive Board, Audit and Finance, and Budget Committees and the USMLE Test Development Committee.  Dr. Polite has been the recipient of numerous mentorship and teaching awards including the coveted CREOG National Faculty Award, the APGO Excellence in Teaching Award, and the ACOG Mentorship Award.  Dr. Polite has served as a medical expert for both plaintiffs and defense since 2011.  She has reviewed medical cases and served as an expert in both depositions and trial work.  She lives in Philadelphia with her husband (a partner at Morgan, Lewis & Bockius LLP)  and their 2 daughters. Rafiq R. Kalam Id-Din II, Esq., a current resident of Bedford Stuyvesant, Brooklyn, is Founder & Managing Partner of Ember Charter Schools for Mindful Education, Innovation and Transformation (Ember). A social entrepreneur, activist, teacher, lawyer and nonprofit leader with over 25-years experience, Rafiq grew up in severe poverty in inner city Philadelphia during the height of the crack epidemic and violence of the 1980s and early 1990s. A two-time graduate of the University of Virginia (Bachelors in English and African-American Studies, and a Master of Teaching—English Education), Rafiq received his JD from NYU School of Law as a Thurgood Marshall Scholar, becoming an Editor of the Law Review and President of the Student Bar Association. Rafiq practiced law with Cravath, Swaine & Moore LLP in New York and Hong Kong, before serving as Executive Director of the AnBryce Foundation in the Washington, DC area, a pioneering pipeline program focused on impactful education opportunities for socio-economically disadvantaged youth. In 2007 Rafiq received the prestigious Echoing Green Fellowship for Social Entrepreneurs for his innovative “Teaching Firm”, an innovative model for fully teacher-led schools managed like law firms, the first of which launched in Bedford Stuyvesant, Brooklyn in 2011. A co-founder and former Executive Board member of the NYC Coalition of Community Charter Schools, founder of the #BlackLedSchoolsMatter initiative and co-founder of the New York Black-Latinx-Asian Charter Collaborative, Rafiq also serves as a member of the Board of Directors of Echoing Green, The Brooklyn Crescents, and President of the NYU Law Alumni of Color Association (LACA). Rafiq was recently honored as a recipient of the Black Voices for Social Justice Fund Award from the Joe and Clara Tsai Foundation. Melissa Diaz - Bronx native Melissa Diaz (New York Comedy Festival, Laugh Your Asheville Off) is a unique and rising talent in the New York City comedy scene. Her sharp and quirky wit paired with an edgy attitude takes audiences through a funhouse of fatalism and hilarity that no amount of therapy will make you forget. Melissa is featured regularly at Caroline's on Broadway, has placed in Devil Cup and Laugh Your Asheville Off competitions, appeared in the New York Comedy Festival and has been named one of NYC's comics to watch.  Always hosted by Marina Franklin - One Hour Comedy Special: Single Black Female ( Amazon Prime, CW Network), Trainwreck, Louie Season V, The Jim Gaffigan Show, Conan O'Brien, Stephen Colbert, HBO's Crashing, and The Breaks with Michelle Wolf

On today's podcast, we will be talking with Tyler Jean Dukes, my doctoral fellow intern.  Tyler (she/her) is a doctoral candidate and graduate instructor at Texas Christian University. Over this past year, Tyler has been working with me as part of a graduate fellowship program. Tyler specializes in the medical humanities and early British literature. She is also a trained childbirth doula, which informs her scholarly and personal interests. Tyler teaches many classes at TCU, including “Introduction to Literature, Fiction, and Narrative Medicine,” and she is one year away from graduating with her Ph.D. We talk about her research with integrating childbirth and birth work into her doctoral studies in literature. We also talk about what Tyler discovered about the history of prenatal ultrasounds and pelvic exams. I encourage everyone to listen to EBB 174 with The Black OBGYN Project and EBB 180 with Stephanie Tillman, who is an expert on trauma-informed pelvic care.  Content warning: We talk about the history of obstetric abuse and trauma, as well as emotional and physical trauma. RESOURCES: Learn more about Tyler by following her on Instagram (https://www.instagram.com/birthandbooks). Learn more about DFW Narrative Medicine here (https://dfwnarrativemedicine.com/).  Learn more aboutAmerican College of Obstetricians and Gynecologists (ACOG) here (https://www.acog.org/womens-health/faqs/ultrasound-exams). Learn more about Listening to Mother's (LTM) here (https://www.nationalpartnership.org/our-work/health/maternity/listening-to-mothers.html). Learn more about World Health Organization (WHO) here (https://apps.who.int/iris/bitstream/handle/10665/259946/WHO-RHR-18.01-eng.pdf;jsessionid=6D347E8AC8A769FE8E922B68675407BA?sequence=1). Learn more about Ultrasound Industry Reports here (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001451.pub4/full). Learn more about Value Penguin here (https://www.valuepenguin.com/cost-sonogram-ultrasound-pregnancy). Learn more about Fortune Business Insights here (https://www.fortunebusinessinsights.com/industry-reports/ultrasound-equipment-market-100515). For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on Facebook (https://www.facebook.com/EvidenceBasedBirth/), Instagram (https://www.instagram.com/ebbirth/), and Pinterest (https://www.pinterest.com/ebbirth/). Ready to get involved? Check out our Professional membership (including scholarship options) (https://evidencebasedbirth.com/become-pro-member/). Find an EBB Instructor here (https://evidencebasedbirth.com/find-an-instructor-parents/), and click here (https://evidencebasedbirth.com/childbirth-class/) to learn more about the Evidence Based Birth® Childbirth Class.

