OB Composed Phone Application Brings the Labor Room to The Doctor, Speeds Response Time
Dr. John Stallworth, an OB-GYN with Sky Ridge Medical Center, can stop and check his newest cell-phone application, AirStrip OB, anywhere to learn the status of his laboring patients. Vital signs in virtual time appear at the push of a button.
Ask the people who use his breakthrough technology, and they might say the maker of AirStrip OB missed the mark when naming his invention. Rest Assured. Peace of Mind. OB Composed. That’s what the mobile phone application is all about. “Pretty much, wherever I am, I can be sure that everything is going well,” says Dr. John Stallworth, an OB-GYN with Sky Ridge Medical Center. For an obstetrician who is on call 24/7, that’s some valuable peace of mind. AirStrip OB, an application approved by the Food and Drug Administration and recently adopted by HealthONE hospitals, securely transmits critical patient data in real time from the hospital nurses and monitoring systems to doctors’ cell phones. Vital information – such as fetal heart-rate, Mom’s blood pressure, strength of contractions and amount of dilation – is at the physicians’ fingertips whether they’re in a meeting, at a hospital across town or with their family at home.
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“With a patient in early labor, I’ve been able to look and see that she has arrived, and I can get a very quick impression of how good the baby’s heart rate pattern looks.”
“We had one case where a baby’s heart rate suddenly dropped, and the doctor was calling in at the same time we were calling out, saying: ‘Open the OR (operating room). I’m on my way.’ Since babies don’t follow nine-to-five hours when making their debuts, patients are often laboring during physicians’ downtime. Dr. Stallworth appreciates being able to monitor from home. “With a patient in early labor, I’ve been able to look and see that she has arrived, and I can get a very quick impression of how good the baby’s heart rate pattern looks,” he says. “We’re actually looking at the fetal heart rate strip.” Doctors aren’t the only ones who appreciate the technology. Labor and delivery nurses play a major role in monitoring moms and babies. With AirStrip OB, if they have a concern, they can call and have the doctor assess a situation almost instantly. “I have some nurses who are saying: I can’t wait until Dr. So-and-So gets AirStrip,” says Terri Bethel, a nurse with the Medical Center of Aurora, where an increasing number of doctors are signing up for the technology. The application was invented by an obstetrician largely to speed communication between doctors and nurses for better patient outcomes. “Before, if we had a problem we would have to call the doctors, and they would have to come in, and it would take time, time we didn’t always have,” Bethel says. Sometimes nurses are headed for the phone and find they don’t even need to call. “We had one case where a baby’s heart rate suddenly dropped, and the doctor was calling in at the same time we were calling out, saying: ‘Open the OR (operating room). I’m on my way.’ We had that baby out within seven minutes of the deceleration, and that baby is doing really well,” Bethel says, adding that in an emergency, there is always a doctor on call in the hospital. “But it’s nice to have their own physician in there.” Bethel, who worked nights for a long time, says the technology is particularly great for her off-hour colleagues. “During the days, there are lots of doctors around, but at night, a lot of them are at home sleeping. I think it really helps out the night nurses, who can just call and say, ‘Look at your phone.’” In an age in which doctors are highly challenged and increasingly mobile, AirStrip OB helps fill a gap, Bethel says. “They have more going on – we have a sicker patient population today (obesity, diabetes, heart disease). And doctors are stretched between different hospitals and offices.” Patients also like the security of AirStrip OB, Bethel says. “I was in a room one time, and a physician called in to me and told me the patient’s Pitocin level needed to be increased,” Bethel says. “The patient said, ‘How did she know that?’ And a lot of our patients have the idea that their doctor is going to be there the entire time. They come in and say, ‘Where’s my doctor?’ By knowing that their obstetricians are seeing all of this information on their phones, I think they feel safer.” AirStrip OB is another cog in the ever-advancing wheel of medicine. “Twenty years ago, we didn’t have all of this technology,” Dr. Stallworth says. “We just had to be in the hospital and literally on the labor deck,” he says, predicting the invention will become standard OB equipment. “It’s just really convenient – and it’s definitely reassuring.”
