Mamas on Bedrest: Get Your Babies off to a Healthy Start!

August 24th, 2011

When I was pregnant with my son, my then 3 year old daughter used to come up to my belly and scream, “Hi baby! How are you? It’s your big sister!” In response to her voice, my son would roll around in my belly and reposition himself (typically away from her voice) comfortably.  So it’s really no surprise to me now, 5 1/2 years later, that my son often tunes his big sister out. “Do this. Do that. You’re not listening to my words…” He’s heard it all before, loud and clear, and has reached the conclusion that he’d really rather place his energy elsewhere.

Mamas on Bedrest, our relationships with our children begin long before they are born.  Some research even suggests that from the moment we become pregnant, our words, thoughts and deeds are influencing the growth and development of our babies and will exert this same influence into adulthood and into the aging process. Mark Hanson, a professor at the University of Southampton in England conducts research into the relationship between prenatal health and care and infant and child development.

According to Hanson, a pregnant mother’s body and the body of her developing baby have an intricate and constant dialogue going on for the duration of the pregnancy-from conception until delivery. Everything that the mother does from eating a nutritiously balanced diet, to exercising, taking a good prenatal vitamin and getting enough rest sends signals to the developing baby how to prepare and how to adapt to the external environment. This ability to accept these cues, integrate them and adapt makes infants more adaptable and as a result, better able to weather complications that may arise not only during the pregnancy, labor and delivery but also later in life.

Research into the “developmental origins of adult disease” suggests that a mother’s healthy living prenatally may help her child avoid problems such as cancer, heart disease, depression and diabetes not just in childhood, but 50 years from now. According to Peter Gluckman at the University of Auckland in New Zealand, even though adults must eat well, exercise and reduce stress to help avoid disease, research is indicating that how mothers take care of themselves during the prenatal course may also have profound impact on whether or not their children develop chronic diseases as a result. Many of these cues come to the fetus via the amniotic fluid and maternal blood.

Here is the explanation.

Prior to birth, environmental cues help program a person’s DNA. This programming is called epigenetics. Through epigenetics, chemical groups attach to DNA. Although they don’t change the order of the genes, the chemical groups can switch those genes on or off. Chemicals, stress and other environmental influences can thus profoundly alter how a person’s DNA manifests.

For example, babies exposed in the womb to synthetic hormones may begin responding abnormally to the natural hormones later made by their own bodies. In the same way babies and children exposed to prenatal stress can also learn abnormal reactions to stress.

So in a nutshell, if a fetus “gets the message” from its mother that there is not enough good, healthy food available (because she is not eating healthy foods or enough food) the baby may hoard its calories. Studies done on pregnant women during famines show that the babies born to them actually developed an extra layer of abdominal fat in preparation for famine. A problem arises when a mother is not in a famine, but perhaps of low income or just eats poorly. If her baby develops the extra layer of abdominal fat, when food is plentiful, that child is at risk for becoming obese and at risk for heart disease and Type 2 diabetes as an adult.

What can Mamas on Bedrest do to get their babies off to a healthy start? First and foremost, relax. I can hear many of you gasping and berating yourselves, thinking you’ve done something wrong and that it’s all your fault that you are on bed rest.

Stop that stinkin’ thinkin’!

Every year some 750,000 women are prescribed bed rest for a portion of their pregnancies. You most likely didn’t do a thing wrong, but are a consequence of the law of averages.

Keep stress to a minimum. The more stressed you are, the more stress your baby will experience and adapt to. Epigenetics is real. Let’s help your baby learn a healthy adaptation to stress instead of a heightened stress reaction.

Rest. Yup, you heard me, get some rest. I know that it can be hard to rest while on bed rest; the boredom, the body aches, the worry… but try. Believe me, once your baby gets here, you’ll wish you had taken more naps!

Eat well. This is one of the most important factors to come from the research findings. Eat enough of a nutritious diet so that your baby learns to expect nutritious foods and in adequate quantities. If you need help, please don’t be afraid to ask. There are many resources available at the local, state and federal levels that will ensure that you and your baby are well nourished. Please make the call if necessary. Your health and the health of your baby depend on it.

