I learned from Representative Tyler Olson today that the Iowa Department of Public Health has released draft regulations to implement the public smoking ban set to go into effect on July 1. Go to www.iowasmokefreeair.gov to read and comment on the regulations.

I was tough on the House Democrats earlier this year for putting so many exemptions in the smoking ban, but I understand that those were necessary to get the bill through the lower chamber.

Legislators removed some of the exceptions when the House and Senate versions were reconciled in conference. My hope is that a court may strike down some of the exemptions that remained in the final version of the bill.

For those who are still bent out of shape about the new law, I again offer my 10 suggestions to help smokers stop whining about the smoking ban.

The press release I got today from Representative Tyler Olson is after the jump.

Over at Daily Kos, nyceve put up another shocking diary about the practices of for-profit insurance companies in the U.S.

Today she links to this article from the New York Times about women facing higher insurance premiums, or even being denied insurance coverage, after giving birth by cesarean:

Insurers’ rules on prior Caesareans vary by company and also by state, since the states regulate insurers, said Susan Pisano of America’s Health Insurance Plans, a trade group. Some companies ignore the surgery, she said, but others treat it like a pre-existing condition.

“Sometimes the coverage will come with a rider saying that coverage for a Caesarean delivery is excluded for a period of time,” Ms. Pisano said. Sometimes, she said, applicants with prior Caesareans are charged higher premiums or deductibles.

This problem could affect millions of American women:

In 2006, more than 1.2 million Caesareans were performed in the United States, and researchers estimate that each year, half a million women giving birth have had previous Caesareans.

“Obstetricians are rendering large numbers of women uninsurable by overusing this surgery,” said Pamela Udy, president of the International Caesarean Awareness Network, a group whose mission is to prevent unnecessary Caesareans.

Although many women who have had a Caesarean can safely have a normal birth later, something that Ms. Udy’s group advocates, in recent years many doctors and hospitals have refused to allow such births, because they carry a small risk of a potentially fatal complication, uterine rupture. Now, Ms. Udy says, insurers are adding insult to injury. Not only are women feeling pressure to have Caesareans that they do not want and may not need, but they may also be denied coverage for the surgery.

The New York Times piece also mentions one woman who was rejected for coverage by the Golden Rule Insurance Company:

She was turned down because she had given birth by Caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified.

Great news–all she has to do to get health insurance coverage is be sterilized!

Seriously, we need a national health care policy that prohibits insurance companies from refusing to cover people with pre-existing conditions.

Until that happens, women would be advised to do whatever they can to reduce their risk of having a c-section.

Some surgical births are unavoidable, and in those cases it is a lifesaving procedure. However, there are ways to reduce the risk of having an unnecessary cesarean.

I advise women who are pregnant or planning to become pregnant to strongly consider using a midwife for your prenatal care, labor and delivery. Most midwives have a far lower cesarean rate in their practices than obstetricians.

One New Jersey hospital that has a thriving midwifery program has the second-lowest rate of c-sections in that state, “despite serving a low-income urban patient population that is more likely to have high-risk pregnancies.”

Hiring a certified doula to help the mother during labor and delivery has been shown to reduce the rate of cesarean births as well. You can have a doula assist you whether you are under the care of a midwife, an obstetrician or a family doctor, whether you give birth in a hospital, a birth center or at home.

You should also seek information about the c-section rates of the hospitals and birth centers in your area, if you have a choice. As I mentioned  in this post on cesarean births in Iowa, the percentage of babies born by c-section can vary widely from hospital to hospital.

For more information on cesarean births and the benefits of having a doula, click here.

Sobering news about the long-term effects of fine particulate matter in the air:

As many as 24,000 deaths annually in California are linked to chronic exposure to fine particulate pollution, triple the previous official estimate of 8,200, according to state researchers. The revised figures are based on a review of new research across the nation about the hazards posed by microscopic particles, which sink deep into the lungs.

“Our report concludes these particles are 70% more dangerous than previously thought, based on several major studies that have occurred in the last five years,” said Bart Croes, chief researcher for the California Air Resources Board. Croes will present his findings at a board meeting in Fresno this morning.

The studies, including one by USC tracking 23,000 people in greater Los Angeles, and another by the American Cancer Society monitoring 300,000 people across the United States, have found rates of heart attacks, strokes and other serious disease increase exponentially after exposure to even slightly higher amounts of metal or dust. It is difficult to attribute individual deaths to particulate pollution, Croes conceded, but he said long-term studies that account for smoking, obesity and other risks have increasingly zeroed in on fine particulate pollution as a killer.

