Pregnancy, while one of the most joyous times in a woman’s life, is also one of the most physically and physiologically stressful times. There is no doubt in anyone’s mind that pregnancy fundamentally changes a woman’s body; some women will gain as much as half of their pre-pregnancy weight during their pregnancies. Others will develop gestational diabetes, pregnancy induced hypertension or, in more severe cases peripartum cardiomyopathy (enlargement of the heart) or kidney failure. During pregnancy, the body increases its blood volume by 50 to better be able to nourish the growing fetus and maintain mama. Most women will “sail” through their pregnancies, labors and deliveries, have healthy children and will “live happily ever after”. Others won’t be so lucky and they or their children will perish from primarily preventable forms of heart disease.
Cardiovascular (heart) disease is a leading cause of death in the United States. A recent article published in Obstetrics and Gynecology reports that researchers in Illinois found that from 2000-2011, nearly 20% of all maternal deaths were heart related, Here is what they found:
- Most of the deaths occurred in the third trimester or within 6 weeks of the post partum period.
- Most of the heart related problems happened in women ages 30-39, while the most severe cases occurred in women over 40.
- Cardiomyopathy (enlarged heart)in pregnancy is a rare cardiac occurrence, is almost exclusively caused by pregnancy and occurs more often in young women, 20-29 years.
- Death from cardiomyopathy is more likely to happen in very young women, less than 20 years old.
- Black women have significantly higher rates of pregnancy related heart disease compared to White or Hispanic women.
- 28% of all of the deaths were potentially preventable.
Yes, you read that last bullet point correctly. Twenty eight percent of the cardiovascular deaths that occurred during or just after pregnancy in the Illinois report were potentially preventable deaths! So what should you, as a Mama on Bedrest do to protect her heart?
- Schedule and maintain your regular prenatal visits. Early detection and early action are the hallmarks of treatment success for any disease, but especially cardiovascular disease during pregnancy.
- Notify your health care provider immediately if you notice any heart palpitations, difficulty breathing, unusual swelling in the hands, feet, face, changes in urine output. Now this may be difficult as you are likely experiencing all of these symptoms as a result of your pregnancy. Suffice it to say that if you have an increase in any of the symptoms or if they suddenly occur where they didn’t previously exist, then consult your health care provider.
- INSIST ON FOLLOW UP AFTER YOU HAVE YOUR BABY!! One of the key points that came out of the points that came out of the Illinois study is that most of the heart disease related deaths occurred after 6 weeks post partum. Many women have their post partum follow up visits with their obstetricians and then don’t return for a year or unless there are other issues. If you had a problem, even a minor problem during your pregnancy, FOLLOW UP FOR UP TO A YEAR POST PARTUM. Many conditions will “flare” with the fluctuation of hormones during the post partum, i.e. get worse, so you want to be closely monitoring for symptoms.
It is imperative that mamas receive comprehensive care of cardiac problems and are fully treated to avoid-or at least mitigate-heart problems in the future. Thankfully not all mamas who have heart problems will die, but many will have life long problems as a result of incomplete care. Be sure to have ongoing follow up and let all subsequent providers know that you experienced heart problems while you were pregnant.
The authors also note that providers must do a better job of
- educating their patients about the signs and symptoms of cardiovascular disease
- referring patients immediately to specialists when problems occur
- continuing to monitor their patients’ conditions well into the post partum period, as long as a year post partum.
As this article clearly states, death from cardiovascular complications is very often preventable. Patients and physicians alike must be aware of the signs and symptoms of cardiovascular disease and both must have a low threshold for seeking evaluation; patients from their obstetricians, physicians from their specialists colleagues. Finally, it is imperative that women who developed cardiovascular symptoms during or just after pregnancy be evaluated for an extended time in the post partum, often up to one year post partum.
What is it like to have a pregnancy related heart problem? Hear a mamas story.
Have you experienced a heart problem during your pregnancy? Please share your story.
