neonatal death

Mamas on Bedrest: Silence can be Golden

January 27th, 2014

Good Monday Morning, Mamas!

When it comes to someone who is grieving, silence is golden and less can definitely can be more.  As I told you last week, a friend lost her 20 something daughter and it has sent me and the women in my women’s group into a tailspin. We have been consumed by how we can help her, what can we possibly do to make this time better for her. The truth is, there is really nothing that we can do to make this time better for her. It sucks and will likely suck for a really long time-likely forever. But Regena Thomashaur, the infamous Mama Gena of the School of Womanly Arts, offered an excellent article published in the New York Times by David Brooks. I strongly encourage you to read this article, tuck it away and refer to it when someone you love is grieving, or, and I hope this doesn’t happen to any of you, in the event that you encounter a loss. Here are the highlights:

Do Be There: So often people think that the grieving familly needs space. Nothing could be further from the truth! Coming and sitting with someone who is grieving (or in despair on bed rest!!) is so comforting. You don’t need to say anything. You don’t have to have any answers. Your presence is your present. Please share this priceless gift!!

Don’t Compare-Ever! Grief is not a game of tit for tat or one upmanship. The events your are witnessing are very profound for the person who is experiencing them. You may empathize, and you may have an equally profound experience. But allow your loved one to have their experience, simply be a witness to their experience and their journey.

Bring Soup-You may not know what to say, but if you notice something that can be done, do it! Dishes need washing? Wash them. Groceries needed? Get a list and go grocery shopping. Anything that you can do will be appreciated, and many times its those subtle, non-verbal expressions of love and support that have the most impact and are never forgotten.

Don’t Say You’ll Get Over It!-When someone suffers a devasting loss, they will never get over it! They will forever be changed by the event. They will move on from it, they will learn to live with the results of the event. But they will never get over it. Respect that your loved one is forever changed and that they will develop a new “normal” to which both you and they will have to adapt.

Be a Builder-This is quite possibly my favorite suggestion of all of the suggestions in this article. When a catastrophic event happens, everyone rushes in and wants to help. After the immediate surge of activity; the initial loss and the ceremonies that ensue, the family is still left with grief and sorry. It is then, after all of the “appropriate” steps have been taken, after all the socially and morally correct displays of grief, sorrow and comfort have been displayed, that the family is often left to fend for themselves. In this article, David Brooks refers to these people as “Fire Fighters”. They rush in at the time of crisis, provide emergency assistance and are then on their way. A “Builder” is someone who is there long after the intial emergency response. They stay for as long as it takes for the family to get back on their feet and they move along with the family as they establish a new “normal”. Builders are needed as much if not more than “emergency responders.”

Don’t say, “It’s all for the best” or try to make sense out of the situation-When I had my second miscarriage, I recall someone saying to me, “Well, it’s probably for the best. This baby wasn’t developing well and probably would have had a lot of problems.” Really?? I know many parents of special needs children and while it is a daily struggle, I don’t know of any of them who would rather be without their child. But this is not the point (except to say that this is a totally absurd thing to say!). When tragedies strike, don’t try to lighten the impact or make sense of it. It hurts and that is all there is to it! It’s not for the best, it simply happened. Be with the family in the moment.

 

I want to emphasize that this is an amazing list of very useful tips for dealing with those loved ones going through the grieving process. It is my sincerest hope that none of you mamas ever has to share this list with loved ones as they are trying to comfort you, but I do hope that when you go to comfort another-and life is such that you will be called on to comfort another-you have some really useful tools to guide you as to what to do. Be well mamas!!

 

Mamas on Bedrest: Yes, Black Mamas do Breastfeed!

November 11th, 2013

I am an African American Mama who breastfed both her babies. Yet according to The Centers for Disease Control and Prevention, African American Women lag far behind women of other ethnicities in breastfeeding. Why?

When I made the decision to breastfeed, both my mother and mother-in-law looked at me, noses squinched up, as if they had smelled something repugnant. Neither of them had breastfed their babies (3 a piece), and they could not fathom why I would want to do such a “primitive” thing. My mother-in-law even went so far as to say, “You’re gonna have saggy boobs”. That fell on deaf ears because I had my kids so much later in life my breasts had already begun to head south! I explained to them both the benefits of breastfeeding; fewer occurences of ear infections, reduction in the incidences of asthma and the mother baby bond. Both became supportive of my breastfeeding and I was able to breastfeed each of my children for just under a year.

The Nation’s Health recently looked at the disparities in breastfeeding and has been asking, “Why is it that African American Women breastfeed at much lower rates than other women and what can be done to improve their breastfeeding rates and success.” 

