With the Re-election of President Barack Obama, The Affordable Care Act (aka Obamacare) is pretty much solidified as part of American Culture. Here, Bedrest Coach Darline Turner reviews just what the Affordable Care Act provides for women, Mamas on Bedrest in particular.
According to a February 1999 New England Journal of Medicine article, separating pregnancies by 18-23 months is optimum to ensure the health of both mamas and babies.
The authors, Bao-Ping Zhu and colleagues found that incidences of adverse pregnancy outcomes such as premature birth and low birth weight were less likely to occur in pregnancies in which conception occurred 18-23 months after a prior pregnancy and delivery. They also found that there were lower incidences of pregnancy complications, such as pre-eclampsia, in pregnancies which occurred 18-23 months after a previous pregnancy and delivery. Interestingly, rates of complications went up when the pregnancy intervals were longer than 23 months between pregnancy and subsequent conception. The authors admitted that while this was a first assessment, there may be likely confounding variables such as maternal age, socioeconomic status, reproductive history and others that may exert an influence on pregnancy outcome.
As you can imagine, this has not always been well received. Many people simply balk at the notion of “planning” pregnancies and feel like pregnancies occur when they are supposed to occur. Others contend that the failures of contraception account for most of the pregnancy failures and that this cannot be helped as not contraceptive method, except for abstinence, is 100% effective at preventing pregnancy.
At the 2011 Association of Reproductive Health Professions Annual Meeting, this topic was discussed and the position of the Reproductive Health professionals present is to recommend long acting contraception (LARC) to women, especially those in the highest risk groups. Robert Hatcher, MD, MPH reviewed the currently available forms of reversible contraception.
- Depro Provera Injection
- Paragard IUD
- Mirena IUS
- Implanon implants
The recommendation for LARC comes as unintended pregnancies in the United States account for approximately half of all pregnancies annually. 60% of unintended pregnancies are what is called “Mistimed Pregnancies” meaning women admit that they would have had (another) child, just not at the time of this particular pregnancy. Most women cited contraceptive failure as the primary reason for unintended pregnancy. But a closer look at contraceptive use habits revealed some interesting statistics.
James Trussell, PhD, Office of Population Research at Princeton University and The Hull York Medical School shared statistics that showed that while the rates of unintended pregnancy has dropped amongst teens, the rates have increased in women in their 20′s. Women of lower education and lower socioeconomic status account for the greatest numbers of unintended pregnancies and African American and Latina Women have the highest rates of unintended pregnancies.
What was even more alarming is that in 2001, 52% of unintended pregnancies were to women who were using no method of birth control. Further, when interviewed for a study between 2006 and 2008, 10.6% of women at risk for unintended pregnancy weren’t using any contraceptive method.
Contraceptive problems arise mostly from “typical use”. What this means is how women typically use the contraceptive method vs. “Perfect use” i.e. how the method is intended to be used. Below is a table taken from the 2011 Contraceptive Technology Handbook outlining the failure rates of contraceptives with “typical use” and “perfect use”.
Method Typical Use Perfect Use
Chance 85% 85% (Percentages are effective rates)
Condom 18% 2%
Pill, Patch, Ring 9% 0.3%
Depo Provera 6% 0.2%
Paragard IUD 0.8% 0.6%
Mirena IUS 0.2% 0.2%
Implanon 0.05% 0.05%
What this table shows is that methods that require consistent (daily) use have a significant failure rate and significant difference between “typical use” and “perfect use”. However, the more “reliable” methods provide no protection against sexually transmitted infections (STI’s).
Anita Nelson, MD, Professor at the David Geffen School of Medicine at Harbor-UCLA Medical Center in Manhattan Beach, CA looked specifically at the oral contraceptives or birth control pills. What she shared both from the research and from her years in clinical practice is that in a 12 month cycle, women rarely take their pills as prescribed. Women on average miss 3 pills a month and as many as 60 pills a year. Even if they take a pill when they remember, for many women, this is days later and they are already at risk for unintended pregnancy.
Nelson also reiterated a little known fact amongst many women. Pregnancy is more dangerous to a woman’s health than hypertension, blood clots in the legs or diabetes and yet pregnancy increases the risk of all of these conditions occurring and persisting throughout a woman’s life. Pregnancy related mortality (death) in the United States between 1998 and 2005 has been higher than at any other time in the previous 20 years. 14.5 women die annually for every 100, 00o births and the rates for African American women is 3-4 times higher. Unintended pregnancy also has a higher risk of “sicker babies”. Nelson and other researchers advocate continuous (or long acting) oral contraceptives and condoms as a way for,
- Women to control their fertility
- Pregnancy to occur when desired, lowering risk for complications
- Unwanted fertility to be eliminated
Family Planning is seen by the US Centers for Disease Control and Prevention as one of the top 10 most important contributions to public health in the 20th century.