Colorectal cancer screening update, COVID-19 vaccine update, and abnormal uterine bleeding basics.Today is May 24, 2021.Colorectal cancer screening update Written by Hector Arreaza, MD. Participation: Ikenna Nwosu, MD, and Daniela Viamontes, MD.Today is May 24, 2021.On august 29, 2020, we were in the midst of a pandemic and we woke up with the sad news about the death of Chadwick Aaron Boseman (also known as Black Panther). An interesting fact: The tweet in which his family announced his death on Twitter became the most-liked tweet in history. But why are we talking about Chadwick’s death? Because he died of colon cancer. I do not know if this recommendation came because of Chadwick, but it’s a good way to open this episode: remembering Black Panther.We heard the rumors, but now it’s official. On May 18, 2021, the USPSTF released their final recommendation statement about colorectal cancer screening. The age to start screening has been changed from 50 to 45 years old. This is a grade B recommendation. Grade B means that this recommendation has moderate to substantial net benefit, so offer this service to your patients. Screening adults between 76 and 85 years old who have been previously screened has a small net benefit (grade C recommendation). So, select patients may be screened for colorectal cancer in this age group (76-85), especially those who have never been screened.Do you remember this recommendation from medical school for high risk patients? Start screening at age 40 or 10 years before a patient’s direct-relative was diagnosed with colon cancer. This was a recommendation given by the US Multi-Society Task Force (which includes the American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy). This same organization already recommended in 2017 to start screening at age 45 in African American patients, and the American Cancer Society recommended screening all patients at age 45 in 2018. The ACS does not have a guideline to screen high risk patients for colon cancer. Most organizations agreed on not screening after age 85.Strategies for screening:High-sensitivity guaiac fecal occult blood test (HSgFOBT) or fecal immunochemical test (FIT) every yearDani: Stool DNA-FIT every 1 to 3 years (Cologuard®)  CT colonography every 5 years Flexible sigmoidoscopy every 5 years OR Flexible sigmoidoscopy every 10 years + annual FIT Colonoscopy screening every 10 yearsDiscuss different options with your patients, choose your favorite and do it!  Introduction: Update on COVID 19 vaccines  By Hector Arreaza, MD, and Lillian Petersen, RN. COVID-19 vaccines now can be co-administered with other vaccines according to the ACIP. COVID-19 vaccines and other vaccines may now be administered without regard to timing. They can be given on the same day or within the 14 days previously recommended between vaccines.  It is not known if reactogenicity of COVID-19 vaccine is increased with co-administration with other reactogenic vaccines (such as vaccines with live attenuated viruses).  How do you decide if you want to co-administer a vaccine? 1. Consider whether the patient is behind or at risk of becoming behind on recommended vaccines.2. Consider their risk of vaccine-preventable disease.3. Consider the reactogenicity profile of the vaccines. If multiple vaccines are administered at a single visit, administer each injection in a different injection site, at least one inch apart or in different limbs. Current or previous SARS-CoV-2 infection: Everyone should be offered COVID-19 vaccination regardless of their history of COVID-19 infection. Viral testing or serologic test is not recommended for the purposes of vaccine decision-making. People with current SARS-CoV-2 infection should be deferred until the person has recovered from the acute illness (if the person had symptoms) and they have met criteria to discontinue isolation. This applies to patients who got the disease before receiving any vaccine or after receiving the first dose.  A minimum interval between infection and vaccination has not been established, but evidence suggests that the risk of reinfection is low in the months after initial infection but may increase with time due to waning immunity. People with a history of multisystem inflammatory syndrome in children (MIS-C) or adults (MIS-A):It is unclear if people with a history of MIS-C or MIS-A are at risk of recurrence of the same dysregulated immune response following reinfection with SARS-CoV-2 or in response to vaccination. People with a history of MIS-C or MIS-A may choose to be vaccinated but they should consider delaying vaccination until they have recovered from their illness and for 90 days after the date of diagnosis. Find more information at the CDC.gov website. This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. ___________________________Abnormal Uterine Bleeding. By Sherika Adams, MS3, P. Eresha Perera, MS3, and Hector Arreaza, MD.  Definition. AUB is a symptom, not a diagnosis. It is equivalent to say: “This patient’s periods are abnormal.” Anything that falls out of what is considered “normal periods” is classified as abnormal uterine bleeding.These 4 elements are assessed when determining if a patient has AUB: Regularity, frequency, duration, and volume.  What is considered normal? Frequency = Every 24-38 days, regularity +/- 2-20 days over 12 months, duration = 4.5 to 8 days, volume = 5-80 mL. 10-30% of women of reproductive age may have AUB. According to the American College of Obstetricians and Gynecologists (ACOG), abnormal uterine bleeding is characterized by bleeding or spotting following sexual intercourse or menopause, between menstrual cycles, menstrual cycles lasting more than 38 days or shorter than 24 days, heavy bleeding during menstruation, and “irregular” menstrual cycles that have 7-9 days of variation.Terms no longer used: menorrhagia, metrorrhagia, and dysfunctional uterine bleeding (DUB). Not all symptoms reported as “vaginal bleeding” are coming from the vagina. For example, bleeding from anus, urethra, bladder, and perineum should be ruled out before establishing the diagnosis of AUB. Classification of Abnormal Uterine Bleeding (AUB). Abnormal uterine bleeding (AUB) in nonpregnant premenopausal women can be classified by the acronym PALM-COEIN, which was established by the International Federation of Gynecology and Obstetrics (FIGO) in 2011.  PALM-COEIN: Palm: Structural etiologies, Coein: Non-structural etiologies P is for polyps: Polyps are epithelial tumors in the endometrium or cervix and can be identified by hysterosonography or hysteroscopic imaging. A is for adenomyosis: Adenomyosis is endometrial stroma and glands in the myometrium and can be identified by histopathology, and now MRI and transvaginal ultrasound. L is for leiomyomas: Leiomyomas also known as uterine fibroids are benign smooth muscle tumors that are diagnosed by pelvic examination and pelvic imaging such as ultrasound with contrast or MRI. M is for malignancy and hyperplasia: Malignancy and hyperplasia are often abnormal epithelial tissue that is benign or cancerous that can be seen with transcervical endometrial sampling. C is for coagulopathy: Coagulopathy is bleeding disorders such as Von Willebrand disease is identified by laboratory testing. O is ovulatory dysfunctions: Ovulatory dysfunction occurs when there is a variation of more than seven days of the menstrual cycle in the past 12 months and ovulation is dysfunctional. In a woman without ovulation, there is no corpus luteum, and there is no progesterone, so estrogen goes unopposed, causing a buildup of endometrium and irregular bleeding.   E is endometrial causes: Endometrial causes can occur when there is normal ovulation, no other identifiable cause of AUB, and there is heavy menstrual bleeding, which includes intermenstrual bleeding. Primary disorders of endometrial hemostasis are likely due to vasoconstriction disorders, inflammation, or infection. Endometrial dysfunction is poorly understood; there are no reliable diagnostic methods, and it should be considered only after other causes are excluded. I is for iatrogenic cause: Iatrogenic causes include gonadal steroids (estrogen, androgens), anticoagulants, intrauterine devices, antipsychotics, antidepressants, and anti-hypertensives. N is for not otherwise classified: Example of an etiology under not otherwise classified might be AV malformations. This classification does not include pregnancy. Postmenopausal bleeding: Abnormal uterine bleeding can also occur in post-menopausal women and is an indication of potentially lethal endometrial cancer. Post-menopausal women should be worked up for cancer when they present with bleeding. However, most common cause of bleeding in this population is atrophy of the vaginal mucosa or endometrium. If younger than 45 patients but history of unopposed estrogen exposure (PCOS, obesity, estrogen therapy) should also undergo endometrial biopsy to rule out possibility of endometrial cancer.  Management of AUB. Management of the AUB can be initiated only after the etiology of the bleeding has been established. Firs of all, rule out pregnancy related bleeding by performing a pregnancy test. Also, rule out other sources of bleeding. The first question to answer would be: Does this patient need an emergent treatment for her AUB or can she be treated as outpatient? Determine that by checking the history, vitals, orthostatic vitals, physical exam, and labs.  If patient requires admission, the options for treatment include: uterine tamponade, intravenous estrogen, dilation and curettage, and uterine artery embolization. In case of severe bleeding without hemodynamic instability, patients can be treated initially with oral estrogen, high-dose estrogen-progestin oral contraceptives, oral progestins, or intravenous tranexamic acid.For chronic AUB, once etiology has been established, the goal is to treat the underlying condition. The goal of treatment is to control the bleeding since AUB can persists until menopause.  Initial outpatient treatment is usually pharmacological. For those not wanting to conceive soon, consider IUD placement. “Among medical therapies, the 20-mcg-per-day formulation of the levonorgestrel-releasing intrauterine system (Mirena) is most effective for decreasing heavy menstrual bleeding (71% to 95% reduction in blood loss) and performs similarly to hysterectomy when quality-adjusted life years are considered.”[8] Other long-term medical treatment options include estrogen-progestin oral contraceptives, oral progestins, oral tranexamic acid, NSAIDs (nonsteroidal anti-inflammatory drugs), and depot medroxyprogesterone. Surgical treatment is often considered for patients on long term medical therapy with no response, or for severe cases of bleeding with recurrent need for emergent treatment. Some surgical options are endometrial ablation, which performs as well as the levonorgestrel-releasing intrauterine system. Some structural lesions can be resected via hysteroscopy (polyps). Myomectomy and uterine artery embolization are options for patients with severe AUB who want to preserve fertility. Uterine leiomyomas or adenomyosis can be medically managed with OCPs but can also be treated with surgery as well, depending on the physician-patient discussion of options. Hysterectomy is the definitive treatment of severe AUB. Remember, PALM COEIN stands for: Polyps, Adenomyosis, Leiomyomas, Malignancy and hyperplasia, Coagulopathy, Ovulatory dysfunction, Endometrial causes, Iatrogenic cause, Not otherwise classified. ____________________________Conclusion. Written by Hector Arreaza, MDNow we conclude our episode number 53 “Abnormal Uterine Bleeding”. Eresha and Sherika did a great job explaining the Palm-Coein classification, and gave us a good overview of the management of AUB. Remember to start screening for colorectal cancer at age 45 now, what strategy for screening will you use? And for those patients who were hesitant about getting the COVID-19 vaccine with other vaccines, well, the ACIP said we can co-administer it with other vaccines. Even without trying, every night you go to bed being a little wiser.Thanks for listening to Rio Bravo qWeek. If you have any feedback about this podcast, contact us by email RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Daniela Viamontes, Ikenna Nwosu, Lillian Petersen, Sherika Adams, and P. Eresha Perera. Audio edition: Suraj Amrutia. See you next week! _____________________References:U.S. National Library of Medicine, Clinical Trials.Gov, https://clinicaltrials.gov/ct2/show/study/NCT02026869. Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States, Centers for Disease Control and Prevention, https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html#Coadministration, accessed on May 20, 2021.  Colorectal Cancer: Screening, Final Recommendation Statement, U.S. Preventive Services Task Force, May 18, 2021, https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening. Abnormal Uterine Bleeding FAQ, The American College of Obstetricians and Gynecologists (ACOG), https://www.acog.org/womens-health/faqs/abnormal-uterine-bleeding, accessed on May 17, 2021.  Fraser, Ian, et al. Abnormal uterine bleeding in reproductive-age women: Terminology and PALM-COEIN etiology classification, Up to Date, last updated: Dec 16, 2019. https://www.uptodate.com/contents/abnormal-uterine-bleeding-in-reproductive-age-women-terminology-and-palm-coein-etiology-classification?search=palm%20coein&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1. Goodman Annekathryn, et al, Postmenopausal uterine bleeding, Up to Date, last updated: Feb 02, 2021. https://www.uptodate.com/contents/postmenopausal-uterine-bleeding?search=abnormal%20uterine%20bleeding%20postmenopausal&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Kaunitz, Andre M, Abnormal uterine bleeding: Management in premenopausal patients, Up to Date, last updated: Aug 25, 2020. https://www.uptodate.com/contents/abnormal-uterine-bleeding-management-in-premenopausal-patients?search=abnormal%20uterine%20bleeding%20management&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1 Wouk N, Helton M. Abnormal Uterine Bleeding in Premenopausal Women. Am Fam Physician. 2019 Apr 1;99(7):435-443. PMID: 30932448. https://pubmed.ncbi.nlm.nih.gov/30932448/ 

