Health News

Sailing to New Heights

Friday, September 18, 2020 By Admin

This November, Natasha Lambert will be embarking on her biggest challenge yet – sailing across the Atlantic Ocean.

Natasha’s love of sailing was immediate. It started on a lake in England when she was nine years old and only grew stronger as she got involved with a local sailing academy back home on the Isle of Wight. However, because Natasha was born with athetoid cerebral palsy and is unable to use her hands, she could not sail the boats herself. Nevertheless, she was determined to find a way to sail independently.

In 2009, Natasha’s parents gave her a life-changing gift – a converted model yacht which allowed her full control using her mouth and a ‘sip and puff’ system – assistive technology that uses air pressure to send signals to a device through the user by inhaling (sipping) or exhaling (puffing) through a straw in the user’s mouth. The sip and puff system works by using one short sip of breath to move starboard (right), quick puffs to turn port (left) and a click of the tongue to control the sails. This system is described as “life-changing” by her mother.

This got Natasha thinking – if she was able to control a model boat, why not a real one?

The following year, Natasha’s family bought a real sailboat and her father Gary spent the next 6 months installing and testing a sip and puff system that he had designed himself in order for Natasha to have full control of the yacht. Their hope is to one day have this same system commercially manufactured to enable others with disabilities to sail.

Since then, Natasha has led many sailing trips which have raised money for charity, including for the charity she helped create, The MissIsle School. This charity provides affordable sailing tuition to young people with physical disabilities who would benefit from the sip and puff method of sailing. She was even awarded the British Empire Medal in 2015 as recognition of her fundraising achievements.

This past July, now 23-year-old Natasha set sail from Cowes, Isle of Wight, to Gibraltar to begin the first leg of her transatlantic voyage on her newly adapted boat, Blown Away, in the hopes of raising £30,000 (approximately $50,000 Canadian) for charity. Although COVID-19 restrictions initially presented as a challenge, the rest of her incredible journey is still scheduled to begin in November.

Natasha’s journey, like those we have celebrated in our previous blogs, highlights the amazing potential of children living with disabilities when provided with sufficient support and adaptive equipment to reach their true potential. At Pacific Medical Law, it is our mission to help children living with cerebral palsy achieve their full potential by providing them with fair compensation for their disability when it was caused or contributed to through medical negligence. We are here to help. Call us for a free consultation – we can provide information about supports and resources in your community as well as legal advice regarding your child’s rights for financial compensation.

No place like home? Thinking twice about midwife-assisted planned home births

Thursday, September 10, 2020 By Arash Adjudani

Over the past two decades, the number of out-of-hospital births has been on the rise in British Columbia. This includes home births, which can be performed by registered midwives or appropriately trained physicians.

But are home births safe? It depends.

A recent US study investigated this question. By analyzing the rates of neonatal mortality in births attended by certified nurse-midwives, the study found that home births had significantly higher rates of neonatal mortality, even for mothers with a low risk profile. These results are not surprising; when unexpected complications occur during labour, hospitals are much better equipped in providing immediate and life-saving intervention for both mother and fetus.

In Canada, birth statistics suggest that hospital births are far safer than non-hospital births. In 2018, for example, non-hospital births were 4.5 times more likely to result in fetal death compared to hospital births. These numbers, however, do not distinguish between high-risk and low-risk pregnancies. In fact, studies have shown that midwife-attended home births for low-risk pregnancies are as safe as hospital births, according to the Society of Obstetricians and Gynaecologists of Canada (SOGC). As such, the current SOGC guideline supports a woman’s choice for a planned home birth, given that she is fully informed of all risks and benefits, and provided that “the birth is anticipated to be uncomplicated”.

To return to the question posed earlier, childbirth is an inherently risky process. For this reason, obstetrical procedures carry the highest rates of medical insurance premiums in Canada. Strictly speaking, therefore, no child birth is ‘safe’ because every delivery, no matter how ‘routine’, can potentially result in catastrophic and life-altering birth injuries to the baby, including cerebral palsy and other types of brain damage.

With this in mind, any woman who is considering a planned home birth by a midwife is well advised to familiarize herself with the Standards & Policies that regulate the scope of practice of midwives in British Columbia.

A number of important factors must be considered to ensure the safety of a planned home birth. First, a midwife has a duty to determine if the pregnancy poses a risk to the pregnant mother and/or the fetus, and whether or not the pregnant mother is an appropriate candidate for a planned home birth. There is a long list of conditions that may preclude a midwife from attending a home birth. These conditions may be present early on in the pregnancy, or they may develop at any time throughout the pregnancy or during labour. In those cases, the midwife is required to transfer the care of the client to a physician, which would require immediate transport to hospital if the labour was underway at home. Likewise, similar criteria exist with respect to water births. Second, a midwife has a duty to develop a written and detailed plan for a home birth. This plan should include an assessment of the home environment as a suitable birthing place. The midwife is also required to have the necessary equipment and supplies for home birth, as well as a comprehensive transport plan to the nearest hospital in case of an emergency. Finally, and most importantly, the midwife has a duty to obtain the client’s informed consent. In doing so, not only must the midwife discuss with the client any theoretical risks, but the midwife must also keep the client informed and updated regarding any unanticipated problems that arise at any stage of the pregnancy, including during labour.