Family Planning is also seen as an important global health issue asserts Willard Cates, Jr., MD, MPH of Family Health International and The UNC Gillings School of Global Public Health. Cates presented data and information from the United Nations Population Fund, an international development agency that promotes the right of every woman, man and child to enjoy a life of health and equal opportunity. Sharing statistics from the Guttmacher Institute, family planning averts 187 million unintended pregnancies and in turn prevents:
• 54 million unplanned births
• 112 million induced abortions
• 1.2 million infant deaths
• 230,000 maternal deaths
• 71 million DALYs saved
(WHO Definition of DALY’s: DALYs = Disability Adjusted Life Years. The sum of years of potential life lost due to prematuremortality and the years of productive life lost due to disability)
Cates reiterated that Family Planning contributes to the Millinium Development Goals for the world which are:
1. End Poverty and Hunger
2. Universal Education
3. Gender Equality
4. Child Health
5. Maternal Health
6. Combat HIV/AIDS
7. Environmental Sustainability
8. Global Partnerships
Cates makes the case that only with widely available, long acting reversible family planning will the world’s goals of economic equality for women, increased educational opportunities for women, improved health and mortality for women and babies, reduced unintended pregnancy rates, reduced abortion rates, increased economic growth and stability for all nations.
What are your thoughts on contraception and unintended pregnancy? Would you ever use a long acting reversible contraceptive (LARC)? Share your comments below.
Immediately after I gave birth to my son via C-section, my OB asked that my son be put to my breast to nurse. I was bleeding more than she liked and she was having some trouble stitching me up. My son, a full term, healthy baby boy latched right on and proceeded to suck my entire breast into his tiny little mouth. Meanwhile my lower abdominal organs, which seemed to be keenly attached to my breasts at that very moment, began to contract. I had never experienced such pain at both ends of my body simultaneously.
I later learned that one of the many benefits of breastfeeding for a mama is that it helps to control uterine bleeding post partum and helps the uterus contract and migrate back down into the pelvis. As such, breastfeeding helps ward off anemia in mamas. I sure could have used this benefit after the delivery of my daughter, when I practically hemorrhaged after her delivery. The attending OB had a really hard time stitching me up after the c-section. Everytime she threw a stitch, blood spurted up like Old Faithful. Add to that I was nauseated and vomiting and things were really complicted. She finally had to further sedate me and inject pitocin directly into my uterus to get it to contract and to get the bleeding under control.
So much data has been amassed on the benefits of breastfeeding that the US Surgeon General, Regina Benjamin, MD, issued a statement reported in this blog post that every effort should be made so that all infants are breastfed for their first year. There are many benefits to a mama who breastfeeds. While not every woman will experience every benefit, most women experience enough benefit to make even a trial of breastfeeding worthwhile.
Faster Return to Pre-pregnancy weight. Many women report that breastfeeding hastened weight loss. I myself found that with my daughter, I lost down to within 6 lbs of my pre-pregnancy weight and then did not lose the final 6 lbs until my daughter stopped nursing at just shy of 11 months. With my son, I actually gained weight. I can only assume that I needed the weight to keep up with his nursing demands (both breasts every 11/2 to 2 hours!). Within 3 months of stopping nursing, I did drop the weight.
Delayed Return on Menses. Again, many women have no menstrual cycles while nursing exclusively. However a word of caution, while exclusive nursing on demand has been associated with decreased fertility, many women do in fact ovulate and end up pregnant while nursing a very young child. If you are unsure, definitely use birth control if you don’t want to become pregnant right away. With both of my children, I breastfeed them both exclusively, yet with both babies my periods resumed by 3 months post partum. The effects of breastfeeding on an individual woman’s menstrual cycle can’t be predicted, so if in doubt, use a reliable form of birth control. (See our blog post, “Mamas on Bedrest: It’s Time to Consider Your Birth Control Options“)
Improved Mood/Prevention of Post Partum Depression. There is a lot of data now that supports the theory that exclusive breastfeeding helps ward off post partum depression. Researchers report that the release of hormones during breastfeeding as well as the bonding that occurs between mother and baby help alleviate (abort) many of the symptoms of post partum depression.
Reduced risk of breast, ovarian, cervical, and endometrial cancers
Protection against osteoporosis and hip fracture in later life
Reduced risk of mortality for women with rheumatoid arthritis has bee associated with total time of lactation
The benefits of breastfeeding are myriad and breastfeeding benefits both mother and baby. Medical societies including as the American Congress of Obstetricians and Gynecologists and the American Academy of Pediatrics have issued position papers stating that breastfeeding should be encouraged and supported for at least the first year post partum.
Mamas on Bedrest, please consider breastfeeding your baby. If you need support, we are here, email@example.com. Let us know how we can help.
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