AirStrip Technologies, maker of AirStrip OB, is researching and developing other applications to improve communication within the health care field. For instance, the company has its sights set on creating an in-home patient monitoring system for rural areas. Two other applications already FDA-approved: • AirStrip Cardiology • AirStrip Patient Monitoring (for all other hospital departments)
AirStrip OB can be used on: • iPhone • iPad • BlackBerry
•Android • Windows Mobile smartphones
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Nature’s Medicine? Supporting Breast-Feeding Can Save Lives, Ease Health-Care Burden In the Neonatal Intensive Care Unit at Sky Ridge Medical Center, the tiny bottles are carefully labeled, strictly monitored and stored under lock and key. Nurses reach for them probably more than they reach for anything else in their job of caring for the hospital’s littlest patients, born ill or too soon. It’s not life-saving medicine these nurses routinely grab. But it’s close. The bottles that line the cooler shelves are filled with mothers’ milk, a substance that can make such a difference in his patients’ lives that NICU Director Dr. Joe Toney has joined efforts in spreading the message: Moms who can breast-feed should, and everyone from doctors and dads to buddies and bosses must offer support. “The benefits have been shown: It reduces the risk of SIDS, obesity, diabetes,” Dr. Toney says. “In the NICU, we consider breast milk a medicine, not just nutrition,” he says, noting that breast milk provides growth factors and protein not available in formula and helps prevent infection and disease, such as necrotizing enterocolitis, a sometimes-deadly intestinal disorder that most often strikes preemies. Dr. Toney is proud of his patients’ mothers. While initially many of them cannot breast-feed naturally, sometimes for weeks, and must pump their milk, 80 percent of them are providing breastmilk at the time of their babies’ discharge. But statistics tell him most of them will stop nursing too soon. Four out of five American women now initiate breast-feeding in newborns, according to data recently released by the Centers for Disease Control and Prevention and lauded for reaching the Healthy People 2010
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national objective. But that 75 percent rate drops after discharge, taking a dramatic plunge at six months, when only 13 percent of moms are still breast-feeding exclusively. The decline, says Rose Medical Center lactation consultant Carol Anderson, is something we, as a society, must address. “It takes a village,” Anderson says. “It’s not just mom. It’s family. It’s society.” For instance, work tops the list of reasons women stop breast-feeding. “Breast-feeding and working is a difficult thing to do,” says Anderson, adding that support is often missing in the workplace and even at home.
Dr. Joe Toney, director of the Neonatal Intensive Care Unit at Sky Ridge Medical Center, stands in front of one of his tiny patients. Because of the health benefits of breast milk for baby, Dr. Toney encourages everyone to support women who breast-feed.
“In the NICU, we consider breast milk a medicine, not just nutrition.” Moves like President Obama’s health carereform mandate requiring employers to provide time and a place for nursing employees and the First Lady’s inclusion of breast-feeding in her campaign to end childhood obesity make a difference. But education in the home is just as important, especially during those early weeks, Dr. Toney says. “Feeding 40 minutes every two hours is a very normal pattern.” And that means two hours from the start of one feeding to the start of the next. “So it doesn’t include the getting up and changing diapers before or the burping breaks and putting baby back down after. You start doing the math, and you see — that’s mostly all these moms are doing.” When they don’t understand that the demands are normal, or they don’t have the support, moms can sabotage their efforts, thinking baby’s not getting enough milk and turning to formula to supplement. Nursing less can decrease milk supply and launch a downward spiral. Anderson’s best advice: Seek help from professionals, understand that the heavy feeding demands don’t last forever, and know that, as with anything else, with some perseverance, baby and mom will become a synchronized team. “It’s like those people on Dancing with the Stars: They don’t start out very good, but then they make it look easy once they’ve had practice.”
Breastfed babies are less likely to have: Ear infections Diarrhea Pneumonia, wheezing, bronchiolitis Bacterial and viral infections, such as meningitis (American Academy of Pediatrics)
One-On-One with... Carol Anderson, Rose Medical Center Lactation Consultant Q: What are some of the chief reasons you find women really want to breastfeed? A: They know it is the healthiest
option for the baby. A lot of moms like the idea of the weight loss; it’s a really good way for them to burn calories. And, especially now, there’s the cost issue of formula, which can run $125 to $150 per month. Q: How does breast-feeding help prevent childhood obesity? A: There’s more than one rea-
son, but one main theory is that breast-feeding is babydirected — the baby eats and stops when full. Bottle Carol Anderson, a lactation consultant with feeding is more parent- Rose Medical Center, shares a laugh with directed, and parents might a patient. Anderson helps women with any be from the clean-plate breast-feeding issues that might arise. club, thinking the bottle should always be emptied. At the breast, you don’t have those food issues. Babies will not, by nature, overeat. So they learn to stop when their body says stop. Q: What are some of the other benefits for mom? A: Recent studies are finding a link between women who breast-fed and a
lower incidence of some of the older-onset diseases, such as heart disease and diabetes. There’s also lower incidence of ovarian cancer and certain types of breast cancer. Q: What are the main reasons women stop breast-feeding by six months? A: 1) Perceived or actual low-milk supply. They think: My baby’s not
getting enough. 2) Painful feeding, which is almost always related to incorrect positioning and can be remedied by a lactation consultant. 3) Not being prepared for the initial often-overwhelming frequency of feedings. 4) Lack of support.
