Amos Grünebaum, MD

ABSTRACT:
In the United States, 98.3% of patients give birth in hospitals, 1.1% give birth at home, and 0.5% give birth in freestanding birth centers. This review investigated the impact of birth settings on birth outcomes in the United States. Presently, there are insufficient data to evaluate levels of maternal mortality and severe morbidity according to place of birth. Out-of-hospital births are associated with fewer interventions such as episiotomies, epidural anesthesia, operative… Show more

ABSTRACT:
In the United States, 98.3% of patients give birth in hospitals, 1.1% give birth at home, and 0.5% give birth in freestanding birth centers. This review investigated the impact of birth settings on birth outcomes in the United States. Presently, there are insufficient data to evaluate levels of maternal mortality and severe morbidity according to place of birth. Out-of-hospital births are associated with fewer interventions such as episiotomies, epidural anesthesia, operative deliveries, and cesarean deliveries. When compared with hospital births, there are increased rates of avoidable adverse perinatal outcomes in out-of-hospital births in the United States, both for those with and without risk factors. In one recent study, the neonatal mortality rates were significantly elevated for all planned home births: 13.66 per 10,000 live births (242/177,156; odds ratio, 4.19; 95% confidence interval, 3.62–4.84; P<.0001) vs 3.27 per 10,000 live births for in-hospital Certified Nurse-Midwife–attended births (745/2,280,044; odds ratio, 1). These differences increased further when patients were stratified by recognized risk factors. Causes of the increased perinatal morbidity and mortality include deliveries of patients with increased risks, absence of standardized criteria to exclude high-risk deliveries, and that most midwives attending out-of-hospital births in the United States do not meet the gold standard for midwifery regulation, the International Confederation of Midwives’ Global Standards for Midwifery Education. As part of the informed consent process, pregnant patients interested in out-of-hospital births should be informed of its increased perinatal risks. Hospital births should be supported for all patients, especially those with increased risks. #birthcenter #home birth #hospital birth
#midwife#neonatal morbidity
#out-of-hospital birth #patient autonomy Show less

ABSTRACT:
A birth defect is a structural or chromosomal change present at birth that can affect almost any part or parts of the body. Birth defects can vary from mild to severe. On June 24, 2022, with its Dobbs v Jackson Women's Health Organization decision the Supreme Court of the United States overturned Roe v. Wade, removing the longstanding landmark 1973 ruling that secured a person's constitutional right to an abortion. With this decision individual states can now decide their own… Show more

ABSTRACT:
A birth defect is a structural or chromosomal change present at birth that can affect almost any part or parts of the body. Birth defects can vary from mild to severe. On June 24, 2022, with its Dobbs v Jackson Women's Health Organization decision the Supreme Court of the United States overturned Roe v. Wade, removing the longstanding landmark 1973 ruling that secured a person's constitutional right to an abortion. With this decision individual states can now decide their own abortion laws. In about one-half of the states that continue the legality of pregnancy termination, the process of offering, discussing, and performing terminations of pregnancy remain the same as previously. In states where abortions are not legal, there will be conflicts between the law and the ethical responsibility of physicians to offer and discuss termination of pregnancy for severe anomalies. Show less

ABSTRACT:
Natural language processing—the branch of artificial intelligence concerned with the interaction between computers and human language—has advanced markedly in recent years with the introduction of sophisticated deep-learning models. Improved performance in natural language processing tasks, such as text and speech processing, have fueled impressive demonstrations of these models’ capabilities. Perhaps no demonstration has been more impactful to date than the introduction of the… Show more

