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The doctor won’t see your newborn now

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At Lake Norman Regional, nurses are replacing neonatal care doctors; Medical group says it is “dangerous”

The following article appeared in the June 11, 2021 issue of The Charlotte Ledger, an e-newsletter of intelligent and original news about the Charlotte area from seasoned local journalists.

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◼️ Nurses are replacing neonatal care doctors in a Charlotte hospital to reduce costs

◼️ Doctors claim it is “dangerous” for babies

◼️ Hospital staff: nurses “are better than a doctor” and “more experienced than a pediatrician”

By Michelle Crouch

When you go to the hospital to have a baby, you can expect a doctor to carefully examine your newborn after it’s born to make sure that your little bundle of joys is perfectly healthy.

But when you deliver at Lake Norman Regional Medical Center in Mooresville, that’s no longer the case.

In March, the hospital hired a team of neonatal nurses to replace the certified pediatricians and neonatologists who saw the newborns earlier. This means that there are no doctors examining the babies there.

The changes at Lake Norman Regional are part of a growing national trend to replace doctors with nurses, creating a heated debate about how much independence should be given to highly skilled nurses.

Proponents say it can lower healthcare costs and give patients more access to care at a time when doctors are scarce, especially in rural areas. However, doctors fear that healthcare facilities are using nurses to cut costs at the expense of patient care.

Doctors protest: The Lake Norman Regional decision prompted more than 200 members of a medical group for women in the Charlotte area to sign a letter to CEO Clyde Wood asking him to reconsider the decision. The letter stated that critical medical problems in infants can appear quickly and without warning, and that it requires “attuned and well-trained eyes” to identify subtle signs that may indicate a health problem.

“A trained doctor with years of clinical experience can make the difference between life and death in these situations,” the letter says. “Your decision to replace doctors and neonatologists with nurses is dangerous and deliberately endangers the care and well-being of our most precious asset – the newborn.” (See full letter here.)

It is not uncommon for smaller hospitals to staff neonatal units with nurses. A small study published in an Oklahoma medical journal found that the quality of care did not decrease under this agreement.

However, it is unclear how common it is in a medical center that doctors do not see their babies at all. The maternity centers at Novant and Atrium Hospitals in the Charlotte area, as well as the Iredell Memorial in Statesville, Piedmont Medical Center in Rock Hill, and CaroMont Regional in Gastonia all have doctors to examine their newborns.

However, Davis Regional in Statesville also relies on neonatal nurses instead of doctors. Davis Regional and Lake Norman Regional share the same leadership team and are both owned by Community Health Systems Inc., a large for-profit hospital operator.

The hospital replies: Lake Norman Area Spokeswoman Leigh Whitfield declined to answer specific questions from The Ledger or make administrators available to discuss the change, but emailed a number of statements in response to questions.

She said the hospital’s maternity center provides “safe, quality care” and stressed that the hospital’s neonatal nurses “specialize in infant care with extensive backgrounds in the neonatal intensive care unit.”

Whitfield said the hospital’s neonatal care center fell from a Level II center to a Level I center in March when the nurses came on board. Level I crèches can only look after the healthiest babies born after the 35th week of pregnancy.

When babies need advanced medical care, Lake Norman Regional transfers them to hospitals in Charlotte and Concord, Whitfield said. The Atrium and Novant Presbyterian Newborn Intensive Care Units (NICUs) at the Carolinas Medical Center are both Level IV, the highest level.

Not enough sick babies: Lake Norman Regional had two neonatologists until last year when one left for another job. Instead of filling the position, hospital administrators used temporary workers to fill their shifts. (A practice known in the medical community as “locum tenens”.)

The hospital discharged the other neonatologist when it brought in the nurses. Neonatologists are doctors who specialize in treating newborn babies, especially those who are premature or sick.

Dr. James Zolzer, an OB / GYN who gives birth to babies in the hospital, said administration told him that the Lake Norman area did not have enough newborns with serious health problems to justify keeping neonatologists on staff. According to PayScale, neonatologists make an average salary of $ 227,943 per year, compared to $ 107,330 for neonatal nurses.