Note: Swedish, Sky Ridge, Rose and The Medical Center of Aurora all offer lactation consulting.
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The HypnoBirthing Concept ®
Holding Focus, Releasing Fear Helps Women Allay Pain of Childbirth She recalls the important things: Her husband’s comforting support. Her nurses’ calm, hushed voices. A meditative tape she had loaded on her iPod. But the little things went unnoticed: A wall clock hidden from her view. A sign hanging on her door informing anyone who entered that a HypnoBirth was underway. For Catherine McEachern, 30, a field sales engineer from Westminster and Rose Medical Center’s first HypnoBirthing® student to give birth, that means one thing: mission accomplished. “It’s funny how little I remember from the outside world, outside my own body, because I was in such a meditative, relaxed state.” HypnoBirthing®, an old concept revitalized, is gaining recognition within the obstetrical world, where doctors find many women are looking for an added boost to pain reduction, whether they choose natural childbirth or not. Ask McEachern if the method helped her reach that pain-relieving goal, and the answer is emphatic: “Oh, my god, yes.”
During the course, which Rose began offering in November, McEachern and her husband learned self-hypnosis, visualization and special-breathing skills. The couple practiced every night during pregnancy, allowing her to enter that deeply relaxed, but still alert, mode in labor. The pair also learned one other important element to reducing childbirth pain: purging the fear.
“The first thing I tell my patients to do is take a childbirth education course. It’s been shown that women who attend childbirth classes have less pain in labor.”
Christi King, a HypnoBirthing® instructor, left, looks on at her first student parents to give birth at Rose Medical Center: D.C. and Catherine McEachern with baby Cadence.
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Anyone who’s ever been pregnant knows that the second other women realize you’re expecting, the worrisome stories begin to fly. Eventually the messages start to resonate, and women bring those fears into the birthing room, says Christi King, Rose-certified HypnoBirthing ® instructor. Once there, the fear breeds tension, and the tension breeds pain. Learning the process of birth and to work with — and trust — their own bodies is key to the HypnoBirthing ® concept, King says.
“I still can’t believe I could go into such a state of relaxation and self-hypnosis.” Education and support are critical for any woman preparing for birth, regardless of the method, says Dr. Kathleen Tate, an OB-GYN at The Medical Center of Aurora. “The first thing I tell my patients to do is take a childbirth education course. It’s been shown that women who attend childbirth classes have less pain in labor.” She also suggests finding good support, whether it’s from a partner or a doula. “I don’t know if I could have done it without him,” McEachern says of her husband, who was quietly staying abreast of everything, from doctor reports to the timing of contractions, so his wife remained focused. Clocks are covered from mom’s sight for that reason. And the sign on the door ensures that anyone entering the room complies with the HypnoBirthing® concept, which has a special vernacular, King says. “For instance, we don’t say contraction. Just the sound of that word makes you tense up,” said King, adding that “surge” is used instead. “I still can’t believe I could go into such a state of relaxation and selfhypnosis,” McEachern said. “And my baby girl was born into a wonderful, non-stressed environment.” For more information on childbirth classes: Rose: 303-320-7673 Swedish: 303-788-6251 Sky Ridge: 720-225-2229 Aurora: 303-873-0630
Medical Pain-Relief Options
About half of Dr. Kathleen Tate’s patients opt to try natural childbirth, and many are successful. But the OB-GYN from the Medical Center of Aurora advises women to enter labor with an open mind, so that the experience is not ruined should an unforeseen situation arise.
Spinal Anesthesia
Local Anesthesia
Epidural
Narcotics
Used for scheduled C-sections, anesthetic and pain killer are injected through the dura (membrane surrounding spinal cord). Pros: Best anesthesia. Does not transfer to baby. Cons: Time-limited. Used for blocking labor pain, a tube provides anesthetic and pain killer around the dura via an IV drip. Pros: Provides continuous relief. Can be patient-controlled for desired level of medicine. Does not transfer to baby. Cons: If given too early, can increase chance of C-section. Can affect recovery.
Used for relieving pain during the pushing phase or tear repair, anesthetic is injected directly into the affected region. Pros: Immediate, localized relief. Cons: Does not help with labor pain. Used for relieving anxiety and pain of contractions, drugs are given via injection or IV. Pros: Provides short-acting pain relief. Good for women in fast labor. Cons: Goes directly to baby. Only partial relief. Can affect cognition, interfering with performing natural pain-relieving methods.
Natural Pain-Relief Options
When it comes to pain-relief attempts, labor and delivery nurses have seen it all. Tiffany Hanson, nurse manager for Women’s Services at Sky Ridge Medical Center, offers a snapshot of the natural means she has seen used.
Acupressure
Gentle pressure, applied by a trained specialist on certain points of the hands, feet and ears believed to correspond to specific organs or structures of the body, can relieve pain.
