I'm sorry I can't take care of your baby because you are Lesbians.

I'm sorry I can't take care of your baby because you are Lesbians.

I know, this sounds like a ridiculous title to a post but it actually happened in Detroit recently.  Krista and Jamie Contreras loving parents of 6 day old Bay were denied care by a Pediatrician solely due to the parents being Lesbians.  Please watch this short video before reading on.

http://www.cnn.com/videos/us/2015/04/04/bts-smerconish-gay-couple-says-doctor-refused-to-treat-baby.cnn

I can’t help but think that the recent laws that have been passed in Indiana and Arkansas open the door for similar situations in those states.  Moreover, imagine the impact if the laws spread to other conservative states in the US.  If you look at some history though, the Religious Freedom Restoration Act (RFRA) was first passed in 1993.  The act was brought into being after an American Indian man was fired from his job for failing a company drug test.  The drug in this case was peyote which culturally was acceptable for him to use but not in keeping with company policy.  The law that was brought into existence was therefore designed to protect people from the Government and industry interfering with religious practices which in this case they were as peyote was used as part of his religious practice.

That sounds like a very positive step in the right direction so why have Indiana and Arkansas come under so much heat over this current legislation?  The reason is that the law makes it possible for not only the individual but a company or business to sidestep the law if their religious beliefs are found to be in conflict with a person or request.  Don’t believe this could happen?  It already did.  The US Supreme Court recently ruled that the Hobby Lobby company could refuse to provide birth control to employees as a health benefit. Using birth control violates the company’s Christian religious beliefs.

The physician in this case lacked a solid RFRA in Michigan so she could do nothing more than apologize for her stance.  What concerns me greatly though is the hypothetical situation in which a member of the Lesbian Gay Bisexual Transgender (LGBT) community decides to have a child with a member of the same sex in a state with an RFRA.  What if for instance Michigan had such a law?  Would this Pediatrician have apologized or simply stood behind the government?  I am not sure what would have happened and in a state like Michigan which in my view is a little more progressive than some of the states in the “Bible Belt” I suspect this family would have found another Pediatrician to take care of them.  If this story had taken place in Arkansas, how difficult would it have been to find another Pediatrician on short notice while the infant was still hospitalized?  Might be a little harder.

On the first day of Medical School all students are asked to take the Hippocratic Oath. The Oath is not the same as was first spoken by Hippocrates but rather in one form or another is based on the version that came from the Declaration of Geneva and reads as follows:

At the time of being admitted as a member of the medical profession:

  • I solemnly pledge to consecrate my life to the service of humanity;
  • I will give to my teachers the respect and gratitude that is their due;
  • I will practice my profession with conscience and dignity;
  • The health of my patient will be my first consideration;
  • I will respect the secrets that are confided in me, even after the patient has died;
  • I will maintain by all the means in my power, the honour and the noble traditions of the medical profession;
  • My colleagues will be my sisters and brothers;
  • I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
  • I will maintain the utmost respect for human life;
  • I will not use my medical knowledge to violate human rights and civil liberties, even under threat;
  • I make these promises solemnly, freely and upon my honour.

Point number 4 states “The health of my patient will be my first consideration”.  Furthermore point #8 specifically spells out that sexual orientation should not matter.

In essence the newborn baby is in need of treatment and you are obligated to provide such treatment without consideration of whether the parents are members of the LGBT community.

Quite frankly I am embarrassed for this physician.  Do not misunderstand my intention here though.  Whether I support the LGBT community or not is irrelevant to this discussion.  What is relevant is that a member of the medical community who swore an oath to put the patient first has violated that oath.  It is my hope that these words will reach the eyes or ears of physicians who may have had similar thoughts and remind them of the oath that they once swore to uphold.  The United States is at a tipping point (quoting Malcolm Gladwell again) where physicians or medical corporations may opt to refuse treatment for infants who happen to be born to LGBT parents.  The infant was born into this world and needs someone to care for them from a medical standpoint.  Whether their parents choose to be intimate with members of the same sex should never enter the equation and I hope that this is the last report I hear of this behaviour by a member of the medical community.  Sadly as I often say hope is not a good plan and I fear that this indeed will not be the last instance we hear of.

