Mamas on Bedrest: Your Love is The Medicine Your Little One Needs to Survive

August 31st, 2010

The Most Heartbreaking News

It was almost too heartbreaking to read. After 20 minutes of trying, neonatologists had to tell Kate Ogg that her tiny little son Jamie, born at a mere 27 weeks and weighing only 2 lbs, was gone.

A Mother’s Loving Touch

Despite the fact that twin sister Emily was doing well, Kate Ogg and her husband David clung to each other and tiny Jamie completely absorbed in their grief. “I couldn’t let him go,” says Ogg. She stayed there, clutching the tiny body to her chest. Miraculously, after two hours of being hugged, stroked, talked to and kissed by his mom, little Jamie began showing signs of life.  First, it was just a gasp. The doctors assured Ogg and her husband that this was simply reflex a breath and that little Jamie was in fact gone. But when the infant began to stir a bit more, Ogg put a drop of breast milk on her finger and little Jamie drank it. Ogg could hardly believe her eyes. Then little Jamie opened his eyes, lifted his hand and grasped her finger. He finally turned his head from side to side. Even the doctors stared in disbelief. Little Jamie was alive, safe and secure in his mother’s arms against her chest.

Kangaroo Care

Numerous research studies have reported on the effects of a mother’s love and touch on infants, especially premature infants. Kangaroo Care, the position that Ogg unknowingly assumed with little Jamie, consists of placing a diaper clad premature baby in an upright position on a parent’s bare chest – tummy to tummy, in between the breasts.  The baby’s head is turned so that the ear is above the parent’s heart. Many studies report that this position soothes the infant; steadying heart rate, calming respiration, alleviating tummy upset and soothing colic. This soothing position has also shown to help babies sleep, gain weight and thus progress enough to leave the NICU and go home. Some researchers dispute the efficacy of kangaroo care, stating that data is too subjective and there are few measurable endpoints.  Most studies have proven that Kangaroo Care has a major, positive impact on babies and their parents. Some studies have proven there is no change, but no study has proven that Kangaroo Care has hurt either parent or baby.

The Mind/Body Connection, A Mother’s Love and Mamas on Bedrest

Jennifer Gunter, MD, gives a wonderful explanation of Mind-Body medicine in her book, The Preemie Primer.

“Mind-Body medicine is the idea that our thoughts and emotions influence physical health, and harnessing this connection improves both emotional and physical well-being.”

Gunter further explains that chemicals such as neurotransmitters and hormones send messages all over the body. These chemicals can either stimulate a stress response or be controlled and used to effect positive health outcomes. While thoughts are not enough to cure disease alone, they can certainly be complimentary.

So what does this mean for Mamas on Bedrest? It means that your thoughts can influence your pregnancy outcome. Bed rest is never anyone’s idea of a great way to spend pregnancy. Unfortunately, about one out of every five pregnancies ends up on bed rest for part of the pregnancy. You may be feeling somewhat discouraged on bed rest, worried and afraid that things won’t turn out well. Stop those negative thoughts-NOW! Because your thoughts affect your body’s chemicals, negative thoughts send out negative brain chemicals and hormones and can have a negative effect on your health and the health of your baby. Start now to tell your baby how much you love him or her. Sing happy songs to your baby, read to him and envision holding your little darling. While this may seem silly, you are actually changing the chemical make up of your body and the chemical make up of your pregnancy. But don’t believe me, look at what soothing words and loving thoughts did for little Jamie Ogg!

How have you used positive imagery and soothing thoughts to get you through your bed rest experience? Share you successes as well as you challenges in our comments section.

Do finances have you worried while on bed rest? Stay tuned to some exciting news coming from Mamas on Bedrest & Beyond.

Pre-Eclampsia: A frequent reason Mamas are prescribed bed rest

August 25th, 2010

Pre-Eclampsia-Definition and Background

Pre-Eclampsia is a medical condition that only affects women during pregnancy and post partum. It is characterized by high blood pressure and protein in the urine, subsequently creating a toxic physical environment for both mother and baby. It is frequently the reason a pregnant woman is prescribed bed rest. While it can occur anytime during pregnancy, it typically occurs after 20 weeks of pregnancy, in the late second or third trimester. Pre-Eclampsia occurs in 5-8% of all pregnancies globally and is the cause of some 76,000 maternal deaths and 500,000 infants annually.

Pre-Eclampsia can rapidly become a serious or even fatal medical condition. Women should know the signs and symptoms of pre-eclampsia and report any signs or symptoms they have to their health care provider immediately.

