Global Women’s Health

Mamas on Bedrest: Your Mental Health Matters

July 6th, 2015

Hello Mamas,

Calling your attention to an amazing organization that is doing exceptional work globally for mamas, The Maternal Health TaskForce (MHTF). A project of the Women and Health Initiative at the Harvard T.H.Chan School of Public Health, MHTF is working towards:

  • Making the most up to date evidence-based information is available to practitioners, provider, researchers and anyone with a vested interest in helping and supporting women during childbearing
  • Provide opportunities for the global maternal health community to come together to discuss and create unified policies on women’s health issues globally
  • Provide resources and support for research in Maternal/Infant/Child Health
  • Train the next generation of Global Women’s Health Practitioners and researchers.

I receive the MHTF e-newsletter and the last newsletter was all about Maternal Mental Health. Maternal Mental Health is an often overlooked (ignored!!) part of women’s health. Current research estimates are that 10-15% of women in upper income countries (like the US, Canada, Australia and the UK for example) experience perinatal mental health disorders. In lower and middle income countries (Africa and parts of Asia), the current estimate is closer to 33% and many researchers feel that this number is low because until now mental health in childbearing women in these countries hasn’t been addressed. However, the impact of adverse maternal mental health has had significant impact on maternal health, infant and child health and the maternal child bond, so researchers and clinicians both are very keen to study the various mental health disorders common in childbearing women-mainly depression and anxiety.

Over the last month, MHTF had a blog carnival addressing mental health issues in childbearing women in their Mental Health: The Missing piece in Maternal Health series. It’s a really interesting series of blog posts and reflect how pervasive mental health disorders are in childbearing women, and how overlooked the signs and symptoms have been until very recently. The blogs also address how the stigma of mental health is so strong in all countries regardless of economic status, and this stigma is keeping many women from receiving much needed care. The articles do a wonderful job of highlighting the issues surrounding the stigma of mental illness, how women are not being heard in terms of the emotional toll of adverse birth outcomes and barriers to care. I highly recommend taking a look.

For those of you not really interested in global women’s health and need assistance closer to home, (i.e. for yourself!!) I am happy to announce that our Third Thursday Teleseminars are going video! It has long been a dream of mine to be able to bring Mamas on Bedrest together to be able to talk and share ! I have been researching platforms on which to do this for years and until recently, the platforms were just too grainy (i.e the images were really not that good), Platforms were only able to accommodate up to 10 participants or platforms that could accommodate more than 10 participants had hefty user fees or required expensive software. Now there is Zoom web conferencing and it’s amazing! I attended a web conference using it last week and I could clearly hear and see all of the other participants! So we are giving Zoom a test drive for our Third Thursday Teleseminar, July 16, 2015. Login details will be shared in our upcoming newsletter and will be available on our website. So if you have concerns about anxiety, depression or other feelings you may be having during your bedrest journey, this is the perfect time and place to bring your concerns.

In the meantime, share pressing questions or concerns in the comments section below or send an e-mail to Info@mamasonbedrest.com for a 24hr response.

Mamas on Bedrest: Want a Smarter Baby? Breastfeed!

March 30th, 2015

nursing infantGood Monday Morning, Mamas!!

According to a recent study done by Brazilian Researchers published in The Lancet Global Health, “Breast-fed babies may be smarter, better educated and richer as adults”. This article so intrigued me that I had to read through and see just what the researchers saw as the determining factors.

According to the Medline report and the actual publication, Brazilian researchers followed enrolled and started following 5914 neonates who were breastfeeding to gather information about IQ and breastfeeding duration. The data was analyzed between June of 2012 and February 2013.  3493 participants remained from the original study group. The researchers found that the durations of total breastfeeding (in months) and predominantly breastfeeding (breastfeeding as the main form of nutrition with some other foods) were positively associated with higher IQ, higher educational attainment, and higher income. Babies who were breastfed for 12 months or more were found to have higher IQ scores, more years of education, and higher monthly incomes than did those who were breastfed for less than 1 month. So based on these findings, the researchers concluded that “Breastfeeding is associated with improved performance in intelligence tests 30 years later, and might have an important effect in real life, by increasing educational attainment and income in adulthood.”

While the results of this study are in line with many other studies, the article has aroused some criticism. Dr. David Mendez, a neonatologist at Miami Children’s Hospital, said “Parents should not take the message from this study that ‘if you do not breast-feed, your child will not be a successful adult.'” The researchers found that it was duration of breastfeeding that was key. It did not depend on the infants’ families being wealthy or on the parents being highly educated, outcomes in the infants still showed breastfed babies were more successful and those who were breastfed longer were more successful.