The Ledger asked if the hospital had reduced its neonatal care fees as replacing neonatologists with neonatal nurses should result in significant cost savings. Whitfield didn’t answer the question.

NC requires medical supervision: Nurse Practitioners are specially trained nurses who have advanced skills and at least a Masters degree. They can order and interpret diagnostic tests, prescribe medications, and perform treatments, but have less training and fewer clinical hours than doctors.

At least 22 other states should allow nurses to practice without medical supervision, and a bill before the legislature would also drop North Carolina’s duty of supervision.

For the time being, however, the state requires nurses to be “monitored” by a doctor. The law does not require the doctor to take direct supervision; it just requires doctors to make an agreement with the nurses they care for and meet with them every six months.

Claims of the medical “supervision” controversial: In an email, Whitfield said the hospital’s newborn nurses work “under the direct supervision of a neonatologist”.

That’s not true, said Dr. Ashleigh Maiers, a Charlotte cardiologist who was the lead author of the letter to the hospital chief. Or at least, she said, the hospital is expanding the definition of “direct supervision”.

Maiers said a hospital administrator told her that neonatologists were available to nurses through telemedicine and that an outside pediatrician would sign patient notes at the end of the day that were written by the nurses but did not see the babies themselves.

“He doesn’t have to touch the baby. He doesn’t even have to speak to the nurse, ”said Maiers, who had her babies in Lake Norman Regional.

A doctor in the hospital who did not want to be named confirmed the agreement.

It is also worrying that the hospital is not more transparent to patients, says Maiers. On its website, the Lake Norman Regional Medical Center announces that its maternity care team “includes knowledgeable, certified obstetricians and neonatologists.”

What does the hospital say to the patient? The Ledger called the main Lake Norman Regional number to see what they are saying to patients about newborn care levels. We were transferred straight to the birth house.

The woman who answered the phone said the neonatal nurses are highly skilled and work in level IV intensive care units in Charlotte. “You’re better than a doctor,” she said. “I know it sounds scary, but they are the ones who really care about these babies. You can line up, intubate, anything a neonatologist can do. You have more experience with sick babies than a pediatrician. “

If nurses have questions or concerns, they can call or ask a neonatologist to come to the hospital.

If a baby is born unexpectedly prematurely or has health problems, staff stabilize the baby and then take the child to a larger hospital by plane or ambulance, the woman said. A nurse stays with the baby.

But if a new mom wants to be with her baby, she either has to be relocated or she has to apply for an early release from Lake Norman Regional and travel to Charlotte or Concord.

Why don’t paediatricians do checkups? When the Ledger asked Whitfield why local pediatricians stopped visiting babies in the hospital, she implied that the doctors made the decision to stop: “It is the doctor’s choice how he or he structures his practice. If … a doctor switches to primary outpatient treatment, this means that he has decided not to carry out any treatment in the hospital that involves rounding the patient. ”

The woman who answered the phone at the birthing center had a similar explanation: “They have decided that they do not want to come on weekends and in the middle of the night.”

Many paediatricians nationwide no longer visit their patients in hospitals. But many hospitals hire a pediatrician to take on this role.

The ledger couldn’t reach pediatricians who used to visit babies in the hospital. However, a doctor at the hospital told The Ledger that after the nurses were admitted, the hospital informed the pediatricians that they could no longer walk around the hospital as the nurses had an exclusive contract.

After resistance from the medical profession, the hospital gave in, but the pediatricians decided not to return. “They didn’t feel welcome at this point,” said the doctor. “The hospital has basically ousted them.”

OB / GYN measures “security level”: Zolzer, the OB / GYN, said the changes in the hospital wouldn’t affect the vast majority of his patients, who have normal pregnancies and healthy babies. But he now has to send some of his high-risk patients to other hospitals for delivery.

He said he had given birth to a high-risk pregnancy patient in Lake Norman Regional since the change, and the neonatal nurse had “handled it exactly – just as if a neonatologist had been there,” he said.