If you have more questions, email email@example.com
Mamas on Bedrest: “Widespread Insurance Coverage of Doula Care Would Reduce Costs, Improve Maternal and Infant Health”January 14th, 2016
As we roll into 2016 one thing is certain: We are on the brink of change in the maternity world! At no time in history have there been so many groups and so many initiatives determined to improve maternity care and birth outcomes. Below is a press release put out by two leading maternity advocacy groups, Choices in Childbirth and Childbirth Connection (a program of the National Partnership for Women and Families) to raise awareness not only of the cost benefit of doula care, but also the tremendous benefit doulas provide to mamas and infants in improving birth outcomes. A doula is “a trained birth attendant who provides non-medical emotional, physical and informational support before, during and after childbirth.” Here is more from the press release:
“Widespread coverage of doula care is overdue,” said Michele Giordano, executive director of Choices in Childbirth. “Overwhelming evidence shows that giving women access to doula care improves their health, their infants’ health, and their satisfaction with and experience of care. Women of color and low-income women stand to benefit even more from access to doula care because they are at increased risk for poor maternal and infant outcomes. Now is the time to take concrete steps to ensure that all women can experience the benefits of doula care.”
“Doula care is exactly the kind of value-based, patient-centered care we need to support as we transform our health care system into one that delivers better care and better outcomes at lower cost,” said Debra L. Ness, president of the National Partnership. “By expanding coverage for doula care, decision-makers at all levels and across sectors – federal and state, public and private – have an opportunity to improve maternal and infant health while reducing health care costs.”
The brief provides key recommendations to expand insurance coverage for doula care across the country. They have also provided an informative infographic which also summarized the major points (see below).
- Congress should designate birth doula services as a mandated Medicaid benefit for pregnant women based on evidence that doula support is a cost-effective strategy to improve birth outcomes for women and babies and reduce health disparities, with no known harms.
- The Centers for Medicare & Medicaid Services (CMS) should develop a clear, standardized pathway for establishing reimbursement for doula services, including prenatal and postpartum visits and continuous labor support, in all state Medicaid agencies and Medicaid managed care plans. CMS should provide guidance and technical assistance to states to facilitate this coverage.
- State Medicaid agencies should take advantage of the recent revision of the Preventive Services Rule, 42 CFR §440.130(c), to amend their state plans to cover doula support. States should also include access to doula support in new and existing Delivery System Reform Incentive Payment (DSRIP) waiver programs.
- The U.S. Preventive Services Task Force should determine whether continuous labor support by a trained doula falls within the scope of its work and, if so, should determine whether labor support by a trained doula meets its criteria for recommended preventive services.
- Managed care organizations and other private insurance plans as well as relevant innovative payment and delivery systems with options for enhanced benefits should include support by a trained doula as a covered service.
- State legislatures should mandate private insurance coverage of doula services.
Seldom do I revert to childish gloating, but occasionally I just have to go there. Such is the case as I am gleefully reading the report put out by the US Centers for Disease Control and Prevention utilizing data from the National Center for Health Statistics which shows that Black fathers are just as engaged-if not more so-in the rearing and support of their children than fathers of other races.
Excuse me while I take a moment to gloat.
“Ha! Told yaaaaaaa!!”
“Na na na na na, you were wrong!!!!!”
Now you may be wondering why I am so over the moon about this research? Well, there are several reasons.
1. I am sick to death of hearing how black men are no good, they “hit it and quit it” and don’t take responsibility for the children that they help create.
2. I am sick and tired of hearing that all the ills of the world are because of black men.
3. I am thoroughly done with the portrayal of black men-black people actually-as uncivilized and bringing down the status of US culture globally.
4. And I am beyond through with this nation feeling that it is okay to kill a black male simply because he is present in time and space!
Now you all may be wondering, “What in God’s name does any of this have to do with high risk pregnancy and bed rest??” Well, it has everything to do with it. As I have often reported, African American women and infants have the worst birth outcomes of any other race or ethnicity in the US, with 2-4 times the morbidity and mortality of women and infants of other races and ethnicities. An African American infant is more than twice as likely to die before its first birthday than infants of other races and ethnicities and this is due primarily to preterm birth!!!
Are you following me yet?
Let me continue. Ever since I can remember and at least for my adult professional life “the party line” regarding the black family has been,
“It’s the breakdown of the black family, and the absence of black fathers in particular, that is the cause of the high maternal and infant morbidity and mortality that exists amongst African Americans.”
As an African American, and now as a divorced single mama, I knew that isn’t at all the case but had no way of substantiating what I knew to be true. Now there is concrete data obtained by one of the most reputable scientific bodies in the United States that has shown what many of us African Americans already knew. Yes, many more African American children are born to and/or raised by “single” mothers, but what this study has shown is that while the parents of a child may not be married, they may in fact be together (co-habitating) and even if they are not living together, African American fathers are intricately involved in the rearing of and support (and here I do mean financially) of their children, in many cases more than White or Latino fathers.
