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 firstname.lastname@example.org
According to WalletHub.com “2016 Best and Worst Places to Have a Baby”. Wallethub.com is a virtual financial planning company that helps individuals track their spending and saving, help repair credit and help individuals protect their credit history including protecting identity. Wallethub.com tracks people and money and in their opinion, if you cannot afford to have a baby, you shouldn’t. When the parameters of delivery budget (cost to have a baby, cost of living and cost/availability of health insurance), overall health care ranking (maternal and infant mortality, rates of prematurity, availability of professionals such as midwives and pediatricians, etc.. ) and baby friendliness (i.e. parental leave, available childcare, support for new moms, etc..) were analyzed for the 50 states and the District of Columbia, Vermont ranked number 1 as best place to have a baby by wallethub.com.
It is important to plan for children as unintended pregnancies can cause huge financial strains on families and can have serious health implications for mothers and infants if pregnancies occur too close together. But there are other, equally important issues to consider before becoming pregnant; availability of and access to quality prenatal care, adequate food resources, housing, how will the mama/family fare without mama’s income, childcare and availability and accessibility of resources such as transportation that may pose potential roadblocks to a healthy pregnancy and birth.
The article in question alluded to the fact that if a couple cannot afford a child, they should not have a child. Well, I live in Texas where availability of and access to family planning information and resources is extremely and increasingly limited. So what is a couple to do? Perhaps they cannot afford a child but in Texas, there is not readily available contraception and virtually no access to abortion. Should people simply stop having sex? That won’t happen!
I agree, finances should factor into the decision of whether or not to have a child. The reality is that conception is happening regardless of financial status (or even couple status!!). In my opinion, the best states or more pointedly, the best places to have a baby (because there are little oases within what I will call “maternity deserts”, areas that are fairly void of any sort of maternity support or reproductive health care) are places with the following:
- obstetricians and midwives, and facilities that allow both to perform deliveries
- birthing facilities that use the least amount of intervention that is safely possible
- birthing facilities that allow fathers and doulas to be present to support mama during labor and delivery
- birthing facilities that allow mama to freely move during labor
- birthing facilities that believe in immediate skin to skin bonding between mother and baby (even before wiping off the vernix, provided there are no health complications in either mother or baby!)
- birthing facilities that promote breastfeeding and provide immediate and readily available lactation support to new mothers
These characteristics should define whether or not a provider, a hospital or birthing center, a city or town or a state is “best for mama and baby.” The worst state in which to have a baby according to Wallethub.com is Mississippi and yet I would bet that within that state there are a few hospitals or birthing centers that are supportive of childbearing women and offer quality care and support. In addition to financial considerations, prior to pregnancy (or at least prior to birth) mamas and their partners should research health care providers and the health care facilities available to them in their states, cities and communities. For sure some cities will have more resources than others, and some states will have more resources than others. But that doesn’t mean that having an uncomplicated, normal healthy birth is absolutely impossible. It just means that mamas will have to be savvy, do research about what is available and collect as many resources for themselves as possible.
Mamas, be careful what you read. The headline “Vermont is the best place to have a baby” is misleading alone, may have had many mamas ready to relocate and truly doesn’t give mamas and their families tools and tips to evaluate birthing resources and facilities in their area that may in fact be “Mama and Baby Friendly”. I believe that every woman can have a healthy, uncomplicated pregnancy and birth a healthy full term normal weight infant. This is much easier to do in some areas where resources are more readily available than in others, but it is possible none the less. Use the aforementioned list as a guide to evaluating resources and with a bit of research, you too can make your pregnancy, labor and delivery mama and baby friendly-no matter where you live in the United States!
Mamas on Bedrest & Beyond is committed to helping mamas have safe, healthy pregnancies, labors & deliveries and healthy full term babies. If you need help finding resources in your area, e-mail email@example.com.
September is Infant Mortality Awareness month and on Saturday, September 24, 2016, Mamas on Bedrest & Beyond and her supporters will walk from Seton Medical Center in Austin to The Dell Seton Medical School at the University of Texas to raise awareness of Black Infant Mortality. Why are we walking?
From 2000 to 2013, The National Vital Statistics Report shows the infant mortality rate (IMR) declined nationally, yet there remains a persistent 2—3 fold disparity in IMR of black infants compared to their white and hispanic counterparts. Texas follows this trend with an IMR of 5.8 overall in 2013. But looking at specific data from the Texas Department of Health and Human Services for 2013, while the overall IMR was 5.8 deaths per 1000 births, the IMR of black infants statewide was 11.9 deaths per 1000 births. The picture gets even gloomier if we look at Travis County. In 2012 (the last year for which data has been compiled) the IMR for black infants was 13.6 deaths per 1000 births, 2.85 times the death rate of white infants. In 2013, the disparity ratio for IMR of black infants to all infants in Texas was 3.02, or black infants are 3.02 times more likely to die before their first birthday than infants of other races here in Travis County.
Austin/Travis County is the state capital and one of the wealthiest counties in the state. Yet since 2000 Austin/Travis County has failed in its attempts to improve birth outcomes and survival rates for black infants to match those of infants of other races. The IMR for 2013 actually represents an increase in IMR from previous data.
The Call to Action
We believe that an IMR of 6.0 deaths per 1000 or less is attainable for black infants in Travis County, just as it has been attained for infants of other races. Here are 6 steps we could initiate to make this possible:
- Strongly encourage the Texas Legislature to take the Medicaid Expansion funds allotted for the state by the Affordable Care Act. This alone would insure another 1.3 million Texans, many of them women and infants, and give more access to comprehensive prenatal care, post natal and pediatric care.
- Work to increase the number of black health care providers (physicians, nurses, midwives, lactation consultants, childbirth educators and community health workers) in Austin/Travis County.
- Include members of the black community in the conversation about Place Based health initiatives and new treatments (like 17P for the prevention of preterm labor) so that they can make informed decisions about their health care, help educate members of the community and increase utilization.
- An aggressive community outreach campaign which includes community gatherings for conversations, presentations at churches and other community venues and even door to door health information and health education efforts by members of the community.
- Educate and elevate. Black citizens in Travis County are not looking for a handout, but a hand up. When information is presented in a clear and understandable way, people are more receptive, more apt to listen and more likely to act.
- Support initiatives that will help restore the infrastructure in the black community such as improved schools, jobs, affordable housing, safe and affordable childcare, additional security, public transportation and grocery stores.
What are you doing to raise awareness about Black Infant Mortality? Share your thoughts and events in our comments section below.
For more information about our walk or to get involved, e-mail us at firstname.lastname@example.org
The National Vital Statistics Report, Volume 64, Number 9. August 6, 2015
The Office of Minority Health and Health Equity, Infant Mortality for the State of Texas and Travis County