Research

Mamas on Bedrest: Pregnancy Can “Break” a Mama’s Heart!

April 13th, 2017

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 info@mamasonbedrest.com

References

Medscape

Maternal Cardiovascular Mortality in Illinois, 2002-2011

Briller, Joan MD; Koch, Abigail R. MA; Geller, Stacie E. PhD
doi: 10.1097/AOG.0000000000001981
Original Research: PDF Only

Mamas on Bedrest: DOULAS SHOUL BE PRESENT AT ALL BIRTHS GLOBALLY!

April 6th, 2017

When people ask me what I think about doulas, I simply say,

“Doulas are an invaluable part of the birthing team and I wish I had had not one but two doulas when I was having my children, especially my daughter! We needed one doula for me and one for my husband!”

Doulas are birth attendants, typically women, who stay with a woman providing support, encouragement and non-medical pain relief and comfort measures to childbearing women during labor, delivery and in the early post partum. The World Health Organization has added their endorsement of birth attendants (doulas) by recommending that, “Birth Attendants be present at ALL BIRTHS GLOBALLY,” as part of the WHO Safe Childbirth Checklist Implementation Guide. This is huge, not only for those of us who are doulas and know the invaluable role we play in supporting mothers during pregnancy, labor and delivery and in the immediate post partum period, but also for mothers who may not know about doulas, or who may have been on the fence about getting a doula.

Research on the efficacy of doulas shows that when childbearing women have doulas attend their births they have:

  • Decreased overall cesarean rate (down 50%) and they are less likely to have a cesarean section delivery or other invasive interventions.
  • Shorter labors (decreased 25%)
  • Decreased use of oxytocin by (decreased 40%) a medication used to start or hasten labor.
  • Decreased requests for an epidural or other pain medications by 60%.

Doulas attend to mothers and/or couples primarily during childbirth and in the early post partum period. However, there are ante partum doulas (Mamas on Bedrest & Beyond for example) who attend to mothers who are experiencing complications prenatally and who need additional support. Prenatally doulas offer non-medical supportive care such as helping mothers on bed rest become more comfortable, attending to home duties, offering resources and tips for comfort and support, emotional support, family support, childbirth education, and lactation support and education.

Many people are under the mistaken impression that doulas are only for women having “natural” (vaginal) or home births. Doulas attend all types of births, in all types of settings; home births, hospital births or birthing centers. Additionally, doulas are as beneficial to women having cesarean sections as they are to women having vaginal births. Doulas are particularly under utilized by high risk pregnant women and yet this group stands to benefit the most from the support and emotional care.

Mamas on Bedrest, you can and should consider having a doula present at the delivery of your child-even if the father is present. This well trained, impartial birth professional can act as your advocate and as a bridge to the health care system and to providers when you are unable to advocate for yourself. They can help explain procedures, assist in getting you information on certain proposed procedures and treatments and can help be sure that you are giving informed consent when you sign forms. Doulas are present first and foremost for the mother and the needs of everyone else in the family or on the healthcare team are secondary. Doulas DO NOT MAKE MEDICAL DECISIONS for their clients, but rather hold a space so that a woman and her partner (if present) can determine the best course of treatment for them based on all the available information.

The doula model has been present historically as far back as Biblical times (Exodus 1:15-21) when women of a family or tribe attended to a birthing woman and made sure that her children and husband were fed and cared for. Doulas and Midwives nearly became extinct during the middle and latter part of the 20th century with the advent of hospital labor wards and the specialty of obstetrics. There has been a resurgence in doula use during the latter part of the 20th century and now in to the 21st century. Unfortunately, the use of Doulas has been limited to women of means as they have been the only ones able to pay for a doula as insurance companies have yet to agree to reimbursement.

But there is good news. There are many doula services that offer a sliding scale or are being reimbursed by Medicaid such that ALL women can receive this potentially lifesaving care. In Austin there are the following groups offering low or no cost doula services.

Austin

Giving Austin Labor Support (GALS)– A non-profit organization that supports women with limited or no resources for doula care so that “No woman gives birth alone.”

Mama Sana/Vibrant woman-a grassroots organization of low income women of color serving women in the community with prenatal, birth and post partum reproductive health support.

Outside of Austin, there are several programs around the country serving women from all income backgrounds:

Ancient Song Doula Services– A non-profit organization in Brooklyn New York serving low income women of color.

The Pettaway Pursuit Foundation-Located in Pennsylvania, this non-profit organization specifically attends to high risk pregnant women on prescribed bed rest. A team of contracted doulas provide care and the organization has contracts with several managed care organizations for reimbursement.

Mamatoto Village– This organization also provides very high quality birth assistance and also has its own training program for its staff.

Uzazi Village – This non-profit organization provides doula services to low income women of color in the Greater Kansas City Missouri area, and has another location in St. Louis Missouri. They also provide doula training, childbirth education, reproductive health education and lactation services. They are also now beginning to train midwives.

These are just a few of the organizations that I know of providing doula services. There are others and I am sure many more that I don’t know about. The point I wish to make is that if you would like a doula to attend your birth with you, there is likely a doula organization or solo doula that can help. Mamas, don’t forgo this vital source of support. Doulas really do make births better!

Looking for a doula? e-mail info@mamasonbedrest.com and we’ll do our best to help match you with a doula.

Know of a doula that is excellent at what she does and serves women in need? Share her information here and we’ll start a running list of doulas that are serving low income.

Know of a doula organization that offers services at low or no cost? Let us know so we can share this information.

Did you have a doula at your birth? Please share your experience in the comments section below.

Mamas on Bedrest: Black Breastfeeding Infographic

August 31st, 2016

Hello Mamas,

As Black Breastfeeding Week wraps up, I am pleased to share with you an infographic that I helped to develop. Hope it helps you have get the vital information you may need to breastfeed!!!Black Breastfeeding Week_Aug 25-31_final