Even so, he said he would prefer to have a neonatologist in the hospital. “You can solve more complicated problems and the mother and baby can stay in the same facility,” he said. “It’s another layer of security.”

Michelle Crouch is a freelance writer and a regular contributor to The Ledger, which often writes about healthcare. Send her story tips to michellecrouchwriter@gmail.com.

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Women’s Health

Australia’s first private, women’s-only mental health hospital opens » J-Wire

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Browse> Home / News / Australia’s First Women’s-Only Private Psychiatric Hospital Opens

November 30, 2021 from J-Wire Newsdesk

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Cabrini Health has officially opened the Lisa Thurin Women’s Health Center in Melbourne’s Elsternwick.

Victoria Governor Linda Dessau, Gandel Foundation Director Lisa Thurin, and Mental Health Parliamentary Secretary Steve Dimopoulos, MP, unveiled the plaque at the official opening of the Lisa Thurin Women’s Health Center.

Parliamentary Secretary for Mental Health, Steve Dimopoulos, MP, today officially opened the Lisa Thurin Women’s Health Center, the country’s first private psychiatric hospital for women only.

Located in the heart of Elsternwick, this service focuses on the treatment of mental illnesses such as mood disorders, addictions and complex trauma, including post-traumatic stress disorder (PTSD).

The building was partially funded by philanthropist and Gandel Foundation director Lisa Thurin.

The women’s health center Lisa Thurin is a modern, 30-bed ward with psychosocial treatment options, paired with new, individualized treatment methods in a private and safe environment.

A short-term mental health program is supported with intensive daytime programs, telemedicine and community support. This model of care is driven by some of Australia’s leading psychiatrists with a special interest in women’s mental health and research.

Sharon Sherwood, Chief of Mental Health and Outreach at Cabrini, said the new care model will give women access to innovative care and offer holistic treatments to optimize outcomes.

“While both men’s and women’s mental health need to be addressed, we know that there is significant unmet need, especially among women,” said Sherwood.

“Aside from the lack of beds, many women do not get help because they feel insecure at the thought of having to go into a common mental health space with men and women.

“The Lisa Thurin Women’s Health Center is a safe environment where women with mental illness can focus on their treatment and getting back to their community.”

Internationally renowned expert on women’s mental health, Professor Jayashri Kulkarni, is the director of the new women’s mental health hospital.

“My many years of research and clinical experience underpin many of the new, holistic treatments that we offer for women with depression, trauma-related problems and addictions,” said Prof. Kulkarni.

“We are further developing our collaborative care model, which combines the most modern innovations with friendliness, respect and compassion – everything tailor-made for women.”

Sue Williams, chief executive of Cabrini Australia, said the global COVID-19 pandemic had highlighted the surge in the number of people with mental illness.

“The incidence of mental health problems has increased significantly in the past two years,” said Ms. Williams.

“Social isolation, domestic violence and financial hardship have all contributed to this surge and people feel like they are not going anywhere.

“We are a mission-based organization and we felt it was important to meet the unmet needs of these vulnerable women.”

Gandel Foundation philanthropist and director Lisa Thurin, who made a generous donation to build this hospital, said it is important to her that women prioritize their health and have the opportunity to meet their own special health needs.

“Through this center we have the unique opportunity to help women with their special and specific psychological needs in a room and an environment in which they can feel safe and secure,” said Ms. Thurin.

“This is truly a silent epidemic that is not being adequately addressed and that requires a concerted effort to provide a personalized approach to women’s needs and problems.”

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Inside the Last Abortion Clinic in Mississippi

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JACKSON, miss. – Patients that morning included a teenage girl with her mother, a nearby hospital clerk in gowns, a college student in a sorority t-shirt, and a woman who left the house for the seven-hour drive long before sunrise from Texas.

They’d all come to get an abortion from the last Mississippi clinic.

Dr. Cheryl Hamlin, an obstetrician and gynecologist from Massachusetts who is part of a rotation of out-of-state doctors who do the work local doctors don’t.

