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Birth & Parenting News: Drugs to Prevent Prematurity
Recently, there has been some dramatic and newsworthy changes in the marketing of drugs to prevent premature birth.
First, the FDA gives strictest warning for the drug Terbutaline, which has been used for decades.
Second, pregnant women will still be able to get a drastically cheaper version of a new expensive drug that prevents premature birth. Since the drug was approved, it’s been unclear whether women would have to pay $1,500 per dose for the licensed version or could continue to have it made by specialty pharmacies for $10 to $20 per dose. The recent price increase caused an outcry, prompting the FDA to take the unusual step of declaring that pharmacies can still make the cheap version of the once-a-week shot on an individual basis, as they have for years. The agency said it wouldn’t step in unless there was a problem with the safety of the specially made version.
Last month, the American College of Obstetricians and Gynecologists, along with the American Academy of Pediatrics and the Society for Maternal-Fetal Medicine, urged the drug’s manufacturer, Ther-Rx Corporation, to reconsider its pricing of Makena, arguing that the extremely high cost will hinder access to the treatment for both insured and uninsured patients.
Doctors and others welcomed the new drug because it would be easier to get and mean more consistent quality, but were stunned when the $1,500 per dose price was announced. Total cost during a pregnancy could be as much as $30,000.
The FDA does not control pharmaceutical pricing. The company said the price was justified because very premature infants need months of intensive care and often suffer disabilities, and because it spent millions bringing the drug to market. Last month, the company sent a letter to special pharmacies across the country, warning them to stop making the cheaper version or they would face FDA enforcement. An FDA spokeswoman initially said the company’s letter was accurate. However, the FDA has become increasingly aware of public worry and anger over whether women would still be able to get the drug, and whether state Medicaid programs that serve the poor would still be able to pay for it, federal officials said.
“In order to support access to this important drug, at this time and under this unique situation, FDA does not intend to take enforcement action against pharmacies” that compound the drug, also known as 17P, the statement said.
Makena is a synthetic form of the hormone progesterone. An earlier version first came on the market more than 50 years ago to treat other problems; it was withdrawn in the 1990s, though not for safety reasons. The drug got a new life in 2003, when a study showed it helps prevent premature birth in women who previously delivered early. Doctors started prescribing it, and pharmacies mixed it.
Each Wednesday, our Birth & Parenting News blog highlights the latest news items, research results, consumer alerts, and legislative action alerts of interest to expectant and new parents and the professionals who work them.
Doula Business Advisor: How to Collect?
Are you having trouble collecting your doula fees? Consistency is important. Hold clients responsible to the agreement and call them on it if they are engaged in shenanigans. The old “I forgot my checkbook” or “the check’s in the mail” (when it’s not!) doesn’t work well if you are counting on your paycheck today and it’s not forthcoming. I have sometimes sat in uncomfortable silence as a response to the “I forgot my checkbook” claim, waiting for the client to work through how she’s going to solve the problem. If she’s not forthcoming, I might say “That’s a problem for me today. How soon can you take care of this?”
Remember, being “sweet” when someone is neglecting their responsibility
to you is an invitation for that person to continue bad behavior. You are not the one who caused this problem, and it is not up to you to fix it. Sweet isn’t really sweet when resentment is behind it.
What about the client who forgets to pay you? You have a lovely prenatal
visit together. You like her and her partner a lot. You are all excited about their upcoming birth. It’s time for you to hit the road. According to your contract together, their final payment is due tonight, and you really wish they would just pull out the checkbook and pay you. Here are some options for bringing up the subject:
“Do you have that final payment for me tonight?”
“Can we take care of payment before I leave?”
Whatever you do, don’t walk out of that house knowing that they should have paid you without having enabled or reminded them to do so. Remember, you are a professional with every expectation of getting paid. As you step into that role, as you own it and take pride in your work, all uneasy feelings about being paid, and paid well, for your time will drop away. The key to having clients who pay you faithfully is to have a matter-of-fact attitude about the business part of your business. Some people will try to make their money problems be your money problems, showing obvious pain as they write you a check or telling you about what they just had to spend to get their car fixed, and so on. You don’t need to engage, and you certainly don’t need to feel guilty (presumably they want your car in working order so you can make it to their birth!). Simply smile and say “thank you” when they hand you your check. It’s just business.