Ask for help and support. That statement, “It takes a village to raise a child” is true. You may be thinking, sure, once the baby is born, but as these researchers and studies show, help and support of mamas is needed from the very beginning. If you are on bed rest, you need even more help and support. Enlist the help of family, friends and neighbors. Don’t be too proud or ashamed to seek out the support of churches and civic groups. And when all else fails, contact us, info@mamasonbedrest or visit www.mamasonbedrest.com and let us help you out!

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References

Aging well starts in womb, as mom’s choices affect whole life USAToday Article, June 30, 2009

Jack P. Shonkoff, MD, W. Thomas Boyce, MDBruce S. McEwen, PhD  “Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities: Building a New Framework for Health Promotion and Disease Prevention” JAMA 2009;301[21]:2252-2259

Mamas on Bedrest: Women need resources, financial and otherwise, to reduce their risk of depressive disorders.

August 22nd, 2011

Daily I hear stories from women who are struggling to maintain their jobs, their homes, their family order and their own sense of self after being placed on bed rest. Data presented by Judith Maloni, PhD and others show that the number of depressive symptoms found in women placed on bed rest are associated with the length of time on bed rest (i.e. the longer women are on bed rest, the more depressive symptoms they tend to exhibit) and that bed rest is a precipitating factor for perinatal depression.

Delving deeper into mood disorders I was alarmed to find that women are disproportionally affected by depressive disorders more than men, and both are dramatically under treated. But what really stuck me is the World Health Organization’s (WHO) explanation for why women are at increased risk. According to WHO,

“Depression, anxiety, psychological distress, sexual violence, domestic violence and escalating rates of substance use affect women to a greater extent than men across different countries and different settings. Pressures created by their multiple roles, gender discrimination and associated factors of poverty, hunger, malnutrition, overwork, domestic violence and sexual abuse, combine to account for women’s poor mental health. There is a positive relationship between the frequency and severity of such social factors and the frequency and severity of mental health problems in women. Severe life events that cause a sense of loss, inferiority, humiliation or entrapment can predict depression.”

Now WHO is speaking about all forms of mental health disorders in all women, not just depression in women on bed rest. But looking at their statement, it is clear why bed rest can be such a difficult situation for a woman emotionally as well as physically.

Those of us who advocate on behalf of women on bed rest know that the loss of independence, the loss of a sense of well being, the potential loss of income which can lead to a loss in home and financial security and the very real potential loss of a child can all lead to depressive disorders. Yet, with all that is going on, depression in women across the board, let alone women on bed rest, remains under diagnosed and under treated. This under recognition and treatment, especially in mamas on bedrest, can lead to significant morbidity and mortality for both mother and baby.  So how can we make changes in this scenario?

According to data presented to WHO by researchers,  there are 3 main factors that are highly protective against the development of mood disorders, especially depression in women. These are:

  • having sufficient autonomy to exercise some control in response to severe events.
  • access to some material resources that allow the possibility of making choices in the face of severe events.
  • psychological support from family, friends, or health providers is powerfully protective.

These are not shocking or highly complex solutions.  Quite the contrary, these points could be easily implemented if we as a culture elevated the needs of women and children in our society.

It’s no secret that I am a staunch advocate for paid maternity leave, especially for women on bed rest. While one could argue that women having uncomplicated pregnancies are not actually “sick” and therefore don’t need to be paid for their time off to deliver, clearly women who are prescribed bed rest have medical issues with their pregnancies that warrant intervention and treatment. Yet, women placed on bed rest are rarely offered any sort of support for making informed choices and retaining any sort of autonomy. They typically lose or face dramatic reduction in material resources at a time when their need for such resources is dramatically increased. And finally, while some women on bed rest may have support of family and friends, many women (myself included) face their high risk pregnancies in relative isolation. It is alarming to me that the same woman could suffer a heart attack or stroke and would not face the same risk of job loss, loss of income, loss of home and security and isolation that a high risk pregnant woman on bed rest faces. We have to change this.

It would not take much for the US systems to reverse their policies and procedures. What it will take is “We the people” standing up and demanding that we place our citizens (women and children in particular) ahead of defense spending, ahead of supporting other nations, ahead of aid to other nations and ahead of corporate taxation and compensation. It can happen. We can make it happen. And the very health of our society and culture demand that we make it happen very soon or face dire consequences.

Judith A. Maloni and Seunghee Park “Postpartum Symptoms After Antepartum Bed Rest” March/April 2005 JOGNN 17. Volume 34 (2) 163-171.