Aromatherapy
Some essential plant oils (such as lavender) can alleviate anxiety, decrease tension and improve mood.
Audio
Music and noises of nature can provide a distraction and point of focus, reducing pain perception.
Hydrotherapy
By immersing themselves in a warm bath during the first stage of labor, women can reduce blood pressure and pain of contractions.
Massage
Providing gentle touch can reduce blood pressure, create a distraction, release muscle tension and decrease pain.
Guided Imagery
By visualizing a pleasant experience or place, women can relax and divert focus from pain. Support people can create visions with simple, soothing statements.
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Different Era Parenting Multiples Changes with the Times When twin boys were born into the Griffin family in the 1920s, the doctors sent the parents home to their northeastern Colorado farmhouse with their extra-tiny bundles of joy and wished them luck. Back then they needed it, as there were no Neonatal Intensive Care Units or life-saving technologies that allow so many multiples to survive today. “They actually kept the babies in the oven to keep them warm,” Missy Griffin says of her greatgrandparents. “They did survive, but back then, it was just sort of hoping for the best.” But that was then, the parent education director at Rose Medical Center and leader of the “Multiples Matter” class tells her students today. Eight decades later, advancements in medical care have boosted outcomes for multiples, and a dramatic surge in their numbers has made raising the once-rare children easier for parents, providing them resources beyond the wildest imaginations of Griffin’s great-grandparents. Griffin, 33, the mother of 8-year-old triplets, teaches parents of multiples about medical- and non-medical changes they can expect as they embark on their big adventure. Below, she offers a brief snapshot of some of the non-medical issues she addresses:
Information Age
Great-grandma would have fallen over in disbelief: Instantly talk to another mom with twins at the push of a button? Online chat groups, instant text messaging and Web pages rife with information are just some of the 24/7 support resources available to parents today. And a 1980s explosion in the number of parents of multiples has resulted in an upsurge of community support, which Griffin teaches parents to tap into right away.
Support in Numbers
A fascination with multiples has always existed, but Griffin’s great-uncles probably felt more alone than her kids do today. “There are four
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Missy Griffin and her husband, Jerry, push their triplets, (from left to right) Kaylie, Alex and Taylor, on the backyard swing-set at their Roxborough home.
sets of twins in my kids’ school,” Griffin says, explaining that having fellow multiples can help children socially and emotionally. “They aren’t all alone in their uniqueness.” And teachers are learning more about how to deal with social issues (i.e., should twins be kept in the same class or separated?), all topics in Griffin’s class.
Gadgets Galore
What Great-grandma did alone at bathing or walking time is hard to imagine, but today, moms can find help in gadgets. From better bottles to bouncy
“There are four sets of twins in my kids’ school. They aren’t all alone in their uniqueness.” chairs, from triple strollers to automatic swings, juggling multiple tots is easier today, thanks to years of inventive minds. Griffin teaches parents how to find deals and make this innovative equipment work for them.
Unwanted Attention
Because of today’s publicized attention to multiples born through in vitro fertilization, much of it negative (i.e., Octomom), some people feel warranted in invading parents’ privacy. “I’ve actually had someone approach me and ask me if I knew what birth control was,” Griffin says. She offers tips in class on warding off the attention – some of it wellintentioned but often negative (i.e., Oh, they’re so cute! How will you ever pay for college?). Her best tip, she says: “Ignore the negatives. Find the good in it and celebrate. Raising multiples is a wonderful experience. There’s nothing like it in the world.” To register: 303-320-ROSE or www.rosebabies.com.
Birthing Boom Largely because of infertility drugs and reproductive-medicine practices, twin birth rates rose 70 percent between 1980 and 2004, and triplet-plus rates rose 400 percent between 1980 and 1998. Since then, changes in reproductive medicine have led to a stabilization or decline in those rates. (Centers for Disease Control and Prevention)
One-On-One with... Devon Uttley, ‘Boot Camp for New Dads’ Graduate Devon Uttley, 34, a web designer from Englewood who took the parenting class for dads and taught by dads at Swedish Medical Center before the birth of his first child, shares some of what he learned: Q: What were your biggest fears as a new-dad to-be? A: Just learning how to take care of such a
fragile little creature and thinking: What if I do this wrong? What if I don’t hold her right? How am I going to teach her to read or tie her shoes? I kind of came to the reality that I was having a baby in the class. It really hadn’t sunk in yet.
Little Adalynn ignores Daddy, Devon Uttley, and flashes a big grin for the camera.