The President of the United States no doubt wishes to leave a legacy as he prepares to leave office.  Obamacare, a nuclear deal with Iran and a two state solution for Israel and the Palestinians will be great accomplishments if they last.  Sadly if he doesn’t weigh in and do something soon the ability of companies, organizations and governments to discriminate against member of the LGBT community will leave a black mark on the Presidency that will be remembered long after the Republicans undo much of what he feels will be his “accomplishments”.

Please Mr. President. Do something.

If you are in need of a good cry read this! Mom sees baby for the first time!

If you are in need of a good cry read this! Mom sees baby for the first time!

The following video is seemingly out of a science fiction story but it is reality and has made a world of difference for a mother and her newborn!

http://www.cnn.com/videos/us/2015/01/23/dnt-legallly-blind-mom-sees-newborn.cbc/video/playlists/oh-baby/

The story is the same.  You and your partner find out that you will be expecting a newborn in the near future.  You dream of what they might look like and dream about meeting them for the first time.  In the case of the mother in this video that was not the case as she suffers from Macular Degeneration.  A disease that typically affects people beyond the childbearing years but in her case afflicted her at an age way too soon.

Medical breakthroughs happen frequently and are wonderful to behold but this story caught my eye due to the impact of being able to restore something that we as parents hold so dear to us.  To be able to view our beautiful baby with our own eyes.  Thanks to an Ottawa company featured in the video this is now a reality for this mother.

As I sit and write this post with my beautiful children close by I can’t help but think how grateful I am to be able to take in their beauty.  This is something I never questioned I would be able to do but for some no doubt this was a dream. The difference is that thanks to http://www.esighteyewear.com/ a Canadian company this is now a reality.

I am not an Ophthalmologist but I have no doubt that such eyewear will transform the quality of life beyond this case as Macular Degeneration is something that many unfortunately live with.  If you know someone with MD you may wish to pass this along to them as it may change their life.

Help stop the senseless theft of breast milk from babies!

Help stop the senseless theft of breast milk from babies!

I wrote this post almost a year ago and could not believe such practice was going on. Here we are this week and the following was published in Men’s Health magazine indicating breast milk consumption by body builders has not gone away quietly. 

For my own thought on this including updates to the original post please read below. 

It may seem like I am making a joke but sadly it is the real deal as you can see from the USA Today video released in the past couple weeks.  The benefits of drinking breast milk to add muscle mass has spread quickly among that community. That is not to say that the majority are using it but there definitely is a following. Taking a look at the website “Only The Breast reveals the sad truth. There are currently 6368 classifieds for women selling breast milk with 804 of these women specifically targeting men who wish to buy (Update:  As of February 23, 2016 the number of offerings has risen to 10135 with 1294 offering to men so the problem is getting worse not better!). Contrast this with only 113 women willing to donate their milk. This is only one site as women are also resorting to Craigslist and Kijiji to just name a couple of alternatives. There is money in selling breast milk and sadly those who most need it may not be getting it. 

The amount of evidence supporting the benefits of an exclusive breast milk diet for preterm infants in particular has exploded in the past few years. There is no question in my mind that breast milk should be distributed to babies whose mothers are unable to provide enough milk for them while in the hospital. The proven reductions In necrotizing enterocolitis; a major cause of morbidity and death in the NICU are reason enough to exclude formula from a low birth weight preterm infant. See Formula versus donor breast milk for feeding preterm or low birth weight infants. 

If each case of necrotizing enterocolitis costs the US Health care system approximately $150000 imagine how much money could be saved when estimates from other studies such as the one by Sullivan et al target the reduction in NEC at about 70%.  In our own centre with approximately seven cases per year we would expect to see 5 less babies affected by this per year.

Aside from the above concerns about using breast milk in a population that has no likely benefit there is substantial risk to purchasing milk online.  As mentioned in the USA today video the FDA has spoken out against such practice due to high likelihood of contamination by bacteria secondary to non standardized methods of storage.  The article cited in the video can be found here.

Where is the harm?

The rate of contamination at 74% is frightening and in turn puzzling that people so focused on treating their bodies like a temple would consider ingesting it.  A search on Pubmed using a combination of different search criteria combined with a broader search using google failed to come up with one article showing any evidence supporting the consumption of breast milk by those wishing to build muscle mass.  Given the lack of evidence and the potential for harm this is a practice that needs to be eliminated as soon as possible.  The selling of excess supply from mothers to males who have no potential to benefit is tragic.  Each ounce that is sold in such a way is a waste of liquid gold and in essence is “stolen” away from the pool of milk that could be sent to a Human Milk Banking Association of North America approved Milk Bank.  All Milk Banks that follow their standards provide breast milk which has is safe to consume as opposed to those sourced from online sites.  Furthermore newer organizations such as the Mother’s Milk Coop pay for such milk as an alternative for mothers seeking income through the selling of their excess supply.  There are of course possible issues that arise from paying mothers for their milk but if they are looking to profit then perhaps the coop is the preferred option.  Selling milk and giving formula to their infants is not something I condone but if they are going to do it anyway the online route is the worse of the two options.

