tag:blogger.com,1999:blog-6329595.post3044912814317327432..comments2024-03-28T18:26:13.768-05:00Comments on Althouse: "I was sitting there, reading this leaflet about planning a funeral and thinking, this is my baby, he isn't even born yet, let alone dead."Ann Althousehttp://www.blogger.com/profile/01630636239933008807noreply@blogger.comBlogger131125tag:blogger.com,1999:blog-6329595.post-14689468722314472912009-09-10T12:36:58.369-05:002009-09-10T12:36:58.369-05:00With 5 previous miscarriages (especially a miscarr...With 5 previous miscarriages (especially a miscarriage outside the first trimester), she should have been treated as high risk from the get-go with frequent ultrasounds, blood tests, monitoring, possibly bed rest, etc (depending on the reason for her previous miscarriages). She should have been seeing a perinatalogist and a maternal-fetal medicine specialist. If this is something as simple as an incompetent cervix, then shame on NHS. If it's a more difficult chromosomal, immune, or clotting problem, we know about these things and have treatments to manage them.<br /><br />Betamethasone (IM steroid injection) is normally administered to high-risk mothers (mothers at increased risk for delivering prematurely, especially those who have done so previously). Since 1994, NIH has recommended their use. They are normally used after 24 weeks and are given in shots at least 24 hours apart. <br /><br />So, if they could have her on bed rest and hold off labor for a few weeks (in the hospital, if necessary) and then administer steroids for lung maturation, this story might have had a happier ending. <br /><br />For her next pregnancy, I suggest she get a transfer at her job to the US and have her baby here. None of this is that uncommon here. A quick trip around the infertility blogosphere and you will see this and much more in terms of intervention for successful outcome. Even Canada, with their nationalized health care, routinely sends moms of higher order multiples (triplets) to the US for their bed rest so their babies can be cared for in our NICUs after they're born.SarcastiCarriehttps://www.blogger.com/profile/16256830838017211858noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-78864850861189329762009-09-10T11:18:53.040-05:002009-09-10T11:18:53.040-05:00Does anyone really not KNOW that they aren't s...<b>Does anyone really not KNOW that they aren't supposed to smoke or drink or consume caffeine or drugs while pregnant?</b><br /><br />People do all kinds of things they know they aren't supposed to do. To pick just one example, there would be no STDs if everyone practiced safe sex outside monogamy.<br /><br />I don't know how to fix that. Pretending the problems are due to our health care system and lack of universal health insurance will definitely not fix it.Laura(southernxyl)https://www.blogger.com/profile/02880277733341078157noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-54896396548820700832009-09-10T00:17:08.908-05:002009-09-10T00:17:08.908-05:00@kathy
Fair enough.
@exhelodrvr1
Good old Occam&...@kathy<br />Fair enough.<br /><br />@exhelodrvr1 <br />Good old Occam's Razor huh? Guess I can't argue with that too much...<br /><br />I would still say to both of you that we don't know anything about the "problems with her pregnancy" that preceded her early labor, although, I suppose that's a smaller question and I'm just parsing now. The big question is one of choice and again, I do think she should've had one. It's just unclear to me what that would've been.<br /><br />@kathy<br />I was just listening to a good <a href="http://bloggingheads.tv/diavlogs/22366?in=37:23&out=59:28" rel="nofollow">diavlog over at bloggingheads</a> w/Glen lowry & Virginia Postrel where Virginia advocated an idea like that (passing on costs). I think it does have some merit.Stephen Parkshttps://www.blogger.com/profile/05241723043926476634noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-81824901276627352022009-09-09T22:55:45.531-05:002009-09-09T22:55:45.531-05:00No, Stephen, we don't have all the facts. So I...No, Stephen, we don't have all the facts. So I'm using the information that is provided, combined with personal experience, and common sense, and going with what is the most likely explanation.exhelodrvr1https://www.blogger.com/profile/15874052265934108903noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-80416107516055443112009-09-09T22:30:00.074-05:002009-09-09T22:30:00.074-05:00Stephen,
I went into labor at 30 weeks with my la...Stephen,<br /><br />I went into labor at 30 weeks with my last pregnancy. They used drugs to stop the labor, and I took medication for the next 4 or 5 weeks (can't remember now exactly how long) and stayed on bedrest to keep labor at bay. Yes, they could have helped this woman. I have friends who have gone into labor much earlier than I did and had their labor stopped long enough for the baby to mature a bit more.<br /><br />I do favor passing the cost on to the patient so that we, the patients, have to decide if the end result is worth the cost. Let us decide if we want to mortgage the house and have pancake breakfasts (fundraisers) to try to pay for it.<br /><br />When government pays for it, why should they delay your labor so that you can have a premature infant who will require a lot of extra care and make their data look bad? They'd rather let the infant die and mark it off as a miscarriage, which then doesn't count against them at all.Kathyhttps://www.blogger.com/profile/15898153617546385281noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-2246707699908630052009-09-09T21:59:31.612-05:002009-09-09T21:59:31.612-05:00I never quite understood the insistence on the imp...I never quite understood the insistence on the importance of pre-natal care, at least in the very early months because I was never told to do anything different. <br /><br />No caffine, no smoking, no alcohol. Take vitamins, don't diet, don't get too fat. <br /><br />This isn't difficult.