Q: What did you learn that really surprised you? A: How important a father figure is in a little girl’s life. I knew we were having
a daughter, and it really made me think a little more. And the realization of the lack of sleep that you are going to get at first – but that you can deal with it. Q: What helped you the most once your baby was born? A: Honestly, it sounds really basic, but how to change a diaper. I had never
changed a diaper before and had never even really seen it done. Q: What else? A: The reasons why a baby cries. I always thought that it was just either that
they were tired, hungry or needed changing. I learned that there are a variety of reasons a newborn will cry (i.e. gas, anxiety). And this is really important: We also talked about how we could get frustrated when the baby won’t stop crying and how the best thing to do at that point is to put the baby down in the crib and go out and take five or 10 minutes. Let them cry. It’s not going to hurt them, but it’s going to do you a lot of good. Q: Would you recommend the class to all new dads? A: Absolutely. It alleviated a lot of the fear of the unknown, and you learned a
lot about how to take care of – and be there for – your little baby and mom. To register: 866-7SWEDISH or www.swedishhospital.com.
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A Different Path to Parenthood Couple Chooses Surrogacy to Fulfill Their Dreams As with most moms, tears slid down Marian Dam’s face when her baby was born. Slightly shaken with the intensity of it all, she cut the umbilical cord that had sustained little Lillian for months, and took her daughter into her arms. Three minutes later, baby Olivia joined her twin sister, and this time, Dad did the honors. But that’s where any similarities end.
(Above) The day-old twins of Marian Dam and Greg Goodwin sleep through their first major photo shoot at Sky Ridge Medical Center. (Right) The couple enjoys their new baby girls, who were carried by a surrogate mother.
In this case, the parents stood side-by-side, Mom wearing street clothes, not a hospital gown. When dad Greg Goodwin cut the cord of his second-arriving twin, it was connected to a surrogate mom, a woman who, a year before, had been a stranger. She looked quietly on as the two tearfully accepted her gift to them. “It was just an overwhelming experience,” Goodwin says. “Those first few minutes when you are holding your children that you have wanted for so long and worked so hard to get.” Having met too late in life to have a baby naturally, the two did some soul-searching and eventually decided surrogacy was the right choice.
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Although the number of surrogate births is still relatively few, a surge of celebrities taking this route – Nicole Kidman, Elton John, Sarah Jessica Parker – has raised interest in the option, which accounts for about 1 percent of the assisted reproductive technology procedures done in the United States each year. And one of the more-recognized doctors in the field practices at Sky Ridge Medical Center, where Dam and Goodwin ended one adventure with the March birth of their twins and began a new one. “We weren’t going to have too many chances to do this at our age, so we decided to go the very best route,” Goodwin, 55, says, explaining why he and Dam, 54, chose
“We were resolved that we wanted to have a family. We would do what it took to get there.” Dr. William Schoolcraft. The choice made the alreadydifficult birthing option harder, because the couple had to travel back and forth from their Seattle home to Colorado at least six times. But Dam and Goodwin say couples considering surrogacy should look for the best people to partner with them through what they call a complex process, with financial, legal and emotional issues at stake. “The first thing people need to decide is if they can afford it,” Dr. Schoolcraft says. Unless they have a friend or family member willing to be their surrogate, they need to go through an agency that finds and pays women to fill the role. “It’s typically a quite expensive option.” Even with their own carrier, it will cost couples at least $20,000 to $25,000 just for the reproductive specialist fees, says Swedish Medical Center’s Dr. Michael Swanson of Conceptions Reproductive Associates of Colorado, another leading fertility clinic. If you add an agency’s fees, on top of legal and other miscellaneous costs, the price tag inches upward, possibly into the $100,000 range. But Dr. Swanson says, especially during these down economic times, he’s always amazed at how determined these couples are, revealing their dedication to parenthood before their child is even born. “We were resolved that we wanted to have a family,” Goodwin says. “We would do what it took to get there.” Couples must hire an attorney, who prepares contracts and assures legal issues are followed. Many states, for instance, don’t allow traditional surrogacy, when the surrogate’s own eggs are fertilized. Neither Dr. Schoolcraft nor Dr. Swanson will do traditional surrogacy, largely for ethical and legal reasons. “It’s psychologically troubling,” Dr. Schoolcraft says. “The baby is biologically hers, so the attachment issues are different.” He has never had a gestational surrogacy – where eggs are fertilized with sperm in a petri dish and the resulting non-related embryos are implanted in the surrogate – turn into a custody battle. Generally (although Goodwin and Dam used donor eggs because of her age) surrogate babies are the biological children of the couple. Emotional issues, particularly trusting another woman to carry your child, are huge. Extensive background checks and physical examinations for the carrier, and psychological counseling for the carrier and the couple, are required, Dr. Swanson says. And surrogates must have an excellent obstetrical history, including an uncomplicated previous birth, he says.
