Jane’s Friday Thoughts are a collection of entries on the state of modern maternity from OB-GYN and Maven Medical Director, Jane van Dis.

The word “care” is actually part of the word “healthcare,” but too often, it’s overlooked in favor of expediency. When healthcare providers don’t take the time to understand basic things about their patients--like their gender or sexuality--many patients feel unwelcome and uncared for, and are less likely to seek follow-up care as a result.

The American College of ObGyn (ACOG) notes that an ObGyn, pediatrician, family medicine physician, or nurse practitioner may be one of first healthcare providers that an adolescent struggling with gender dysphoria (distress caused by the incongruence between one’s expressed or experienced--a.k.a. affirmed-- gender and the gender assigned at birth) may encounter. Making sure that first encounter is safe can be key to fostering continued engagement with the healthcare system and good healthcare outcomes.  

This means having providers who use inclusive and sensitive language across the gender and sexual spectrum-- not only for gender and sexuality focused care, but for all healthcare needs, from nutrition to dental care to primary care to fertility. When healthcare providers misgender patients, or assume that they’re in heterosexual relationships when they’re not, those patients receive substandard care and are discouraged from seeking healthcare in the future.

Why it matters

• In the U.S. approximately 1.1 and 3.5% of women identify as lesbian and bisexual, respectively, and 0.6% identify as transgender
• Not all women who identify as LGBTQIA are necessarily going to identify themselves as such to their healthcare provider
• Studies have shown that LGBTQIA persons report higher rates and more severity of sexual violence than heterosexual women
• As a result of disparities, stigma, and prior negative experiences, LGBTQIA persons often under utilize healthcare, present later in disease process than heterosexual females, and have fewer encounters for preventative healthcare

How Maven can help

According to one of Maven’s practitioners, Elyssa Kilman, Maven’s professional network has the capacity to reach members of the LBGTQIA community who otherwise might not have access to affirming medical or mental health care. In her work as a Licensed Professional Counselor and Creative Arts Therapist, she explains, “A significant number of the clients I have connected with and developed long-term relationships with through Maven are queer or trans identified, and located in areas of the country or internationally where they couldn't easily find a therapist with whom they felt it was a given that their gender and sexual identities would be understood, processed appropriately when necessary, accepted, and celebrated.”

Everyone deserves access to caring, accepting, affirming healthcare, regardless of gender, sexual orientation, or geographical location. Maven’s app-based platform makes this accessibility a reality.

Bottom line

Meeting individuals for healthcare where they are and how they are--and seeing them for who they are--is key to creating an inclusive health care company. Maven’s practitioners, our care concierges, and our team comprise a group of people committed to keeping the “care” in healthcare.

More reading

HRC Releases 2018 Healthcare Equality Index, Honors Record Facilities for LGBTQ Inclusion

Human Rights Campaign

Here’s How the Affordable Care Act has Provided Crucial Protections for the LGBTQ Community

Human Rights Campaign

NOW Updates Acronym: LGBTQIA

National Organization for Women

Take care,

Jane

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Jane’s Friday Thoughts are a collection of entries on the state of modern maternity from OB-GYN and Maven Medical Director, Jane van Dis.

Nothing in pregnancy compares to the struggles of breastfeeding. Around 85% of my patients struggle with it-- even with the basics, such as latch, leaking, cluster feeding, and supply (too much or too little). Having said that, the good news is that more women are breastfeeding, despite all its challenges. Breastfeeding rates have increased substantially. From 2000-2015, breastfeeding rates at 12 months of infant age went from 16% to 36%, and the proportion of babies who had ever breastfed went from 71% to 83%. When we think about breastfeeding and its health benefits we often think about the benefits to the baby, but there are some amazing health benefits for mothers, too!

Benefits of breastfeeding: Why it matters

·     Breastfeeding reduces mothers’  lifetime risk of diabetes by up to 69%

·      It reduces mothers’ risk of developing hypertension by 12%

·      It reduces mothers’  risk for myocardial infarction by 37%

·      It reduces mothers’ risk of developing breast cancer by 26%

·      It reduces mothers’ risk for developing ovarian cancer by 37%

·      It reduces mothers’ risk for endometrial (uterine) cancer by 26%

·      Breastfeeding helps women lose weight after pregnancy

·      It helps the uterus return to normal faster after pregnancy

·      It reduces maternal responses to stress

·      It might decrease the risk for postpartum depression

How Maven can help

Maven takes breastfeeding, combination feeding, pumping and return to work very seriously. Many families might get a visit or two from a lactation consultant while in the hospital after delivery, but many still find they need more support when they arrive home and are on their own. Maven provides access to on-demand lactation consultations (with an invaluable video component), so that breastfeeding parents can get support on topics like latch, milk supply, and feeding schedules, as well as more complicated questions, such as, "Do I have mastitis [painful infection of the breast tissue] or a clogged duct?" Maven's lactation consultants are also often key sources of support as families transition back to work. They can also help with questions around pumping, supplementing with infant formula, breastfeeding and travel, weaning, and moving to solid foods.

