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Ethicon Media Monitoring 5/4/2018
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The enduring mystery of the postpartum pooch
May 4, 2018 | CNN
By Elissa Strauss
Culturally, the postpartum body is a source of abiding fascination. We are enthusiastic observers of women's shapes after childbirth and celebrate those who shed all evidence of pregnancy a few months after having a baby. -
Safety in Numbers?
May 3, 2018 | Lexology
By Duncan Batchelor
Holyrood has given the green light to new law bringing US-style "class actions" to Scotland for the first time. The aim is to improve access to justice, especially for consumers, by grouping similar claims together - but is the new procedure up to the mark? -
The cancer screening scandal is no surprise – older women are too often ignored
May 3, 2018 | The Guardian
By Gaby Hinsliff
How can almost half a million women go missing, and nobody notice? Yet that is what we are told has happened. Jeremy Hunt, the health secretary. -
Men must come on board for women's rights
May 3, 2018 | Evening Echo Cork
By Colette Sheridan
IF you’re of a conspiratorial disposition, you could be of the view that there is a vast apparatus aimed at keeping women subjugated, silenced and shamed.
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The enduring mystery of the postpartum pooch
May 4, 2018 | CNN
By Elissa Strauss
Culturally, the postpartum body is a source of abiding fascination. We are enthusiastic observers of women's shapes after childbirth and celebrate those who shed all evidence of pregnancy a few months after having a baby. These are the women who, as tabloids put it, "bounce back," even though few believe that the effort involved was akin to bouncing or any such rapid and organic movement.
Medically, the postpartum body is basically invisible. In the United States, women generally have just one appointment in this period, six weeks after childbirth, and it tends to be brief. (The American College of Obstetricians and Gynecologists recently recommended changing this.) We are largely -- and a little hopelessly -- on our own when navigating the various aches and dysfunction that pregnancy and childbirth leave in their wake.
Not only did I not bounce back after my pregnancies, but the notion of bouncing, in any direction, sounded awful. Like many women, I had postpartum abdominal separation, known clinically as diastasis recti abdominis and colloquially as mummy tummy: The connective tissue between my rectus abdominis, a.k.a. the six-pack muscles, had stretched out about 2 inches. I also was feeling quite unstable, and I assumed that these two things were related.
Ob-gyns don't routinely screen for or discuss abdominal separation, despite the fact that up to 60% of women experience it to some degree during the first year postpartum and an estimated 33% are dealing with it beyond that. Many of us discover that we have it after experiencing pain, impaired mobility or, yes, the not-always-beloved lower belly pooch that tends to happen as a result.
I was experiencing all of the above when I signed up for a postpartum rehabilitation class led by my yoga teacher. A dutiful student, I followed each and every instruction. I avoided crunches, which allegedly would widen the gap. And I worked hard on strengthening my transverse abdominis, the muscles that run up and down the sides of our midsections, which allegedly would bring it all together.
Months passed, and I felt stronger, slimmer. But the gap remained. Did I fail at the regimen? Or, more likely considering my deep commitment, did the regimen fail me? Also, when, if ever, could I consider myself healed?
Now, research shows that I was right to be suspicious. Doctors and physical therapists still don't know what heals abdominal separation -- or whether it needs to be healed at all.
"It may not be fun to hear, but at the moment, we don't know how to fix it with the tools we have," said Dr. Elwin Mommers, who studies hernias at Maastricht University Medical Center in the Netherlands.
Very little is known about diastasis recti
Mommers is the lead author of a review of studies on abdominal separation published in December in the journal Surgical Endoscopy. He and his team sorted through all the available research on the topic and found that it offered very little in the way of clarity. There was a shortage of quality studies to draw conclusions from, and the few quality studies out there didn't yield any substantial findings.
They couldn't find any evidence that physiotherapy brings together the gap or that one particular exercise plan is more effective than another. Yes, women who take up an exercise plan might leave it with a smaller gap -- but it's likely that the gap would have closed on its own, without the exercises. Mommers said women should see this as a reason to ignore any overly prescriptive exercise plans that prohibit things like back bends and crunches, and do what feels right for their bodies.