<br /><br />I suppose that later on problems might be caught early and both my sister and my sister in law ended up on bed rest but that wasn't a result of something they weren't aware of... they *felt* like something was wrong. And gestational diabetes might be caught early with tests and stuff.<br /><br />Maybe more women and young girls would go to the doctor if what they needed to go for was made more explicit.<br /><br />If the problem is smoking, drugs, or alcohol it might be that women who give up those things *also* get prenatal care... an incidental correlation and not one that proves that one thing leads to the other.<br /><br />Does anyone really not KNOW that they aren't supposed to smoke or drink or consume caffeine or drugs while pregnant?Synovahttps://www.blogger.com/profile/01311191981918160095noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-57546757076179226952009-09-09T21:42:36.951-05:002009-09-09T21:42:36.951-05:00The high infant mortality rate among African Ameri...The high infant mortality rate among African American women does not reflect on the health insurance situation because all pregnant women can qualify for Medicaid. No pregnant woman goes without health care.<br /><br />Automatic ball return.kentuckylizhttps://www.blogger.com/profile/08110491371985845560noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-46227186195343444572009-09-09T21:12:55.837-05:002009-09-09T21:12:55.837-05:00@exhelodrvr1
I didn't say anything about what ...@exhelodrvr1<br />I didn't say anything about what the guidelines are for, but yes they probably exist to allocate resources, among other things. And I'm sure there's pressure, but most likely both sides of the issue. <br /><br />But we don't know anything about what the doctors knew, or why they chose to follow the guidelines. We just can't tell anything for sure from this article without speculating. We simply don't have all the facts.Stephen Parkshttps://www.blogger.com/profile/05241723043926476634noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-55834089584122582232009-09-09T21:00:59.624-05:002009-09-09T21:00:59.624-05:00@laura
You're right it's probably more of ...@laura<br />You're right it's probably more of a risk to you, risk to the baby etc. kind of thing. <br /><br />Anyway I'm glad we could reach a degree of agreement here. It's always nice to talk to a reasonable commenter. Those are in short supply on the internet these days. <br /><br />You have a pleasant evening and I'll see you 'round the threads I suppose.Stephen Parkshttps://www.blogger.com/profile/05241723043926476634noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-34669955678180002422009-09-09T20:55:48.775-05:002009-09-09T20:55:48.775-05:00knox, you're misconstruing my words. Want to ...knox, you're misconstruing my words. <i>Want to die</i>? No. <i>Accept the inevitability of dying with grace when you're in your mid-90s?</i> Yes.MadisonManhttps://www.blogger.com/profile/01212179466758420208noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-63687749124906952992009-09-09T20:49:55.681-05:002009-09-09T20:49:55.681-05:00"There is room to believe the doctors were ac..."There is room to believe the doctors were acting in the best intrest of the health of the mother. "<br /><br />Which is more likely, that the guidelines were put in place for the health of the mother, or for the allocation of resources? And do you think that there is no pressure for the doctors to adhere to the "non-compulsory guidelines"?exhelodrvr1https://www.blogger.com/profile/15874052265934108903noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-90773699692294860202009-09-09T20:45:06.931-05:002009-09-09T20:45:06.931-05:00This comment has been removed by the author.exhelodrvr1https://www.blogger.com/profile/15874052265934108903noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-79682427918696541012009-09-09T20:18:24.443-05:002009-09-09T20:18:24.443-05:00When all the facts are in we can condemn them all ...<b>When all the facts are in we can condemn them all we want, but at present, the phrase reasonable doubt comes to mind.</b><br /><br />I'll give you that.<br /><br /><b>There is room to believe the doctors were acting in the best intrest of the health of the mother.</b><br /><br />As you say, it would be nice if they had given her a choice. If the choice was, "we can do X to try to save the baby but it will kill you," that's one thing. Doubt that would have been the case. It should probably have been, "we can do X to try to save the baby; the risks to the baby are blah blah, and the risks to you are blah blah. The alternative is Y. What do you want to do?"Laura(southernxyl)https://www.blogger.com/profile/02880277733341078157noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-62237317469035666142009-09-09T19:53:32.284-05:002009-09-09T19:53:32.284-05:00Like I said, she should've been given a choice...Like I said, she should've been given a choice. I'm not arguing that something should or shouldn't have been done. <br /><br />However, because of the omissions I was talking about, I don't think the article gives us a clear picture of the situation as to the condition of both the mother and child, or what the doctor's decision making process was. (Except to site the guidelines, which are not compulsory).<br /><br />All I'm saying is that we don't have enough information about what happened to make a moral judgement either way. There is room to believe the doctors were acting in the best intrest of the health of the mother. We don't have their side of the story at all. <br /><br />When all the facts are in we can condemn them all we want, but at present, the phrase reasonable doubt comes to mind.Stephen Parkshttps://www.blogger.com/profile/05241723043926476634noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-58364407382868819402009-09-09T19:03:29.177-05:002009-09-09T19:03:29.177-05:00@laura
