infant mortality

Mamas on Bedrest: It’s National Breastfeeding Awareness Month

August 4th, 2014

nursing infantGreetings Mamas!!

August kicks off National Breastfeeding Awareness Month here in the US. Officially designated on August 6, 2011 by the United States Breastfeeding Committee (USBC), the month of educational and promotional activities is designed to raise awareness of the benefits of breastfeeding-physiologically for mamas, developmentally for babies, emotionally for both and economically for families.  Here is the full proclamation. Breastfeeding has been reported to have the following benefits. In Babies

  • Breast milk is widely acknowledged as the most complete form of nutrition for infants, with a range of benefits for infants’ health, growth, immunity and development. (Healthy People 2010, Centers for Disease Control and Prevention, Atlanta, Georgia)
  • Breast-fed children are more resistant to disease and infection early in life than formula-fed children. Many studies show that breastfeeding strengthens the immune system. During nursing, the mother passes antibodies to the child, which help the child resist diseases and help improve the normal immune response to certain vaccines. Breast-fed children are less likely to contract a number of diseases later in life, including juvenile diabetes, multiple sclerosis, heart disease, and cancer before the age of 15
  • Breastfed babies are less likely to be obese as adults
  • Breastfeeding has been shown to reduce the likelihood of ear infections, and to prevent recurrent ear infections. Ear infections are a major reason that infants take multiple courses of antibiotics.
  • Researchers have observed a decrease in the probability of Sudden Infant Death Syndrome (SIDS) in breast-fed infants.
  • Another apparent benefit from breastfeeding may be protection from allergies. Eczema, an allergic reaction, is significantly rarer in breast-fed babies. A review of 132 studies on allergy and breastfeeding concluded that breastfeeding appears to help protect children from developing allergies, and that the effect seems to be particularly strong among children whose parents have allergies.

In Mamas

  • Breastfeeding helps a woman to lose weight after birth.
  • Breastfeeding releases a hormone in the mother (oxytocin) that causes the uterus to return to its normal size more quickly.
  • When a woman gives birth and proceeds to nurse her baby, she protects herself from becoming pregnant again too soon, a form of birth control found to be 98 percent effective — more effective than a diaphragm or condom. Scientists believe this process prevents more births worldwide than all forms of contraception combined. In Africa, breastfeeding prevents an estimated average of four births per woman, and in Bangladesh it prevents an estimated average of 6.5 births per woman.
  • Breastfeeding appears to reduce the mother’s risk of developing osteoporosis in later years. Although mothers experience bone-mineral loss during breastfeeding, their mineral density is replenished and even increased after lactation.
  • Diabetic women improve their health by breastfeeding. Not only do nursing infants have increased protection from juvenile diabetes, the amount of insulin that the mother requires postpartum goes down.
  • Women who lactate for a total of two or more years reduce their chances of developing breast cancer by 24 percent.
  • Women who breastfeed their children have been shown to be less likely to develop uterine, endometrial or ovarian cancer.
  • The emotional health of the mother may be enhanced by the relationship she develops with her infant during breastfeeding, resulting in fewer feelings of anxiety and a stronger sense of connection with her baby. Breastfeeding has also been shown to reduce the incidence of post partum depression in mamas. (See our posts on Breastfeeding and Post Partum Depression!)

August 1-7, 2014 is also World Breastfeeding Week. Coordinated by the World Alliance for Breastfeeding Action (WABA), the theme for this year’s week of awareness is to impress upon everyone importance of increasing and sustaining the protection, promotion and support of breastfeeding. Breastfeeding is one of the methods advocated in the Millennium Development Goals, developed in 1990 by the United Nations and affiliated governments to help fight poverty and promote healthy and sustainable development in a comprehensive way by 2015.