00:00 cold opem - It's A Crossover Episode01:30 Theme song03:10 Meet our guest - COVID vaccine side affects07:30 disparities in vaccine distribution based on race - Hesitency or availability 11:00 stressers of work in a COVID world - An American problem13:30 Herd Immunity - Public health for all - Seat belts and J walking22:00 Uncle Toms stoke - Following the science over falloing for preconceptions 27:00 Where should we be changing minds - Are people listeniung to the science29:00 Can people with allergies get the COVID-19 vaccine? A. People with a severe allergic reaction (anaphylaxis) to any component of the COVID-19 vaccine should NOT receive the vaccine.Ingredients - The Pfizer- COVID-19 vaccine mRNA is the only active ingredient in the vaccineLipids, salts, Sugars Ingredients -  Moderna COVID-19 Vaccine MRNA, lipids, acids, acid stabilizers, saltsIngredients -  Johnson & JohnsonAcids, citric, salts, sugars, ethanol https://www.hackensackmeridianhealth.org/HealthU/2021/01/11/a-simple-breakdown-of-the-ingredients-in-the-covid-vaccines/31:00 What is in the vaccine that expires - fake viruses break down40:00 The mercury tangent - Be scared of the apple and water47:00 communicating - matching your audience - Health literacy54:00 B. People with a severe allergic reaction (anaphylaxis) to any vaccine or injectable (intramuscular or intravenous) medication should consult with their health providerC. Everyone else with severe allergic reactions to foods, oral medications, latex, pets, insects, and environmental triggers may get vaccinated. Your observation time may be longer 30 min50:00 If I am pregnant or breastfeeding? The American College of Obstetricians and Gynecologists (ACOG) recommends that the COVID-19 vaccine should not be withheld from pregnant or breastfeeding individuals.Upwards of 80,000 pregnant women have been vaccinated and more than four thousand women are being monitored by the v-safe COVID-19 Pregnancy Registry.1:00:00 Is the vaccine as effective in people with suppressed immune systems? efficacy and safety data are not yet available for people with immunosuppression due to medications or chronic illness. People with autoimmune conditions or who are immunocompromised are not excluded from getting the vaccine. Those who are vaccinated should be counseled on the potential for reduced immune responses and the need to continue to follow all current guidance to protect themselves against COVID-19. If you are immunocompromised or have an autoimmune disease, you and your doctor can decide together by weighing the benefits and risks.Twitter @PublicAccessPodhttps://twitter.com/PublicAccessPodinstagram @PublicAccessAmericaClips and extras from the show and what might be going on behind ithttps://www.instagram.com/publicaccessamericaYouTube Live stream Sunday Noon est 9 am pstJoin the chat and share your opinionhttps://www.youtube.com/channel/UCgQdy5FdAAjcTFkGaNGYV4ASnapChat Public Access GuyHave something to say? share with Jason nowhttps://www.snapchat.com/add/jasonanthony850Support this podcast at — https://redcircle.com/public-access-america/exclusive-contentAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

This week on The Lobby Shop, Dee Martin and Caitlin Sickles spoke with Skye Perryman, Chief Legal Officer and General Counsel at the American College of Obstetricians and Gynecologists (ACOG). The discussion covers ACOG's work, a battle over the drug mifepristone that went to the Supreme Court, the importance of collaborations, and how effective reproductive health care advocacy is done in the modern age.

What is comprehensive sex education? The American College of Obstetricians and Gynecologists (ACOG) gives a very thorough explanation here (click on hyperlink). In a nutshell, comprehensive sex education teaches students about reproductive development in ways that are medically accurate, evidence-based, and age-appropriate. In addition to addressing prevention of pregnancy and STI's, it also addresses forms of sexual expression, healthy sexual and nonsexual relationships, gender identity and sexual orientation and questioning, communication, recognizing and preventing sexual violence, consent, and decision making. Does the United States provide this consistently in all states? No. Here is another link that outlines what each state requires: https://www.guttmacher.org/state-policy/explore/sex-and-hiv-education. If you get a chance to navigate the website, you'll find plenty of information about where the United States ranks among other developed countries in teen pregnancies and STI's.  Andrea Brand, MSW, MPH is passionate about helping parents fill in knowledge gaps for their children when it comes to sex. Borrowing from her own experiences in teaching sexual education and in public health, she has authored a book: Stop Sweating & Start Talking: How to Make Sex Chats with Your Kids Easier Than You Think, which should be available by fall of 2021. More about Andrea and all of her services can be found at www.arbcoaching.com. Andrea's Ten Tips for Talking to Your Kids About Sex Are: 1. Keep it brief.  2. Validate their questions.   3. Keep the conversation at their level.  4. Admit what you do not know.   5. Up the frequency.   6. Verify your kids understand what you're saying by asking them.   7. Use the environment as conversation prompts.   8. Find settings free of distraction.   9. Timing is key.   10. Breathe and relish the opportunity.   One resource that Andrea would like to add for parents and adolescents is www.amaze.org Please listen for more details!   Ten with Yinh Produced By: Yinh Kiefer and Jasmati Productions Theme Song, Georges, Part Deux Written by Yinh Kiefer, Arranged and Performed by Jasmati Productions   

Part 1 of 'Getting ready for a healthy pregnancy'. I talk with Manijeh Kamyar M.D., Maternal Fetal Medicine Specialist. She is one of the contributing editors to the 7th edition of "Your Pregnancy and Childbirth" by The American College of Obstetricians and Gynecologists (ACOG). We discuss the many things you can do to prepare for a successful pregnancy and a healthy baby.

