The US has failed pregnant women for years, resulting in the needless deaths of thousands of babies. This information is part of the message of New York pregnancy care professor Dr. Alexander Kofinas, in his new book, THE WORKING WOMB.
ANTICIPATE pregnancy obstacles with foreknowledge.
MINIMIZE the chances of their worsening.
CORRECT them in good time BEFORE they get big enough to threaten your pregnancy with disaster.
Dr. Kofinas holds the medical establishment to account for “shrugging off” America’s high rate of miscarriage, which he attributes to “placenta science illiteracy” among health insurers and doctors. And he urges women to lobby for a Placenta Bill of Rights guaranteeing adequate placenta care.
The placenta, an organ that grows in the uterus during pregnancy, not only supplies the fetus with oxygen and food and removes fetal waste, but also determines aspects of fetal health that carry over into childhood and adulthood. “This profoundly important public health fact is almost entirely ignored by the health care establishment,” Dr. Kofinas says.
American women, he reports, are receiving pregnancy care based on obsolete placenta science, including a trimester concept that divides pregnancy into three stages, of which the first — a crucial phase for healthy placenta development— is generally neglected.
“Disastrous consequences for women and their babies”
“This has disastrous consequences for women and their babies,” he argues. “Of all human embryos conceived in the US, 65% don’t survive past four weeks. Of those that do, one in four miscarry. The medical establishment shrugs off these shocking numbers, apparently finding them acceptable, just as it avoids publicizing the fact that every year more American women die of cardiovascular disease than from cancer, accidents, Alzheimer’s and respiratory diseases combined. What all these illnesses have in common is the placenta. But the medical establishment is to a large degree placenta-science illiterate.”
It’s common, Dr. Kofinas says, to wait till Trimester 2 before checking on the placenta. By then, it’s often too late to fix problems which should have been detected and treated earlier. However, insurance companies resist paying for early tests. “Time and again women have told me that after a miscarriage, or even two or three pregnancy losses, they were told they must just accept such catastrophes as ‘nature’s way’, or the will of God. But it had nothing to do with nature or God and everything to do with insurance.”
Physicians receive outdated placenta science education
Dr. Kofinas maintains that physicians, including specialists, mostly receive outdated placenta science education, from decades when the placenta’s crucial role was far less understood. “We now know the placenta not only determines pregnancy outcome but affects the surviving baby’s lifelong health. But medical practice has miserably failed to translate these facts into health care practice. Research and medical practice are different professional worlds. The hard truth is that few doctors have time and attention span to keep up meaningfully with complex research literature. A huge, enforced change in health care philosophy is needed to prioritize placenta -centered pregnancy education and care.”
Insurance companies help preserve the status quo, he says. “I don’t believe in demonizing all big business, but in my experience the companies driving medical care don’t serve public health as the first priority. Their chief concern is their profit. When this is inconsistent with public health, guess which one wins?”
Women must speak out
Placenta ignorance is also reinforced by barriers to the legitimization of new clinical knowledge. “The knowledge certification business is about power, control and money. Only people who have access to a fortune can go through the expensive trials currently demanded to satisfy knowledge certification. This keeps clinical knowledge, generated in the course of medical practice rather than in a laboratory, from being certified as real knowledge, despite its having been amply validated in clinical settings.”
Dr. Kofinas says he wrote “The Working Womb” to expose the woeful quality of medical care being provided to women who experience pregnancy complications. “Because of my long frustration and exhaustion with trying to change the stubborn habits of the medical profession, in the face of the pressure of powerful health insurance companies whose interests are served by resisting change, I decided to write a book that speaks directly to patients. It’s time women who struggle to sustain a pregnancy know the truth about the health care system. The only way this unacceptable position will be changed is if women educate themselves about proper placenta care and speak out to demand it.”
Alexander Kofinas, MD
Dr. Kofinas is a physician specializing in the application of placenta science to pregnancy complications. His awards include New York magazine Best Doctor (eight times), Patient Choice and Most Compassionate Doctor. Certified by the American Board of Obstetrics & Gynecology (Division of Maternal-Fetal Medicine), he is licensed in New York, Pennsylvania, North Carolina and Maryland, and is a member of the American Society for Reproductive Medicine, American Society for Reproductive Immunology, American College of Angiology, International Society of Ultrasound in Obstetrics & Gynecology, International Society of Perinatal Obstetricians, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American Medical Association, American College of Obstetricians & Gynecologists, Athens Medical Association (Greece) and International Federation of Placenta Associations. Since 2003, he has served as Associate Professor of Clinical Obstetrics & Gynecology, Weill Cornell Medicine, Cornell University, New York. He has published dozens of scientific papers and served as academic reviewer for the American Journal of Obstetrics & Gynecology, Journal of Perinatology, Journal of Ultrasound in Medicine, Journal of Maternal-Fetal & Neonatal Medicine, Journal of Pregnancy, Obstetrics & Gynecology, Hypertension in Pregnancy, and the authoritative medical journal Placenta. He has also co-authored a textbook and served as Assistant Professor of Clinical Obstetrics & Gynecology, New York University, taught at the University of Pennsylvania and Wake Forest University, North Carolina, and served as Director of Maternal-Fetal Medicine and Associate Director, Obstetrics/ Gynecology Residency Program, at York Hospital, Pennsylvania, as well as Chief, Maternal-Fetal Medicine, at Brooklyn Hospital Center, New York. Since 2000, he has led Kofinas Perinatal PC’s clinics in Manhattan, Brooklyn and Garden City, New York. Dr. Kofinas studied at Athens University, Greece; Good Samaritan Hospital, Cincinnati, Ohio; Brooklyn and Caledonian Hospitals, New York; and Bowman Gray School of Medicine, Wake Forest University.