It is my hope that this post serves to educate even one mother that while their efforts to earn some income are understood there are better and safer ways to do so than an unregulated site such as  “Only The Breast” or others.  If you come across anyone who even hints at selling their milk through the means mentioned above, direct them to the closest breast milk bank or to the Coop mentioned above (recognizing that this too is not ideal)!

Finally, with the significant impact exclusive breast milk diets can have on outcomes for premature neonates hospitals worldwide would be wise to follow the lead of the University Hospital of Limerick who was just honoured for their initiative to ensure near 100% use of breast milk in their hospital through the use of donor milk.

Encourage your local hospitals to acquire donor breast milk if they don’t have a program to do so already.  If they already have a program work with your health region to expand it.

Money very well spent I say.

When is the optimal time to deliver a baby? Doctors in Denmark may have the answer!

download

The answer to this question seems to be quite elusive!  In 2009 the American Society of Obstetricians and Gynecologists published a recommendation to avoid elective delivery of infants < 39 weeks gestational age.

http://bit.ly/1JT84fm

Induction after 41 but before 42 weeks was advised, however due to the increased rates of complications after 42 weeks including mortality, asphyxia and complications of having a large infant to name a few.  This was also supported by the Cochrane Review on the same topic that can be found here: http://1.usa.gov/1E2aq8a

The decision to avoid elective delivery prior to 39 weeks was secondary to many published reports demonstrating that such deliveries had a higher chance of having babies born with complications, the most likely of which was respiratory distress leading to increased rates of NICU admissions.  That being said the incidence of asphyxia in the same group was lower than if one waited until a later gestational age.

Since that time, the recommendations have been to avoid these elective deliveries but a recent article has been receiving a lot of press that suggests we have it all wrong.  Outcomes may be better if one delivers prior to 37 weeks.

http://www.mirror.co.uk/news/world-news/inducing-labour-37-weeks-can-5181536

In this study from Denmark (published Feb 18th in the British Journal of Obstetrics and Gynecology) an enormous sample of patients (832935) over a ten year period were studied to determine outcomes for each pregnancy when one compared elective delivery prior to 37 weeks with c-sections or planned vaginal birth.  Despite an adoption in Denmark of the recommendations as outlined above from ACOG, the incidence of delivery prior to 37 weeks increased significantly.  What makes this article so sensational is that during this time the number of NICU admissions decreased in this cohort delivered prior to 37 weeks vs the expectant vaginal births. Concurrently the risk of cerebral palsy decreased, large babies decreased and also less nerve injuries after birth but strangely with an increase in the incidence of shoulder dystocia.  The original article abstract is found here:  http://1.usa.gov/1MXaE2U

Before I go on I feel the need to state the obvious. As a man I have no idea what it is like to be pregnant although I do know that as women approach and then pass the 37 week mark of their pregnancy, many are enamoured with the idea of giving birth ASAP.  I have no doubt there is an appeal to this research study explaining why so much press has been devoted to this paper.  It suggests an action that many women I believe would be more than happy to accept but is it the right way to go?

The short answer is I don’t know for sure.  The authors do a fairly good job of looking at variables that might have influenced outcomes such as maternal age, smoking rates, number of prior pregnancies etc but one has to question what variables may have influenced outcomes that were not measured?  Looking at a massive number of patients gives a robustness to the results but it also means that you have collected a sample over a large period of time.  Over a ten year period, practices can change, new technologies become implemented and new NICUs may be built all of which may account for an improvement in outcome over time.  This is not to say that the authors are not on to something here but it does give one reason to pause and question how one study can have such a different result than many others that have come before it.

I think that the authors in this case took the right path and acknowledge at the end of the article that more work must be done in essence to confirm the findings.  As a Neonatologist I am very interested to see if further work in the area will confirm these findings in a modern cohort.

If they do though will we have the capacity to deal with the increased number of admissions if it turns out they are wrong.  Only time will tell.