wbw2014-objectives According to the WABA breastfeeding and the Millennium Develoment Goals are intricately linked, “The Millennium Development Goals (MDGs) are meant to be achieved by 2015 – next year! Although much progress has taken place, there is still a lot of “unfinished business”. Here are some examples: Poverty has gone down, but 1 in 8 people still go to bed hungry. Undernutrition affects about a quarter of all children globally. Overweight, the other form of malnutrition is becoming more common too. In the last 2 decades, child mortality has decreased by about 40%, but still almost 7 million children under five die each year, mainly from preventable diseases. As the overall rate of under-five mortality has declined, the proportion of neonatal deaths (during the first month of life) comprises an increasing proportion of all child deaths. Globally, maternal mortality has declined from 400 per 100,000 live births in 1990 to 210 in 2010, but fewer than half of women deliver in baby-friendly maternities. By protecting, promoting and supporting breastfeeding, YOU can contribute to each of the MDGs in a substantial way. Exclusive breastfeeding and adequate complementary feeding are key interventions for improving child survival, potentially saving about 20% of children under five. Let’s review how the UN’s Scientific Committee on Nutrition illustrated how breastfeeding is linked to each of the Millennium Development Goals.” So breastfeeding can go a long way to not only benefitting the health of mamas and babies individually, but help reduce poverty, malnutrition and infant and child mortality globally. If you are considering breastfeeding and want more information, the links in this post are from some of the best resources globally, especially if you want to take on an advocacy role. If you want more specific personal information on breastfeeding, I suggest you contact your local La Leche League. These folks really know breastfeeding!! They offer a plethora of information on their website, have many books on breastfeeding available for purchase and do phone and often in person consultations. You can also check with your healthcare provider and local hospital for referrals to lactation consultants who can assist with breastfeeding.   Do you have more questions? Join Bedrest Coach Darline Turner for a one hour Q & A session during the Free Third Thursday Teleseminar, August 21, 2014, 1:00-2:00pm ET. She will field any and all questions relating to bedrest, pregnancy and post partum. You can join the conversation live or submit your questions up to 24 hours before via e-mail at info@mamasonbedrest.com. Join our interactive bed rest community on Facebook and chat with mamas globally on all things bed rest! Finally, Get your copy of the e-book From Mamas: The Essential Guide to Surviving Bedrest! This guide will help you not only survive bedrest, but THRIVE on bedrest! Order your copy now on Amazon.com   Other Resources: Natural Resources Defense Council 101 Reasons to Breastfeed Your Child

Mamas on Bedrest: US Preterm Birth Rate Drops to a 15 Year Low

February 24th, 2014

Great News Mamas!

According to a November 1, 2013 report released by The March of Dimes, The US Preterm Birth Rate is at a 15 year low of 11.5%. The preterm birth rate has dropped for the sixth year in a row according to 2012 reports, the lowest it’s been since 1998. The US Preterm birth rate peaked at 12.8% in 2006.

While these numbers are encouraging, the March of Dimes still gives the United States a grade of C overall in terms of preterm births when compared to other nations. According to March of Dimes President Dr. Jennifer Howse, PhD, there are still too many states with poor or failing grades when it comes to preterm births. The US ranks highest of all industrialized nations in regards to premature births. The goal of the March of Dimes is to achieve a preterm birth rate of 9.6% by 2020.

premature_birth_report_card_103013-01 (1)

The March of Dimes cites the increased developmental challenges of premature infants as their main motivation for wanting to lower the preterm birth rate.

“Preterm birth is the leading cause of newborn death, and babies who survive an early birth often face the risk of serious and sometimes lifelong health problems, such as breathing problems, jaundice, developmental delays, vision loss and cerebral palsy. Babies born just a few weeks too soon have higher rates of death and disability than full-term babies. Even infants born at 37-38 weeks of pregnancy have an increased risk for health problems compared to infants born at 39 weeks.”

However, the March of Dimes cites another, and perhaps even more widely understandable reason to lower preterm labor and preterm births-cost. According to the Institute of Medicine, Preterm birth (birth before 37 weeks of pregnancy) is a serious health crisis that costs the US more than $26 billion annually. Dr. Howse states,

“A premature birth costs businesses about 12 times as much as an uncomplicated healthy birth. As a result, premature birth is a major driver of health insurance costs not only for employers.”

