transparentimage

  

Under  Construction

Several new articles are currently being assembled and will soon be published under this tab, "Local Economy Development."

Please check back later.

 

Problem C-Section Births

by Francis P. Koster, Ed.D.

Cesarean section (c-section) is the most commonly performed surgery in the United States. The frequency of surgical birth has increased from 4% in 1965 to about 33% today, despite World Health Organization (WHO) recommendations that a 5% to 10% rate is optimal and that a rate greater than 15% does more harm than good.[1-3]

Reasons for this increase have been discussed profusely:

  • The surgical focus of obstetrics and the need to train residents
  • The low priority and few practical skills for supporting women's abilities to labor and give birth naturally
  • A rigid view of the duration of normal labor
  • A low threshold of definition for 'labor dystocia' (the justification for up to 60% of cesarean births[4])

Surgical birth is also a 'side effect' of interventions associated with actively managed labor: induction, artificial rupture of membranes, labor medications, and fetal monitoring.[5,6] Policies against vaginal birth after cesarean (VBAC) and, increasingly, unsupported 'supply-side' justifications such as "baby seems large," also drive the trend toward cesareans. A recent report by the Lamaze Institute associates surgical birth with obstetricians' personalities -- specifically their anxiety levels.[7-9]

The risks during birth by surgery have also come under discussion. Maternal risks include a higher overall death rate, rehospitalization for wound complications and infection, placenta accreta and percreta (both with 7% mortality rate), placenta previa, uterine rupture with subsequent pregnancy, and preterm birth, with its own set of risks and complications for the newborn.[10-15]

  1. The Childbirth Connection. Why does the national U.S. cesarean section rate keep going up? Available at: http://www.childbirthconnection.org/article.asp?ck=10456 Accessed June 18, 2009
  2. The Childbirth Connection. Relentless rise in cesarean section rate. Available at: http://www.childbirthconnection.org/article.asp?ck=10554 Accessed June 18, 2009
  3. Hamilton BE, Martin JA, Ventura SJ; Division of Vital Statistics. Births: preliminary data for 2006 Natl Vital Stat Rep. 2007;56:1-18. Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_07.pdf Accessed June 18, 2009
  4. Joy S, Scott PL, Lyon D. eMedicine Obstetrics and Gynecology. Abnormal labor. Available at: http://emedicine.medscape.com/article/273053-overview Accessed June 18, 2009
  5. Buckley SJ. The hidden risk of epidurals. Mothering Magazine. Available at: http://www.mothering.com/hidden-risk-epidurals Accessed June 18, 2009
  6. Childbirth Connection. Cesarean section, Available at: http://www.childbirthconnection.org/article.asp?ck=10167#factors Accessed June 18, 2009
  7. Sakala C, Corry MP. Evidence-based maternity care: what it is and what it can achieve. Available at: http://www.milbank.org/reports/0809MaternityCare/0809MaternityCare.pdf Accessed June 18, 2009
  8. Romano AM. Woman's risk of having cesarean surgery may depend on her obstetrician's personality. Lamaze Research Summaries. 2008;5 Available at: http://www.lamaze.org/LinkClick.aspx?fileticket=2drWyVEO4IA%3d&tabid=120&mid=566 Accessed June 18, 2009
  9. Burns LR, Geller SF, Wholey DR, The effect of physician factors on the cesarean section decision. Med Care. 1995 ;33:365-382. Abstract
  10. Cesarean delivery associated with increased risk of maternal death from blood clots, infection, anesthesia. ACOG Office of Communications, News Release, August 31, 2006. Available at: http://daraluznetwork.com/CesareanTriplesMaternalDeath.pdf Accessed June 18, 2009
  11. Rosen T. Placenta accreta and cesarean scar pregnancy: overlooked costs of the rising cesarean section rate. Clin Perinatol. 2008;35:519-529. Abstract
  12. Rosen T. Placenta accreta and cesarean scar pregnancy: overlooked costs of the rising cesarean section rate. Clin Perinatol. 2008;35:519-529
  13. Cunningham FG, et al. Placenta accreta, increta, and percreta. In: Williams Obstetrics. 19th Ed. New York: McGraw-Hill; 1993:620-622
  14. Bettegowda VR, Dias T, Davidoff MJ, Damus K, Callaghan WM, Petrini JR. The relationship between cesarean delivery and gestational age among US singleton births. Clin Perinatol. 2008;35:309-323 1 Abstract
  15. Declerq G, Norsigian J. Mothers aren't behind a vogue for caesareans. Boston Globe, April 3, 2006. Available at:
    http://www.boston.com/news/globe/editorial_opinion/oped/articles/2006/04/03/mothers_arent_behind_a_vogue_
    for_caesareans/?p1=email_to_a_friend Accessed June 18, 2009
  16. Declerq G, Norsigian J. Mothers aren't behind a vogue for caesareans. Boston Globe, April 3, 2006. Available at: http://www.boston.com/news/globe/editorial_opinion/oped/articles/2006/04/03/mothers_arent_behind_a_vogue_
    for_caesareans/?p1=email_to_a_friend Accessed June 18, 2009