What are the primary sources of fine particulate pollution? According to the World Health Organization:

“Short-term epidemiological studies suggest that a number of source types are associated with health effects, especially motor vehicle emissions, and also coal combustion. These sources produce primary as well as secondary particles, both of which have been associated with adverse health effects. One European cohort study focused on traffic-related air pollution specifically, and suggested the importance of this source of PM. Toxicological studies have shown that particles originating from internal combustion engines, coal burning, residual oil combustion and wood burning have strong inflammatory potential.

Translation: we now have even more compelling health reasons to reduce vehicle-miles traveled by car and not build any new coal-fired power plants in Iowa.

The Iowa Department of Natural Resources has more information about fine particulate levels in our state.

The Des Moines Register reported on Monday that a group of business owners is raising money to challenge the smoking ban that is slated to go into effect on July 1.

They have not yet retained an attorney, in part because they have not reached a consensus about the right legal angle. Some want to challenge the law’s exemptions, recognizing that there is little hope of getting the whole bill overturned:

Randy Stanford, a Des Moines small business owner who organized Iowans for Equal Rights, said no smoking ban has ever been overturned.

“They can waste their money any way they want, but there’s only one legal issue,” he said. “I wish there was a way to challenge the entire bill and be successful, but there isn’t.”

The only option is to “get rid of the unfair exemptions that are in the bill,” he said.

Stanford said the exemptions give some over-21 entertainment venues a financial advantage over others. “How can they say it won’t hurt the other small businesses when they say it’ll hurt the casinos?” he asked.

As for exactly which exemptions would be targeted, Stanford said: “That would be up to the judge. I have no clue what they would strike.”

The Register reported that some of the businesses want to retain former Governor Tom Vilsack, who said he would be open to taking the case if it focuses on overturning the law’s exemptions:

“It would be sort of reinforcing the law,” he said. “The Constitution requires you to treat people equally. … I think we have a legitimate argument.”

Vilsack said he has not yet been officially asked to represent anyone, but if he is asked, his law firm would first have to ensure there would be no potential conflicts.

“I feel very strongly about this. This is significant and important,” Vilsack said. “When we craft laws, even though there may be political reasons for exemptions, the Constitution may not recognize those exemptions.”

From my perspective, this is all good. The exemptions were needed to get the smoking ban through the Iowa House. Now that it has been signed into law, I would be pleased to see a court strike them down. That would protect even more Iowa workers and their children from the many health hazards associated with secondhand smoke.

While the casino owners and their lobbyists would fume, research suggests that their anger would be unfounded. Contrary to what many business owners in the hospitality industry believe, smoking bans do not hurt the bottom line. On the contrary, smoking bans often lead to increased sales, as well as other economic benefits for businesses. Many people will go back to places they’ve been avoiding because of the smoke.

Not long ago I posted about a poorly-researched and poorly-written article by the Associated Press on the rising rate of cesarean births in Iowa.

Lisa Houchins, a mom in Des Moines who is also education director for the International Cesarean Awareness Network, responded to the same article with this letter to the editor that the Register published earlier this week:

Regarding, “More U.S. Women Delivering Babies by Caesarean Section” (March 29): According to the World Health Organization, more than half of all Caesareans in the United States could be avoided. When used properly, a Caesarean can be a life-saving procedure. When used indiscriminately, C-sections introduce unnecessary risks to mothers and infants.

Women who deliver by Caesarean are more likely to have complications, including increased pain and recovery time, infection or death. Babies delivered by Caesarean are also more likely to suffer complications.

Women with Caesareans are at increased risk for miscarriage, infertility and complications in later pregnancies. Also, their future birthing choices can be severely limited. Some hospitals (including many in Iowa) and doctors are attempting to ban vaginal births after Caesareans.

Caesareans may be safer than they were 20 years ago, but that does not make them safer than a vaginal birth. C-sections are major surgery, and they should be reserved for times when there is a true medical indication. I encourage all pregnant women to educate themselves on how to avoid a Caesarean and how to have the safest and most satisfying birth possible.

April is Cesarean Awareness Month, and the ICAN website notes:

What is Cesarean Awareness Month? An internationally recognized month of awareness about the impact of cesarean sections on mothers, babies, and families worldwide. It’s about educating yourself to the pros and cons of major abdominal surgery and the possibilities for healthy birth afterwards as well as educating yourself for prevention of cesarean section.

Cesarean awareness is for mothers who are expecting or who might choose to be in the future. It’s for daughters who don’t realize what choices are being taken away from them. It’s for scientists studying the effects of cesareans and how birth impacts our lives. It’s for grandmothers who won’t be having more children but are questioning the abdominal pains and adhesions causing damage 30 years after their cesareans.

CESAREANS are serious. There is no need for a ‘catchy phrase’ to tell us that this is a mainstream problem. It affects everyone. One in three American women every year have surgery to bring their babies into the world. These women have lifelong health effects, impacting the families that are helping them in their healing, impacting other families through healthcare costs and policies, and bringing back those same lifelong health effects to the children they bring into this world.