Major Signs and Symptoms of Pre-Eclampsia

None – The problem with Pre-Eclampsia, much like other hypertensive disorders, is that it often has no symptoms.
Hypertension is known as “the silent killer” and pre-eclampsia is no different. Bed rest has been shown to reduce blood pressure and frequently reduces the signs, symptoms and complications that may arise as a result of pre-eclampsia. Even though bed rest is inconvenient at best and quite uncomfortable and physically challenging at its worst, if your health care provider prescribes bed rest for pre-eclampsia, Please follow his or her directions, even if you feel fine.

Hypertension – Hypertension or high blood pressure is defined as two blood pressure readings over 140/90 at two different times at least six hours apart. However, pregnant women with normally low blood pressure, such as 110/65, may be diagnosed with pre-eclampsia prenatally or in the post partum period when their blood pressure rises to 135/80 and/or they develop signs and symptoms of pre-eclampsia.

In 1990 the National Institutes of Health, National High Blood Pressure Education Program: Working Group Report on High Blood Pressure in Pregnancy issued the following research guidelines:

In the past it has been recommended that an increase of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure be used as a diagnostic criterion, even when absolute values are below 140/90 mm Hg. This definition has not been included in our criteria because the only available evidence shows that women in this group are not likely to suffer increased adverse outcomes. Nonetheless, it is the collective clinical opinion of this panel that women who have a rise of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure warrant close observation, especially if proteinuria and hyperuricemia (uric acid [UA] greater than or equal to 6 mg/dL) are also present.

For this reason, it is extremely important that women know what their baseline blood pressure readings are and at each prenatal visit they ask their providers what their blood pressure is. In this way, both health care provider and patient can be on the look out for blood pressure abnormalities and address them as soon as possible.

Swelling (Edema) – Swelling can be an insidious symptom of pre-eclampsia because so many women experience swelling of their hands and/or feet or even their faces when they are pregnant. However, when the swelling is significant enough to change your facial features, you should notify your health care provider immediately, advising them that you believe the swelling has become excessive. You may need to show them a photo of you prior to pregnancy, your driver’s license for example, to prove your point. In any event, if swelling concerns you, make sure it becomes a concern of your health care providers and that it is addressed.

Proteinuria – Proteinuria occurs when proteins, usually filtered by the kidneys and retained in the blood stream, leak into the urine because the small blood vessels in the kidneys have become damaged allowing the proteins to pass through. (This is usually due to your elevated blood pressure. Remember, pre-eclampsia creates a toxic physical environment to both mother and baby!)

Other Common Signs and Symptoms of Pre-Eclampsia

Sudden Weight Gain – Since weight gain is a hallmark of pregnancy, it’s often hard to discern between regular pregnancy weight gain and weight gain associated with Pre-Eclampsia. The rule of thumb is that if you start gaining more than 2 lbs per week or more than 6 lbs in a month, you should consult with your health care provider as this could be an indication of pre-eclampsia.

Headache – Severe, migraine-like headaches which are often one sided and dull and throbbing could be a warning that your blood pressure is dangerously high. Contact your health care provider immediately for evaluation.

Nausea or Vomiting – While nausea and/or vomiting is common in the first trimester, it usually abates during the second and third trimesters. If you have sudden onset of nausea and/or vomiting in the second or third trimester, contact your health care provider immediately for evaluation.

Changes in Vision – If you experience any sudden blurred vision, double vision, flashing spots, or sudden light sensitivity, this is another warning that your blood pressure may be dangerously high.  Contact your health care provider immediately for evaluation.

Racing pulse, mental confusion, heightened anxiety, trouble catching your breath – While all of these symptoms can occur in pregnant women, when they suddenly occur from out of the blue and especially if they occur together, this is cause for concern. Contact your health care provider immediately.
Stomach or Right Shoulder Pain – I want to be a bit more specific here. The pain you may be experiencing here is right upper quadrant abdominal pain, specifically, liver pain. The pain may be “radiating” or “referred” to the right shoulder, but its origin is in the liver. This pain requires immediate attention as it is an indication that the liver is under stress and you may be suffering from HELLP (Hemolysis-bursting of red blood cells, Elevated Liver enzymes levels, and Low Platelet count) as serious obstetrical complication. It is imperative that you be evaluated immediately if you have symptoms of HELLP to avoid more serious complications or even death.

Lower back pain – Low back pain is so common in pregnancy that it is difficult to distinguish between the typical low back pain of pregnancy and low back pain associated with pre-eclampsia. If you are unsure, certainly consult your health care provider. But consult with your health care provider immediately if the low back pain is present with right upper quadrant abdominal pain as this may be another sign of pre-eclampsia.