(continued on page 75)
Who Are Surrogate Moms? We posed the question to Sky Ridge Medical Center’s Dr. William Schoolcraft, who founded the Colorado Center for Reproductive Medicine nearly 25 years ago. Requirements: Should be under 40 and must have had at least one full-term, uncomplicated pregnancy. Why they do it: “Typically, what they say is: I love being pregnant. I’ve never felt better than when I’m pregnant. And if I could help another couple have a baby that otherwise could not, that would be huge for me.” Biggest misperception about them: “The perception that the gestational surrogate will bond with the child and this bond could be difficult to break. In most cases these women chose to become a gestational surrogate to help another woman and have little to no desire to raise the child.”
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Medically unable to carry a pregnancy (complicated previous pregnancy; severe medical conditions, such as heart or lung disease; cancer for which she’s being treated)
Sixth Ave
The Medical Center of Aurora
Swedish Medical Center
Swedish SW ER
Centennial Medical Plaza
Rd
• Multiple failed pregnancy attempts (naturally and/or through IVF)
Rose Medical Center
ker
• Abnormal uterus (misshapen; uterine fibroids; endometrial ablation)
Colfax Ave
Par
• Absent uterus (congenital; previous hysterectomy)
Presbyterian/ St. Luke’s Medical Center
HealthONE Hospitals and ERs Rocky Mountain Hospital for Children ERs
Colorado Blvd
Swedish Medical Center’s Dr. Michael Swanson of Conceptions offered some of the reasons he’s seen in his nearly 25 years of performing in vitro fertilization:
North Suburban Medical Center
University Blvd
Reasons Women Choose Surrogate Moms to Carry Their Baby
HealthONE Locations
Wadsworth Blvd
Finding a surrogate is one of the hardest parts, says Goodwin, who chose a Colorado woman, so that she would be close to Dr. Schoolcraft and Sky Ridge. “You try to determine to the best of your ability that that person has the personality, the discipline and the lifestyle that will give you a reasonable amount of success. There’s an awful lot of trust there.” Starting with a good reproductive medicine center can lead couples to reputable surrogacy agencies and knowledgeable legal and medical help, Dr. Swanson says. Although surrogacy often attracts criticism, Drs. Swanson and Schoolcraft say, done ethically and responsibly, it’s a viable option. By the time most patients resort to it, they’ve generally endured years of trouble and heartbreak, Dr. Swanson says. “There can’t be any greater gift then helping a childless couple create a family,” he says. Dam and Goodwin would agree. The couple, who opted to transfer two embryos to increase the chances of having just one baby, was thrilled at the sound of two heartbeats during the first ultrasound. Though the process was arduous, they say, little Olivia and Lillian made it all worth it. “We were lucky,” Dam says. “We were very lucky.”
Sky Ridge Medical Plaza Centennial Medical Plaza 303-699-3000 14200 East Arapahoe Rd, Englewood www.auroramed.com
Rocky Mountain Hospital for Children* 303-839-1000 1719 East 19th Ave, Denver www.rockymountainhospitalforchildren.com
Medical Center of Aurora 303-695-2600 1501 South Potomac St, Aurora www.auroramed.com
Rose Medical Center 303-320-2121 4567 E 9th Ave, Denver www.rosemed.com
North Suburban Medical Center 303-451-7800 9191 Grant St, Thornton www.northsuburban.com
Sky Ridge Medical Center 720-225-1000 10101 RidgeGate Pkwy, Lone Tree www.skyridgemedcenter.com
Presbyterian / St. Luke’s Medical Center 303-839-6000 1719 East 19th Ave, Denver www.pslmc.com
Swedish Medical Center 303-788-5000 501 East Hampden Ave, Englewood www.swedishhospital.com
* Located adjacent to Presbyterian / St. Luke’s Medical Center
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Midwife Myths Popularity of Well-Woman Care Providers Grows, Profession Still Misunderstood
Susan McConaughy, left, and Jenny Baxter, Certified Nurse Midwives for HealthONE, say misperceptions still surround their profession.
If you are considering a midwife to guide you through the big day, you’re not alone. More than 300,000 women will choose midwife-assisted births this year, a number that has risen nearly every year since 1989, according to the National Center for Health Statistics. While a growing number of hospitals, including HealthONE, now offer patients the midwife option, public misperceptions persist. Below, Swedish Medical Center’s Susan McConaughy and Rose Medical Center’s Jenny Baxter (both Certified Nurse Midwives) address some of those myths. Myth: A midwife is a midwife.
Myth: A midwife offers only non-medical support during childbirth.
Fact: Unlike “lay midwives,” Certified Nurse Midwives
Fact: CNMs are medical professionals who function in
(CNMs) and Certified Midwives (CMs) are accredited by the American College of Nurse-Midwives, which requires a graduate degree in a university-based midwifery program. CNMs, who work in HealthONE hospitals, also earn advanced nursing degrees. “We are certified at the national and state level, are medically insured, and have hospital privileges,” McConaughy says.
