Mid-section of a prenant woman outdoorsDoctors, hospitals and judges have over the years attempted to control the decisions of pregnant women. In a recent Florida case, it’s not clear whether the controllers sought to protect the fetus, the woman or both. They may have wanted to protect the hospital from potential liability.

The case involved a 39-week-pregnant woman.

According to a press release issued by the National Advocates for Pregnant Women (NAPW), the hospital threatened to force the woman to have cesarean surgery against her will or risk being reported to child-welfare authorities. The woman, 29-year-old Jennifer Goodall of Cape Coral, had had three previous cesarean sections; based on those experiences, she elected to have a trial of labor for a normal vaginal delivery before agreeing to a c-section if it became necessary.

According to NAPW, the chief financial officer of Bayfront Health Port Charlotte sent a letter Goodall, threatening to report her to the Department of Children and Family Services, seek a court order to perform surgery and perform cesarean surgery on her “with or without [her] consent” if she went to the hospital. The hospital has declined comment on the case, citing patient confidentiality.

There are risks involved with repeated cesarean sections, as well as risks to women who have vaginal births after having had cesarean sections (known as VBAC). According to guidelines issued in 2010 by the American College of Obstetricians and Gynecologists (ACOG), ”attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans.”

ACOG reports that before 1970, VBAC was rarely performed, but the practice increased steadily, reaching 28 percent of women who had had previous c-sections by 1996. After that, the practice steadily declined, reaching 8.5 percent only a decade later. The apparent reason for the decline was the restrictions placed by hospitals and insurers on a trial of labor following previous cesarean sections. This shows that it is not only physicians, but also hospitals and insurance companies, who try to control pregnant women.

In 2005 the ACOG Committee on Ethics issued an opinion that included the following points:

  • Coercive and punitive legal approaches to pregnant women who refuse medical advice fail to recognize that all competent adults are entitled to informed consent and bodily integrity.
  • Court-ordered interventions in cases of informed refusal, as well as punishment of pregnant women for their behavior that may put a fetus at risk, neglect the fact that medical knowledge and predictions of outcomes in obstetrics have limitations.
  • Coercive and punitive policies are potentially counterproductive in that they are likely to discourage prenatal care and successful treatment, adversely affect infant mortality rates, and undermine the physician–patient relationship.

Despite these statements issued by the leading professional society of obstetricians and gynecologists in the United States, a federal district judge in Florida denied the request, set forth in a formal complaint filed by NAPW, for a temporary restraining order preventing the hospital from carrying out its threats.

The judge said that Ms. Goodall had no “right to compel a physician or medical facility to perform a medical procedure in the manner she wishes against their best medical judgment.” Apparently, one of the hospital’s concerns was malpractice liability in case of a bad outcome.

For her part, according to NAPW, the patient was willing to undergo a cesarean section if the trial of labor resulted in complications that would require a c-section for her or her baby’s health. The patient stated that her decision was “based on years of research, careful consideration of the risks to me and my baby, and my family’s needs.” This is not a woman whose decision was capricious or uninformed.

Over the weekend, Goodall gave birth to a healthy boy—at a different hospital. The hospital allowed her to choose VBAC; however, when it became obvious that the labor was not progressing, she elected to have a c-section. She reportedly stated on her Facebook page that all she wanted was to be given the option.

If this were an isolated case of an attempt to control the behavior of a pregnant woman, we could chalk it up to an excessively paternalistic medical environment and a judge who is ignorant of precedents set in other court cases that granted pregnant women the right to refuse coerced cesarean sections. But although appellate courts have upheld the right of pregnant women to refuse medical treatments, including c-sections, other actions continue to violate the decision-making autonomy of pregnant women.

As the ACOG guidelines clearly state, if a pregnant woman is informed of all risks, she should be empowered to choose the delivery method of her choice.

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EiSci club members present informaton at a Bronx high school

Viraj Patel and Carly Hirschberg, EiSci board members and second-year M.D. students at Einstein, visiting a Bronx high school class.

What do you picture when you think of a doctor or scientist?

We imagined that ninth graders at the Pelham Lab High School in the Bronx might see doctors and scientists as we do: altruistic, hard-working, smart, hip and even fun. We were wrong.

Instead, according to these students asked to draw their impressions, doctors had “brain juice” dripping from their ears and didn’t have time to do anything except work; scientists “lived in their lab coats”, had “frizzy hair”, and were described as “geeky, weird, and boring.”

That dreary impression illustrates why a diverse group of nine first-year Einstein students got together in 2013 to form EiSci, a group dedicated to encouraging local Bronx high school students to explore the sciences as a career.

Changing images and futures
We were all a bit shocked by the student drawings. We used the images as a conversation-starter. Did we appear at all like the drawings, we asked? They cautiously agreed that we did not, but in that moment we could see some of them had never considered that scientists could look anything different from their impressions. That doctors and scientists might actually look like us – or them.