The biggest factor is support. While nationally many hospitals have increased their support and are advocating for exclusive breastfeeding (motivated in large part to earn the designation “Baby Friendly”), and are making lactation consultants widely available and ceasing to distribute formula care packages provided by formula companies, public health experts note that the support of a woman’s intimate family and friends plays a far more significant role in whether or not a woman decides to breastfeed and whether or not she succeeds. A woman is highly influenced by those around her.The responses of my mother and mother-in-law could have completely sabotaged my breastfeeding efforts. Strong, influential women like a mother or mother-in-law can make or break breastfeeding efforts. A supportive partner is also crucial to breastfeeding success. Women who have the support of their partners are also more likely to breastfeed and to have breastfeeding success. In communities in which breastfeeding is the norm, women are more likely to initiate breastfeeding and to be more successful at breastfeeding. Community groups and organization where mamas can gather and gain support also have an important role in breastfeeding success.

Education is extremely important. Many people are unaware of the significant health and emotional benefits of breastfeeding to both mother and baby. When I explained these important benefits (i.e. fewer ear infections, reduction in allergies and asthma, reduction in the incidence of reflux, bonding between mother and baby, and the financial savings) to my mother and mother-in-law, both quickly became supporters. Among teens, breasts are seen only as objects of sexual pleasure (as depicted in music videos and other media) and many young women report never having seen a woman breastfeed a baby and are unaware that the God given intentional use for breasts is to feed the young. We have to return to such basics.

We also have to consider the financial benefits and convenience of breastfeeding. Formula is not cheap and if a baby has any sort of allergy, specialty formulas are even more expensive than standard formulations. Additionally, with breastfeeding, there is no need to bring additional supplies in the diaper bag, no need to worry about temperature or if the formula is mixed in the right proportions to water. Breastmilk is always the proper temperature, the proper composition of water to nutrients and ready for immediate consumption! This is a huge consideration as we enter into Health Care Reform and the initiation of the Affordable Care Act. If we need to consider cost containment, Breastfeeding versus formula feeding must be targeted.

Finally, African American Women need to see other African American Women breastfeeding. While the CDC and other advocacy agencies have begun to show images of African American mothers nursing their infants, most informational material still shows white mamas and babies. Subconsciously, the message is “black mamas don’t breastfeed”. It may seem trivial, but we are visual creatures. When African American mamas are aware that other African American mamas breastfeed and can actually see other African American mamas breastfeed, they are more likely to breastfeed themselves.

While overall rates of breastfeeding among African American women has increased, these rates still lag far behind women of other races and ethnicities. With the known health advantages of breastfeeding for both mamas and babies, including the potential to lower infant illness and death in African American babies (who have the highest rates amongst infants of all ethnicities) Breastfeeding support and education must be made a priority for all mamas, but for African American mamas in particular.

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My son and I circa 2006. Note the chubby breastfed cheeks!

 

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My daughter in 2002 at approximately 4 months. Though born at 5 lbs 3oz, note the chubby breastfed cheeks!

Mamas on Bedrest: Implications for African Americans from Familism Study

January 7th, 2013

I’ve been mulling over the study, “Maternal familism predicts birthweight and asthma symptoms three years later” by Dr. Cleopatra Abdou and her colleagues. This study, summarized in our last blog post, states that for mamas to be,  familism (assessed as maternal endorsement of traditional {cultural?} views on familial obligation) is a stronger predictor of health over and above mamas’ relationships to ethnicity, nativity, and lifespan familial socioeconomic position (FSEP). In plain terms, the stronger mamas’ beliefs in family and familial roles and obligations, the less likely they are to have low birth weight babies and children who develop asthma within the first 3 years of life.

Most people correctly assume that in well to do families, every possible provision is made to ensure that the anticipated infant has every possible advantage to have a strong start in life. It is also well known that children born to families of lower socioeconomic status and with far fewer resources, while no less loved and anticipated, are often at risk of being born low birth weight and subsequently developing a variety of illnesses as a result. But there is a paradox within all of this,  first referred to as the Latino Paradox by Markides & Coreil in their 1986 publication, The health of Hispanics in the Southwestern United States, An Epidemiological Paradox. The consensus regarding the paradox is this,

It seems that among certain segments of ethnic minority populations in America, including those who are presumed to be less acculturated to mainstream America and/or to have retained more traditional (cultural) values, particularly surrounding family, unassimilated minorities are among the healthiest Americans, particularly where pregnancy and birth outcomes are concerned.

Since the phenomenon is increasingly observed in other minority groups, including U.S. and foreign born Blacks and Whites, the paradox is becoming more broadly known as the Epidemiological Paradox.

I observed this “paradox” during my clinical practice years, most notably in Hispanic and Asian families. In “traditional” families, when a mama was pregnant there was often an entourage that accompanied her to prenatal visits and although she may have been recommended certain medically accepted treatments, it was abundantly clear that mama was under the watchful eye and in the hands of  of her mother, grandmother, aunts, sisters and cousins and whatever they deemed best for mama and her baby would be done (as had been done for generations of babies within that culture) regardless of what any “medical professional” had to say.

