infant mortality

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.

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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

Mamas on Bedrest: Yes, Black Mamas do Breastfeed!

November 11th, 2013

I am an African American Mama who breastfed both her babies. Yet according to The Centers for Disease Control and Prevention, African American Women lag far behind women of other ethnicities in breastfeeding. Why?

When I made the decision to breastfeed, both my mother and mother-in-law looked at me, noses squinched up, as if they had smelled something repugnant. Neither of them had breastfed their babies (3 a piece), and they could not fathom why I would want to do such a “primitive” thing. My mother-in-law even went so far as to say, “You’re gonna have saggy boobs”. That fell on deaf ears because I had my kids so much later in life my breasts had already begun to head south! I explained to them both the benefits of breastfeeding; fewer occurences of ear infections, reduction in the incidences of asthma and the mother baby bond. Both became supportive of my breastfeeding and I was able to breastfeed each of my children for just under a year.

The Nation’s Health recently looked at the disparities in breastfeeding and has been asking, “Why is it that African American Women breastfeed at much lower rates than other women and what can be done to improve their breastfeeding rates and success.” 

The biggest factor is support. While nationally many hospitals have increased their support and are advocating for exclusive breastfeeding (motivated in large part to earn the designation “Baby Friendly”), and are making lactation consultants widely available and ceasing to distribute formula care packages provided by formula companies, public health experts note that the support of a woman’s intimate family and friends plays a far more significant role in whether or not a woman decides to breastfeed and whether or not she succeeds. A woman is highly influenced by those around her.The responses of my mother and mother-in-law could have completely sabotaged my breastfeeding efforts. Strong, influential women like a mother or mother-in-law can make or break breastfeeding efforts. A supportive partner is also crucial to breastfeeding success. Women who have the support of their partners are also more likely to breastfeed and to have breastfeeding success. In communities in which breastfeeding is the norm, women are more likely to initiate breastfeeding and to be more successful at breastfeeding. Community groups and organization where mamas can gather and gain support also have an important role in breastfeeding success.

Education is extremely important. Many people are unaware of the significant health and emotional benefits of breastfeeding to both mother and baby. When I explained these important benefits (i.e. fewer ear infections, reduction in allergies and asthma, reduction in the incidence of reflux, bonding between mother and baby, and the financial savings) to my mother and mother-in-law, both quickly became supporters. Among teens, breasts are seen only as objects of sexual pleasure (as depicted in music videos and other media) and many young women report never having seen a woman breastfeed a baby and are unaware that the God given intentional use for breasts is to feed the young. We have to return to such basics.

We also have to consider the financial benefits and convenience of breastfeeding. Formula is not cheap and if a baby has any sort of allergy, specialty formulas are even more expensive than standard formulations. Additionally, with breastfeeding, there is no need to bring additional supplies in the diaper bag, no need to worry about temperature or if the formula is mixed in the right proportions to water. Breastmilk is always the proper temperature, the proper composition of water to nutrients and ready for immediate consumption! This is a huge consideration as we enter into Health Care Reform and the initiation of the Affordable Care Act. If we need to consider cost containment, Breastfeeding versus formula feeding must be targeted.

Finally, African American Women need to see other African American Women breastfeeding. While the CDC and other advocacy agencies have begun to show images of African American mothers nursing their infants, most informational material still shows white mamas and babies. Subconsciously, the message is “black mamas don’t breastfeed”. It may seem trivial, but we are visual creatures. When African American mamas are aware that other African American mamas breastfeed and can actually see other African American mamas breastfeed, they are more likely to breastfeed themselves.

While overall rates of breastfeeding among African American women has increased, these rates still lag far behind women of other races and ethnicities. With the known health advantages of breastfeeding for both mamas and babies, including the potential to lower infant illness and death in African American babies (who have the highest rates amongst infants of all ethnicities) Breastfeeding support and education must be made a priority for all mamas, but for African American mamas in particular.

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My son and I circa 2006. Note the chubby breastfed cheeks!

 

Vamessawaves

My daughter in 2002 at approximately 4 months. Though born at 5 lbs 3oz, note the chubby breastfed cheeks!