Opportunity to decrease healthcare costs

and

improve health quality by reduction of Cesarean Section Deliveries

Cesarean section (c-section) is the most commonly performed surgery in the United States. The frequency of surgical birth has increased from 4% in 1965 to about 33% today, despite World Health Organization (WHO) recommendations that a 5% to 10% rate is optimal and that a rate greater than 15% does more harm than good.[1-3]

Reasons for this increase have been discussed profusely:

  • The surgical focus of obstetrics and the need to train residents;
  • The low priority and few practical skills for supporting women's abilities to labor and give birth naturally;
  • A rigid view of the duration of normal labor; and
  • A low threshold of definition for 'labor dystocia' (the justification for up to 60% of cesarean births[4]).

Surgical birth is also a 'side effect' of interventions associated with actively managed labor: induction, artificial rupture of membranes, labor medications, and fetal monitoring.[5,6] Policies against vaginal birth after cesarean (VBAC) and, increasingly, unsupported 'supply-side' justifications such as "baby seems large," also drive the trend toward cesareans. A recent report by the Lamaze Institute associates surgical birth with obstetricians' personalities -- specifically their anxiety levels.[7-9]

The risks for birth by surgery have also come under discussion. Maternal risks include a higher overall death rate, rehospitalization for wound complications and infection, placenta accreta and percreta (both with 7% mortality rate), placenta previa, uterine rupture with subsequent pregnancy, and preterm birth, with its own set of risks and complications for the newborn.[10-15]

1. The Childbirth Connection. Why does the national U.S. cesarean section rate keep going up? Available at: http://www.childbirthconnection.org/article.asp?ck=10456 Accessed June 18, 2009.

2. The Childbirth Connection. Relentless rise in cesarean section rate. Available at: http://www.childbirthconnection.org/article.asp?ck=10554 Accessed June 18, 2009.

3. Hamilton BE, Martin JA, Ventura SJ; Division of Vital Statistics. Births: preliminary data for 2006. Natl Vital Stat Rep. 2007;56:1-18. Available at: http://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_07.pdf Accessed June 18, 2009.

4. Joy S, Scott PL, Lyon D. eMedicine Obstetrics and Gynecology. Abnormal labor. Available at: http://emedicine.medscape.com/article/273053-overview Accessed June 18, 2009.

5. Buckley SJ. The hidden risk of epidurals. Mothering Magazine. Available at: http://www.mothering.com/hidden-risk-epidurals Accessed June 18, 2009.

6. Childbirth Connection. Cesarean section, Available at: http://www.childbirthconnection.org/article.asp?ck=10167#factors Accessed June 18, 2009.

7. Sakala C, Corry MP. Evidence-based maternity care: what it is and what it can achieve. Available at: http://www.milbank.org/reports/0809MaternityCare/0809MaternityCare.pdf Accessed June 18, 2009.

8. Romano AM. Woman's risk of having cesarean surgery may depend on her obstetrician's personality. Lamaze Research Summaries. 2008;5 Available at: http://www.lamaze.org/LinkClick.aspx?fileticket=2drWyVEO4IA%3d&tabid=120&mid=566 Accessed June 18, 2009.

9. Burns LR, Geller SF, Wholey DR, The effect of physician factors on the cesarean section decision. Med Care. 1995 ;33:365-382. Abstract

10. Cesarean delivery associated with increased risk of maternal death from blood clots, infection, anesthesia. ACOG Office of Communications, News Release, August 31, 2006. Available at: http://daraluznetwork.com/CesareanTriplesMaternalDeath.pdf Accessed June 18, 2009.

11. Rosen T. Placenta accreta and cesarean scar pregnancy: overlooked costs of the rising cesarean section rate. Clin Perinatol. 2008;35:519-529. Abstract

12. Rosen T. Placenta accreta and cesarean scar pregnancy: overlooked costs of the rising cesarean section rate. Clin Perinatol. 2008;35:519-529.