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the hospital like their OB-GYN colleagues, monitoring medical devices, ordering drugs — or IVs if necessary — and assuring the health of mother and baby. One difference: “Midwives are able to spend more time with their patients, both during the prenatal care and during birth,” Baxter says.
Myth: Choosing a midwife puts a baby at risk if a serious medical issue arises. Fact: CNMs are highly skilled in identifying and han-
dling medical problems during prenatal care and labor, and they also partner with a physician to handle surgeries, high-risk patients and any procedure beyond their education. “Any kind of emergency procedure available to a doctor is just as available to a midwife and will happen just as quickly,” Baxter says.
Myth: Midwives assist only in at-home births. Fact: Greater than 90 percent of midwife-assisted births
are in a hospital, and HealthONE midwives don’t do home births.
Eye on the Prize Birth Plans Serve Multiple Roles, but Most Have the Same Ultimate Goal So you’re fairly certain that your Facebook-fanatic biggest fan — your baby’s daddy — will slide toward the sidelines a few times during the big event for a little “wall-posting”. And you’re pretty sure that you want to spend some labor time in the warm waters of a Jacuzzi. Or maybe you just know that when your long-awaited baby finally arrives, you plan on being the first person to look into those eyes and say hello. Although you can carefully list all of those things in a birth plan, it’s not necessary, says Swedish Medical Center labor and delivery nurse Abby Sinnett. As long as their plans don’t endanger Mom and baby, nurses are going to let parents-to-be design their birthing experience the way they want it, she says.
Myth: Choosing a midwife means choosing natural childbirth.
Here are Sinnett’s Top Five Birth Plan Tips:
Fact: “The goal of the midwife is to help a woman
Take a wide-lens view: “At Swedish, we ask patients to list their five biggest hopes and their five biggest fears.” That opens the communication doors for doctors, midwives and nurses and helps patients stay focused on the big picture.
achieve the kind of birth she would like to have, whether that means natural childbirth or birth with the assistance of medicine or anesthesia,” Baxter says. More than 40 percent of McConaughy’s patients actually choose and achieve a medicationfree birth, she says.
Myth: Insurance does not cover midwife births. Fact: Most insurance policies cover CNMs, including
Medicaid and Medicare, although a home birth with a lay midwife is unlikely to be covered, McConaughy says. “Insurance companies have very stringent qualifications that we meet.”
Myth: Midwives serve only pregnant women. Fact: “We do all kinds of well-woman care and serve as
(and are federally approved as) primary-care providers,” McConaughy says. “We do everything from annual exams to treating bladder infections to providing birth control. I have women who have been committed to me for 25 years.”
Think “back-to-school”: “It’s kind of like doing your homework.” It guides parents in learning about the birthing process. What position does Mom want to be in during labor? Does she want pain medication? Will she breastfeed? All questions worth researching, but certain to be asked anyway. Adopt a team approach: “Do I want an episiotomy? Who is going to clamp the cord? Those are answers that should be discussed with the doctor (or midwife) beforehand.” And remember, nurses are also on your team and do this every day. Written down or not: “We’re not going to give you pain medication if you don’t want it.” Bend, don’t break: “I would say the most common birth plan mistake people make is holding onto it like this is the way it has to happen.” A mom herself, Sinnett says parenting demands flexibility, something parents learn before their baby even enters the world. Keep an eye on the prize: All of the above will help parents-to-be have a better birth experience, especially if they stay focused on those big-picture goals. “I would hope that the ultimate, No. 1 goal for the whole experience would be for a healthy mom and a healthy baby. In the end, that’s what really matters.”
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Completing the Circle Doctor Transforms Practice for a More Rounded Approach to Women’s Care When Rachel Kuzmich walks into her gynecologist’s exam room, a hint of lavender tickles her nose. In soothing harmony, water trickles from a fountain and soft, meditative music fills the air. As she lies down on the table, hot packs replace cold stethoscopes as her doctor prepares her for the treatment ahead. In a move away from the traditional, Dr. Kimberly LarsonOhlsen of The Medical Center of Aurora has combined a touch of natural medicine with her modern medical practice. She performs acupuncture on Kuzmich, using the art of Traditional Chinese Medicine to treat her debilitating premenopausal insomnia, which had limited her to two hours of sleep a night for three months. “I’m just into my third week of treatment,” says Kuzmich, 44, of Aurora. “I’m already up to four to six hours a night.” Skeptical of acupuncture at first, Kuzmich now believes the art of using tiny needles placed in specific areas for different conditions works, and she is confident she’ll be sleeping like a baby again soon. Dr. Larson-Ohlsen, an OB-GYN who’d grown frustrated with not being able to fully treat many of her patients’ conditions with Western medicine, went on sabbatical and began researching acupuncture. She became certified and tried it on friends and family. “And I saw results.” In November, she opened Colorado Complete Health for Women, where she blends the best of both East and West for a whole approach to treatment. “I’m just a huge proponent of educating women and providing them with choices. I’m hoping the integrative approach is the wave of the future.” Kuzmich, who used the word “ecstatic” to describe how she felt when Larson-Ohlsen opened her new practice, would agree. “I searched for a long time for a woman practitioner who could have an overall view of my needs and be able to treat them with both types of practices.”