So again you may be asking, “What does this have to do with preterm labor and infant mortality?” Stay with me.
There is a lot going on in the United States as regards race and quite frankly none of it is good. We have all seen and heard the news reports of police shooting unarmed African American men, racial profiling of both African American men and women, disparities in discipline for African American School Children and so on and so on and so on. These are daily facts of life, daily stressors for African American women, and daily stressors for the infants they are carrying. Additionally, poverty for all families is reaching heights not seen since the great depression and other times in our history. The unemployment rate is still teetering on the high side and looms highest amongst African American men. More depressing is the fact that people of any race with higher educations are now just as likely as those with little to no education to endure a prolonged time of unemployment, and those numbers are again higher for African American men. This amounts to markedly elevated stress for African American men and African American women, their partners. Stress, as well as poverty, is not good for anyone, but particularly not good for pregnant African American women and the infants that they are carrying. We know that stress is an independent risk factor for preterm labor, prematurity and low birth weight all areas in which African Americans have the highest rates. So I think that it is safe to say that poverty, unemployment and racism are far strong predictors and stressors on maternal and infant morbidity and mortality in African Americans than “absentee dads”.
Now I know that many of you are going to come right back at me and say, “But what about black on black violence? What about the crime rates in predominantly black neighborhoods? And we know that many African American men abandon their family responsibilities.” Agreed. But the data from this study, which was broad and the study well constructed, shows that despite all these negative influences, African American men continue to be hands on fathers, and at greater rates than white or Latino fathers.
I wholeheartedly admit that there is much that needs to be done within my culture to heal it. But let’s not look astray too much to lay blame. Much of what we see in these urban, depressed areas is poverty; boarded up buildings, non-existent stores and services, poorer schools and no revenue coming into these areas. Add to that no jobs, no way for people in these areas to support themselves and their families, no money, leads to crime and yes, homicides. Is it okay? No. Is it an excuse? Of course not. But let’s consider the fact that if people in these areas had jobs, income and ways in which to support and sustain their families, then, according to data from the CDC again, crime rates would in fact go down and quality of life would go up.
But I myself have veered a bit off topic. The bottom line is this-even in depressed economic times, even in economically depressed communities, even when jobless, even with the threats to their lives black men are taking care of their children. Contrary to the sensationalized news reports and the stereotypic depictions on television and in movies, black men are taking care of their children-their families. The question now becomes, how can we as a culture, as a nation give them a hand so that this can continue? What are we as a nation, as a culture doing to reduce poverty, increase jobs, increase opportunities for education so that not just black men, but all men, can have the means to raise and support their children?
Finally, we have to ask the question, “Have we too narrowly defined “family”? We know from this work that there are men and women living together and raising their children but not married, or married and helping to raise their spouse’s children. Aren’t they still a family? What about blended families? Large extended families? This is all data that is yet to be analyzed-or even obtained. We know that African Americans being of the African diaspora are a “tribal” people. Migration and dispersion-both voluntary and involuntary-has also played a role in the depressed socioeconomic status of African Americans resulting in decreased community support for families. How are we as African Americans going to re-establish our communities and our families going forward?
There are many unanswered questions and I am sure that many more studies will come about, but what we do know is this: African American men are supporting their children and its time to toss out the stereotypes of them as “absentee fathers” and do what we can to support their efforts and the efforts of all men who want to be active parents to their children.
Jo Jones, Ph.D., and William D. Mosher, Ph.D., “Father’s Involvement With Their Children: United States, 2006–2010”. National Health Statistics Report, Number 71, December 20, 2013
The Causes of Infant Mortality-The US Centers for Disease Control and Prevention
African-American Women and Their Babies at a Higher Risk for Pregnancy and Birth Complications–The US Centers for Disease Control and Prevention
Black Unemployment Rate 2015: In Better Economy, African-Americans See Minimal Gains–International Business Times.
Murry, V. M., Brown, P. A., Brody, G. H., Cutrona, C. E. and Simons, R. L. (2001), “Racial Discrimination as a Moderator of the Links Among Stress, Maternal Psychological Functioning, and Family Relationships.” Journal of Marriage and Family, 63: 915–926. doi: 10.1111/j.1741-3737.2001.00915. x
The Absent Black Father Myth Debunked-by CDC–The Daily Kos