Fetal Health and Development
November 17th is World Prematurity Awareness Day. All over the globe there will be educational events, initiatives, presentations and activities all designed to raise awareness about the very serious problem of prematurity. Premature birth is the leading cause of neonatal death in infants under one year old and each year, 15 million babies die as a result of being born too soon-and are too young and too sick to survive.
Now we are all likely sitting here and thinking, that’s a shame. Those poor babies in developing countries have such a tough road to hoe. Well fasten your seat belts! Despite spending more than most other countries on the planet for health care, The United States has one of the worst rate of premature births of the developed nations. Each year nearly 500,000 infants are born too soon in the US-that’s 1 out of 9 infants!! These numbers are sobering. What’s more, where you are born has a lot to do with your chances of being born prematurely.
Taking a look at the US as a whole, there has been a reduction in the overall rates of preterm labor and premature births. As of this month, the March of Dimes reports rates of premature births (2013 data) has fallen for the 7th straight year to 11.4% and as such, the nation has reached its goal (9.6%) set for Healthy People 2020 7 years early. But when we look at individual states, there is a much different picture. While some states are doing well reducing the number of premature infants born, others are not faring so well. Texas, where I live, currently has a grade of “C”, while my home state of Massachusetts is graded a “B” and only Maine, New Hampshire, Vermont, Oregon and California earned “A” Grades. Sadly, Mississippi, Louisiana, Alabama and Puerto Rico earned “F’s”.
The March of Dimes is working aggressively with state, national and international health representatives to determine what factors are the major reasons babies are born prematurely, and what interventions can be put in place to ameliorate them so that babies won’t be born too soon. The solutions are really pretty simple. It’s not more technology. It’s not more complicated political laws. It’s education. Women need to know that as soon as they become pregnant, they must begin prenatal care. It’s access. Women globally need access to comprehensive, affordable prenatal care. In developing nations as well as in many areas of the United States, women don’t have easy access to health care services. If the nearest health care center is 3 hours away by car and they don’t have a care and no access to any sort of public transportation, they won’t get regular prenatal care! It’s resources. In many rural or economically depressed areas, women simply don’t have the money for food, shelter and prenatal care. Health care resources may be limited. Access to the midwifery model of care; Attendant care with midwives and doulas which have been shown to reduce the rates of complications and poor birth outcomes, makes these women vulnerable to poor birth outcomes. Breastfeeding Education. Many women still are uneducated about the benefits of breastfeeding, don’t receive breastfeeding education/suppport and don’t have access to pumps.
So how does your state rate? What’s its grade? How is your prenatal care? Let us know in the comments section below. If you need assistance or information, feel free to include that in your comment or write privately to firstname.lastname@example.org
Bedrest is in the news again! This time via Great Britain, in the online News Report “The Daily Mail”.
Citing research presented at the 2014 Society for Maternal Fetal Medicine annual conference held February 3-8, 2014, The Daily Mail reports,
“Bed rest during pregnancy could harm your baby: ‘Putting your feet up increases risk of blood clots, diabetes, depression and having a smaller newborn,’ warn experts”
This is not news. As seen in our book, “From Mamas to Mamas: The Essential Guide to Surviving Bedrest”, many physicians, researchers, writers and pundits have questioned the bed rest prescription. THERE IS NO EVIDENCE THAT IT IS EFFECTIVE and THERE IS EVIDENCE BEDREST CAUSES HARM TO MAMAS AND BABIES. As such, there is an increasing demand to stop the practice.
I want to be very clear here. There are instances and situations in which bed rest is ABSOLUTELY the right thing to do. When a woman presents in preterm labor with high blood pressure, spotting or amniotic fluid leaking, in the acute period until she is stable, medical care and yes, bed rest, are indicated. What is being questioned is the extended periods of inactivity-lasting weeks to months. In these cases, when there isn’t any acute medical intervention being done, obstetricians and researchers are questioning placing a woman on bed rest “just in case”.
Co-author of the cited study Anthony Sciscione, of the Delaware Centre for Maternal and Fetal Medicine, said: ‘There is no evidence bed rest improves outcomes.”
But there is evidence that bed rest can be harmful for mamas and babies. Here are health complications associated with prolonged inactivity as a result of bed rest:
Muscle and bone loss. This ‘deconditioning’ can start after only a few days and there is a lack of information on its effect on pregnant women. (See our resources on this!)
Increases the risk of developing blood clots in the legs – and raises the chance that clots will move to the lungs, which can be fatal. Such clots are more common among pregnant women, so limiting physical activity may compound these risks.
Increases a woman’s risk of gestational diabetes. The Society said that being admitted to hospital for problems during pregnancy has been associated with a higher chance of this condition. It pointed to studies which have shown that patients who are put on bed rest when not pregnant tend to develop high blood sugar levels, a key risk factor for diabetes.