ABSTRACT:
Natural language processing—the branch of artificial intelligence concerned with the interaction between computers and human language—has advanced markedly in recent years with the introduction of sophisticated deep-learning models. Improved performance in natural language processing tasks, such as text and speech processing, have fueled impressive demonstrations of these models’ capabilities. Perhaps no demonstration has been more impactful to date than the introduction of the publicly available online chatbot ChatGPT in November 2022 by OpenAI, which is based on a natural language processing model known as a Generative Pretrained Transformer. Through a series of questions posed by the authors about obstetrics and gynecology to ChatGPT as prompts, we evaluated the model’s ability to handle clinical-related queries. Its answers demonstrated that in its current form, ChatGPT can be valuable for users who want preliminary information about virtually any topic in the field. Because its educational role is still being defined, we must recognize its limitations. Although answers were generally eloquent, informed, and lacked a significant degree of mistakes or misinformation, we also observed evidence of its weaknesses. A significant drawback is that the data on which the model has been trained are apparently not readily updated. The specific model that was assessed here, seems to not reliably (if at all) source data from after 2021. Users of ChatGPT who expect data to be more up to date need to be aware of this drawback. An inability to cite sources or to truly understand what the user is asking suggests that it has the capability to mislead. Responsible use of models like ChatGPT will be important for ensuring that they work to help but not harm users seeking information on obstetrics and gynecology. Show less

The Apgar score introduces a bias by systematically lowering the score in people of color. Embedding skin color scoring into basic data and decisions of health care propagates race-based medicine. By removing the skin color portion of the Apgar score and with it's racial and ethnic bias, we will provide more accuracy and equity when evaluating newborn babies worldwide.

Adverse outcomes are known to occur more commonly with certain risk factors. Our study shows that well over 60% of all intended home births in the United States are not low risk, and that these women have at least a single or several combined obstetric risk factors.
Appropriate patient selection to include only low-risk women among intended home births would reduce adverse outcomes. This can be done best by establishing risk guidelines for patient selection at intended home births as they… Show more

Adverse outcomes are known to occur more commonly with certain risk factors. Our study shows that well over 60% of all intended home births in the United States are not low risk, and that these women have at least a single or several combined obstetric risk factors.
Appropriate patient selection to include only low-risk women among intended home births would reduce adverse outcomes. This can be done best by establishing risk guidelines for patient selection at intended home births as they exist in other countries such as in Canada, the Netherlands, Germany, New Zealand, Australia, and England. In these countries, twins, breech, meconium, and postterm births, for example, are considered contraindications to intended home births; in addition, women >34 years of age, those who are obese, those with prior cesarean deliveries, and grand multiparous women are advised of their increased risks and against home births as part of the informed consent process. In contrast to these countries, no established guidelines for patient selection exist in the United States for intended home births.
Intended home births have been put forward as a viable option to reduce obstetric interventions and cesarean deliveries. However, to quote Clark et al., “… promulgating practice directives that are marginally evidence-based or influenced by social pressures are both ineffective and potentially harmful.”
Improving adverse outcomes of intended home births requires the appropriate selection of low-risk candidates and the exclusion of patients at high risk. Invoking patient autonomy as the basis for including high-risk patients at planned home births is unprofessional. Professionalism for birth attendants at planned home births requires establishing and following guidelines that define low-risk pregnancies for intended home births and recommending against high-risk intended home births. Show less

Lessons in Survival: All About Amos by Susan L. Pollet is the life story of Amos who was born in Haifa, Israel, raised in post World War II Germany under difficult financial circumstances and with parents who suffered the effects of having been in concentration camps. He managed to succeed against all odds, despite having been the only Jewish boy in his school classes amongst seven hundred students. He eventually moved to New York City where he became a board certified doctor, a professor at a… Show more

Lessons in Survival: All About Amos by Susan L. Pollet is the life story of Amos who was born in Haifa, Israel, raised in post World War II Germany under difficult financial circumstances and with parents who suffered the effects of having been in concentration camps. He managed to succeed against all odds, despite having been the only Jewish boy in his school classes amongst seven hundred students. He eventually moved to New York City where he became a board certified doctor, a professor at a major medical institution, an international lecturer, a published author of numerous peer reviewed journals and a few popular books, a holder of several patents, and the creator and operator of major medical websites. He overcame the challenges of traumatized parents, poverty, his own ill health, divorces, the loss of family to the Holocaust and the loss of many friends to suicide.Amos’s life story is inspirational for anyone who has major life challenges, which includes a wide audience as evidenced by Oprah’s popularity. Amos is a unique and fascinating personality. It explains how he dealt with his family’s dark and tragic history, and how his strong spirit, and the lessons learned from his parents, allowed him to survive, thrive, and to never succumb to bitterness. Show less