" 'You can do anything you want' is the first thing we tell them. If you look at the studies, the exercises that are prescribed to treat it, or attempt to treat it, are completely opposite of each other. Some focus on stretching, others focus on pulling it all together, and none of them work," Mommers said.
He added that many looking to document the benefits of an exercise plan measure the gap when the muscles are contracted. In this state, a stronger core might more effectively push together the center muscles and make it appear as though the gap has shrunk. The trick, he said, is to measure in a relaxed state in order to accurately determine results.
Many believe that when the connective tissue between the abs is stretched out, it also becomes weaker, but Mommers says this isn't necessarily true. "If it were weak, then [people with abdominal separation] would be more prone to develop hernias, and there is absolutely no proof that abdominal separation eventually results in hernia," he said.
Mommers' research also led to him conclude that although surgery can help close the gap and make the belly flatter, it doesn't necessarily lead to more stability. For now, it appears to be mostly a cosmetic fix.
Another new study, published in the journal Physical Therapy, also casts doubt on the current consensus surrounding abdominal separation treatment. A group of Norwegian researchers looked at whether strengthening the transverse abdominis -- widely recommended, including by my instructor -- really works. It doesn't.
Kari Bø, a professor at the Norwegian School of Sports Sciences and one of the study's authors, said the findings surprised her. She believed that such exercises were the solution. Now, she's not so sure.
"It is a very prevalent condition, [but] unfortunately, the evidence behind any advice we give is very low or nonexistent," she said.
The one recommendation she can make with some confidence is that "there should be no outward or visible opening up when doing abdominal exercise." So crunches and back bends are fine as long as the stomach isn't bulging out during them.
Her research has also led her to cast doubt on whether the abdominal separation is really the cause of back and pelvic floor pain. She said studies show that the prevalence of such symptoms in postpartum women is not higher in those with mild to moderate separation, compared with those with no separation. "It may be that for many women, a tiny gap may not influence function."
Still, Bø understands that a "cosmetic problem is still a problem" and is planning to study the way they can affect a woman's life.
What women can do
Even if core training doesn't help close the gap, it might help with the associated pelvic floor issues and back pain. Bø said there is strong evidence that training the pelvic girdle can help with urinary incontinence and pelvic organ prolapse. She said there is no evidence that specifically working the transverse muscles helps with back pain, among the general population. She is not aware of any studies looking specifically at those with abdominal separation.
However, there is some evidence that overall core strengthening helps with lower back pain -- and there's little doubt that pregnancy and childbirth weaken the core, especially in the short term.
Wendy Powell, founder and CEO of MUTU System, an online exercise program for postpartum recovery, said that women with back pain or pelvic floor issues should focus more on alignment and strength and less on the gap.
"It's not all about gap. That's a disservice. The idea that this gap is the problem and closing it is the solution -- we are missing what matters," she said.
Powell said women should look for exercise programs that take the whole body into account, not just isolated muscles. "To me, success looks like function, a body that works, that doesn't hurt, that doesn't leak, bulge, protrude or feel pressure."
According to this definition of success, I seem to be mostly healed. My body works just fine now. There's not much in the way of pain, leaking or bulging when working out my core. Just last night, I bounced around the living room with my two children without fear of retribution from my midsection.
But that gap? Unless I opt for what I now know would be entirely cosmetic surgery, it appears to be here to stay.
Elissa Strauss writes about the politics and culture of parenthood.
https://edition.cnn.com/2018/05/04/health/postpartum-abdominal-separation-parenting-strauss/index.html
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May 3, 2018 | Lexology
By Duncan Batchelor
Holyrood has given the green light to new law bringing US-style "class actions" to Scotland for the first time. The aim is to improve access to justice, especially for consumers, by grouping similar claims together - but is the new procedure up to the mark?
On 1 May 2018, the Scottish Parliament passed the Civil Litigation (Expenses and Group Proceedings) (Scotland) Bill. Coming 40 years after Scottish lawmakers first contemplated multi-party procedure, it fulfils recommendations left over from Lord Gill's 2009 Scottish Civil Courts Review. Arguably long overdue, Scottish "group procedure" is finally set to become law. But how will this impact litigation in practice?