This is a cursory overview of Pre-Eclampsia and we will delve into the subject with more depth in coming blog posts. Just remember that pre-eclampsia can have serious medical consequences for both you and your baby including death, so if you are concerned about symptoms, consult with your health care provider and have an immediate evaluation.

This list of signs and symptoms is edited and reprinted from the list presented on The Pre-Eclampsia Foundation website. This website is a holds a wealth of information on pre-eclampsia; current research and resources for more information and to get more help and/or support.

Did you have pre-eclampsia during your pregnancy? Are you a Mama on Bedrest now for pre-eclampsia? Share your story in our comments section below.

Hypothetical question: Preemies & Maternty Leave?

August 24th, 2010

Libby283, A mama to be posted the following “hypothetical question”  to the community on The Bump.

This is just a hypothetical question and wondering if any other ladies had it happen and how it was handled…

What happens with maternity leave if you have a preemie baby that will require a lengthy hospital stay. For instance I only get 6 weeks maternity leave with my employer. If I delivered tomorrow, at 30 weeks, the baby would be in the hospital for the duration of the maternity leave. Does your doctor & employer let you go back to work early and then use the remaining leave time for when the baby comes home?

Just curious, but I hope I don’t have to worry about it as a reality.
There were some conflicting responses to her question, and I thought it a really good question to respond to on Mamas on Bedrest & Beyond. We’ll also be posting a reply on The Bump.

First and foremost, Libby283 is entitled to 12 weeks of unpaid medical leave as stipulated in the United States Family Medical Leave Act (FMLA). This act states that eligible employees (who work for companies with 50 or more employees) are entitled to up to 12 weeks of unpaid leave with guaranteed job protection each calendar year to,

  1. Deliver a baby,
  2. Bring home An adopted or foster child
  3. Care for a critically ill family member such as a spouse, child or parent
  4. Heal and recuperate from serious illness.

Here is the actual text of The Family Medical Leave Act as posted on the US Department of Labor Website:

The Family and Medical Leave Act (FMLA) provides an entitlement of up to 12 weeks of job-protected, unpaid leave during any 12-month period to eligible, covered employees for the following reasons: 1) birth and care of the eligible employee’s child, or placement for adoption or foster care of a child with the employee; 2) care of an immediate family member (spouse, child, parent) who has a serious health condition; or 3) care of the employee’s own serious health condition. It also requires that employee’s group health benefits be maintained during the leave. The FMLA is administered by the Employment Standards Administration’s Wage and Hour Division within the U.S. Department of Labor.

So Libby283 is actually covered by the law as well as her employer.

What gets sticky is when people try to combine two or more leave policies to get more time off.  The scenarios play out very differently depending on your employer, your state laws and how you choose to use the federal law. Recently in Massachusetts, the courts ruled that the Massachusetts Maternity Leave Act entitled women to 8 weeks maximum for maternity leave (See Massachusetts Maternity Leave Act: No Help for Mamas on Bedrest). However, since that is only a state ruling, women could then attach an additional 12 weeks onto their leave as stipulated by the Family Medical Leave Act. What is allowed varies from state to state so women planning to become pregnant should find out what they are entitled to and to make provisions in the event of a complicated pregnancy (requiring bed rest) and/or a complicated delivery requiring an extended hospital stay for mama, baby or both.

What employers choose to do becomes another matter. Libby283’s employer can say, okay, you can have 6 weeks paid leave (not sure if she is being paid or not) but if you want the entire 12 weeks, the remaining 6 weeks is unpaid. In that way her employer has not violated FMLA and has not breached the company policies. Likewise, the company can say, you are entitled to the 12 weeks of unpaid leave as stipulated by FMLA, but we are not obligated to pay you. Or, if they are a really family friendly company, they may even offer 12 weeks of paid leave (haven’t seen this one in a while, but one could hope!)

As the law reads you are entitled to 12 weeks family medial leave total per calendar year. So Libby283 could in fact split her time off between when she actually delivers and is discharged and when her baby comes home. While this is good in theory, it is my experience that when a mama has a preemie, she is not back to work but in the NICU any chance she gets, so time off could still be an issue.

It’s clearly evident from Libby283’s question and the laws that this is a confusing issue.  Mamas on Bedrest & Beyond is committed to working with other organizations to advocate for improved maternity privileges including extending maternity leave and having maternity leave be paid. Subscribe to our blog and e-newsletter to stay abreast of what is happening with maternity leave and how we are working to initiate change at local, state and national levels.