On today’s podcast, we will be talking with our honored guest, Dr. Amber Warmsley. Dr. Warmsley is a wife of five years to an amazing husband and a mother of two young children. She's a native Southern Californian transplanted to the D.C. metro area who will always love the beach. Dr. Warmsley is also an attending board-certified practicing OB-GYN with 8 years experience, 12 years if you count residency (which you definitely should). Dr. Warmsley is currently Chairperson of the department of OB-GYN and hospitalist site director at a hospital in Maryland. Dr. Warmsley is passionate about fostering a collaborative care approach to pregnancy-related care and creating a safe, positive, and uplifting birthing experience. She believes that all women and families deserve compassion, respect, dignity, and shared decision-making from their birthing team.  RESOURCES: Learn more about The American College of Obstetricians and Gynecologists (ACOG) here (www.acog.org). Hishikawa, K., Kusaka, T., Fukuda, T., et al. (2020). Neonatal outcomes of two-step delivery in low-risk pregnancy: A prospective observational study. J Obstet Gynaecol Res. 2020 Jul;46(7):1090-1097.   Huang, H., Yang, M., Zhou, H., et al. (2018). Method of shoulder delivery and neonatal outcomes: A meta-analysis of prospective controlled studies. Natl Med J India. 2018 Nov-Dec;31(6):324-328.   Kotaska, A. & Campbell, K. (2014). Two-step delivery may avoid shoulder dystocia: head-to-body delivery interval is less important than we think. J Obstet Gynaecol Can. 2014 Aug;36(8):716-720.    Locatelli, A. Incerti, M., Ghidini, A., et al. (2011). Head-to-body delivery interval using ‘two-step’ approach in vaginal deliveries: effect on umbilical artery pH, The Journal of Maternal-Fetal & Neonatal Medicine, 24:6, 799-803.   Zhang, H., Zhao, N., Lu, Y., et al. (2017). Two-step shoulder delivery method reduces the incidence of shoulder dystocia. Clin Exp Obstet Gynecol. 2017;44(3):347-352. For more information and news about Evidence Based Birth®, visit www.ebbirth.com. Find us on Facebook (https://www.facebook.com/EvidenceBasedBirth/), Instagram (https://www.instagram.com/ebbirth/), and Pinterest (https://www.pinterest.com/ebbirth/). Ready to get involved? Check out our Professional membership (including scholarship options) (https://evidencebasedbirth.com/become-pro-member/). Find an EBB Instructor here (https://evidencebasedbirth.com/find-an-instructor-parents/), and click here (https://evidencebasedbirth.com/childbirth-class/) to learn more about the Evidence Based Birth® Childbirth Class.

Dr. Ramos, a health professional with the American College of Obstetricians and Gynecologists (ACOG) joins Janeane on KUCI 88.9fm. ACOG has been the nation’s leading group of experts in women’s healthcare for 60+ years, caring for millions of women. And now the organization is releasing a new book that empowers pregnant women and new moms. There are obviously a lot of pregnancy books out there, but this one is truly a gamechanger for women. "Your Pregnancy and Childbirth: Month to Month" (releasing on Jan. 26) is focused on shared decision-making in healthcare, so women can feel empowered in their choices rather than having medical decisions dictated to them. The language is more conversational and includes some updates on how to manage work, travel prenatal visits and breastfeeding during COVID.

Dr. Florencia Greer Polite is an Associate Professor of Clinical Obstetrics & Gynecology and Chief of the Division of General OBGYN at University of Pennsylvania Perelman School of Medicine.  Dr. Polite is a native of Philadelphia and a graduate of Harvard College and the University of Pennsylvania School of Medicine. She completed her residency training in Obstetrics and Gynecology at NYU & Bellevue hospitals, where she served as the Administrative Chief Resident and received the Lyman Barton Memorial Chief Resident award.  Upon graduation, Dr. Polite joined the faculty at NYU and served as the Associate Residency Program Director for the Department of Obstetrics and Gynecology.   In August 2010, Dr. Polite joined the LSU faculty as an attending in the Generalist Division of OBGYN, becoming Director of the Residency Program in 2012, Director of the Generalist Division in 2014, and the Director of Faculty and Resident Development in 2017.  In September of 2018, Dr. Polite returned to the University of Pennsylvania as the Chief of the Division of General Obstetrics and Gynecology.  In this capacity, Dr. Polite is responsible for the largest division in the department of Obstetrics and Gynecology including four clinical practice sites. Dr. Polite is board certified by the American Board of Obstetrics and Gynecology. She is a Fellow of the American College of Obstetricians and Gynecologists (ACOG), a member of the Association of Professors of Gynecology and Obstetrics (APGO), and a member of the Society for Academic Specialists in General Obstetrics and Gynecology (SASCOG).  She serves on the National Board of Medical Examiners (NBME) Executive Board, Audit and Finance, and Budget Committees and the USMLE Test Development Committee.  Dr. Polite has been the recipient of numerous mentorship and teaching awards including the coveted CREOG National Faculty Award, the APGO Excellence in Teaching Award, and the ACOG Mentorship Award.  Dr. Polite has served as a medical expert for both plaintiffs and defense since 2011.  She has reviewed medical cases and served as an expert in both depositions and trial work.  She lives in Philadelphia with her husband (a partner at Morgan, Lewis & Bockius LLP)  and their 2 daughters. Rafiq R. Kalam Id-Din II, Esq., a current resident of Bedford Stuyvesant, Brooklyn, is Founder & Managing Partner of Ember Charter Schools for Mindful Education, Innovation and Transformation (Ember). A social entrepreneur, activist, teacher, lawyer and nonprofit leader with over 25-years experience, Rafiq grew up in severe poverty in inner city Philadelphia during the height of the crack epidemic and violence of the 1980s and early 1990s. A two-time graduate of the University of Virginia (Bachelors in English and African-American Studies, and a Master of Teaching—English Education), Rafiq received his JD from NYU School of Law as a Thurgood Marshall Scholar, becoming an Editor of the Law Review and President of the Student Bar Association. Rafiq practiced law with Cravath, Swaine & Moore LLP in New York and Hong Kong, before serving as Executive Director of the AnBryce Foundation in the Washington, DC area, a pioneering pipeline program focused on impactful education opportunities for socio-economically disadvantaged youth. In 2007 Rafiq received the prestigious Echoing Green Fellowship for Social Entrepreneurs for his innovative “Teaching Firm”, an innovative model for fully teacher-led schools managed like law firms, the first of which launched in Bedford Stuyvesant, Brooklyn in 2011. A co-founder and former Executive Board member of the NYC Coalition of Community Charter Schools, founder of the #BlackLedSchoolsMatter initiative and co-founder of the New York Black-Latinx-Asian Charter Collaborative, Rafiq also serves as a member of the Board of Directors of Echoing Green, The Brooklyn Crescents, and President of the NYU Law Alumni of Color Association (LACA). Rafiq was recently honored as a recipient of the Black Voices for Social Justice Fund Award from the Joe and Clara Tsai Foundation. Melissa Diaz - Bronx native Melissa Diaz (New York Comedy Festival, Laugh Your Asheville Off) is a unique and rising talent in the New York City comedy scene. Her sharp and quirky wit paired with an edgy attitude takes audiences through a funhouse of fatalism and hilarity that no amount of therapy will make you forget. Melissa is featured regularly at Caroline’s on Broadway, has placed in Devil Cup and Laugh Your Asheville Off competitions, appeared in the New York Comedy Festival and has been named one of NYC’s comics to watch.  Always hosted by Marina Franklin - One Hour Comedy Special: Single Black Female ( Amazon Prime, CW Network), Trainwreck, Louie Season V, The Jim Gaffigan Show, Conan O'Brien, Stephen Colbert, HBO's Crashing, and The Breaks with Michelle Wolf    