I understand what you're saying, and yo...<b>@laura<br />I understand what you're saying, and you clearly know more about this than I, but I think we can both agree that 36 weeks is not 22 weeks.</b><br /><br />Duh.<br /><br /><b>You say the treatment you got postponed the labor for about a week. For Capewell's baby to reach the 36 week mark, that would presumably require almost 14 weeks of treatments.</b><br /><br />But Capewell's baby didn't have to go 14 more weeks, just one more and then he might have been far enough along to save. They couldn't even give him that chance.<br /><br /><b>Those things leave some room for shades of grey to creep in, no?</b><br /><br />When in doubt, do you err on the side of life, or death?Laura(southernxyl)https://www.blogger.com/profile/02880277733341078157noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-90050464950412343482009-09-09T18:56:09.657-05:002009-09-09T18:56:09.657-05:00@laura
I understand what you're saying, and yo...@laura<br />I understand what you're saying, and you clearly know more about this than I, but I think we can both agree that 36 weeks is not 22 weeks. <br /><br />You say the treatment you got postponed the labor for about a week. For Capewell's baby to reach the 36 week mark, that would presumably require almost 14 weeks of treatments.<br /><br />@exhelodrvr1 <br />I understand your feelings on this matter as well, but 28 weeks, while closer, is also not 22 weeks. <br /><br />I'm not accusing either you of being disingenuous, and as I said, she should've been given a choice, but still, I think the situation is more complicated than you make it out to be. For instance the article says she had problems during her pregnancy, and those are not elaborated on, as well as the miscarrages I mentioned before. It also said next to nothing about the condition of the child, except to say that he was premature. Those things leave some room for shades of grey to creep in, no?Stephen Parkshttps://www.blogger.com/profile/05241723043926476634noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-81269001953514121062009-09-09T18:50:52.038-05:002009-09-09T18:50:52.038-05:00Laura,
"Having decent test scores doesn't...Laura,<br />"Having decent test scores doesn't make you have a healthy pregnancy or a healthy baby."<br /><br />No, but education level tends to be symptomatic of a number of other issues.exhelodrvr1https://www.blogger.com/profile/15874052265934108903noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-85933111929688436732009-09-09T18:44:36.126-05:002009-09-09T18:44:36.126-05:00Stephen,
Attempting to stop labor IS pretty "...Stephen,<br />Attempting to stop labor IS pretty "cut and dried". There are a number of different medications that can be used; sometimes they work, and sometimes not. We were lucky; our 28-week labor was finally stopped in the delivery room with magnesium sulfate; my wife was on bed rest for the rest of the pregnancy, but our daughter is now 23 years old and a wonderful young woman. With the two subsequent pregnancies, terbutaline was used proactively, and they both went to near full-term. So yes, attempting to stop the early labor is worth it.exhelodrvr1https://www.blogger.com/profile/15874052265934108903noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-67514319196465737472009-09-09T18:31:33.256-05:002009-09-09T18:31:33.256-05:00@pogo
Fair enough on your first point. I agree. It...@pogo<br />Fair enough on your first point. I agree. It is pathetic. <br /><br />And I'll agree that competition is probably not the right word in it's normal sense. Perhaps I should've said "...not an argument against a public plan providing an alternative to the private insurance system."<br /><br />But my point wasn't really based on competition. When fighting the public option, opponents of reform are actually limiting choice, and citing stories like this one do not address what is being proposed. Look at this <a href="http://www.donkeylicious.com/2009/08/flowchart.html" rel="nofollow">flow chart.</a> It doesn't seem to me like a public plan would crush private insurance.<br /><br />The fact of the matter is that single payer is not on the table, and these stories about the British system have little to no bearing on the public option debate as it stands today.Stephen Parkshttps://www.blogger.com/profile/05241723043926476634noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-5582233573730669472009-09-09T18:24:08.220-05:002009-09-09T18:24:08.220-05:00The idea that you can launch a huge new healthcare...<i>The idea that you can launch a huge new healthcare benefit - free prescription drugs, free dialysis - and not pay for it but instead cut taxes and "Growth!!" will magically happen and create unlimited resources to fund anything, is over.