CIMS is Hard at Work for Mamas on Bedrest

February 25th, 2010

I’m so excited! The Coalition for Improving Maternity Services (CIMS) Annual Meeting and Forum will be held in Austin this weekend, February 26-27th and I’m going to be there!  Some of the most prominent experts in mother and baby care will be presenting and relating data from their latest research. I know that I am going to learn a lot about how to better care for and serve mamas on bed rest. Of course I will be sharing all that I learn with you.

CIMS defines itself as,

“The Coalition for Improving Maternity Services (CIMS) is a coalition of individuals and national organizations with concern for the care and well-being of mothers, babies, and families. Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs. This evidence-based mother-, baby-, and family-friendly model focuses on prevention and wellness as the alternatives to high-cost screening, diagnosis, and treatment programs.”

What does CIMS do for Mamas On Bedrest?

“How does this pertain to me? I have a high risk pregnancy and all of those “natural” treatments and birthing options won’t work for me. There will be lots of medical intervention in my birth-there already has been!” CIMS is dedicated to ensuring that all mamas have as natural and as safe a pregnancy, labor and delivery as possible-whether they are considered “high risk” or an “uncomplicated” pregnancy.

Why is CIMS’ work so important?

Mostly because of the poor maternal and infant mortality rates in the United States. According to the March of Dimes 2003 data , infant mortality rates in the US are at approximately 6.8 deaths per 1000 births. This is a sobering number given that in the US, we have some of the most technological treatments available. Despite our technological advances and our ever rising medical costs, the United States lags far behind most industrialized nations and many developing nations in infant mortality. For all we do, many American infants still die well before their first birthdays. The statistics are worse or African American babies. Black babies die at a rate of 13.5/1000 according to the March of Dimes.

Maternal mortality is not much better. According to the US Department of Health and Human Services Health Resources and Services Administration, in 2006 13.3 maternal deaths occurred for every 100,00o births. This may not seem like a lot, but in 1n 1987, that number was 6.6 per 100,000. We’re going backwards, not forwards. What is most alarming to me, an African American woman, is that the vast majority of deaths occur in African American women and babies. African American mothers are 3 times more likely to die from complications of pregnancy or childbirth than their white counterparts.

Part of the problem is that for all of our technology and advanced treatments, they are not readily available to everyone. Women from lower socioeconomic groups, women without insurance  and women whose insurance dictates caregivers or place of birth are at the mercy of whatever care their providers choose to give them.

And in many cases, that means cesarean section. The United States has one of the highest rates of cesarean section delivery in the world. Nearly a full 34% of babies born in the United States are born via cesarean section. While cesarean section is a necessary procedure in certain cases, often in the United States cesarean sections are elected based on convenience or to avoid the potential for a poor outcome and subsequent litigation. The World Health Organization (WHO) clearly states,

“Countries with some of the lowest perinatal mortality rates in the world have cesarean rates of less than 10%. There is no justification for any region to have a rate higher than 10-15%” (From the International Cesarean Awareness Website, www.ican-online.org)

CIMS is working with ICAN and other organizations to push tougher regulations on cesarean sections so that mamas and babies won’t be put at unnecessary risk.

CIMS is also at the forefront when it comes to education, especially regarding breast feeding. It has long been established that breastfeeding is the best way to nourish an infant and has been endorsed by the WHO and the American Academy of Pediatrics. Yet a small percentage of American women and their babies have established breastfeeding by 6 weeks. CIMS’ members work diligently to provide breastfeeding education resources to underserved areas and to assist mamas who want to breast feed to do so.

CIMS is working to change the way American clinicians provide prenatal care to pregnant women. They advocate for the midwifery model of care which sees a woman as the primary driver of her health care and as an active participant in all decisions regarding her prenatal care.

The Mother Friendly Childbirth Initiative (MFCI)

With all of these interests, CIMS has issued The Mother Friendly Childbirth Initiative (MFCI). MFCI clearly states the position of CIMS on maternal, child and family birth and health care and what they are doing to change our current maternal health care system. The entire consensus statement can be read here.

CIMS is not a bunch of loud mouths hippies calling for everyone to have home births, and unfortunately, that is how some of their opponents try to portray them. On the contrary, CIMS is an organization whose members and advocates research pregnancy and child birth while adhering to the most stringent medical research methods currently required.  Any treatment or procedure that they advocate is endorsed because there is clearly defined evidence that the treatment is effective and beneficial and works with minimal or no inhibition to the natural course of pregnancy, labor and delivery. As we all know there are a number of treatments and procedures performed today during the course of “normal” prenatal care, pregnancy, labor and delivery that while they “get the job done,” they are often detrimental to mama and baby either physically and/or emotionally. CIMS raises awareness about such procedures while at the same time advocating for alternatives that are more supportive, nurturing, and equally beneficial and effective for mama and baby.

CIMS is an advocate for safe, natural pregnancies and births. No, they are not going to reem you for being high risk and needing intervention such as bed rest. But they are going to advocate that you be offered all possible options for your situation, that you get the support that you need while you are on bed rest regardless of your economic or insurance situation, that you be allowed to at least try vaginal birth in the absence of an evidence based contraindication, that you be close to your baby as soon as possible after delivery and that you have all the education, assistance  and support that you need to skillfully breastfeed your newborn.