Although the country has justifiably turned its attention to the COVID-19 crisis, maternal mortality remains a public health crisis.The maternal mortality rate in the United States is higher than any other high-income nation. Approximately 60% of maternal deaths are preventable. Inexcusably, women of color are disproportionately impacted by this crisis. Black women experience mortality as a result of complications of pregnancy at a rate THREE TO FOUR times higher than white women. American Indian and Alaska Native women die at a rate two to three times higher. This must stop.   Today on the podcast is Dr. Tamika Auguste, an OB/GYN at MedStar Washington Hospital Center in Washington, DC, and a member of the Board of Directors for the American College of Obstetricians and Gynecologists (ACOG).    Dr. Tamika Auguste discusses the American maternal mortality crisis, and in particular, why there are such stark racial disparities in maternal mortality. As a contributor to ACOG's guidance on optimizing postpartum care, Dr. Auguste also discusses why postpartum care is so important, what often gets overlooked in postpartum care, how we can ensure moving forward that postpartum care is more accessible to everyone - both so that we can reduce maternal mortality and generally increase the health and wellbeing of postpartum people.   Dr. Auguste and Femtastic host Katie Breen discuss both clinical solutions and public policy solutions to this crisis, and what you can do to help.    Lastly, Dr. Auguste tells us about ACOG's new book, available on January 26, 2021, called Your Pregnancy and Childbirth: Month to Month. Parents who are in the pre-conception, pregnancy, or postpartum period can learn more about pregnancy from the top medical experts on the topic. Offering real clinical guidance without the clinical jargon, this straightforward book breaks down each step of pregnancy, month-by-month, in ways that every person can understand and relate to during each phase of the pregnancy experience. It answers parents' most pressing questions, including what bodily changes to expect each month; changes in fetal development; how to manage self-care; how to think about pain relief during labor and delivery; how to handle travel, work, and exercise; COVID-19 considerations; and a new chapter where new parents and parents-to-be can find quick answers to frequently asked questions.  Resources: - Buy ACOG's new book from independent booksellers - Learn more about the American College of Obstetricians and Gynecologists (ACOG), including their helpful guidance for handling COVID-19 precautions and vaccinations in pregnancy, delivery, postpartum, and breastfeeding    

In this episode, I discuss "term", which is the length of time a fetus spends in the womb before he/she is born. Relatively recent changes by the American College of Obstetricians and Gynecologists (ACOG) have created further distinctions with what used to be the normal term. My baby is considered pre-term himself, but he was thankfully healthy and normal when he came out.