The bottom line:

Midwife-assisted planned home births are a relatively safe option for a certain group of low-risk pregnancies, as described by the CMBA guidelines. In obtaining the client’s informed consent for a home birth, the midwife has a duty to determine the risk profile of the pregnancy and appropriateness of the client for a home birth, to clearly communicate and discuss those risks with the client and to develop a detailed plan, including an emergency transport plan. Most importantly, the midwife must be ready to promptly transfer the care of the patient to a physician when complications arise that exceed his or her scope of practice, or when requested by the pregnant mother.

If you have questions or concerns about your home birth experience, we are here to help. We work in collaboration with a team of lawyers, physicians, midwives and nurses. We will take the time to listen to your concerns, and carefully review your medical care in order to answer your questions. Please contact us for a free consultation.

A new study finds hope in a blood test – helping babies born with brain injuries

Friday, September 4, 2020 By Admin

A recent study gives new parents hope following the heartbreak that comes with hearing your baby has suffered a brain injury.

Scientists have found that a simple blood test might be a way to identify if your baby is at higher risk for a poor outcome following a birth-related brain injury – also known as neonatal encephalopathy.

Neonatal encephalopathy associated with oxygen deprivation in the weeks before, during, and after birth is the most common cause of death and brain damage in full term babies. Identifying at-risk babies sooner means faster treatment, which could protect them from some of the worst damage triggered by this kind of injury.

There are a number of other causes for neonatal encephalopathy and these include inflammatory processes, infections, metabolic and genetic causes. The outcome of all these sources look very much the same to you – your baby has a brain injury and there might not be a clear answer as to why. Given so many possible reasons for your baby’s injury, it might be difficult to get appropriate treatment. If the findings in this study are confirmed, it means hope of a better future for you and your baby.

Working with whole blood samples taken within six hours of birth from 45 babies with neonatal encephalopathy, the researchers analyzed the babies’ Ribonucleic Acid (RNA) with new generation sequencing. The babies were reassessed at 18 months of age and the RNA sequences of babies with worse outcomes were compared with the RNA sequences of babies with better outcomes.

Looking at the changes in RNA sequences between these two baby groups, researchers discovered that the same genes were working differently. The study revealed when, what kinds, and how much of each protein was being made in the babies’ cells. Some of these proteins were found to be harmful and some of them to be helpful. Babies with the worst outcomes made more of the bad proteins and less of the good ones.

Out of the 855 genes that were discovered to be most different between the two baby groups – two specific genes, RGS1 and SMC4, were identified as showing the most differences as well as being predictors of a worse outcome.

Knowing what genes are involved in poorer outcomes and the ability to identify these genes soon after birth, may mean the hope of faster and improved treatment for your baby with neonatal encephalopathy.

In all the good news, there are some cautions that come with these findings. The scientists were not necessarily looking for what they found and there weren’t many babies in the study. This means that the evidence is not quite as good as it might be and may not be duplicated in a larger more focused study.

However, it is still a hopeful finding and if you are a parent with a brain-injured baby – hope is good.

Click here to read the study

Racism, Maternal Deaths and Healthcare Inequality

Thursday, September 3, 2020 By Letty Condon

More than 2 months have passed since the death of George Floyd. During this time, there have been efforts on an international scale to acknowledge racial injustice and reform systems which allow or encourage racism to persist. In healthcare, data from the CDC has revealed the startling differences between the risk of dying in pregnancy faced by non-Hispanic black women in the United States when compared to all women in pregnancy. More recently, data also from the CDC has shown that two thirds of deaths related to pregnancy were considered to be preventable. In Canada, the story of the preventable death of Brian Sinclair, an Indigenous man who died in a hospital room, shocked the nation in 2008. Despite more than 10 years having passed since his death, there are examples that Indigenous Peoples face inequitable access to healthcare and racism.

The CDC has recently published data received from 14 Maternal Mortality Review Committees (MMRCs) who were able to review information related to the health and social factors that affect pregnant women. Between 2008 and 2017, information related to the deaths of the 1,347 women who died during pregnancy or within a year of delivery was analysed. These committees found that the deaths could have been prevented in two thirds of the cases. The percentage of deaths that were considered to be preventable did not vary significantly between women of different ethnicities. However, the data published by the CDC in 2019 shows that the risk of dying during pregnancy or within a year of giving birth for non-Hispanic black women was 40.8 per 100,000 births, 29.7 per 100,000 births for non-Hispanic American Indian/Alaska Native women, and overall the mortality rate was 16.7 per 100,000 births.

So why is there a difference in the risk of dying between women of different ethnic backgrounds? Research has shown that the difference may be partly related to medical conditions that ethnic minority women are more vulnerable to. However, this biological basis is less clear as there is also a significant difference in the access to healthcare these women have and the quality of care provided is significantly lower. These differences can influence the impact that any pre-existing medical condition or vulnerability to illness has.

