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Emergency Medicine

Vaginal Birth After Cesarean Section (VBAC) + Repeat C-Sections: Myths vs Reality, Part Three

By and January 28, 2016 No Comments

Interview with Dr. Jean-Giles Tchabo

In my last two posts (which you can read here and here), I talked about my experience approaching the delivery of my second child, after having an emergency c-section for my first. My OB/Gyn, Dr. Jean-Giles Tchabo was someone I found who encouraged vaginal deliveries after cesarean sections (VBACs) as an option for women in my situation, so I interviewed him for answers to common questions about VBACs.

In the first post we dispelled some of the myths of VBACs, and in the second we delved deeper into the topic with a series of reader questions around policies, and health issues. In this post, we turn our focus to issues and science involved in e
mergency c-sections.

What is the difference in terms of procedure and experience between an emergency c-section and a repeat c-section?

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Categories: Pregnancy, Birth + Family Planning, Science 101 + Mythbusting

Pediatric Emergencies: Prepare to Avoid Them and Prepare To Deal With Them

By May 5, 2015 1 Comment

Summer break is nearly upon us – which means that about now, parents everywhere are weary of slogging through their kids’class projects and are ready for a break (yes, please!). But with the delicious siren song of summer comes all of the typical childhood shenanigans that lead to injury  – plenty of free time to putter around outdoors, attend camps, play sports, travel, play in the pool and slide on that old Slip’n Slide.

I can point to any number of old scars on my body and tell you a story about how I got them as a kid, playing outside during that long stretch of break between school years. It was a rite of passage to come back to school in September with a cast, stitches, a peeling sunburn, a new scar, or scabbed knees and elbows. The stats back it up, too – childhood injury and fatality rates historically spike during the summer time, when warm weather and more free time lead to less supervision and increased physical activity.

There are plenty of dos-and-don’ts for avoiding summertime injury and accidents, list after list of tips for parents to follow to keep their kiddos safe, such as those from the American Academy of Pediatrics and the Centers for Disease Control and Prevention. Personally, it seems like half of these injury prevention warnings are common sense (watch your young children around open water, don’t let your child operate motor vehicles of any kind, or play with fireworks), and the other half make me feel as though wrapping our kids in bubble wrap is an inadequate means of protection (don’t wash in scented soaps? Really?). Regardless, I’d recommend checking out those tips just to make sure you’re up to speed on solid preventative safety practices.

On the other hand, accidents do happen. According to the CDC, the #1 cause of death in children ages 1-18 is accident or injury. Though rare, top accidental causes of death causes include drowning, motor vehicle accidents, suffocation, and other physical injuries, which gives you an idea of what injuries would be on the extreme end of the spectrum of summertime accidents. The World Health Organization’s materials on child injury prevention have additional tips for accident and emergency preparedness, such as learning CPR designed specifically for children or infants and having a well-stocked first aid kit that includes emergency contact numbers in the event something does go awry.

A third piece of this preparedness puzzle is one that I believe tends to get lost in all of the “tips” chatter mentioned above. What do you do when your kid is hurt, when you’ve done what you can to protect them, and you need to get to the doctor ASAP? The last thing any parent needs is to be at a loss when something has gone wrong – and believe me, if you have kids, know kids, care for kids, are around kids in any capacity, you know it can happen easily.

A few years ago I had the great privilege to work with an outstanding group of perinatal doctors and nurses, who mentored me on the ins and outs of perinatal clinical care. In pediatric and neonatal intensive care and emergency care scenarios, all of the equipment you would expect to find is much smaller and very specifically made, tailored for use on literally miniature human bodies. Small intubation kits, smaller neck braces, tiny blood pressure cuffs, the list goes on and on.

Injury rates in pediatric patients increase during the summer

Injury rates in pediatric populations spike in the summer

Along those lines, a recently released study says that E.R.s in the US are now considered more well-prepared for pediatric patients in terms of appropriately-calibrated equipment and trained professionals. I consulted with my friend Julie Vass, a Maternal-Child Registered Nurse who has 23 years in the industry and two healthy adult children who have survived plenty of summer breaks, to discuss the pediatric readiness study.

Vass said that while it’s great that ERs are more prepared for children in those ways, parents should remember that an ER isn’t necessarily the best go-to option for kids with injuries, despite the fact that it can be panic-inducing as a parent when they’re hurt. She says it’s best to talk to your child’s doctor before you need to use emergency services.

“Ask your pediatrician, when should I take my child to the emergency room?” Vass says. “What conditions are serious enough that they can’t wait? And then find out which E.R.(s) or urgent care centers your child’s physician recommends.”

Typically physicians have practicing privileges in specific hospitals, or have familiarity with other facilities, which can help inform you of your local options. Also, for small children and babies some options may be better than others based on their size – so be sure to ask. Under the age of 8 or so, kids may require smaller equipment, but depending on their height and weight, children may alternatively be treated using the smallest adult-sized equipment. For standard treatments like stitches or setting broken bones, though, most hospitals can handle it easily.

Vass says that the most prepared trauma centers tend to be the larger, higher-level facilities, which may not always be your closest neighborhood/community hospital. That kind of information is good to know if you’re driving your child for care yourself. But remember, Vass says, if it’s a true emergency, a parent should always go to the nearest ER or better yet, call an ambulance, which typically rushes you to your closest and most immediate facility for care.

“Just remember, a small hospital can organize a transport team to a bigger location much faster than any parent,” said Vass, which can be reassuring for parents who aren’t familiar with their options or when time is of the essence.

I still have a tiny NICU blood pressure cuff given to me by one of my dear nursing friends, who knows of my penchant for miniature things. It fits perfectly around my pinky finger, much to my fascination. But it also reminds me of how crucial the right equipment is when it’s really needed. There really is no substitute for a properly prepared facility for our smallest patients – or an empowered, prepared parent who can advocate for their child when they need it the most.