Part of EiSci’s mission is to use research to help understand what’s driving only a dearth of minorities to pursue careers in science and medicine. We presented a literature search study earlier this year at the Columbia Teacher’s College Health Disparities Conference and Einstein’s Medical Student Research Forum.

Our research found that under representation was due to “aspirational disparities” for high school students living in these communities. The students we interviewed faced a number of high hurdles to a science career. The received inadequate or poor-quality college counseling and career guidance, had little access to career resources, had few academic support services, few scholarship opportunities and, last but not least, had no contact with medical or science role models.

Inspiring student aspirations
EiSci is using “aspirational education” to help address these challenges. This method exposes high school students to necessary resources, information and yes, living breathing medical students, Ph.D. students, doctors and scientists!

On a practical level, this means our volunteers lead personalized mentoring sessions and take students into Einstein classrooms and labs they might otherwise not have the chance to visit. EiSci also shows what it takes to realize career goals by matching student interests with scientific demonstrations.

For instance, we have conducted DNA extractions and solved fake crimes via fingerprint testing and even tested blood to determine its type.

Once we’ve sparked interest in medicine and science through creative examples, our medical and Ph.D. student volunteers each meet regularly with a high school mentee to reinforce the lessons learned.

EiSci is in its early days. While we’re short on results just yet, we’re definitely deep on passion and commitment. We are determined to change perceptions about the medical and scientific fields.

Rather than see roles filled by awkward disengaged brainiacs, we hope our students can envision the promise of science and medicine as consider their own futures.

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Yiyu Zou, Ph.D.  - Einstein Magazine

For Einstein scientist Yiyu Zou, Ph.D., the struggle against lung cancer and the crusade to find better treatments are deeply personal.

In a recent Einstein magazine article, Dr. Zou explained what it was like in China watching his father, a heavy smoker, lose 80 percent of his lung capacity. He eventually died from lymphoma. [click to continue…]

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Children performing chemistry experiement When a child is admitted to the hospital, you can usually count on three things. Time seems suspended. There’s often apprehension. And there’s seldom enough to keep a child’s curious mind occupied and his or her spirits lifted.

Family members are present and the hospital’s medical staff is focused on providing medical care—both of which are critically important. Yet many hospitals lack the resources to offer enough recreational activities to keep the minds of their youngest patients engaged.

Helping fill the gap is Project TEACH (Together Educating All Children in Hospitals), founded in the spring of 2013.

TEACH is a joint Einstein and Yeshiva University undergraduate student-run initiative under the guidance of Einstein’s executive dean, Edward Burns. It allows students to plan and lead educational lessons and modules in hospital playrooms.

Fun lessons in the hospital
Here’s how it works. Volunteers come to the hospital prepared with fun and educational modules. The sessions are designed to give children a healthy activity while also spurring their interest in learning.

There are about 14 different modules each month, and each has anywhere from 1 to 35 child patients in attendance. The sessions provide parents and guardians comfort; they know their children can keep their minds engaged while their bodies are being treated.

Popular modules include an egg-drop experiment where the objective is to protect an egg from a fall; making materials like Silly Putty; and telling stories through artwork. These lessons are fun and distract the children’s minds from the sometimes difficult treatments they face.

It’s interesting to watch how the same experiment can have different meanings for different groups and ages of children. For example, when we do an experiment that creates color by adding a substance to a liquid mixture, the older children apply what they have learned about acids and bases while the younger kids just have a good time mixing the solutions and guessing if the indicator is going to turn red or blue.

Training the next generation
Project TEACH extends its influence beyond the hospital walls. Through TEACH, Einstein and Yeshiva students interact with diverse local high school students who are part of the Einstein Enrichment Program.

We train these students how to prepare and demonstrate the TEACH modules. This allows them to volunteer at hospitals while providing a unique leadership opportunity. They get a chance to do science experiments with the kids. Many of the high school students have an interest in research or medicine. We see TEACH as a great way to encourage their career pursuits.

TEACH ran its pilot program in the spring of 2013 at The Children’s Hospital at Montefiore and has since grown greatly, with almost 300 volunteers operating in an additional seven hospitals and facilities: Long Island Jewish Medical Center, Mount Sinai Beth Israel (EEG unit), Jacobi Medical Center, NewYork–Presbyterian/Weill Cornell Medical Center, NewYork–Presbyterian/Morgan Stanley Children’s Hospital, NYU Langone Medical Center and Einstein’s Rose F. Kennedy University Center.

We see this growth as a tremendous sign of the need for Project TEACH and hope it will expand further, helping both the students who teach and the children whose lives the program enriches. 

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Ebola Virus at 108,000 MagnificationThe deadly outbreak of Ebola virus in West Africa is the worst on record, with over 603 deaths reported as of July, 12, 2014 (according to the CDC Ebola outbreak update). The virus is confirmed in Guinea, Liberia and Sierra Leone ─ and the crisis appears to be far from over. [click to continue…]

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