“The state of Mississippi obliges me to tell you,” said Dr. Hamlin, “that having an abortion increases your risk of breast cancer.”

“Don’t,” she added without hesitation. “Nobody thinks that it is. The American College of OB-GYNs does not believe this is the case. “

The clinic, Jackson Women’s Health Organization, has long negotiated measures intended by lawmakers to discourage women from having abortions and to make surgery difficult for doctors. They include a requirement that doctors warn patients about a link between breast cancer and abortion, although the American Cancer Society says that “scientific evidence does not support this notion.”

Now, the culmination of that legislative effort – a state law banning abortion after 15 weeks of gestation – has put the clinic at the center of what could lead to one of the most momentous abortion law rulings in decades.

The Jackson Women’s Health Organization sued Mississippi over the new restrictions, and attorneys will try the case in the Supreme Court on Wednesday. The effects will most likely be felt well beyond Jackson. The law was created as a direct challenge to Roe v. Wade designed that established a constitutional right to abortion and prevented states from banning the procedure before fetus viability, which most experts estimate at around 23 or 24 weeks.

The law, which provides exemptions for medical emergencies or serious fetal abnormalities, reflects efforts by state leaders to “make Mississippi the safest place in America for an unborn child,” said Phil Bryant, the former Republican governor, when he signed the bill in 2018.

If justices overturn Roe entirely, the verdict will trigger laws in about a dozen states – including Mississippi – that make abortions illegal almost immediately. Even if Roe isn’t completely overturned, the court could give states more leeway to limit how and when abortions are performed.

Although the Jackson Clinic is in danger of survival, it has never been so busy. In the past few months, it has expanded its operating hours from three days a week to five. The phone keeps ringing with people trying to make appointments, calling from all over Mississippi and more and more from Texas – an influx attributed to the new law, which is the most restrictive there. The clinic now sees around 300 women a month.

“Our patient burden has nearly doubled,” said Shannon Brewer, the clinic’s director. “We adapt,” she added. “We just know it has to be done.”

The weight of the ramifications of the judgment was inevitable. Camera crews have been crowding into Ms. Brewer’s office for the past few weeks. The cover of Time magazine featured a photo of her staring frantically into the distance.

But taking the time to think about it all feels like a luxury. “When I get home and I am, I go to sleep,” said Ms. Brewer. “I don’t sit up and think about it.”

Dr. Hamlin, who travels to Mississippi about once a month, arrived at the clinic around 8 a.m. on a Monday with two and a half full days ahead of her.

The morning started with government-mandated counseling sessions that begin a 24-hour countdown before patients are allowed to complete the abortion process. About half a dozen women sat in a back room at a time while Dr. Hamlin provided an overview that vividly illustrated the conflict between Mississippi’s legal requirements and her professional opinion.

“There are a lot of laws that restrict the care we can offer here,” said Dr. Hamlin. “I encourage all of you – if this is an important issue for you – to vote in all upcoming elections.”

The women then lined up individually to speak to her. They came from all walks of life, but mostly reflected the demographics of Jackson, which has a predominantly African American population, and Mississippi, one of the poorest states in the country.

As a patient sat across from the desk, Dr. Hamlin in a folder with a copy of her sonogram and medical information. Her blood pressure was a little high, she found.

“You might also be nervous,” said Dr. Hamlin.

The woman needed a surgical abortion. Dr. Hamlin looked through a calendar. Her only option was to come back the next day or wait another week which would leave her a narrow window. The 15-week restriction has been put on hold pending a court ruling, but the clinic, restricted by a variety of other state laws, only performs abortions for up to 16 weeks.

“I would like to come tomorrow,” replied the woman, “but I want to make sure that I have all the money.”

Surgical procedures range from $ 650 to $ 800. Drug abortions cost $ 600. Patients must pay in cash or by credit card, but financial support is also available.

“Why don’t I put you up for tomorrow?” said Dr. Hamlin. “And if for any reason you feel you can’t make it, just let us know.”