An Ad Hoc Approach
Scottish courts currently have no formal procedure to deal with multiple claims as a group. To get around this, litigants adopt the pragmatic solution of running one or two "test cases" to trial, while the rest are paused. This is not ideal, as claimants still need to raise each case individually, at considerable expense. To compound problems for both sides, there is no certainty, as a test case decision is not usually binding on the rest.
Large or complex group claims have called for a more creative approach. In the pelvic mesh and Vioxx drug litigations, the Court of Session set out bespoke procedure in Practice Directions. Whether the court actually has power to do this has been questioned.
Against this background of uncertainty, group procedure has been widely welcomed in Scotland. The proposals enjoyed vigorous support from personal injury lawyers and consumer groups, who say costs for pursuers would massively reduce. Businesses would be deterred from harmful behaviour by the threat of mass litigation; corporate social responsibility would be encouraged; a streamlined, cost-effective outcome would be delivered; and precious court time saved. Access to justice is the central theme. But does the new procedure match these ambitious, noble aims?
When it comes into force in summer 2018, group procedure in Scotland will look like this:
Available only in the Court of Session.
Minimum of two claims per group, but no maximum.
"Opt-in" - relevant claims are not automatically included in the group.
One representative party's case, not necessarily a member, is heard on behalf of the group.
A decision in the representative party's case is binding on the group.
The court must give permission to apply the procedure, which will only be granted if all of the claims "raise issues (whether of fact or law) which are the same as, or similar or related to, each other."
Unanswered Questions
In fact, the procedure raises more questions than answers, particularly for defenders. For example:
Why exclude the sheriff court, which is surely a more cost-effective forum for low-value claims?
Why "opt-in" procedure? Why not "opt-out," where cases meeting set criteria are automatically conscripted, unless they choose to leave the group? Imposing the step of opting-in on claimants increases costs. It also risks outlier claims running alongside the group.
How would a decision in those claims affect the group? How will a claimant join the group?If they need to raise individual proceedings, that negates the purpose of the procedure. If they simply add their name to a list, how will defenders know all claims are genuine?
Perhaps most importantly, what defines "similar" or "related" claims? This is ripe for dispute. Must all claims have the same defender? The same legal basis? The same facts? The wording of the Bill casts the net widely - maybe too widely. On one view, all asbestos cases are "similar" and all claims against the NHS "related." Guidance will be needed from the court to make these new definitions workable in practice.
The American Way
In the USA, group procedure has been around for decades. There, a distinction is drawn between "mass tort" and "class actions." In mass tort, every claimant is a member of a group but treated as an individual. In a class action, there is a representative who stands in for the rest of the class. All members of the class are treated as one claimant, not separately. Specific criteria must be met for an action to proceed as a class action.
Interestingly, and regrettably, there is no attempt to draw the same distinction in Scotland. A missed opportunity perhaps? Here, it remains to be seen whether the one-size-fits-all procedure will be flexible enough to adapt to the complexities of modern group litigation. Specific court rules are yet to be developed by the Scottish Civil Justice Council, so the devil may ultimately be in the detail. Hopefully those rules will strike a balance between reducing cost and inconvenience for claimants and maintaining protection for defenders from potentially spurious claims.
https://www.lexology.com/library/detail.aspx?g=0c515b06-c7bc-456b-86bd-774330b405dd
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The cancer screening scandal is no surprise – older women are too often ignored
May 3, 2018 | The Guardian
By Gaby Hinsliff
How can almost half a million women go missing, and nobody notice? Yet that is what we are told has happened. Jeremy Hunt, the health secretary, came to parliament on Wednesday to confess that up to 450,000 older women in England may have somehow fallen off the breast cancer screening system, thanks to a computer glitch. Unravelling the real-life consequences of that is a complicated and contested business, but Hunt said it was likely there were people who “would have been alive today if this had not happened”; and that up to 270 lives may have been shortened. The next few days will be difficult ones for already overloaded GP surgeries and screening clinics, with anxious women now calling the hotline set up by the Department of Healthin their thousands. But brushing something like this under the carpet was hardly an option.
