Mamas on Bedrest: Can routine cervical measuring and treatment with progesterone as indicated reduce and/or eventually eliminate bed rest?January 6th, 2015
Hello Mamas and Happy New Year!!!
Right before we all took a much anticipated holiday break, The Society for Maternal-Fetal Medicine (SMFM) added their voice to those of The American Congress of Obstetricians and Gynecologists (ACOG), The American College of Nurse Midwives (ACNM), The March of Dimes, Medicaid and The Perinatal Research Branch of the Eunice Kennedy Shriver Institute to recommend that preterm birth risk screening include cervical length measurements and for those women at increased risk, treatment with progesterone injections.
Why is this important? Well, if you visit our Facebook page, you will notice that a large number of the mamas in our community are on bed rest for cervical insufficiency or incompetent cervix. Cervical insufficiency is one of the leading causes of preterm labor in the US and one of the leading causes of infant mortality (infant death). The United States ranks 55th globally in infant mortality, with 26,000 infants dying annually before their first birthdays. This is a horrendous and utterly embarrassing statistic given that the US is one of the richest countries in the world with some of the most advanced health care, yet we can’t seem to save our babies. What is worse, infant mortality in the United States for African American babies is twice that of Caucasian babies, so deaths among little black infants is disproportionately high in the US.
But despite all this doom and gloom, the upside is that all of these medical societies have looked at the data as well as at available treatments and they have all come to the same conclusion: If there is more screening for preterm labor in pregnant women-measurement of the cervix and in those women at risk, the initiation of progesterone injections-the rates of preterm labor can be reduced 40-50% in mamas having just one baby and no prior history of preterm birth. And if every pregnant woman is screened for shortened cervix and those at risk identified and started on progesterone shots, medical costs associated with preterm labor, premature birth and subsequent medical and developmental support could be reduced by $750 million annually. Given that preterm labor and prematurity currently costs the US in excess of $26.2 billion annually, this is substantial savings. All of the medical societies are also in agreement that if a woman is noted to have a shortened cervix and is less than 24 weeks gestation, she should have a cerclage (a surgical stitich placed to hold the cervix closed) placed.
Preterm labor and prematurity are major issues in Maternal and Infant health and the leading cause of infant death before one year in the United States. If by simply screening and measuring cervical length early on with ultrasound and providing treatment with progesterone and cerclage can reduce preterm labor and prematurity and save the lives of babies, then we should be adopting these recommendations.
The elephant in the room for us here is will these practices negate the need for prescribed bed rest? That subject was not addressed in these recommendations, however, many of these same professional medical societies are recommending that bed rest not be routinely prescribed due to the negative effects that is has on Mamas’ bodies. So it will be very interesting to see how these recommendations are implemented and their effect on the overall preterm labor and prematurity rates. My guess is that if rates start dropping, we my in fact see a reduction in the bed rest prescription. Now wouldn’t that be exciting???
Mamas, share this information with your health care providers and see what they have to say. If you’ve been screened for a shortened cervix and started on progesterone, let us know in the comments section below. We would love to share the journey with you (join our Facebook Community!!)! And if you are prescribed the progesterone and/or cerclage without bedrest, do let us know how you fare and when you deliver your baby.
Society for Maternal-Fetal Medicine Joins with Other Organizations to Brief Congress on Need for Medical Protocols that will Save the Lives of Infants in the US by Reducing Preterm Birth. (Press Release December 17, 2014, Washington, D.C. Society for Maternal-Fetal Medicine. www.smfm.org
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 email@example.com
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.
- 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.
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 firstname.lastname@example.org. 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