Episode 35: Palliative Care and HospiceCOVID-19 vaccines and USPSTF recommendations. Palliative care and hospice briefly explained by Dr Tu. Pyogenic granuloma is defined. Feliz Navidad, and jokes._________________Hepatitis B screening in adolescents and adultsFirst, on December 15, 2020, the USPSTF recommended to offer screening for Hepatitis B virus infection to all adolescents and adults at increased risk for infection, regardless of their immunization status[1]. Some examples of patients at increased risk are:Those coming from countries with HepB prevalence above 2% (for example, most countries in Africa and Southeast Asia, South Korea, Italy, Colombia, Ecuador, and Peru, among others). Also, US-born children if they did not receive the HepB vaccine as infants AND their parents come from countries with a prevalence above 8% (check the list online).Other groups include: IV drug users, MSM, HIV, even household contacts of persons known to have POSITIVE HepB surface antigen. Remember to order the right test for screening: HepB surface antigen. As a reminder, Hep B screening in pregnant women at the first prenatal visit is a USPSTF “A” recommendation. Screening for high blood pressure in children and adolescentsOn November 10, 2020, the USPSTF concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for high blood pressure in children and adolescents. This is a Grade I recommendation[2]. When screening, clinicians should consider risk factors, such as obesity, family history of hypertension, and ethnicities such as African-American or Hispanic. The grade I recommendation means that more research is needed. Maybe you guys can use that as a research idea.Announcement of Coronavirus VaccinesOn December 11, 2020, the FDA granted an Emergency Use Authorization for tozinameran or the BNT162b2 vaccine, manufactured by Pfizer-BioNtech, becoming the first coronavirus vaccine approved in the USA. A week later, on December 18, 2020, the mRNA-1273 vaccine, manufactured by Moderna, was also approved for emergency use. The two vaccines are being administered as we speak to front-line health care providers across the nation. The two vaccines have an efficacy above 90%, and consist of two doses: 3 weeks apart for Pfizer, and 4 weeks apart for Moderna. They seem to reduce the risk of severe COVID-19.Reported side effects include: injection site pain, fatigue, headache, muscle pain, and joint pain. Some people may experience fever. Side effects are more common after the second dose; younger adults, who have more robust immune systems, reported more side effects than older adults. Staggering vaccinations among staff is recommended.The vaccines have not been tested in children or pregnant women yet. The American College of Obstetricians and Gynecologists (ACOG), recommends that COVID-19 vaccines should not be withheld from pregnant individuals who meet criteria for vaccination based on ACIP-recommended priority groups. ACOG recommends that pregnant individuals should be free to make their own decision in conjunction with their clinical care team. Efforts across the globe are being made to find a vaccine and medications to treat COVID-19. Sputnik V was a vaccine created in Russia and being distributed in allied countries; the Soberana 1 and Soberana 2 were created in Cuba and are under investigation; and in October, a “molecule” called DR-10 was announced in Venezuela that reportedly neutralizes 100% of SARs-CoV-2. There is so much to say about this topic, and the conversation may go beyond just science, but we invite you to follow the news from trustworthy sources as they continue to evolve. This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA and it is sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home.“You matter because you are you. You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully, but to live until you die.”Dame Cicely Mary SaundersEnd-of life care may be challenging but also very rewarding. You get to take care of people during this critical time or their lives. Some people think it’s the end of a life, some people see it as a period of your existence, a passage to a “better life” or whatever your belief is about it. As doctor, we consider seriously the principle of sanctity of life vs quality of life.  Today, we have Dr Tu, who previously talked about wound care, and now he comes with a new topic to discuss. Welcome again Dr Tu.1.  Question #1: Who are you? Presently I am a second-year family medicine resident.  And I recently finished my palliative care-hospice elective 2 weeks ago with Dr. Warren Wisnoff.  And I had a wonderful and full of learning experience during this rotation.  And I really want to share some of those experiences with you. 2.  Question #3: What did you learn this week? Just like what I said I recently finished my elective KM with Dr. Wisnoff for palliative care and hospice.  I learned the difference between palliative care and hospice and the different services that are involved in this specialty. Palliative care and hospice service also known as end-of-life care and focuses more on comfort care and quality of life. Difference between palliative care and hospice   I am not an expert on palliative care and hospice but based on my recent elective and previous experience working in hospice care as a registered nurse there are overlapping similarities but also significant differences in terms of services being offered in palliative care and hospice. Palliative care Palliative care service is not reimbursable under CMS regulation.  Palliative care focuses on improving quality of life for patients with serious illness in their families.  This approach may include providing relief from pain and or other distressing symptoms, integrating psychological and spiritual aspects of care, assisting with difficult decision making, and supporting patients and families.   Another main difference of palliative care from hospice is specialty services that patient can still benefit from chemotherapy and other specialty visits. History The specialty of palliative medicine arose as a direct result of the hospice movement.  Palliative medicine incorporates the holistic care developed by hospice, focusing on symptom management, supporting and assisting with communication, and providing such care to avoid a group of patients including those who are not dying or who cannot receive or choose not to receive hospice services.  Palliative care aims to relieve suffering and no stages of disease and is not limited to end-of-life care. Type of services offered by palliative care service Assessment and treatment of physical symptoms most especially pain.  Around 80% of cancer patient patients will complain of severe pain.  Or patient will also complain of breathlessness especially patients with congestive heart failure.  Symptom assessment and management are necessary not only to provide diagnosis but also to help in controlling these symptoms.  The symptoms are a big burden to patient's quality of life and there are management available to address these symptoms.  Pain management is critical and cancer patient and opiate management in patients with breathlessness. Psychological, social, cultural, and spiritual aspect of care. Attention to the psychological, social, cultural, and social needs of patients and families is an important part of good medical care.  Symptoms of depression, anxiety, social and financial stressors, and caregiver burden are, and serious illnesses.  Patient's and family's approach of serious illness, death, and dying, and spiritual needs are often heightened near the end of life.  All clinicians who care for patients with serious illness need basic skills to recognize and treat uncomplicated depression and anxiety, recommending appropriate social supports, and eliciting and respecting cultural traditions since with well preferences. Serious illness communication skills.  Basic serious illness communication skills include communicating bad news, eliciting patient preferences, establishing goals of care, identifying a surrogate decision maker, deciding about future CPR and mechanical ventilation and providing emotional support.  These skills are required routinely in the care of seriously ill patients and should therefore be familiar to all clinicians who provide palliative care. Care coordination.  Basic care coordination in serious illness means of ensuring the transfer between healthcare settings are timely and reflect patient/family needs and goals.  Primary team must also have basic knowledge about how to refer patients for hospice care.  Hospice care is a model and philosophy of care that focuses on providing palliative care to patients with life limiting illness, focusing on palliating patient's pain and other symptoms, attending to their and their family's emotional and spiritual needs and providing support for their caregivers. Candidates for hospiceHospice is appropriate when patients are entering the last week to months of life and patients and their families decide to forego disease modifying therapies with curative/life-prolonging intent in order to focus on maximizing comfort and quality of life.  In the United States guidelines from Medicare are available to help in the determination of terminal status for hospice qualification.  Commonly if the patient meets the indication for an estimate of 6-month life expectancy using a decline in clinical status. The hospice team Registered hospice nurse: Primary case manager and is responsible for skilled nursing care and coordination of other members of the interdisciplinary team. Hospice physician: They have medical and administrative roles, they may be board-certified in the specialty of hospice and palliative medicine.  Some hospice physicians visit patients at home particularly if the patient does not have an involved attending physician.  Hospice physician also acts as a liaison with attending clinicians and can assist with symptom management. Primary attending physician or referring physician: They are encouraged to remain involved in the care of their patients after referral to hospice, unfortunately for the continuity of the doctor-patient relationship, this does not occur often. Ideally, the primary attending physician works directly with the hospice nurse and also in collaboration with the hospice medical director to monitor symptoms in order intervention such as medications or skilled nursing care. Social worker: They provide psychological support for patients and families including counseling, bereavement support, burial/funeral planning, and/or referrals to other support systems. Chaplain: He or she oversees the spiritual needs of patients and families.  Spiritual care is offered to patients with both formal and unstructured religious beliefs. Home health aides: Home health aides and other direct care workers help the patient and caregivers in the home, including personal care, food preparation, and shopping. Bereavement counselors: They are available to provide support to bereave once of hospice patients for the 13 months after patients that. Community volunteers: Volunteers are a mandatory component of hospice care and received training and support for their work. They will provide extra support for patients and families such as reading to patients, visiting, and assisting with errands.  Managing common symptoms during end-of-life careClinician should follow certain guiding principles when prescribing medication for symptoms management at the end of life.  Medication should be used to treat the primary etiology of these symptoms.  For example, if the patient is anxious because of shortness of breath, treatment should focus on the dyspnea to alleviate the primary symptom and the resulting anxiety.  Medication should generally start at lower doses a titrate up or down until you get desired effect.  The dosing should initially be as needed (prn) and then transition to a standing dosage or long-acting medication for symptom management. Whenever possible, proactive regimens that prevent symptoms should be used, because it is generally easier to prevent than treating an acute symptom. Pain: It is a common symptom occurring in approximately 50% of person in the last month of life.  It is important to recognize the patient's total pain which includes not only physical symptoms but also the psychological, social, and spiritual components of distress. Some medications include fentanyl, hydromorphone, morphine, oxycodone, and hydrocodone. Dyspnea: Although dyspnea is common in patients with end-stage pulmonary and cardiac disease, it is also regularly observed in patients with cancer, CVA, or dementia. Opiates are the medications of choice for the management of breathlessness and end-of-life care, especially morphine. Delirium and agitation: Patients often experience delirium and agitation in the last days and weeks of life.  Symptoms that do not cause the patient distress can be managed conservatively without medication.  It is essential to assess reversible or treatable causes of delirium such as medication adverse effects, uncontrolled pain or discomfort, constipation, or urinary retention. Medications: antipsychotics such as haloperidol and risperidone are effective in the treatment of delirium and agitation at the end of life.  Dosing for delirium tends to be significantly lower than for psychosis and schizophrenia.  Benzodiazepine should be used with caution for the treatment of agitation and delirium because they can potentially provoke increased symptoms in older patients.  However, benzodiazepines can effectively treat anxiousness and agitation in the last hours and days of life because of the potentially sedating effects. Nausea and vomiting: These are common symptoms during the end of life. Multiple receptor pathways in the brain and in the gastrointestinal tract mediate nausea and vomiting. Medications that target dopaminergic pathways are effective like haloperidol, risperidone, metoclopramide, and prochlorperazine.  Constipation: Effective management of constipation is critical because constipation can lead to pain, vomiting, restlessness, and delirium. Common causes of constipation are low oral intake of food and fluids and adverse effects of opiates. Medications: stimulant laxative like senna, stool softener like docusate, and polyethylene glycol. Oropharyngeal secretions: It is common for patients to lose the ability to manage oropharyngeal secretions as they progressed through the dying process.  This can result in noisy breathing pattern, sometimes referred to as death rattle. Medications: hyoscyamine, atropine sulfate, glycopyrrolate, and scopolamine. Fever: Treatment of fever at the end of life is based on the patient's life expectancy and goals of care. Medication: acetaminophen, NSAIDs, corticosteroids. Common end-of-life medications (hospice comfort kit):  Effective management of symptoms at the end of life is challenging but often can be achieved with fewer than 4 or 5 key medications which are commonly found in hospice comfort kit in the patient's home. The kit is composed of antipsychotics, antipyretics, benzodiazepines, opiates, and secretion medication. Question #3: Why is that knowledge important for you and your patients?There are significant number of patients that during the end of life still suffer significantly whether it is from pain, nausea and vomiting, severe dyspnea, or constipation. Hospice care provides medical care and support services that focus on quality of life rather than life prolongation or cure. Hospice philosophy seems to help patient achieve comfort and quality of life until they die with dignity, and the care and treatment provided are based on the patient and family goals and values.  As of 2015 and estimated 1.38 million Americans yearly are being served by hospice programs around the country, and around 50% of Medicare patients utilize hospice at some point in their care. Question #4: How did you get that knowledge?Before getting accepted in the residency program I worked as an RN case manager both in home health and hospice here in Bakersfield, and recently I finished an elective at Kern Medical with Dr. Warren Wisnoff. My other sources include the American Academy of Palliative and Hospice Medicine book, up-to-date, and the American Academy Family Physician website.____________________________Speaking Medical: Pyogenic Granuloma by Muhammad Suleman, MS4 I’m going to present to you a case and then I’ll explain our Medical word of the week. Just imagine you have a patient who is an 8-year-old child with no significant past medical history. He comes to the clinic with a concern of a red ball-like mass on his lower lip. The mother states it started as a small pimple and has progressively gotten bigger over the last 2 weeks. It is mildly tender, nothing makes it better or worse. Patient denies trauma, recent sick contact, or infections, or weight loss. Skin lesion is a friable, pedunculated mass on right side of lower lip, beefy red, moist, with no purulent discharge. It measures 1 cm x 1cm. What do you think it is? This is a pyogenic granuloma (PG). Not to be confused with the other PG Pyoderma gangrenosum (another type of PG). Pyogenic granuloma is a benign vascular tumor of the skin or mucous membranes characterized by rapid growth and friable surface. Pyogenic granuloma occurs at any age, although it is seen more often in children and young adults. In children, most common in age 6-10 years old. Trauma can be a trigger of PG. It may also be drug induced (antineoplastic agents). It may also be found in chronic inflammation in ingrown toenails. PG is usually solitary but can be disseminated. Sizes rarely exceed 1cm. PG may be pedunculated or sessile. The base is often surrounded by thick ring of epidermis. In pregnant women 2-3 trimester, we can see PGs in the oral cavity, which tends to regress after birth.  PG usually regresses but can be treated with surgical treatments, such as full-thickness excision or cryotherapy) and topical and intralesional therapies. So, remember the medical word of the week: Pyogenic granuloma (PG). Espanish Por Favor: Feliz Navidadby Yosbel Martinez, MDAs residents, we always want to have a good relationship with our patients. That is what we call rapport. Rapport is all we need to have a bidirectional conversation. Having a harmonious relationship with your patient will allow you to collect a more comprehensive history, perform an effective physical exam, discuss treatments and have a more enjoyable patient encounter. The ideal doctor-patient relationship should be one full of trust, accountability, and respect. This Christmas, if you have a Spanish-speaking patient, an easy way to break the ice may be telling them “Feliz Navidad”. We wish everyone of you a Merry Christmas and a Happy New Year from our Rio Bravo Family. ____________________________For your Sanity: Christmas Jokesby Julia Peters, MS3, and Jennifer Amezcua, MAResident 1: What do you get when you cross a snowman with a vampire?Resident 2: A mean, flying snowman? I don’t know. Resident 1: A Frostbite!Resident 1: What do you get if you cross Santa with a detective?Resident2: Santa Holmes?Resident 1: Good thought: Santa Clues!Resident 1: What do you call Santa when he's got no money?Resident 2: Saint-NICKEL-less!Resident 2: What do elves post on social media?Resident 1: Elf-ies!Resident 2: Someone must be mad at Frosty the Snowman.Resident 1: Why?Resident 2: Because they gave him two black eyesNow we conclude our episode 35, “Palliative Care and Hospice.” We gave you an update on the USPSTF screening guidelines, and gave you the long-waited news about the coronavirus vaccines. Yes, we are full of excitement and hope. Then, Dr Tu explained the importance of providing palliative and hospice services to our chronically-ill and terminally-ill patients. Our patients deserve special care during those critical moments of their lives. Moe explained pyogenic granuloma, a small growth that can be alarming for patients but easily treated in office. Dr Martinez reminded us of the holidays by wishing us “Feliz Navidad”, and Jenni and Julia made us laugh with their silly jokes about Santa. May you enjoy the holidays!This is the end of Rio Bravo qWeek. If you have any feedback about this podcast, send us an email to RBresidency@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. This podcast was created with educational purposes only. Visit your primary care physician for additional medical advice. This week we thank Hector Arreaza, Ariana Lundquist, Manual Tu, Xeng Xiong, Yosbel Martinez, Julia Peters, and Jennifer Amezcua. Audio edition: Suraj Amrutia. See you soon!  References:Screening for Hepatitis B Virus Infection in Adolescents and Adults, December 15, 2020, U.S. Preventive Services Task Force(USPSTF), https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/hepatitis-b-virus-infection-screening. High Blood Pressure in Children and Adolescents: Screening, November 10, 2020, U.S. Preventive Services Task Force(USPSTF), https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/blood-pressure-in-children-and-adolescents-hypertension-screening#bootstrap-panel--6. “Your questions about the coronavirus vaccine, answered”, The Washington Post, https://www.washingtonpost.com/health/2020/11/17/covid-vaccines-what-you-need-to-know/?arc404=true , accessed on December 21, 2020. “Venezuela Developed A Drug That Eliminates The Coronavirus 100 Percent”, The Venezuelan Journal, https://thevenezuelanjournal.com/maduro-bivenezuela-developed-a-drug-that-eliminates-the-coronavirus-p2791-155.htm, accessed on November, 12, 2020. Ross H. Albert, MD, PhD, End-of-Life Care: Managing Common Symptoms, Am Fam Physician. 2017 Mar 15;95(6):356-361. https://www.aafp.org/afp/2017/0315/p356.html, accessed on November 9, 2020. Thompson Ruth M., Chirag Rajni Patel, and Kate M. Lally, Essential Practices in Hospice and Palliative Me, 5th edition, Unipac 1, Medical Care of People with Serious Illness, AAHPM. Dawn A. Marcus, M.D., Treatment of Nonmalignant Chronic Pain, Am Fam Physician. 2000 Mar 1;61(5):1331-1338. https://www.aafp.org/afp/2000/0301/p1331.html.    