It should be said, however, that this is not another Windrush scandal. It’s down to a faulty computer algorithm, rather than to some kind of hostile medical environment; the glitch that wrongly cancelled some women’s scans crept in accidentally in 2009, during the setting up of a pilot project on whether it was worth expanding the screening programme, not in some attempt to chop it back. Nonetheless, eight years is a hell of a long time for nobody to notice. Older women – that perennially invisible group – can be forgiven for wondering whether it would have happened to anyone else.
Those worst affected would have been in their late 60s when their scans were cancelled and perhaps in their 70s when they started getting sick, a time of life when bad news is half-expected and medicine becomes mainly about managing decline not reversing it; when routine visits to the doctor end in apologetic mumbling that unfortunately, these things are to be expected when you get older. And older women are so often not the type to make a fuss. They’re of a generation that waits to be served, doesn’t like to bother anyone, trusts the people in charge to know what they’re doing. Of late, they have not been repaid well for that trust.
Think of the Waspi (Women’s Against State Pension Inequality) women, who didn’t realise the government had moved the goalposts on their state pension age until it was too late, and whose subsequent rage at their poverty has fallen on deaf ears. Think even of the middle-aged women who suffered for years from complications from vaginal mesh, whose complaints of agonising pain and infections weren’t taken nearly seriously enough at first, because they were often post-menopausal and well, what do you expect at your age, after a few difficult childbirths? They too found it difficult to get a public hearing, because incontinence and pelvic pain are not considered glamorous stories. Given the indignities heaped upon them – their erasure from a culture still fixated on the young – it’s surprising in a way that older women are not more radicalised politically.
To be fair to the NHS, it’s possible that the inquiry Hunt has ordered will discover that this isn’t as bad as it initially looks. Most of the women who missed a scan would thankfully have been perfectly healthy; some of those who didn’t get called in will have had scans for other reasons, such as finding a lump by themselves or being part of a programme of extra checks scheduled for women who have had breast cancer in the past. It may be that there were never enough cases clustered in the same place for doctors to spot a pattern of patients presenting with tumours who inexplicably hadn’t had mammograms for years, or for clinics to wonder why women who diligently showed up for previous scans had mysteriously stopped coming.
My heart goes out to all the grieving families who will now be wondering if their mothers and wives could have lived for longer, but sadly even some of those who died after missing a scan might not necessarily have been saved by screening. Early diagnosis gives a much better chance of survival, but it is not a cast-iron guarantee of anything.
The sad thing, however, is that the women themselves presumably weren’t asking questions. When the letters stopped coming, they must have just assumed they’d had their lot from the NHS. It’s an age when you get used to dropping off people’s radar, after all. It is partly to avoid such human blind spots, of course, that algorithms like those our public services now use to manage data exist in the first place. Machines are meant to excel at routine tasks like churning out appointments and they don’t make emotional judgments about what you can expect at your age (or at least, not unless they’re programmed by people who do).
But we have grown so used to relying on computers to do the thinking and the remembering for us that we barely realise how much has been delegated to systems we don’t particularly understand, and didn’t realise could fail until it was too late – as those TSB customers still struggling to get into their bank accounts after an almighty car crash of an IT upgrade will know. The cervical cancer scandal currently unfolding in Ireland, where early abnormalities were not picked up in the cases of over 200 women who went on to develop cancer, and who in some cases have since died, is another grim reminder that no system is infallible.
It is important not to over-romanticise the past. These scandals did not used to happen, but only because worse ones did; before screening, more women died unnecessarily. For all its flaws and the hotly debated risks of over-treatment, screening has saved thousands of lives over the years, including in my own family. The risk remains small, but if you’re putting off a smear test, prostate check or mammogram then for heaven’s sake, go. But it isn’t women’s fault that, for whatever reason, the system missed any clue that something had gone awry for eight years. And all too often, dismissiveness and casualness is what older women have been taught to expect from a society that looks right through them. They need to be reassured that the doctor will, in all possible senses of the word, see them now.
https://www.theguardian.com/commentisfree/2018/may/04/cancer-screening-it-glitch-jeremy-hunt-older-women
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Men must come on board for women's rights
May 3, 2018 | Evening Echo Cork
By Colette Sheridan
IF you’re of a conspiratorial disposition, you could be of the view that there is a vast apparatus aimed at keeping women subjugated, silenced and shamed. And you would probably be right. Look at the cervical cancer screening scandal, the barbarism of symphysiotomy and the awful side effects of vaginal mesh implants used for incontinence, sometimes arising from childbirth. Despite the great strides made by feminism and the assertiveness and honesty of a small number of mostly prominent Irish women, speaking publicly about their abortion experiences, we still live in a society that would prefer if we just shut up and got on with reproducing, so that there will be enough people to contribute towards pensions for our ageing population.