The World Health Organization. Gender and Women’s Health. Gender Disparities and Mental Health: The Facts.

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Pregnancy Medical Home Program for Mamas on Bedrest?…

August 17th, 2011

Not yet, but they would surely be a welcome addition to high risk pregnancy care.

The Pregnancy Medical Home Program is a program initiated in North Carolina that links payment incentives to prenatal care services-specifically those services and treatments shown to lower the incidence of premature birth and that lower maternal and infant morbidity and mortality.  The program currently targets providers who care for women who are eligible for Medicaid.

The maternal mortality rate in the United States is abysmal and is far higher than most European Countries.  According to statistics presented in a recent blog by Lee Partridge, Senior Health Policy advisor for the National Partnership for Women and Families,

In 1990 in the United States, 343 women died in childbirth; by 2007 that number had increased to 548.  A report released July 6 by the National Institute of Child Health and Human Development documents some progress on reducing the incidence of preterm birth, down from 12.8 percent in 2006 to 12.2 percent in 2009.  But that rate is still woefully behind the U.S. Healthy People 2010 target of 7.6 percent of all live births.

To date, little has been done that has had a significant impact on these statistics. With the Pregnancy Medical Home Program North Carolina hopes to reverse these turn statistics and turn the tide on maternal and infant mortality.

As previously stated, the Pregnancy Medical Home Program is an incentive program. Providers who wish to become Pregnancy Medical Home Centers agree to provide specific services and treatment during the perinatal period and in exchange, they will receive additional reimbursement, incentives, from Medicaid. The requirements and incentives are briefly outlined in the brochure put out by Community Care of North Carolina, the network of organizations that developed the program.  But the aforementioned blog from the National Partnership for Women and Families gives a very good 4 point summary of the program:

Maternity care providers – obstetricians, family practitioners, nurse midwives, community clinics – can apply to be designated as a Pregnancy Medical Home.  They must agree to do four things:

  1. At the first obstetric visit, administer a standardized pregnancy risk tool that provides not only clinical health history but other information about the woman and her situation that could indicate she is at risk of a poor outcome.  The questions include poor nutrition, smoking status, use of alcohol or possible physical violence.   If a women looks like a high risk, the provider must contact his or her CCNC network and arrange for care management services for that patient throughout her pregnancy.  The provider and patient also develop a plan for managing her care.
  2. Ensure that none of the providers in the Pregnancy Medical Home perform “elective” deliveries – deliveries for which there is no medical reason to induce labor — prior to 39 weeks of gestation.  Early deliveries increase the likelihood of infant death, admission to a Neonatal Intensive Care Unit, or life-long health problems for the child.
  3. Provide the drug 17 alpha hydroxyprogesterone caproate (commonly called 17P) to patients at risk of preterm delivery.
  4. Aim for a caesarean-section rate for low-risk, singleton births below 20 percent.  C-sections expose both mother and child to surgical risk and possible infection, and can create complications for future pregnancies.

The program offers providers an additional $200/patient over and above the normal maternity fees to participate in the program. They receive the first $50 once they complete the initial pregnancy risk tool. The final $150 is paid after a woman has her final post partum visit which must include screening for depression, reproductive health and family planning and any referrals for ongoing care if necessary. 

This is an amazing program! While I can appreciate the strategy of attacking the problem of maternal and infant morbidity and mortality in those who are often most vulnerable, women of low income and limited means/resources, I really wish that there had been at least a small portion of the program allotted to high risk pregnancy. I don’t really think that it would necessarily have to change the reimbursement incentives, but to include some provisions/requirements for care for women who do become high risk and require bed rest would have been nice. How about making sure that they have adequate resources for childcare of their existing children? How about at least asking if they are in danger of losing their jobs and assisting them to find resources to make ends meet? How about stress reduction? Maintaining physical strength and endurance while on bed rest? Okay, I am going a little bit off on a tangent, but once again I feel that high risk pregnancy and mamas on bed rest have been overlooked.

But there is a silver lining to this perceived dark cloud. This is the first program of its kind in this country. Other states are following. (See Washington State’s program here.) As a model, its not bad. Hopefully, as other states adopt and tweek the program for their citizens, they will remember the mamas on bed rest, at home (or in the hospital) silently waiting for help and assistance.

What would you add to the Pregnancy Home Program if you were to adapt it for Mamas on Bedrest? Share your comments below.

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