Prenatal Health Maintenance
I have to confess, I’m having a moment of Geek. I received an article link from a former Mama on Bedrest and the Geek in me has been jumping up and down as I am reading it. Finally, researchers here in the United States are taking notice of the fact that intra partum maternal mortality rates are atrocious and they are doing something about it!
Now you are probably saying, “What has that got to do with me, a Mama on Bedrest?” Well, it has everything to do with you! It means that physicians, researchers and hospitals around the country are making changes to ensure that if you have a complication during your labor and delivery, you don’t die from it. In my book, that’s a pretty big deal!
Okay, this is not exactly a sexy topic. It’s not, “4 Ways to better prop yourself up on pillows while on bed rest,” or some other topic that is immediately associated with your current situation. It’s not soothing, it’s not comforting. Yet it’s extremely important. It’s the nuts and bolts of maternity care. Its looking at a grave situation-maternal mortality in the United States (which is worse than any other industrialized nation by the way and 3-4 times worse in African American women!)-and saying, “We’re going to fix this!!” The good thing is that when American physicians and researchers put their minds and energy into improving outcomes, things typically do improve! (Look at how care of preterm infants has vastly improved, assisted reproductive technology allows women to become pregnant in the first place, and all the advances in perinatal care if you want examples!)
So what is the article saying-Exactly?
The article is from the St. Louis Post Dispatch and asked the question, “Why are so many US women dying during childbirth?” The doctors and researchers in this article, all from the St. Louis Missouri area, began looking closely at cases of maternal intra partum death and came up with the following reasons and solutions:
- Preconception counseling or at least very early prenatal counseling is important-especially in women with pre-existing conditions and/or riskfactors for complications.
- Pregnancy has become increasingly risky because of the prevalence of obesity, Type 2 diabetes, hypertension and cardiovascular disease; more older women having children; advancements in fertility treatments resulting in twin births; and the high rate of C-sections. All of these issues must be addressed early and aggressively, from start to finish during pregnancy.
- Researchers and high-risk pregnancy specialists say an important step is stratifying maternity care, parallel to what has been adopted in the care of high-risk newborns. Higher-level hospitals would have the specialists and infrastructure needed to take care of complex (maternal health) cases, help institute guidelines to improve care, and consult with lower-level hospitals on complex cases. They note that often a mama and her baby are transferred to another hospital to care for a sick, fragile infant, forgetting that the infant is ill because the mama is also in poorer health. Care must start with mama!!
- Physicians and hospitals must be continually evaluating their outcomes and making adjustments to improve care. Complication protocols must be instituted and everyone must be trained in these protocols. Doctors and staff who fail to comply must be “reined in.”
- What hospitals can also do, many say, is promote spontaneous, vaginal births — the safest for mothers and babies. One procedure or drug increases the risk for another, often causing a cascade of interventions that ends with a C-section. In the U.S., the C-section rate has skyrocketed to 33 percent of all births. The World Health Organization says it should be closer to 15 percent.
- Consider using more Midwives and for uncomplicated births. Their low-tech approach has been shown to reduce C-section rates and improve other health outcomes.
- More research and study needed to understand the causes and treatments of potentially catastrophic maternal conditions. Even if a complication is rare, there should be protocols in place every part of the health care team should be educated on the condition and the protocol and know what to do in the event of a catastrophic event.
- Statewide maternal mortality review committees (and a national registry??) made up of key players in prenatal, childbirth and postpartum care are being instituted. Committees regularly review deaths to gain insight on warning signs, prevention and treatments. Such committees exist in Illinois and Missouri and the Illinois committee is the model for several other committees forming around the country. Federal legislation proposed two years ago to beef up state maternal mortality committees stalled, but nationally, there is a bigger effort around improving care than there ever has been before by government, doctors groups and researchers.
The wheels of change are slowly turning and finally there is emphasis on the health of mamas! I’ve said my goal is to put myself out of business. Hopefully with these changes in maternity care, that desire is not long off!
I love it when research confirms what I already know and am doing.
Shelley Wilkinson and H. D. McIntyre started a program in Australia called “Healthy Start To Pregnancy” in Australia. Their premise was that women given information and tangible guidance at the beginning of and during pregnancy will have better outcomes.
The researchers compared 182 “Usual Care” women, i.e. women who received routine prenatal care from the Maternity Hospital to 178 women who enrolled in the Healthy Start to Pregnancy Program, a low intensity, behavior modification program. The program consisted of (2) one hour prenatal workshops (one at the start of the program and one midway through) presenting information on healthy nutrition, exercise , information on smoking cessation, information on appropriate weight gain and Breastfeeding education . The women who participated in the program were also given written information to which they could refer. The researchers found that approximately half of the study women completed the study. The researchers found that significantly more women in the study met the prenatal guidelines for consumption of fruits and vegetables and for exercise than women not in the study. The study women were also more likely to be in range for appropriate weight gain. There was not a significant difference between women who quit smoking or intended to breast feed between the study and non-intervention groups.
