In this New York Times story, Catherine Saint Louise tells of a 34 year old women, in her second trimester, denied urgent dental care because she did not have a note from her doctor. Weeks later when she was finally seen, two abscessed teeth had to be removed. She was bed ridden on pain killers.
This story raises two issues. First, pregnant women and their fetuses deserve evidence based care and treatment. But given the persistent exclusion of pregnant women from research, much of their medical care remains guess work. And, as this story illustrates, their care can be undermined by outdated views of risk management. We know that maternal periodontal disease is linked to preterm birth, low birthweight, and preterm low birthweight. Best practice requires timely treatment and management of periodontal disease during pregnancy. Something this young women was unjustly denied.
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Second, we must weigh the benefits and risks in deciding whether to take medication or other health treatment during pregnancy. Too often this doesn’t happen. Risk, in the simplest sense, drives behavior during pregnancy. Many risks are not quantified or balanced against the potential benefits of an activity. One woman in New Zealand has “suspected” listeria from hummus; and hummus along with all prepared dips are added to the Dangerous Foods list. Many pregnant women stop using anti-depressants and blood pressure medication during pregnancy; when in many cases leaving the underlying medical condition untreated is in fact more dangerous for both the mother and the fetus.
Although this piece does mention the notion of risk management, it doesn’t really address the legal side of the notion of risk management. Requirement of a note from an OB isn’t so much because data on safety doesn’t exist – it does – but is often used as a way to place liability (to some degree) on the OB provider, and not on the dentist. We (full disclosure: I’m on OB/Gyn) often see the same thing with needed radiological exams. Good evidence of safety exists, yet radiologists require the OB’s ”blessing” as a way to cushion themselves from liability. Malpractice reform would be another place at which to aim efforts to improve access to general health care for pregnant women.