Natural medicines and acupuncture can be effective for many conditions, including: Infertility Sciatica Nausea
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Depression Anxiety Breech babies
• HealthONE Women’s Care
Labor induction Menopausal symptoms Menstrual symptoms
Dr. Kimberly Larson-Ohlsen, an OB-GYN at The Medical Center of Aurora, performs acupuncture on a patient.
Dr. Larson-Ohlsen’s vision for her practice includes nutritionists, massage therapists, and yoga and tai chi classes. “I’d really like to be a wellness center, where it’s really one-stop shopping.” Since narrowing her focus on women’s gynecological needs, she’s looking for an OB partner for her pregnant patients. “Acupuncture is great during pregnancy. Nobody wants to take medicine when they are pregnant, but they still can have health problems.” And acupuncture is a good option for pain relief during labor, she says. Kuzmich, who also has arthritis, is looking forward to being treated for that condition next. “Since insomnia has such an effect on wellness, Dr. Larson-Ohlsen wanted to focus on that first,” Kuzmich says, a statement that exemplifies her doctor’s philosophy. “You can’t just treat the body,” Dr. Larson-Ohlsen says. “You have to treat the mind and spirit. I think that’s what women are really looking for. I think they know that’s what it takes to be really well.” For more information: (303) 690-2198; www.cchw.com
Peace of Mind Minimally Invasive Methods Offer Women Permanent Contraception with Less Risk For Aimee Dickenson, the decision was made easier when she found how hard it was caring for her son, born two months premature, with a husband whose disability made it impossible for him to help. The verdict was clinched: Her family was complete. “I knew he was all that I could handle,” she says of her baby. “So I was constantly worrying about contraception,” says Dickenson, 32, of Aurora. While sterilization was the obvious answer, the last thing she wanted to do was have another surgery. Dickenson’s son was born C-section, and she had a gallbladder removed shortly after. Then her doctor told her about two minimally invasive procedures now done in the doctor’s office: Essure and Adiana. The procedures have been breakthroughs in sterilization for women. “Before these were available, if the husband was willing to have a vasectomy, I would steer my patients in that direction,” says Dr. Chute Charnsangavej of the Medical Center of Aurora. “Now I consider these fairly equivalent when it comes to ease and risk.” Since her office began offering the newer methods, between 80 and 90 percent of her patients opt for them, Dr. Charnsangavej says. For decades tubal ligation, an in-hospital surgery involving incisions and general anesthesia, was women’s only choice. With the newer methods, pain medicine and local anesthesia are used, no incisions are involved, and women are back to work the next day. Because they are non-hormonal, the procedures are also attractive to women who suffer headaches, weight gain or bleeding with some of the reversible contraception options. “But these methods are permanent,” Dr. Charnsangavej says. “Women need to be sure they are happy with the size of their family.” Dickenson, who chose Essure, says the pain pill she took before the insertion made her so drowsy, she slept through the 10-minute procedure. Menstrual-like cramping was the only side effect she noticed. And a confirmation test done three months after the insertion was an attractive, peace-of-mind bonus. “I really like that idea. Then you know you are safe.”
A flexible catheter is inserted to deliver a low level of radiofrequency energy to an area in each fallopian tube. The heat creates superficial lesions, where rice-grain-sized, soft inserts are then placed. The body’s tissues slowly grow around the insert, blocking the tubes. Alternate birth control is used for three months, at which time a dye is inserted into the fallopian tubes and photographed using X-rays to confirm the tubes are closed. Length of procedure: 15 minutes • Efficacy: 98.4 percent
The procedure is similar, including the three-month confirmation test, but no energy is applied first, and the inserts are tiny, coil-like inserts (made from the same material as stents, used by cardiologists for years) that are placed in each fallopian tube. Length of procedure: 10 minutes • Efficacy: 99.95 percent. Note: Most insurance covers both procedures.
For more information: (303) 695-4800; www.pinnaclewomenshc.com.
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RMHC First Call HealthWellness 4-11_Health and Wellness Parent Edition April 2011 4/14/11 9:31 AM Page 1
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