Increases the risk of anxiety and depression, perhaps because of the forced inactivity. (Also think lonliness and isolation)
Loss of income due to inability to work and has been linked to having a baby with a lower birth weight.
But we all know this and I have written extensively on this subject in this blog. And thankfully folks are listening. I realize that many mamas are attached to the notion that bed rest saved their baby’s life and I am not here to discount that. What I am here to report, and what I am hoping for, is that rather than simply putting a woman on bed rest and with that prescription increasing her risk for other health problems, I (and many others) advocate for finding solutions to the complications that result in the bedrest prescription. It’s exciting to see Pluristem doing stem cell research as a way to cure PreEclampsia. It is encouraging to see the March of Dimes pouring funds into research to investigate and treat preterm labor and preterm births. And who knows? Perhaps the March of Dimes Research is onto something noting that low maternal blood levels of vitamin D are associated with preterm labor and preterm birth.
Do not be dismayed, Mamas. There is research going on and more and more mama and babies are surviving pregnancy complications every day. While bed rest is still a major part of high risk pregnancy treatment here in the United States, it is nice to see that new treatments are on the horizon. For me, when I was having my children (namely my daughter), I was offered bed rest as a treatment. I most certainly hope that when my now 12 year old daughter is having her children, if she has complications as I did while pregnant with her, there will be more effective, evidences based and non debilitating treatments available for her and her baby than there were for me while I struggled to carry her.
Want to know more about the origins of bed rest, it’s role in obstetrics and what’s on the horizon as treatment for high risk pregnancies? Subscribe to our blog (the little orange button on the upper right hand corner of this webpage) and also check out our extensive archives. There is a plethora of information for mamas and those who love and are caring for them in our post. For mamas wanting more tips on how to survive bed rest, Download our ebook guide, “From Mamas to Mamas: The Essential Guide to Surviving Bedrest” Available exclusively on Amazon.com.
Are you getting the nutrition you need? As many of you settle into your bed rest routines, it can be very easy to skip meals (especially breakfast! Don’t do it!!!), snack a lot and give into many of those crazy cravings as a way to soothe your “sorrow” over your bed rest experience. I want to reiterate, this is no time to be slack with your nutrition! Mamas on Bedrest are at increased risk of insufficient weight gain and low birth weight infants. Because Mamas on Bedrest are physically inactive and confined to bed, they are less apt to take in some essential nutrients like Vitamin D (Vitamin D is manufactured in your body by converting the suns rays along with Cholesterol into the vitamin) and they may require additional Calcium to not only support the pregnancy, but to support mama’s bones as she is not able to do any weight bearing exercise (even walking with a light grocery bag is load bearing exercise!) during pregnancy.
As always, it is best to receive necessary nutrients from a well balanced, nutrient dense diet. Karimums, an Australian support website for mamas, has provided the following infographic which outlines the necessary nutrients and amounts needed to sustain a healthy pregnancy. The infographic also shows the foods that can help meet these nutritional needs. Here is a copy of the info graphic:
And while this infographic is a great reminder of the nutritional needs of pregnant mamas, it also shows that it may be difficult to consume enough foods to take in the necessary nutrients. Hence, I want to reiterate the vital importance of prenatal vitamins. This is always a controversial topic, but one of vital importance. One look at this infographic and a mama on bedrest may say to herself, “There is no way that I can eat 18 cups of raw spinach a day! While this may be true (and we don’t want to discourage mama from eating spinach at all!!) mama still needs the folic acid, and taking a pharmaceutical grade prenatal vitamin will enable mama to get the vital nutrition she and her baby need without having to consume an entire spinach garden daily!
I want to add a note about prenatal nutrition here. Nature has designed it so that when a woman becomes pregnant, the first nutrients that are available to her body are directed towards the baby for its growth and development. Ideally, a woman is taking in enough nutrient foods to support herself and her baby. But if mama happens to be deficient, let’s say, in calcium, when her body takes in calcium it is first directed to the growing baby and any left over is then used to sustain mama. So if a woman is calcium deficient or not taking in enough calcium to sustain both herself and her baby, she will suffer. To this end, I have personally seen women develop cavities during pregnancy (Calcium aids in good dental health!) and in an extreme case, a woman was osteopenic (had low bone mass density) after her pregnancy.
Mamas, eat well. Use the infographic above to fortify your diet. If you are not already taking a high grade prenatal vitamin, discuss with your health care provider if you need prenatal vitamins and which ones might be best for you. E-mail email@example.com and we can share with you pharmaceutical grade prenatal vitamins that will supply the nutrients your body needs to serve you and your baby! Also, check out “From Mamas to Mamas: The Essential Guide to Surviving Bedrest” as we have an entire section dedicated to prenatal nutrition and vitamins! Download your copy now from Amazon.com!