I’ve said it before and I’ll say it again. Being on prescribed bed rest with a high risk pregnancy does not mean that you, a mama on bed rest,  lose all rights to decide your course of care. Nor should it prevent you from receiving the best care for you and your baby; care that supports you, nurtures you and results in both of you. CIMS may advocate for vaginal births and a midwifery model of care, but at its heart, CIMS seeks to defend and advocate for the health and well being of mothers and babies.

When Love Hurts: Domestic Abuse in Pregnancy

February 23rd, 2010

Pregnancy is a time when a couple should be savoring their time together while eagerly anticipating the arrival of their new little one. Sadly for some couples, pregnancy becomes a time of increased stress and ends in abuse-both physical and emotional.

Reasons for Domestic Abuse During Pregnancy

The most common reason for abuse during pregnancy is that it is a continuation of pre-pregnancy abuse. Women who are abused prior to pregnancy are at increased risk of being abused during the pregnancy. Domestic abuse during pregnancy is also the result of:

  • Stress related to the pregnancy-especially if the pregnancy was unintended.
  • Financial concerns regarding the pregnancy, delivery and subsequent addition to the family
  • Change in the partner’s relationship, especially insecurity and/or jealousy of the father regarding mother’s divided time and increased attention to the baby.

How Common  is Domestic Abuse in Pregnancy?

The March of Dimes and other resources state rates of domestic abuse during pregnancy reach as high as 25% of all pregnancies. Abuse of pregnant women occurs in all ages, races and ethnic groups and in all socioeconomic levels.

What is Considered Abuse?

The abuse can range from name calling, verbal insults and controlling/isolating behavior to pushing, hitting, punching, kicking or choking. While emotional abuse is extremely stressful, physical abuse can be extremely harmful-even deadly to mother and baby. If you are unsure if you are in an abusive relationship, ask yourself the following questions:

  • Does my partner always put me down and make me feel bad about myself?
  • Has my partner caused harm or pain to my body?
  • Does my partner threaten me, the baby, my other children or himself?
  • Does my partner blame me for his actions? Does he tell me it’s my own fault he hit me?
  • Is my partner becoming more violent as time goes on?
  • Has my partner promised never to hurt me again, but still does?

If you answered “yes” to any of these questions, you are in an abusive relationship and need to get help-if not for yourself, then do it for your baby.

Effects on Mother and Baby

Abuse certainly has detrimental effects to both mother and baby. For mother, the increased and persistent stress can cause her to withdraw. She may begin missing prenatal appointments and thus not getting much needed care for herself and her baby. She may not eat well or sleep well and is at increased risk of depression. If the abuser is controlling, she may have lost contact with family, friends and loved ones. Isolation is an integral part of abuse as it keeps women from seeking and obtaining help. It also helps hide the physical signs of abuse-if there are any.

If mother has any sort of chronic disease, these will likely get worse and can cause complications for both mom and baby. Mother may not be taking necessary medications or getting necessary treatments so her overall physical health is compromised. Hence the energy and nutrients she has to give to her baby are also compromised.

The added stress is no better. When mom is stressed, so is baby. Additional stress has been linked to preterm labor,  miscarriage and even still birth.

Physical abuse is quite possibly the most dangerous form of abuse. In addition to the overall physical injuries a pregnant woman may sustain, physical blows to a pregnant woman’s belly can result in placental damage or abruption, vaginal bleeding, injury to the fetus, preterm labor or even miscarriage.

What To Do

First and foremost, if a pregnant woman (or any woman) is at risk for domestic abuse, she needs to get help.

Start by speaking with your obstetrician or midwife (if you can speak with them alone). Health care providers often have access to resources or people on their staff can help you get help.

Contact your local police department if you feel you are in immediate danger.

Find a safe place to stay where you can get help. This may be with a good friend, neighbor or family member. You may be able to get help from your church or other civic organizations. If woman’s shelters are available in your area, contact them to see if they can assist you.

Gather some of your things, especially important documents such as bank account numbers, credit card information, prescriptions, etc…Have a bag ready and easily accessible in the event you have to leave abruptly. You may even want to have them somewhere outside your home (at a friend’s home for example) in the event that you have to flee unexpectedly.

Domestic abuse during pregnancy is more common than many of us realize. However, it is not normal and need not be tolerated. Help is available from the resources below.

National Council of Child Abuse and Family Violence
http://www.nccafv.org

Alliance for Children and Families
http://www.alliance1.org

Stop Abuse for Everyone
http://www.safe4all.org/resource-list/

National Domestic Violence Hotline (800) 799-SAFE (7233)
http://www.ndvh.org

This post was compiled using data from The March of Dimes, Cyberparent.com and Women’s Healthcare topics.com

Mamas, The Decision is Yours!

February 19th, 2010

Mamas on bed rest may feel that much about their pregnancy is out of their control. But despite being high risk, decisions about your health care and the care of your baby are ultimately still yours! Be sure to fully understand your condition, treatments being proposed and most important of all do your own home work before giving your consent to any treatment or procedure.