This provocative book challenges some of America’s most common ideas and attitudes about pregnancy. Some will denounce its apparent irreverence toward the health care system. Others, especially women who have anguished over miscarriage and other bad pregnancy outcomes, will find it liberating and refreshing.
Dr. Kofinas is one of America’s leading experts on pregnancy complications. In this book he confronts our society’s widespread ignorance of the placenta’s key role in determining pregnancy outcomes, and exposes the disgrace of America’s high fetal death rate. In plain language that can be understood by readers with no scientific education, he explains how fetal deaths, recurrent miscarriage and women’s cardiovascular disease all relate to the placenta. The book is filled with surprising facts that the public should know about how the placenta shapes pregnancy outcomes, as well as human health in the womb, infancy, childhood and adulthood. This information-packed distillation of decades of clinical experience and insight offers science-based hope to women who want to defeat recurrent miscarriage and other pregnancy disorders arising from later-age motherhood, genetic problems, immune-system problems, and more. Revealing how insurance companies influence pregnancy management, Dr. Kofinas spotlights neglected areas of pregnancy science, women’s health, healthcare failure, the shortcomings of physician education, the questionable practice of dividing pregnancy into trimesters, the ways in which valuable but often ignored clinical knowledge can be amassed by physicians outside the research establishment, and the massive economic and human cost to society of healthcare that focuses less on preventing illness than on waiting for predictable illness to happen before responding to it, often too late.
THE WORKING WOMB explains what the placenta is, how it’s formed, its profound effects, what it needs to work successfully, how its problems relate to various types of pregnancy failure, and how the timely, responsive monitoring of placenta development can prevent disaster and address womb crises in time to save the pregnancy. It is aimed primarily at women experiencing or anticipating pregnancy complications, but it will also be invaluable for their families and for physicians, including obstetricians. Dr. Kofinas weaves his medical explanations skillfully into a conversational narrative. In addition to illustrating his his explanations with stories from his patient files, he describes how his clinical career has reshaped his own attitudes toward pregnancy and the health care establishment, including the insurance sector, with which he has found himself at loggerheads on behalf of his patients. This powerfully human statement, by a physician who has devoted the bulk of his working life to saving fetal lives, challenges us to re-evaluate our conventional thinking about how pregnancy works and should be managed. Dr. Kofinas’s criticism of reigning pregnancy-related practices in our health care system will provoke debate among his peers. He criticizes not only the conventional concept of the trimester, but also the amount of placental education and research to which physicians are typically exposed, and the tendency, as he sees it, of physicians to ignore or at least dangerously underestimate the importance of the earliest stages of pregnancy. He even tackles the commonly accepted concept of medical knowledge, arguing that by denying a rightful place to knowledge amassed by clinical practice, as opposed to laboratory studies, the medical establishment deprives patients of treatments which can be life-saving. He addresses the power of insurers to dictate pregnancy treatments by withholding coverage, urges women to take pregnancy management back from the healthcare bureaucracy, and boldly proposes a Placenta Bill of Rights to improve America’s treatment of pregnancy complications and reduce the fetal death rate. Dr. Kofinas argues that powerful interests in the health care establishment have taken control of pregnancy management, that the result of this has been disastrous for women and their babies, and that the time has come for drastic and urgent change. This is the book to help women lead that change.
Advance Praise
“Eye-opening. I am in awe reading this book. The mix of medicine with personal experiences is unique. If I knew these facts when I got pregnant, I would have taken better care of myself and my fetus. Highly informative, compassionate ...pioneering ideas and innovative applications ... empathy for patients ... tremendous medical detail and difficult concepts presented in simple terms ... understanding becomes easy”
–Dr. Litsa Kranias, PhD, Fellow of the American Heart Association; Hanna Professor, Director of Cardiovascular Biology and Distinguished University Research Professor, Department of Pharmacology & Systems Physiology, University of Cincinnati College of Medicine
“Remarkable... For women and their partners who have experienced multiple miscarriages and ask ‘why does this keep happening?’ But importantly, this book is ultimately also for open-minded obstetricians who are willing to consider new pathways to help their patients. As a medical doctor, I confess that we learned next to nothing about the placenta in medical school...Dr. Kofinas, having devoted his career to understanding this orphan organ, shares his experience on how to diagnose and treat the most common placental problems that lead to miscarriage. I have had the incredible privilege to be under Dr Kofinas’s care for two tenuous but ultimately healthy pregnancies after six prior miscarriages. This book is like being in his office... instead of patronizing pregnant women, it refreshingly provides them with medical knowledge to understand their placentas and advocate for better care.”
– Dr. Umut Sarpel, MD, Fellow of the American College of Surgeons; Associate Professor of Surgery, Division of Surgical Oncology & Hepatobiliary Surgery, Icahn School of Medicine at Mount Sinai; Director, General Surgery Program, Icahn School of Medicine at Mount Sinai (Morningside/West)
“I highly recommend THE WORKING WOMB, an informative book specifically for an often forgotten group: women having difficult pregnancies. Dr. Kofinas explains the placenta science that underlies many pregnancy problems in language that’s easy to understand. The cases he presents from his files will give readers much-needed hope, by showing them how others have endured similar problems and succeeded.”
– Dr. Lorraine Chrisomalis-Valasiadis, MD, obstetrician and gynecologist, New York City, Adjunct Professor of Obstetrics and Gynecology, Northwell Health (New York State’s largest healthcare provider)
“Dr. Kofinas has done a great job in producing a book that explains, in language that will be understandable to people with no medical background, the very complex development process and vital role of the placenta, in pregnancy and in the health of both the baby and the mother. He is a modern Renaissance man.”
– Dr. James C Rose, PhD, Emeritus Director, Center for Research in Obstetrics and Gynecology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina