Tuesday, August 23, 2011

Preconception Health Interviews

Dr. Michael Lu, associate professor of obstetrics & gynecology and public health at UCLA,was interviewed over several parts on Science and Sensibility: Preconception and Women’s Healthcare: An Interview with Dr. Michael Lu 

I've included some great segments of the posts below. If you are a maternal and child health scholar, I encourage you to read the posts in-depth!

Part One: Preconception Care
Allen Rosenfield probably 30 years ago asked the question, “Where is the ‘M’ in MCH?” Where’s the “mother” in maternal and child health programs–because much of MCH has focused on children’s health and much less on maternal health.  I think the question we’re asking today is where’s the ‘W’ in MCH—where’s the woman in maternal and children’s health?  If we really want to improve maternal and child health in this country, we really have to start by improving women’s health.
I think it’s pretty much in alignment with what you’re saying; it’s not just about childbirth.  If the natural childbirth movement is all about natural childbirth, it doesn’t have the kind of impact that it could have. The focus should really be on promoting women’s health over their life course continuum and how we would be a better society for doing that.
Part Two: Working Smarter - Prenatal Care 2.0
All of the things we’ve been learning about the fetal origins of health –the importance of nutrition, mental health, environmental exposures in developmental and fetal programming, how much of that counseling do you think is actually going on in OB’s office?  And remember most of these OB’s didn’t sign up to be a health educator, to be a nutritional counselor, to be a teratogen information specialist, to do all the things that we know are important in terms of really promoting maternal and infant health.
The public health response over the last couple of decades has been if the OB’s aren’t doing all those things, then let’s create these “wrap-around services”– some kind of the enhanced prenatal care model: I call it the prenatal care 2.0 system.

Part Three: Prenatal Preparedness and Childbirth Educators

Given the current constraints I think childbirth educators could try to really expand the content of their education into, not only the immediate postpartum, but also the inter-conception.  And if you think about it, for women that are going to have more babies, the postpartum care is really preconception [care] for the next.  I think it would be a good first step.  I think most health educators actually do a pretty good job in terms of talking about breast feeding.  I don’t think they do as good a job talking about family planning, at least I think its variable.  I don’t think they talk very much about postpartum weight retention, nutrition, physical activities.  So we know that both gestational weight gain as well as postpartum weight retention are main drivers of the obesity epidemic that’s going on in this country.  What are childbirth educators doing about that. 
We’re talking about baby-friendly hospitals.  What would a father-friendly hospital look like?  What would father-friendly prenatal care look like?   I think dads are changing.  There are a lot of dads that really want to be involved but aren’t very well supported to get involved.  What’s the role of the childbirth educator in terms of involving dads?  There are things both during childbirth as well as after the baby’s born in which dads can play a very important role.  But I think like most obstetricians, most childbirth education really doesn’t focus that much on dad’s role in all of this.

Part Four: Sacred Trust
It’s a system flaw.  It’s not just about asking the individual OB to work harder, but it’s asking the system to work smarter.  So this is where the teamwork approach actually comes into play.  I think doulas are much better trained in terms of providing support during labor than obstetricians are.  Most of us didn’t sign up to stay by the bed side.  We signed up for obstetrics.  You know that obstetrics is actually a surgical specialty? OBs are trained to screen for disease, to treat complications, etc.  They’re not really trained to provide nurture and support.

Part Five: Racial Gaps, Future Research
What’s the impact of the Medicaid Reform going to be on infant mortality and on the racial gap of infant and maternal mortality?  There’s very little discussion about that.  I’m all for Health Care Reform, but it’s really just health insurance reform.   Instead, let’s think through what are the components of care that really optimize women’s health, and make sure there is equal access to those components for African American women.

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