What was most striking to me is that Abdou’s most recent publication makes a clear argument that the legacy of slavery (if one can call such an atrocious miscarriage of humanity a legacy) has had profound detrimental effects on African Americans not only from a cultural and economic standpoint, but also from a health standpoint.  For almost every chronic disease (i.e. Heart Disease, Diabetes, Asthma, and Most Cancers just to name a few) African Americans are at greater risk for contracting the diseases, fare far worse, suffer more debilitating complications and are more likely to die from the complications of the diseases than any other ethnic group. As a physician assistant student, I learned about the various body systems and how they work to regulate metabolism and enable the body to function. As I looked at African Americans, I couldn’t understand why diseases hit us with what seems like catastrophic effects.  The Epidemiologic Paradox puts it all in perspective and gives a partial explanation.

African Americans are the only ethnic group that came to America against their will and were unable to maintain any of their cultural traditions. Families and tribes were separated, languages and dialects were forgotten, lineages were disrupted, tribal/cultural rights and customs were lost. Africans brought to America as slaves had a physiologic make up adapted for a very arid and nomadic lifestyle. In America the climate and food and environment were markedly different. Slaves were purposely separated from their families, communities and tribes, a move made to prohibit congregation and revolution. They were prohibited from exhibiting any of their nativity; dances, languages, oral traditions, dress, even names.  They were not free to move about or to even eat foods to which they were accustomed or for which they were physiologically adapted. In so doing, the American Slave Trade effectively obliterated families, cultures, tribes, traditions-and the general health of African Americans.

Fast forward to today. African American women and infants have the highest rates of perinatal and infant mortality among all ethnic groups, and in light of Dr. Abdou and her colleagues’ research this should come as no surprise. What cultural heritage  do African American women possess and pass on to future generations? African American women as slaves were at the whim of slave owners. African rights of passage from childhood girlish years into womanhood were replaced by random seizure and rape. The children that they bore, whether those of slave owners or of other slaves, were often taken from them either as infants or as children, and ritual pregnancy, birth and infant blessing ceremonies were lost. Traditions and rituals that should have been passed down from mother to daughter were lost and have been replaced with advice on how not to draw attention to yourself as a means to stay safe and possibly avoid sexual attention. Today some might argue that it has been replaced with do whatever it takes to get and keep a man-any man-even if he doesn’t respect you or treat you well in light of the deplorable state or African American relationships and families. But that is a discussion for another time. By and large it is safe to say that the family structure in African American culture is severely fractured, relationships between African American men and women is strained, African American children are at risk for sickness, disease, violence and death and if we accept and understand the Epidemiological Paradox as a veritable and verifiable factor in the health of Americans of different ethnic backgrounds and cultures, then we have to acknowledge that this paradox is no more clearly evident than in African Americans.

African Americans have little to no native culture upon which to draw. Most of us  don’t have century old traditions or regal family ties.  Many African American mamas have little or no support and move through the prenatal period alone, while at the same time trying to navigate where they are going to live, how they are going to eat and how they are going to pay their bills.  If they have other children from other relationships they also face social disdain and at times overt disgust for their station in life. And even when everything is “in order” there is the pervasive perception that African American mamas and their babies are less likely to be of means, education or ability. I say this from experience as when I had my son, I was married and insured and yet the day after my son was born, a social worker came into my hospital room and proceeded to present me with “information I would need” to apply for WIC and medicare for my son. She obviously never looked at my chart for she would have seen that we had private insurance and that we were in no way eligible for-or in need of-WIC.

The current American culture is a capitalistic, solitary, “dog eat dog” type of culture. Americans pride themselves on “pulling themselves up by their own bootstraps”,  “being self made individuals” and “I did it my way.” The work of Dr. Abdou and her colleagues, the Epidemiologic Paradox in other Americans who have retained their native cultures and the life and legacy of African American people shows us that this American lifestyle is unhealthy to say the least and for African Americans (as well as for people of other cultures who become more accustomed, more Americanized), it’s deadly plain and simple.

As Dr. Abdou rightly states, cultural familism is a readily available resource for many women. The next thing we health care practitioners, advocates and public health scientists  must do is consider how we’ll take this information and the resources available to us to help craft a cultural resource for African Americans in the hope of not only lowering maternal and infant morbidity and mortality rates, but improving the overall health and well being of African Americans as a whole.

References

Cleopatra M. Abdou, Tyan Parker Dominguez, Hector F. Myers. Maternal familism predicts birthweight and asthma symptoms three years later. Social Science & Medicine, 2012; DOI: 10.1016/j.socscimed.2012.07.041

Markides, K. S., & Coreil, J. (1986). The health of Hispanics in the Southwestern United States An Epidemiological Paradox. Public Health Reports, 101, 253e265.