Gausche-Hill M, Ely M, Schmuhl P, et al. A National Assessment of Pediatric Readiness of Emergency Departments. JAMA Pediatrics. Published online April 13, 2015. doi:10.1001/jamapediatrics.2015.138. Accessed May 4, 2015.

Loder, R.T., Abrams, S. Temporal Variation in Childhood Injury From Common Recreational Activities . Injury. Volume 42, Issue 9, September 2011, Pages 945–957 doi:10.1016/j.injury.2010.02.009 Accessed May 4, 2015.

Is it a Medical Emergency? Kids Health. Accessed May 4, 2015.

Foltran, F., Francesco, A. et al. Seasonal Variation in Injury Rates in Children: Evidence from a 10-year Study in the Veneto Regiion, Italy. International Journal of Injury Control and Safety Promotion. Volume 20, Issue 3, 2013. Accessed May 4, 2015.

2014 Summer Safety Tips. American Academy of Pediatrics. June 2014. Accessed May 4, 2015.

Family Health: Make Summer Safe for Kids. Centers for Disease Control and Prevention. Accessed May 4, 2015.

Stay Safe this 4th of July – Fireworks Info Page. Accessed May 4, 2015.

CDC Childhood Injury Report. Centers for Disease Control and Prevention. Accessed May 4, 2015.

WHO Child Injury Report Fact Sheet: What You Can Do To Keep Kids Safe From Injury. World Health Organization. Accessed May 4, 2015.

Ready Reference: Pediatric First Aid/CPR/AED. American Red Cross. Accessed May 4, 2015.

CDC Chart: Leading Causes of Death by Age Group 2013. Centers for Disease Control and Prevention. Accessed May 4, 2015.

CDC Chart: Leading Causes of Injury Deaths Highlighting Unintentional Injury.  Centers for Disease Control and Prevention. Accessed May 4, 2015.

Emergency Care of Children Fact Sheet/Guidelines. American College of Emergency Physicians. Accessed May 4, 2015.

When Your Child Needs Emergency Medical Services. Accessed May 4, 2015.

WHO Child Injury Report: Multimedia Guide. World Health Organization. Accessed May 4, 2015.

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Categories: Accidents, Injuries, + Abuse, Ages + Stages, Newborns + Infants, School-Aged Children, Toddlers + Preschoolers, Tweens + Teens

Accidental Medication Overdoses: the Pediatric Case for U.S. Metric Conversion

By April 1, 2015 3 Comments

When I encounter something that interests me, I tend to intensely focus on that subject and try to master the basics as soon as possible. Though I don’t consider myself “domestic” per se (since when does cooking and organizing within my home make me of the non-exotic/wild/free spirit variety? I have to eat and survive, don’t I?), I will admit I have recently taken on to teach myself some old-timey skills. I mean, after all, you never know when one of those godawful sci-fi plotlines come to fruition and we’re all forced to live primitively, right? I’m looking at you, Leslie, and your ardent love of The Walking DeadThat being said, I’ve taught myself how to bake bread. And not just any bread. Gorgeous, beautiful, delicious, and dare I say it, edible bread. Like a mad scientist, I’ve learned how to work with yeast and flour and make things happen. Like a grown up who does real things! Which brings me by way of a long introduction, to the topic of this post.

Did you know that most experienced bakers try to use recipes measured in the metric standard? I’m referring to yeast, flour, sugar, salt and water being measured in grams and milliliters, not the preferred US Customary Units, a version of the imperial system. I was completely irritated by it at first, being so accustomed to relying on my measuring spoons and cups, until I saw how a slight deviation in precision could lead to a bread science disaster.


My delicious bread, Loafy the Fourth

Somewhere along the way, the recipe I’d been faithfully using to produce what my future hubby and stepsons call Loafy the First and Loafy the Second, I slightly mis-measured. Not enough for it to be noticeable at first, of course; I checked and rechecked measurements and nothing seemed out of the ordinary. But as that mixer churned, I found that I was left standing with a bowl of sticky pellets, a frown, and the youngest of the wolfpack consoling me on the untimely passing of Loafy the Third.

I sometimes take my mistakes as issues of a bigger problem; was I not careful enough? Should I have rechecked once more? But, no matter. It’s easy to throw away $1 worth of dough and start again. But what if it had been something more important, like medication for one of the kids, our future babies, or even my cat?

I’m no stranger to medical malpractice on account of pediatrician-prescribed medication overdose. In fact, I’ve seen what it looks like up close, the suffering and long-term damage that can happen to a child as a result. It can be devastating both for the child and the parents that provided the medication.  And it’s not as uncommon as you would think – according to a recent policy paper by the American Journal of Pediatrics, each year more than 70,000 children end up in the emergency room due to accidental medication overdoses. Many of these are due to the difficulty in measuring appropriate dosages, which can be even more complicated for infants and children due to the frequency and small amounts – and the tendency to prescribe in teaspoons or tablespoons (which are neither consistent or standardized from home to home unless one uses cooking utensils).

Fortunately, The AJP has pushed in recent years for pharmaceutical conversion to metric measurements, and the American Medical Association and Food and Drug Administration support the transition as well. For tips on how to prevent a medication error with your own child, The Institute for Safe Medication Practices has advice for parents that CBC News summarizes well, which you can check out here.

In the meantime,  my wolfpack is a rowdy one and naturally rallied for a Loafy the Fourth. Which, thanks to my digital scale measuring in grams, came out perfectly. But really, I’m more grateful that this time, it was just an inexpensive mistake.


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Categories: Accidents, Injuries, + Abuse, Policy, Politics, + Pop Health