Vaginal Birth After C-Section? 4 Factors to Consider
Pregnant women who have had a previous cesarean section may now be given the option of having a vaginal birth if doctors get on board with guidelines issued yesterday by the American College of Obstetricians and Gynecologists. The organization says that the procedure, known as vaginal birth after cesarean, or VBAC, is safe and appropriate for most women who have had one prior C-section (with a horizontal incision below the bikini line) and even for some who have had two previous incisions or those carrying twins, U.S. News's Deborah Kotz writes. "The potential risks and benefits" of both VBAC and a repeat C-section should be discussed, and the "ultimate decision...should be made by the patient in consultation with her health care provider," read the guidelines, which were published in the August issue of Obstetrics and Gynecology.
The latest recommendations are similar to those issued in April by a National Institutes of Health expert panel and are driven by concern over a recent spike in C-sections in the U.S., with a rate that's jumped from 5 percent to more than 31 percent in the past 40 years. Although VBACs used to be performed routinely, they declined dramatically after a handful of studies found that women who tried vaginal labor following a C-section had higher rates of uterine rupture, which can be life threatening for both mother and baby. While still a concern, more recent research has demonstrated that the risk of rupture is very small, less than one percent, and the risk of serious complications even smaller. [Read more: Vaginal Birth After C-Section? 4 Factors to Consider.]
- Vaginal Birth After C-Section: Giving Women the Option
- Pregnant Women: Just Say 'No' to Early C-Section
Recuperating From Heart Surgery: An 8-Step Comeback Plan
Surgeon Marc Wallack was seven minutes into his run through Central Park in 2002 when he felt chest pain that he attributed to stress and indigestion. It happened again the next day, and again on a subsequent run. Finally, unable to ignore the telltale warning sign of heart problems, Wallack went to see a cardiologist and was told that all four of his coronary arteries were more than 95 percent blocked. He needed immediate open-heart surgery—a quadruple bypass—which he sailed through successfully from a physical standpoint, but psychologically left him feeling broken, U.S. News's Deborah Kotz writes. "I woke up from the surgery and wasn't the same person," recalls Wallack, who is vice chair of the department of surgery at New York Medical College. His fears overwhelmed him. "I worried I was never going to operate again, pay my mortgage, support my family; every time I ate I could visualize the plaque going back on my arteries."
And he fantasized about dying, a hallmark of depression, which afflicts one in five patients after heart surgery and one in three heart attack survivors. Wallack knew other colleagues in the same boat; one had to quit his medical practice as a result. And Wallack knew that his depression, if left untreated, would dramatically increase his likelihood of more heart complications. So he and his wife, Fox News anchor Jamie Colby, devised an 8-step comeback plan and detailed it in their recently released book Back to Life After a Heart Crisis. "It was about helping to bring him back amongst the living," says Colby. For Wallack, that meant training for another marathon, which he managed to complete two years after his surgery; for Colby, it meant getting her husband through doctor's appointments, navigating him through career changes, and convincing him to see a therapist. Anyone who has been through heart surgery, Colby says, can benefit from trying the following.
Step 1: Take one night at a time. Most bypass surgery patients experience sleep problems initially, according to surveys, with many finding that the problems become chronic. "I'd close my eyes at night and worry that my heart wasn't going to continue to beat," recalls Wallack. What helped? His wife's reassuring words. "One night we were lying in bed and I had my head on his chest listening to his heart beat," says Colby. "I said, Marc, your heart is so loud, it's beating stronger than I've ever heard it before; I think that helped him." Regular visits to a psychiatrist and prescription sleeping pills (which he now only takes occasionally) also brought better sleep for the first few months. [Read more: Recuperating from Heart Surgery: An 8-Step Comeback Plan.]
- Your Heart Health: 14 Numbers Everyone Should Know
- Depressed and Coping: Treating Depression When Medication Fails
Health Reform Takes Aim at Hospital Readmission Rates
One day last August, Tillie Hawthorne, 67, arrived at Scott and White Healthcare in Temple, Texas, struggling to breathe and swallow. A flare-up of her muscle-weakening myasthenia gravis would keep her bedridden for days, and not for the first time, as a $3,000 course of intravenous antibodies helped restore her strength. But this time, at checkout, Hawthorne got more than her discharge papers; she left with the name of her very own coach, U.S. News contributor Ann Carrns writes.
Chronically ill and on multiple medications, Hawthorne was a prime candidate for Scott and White's new "care transitions" initiative, aimed at saving older patients a quick return trip to the hospital. Hospital readmission rates are getting intense scrutiny now that health reformers have promised to slash spending and improve care by penalizing institutions that overdo it.
Nationally, about 20 percent of hospitalized Medicare patients are back within 30 days, according to a 2009 study published in the New England Journal of Medicine. The cost: some $17 billion a year. In half of the cases, patients don't see a doctor between stays, suggesting a dismal lack of follow-up. Sometimes, they develop an infection because the medical staff didn't follow infection-control procedures. A study of heart failure patients published in June revealed that as hospital stays shortened between 1993 and 2006, the readmission rate jumped by 3 percentage points. "There are a lot of factors that can play a part," says Michael Rapp, director of the quality measurement and health assessment group at the Centers for Medicare and Medicaid Services, or CMS. "How completely was the patient evaluated in the hospital? Was the patient prepared for discharge?" [Read more: Health Reform Takes Aim at Hospital Readmission Rates.]
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