“Because of course,” she added, “the sooner the better.”

Known as the Pink House for its flamingo-colored stucco, the clinic is located in Jackson’s lively Fondren district, a small arts district with boutiques, cafes and trendy restaurants.

It preceded the neighborhood’s boom and has resulted in a sometimes awkward neighbor. Protesters for and against abortion regularly face each other outside, often at high volume.

The entrance to the clinic is blocked by a black fence to protect the privacy of the patients. That day a protester walked along the outside while women walked in, “You are already mom and dad to the baby!” She yelled. “Let us help you! You’re paying someone to kill your baby!”

Derenda Hancock, who leads the Pink House defenders, as the volunteers who escort women into and out of the clinic are called, apologized to a patient on the other side of the fence.

“You won’t block me,” the woman replied. “I have to live with it. You don’t have to live with it. “

Just outside the fence, Pam Miller, an anti-abortion protester, waved as cars came and went, trying to give the women gift bags of Cheez-It crackers, applesauce, and a leaflet about reversing the effects of the first part of a drug Abortion, a practice touted by anti-abortion groups but considered by many researchers to be based on dubious science.

“For me it is a biblical subject,” said Ms. Miller, “because God created man in His image and that means that we are special, we are of intrinsic worth just because we are like that.”

Dr. Hamlin had planned to become a veterinarian, but a student advisor pushed her into medical school. In her first year she accompanied a doctor who had her seen giving birth to a woman.

“I just thought it was the most wonderful thing I’ve ever seen in my life,” she recalls. “I cried.”

She decided to become a gynecologist. “I just felt like the doctors were so paternalistic,” said Dr. Hamlin, who finished her specialist training in 1992.

In autumn 2016, Dr. Hamlin, a hospital doctor in the greater Boston area, unsettled by the election of Donald J. Trump. She realized that there was a large part of the country that she did not understand. She signed up to work at the clinic in Jackson and another one in Alabama.

On a typical day in Jackson, she sees more than a dozen patients and most of her counseling sessions last only a few minutes.

“This is your first pregnancy?” asked Dr. Hamlin saw a patient and scanned her medical records. “Looks like you’re healthy. Your blood pressure is good Blood count is good. All right, anything else? “

The afternoons are devoted to surgical procedures and group sessions where she dispenses pills for drug abortion and introduces women to the process.

From her desk, Ms. Brewer, the clinic director, is watching a screen showing the view of security cameras set up in the clinic, alerting them to any signs of a problem. There have been threats and confrontations have broken out outside.

“I’m a very cautious person because of this place,” said Ms. Brewer, who has been a director for 11 years and an employee for 20 years.

Jackson is a town of around 154,000 people that can feel like a small town, which is especially true for the people who work in the clinic. Ms. Brewer lived down the street from a regular protester. Occasionally she sees others in the supermarket. “Usually they seem more frightened when they see me outside of this place,” she said.

After the last patient left that day, Dr. Hamlin went through a pile of folders on her desk, checking charts and signing paperwork.

The clinic hadn’t had a staff doctor for over a decade. Local doctors have declined to do this work, whether on moral grounds or out of safety concerns. Instead, the clinic maintains a house to accommodate doctors from other states. Dr. Hamlin keeps a pair of running shoes and clothes there, but her connection with the city is limited. Her job is not safe, but unlike other women who work in the clinic, she knows that she can return to Massachusetts after any short trip.

“I come and go,” she said, “and they carry on.”

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More countries ‘trying to coerce women to have more children’, report finds

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Study shows three out of ten countries in the world now have pro-natalistic policies – defined as measures aimed at increasing the birth rate (Getty Images Europe)

One report found that more and more countries are adopting policies that force women to have more children.

About three in ten nations around the world now have pro-natalistic guidelines encouraging citizens to have more children, according to the charity Population Matters.

Researchers examining United Nations data found a significant increase from the 10 percent of nations that enacted such policies in 1976.