The Doula Business Advisor blog is designed to support the establishment and long-term sustainability of private doula businesses. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Birth & Parenting News: Epidural Facts & Fiction
A recent book by anesthesiologist Dr. Gilbert Grant, Epidural Without Guilt, Childbirth Without Pain, has hit a nerve with doulas, childbirth educators, and other informed birth advocates. For a balanced perspective on the topic, check out recent posts on the topic by Lamaze International’s Science and Sensibility blog. And be sure to also read, Henci Goer’s response to Dr. Grant’s book in her blog post, Straight Talk on Epidurals for Labor. Henci Goer has long been devoted to making evidence-based information related to childbearing practices visible to consumers. She is the author of The Thinking Woman’s Guide to a Better Birth and Obstetric Myths versus Research Realities.
Each Wednesday, our Birth & Parenting News blog highlights the latest news items, research results, consumer alerts, and legislative action alerts of interest to expectant and new parents and the professionals who work them.
Doula Business Advisor: Retainer Fees
Postpartum doulas will also want to get a retainer fee to hold time in their schedules for clients who hire them prior to the baby’s birth. Some postpartum doulas ask for a nonrefundable payment in full for the first week of services upon signing the contract. In the case of twins or multiples, where relatively prolonged care is anticipated, the retainer fee can be figured on a percentage of the anticipated overall service package. Once the retainer has been worked off, the balance of fees are billed and collected at the end of each week of services.
em>The Doula Business Advisor blog is designed to support the establishment and long-term sustainability of private doula businesses. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Doula Programs & Centering Pregnancy Model
The Centering Healthcare Institute (CHI) will host its 1st National Centering Research Symposium, “Evidence for Centering Group Care: Linking Research and Practice” in Chicago, IL on April 28-29, 2011. The meeting will include presentations of Centering studies by researcher from across the country and a keynote address, “Innovation, Integration, Inspiration: Using Groups to Transform Prenatal Care.” CHI’s mission is to change the paradigm of health services to a group care model in order to improve the overall health outcomes of mothers, babies, and new families. Centering is an evidence-based redesign of health care delivery that helps to promote: safety, efficiency, effectiveness, timeliness, culturally appropriate patient-centered care, and more equitable care.
In recent years March of Dimes has promoted the Centering Pregnancy model as an evidence-based intervention for families at risk. There may be an opportunity here for doula programs to partner with midwives and other care providers who are implementing the Centering model. The incorporation of doulas into the model makes sense and is perfectly congruent with the overall approach. It is innovative and may get the attention of funders like the March of Dimes.
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Birth & Parenting News: Early Elective Delivery
A recently released hospital survey by Leapfrog, a hospital quality watchdog group, found that hospital rates of early elective deliveries range from less than 5% to more than 40%. According to Leapfrog, this survey “is the first real evidence that the practice of scheduling newborn deliveries before 39 weeks without a medical reason is common and varied among hospitals even in the same state or community.”
Elective early deliveries contribute to the nation’s high preterm birth rate (which is much higher than in other industrialized countries) and the significant health complications experienced by premature babies. Although the preterm birth rate continued its downward trend for a third straight year in 2009, the March of Dimes’ recently released 2010 Premature Birth Report Card gave the U.S. a “D” grade as measured by Healthy People 2010 goals set at 7.6 percent. According to the CDC, the preterm birth for 2009 was 12.18 percent of all births.
There are known strategies that can lower the risk of an early birth, such as smoking cessation, preconception care, early prenatal care, progesterone treatments for women with a history of preterm birth, avoiding multiples from fertility treatments and avoiding unnecessary c-sections and inductions before 39 weeks of pregnancy.
In addition, according to a new study published in Journal of Reproductive Medicine, women having their first baby, elective induction of labor is associated with negative outcomes for the mother, including increased rates of cesarean delivery, greater blood loss, and an extended length of stay in the hospital, and does not provide any benefit for the newborn.
Each Wednesday, our Birth & Parenting News blog highlights the latest news items, research results, consumer alerts, and legislative action alerts of interest to expectant and new parents and the professionals who work them.