Autism and Labor Epidurals? Dr. Rosenblum discusses JAMA’s October 2020 article that suggests an association between Labor Epidural and the diagnosis of Autism Spectrum Disorder Summary of the study Responses from other physicians Statements by the The Society for Obstetric Anesthesia and Perinatology (SOAP), the American Society of Anesthesiologists (ASA), the Society for Pediatric Anesthesia (SPA), the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) Speaking of Labor Analgesia... Learn TAP Blocks, Ilioinguianl Block and more! Next Ultrasound Guided Regional Anesthesia and Interventional Pain Courses.. November 22, 2020 - Live In Person Ultrasound Training- "In-Person" Ultrasound Guided Pain Management 7 CME Credit Training Event Nov. 22nd, 2020. Limited Spaces! Covering:-Upper Extremity (Brachial Plexus, Axillary, Suprascapular) -Lower Extremity (Femoral, Sciatic, Popliteal, Ankle, IPACK, Genicular) -Soft Tissue & Joint (Shoulder, ITB, Hip, Knee, Plantar Fascia) -Peripheral Nerve Blocks and Spine (Ilioinguinal, TAP, Intercostal, -Paravertebral, Caudal, Cervical , Cluneal and much more!) -Live Model Scanning and Practice with Phantoms Register Now! https://painexam.com/events/in-person-live-ultrasound-training-november-22-nyc/ December 6, 2020-  Virtual Interventional Pain and Regional Anesthesia Training Webinar- New Ultrasound Guided Interventional Pain Management & Regional Anesthesia 4 CME Webinar Event by PainExam, Set for Dec. 6th, 2020 Covering: Ultrasound Guided Interventional Pain Virtual Training on Nerve Blocks, Soft Tissue Injections, Spine, etc. -Upper extremity (Brachial Plexus, Axillary, Suprascapular, Radial, Ulna, Median) -Lower Extremity (Femoral, Sciatic, Popliteal, Genicular, IPACK, Ankle) -Soft Tissue and Joint (Knee & Shoulder) -Peripheral Nerve Block (Occipital, TAP, Ilioinguinal, Intercostal Paravertebral -Spine (Sacroiliac, Caudal, Cervical Selective Nerve Root, Medial Branch) Register Now! https://painexam.com/events/ultrasound-guided-interventional-pain-and-regional-anesthesia-virtual-training/ Podcast References: https://www.asahq.org/about-asa/newsroom/news-releases/2020/10/labor-epidurals-and-autism-joint-statement https://jamanetwork.com/journals/jamapediatrics/article-abstract/2771634 Subscribe to our mailing list * indicates required Email Address *      