What those critical to the study did point out is that it does take time and effort to breastfeed. Parents who are dedicated to breastfeeding and mamas who have a strong support while they breastfeed are going to be more successful. Moreover, they are more likely to be invested in the overall development of their child, making choices and exhibiting habits that nurture their child and guide them in more positive behaviors. They caution people against thinking that breastfeeding alone will give a child an advantage. However, the more its studied, the more we can see that breastfeeding does in fact lead to numerous benefits-for infants as well as for their mamas. Here are some of the benefits:

  • Breastfed infants are getting high quantities of saturated fatty acids (of which breastmilk is composed) and which the infant brain preferentially uses for growth and development
  • Breastmilk contains important immunologic factors that are passed from mama to baby so that babies are protected from many dangerous diseases while they are growing and being immunized.
  • Breastmilk is always ready; perfect amount, at perfect temperature. No need for bottles, or additional time to mix or prepare
  • Breastfeeding is economical. No additional costs to the family
  • Breastfeeding provides additional “skin to skin” time for mama and baby and numerous studies have shown that skin to skin, cuddling and closeness improves growth and development in infants
  • Breastfeeding has been shown to help some mothers lose the pregnancy weight
  • Breastfeeding is linked to reduced rates of breast cancer in mothers.

With all of these benefits and more, one would think that Breastfeeding would be a “no brainer” (pun intended!!). However, Breastfeeding is still somewhat controversial here in the United States, despite all the scientific evidence for its benefit, the “Breast is Best” campaigns and the recommendations from the American Academy of Family Physicians and the American Academy of Pediatricians. According to the US Centers for Disease Control and Prevention, only 79% of American mamas initiate breastfeeding at birth, and at 6 months that number drops to somewhere around 27%. At 12 months, a mere 12% of mamas are still breastfeeding their babies. Barriers to breastfeeding include:

  • Difficulty latching on
  • Lack of support from parnter/familly
  • Painful/sore nipples
  • Insufficient milk supply
  • Mother returns to work/limited ability to pump.

Many of these barriers are being addressed. “Baby Friendly Hospitals”(1) are allowing more time for mamas and babies to bond right after birth and during the hospital stay. Mothers are encouraged to breastfeed and lactation consultants are available to assist with any logistical difficulties. Lactation consultants are also available to answer questions partners or family members may have, and to educate the family on the benefits of breastfeeding and their important role in supporting mama.

Public breastfeeding is not widely accepted in the United States and many states, cities and local areas have laws/restrictions about how and where mothers may feed their infants. Breastfeeding advocates are working to have many of these laws and rules overturned, but face an uphill battle in some areas. Legislation has been passed in many states requiring employers to provide “pumping breaks” for breastfeeding mamas, as well as quiet, private and comfortable areas in which mamas can pump. These are all works in progress.

We cannot ignore the fact that up until the turn of the 20th century, everyone was breastfed. While the wealthy or nobility may have had “wet nurses” (other, often poor or servant lactating women breastfed their babies), all babies were breastfed until they were old enough to eat mashed table foods or cereals. It’s how we as a species survived. It has worked for centuries. Why is it suddenly “passe”?

I am sure that this article will continue to spark controversy. However, I hope that we don’t lose fact of the basic principle: babies were meant to be breastfed by their mothers. The physiology of a woman’s breast, and the milk that she makes is specifically designed to feed her infants regardless of the size of her breast tissue. Most infants can breastfeed unless they have a physical anomaly prohibiting them from doing so, and this is rare. Even in such cases, if mothers can pump, the infant can still reap the benefits in breastmilk. In mothers who have difficulties, with support, education and guidance, most all mamas who want to breast feed, can. The data is in and yes, Breast is best-for infants and quite possibly for the adults they will become!

 

 

References

1. Prof Cesar G Victora, PhD, Dr Bernardo Lessa Horta, PhDcorrespondenceemail, Christian Loret de Mola, PhD, Luciana Quevedo, PhD, Ricardo Tavares Pinheiro, PhD, Denise P Gigante, PhD, Helen Gonçalves, PhD, Fernando C Barros, PhD. “Association between breastfeeding and intelligence, educational attainment, and income at 30 years of age: a prospective birth cohort study from Brazil” The Lancet Global Health. Volume 3, No. 4, e199–e205, April 2015 (Released online March 17, 2015).

2. The Baby-Friendly Hospital Initiative (BFHI) is a global program that was launched by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) in 1991 to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding and mother/baby bonding. It recognizes and awards birthing facilities who successfully implement the Ten Steps to Successful Breastfeeding (i) and the International Code of Marketing of Breast-milk Substitutes (ii). 

 

 

 

 

 

Mamas on Bedrest: Texas earned a “C”. What’s your state’s premature birth grade?

November 18th, 2014

World Prematurity DayHello Mamas,

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 info@mamasobedrest.com