Childbirth Education

Stepping into the Global Prenatal Initiative on Behalf of Mamas on Bedrest!

May 16th, 2014

Global Prenatal InitiativeGreetings Mamas!!

A few weeks ago (March 21st to be exact) I introduced you to the Global Prenatal Initiative. Well, things have been heating up since that post and I want to give you an update-mainly because I have jumped in with both feet and am involved with organizing the US Prenatal Education Association!

No one is more acutely aware of the shortcomings in US prenatal care than Mamas on Bedrest. While it is safe to say the we receive prenatal care, in many instances one would be loathe to say that it is patient centered, baby friendly or offering a compassionate start to our little ones. And while many of the interventions that Mamas on Bedrest endure are necessary, how they are administered and how Mamas on Bedrest are cared for are often lacking in the compassion and nurturing department.

The foundation principle of the Global Prenatal Initiative is,

“The time spent in the womb is the foundation for long-term health, emotional security, intelligence, creativity and much more for every human being. It is vital that the link between these early stages of human development, their long-term impact and the current global challenges be known.”

~ Julie Gerland, GPI Co-Founder and Director

Dr. Gerland and other members of the United Nations have been collaborating to improve maternity outcomes and have come to the very reasonable conclusion that to make any sort of appreciable impact on our cultural deficiencies and disparities, it is imperative that we focus on human development-namely improving birth outcomes and in turn, life expectancy and quality of life. Their major focuses are:

  1. Confronting family poverty
  2. Ensuring work-family balance
  3. Advancing social integration
  4. Inter-generational solidarity

This is all well and good, but what does this mean for Mamas on Bedrest exactly???

  1. It means empowering mamas about what they can do to feel safe, secure and healthy during pregnancy.
  2. It means empowering mamas to provide safe, secure environments for their babies to develop and grow-both in utero and externally. We have to remember, whatever mama is experiencing during her pregnancy, her baby is also experiencing. As much as possible, we want those experiences to be peaceful and to have positive impacts on baby’s growth and development.
  3. It means working with both parents in the pre-conception and prenatal periods to foster healthy relationships, ones in which as much as possible both parents stay connected (not necessarily married) and involved in the lifelong growth and development of the baby.

Mamas, We already know so much of this! We know what it’s like for our families to face financial challenges because we go on bed rest and are not paid while we are not working. We know what it’s like to lose a job because we go on bed rest! We know what it is like to have to choose to nurture our children on bed rest in lieu of pursuing a career. We know what it is like to try to navigate bed rest without the support of family. We could (wo)man these panels ourselves and give birds eye views of what life is like when we don’t have the resources necessary for a peaceful pregnancies. And while all of you are welcome to step up in support of the Global Prenatal Initiative, I am stepping in and stepping up on behalf of high risk pregnant women, the Mamas on Bedrest. Stepping into this community of global prenatal health workers, it is my intention to not only represent Mamas on Bedrest but to also be your eyes, your ears and most importantly-YOUR VOICE! This is the chance for our voices to be heard, for our stories to be told and for the management of high risk pregnancies to be evaluated and changed as necessary to suit the needs of Mamas on Bedrest. I am counting on you all to speak up! I am counting on you all to tell me exactly what you needed when you were on bed rest; what would have made bed rest bearable and more successful. In return, I will relay your thoughts and request to my colleagues in the association, as well as to the pertinent United Nations sub-committees on human growth, development and overall well being.

The time has come, Mamas! We have the chance to change the course of prenatal care and birth outcomes for generations to come! Most importantly, we have the chance to make much needed changes in the care of high risk pregnancy!

 

 

Mamas on Bedrest: What You Need to Know if Your Baby is Born Between 34-36 Weeks 6/7 Days

February 10th, 2014

VamessawavesMy daughter was a “late phase” preemie.

It’s kind of funny to me to recount those early days with her. She’s 11 now, pubertal and as sassy as they come! But in the beginning, everything was a juggling act to make sure that she had all that she needed to start her life off well.

My daughter was born at 36 weeks and 6 days and was literally 3 hours and 57 minutes shy of being a “term” infant. When she was first born the hospital staff kept referring to her as a “preemie” and I kept railing against this term knowing its implications. But as the days went by, she exhibited more and more of the signs of a preterm infant and I had to admit that she was in fact a preemie-no matter how close in hours and minutes she had been born to term.

When my daughter was born, she didn’t immediately cry. After the neonatal staff worked on her for a few moments, she did let out a wail that sent the biggest wave of relief through my body. But we weren’t out of the woods. On examination she had some fluid in her lungs and was in a bit of respiratory distress. So they wrapped her up, whisked her by my face and hurried her off to the nursery for a closer look.

In the days that followed, my daughter continued to have difficulty breathing. When I would nurse her, her oxygen saturation would drop into the low 80’s. She would also get quite tired while nursing and we had to supplement her feedings with bottle feedings. Although she never required supplemental oxygen nor slept in an incubator, she did initially have some problems with temperature regulation and slept on a little warming bed. The first time I saw her on this thing, with little eye covers over her face, it reminded me of a tanning bed and I asked “Why was my little brown baby was being tanned?” I was informed that the warming bed would help her regulate her temperature and help with bilirubin  metabolism (although she never did have an increased bilirubin level which is common in late phase preemies.) Overall, my daughter did really well and continued to progress during her 10 days in the NICU. By the time she was discharged, her father and I were providing the bulk of her care; holding her skin to skin, feeding her and changing her. I was increasingly frustrated that they would not allow her to go home and actually “had it out” with the neonatologist one day when he proposed yet another day of “watching”. But if I were to have my daughter today, knowing what I know, I would be (and I am now) ever thankful for the care of the NICU staff provided for my daughter.