Doula Business Advisor: Getting Paid
Doulas should not allow a payment decision to be based on the birth outcome, for example, in the case of a woman whose intention was to have a VBAC birth that ended in cesarean. Does she still have to pay her doula? You bet! You are not responsible for her birth outcome. She is! Everything you do in the course of building your relationship with her should communicate this simple fact—she is central to her own experience. You cannot protect her from the big, bad medical profession or save her from a repeat cesarean. You can support her in her strengths. Teach her how you will support her and help her set up a plan to succeed. Do your best, but, in the end, it’s all on her, and you need to get paid regardless.
At a minimum, doulas should be paid something to reserve time in their schedule and at least 50 percent (if not 100 percent) of the full fee paid prior to the birth. Exceptions can be made on occasion; however, if you are using credit cards to buy groceries so that your client doesn’t have to use her credit card to buy groceries, then your business is not viable.
The Doula Business Advisor blog is designed to support the establishment and long-term sustainability of private doula businesses. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Doula Programs: Substance Abuse During Pregnancy
The Indiana Perinatal Network has launched a web-based provider training program entitled “Integrating Screening and Treatment of Substance Use into Prenatal Care.” The 54-minute program addresses tobacco, alcohol, and other drug use during pregnancy and incorporates practical role-play scenarios with clinical and research-based materials and interventions. This award-winning program includes helpful resources and detailed clinical presentations on substance use-related topics.
Click on https://www.indianaperinatal.org/order.start.php to order this program or call the Indiana Perinatal Network at (866) 338-0825.
The Doula Programs blog provides a forum for doula program visionaries and implementers to consider common challenges, ask questions, and learn from each other. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.
Birth & Parenting News: Babywearing Safety
Babywearing can be an essential element in a new mom or dad’s sanity safeguard plan and part of the solution to reclaiming one’s life upon becoming a parent. Pretty much all babies really want to be held and carried–it’s just their nature. When caring for twins or multiples, or for moms with a toddler and a newborn, or a particularly fussy baby, babywearing is a gift. But recently babywearing has received some bad press. How can we wear our babies safely so we can tend to necessary tasks and meet the baby’s needs at the same time?
The Consumer Product Safety Commission (CPSC) is educating new parents on the safe use of slings and wraps for “babywearing.” Over the past 20 years, 14 infant suffocation deaths have been identified due to the use of sling-style carriers. Following review of these cases, child safety experts at CPSC recommend that parents with infants younger than four months of age, premature babies, low-birthweight babies, and babies with colds and respiratory problems should take extra care in using a sling.
When babies are contained entirely within the pouch of a sling with their face pressed against the adult’s body, their breathing can be blocked and suffocation/asphyxiation can occur. Some slings also tend to keep an infant in a curled, chin-to-chest position, which can interfere with breathing.
Click here for detailed recommendations on babywearing, including photos with proper and improper use of a sling.
Each Wednesday, our Birth & Parenting News blog highlights the latest news items, research results, consumer alerts, and legislative action alerts of interest to expectant and new parents and the professionals who work them.
Doula Business Advisor: Establishing a Payment Timeframe
Once you have set your rates for birth doula or postpartum doula services, the next step is to become proficient at collecting your fees. It will help considerably if you have set a fee that you believe is reasonable and feel, in your heart, that you are worth every penny. Commit to writing a payment policy. It is an essential piece of your client contract or “letter of agreement.” When must payment be made? How much is due each payment? At what point must the client pay in full? Communicate your fees and payment policy, without hesitation or apology, to the client.
I recommend that birth doulas collect their full fee prior to the start of the
“on-call” period, as defined by the contract. I ask for 50 percent of the total as a retainer fee at the time that the client hires me and signs the contract. If you can only accept two clients per month, then you may be turning down other work. You are being asked to make a commitment and you need the client to reciprocate. Commitment is a two-way street.
The balance is due at the final prenatal visit, scheduled at 36 weeks. That way, I am not in the position of asking for payment at a postnatal visit—a time when I want to continue my focused, caring support. If I have a tearful postpartum mom who is struggling with breastfeeding, it can be very difficult to bring myself to ask for payment if she doesn’t remember to pay without prompting. And, frankly, it is not likely to be the top thing on new parents’ minds. If the situation drags out, it is
amazing how quickly the doula will fall down on the list of priorities for who gets paid after the birth has concluded.
The Doula Business Advisor blog is designed to support the establishment and long-term sustainability of private doula businesses. Patty Brennan is the author of The Doula Business Guide: Creating a Successful MotherBaby Business.