<br /><br /></i>I'm not going to address the issue of increasing tax revenues by cutting taxes. I'd just like to point out that Medicare's End Stage Renal Disease Program -- for patients of any age with chronic kidney failure -- began in 1973. It is of course another patch in the quilt of government health care.former law studenthttps://www.blogger.com/profile/15196697206046544350noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-60481662714957118442009-09-09T18:20:26.280-05:002009-09-09T18:20:26.280-05:00On the French loss of thousands of seniors in a br...On the French loss of thousands of seniors in a brutal summer heat wave. A horror story, like the flesh-eating staff infections at dirty US and UK hospitals....but...:<br /><br />The French treated it as a medical misadventure. Took steps to understand what could have been done to avoid 90% of premature elderly death..mobilizing workers from other nonheathcare gov't jobs to provide fluids & electrolytes, ice compresses, water spray, installing emergency AC. Train medical staff better to recognize early signs of heat related trouble. Recognize which patients were bound to "check out soon" and the heat was just the final straw..<br /><br />The French note that even factoring the heat wave deaths in as medical misadventure, their rates of such deaths were well below the abysmal American rates that spawn 95,000 -105,000 medical misadventure deaths a year. Even in that year.Cedarfordhttps://www.blogger.com/profile/00602418702398818596noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-46782750057476512092009-09-09T18:00:02.677-05:002009-09-09T18:00:02.677-05:00So, how does that work? Do they have to give her m...<b>So, how does that work? Do they have to give her multiple shots? How many? How does that effect the health of the baby?</b><br /><br />Well, dying was a lead-pipe cinch to affect the health of the health of the baby in a fairly negative fashion, wouldn't you say?<br /><br /><b>How does that effect her health? She'd also had 5 miscarrages previously. Doesn't that complicate things?</b><br /><br />It probably means that she really, really wanted this baby and may not ever get so close again to having one.<br /><br />I went into labor at 36 weeks, 22 years ago. Because I carried small (didn't look in any way ready to give birth) and because they were worried about her lungs and could not treat hyaline membrane disease as they can now, I was given an injection of terbutaline followed by a prescription of terbutaline pills, to hold off having her a few more days. It gave her about a week more in the womb. She was fine when she was born, but I appreciate the doctors caring. This isn't some new exotic treatment.Laura(southernxyl)https://www.blogger.com/profile/02880277733341078157noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-30617581126665455342009-09-09T17:30:36.231-05:002009-09-09T17:30:36.231-05:00"Your elderly patient's irrational fear d...<i>"Your elderly patient's irrational fear does not...</i>"<br /><br />Who said it did? I'm merely telling something that happened to me this morning that speaks volumes for how much the Democrats have screwed the reform pooch if they've lost the ones <i>currently on a single payer program</i>. Kinda funny, really.<br /><br /><i>"...not an argument against a public plan competing with private insurance</i>". <br />Public plans do not "compete" in any normal sense of the word. Competition means creative destruction exists, but with state plans, failure is an impossibility, and losses are forever absorbed.<br /><br />That is, you're completely wrong about the very basis of your beliefs here.KCFleminghttps://www.blogger.com/profile/00124201866124646626noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-31282999557450460832009-09-09T16:55:32.610-05:002009-09-09T16:55:32.610-05:00@pogo
Your elderly patient's irrational fear ...@pogo<br /><br />Your elderly patient's irrational fear does not constitute proof that she will be "rationed out of her medical care" if a public option is made available. Restating people's fears does not validate them.<br /><br />@Salamandyr<br />Yes I did. Now, I'm no expert, But think about it this way: <br /><br />The mother "went into labour in October last year at 21 weeks and four days after suffering problems during her pregnancy." So if the doctors stop her labor with an injection there's still one week and three days left before getting to 23 weeks, and that's still premature. <br /><br />So, how does that work? Do they have to give her multiple shots? How many? How does that effect the health of the baby? How does that effect her health? She'd also had 5 miscarrages previously. Doesn't that complicate things? <br /><br />This situation is not as cut and dry as it might seem. If they had tried it your way it seems plausible that they might both have ended up dead. It does bother me that she didn't seem to have a choice in the matter, but that's only an argument against the British system, not an argument against a public plan competing with private insurance. <br /><br />It would seem to me more options would be afforded in that kind of system.Stephen Parkshttps://www.blogger.com/profile/05241723043926476634noreply@blogger.comtag:blogger.com,1999:blog-6329595.post-987570260559238492009-09-09T16:45:45.105-05:002009-09-09T16:45:45.105-05:00Here's the rule:
People allowed to die in a g...Here's the rule:<br /><br />People allowed to die in a government system were "going to die," "untreatable," or, as MM implies, maybe they wanted to die anyway.knoxhttps://www.blogger.com/profile/13231876226573540476noreply@blogger.com