I believe that studies of this nature are important and highlight some really important habits that we here in the United States need to notice. While most (but not all!) women in the United States have access to good quality prenatal care, just as it was shown here, medical prenatal care alone is not enough to ensure healthy prenatal outcomes. Women need tangible information and as this study shows, having access to support and guidance further enhances outcomes. Many obstetrical offices offer birthing classes and breastfeeding basics. But classes targeted specifically to prenatal nutrition and exercise have significant impact on compliance and on outcomes.
One thing that the researchers noted and I have seen in my practice as well, programs have to be easily accessible so women can participate. Hospital based programs, while often good aren’t always the best venues. Many women get their prenatal care at offices that may be close to work but would prefer to exercise closer to home for example. Other women may only have access to public transportation so they will make the trek to see their health care providers but not necessarily for a fitness or nutrition class. And when I was teaching prenatal fitness, having childcare was a must-especially at morning classes. Now add the twist of women on bed rest and we now need to integrate technology so that ALL mamas can reap the benefits of these proven behavior strategies.
We’re getting there. As awareness of the necessity of behavior modification during pregnancy (and during many other phases of a woman’s life) rises, my hope is that the US medical community will recognize the great benefit of such programs on health and promote more of these programs. As you all know, I am “Pro Action”, working to maintain rather than fix once broken. I believe that if in the US we can adopt a more “Pro-Action” stance, especially as it pertains to pregnancy and prenatal care, we can improve outcomes as well as improve women’s overall pregnancy experiences.
While Today is April Fool’s Day, the news below is certainly no joke. Yet another study has reported that low levels of Vitamin D in pregnant women is associated with adverse pregnancy outcomes.
Fariba Aghajafari, MD, CCFP, and colleagues from the University of Calgary in Alberta, Canada, published their findings after performing a systematic review and meta-analysis of the available data online March 26 in in the British Medical Journal. Reviewing data from studies published on MEDLINE, PubMed, Embase, CINAHL, the Cochrane Database of Systematic Reviews and the Cochrane database of registered clinical trials, the researchers reviewed 31 studies and found the following results:
- Low levels of 25-OHD Vitamin D (the best indicator of Vitamin D status in Humans) is associated with increased risk of Gestational Diabetes
- Low levels of 25-OHD Vitamin D is associated with increased risk of pre-eclampsia
- Low levels of 25-OHD Vitamin D is associated with small for gestational age infants.
And these findings are only from this one study! We here at Mamas on Bedrest & Beyond have reported in several of our blog posts the effects of low levels of Vitamin D and adverse pregnancy outcomes. Here is what we have found in the literature to date:
- Low levels of Vitamin D are associated with Post Partum Depression.
- Low levels of Vitamin D are associated with Gestational Diabetes
- Low levels of Vitamin D are associated with Pre-Eclampsia
- Low levels of Vitamin D are associated Low Birth Weight and Asthma in the Baby
We have also found that while current medical recommendations are only 200-400 IU of Vitamin D for daily supplementation, Studies we have seen recommend far more for optimum function (upwards of 2000-4000IU daily).
So what should you do with all of this information? Talk To Your Doctor!! While you may initially experience a bit of push back from your OB, if you bring in these citations, they will take you seriously. Leading medical experts are recognizing the importance of Vitamin D supplementation and noting that the vast majority of individuals in the United States are deficient. Interestingly enough, darker skinned people are at increased risk of Vitamin D Deficiency because Vitamin D is absorbed through the skin from the sun and darker skin protects against penetration from the sun’s rays, so less Vitamin D is absorbed by darker skinned individuals.
Personally, I think that there is a growing body of evidence to support Vitamin D supplementation. The question becomes, at what dose? You will have to discuss this with your doctor. My guess is that optimum dosage may have to be done individually and for that, you may need to have blood levels of Vitamin D assessed in order to figure out how much (if any) supplementation you need.
I warn you now that not all OB’s have jumped on the Vitamin D bandwagon. Many are content to simply prescribe a prenatal vitamin and leave it at that as they, “Don’t believe the hype”. But I suggest to you that if you are at increased risk for any of he aforementioned conditions for which low vitamin D levels increase the risk, then at the very least a discussion with your physician is in order. It may not be the ultimate cure for what ails you, but if it can help you decrease your risk of pregnancy complications and adverse outcomes, a simple pill or 2 a days seems easy enough for your OB to prescribe and for you to take, and there is little to no risk of toxicity or overdose.
Talk with your doctor about your Vitamin D levels and see if you need supplementation. It’s easy, and it may well vastly improve your health, the health of your baby and your ability to have a healthy, full term infant.