13. Cunningham FG, et al. Placenta accreta, increta, and percreta. In: Williams Obstetrics. 19th Ed. New York: McGraw-Hill; 1993:620-622.

14. Bettegowda VR, Dias T, Davidoff MJ, Damus K, Callaghan WM, Petrini JR. The relationship between cesarean delivery and gestational age among US singleton births. Clin Perinatol. 2008;35:309-323 1 Abstract

15. Declerq G, Norsigian J. Mothers aren't behind a vogue for caesareans. Boston Globe, April 3, 2006. Available at:
http://www.boston.com/news/globe/editorial_opinion/oped/articles/2006/04/03/mothers_arent_behind_a_vogue_
for_caesareans/?p1=email_to_a_friend Accessed June 18, 2009.

16. Declerq G, Norsigian J. Mothers aren't behind a vogue for caesareans. Boston Globe, April 3, 2006. Available at: http://www.boston.com/news/globe/editorial_opinion/oped/articles/2006/04/03/mothers_arent_behind_a_vogue_
for_caesareans/?p1=email_to_a_friend Accessed June 18, 2009.

Problem Statement Here

Content here

Obesity

by Francis P. Koster, Ed.D.

As of 2006 data, one hundred and nineteen million (64.5 percent) of American adults are overweight or obese. For Hispanics and African Americans, the rate is even higher.

A person has traditionally been considered to be obese if they are more than 20 percent over their ideal weight.

Obesity has been more precisely defined by the National Institutes of Health (the NIH) as a Body Mass Index (BMI) of 30 and above. (A BMI of 30 is about 30 pounds heavier than they should be.) A BMI between 24.9 and 30 is considered to be “overweight”, and carries significant health risks as well, but not as bad as those of people who are obese.

When the statistics for 2008 are released late in 2009, a projected 73 percent of American adults are anticipated to be overweight or obese. (2)

Obese people have annual medical costs that are 37% higher than their healthy weight counterparts, (3) representing an additional $732 per obese person per year. The direct medical costs of obesity in the U.S. have been estimated to be greater than $92 Billion a year, or roughly equal to 10% of the annual federal deficit. Nearly one half of overweight and obesity driven medical spending is the responsibility of the public sector (Medicaid and Medicare). (4)

One recent study suggests 86 percent of Americans could be Overweight or Obese by 2030 with related health care spending projected to be as much as $956.9 billion(5).

When the word “Mal-nutrition” is used, people often think it means underfed. In fact, it means inappropriately fed, because obese people are also mal-nourished. Recent research suggests that just as undernourishment in pregnant mothers negatively impacts both their children and grandchildren's health, so does obesity. (6) Thus, the current epidemic of Obesity is laying down the foundation of degenerating health for at least two generations to follow.

Additionally, related research indicates that in time of epidemic, obese infected individuals provide a much more fertile incubator for more virulent forms of the disease to grow.  Thus, the presence of a large and growing obese population is a threat to the overall public health as a larger percentage of the infected population is capable of causing increasingly dangerous disease forms. (7)

Obesity has several causes, including (but not limited to) caloric intake and lack of physical exercise. In the category of caloric intake, the vast majority of excess calories are consumed in drinks, not food (8) which opens up opportunities for intervention that could increase national health, decrease health care expenditures, and extend life expectancy by focusing on a single behaviour.

 

1) http://www.medterms.com/script/main/art.asp?articlekey=4607

2) F as in Fat released by Trust for America’s Health 2005

3) Finkelstein EA., Fiebelkorn IC, Wang G. National medical spending attributable to overweight and obesity: how much, and who's paying? Health.Aff. 2003, Suppl Web Exclusives, W3-219-26.

4) ibid

5) Youfa Wang, May A. Beydoun, Lan Liang, Benjamin Caballero and Shiriki K. Kumanyika. Will All Americans Become Overweight or Obese? Estimating the Progression and Cost of the US Obesity Epidemic. Obesity, Advance online publication, July 24, 2008 DOI:doi:10.1038/oby.2008.351

6) http://www.sciencedaily.com/releases/2006/11/061113180343.htm

7)  http://www.journals.uchicago.edu/doi/abs/10.1086/520026

8) Barry M. Popkin Department of Nutrition, School of Public Health and Medicine. Energy intake positively associated with non-diet soft drinks in children . www.cpc.unc.edu/projects/beverage/publications/us-diet-and-the-role-of-beverage.ppt -

bookfooter

bookfooter

bookfooter