As we recoil from gruesome posters defacing our streets, asking if Repeal the 8th Amendment is “a licence to kill” and statistics such as “one in five pregnancies” in pagan England results in pregnancy (untrue) and a huge billboard ad that I spotted on Southern Road depicting a fat baby of about ten months with a thought bubble saying; “I had no idea..” followed by the statement “They want to legalise abortion up to six months”(untrue), women are being goaded to put their wombs to use as the Government is developing a ‘baby boom strategy.’
Get this: In order to encourage women to reproduce, there is going to be a rollout of ‘baby boxes’ for all new parents. The boxes, which will contain items such as blankets and nappies, can double up as cribs. Wow, what great housekeeping — a container of necessities for babies that can also be used in such a practical way. If only the baby-producing business was such a cosy scenario. But as we know all too well, being pregnant in this country isn’t always a happy affair. It can result in a grim trip to the UK to terminate a crisis pregnancy. Or, consider that three women in Ireland today will take illegal abortion pills to abort a foetus, alone and without medical supervision. We have abortion in this country. It’s just that it’s outsourced or precariously carried out in bedrooms and bathrooms. It’s an Irish thing — our hypocritical and inhumane solution to a problem, a problem that won’t go away.
Strolling along the Grand Parade the other night with a friend, a pro-life campaigning man and woman sidled up to us and offered us a leaflet. Out of curiosity, I took one while my friend delivered a mini-lecture on compassion, complaining that supposedly much valued babies are often left in dire circumstances once they’re born, because of economic hardship. The leaflet, pink and blue, contains sketches of a foetus at various stages. The sketches depict chubby-looking foetuses (unrealistic) and the theme of the message is of the ‘epic’ journey the foetus takes.
‘Epic’ is a good word to describe the whole baby business. Having a child is a life-changing event and one that shouldn’t be forced on teenagers, victims of rape and incest and women who are carrying foetuses that have a fatal abnormality.
The pro-lifers will tell you that Ireland is safe place in which to be carrying a child. Oh yeah? Savita Halappanavar anyone, who died as a result of the 8th Amendment? In the current issue of Hot Press magazine, Dr Peter Boylan, the former Master of the National Maternity Hospital, a key witness in the inquiry into the tragic death of Savita Halappanavar, has clearly identified at least three women whose lives have been lost directly as a result of the 8th Amendment.
In the interview, Dr Boylan says that as a young doctor, he used to be opposed to abortion. However, he changed his mind having witnessed first-hand, the pain and suffering many women are forced to endure with pregnancies involving fatal foetal abnormalities, life threatening situations or crisis pregnancies.
The 8th Amendment equates the right to life of the foetus with that of the pregnant woman. Dr Boylan poses the question: “How close to death does a woman have to be before we can intervene?”
The truth is, no one can possibly know. How many more lives will be lost if the 8th Amendment isn’t repealed?
One welcome if rather belated development in the whole referendum debate is Irish male celebrities encouraging men to exercise their vote on May 25. Cork-born actor and Hollywood star, Cillian Murphy, in conversation with Blindboy Boatclub from the Rubberbandits, said last week: “Men and women are custodians of this society. We both decide what’s going to happen for our future.”
Dismissing the referendum as women’s business is not an option for any fully fledged thinking male. Join women on their epic journey, whatever route they choose to take.
It’s called participating in democracy. And after all, it takes two to tango.
http://www.eveningecho.ie/opinion/Men-must-come-on-board-for-womens-rights-08ff4810-4256-4ff8-9f37-beb38d5bc835-ds
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