Additionally, The March of Dimes estimates that, “since 2006, about 176,000 fewer babies have been born too soon because of improvement in the preterm birth rate, potentially saving about $9 billion in health and societal costs.”

So given the almost untenable cost of health care in this country and the morbidity and mortality associated with preterm infants, it behooves the US to continue to do what it can to reduce rates of preterm labor and preterm birth.

The March of Dimes noted that while rates of preterm labor are down overall, disparities persist. The preterm birth rate for non-hispanic blacks is still an alarming 16.8% down from 18.5% in 2006 and the lowest it’s been in 20 years. The rates of preterm births in blacks, while narrowing, still remains 1.5 times that of whites.

So mamas, while I know that bedrest is hard, it is boring, it is painful (physically and emotionally) for the time being, it is what we have and it may be contributing to the reduction in preterm births. Now mind you, there is no scientific or medical data that concretely links bedrest with improved birth outcomes. But if you are placed on prescribed bed rest and you deliver a term infant or deliver after 37 weeks, you have helped do a monumental thing for the health and life of your baby. So keep it up mamas! Hang in there! You can do this!!! And if there is anything that we here at Mamas on Bedrest & Beyond can do, please don’t hesitate to contact us-here in the comments section of this blog post or at info@mamasonbedrest.com. 

References

MedScape OB/GYN Women’s Health

“US Preterm Birth Rate Drops to a 15 Year Low, But More to Go” By Megan Brooks, November 1, 2013

The March of Dimes “US Preterm Birth Rate Drops to 15 Year Low”  Elizabeth Lynch and Todd Dezen

Mamas on Bedrest: What You Need to Know if Your Baby is Born Between 34-36 Weeks 6/7 Days

February 10th, 2014

VamessawavesMy daughter was a “late phase” preemie.

It’s kind of funny to me to recount those early days with her. She’s 11 now, pubertal and as sassy as they come! But in the beginning, everything was a juggling act to make sure that she had all that she needed to start her life off well.

My daughter was born at 36 weeks and 6 days and was literally 3 hours and 57 minutes shy of being a “term” infant. When she was first born the hospital staff kept referring to her as a “preemie” and I kept railing against this term knowing its implications. But as the days went by, she exhibited more and more of the signs of a preterm infant and I had to admit that she was in fact a preemie-no matter how close in hours and minutes she had been born to term.

When my daughter was born, she didn’t immediately cry. After the neonatal staff worked on her for a few moments, she did let out a wail that sent the biggest wave of relief through my body. But we weren’t out of the woods. On examination she had some fluid in her lungs and was in a bit of respiratory distress. So they wrapped her up, whisked her by my face and hurried her off to the nursery for a closer look.

In the days that followed, my daughter continued to have difficulty breathing. When I would nurse her, her oxygen saturation would drop into the low 80′s. She would also get quite tired while nursing and we had to supplement her feedings with bottle feedings. Although she never required supplemental oxygen nor slept in an incubator, she did initially have some problems with temperature regulation and slept on a little warming bed. The first time I saw her on this thing, with little eye covers over her face, it reminded me of a tanning bed and I asked “Why was my little brown baby was being tanned?” I was informed that the warming bed would help her regulate her temperature and help with bilirubin  metabolism (although she never did have an increased bilirubin level which is common in late phase preemies.) Overall, my daughter did really well and continued to progress during her 10 days in the NICU. By the time she was discharged, her father and I were providing the bulk of her care; holding her skin to skin, feeding her and changing her. I was increasingly frustrated that they would not allow her to go home and actually “had it out” with the neonatologist one day when he proposed yet another day of “watching”. But if I were to have my daughter today, knowing what I know, I would be (and I am now) ever thankful for the care of the NICU staff provided for my daughter.