Racial discrimination may also contribute to the severity of the condition. For example, death related to high blood pressure in pregnancy was shown in the research by the CDC to affect proportionally more black women than white women. A study has shown that high blood pressure is more common among those of black ethnicity than white and those who have high blood pressure are more likely to have suffered racism. Therefore, genetic differences may contribute less than discriminatory attitudes and systems.

These inequalities on the basis of race exist internationally. Research looking at maternity care in the U.K. has shown that the rates of death faced by women during pregnancy or in the weeks after birth are five times higher for those of Black ethnic backgrounds and twice as high for those of Asian ethnic backgrounds when compared to white women. Indigenous peoples in New Zealand and Australia face delays in accessing the lifesaving investigation and treatment of heart disease.

The case of Brian Sinclair in 2008 highlighted the issue of healthcare inequality in Canada, where an Indigenous man with cognitive impairment was left without medical care and attention in the waiting room of an ER for 34 hours. An interim report looking into his death, published in 2017, identified that Mr. Sinclair was ignored as a result of racism and lack of care for an Indigenous person. Another report from 2017 reviewed cases in a Saskatoon Health Region hospital where Aboriginal women (this being the way the women described themselves) were coerced into having a surgical sterilization procedure following childbirth. Jordan River Anderson was a First Nations child born with complex medical needs in Manitoba. He spent more than 2 years unnecessarily in hospital awaiting a financial decision about the funding for his home care because he was a First Nations child. He died in hospital without spending a day in his family home.

There are ongoing efforts to address racism in healthcare and physicians in Canada are encouraged to develop their understanding of the barriers faced by those of racial minority groups. There are also physician groups which advocate with and on behalf of affected communities. There are plans to address healthcare inequalities through Jordan’s Principle and the Inuit Child First Initiative.

The extent to which these initiatives lead to significant changes in the provision of healthcare in Canada remains uncertain. What is certain, however, is that healthcare providers are required as a matter of law, to provide all patients with safe and appropriate medical care regardless of the patient’s racial or ethnic background. Moreover, positive steps are required to ensure that equitable treatment and care is received by those of racial minority groups.

Helping hands: how medical treatment and care is improving the long-term health of premature babies

Thursday, August 20, 2020 By Letty Condon

Preterm, or premature birth, where a baby is born before 37 weeks of pregnancy, affects around 8% of pregnancies in Canada. There are health problems which may affect premature babies soon after birth, as they go through childhood and also as adults. There has been significant work to help babies who are born early and this has helped reduce the chances of preterm babies being affected by long-term health conditions.

A collaborative program in Canada, involving the doctors, nurses and parents who care for premature babies, studied how implementing changes on a national level can affect the health of babies born prematurely over time. This program encouraged communication between those caring for pregnant women facing preterm delivery and the neonatal units who look after premature babies after birth.

What are the risks of prematurity and what can be done to improve outcomes?

Between 2004 and 2017, significant changes in medical care for babies were made and their effect was measured. The changes that were made included giving women steroids who were about to deliver prematurely, treating premature babies with a medication called surfactant and ensuring that babies maintained an ideal temperature after birth. The program also advised on how best to provide care to premature babies after birth, guided doctors and nurses to avoid using a ventilator if possible, gave guidance on how to support babies with their feeding and nutrition and encouraged developmental care.

The research showed that the survival of very premature babies improved by 25% during this time and reduced the chances of premature babies being affected by:

bronchopulmonary dysplasia – this is a severe chronic lung disease which can make a baby born prematurely more prone to developing asthma and or suffering pneumonia later in life;
retinopathy of prematurity – this is a condition which affects the eyes and, in turn, can cause blindness;
necrotizing enterocolitis – this is a condition causing infection and inflammation of the bowel which can cause severe damage and ongoing problems with digestion, growth and development.

The effect of the environment and level of support provided to families caring for premature babies has also been shown to impact upon their health and development. A study in Rhode Island, Providence compared babies who were cared for in an open bay to those in a single-family room and found that the premature babies cared for in a single-family room had better developmental scores between 18 months and 2 years of age. They also found that the volume of human milk produced by the mothers who were nursing babies in a single-family room was higher. An increased volume of human milk has been shown in other studies to impact positively upon the health of premature babies.

The development of premature babies may be affected if they have cerebral palsy and premature babies are at an increased risk of having this condition. As we reported recently, new research has shown that babies born prematurely to mothers who have been given magnesium sulfate shortly before birth had 30% less risk of developing cerebral palsy. This study and the research described above show the positive impact that the care, medication and support provided to premature babies and their mothers can have.

The timely administration of these interventions coupled with careful assessment and monitoring can make the difference between a premature baby who is able to overcome the risks of prematurity and the baby who suffers permanent health and developmental challenges that last a lifetime. If you have questions about whether your premature baby received appropriate medical care consistent with the standard of care in Canada, feel free to contact us for a free consultation. We are here to help.