Autism and Labor Epidurals? Dr. Rosenblum discusses JAMA's October 2020 article that suggests an association between Labor Epidural and the diagnosis of Autism Spectrum Disorder Summary of the study Responses from other physicians Statements by the The Society for Obstetric Anesthesia and Perinatology (SOAP), the American Society of Anesthesiologists (ASA), the Society for Pediatric Anesthesia (SPA), the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) Speaking of Labor Analgesia... Learn TAP Blocks, Ilioinguianl Block and more! Next Ultrasound Guided Regional Anesthesia and Interventional Pain Courses.. November 22, 2020 - Live In Person Ultrasound Training- "In-Person" Ultrasound Guided Pain Management 7 CME Credit Training Event Nov. 22nd, 2020. Limited Spaces! Covering:-Upper Extremity (Brachial Plexus, Axillary, Suprascapular) -Lower Extremity (Femoral, Sciatic, Popliteal, Ankle, IPACK, Genicular) -Soft Tissue & Joint (Shoulder, ITB, Hip, Knee, Plantar Fascia) -Peripheral Nerve Blocks and Spine (Ilioinguinal, TAP, Intercostal, -Paravertebral, Caudal, Cervical , Cluneal and much more!) -Live Model Scanning and Practice with Phantoms Register Now! https://painexam.com/events/in-person-live-ultrasound-training-november-22-nyc/ December 6, 2020-  Virtual Interventional Pain and Regional Anesthesia Training Webinar- New Ultrasound Guided Interventional Pain Management & Regional Anesthesia 4 CME Webinar Event by PainExam, Set for Dec. 6th, 2020 Covering- Ultrasound Guided Interventional Pain Virtual Training on Nerve Blocks, Soft Tissue Injections, Spine, etc. -Upper extremity (Brachial Plexus, Axillary, Suprascapular, Radial, Ulna, Median) -Lower Extremity (Femoral, Sciatic, Popliteal, Genicular, IPACK, Ankle) -Soft Tissue and Joint (Knee & Shoulder) -Peripheral Nerve Block (Occipital, TAP, Ilioinguinal, Intercostal Paravertebral -Spine (Sacroiliac, Caudal, Cervical Selective Nerve Root, Medial Branch) Register Now! https://painexam.com/events/ultrasound-guided-interventional-pain-and-regional-anesthesia-virtual-training/ Podcast References: https://www.asahq.org/about-asa/newsroom/news-releases/2020/10/labor-epidurals-and-autism-joint-statement https://jamanetwork.com/journals/jamapediatrics/article-abstract/2771634 Subscribe to our mailing list for Free Board Prep Material & More! * indicates required Email Address * Email Format html text      

Autism and Labor Epidurals? Dr. Rosenblum discusses JAMA's October 2020 article that suggests an association between Labor Epidural and the diagnosis of Autism Spectrum Disorder Summary of the study Responses from other physicians Statements by the The Society for Obstetric Anesthesia and Perinatology (SOAP), the American Society of Anesthesiologists (ASA), the Society for Pediatric Anesthesia (SPA), the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) Speaking of Labor Analgesia... Learn TAP Blocks, Ilioinguianl Block and more! Next Ultrasound Guided Regional Anesthesia and Interventional Pain Courses.. November 22, 2020 - Live In Person Ultrasound Training- "In-Person" Ultrasound Guided Pain Management 7 CME Credit Training Event Nov. 22nd, 2020. Limited Spaces! Covering:-Upper Extremity (Brachial Plexus, Axillary, Suprascapular) -Lower Extremity (Femoral, Sciatic, Popliteal, Ankle, IPACK, Genicular) -Soft Tissue & Joint (Shoulder, ITB, Hip, Knee, Plantar Fascia) -Peripheral Nerve Blocks and Spine (Ilioinguinal, TAP, Intercostal, -Paravertebral, Caudal, Cervical , Cluneal and much more!) -Live Model Scanning and Practice with Phantoms Register Now! https://painexam.com/events/in-person-live-ultrasound-training-november-22-nyc/ December 6, 2020-  Virtual Interventional Pain and Regional Anesthesia Training Webinar- New Ultrasound Guided Interventional Pain Management & Regional Anesthesia 4 CME Webinar Event by PainExam, Set for Dec. 6th, 2020 Covering: Ultrasound Guided Interventional Pain Virtual Training on Nerve Blocks, Soft Tissue Injections, Spine, etc. -Upper extremity (Brachial Plexus, Axillary, Suprascapular, Radial, Ulna, Median) -Lower Extremity (Femoral, Sciatic, Popliteal, Genicular, IPACK, Ankle) -Soft Tissue and Joint (Knee & Shoulder) -Peripheral Nerve Block (Occipital, TAP, Ilioinguinal, Intercostal Paravertebral -Spine (Sacroiliac, Caudal, Cervical Selective Nerve Root, Medial Branch) Register Now! https://painexam.com/events/ultrasound-guided-interventional-pain-and-regional-anesthesia-virtual-training/ Podcast References: https://www.asahq.org/about-asa/newsroom/news-releases/2020/10/labor-epidurals-and-autism-joint-statement https://jamanetwork.com/journals/jamapediatrics/article-abstract/2771634 Subscribe to PainExam's mailing list * indicates required Email Address *      

We’re all in this Together: COVID-19 Allies in Infection Prevention This podcast series will focus on the collaborative efforts and opportunities for different disciplines to address and confront the COVID-19 pandemic. This episode focuses on collaborations in a discussion with American College of Obstetricians and Gynecologists (ACOG). Speakers: - Denise Jamieson, MD, MPH - Anna Sick-Samuels, MD, MPH (moderator) Special thank you to our partnering organization for their collaboration on this podcast series, American College of Obstetricians and Gynecologists (ACOG): www.acog.org

There are too many statistics showing how black communities receive less healthcare. There are many reasons and barriers both from a patient perspective and a provider perspective. Social determinants of health are critical to healthcare delivery. Dr. Camille Clare breaks this very difficult topic for us in ways we can easily understand so that we can take steps together as a society to bring more equality into this space. She discusses institutional and structural racism, implicit and explicit bias in healthcare delivery, and the importance of educating people on structural factors that impact care. Dr. Clare stresses the need to increase diversity in the healthcare profession. She gives us tangible advice on how physicians can be there for patients in the best way possible and how to improve communication in the doctor-patient relationship. A bit on our guest:Dr. Clare, MD, MPH, CPE, FACOG is an Associate Professor of Obstetrics and Gynecology at New York Medical College, a board-certified obstetrician and gynecologist and attending physician at New York City Health + Hospitals/Metropolitan in Manhattan, and the Director of Resident Research in her department. She has received numerous teaching awards from the New York Medical College Department of Obstetrics and Gynecology for medical student teaching and received the Association of Professors of Gynecology and Obstetrics Excellence in Teaching award. Dr. Clare is an active member of the National Medical Association (NMA) and the American College of Obstetricians and Gynecologists (ACOG).

Season 1 Episode 5 features an interview with Carmen Mojica. We discuss her journey into birthwork and motherhood, the history and current practice of midwifery, and what it will take to achieve birth justice in the Bronx and in New York City. Carmen Mojica Bio:Carmen Mojica CPM, LM CLC is an Afro-Dominicana born and raised in the Bronx. She is a midwife, mother, writer and reproductive health activist. The focus of her work is on the empowerment of women and people of the African Diaspora, specifically discussing the Afro-Latina identity. She utilizes her experience as a midwife to raise awareness on maternal and infant health for women, highlighting the disparities in the healthcare system in the United States for women of color. She is a cofounder of Bronx Rebirth and Progress.References During the Episode:Donate to Bronx Rebirth and Progress via PayPal and through their registry on TargetPregnancy and Postpartum in the time of COVID-19: NYC Resources[Book] Birthing Justice: Black Women, Pregnancy and Childbirth edited by Julia Oparah and Alicia Bonaparte[Book] Killing the Black Body by Dorothy Roberts[Book] Medical Apartheid by Harriet Washington[Book] Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First by Marsden WagnerTypes of midwives: Certified Midwife, Certified Nurse Midwife, Certified Professional Midwife, Certifying institutions: American College of Obstetricians and Gynecologists (ACOG), American College of Nurse-Midwives (ACNM)Robert Woods Johnson Foundation's County Health Rankings and Road MapsQuestions to Consider After the Episode:How can we make midwifery more accessible in our City, namely Certified Nurse Midwives? What are ways our City can provide resources for people to give birth outside of hospitals? This can be in people's homes and in birthing centers.How can we shift conversations that focus solely on maternal mortality to take a look at the broad scope of how maternal healthcare is not serving the needs of pregnant and birthing people overall?Created and Hosted by Taja LindleyProduced by Colored Girls HustleMusic, Soundscape and Audio Engineering by Emma AlabasterSupport our work on Patreon or make a one-time payment via PayPalFor more information visit BirthJustice.nyc This podcast is made possible, in part, by the Narrative Power Stipend - a grant funded by Forward Together for members of Echoing Ida.Support the show (https://www.patreon.com/TajaLindley)