In 2009, 71% of all preterm infants were late preterm infants, born between 34 and 36 weeks 6/7 days. The most common reasons for these early deliveries were:

 

  • Spontaneous Labor
  • Premature Rupture of Membranes
  • Pregnancy Induced Hypertension
  • Placental Disorders
  • Fetal Disorders
  • Intrauterine Growth Restriction
  • Multiple Gestation (Twins or higher order multiples)
  • Maternal Medical Disorders

Because many late phase preterm infants look like term infants, signs and symptoms of complications can be missed. But these can be a crucial errors. Late preterm infants born to mothers with antepartum hemorrhage ae 12 times more likely to develop problems in the early post partum compared to term infants. Infants born to mothers who had pregnancy induced hypertension are 11 times more likely to have post partum complications. The earlier the infant (i.e. the closer to the 34 weeks) the more likely they are to experience complications. And when an infant is an “early late phase preemie” and born to a mother with medical problems such as pregnancy induced hypertension, the more likely the infant is to have complications. The most common complication seen in late phase preterm infants are:

  • Elevated Bilirubin levels (hyperbilirubinemia)
  • Respiratory Issuesn (rapid, labored breathing and/or Pneumonia)
  • Hypoglycemia
  • Poor feeding (fatigue and poor weight gain)
  • Temperature instability (inability to regulate temprature due to lower amounts of brown and white fat on their bodies)
  • Infections

Any one or a combination of these issues may land the infant in the Neonatal Intensive Care Unit (NICU). However, not all infants who exhibit these complications need the expert skill rendered in the NICU. Well trained hospital staff and well educated parents can manage many of these infants.  So what do parents and care providers need to know?

Mamas, if at all possible, avoid having a cesarean section-especially if it is your first child. First time Cesarean section delivery of the 32-36 week infant increases the infant’s risk of developing the aforementioned complications as well as their risk of not surviving. Almost all of these infants end up in the NICU. While a cesarean section may be indicated if mama, baby or both are in distress, elective cesarean sections should be avoided.

Watch your child’s feeding patterns. Because these infants often tire easily with nursing, infants who fall asleep while nursing my be mistaken for being full when they are actually fatigued. These infants may have long periods between feedings and fail to gain weight. Parents of such infants must adopt an every 2-3 hour feeding schedule and keep a close watch on weight gain to ensure adequate nourishment and development.

These infants should not be discharged early. Late preterm infants have a high rate of “bounce back admissions”. Many of the complications that arise do so within the first 48 hours to 2 weeks post partum. Careful monitoring in the hospital for 48 hours can allow medical staff to detect arising complications and treat them early to avoid major problems as well as readmission. While these infants should be assessed often, they don’t necessarily need to be in the NICU. They should be evaluated by a pediatrician 48-72 hours after discharge and at 2 weeks then 8 weeks. This may seem like a lot, but complications, if they are going to arise, will occur within the first 28 days of life.

Looking at my daughter today I can hardly believe she was the tiny little baby I held so close. Just 3 inches shorter than me (Okay, I’m only 5 ft, but she’s only 11!) and already developing the curves of a young woman, she has grown and developed really well. She has asthma that is well managed and does anything she wants to do. But those early days of keeping her bundled up (she was an October baby) and watching her feedings were hard-but well worth it. And the expert care of the NICU staff are much credited with her health success. I was a stressed out mama then, just wanting to take my baby home.  But I am forever grateful that the staff-the neonatologist in particular-stood firm, monitored her carefully and only sent her home when they were absolutely sure that she wouldn’t come back. And she never has!!!

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Resources:

Erica Saleski Forsythe, MSN, RN, Patricia Jackson Allen, MS, RN, PNP-BC, FAAN “Health risks associated with late-preterm infants: implications for newborn primary care.” Pediatric Nursing. 2013 Jul-Aug;39(4):197-201. 

MedScape OB/GYN Women’s Health

Mamas on Bedrest: The Importance of Spacing Your Pregnancies

November 13th, 2013

Hello Mamas,

We’re talking about spacing your pregnancies. I know this sounds absolutely absurd given that you are already pregnant and on bed rest. But I had the great fortune to listen in on a very well done webinar presented by the Association of Reproductive Health Professionals and I feel compelled to share some of the information.

We all know pregnancy ushers in a whole host of hormonal, physiologic, psychologic and emotional changes for women. But what some of you may not know is that when women have pregnancies close together, they deny their bodies much needed time to readjust to the rigors of pregnancy, labor and delivery and their new role as mama. An immediate repeat pregnancy may result in fatigue, anemia, preterm labor, and other physical problems. The second infant may be born prematurely, at a low birth weight, be small for size/age and have other developmental problems. Finally, pregnancies close together shorten the bonding time the first infant has with mama.

We all know life happens. But pregnancies don’t have to happen. In most areas of the US and in most industrialized nations, women have access to a wide range of birth control methods. There’s a lot out there to choose from and I review many of these methods here.  And let’s be clear, I am not trying to tell anyone what to do, I merely seek to inform and to educate. And FYI, The literature on spacing pregnancies suggests women space pregnancies at least 18 months, but no more than 5 years apart, with an optimal range of about 2-3 years.