Be aware. Read. Learn. Ask questions. Get informed consent. Be your own advocate for the information you need to know.

There is lots of information on the ICAN website, so if you or your partner or your friend is pregnant, I encourage you to check it out. C-sections can be lifesaving procedures, but it makes sense to take reasonable steps to avoid having unnecessary surgery.

The ICAN of Central Iowa website has statistics comparing c-section rates in the largest Iowa counties and hospitals.

If you want to avoid a cesarean birth unless it is medically necessary, ask about c-section rates when you are choosing a provider.

Don’t induce labor without medical need (for instance, because you hit your due date, or because you don’t want to go into labor over a weekend), because trying to induce a cervix that isn’t ripe is more likely to lead to “failure to progress” and a resulting c-section.

Consider getting a certified doula to help with childbirth education during pregnancy and to support the mother during labor. The website of Doulas of North America explains the benefits of having a doula:

Women have complex needs during childbirth and the weeks that follow. In addition to medical care and the love and companionship provided by their partners, women need consistent, continuous reassurance, comfort, encouragement and respect. They need individualized care based on their circumstances and preferences.

DONA International doulas are educated and experienced in childbirth and the postpartum period. We are prepared to provide physical (non-medical), emotional and informational support to women and their partners during labor and birth, as well as to families in the weeks following childbirth. We offer a loving touch, positioning and comfort measures that make childbearing women and families feel nurtured and cared for.

Numerous clinical studies have found that a doula’s presence at birth

   * tends to result in shorter labors with fewer complications

   * reduces negative feelings about one’s childbirth experience

   * reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans

   * reduces the mother’s request for pain medication and/or epidurals

Research shows parents who receive support can:

   * Feel more secure and cared for

   * Are more successful in adapting to new family dynamics

   * Have greater success with breastfeeding

   * Have greater self-confidence

   * Have less postpartum depression

   * Have lower incidence of abuse

Click through to find links to some research. Dads, don’t worry about the doula trying to take your place during labor. My husband is a huge advocate for doulas. She doesn’t do your job–she just helps the mother with practical advice based on training and the experience of attending many births. She will not freak out to see the mother in pain, and she will be able to reassure both parents if panic sets in while labor is progressing normally.

I know women who would have ended up with c-sections if not for their doulas. In one case, the baby was presenting with the cheek rather than with the crown of the head. The medical staff were convinced a c-section was the only way to get that baby out, but the doula encouraged the mother to try leaning and squatting in some different positions during and between contractions. After a few tries, the baby shifted, and the rest of the labor was over in less than 20 minutes.

When I was in college nearly 20 years ago, I remember reading an article in the Des Moines Register about the rising rate of births by cesarian-sections in Iowa. At some rural hospitals, the rate was approaching 25 percent, and that was alarming to some doctors.

Now almost a third of all births in Iowa are by c-section, and in some counties that figure is above 40 percent.

During the past week, the Des Moines Register, Cedar Rapids Gazette and several other newspapers  published this piece from the Associated Press about the rising rate of cesarean births, which quotes several women in Linn County and Johnson County.

Unfortunately, the article does a poor job of assessing the causes of the this trend and ignores the most significant problems associated with unnecessary c-sections. I explain why after the jump.

Who, besides smokers themselves, is most harmed by smoking in public places?

People who work in very smoky rooms in restaurants, bars and casinos. If you work a 40-hour week in one of those places, you might as well be a pack-a-day smoker yourself.

So it’s disappointing to see that the Iowa House substantially changed the proposed ban on smoking in most public places, according to the Des Moines Register:

http://www.desmoinesregister.c…

Smoking opponents called the new version of the bill a devastating blow to an earlier proposal that would have prohibited smoking at an estimated 99 percent of Iowa’s public places. They said the exemption approved by the House would weaken current law because, in some cases, special nonsmoking sections of restaurants would be unnecessary.

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“It’s not very much good at all,” said Dan Ramsey, director of advocacy for the American Lung Association of Iowa. “It’s pretty much useless at this point.”

It sets up a showdown with the Iowa Senate, which has approved a widespread smoking ban that would include casinos, as well as nearly all bars and restaurants.

Some laws address problems, and some are intended to give the appearance of addressing a problem. The House version of the smoking ban is clearly the latter. It would do little to help the Iowans who are most at risk of falling ill because of exposure to second-hand smoke.

I sometimes take my kids to the Waveland, a classic old-fashioned diner in Des Moines. Last year I was stunned when the owner made that restaurant smoke-free. He said he had noticed over time that families were less likely to come because they didn’t want their kids around the smoke.

I would have thought the Waveland regulars would have rioted over a smoking ban, but the waitresses there told me everything went great with the transition. It’s a much more pleasant place to eat now, and the employees are not exposed to second-hand smoke all day long.