The paper highlighted examples of pronatalism persecuted in countries such as Turkey, Russia, Hungary, Poland, Iran, and China.

However, it also warned that politicians in the US and Germany are beginning to advocate parallel policies.

Monica Scigliano, author of the report, said: “When people think of forced population policies, they often think of examples like China and India where leaders tried to limit population growth by forcing women to have fewer children.

“But now that birthrates are falling and emigration is reversing demographic trends in some cases, that has changed.

“As people continue to choose smaller families, more and more governments around the world are resorting to coercive tactics and depriving people of their reproductive rights in order to enlarge their populations.”

Ms. Scigliano, a political adviser, said nationalism could spawn a “toxic type of pronatalism” that poses an “almost inevitable threat to sexual and reproductive health and rights”.

Researchers warned that nationalist governments violate women’s rights to reproductive and sexual freedom – suggesting that “right-wing, populist, and nationalist governments stigmatize women who choose to have smaller families as unpatriotic”.

Proponents of pro-natalist politics sometimes believe in the deeply racist and xenophobic conspiracy theory of the “Great Substitute” that upholds Christian and European populations and their cultures are being exterminated as immigrants from Muslim countries relocate overseas to avoid human rights abuses.

The report found that Viktor Orban, Hungary’s far-right prime minister, has proposed “a comprehensive deal with Hungarian women” in order to have more children. The Führer promotes debt-free education for women, but only if they have at least three children.

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He also promised that women who have four or more children would never have to pay income tax again.

“We want Hungarian children. For us, migration means surrender, ”Orban said earlier.

The researchers also drew attention to the pro-natalist policies in Poland, where a near-complete ban on abortion was passed last October – further tightening the country’s already very restrictive abortion laws and sparking the largest protests in the country since the collapse of communism.

Under the new laws, it is now illegal to terminate pregnancy in the event of fetal defects. Abortion was previously prohibited in Poland for a long time, but fetal malformations were one of the exceptions where abortion was allowed, as well as cases of rape, incest or the death of the mother.

Before the strict new abortion rules were introduced, about 98 percent of the tiny number of legal abortions that took place in the predominantly Catholic country were cases of fetal defects.

Activists have blamed the new for the recent death of a 30-year-old pregnant woman named Izabela, who died after being denied emergency surgery when doctors said they had to wait until they could no longer hear her baby’s heartbeat.

Antonina Lewandowska, an abortion rights activist and one of the authors of the report, said anti-abortion activists in Poland forced doctors into “such a state of anxiety” that they would rather than “septic shock” Izabela having an abortion earlier and therefore “saving your life”.

She said, “They fear law enforcement and stigma as the pro-natalist anti-electoral movements would likely eat them alive. On the other hand, there is a group of medical professionals who are more likely to be satisfied with the current situation.

“As they argue that medical negligence is more the result of the ‘freezing effect’ of a hideous law than their own incompetence, mistake, or conscious choice not to provide their patients with necessary medical care – an abortion – because of their personal beliefs.

“In both cases it is clear – aggressive, fundamentalist pronatalism has paved the way for human rights violations in Poland.”

The report is titled Welcome to Gilead, a nod to The Handmaid’s Tale – a 1985 dystopian novel by Margaret Atwood set in a patriarchal, totalitarian state where women are forced to bear children for a ruling class of men.

Robin Maynard, Director of Population Matters said, “Forced prenatalism is not simply a manifestation of patriarchy or misogyny, but can be a product of political and economic forces completely indifferent to women for whom they simply exist as productive or unproductive wombs.

“These regimes exploit women’s bodies to serve nationalist, economic and patriarchal interests. Violation of sexual and reproductive health and rights is never justified. It is imperative that we defend them all wherever they are threatened and for whatever reason. “

The report warned world leaders that choosing fewer children would hamper their “economic and political goals”.

“Pronatalism is often associated with a restrictive, patriarchal ‘pro-family’ agenda and the promotion of ethnic nationalism, often based on religious orthodoxy and hostility to multiculturalism and immigration,” researchers added.

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