In 2009, 71% of all preterm infants were late preterm infants, born between 34 and 36 weeks 6/7 days. The most common reasons for these early deliveries were:

 

  • Spontaneous Labor
  • Premature Rupture of Membranes
  • Pregnancy Induced Hypertension
  • Placental Disorders
  • Fetal Disorders
  • Intrauterine Growth Restriction
  • Multiple Gestation (Twins or higher order multiples)
  • Maternal Medical Disorders

Because many late phase preterm infants look like term infants, signs and symptoms of complications can be missed. But these can be a crucial errors. Late preterm infants born to mothers with antepartum hemorrhage ae 12 times more likely to develop problems in the early post partum compared to term infants. Infants born to mothers who had pregnancy induced hypertension are 11 times more likely to have post partum complications. The earlier the infant (i.e. the closer to the 34 weeks) the more likely they are to experience complications. And when an infant is an “early late phase preemie” and born to a mother with medical problems such as pregnancy induced hypertension, the more likely the infant is to have complications. The most common complication seen in late phase preterm infants are:

  • Elevated Bilirubin levels (hyperbilirubinemia)
  • Respiratory Issuesn (rapid, labored breathing and/or Pneumonia)
  • Hypoglycemia
  • Poor feeding (fatigue and poor weight gain)
  • Temperature instability (inability to regulate temprature due to lower amounts of brown and white fat on their bodies)
  • Infections

Any one or a combination of these issues may land the infant in the Neonatal Intensive Care Unit (NICU). However, not all infants who exhibit these complications need the expert skill rendered in the NICU. Well trained hospital staff and well educated parents can manage many of these infants.  So what do parents and care providers need to know?

Mamas, if at all possible, avoid having a cesarean section-especially if it is your first child. First time Cesarean section delivery of the 32-36 week infant increases the infant’s risk of developing the aforementioned complications as well as their risk of not surviving. Almost all of these infants end up in the NICU. While a cesarean section may be indicated if mama, baby or both are in distress, elective cesarean sections should be avoided.

Watch your child’s feeding patterns. Because these infants often tire easily with nursing, infants who fall asleep while nursing my be mistaken for being full when they are actually fatigued. These infants may have long periods between feedings and fail to gain weight. Parents of such infants must adopt an every 2-3 hour feeding schedule and keep a close watch on weight gain to ensure adequate nourishment and development.

These infants should not be discharged early. Late preterm infants have a high rate of “bounce back admissions”. Many of the complications that arise do so within the first 48 hours to 2 weeks post partum. Careful monitoring in the hospital for 48 hours can allow medical staff to detect arising complications and treat them early to avoid major problems as well as readmission. While these infants should be assessed often, they don’t necessarily need to be in the NICU. They should be evaluated by a pediatrician 48-72 hours after discharge and at 2 weeks then 8 weeks. This may seem like a lot, but complications, if they are going to arise, will occur within the first 28 days of life.

Looking at my daughter today I can hardly believe she was the tiny little baby I held so close. Just 3 inches shorter than me (Okay, I’m only 5 ft, but she’s only 11!) and already developing the curves of a young woman, she has grown and developed really well. She has asthma that is well managed and does anything she wants to do. But those early days of keeping her bundled up (she was an October baby) and watching her feedings were hard-but well worth it. And the expert care of the NICU staff are much credited with her health success. I was a stressed out mama then, just wanting to take my baby home.  But I am forever grateful that the staff-the neonatologist in particular-stood firm, monitored her carefully and only sent her home when they were absolutely sure that she wouldn’t come back. And she never has!!!

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Resources:

Erica Saleski Forsythe, MSN, RN, Patricia Jackson Allen, MS, RN, PNP-BC, FAAN “Health risks associated with late-preterm infants: implications for newborn primary care.” Pediatric Nursing. 2013 Jul-Aug;39(4):197-201. 

MedScape OB/GYN Women’s Health