Bottom line

Breastfeeding can be one of the most joyous experiences of postpartum, and one of the most challenging. Luckily, Maven is here to support women and families throughout the entire process. The benefits of breastfeeding for mom (and, of course, baby!) are too good to miss out on.

More reading

Optimizing Support for Breastfeeding as Part of Obstetric Practice

ACOG

Take care,

Jane

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Jane’s Friday Thoughts are a collection of entries on the state of modern maternity from OB-GYN and Maven Medical Director, Jane van Dis.

It's a story familiar to any ObGyn. A life turned completely upside down in a matter of hours. A few weeks ago, a normal ultrasound showing excellent growth, fluid and markers – a woman who has every reason to feel excited about her pregnancy.  Zero indication of the catastrophe ahead. Her water breaks, she starts to have pain, and shortly after that, a fever, and then an infection (called Chorioamnionitis) that spreads in minutes, like wildfire, in her uterus. Sometimes a Code Sepsis is called, as bacteria and their toxins invade and overwhelm her organs. Some of these women end up in the ICU. In the developing world, sepsis can cause up to 13% of pregnancy-related deaths.  It's a condition we as ObGyns take very seriously. According to the CDC, between 2011 and 2013, sepsis caused 12.7% of pregnancy-related deaths in the US. But in nearly every case, the fetus dies. And that loss, no matter the trimester, is profound.

Miscarriage and why it matters

-       25-30% of all pregnancies end in miscarriage

-       Nearly 50% of pregnancies end in miscarriages before implantation, 30% of pregnancies end after implantation but before a woman knows she’s pregnant, and 10-15% after clinical recognition of the pregnancy

-       Most miscarriages happen before a woman even knows she’s pregnant

-       In one study, 43% of parous women had experienced at least 1 miscarriage

-       80% of miscarriages happen in the 1st trimester

-       Women in their 20’s have a 9-17% chance of miscarriage, at 35 it’s 20%, at 40 it’s 40% and at 45 it can be as high as 80%

-       Most of the time, miscarriage is due to an embryo not having the right number of chromosomes, according to the American College of Obstetricians and Gynecologists. Eggs and sperm should have 23 chromosomes each. But too many or too few chromosomes—in egg, sperm, or both—produce an embryo that probably won’t survive.

-       50% of miscarrying women suffer some form of psychological morbidity in the weeks and months after loss

-       Elevated anxiety and depressive symptoms are common, and major depressive disorder has been reported in 10–50% after miscarriage

-       Psychological symptoms could persist for 6 months to 1 year after miscarriage

-       Risk factors for miscarriage include advanced maternal age, previous spontaneous abortion, and maternal smoking

-       Feelings of depression and anxiety following a miscarriage may last for almost 3 years after the birth of a healthy baby, which points to the long-lasting effect miscarriages have on women’s brains, psychology and spirituality

-       Signs that a woman may still be recovering emotionally from miscarriage include feelings of sadness that affect everyday functioning, not sleeping, and changes in diet/weight

-       History of pregnancy loss may be a risk factor for postpartum depression in a similar way as other known risk factors, such as personal or family history of depression

How Maven can help

At Maven, we recognize that pregnancy loss happens to a lot of women – and we are here to talk about it. We provide clinical support through our ObGyns, our CNMs, and our NPs. We provide psychological support through our maternal mental health specialists – our social workers, our psychologists, our counselors. And we are here to help if a woman has had a miscarriage and wants to talk about  what’s next  on her family planning and fertility journey.

My title for this week’s column, Hope is a Circle, is a philosophy that I often share with my patients. After a pregnancy loss, many women report experiencing a common thread of hopelessness, feelings of failure, a wall of sadness, and worries that their bodies will never be able to hold a pregnancy – not to mention mourning and dealing with death. On the one hand, I acknowledge and stand with these women in their grief, pain, and loss. But I also talk about the role of hope, and how it’s an essential element of the conversation around loss. I had 4 miscarriages before I got pregnant with my twins at age 39, and I felt really scared for years, and also very alone. One of these miscarriages  was an ectopic pregnancy, and I lost an entire fallopian tube. But I turned that loss into hope when I decided in the emergency room that night to become a doctor. Hope is essential.

Take care,

Jane

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