Patient Rights

Mamas on Bedrest: Medical Research and the African American Community

December 5th, 2012

I have an interview tomorrow with a research group seeking to understand what matters most to mamas during pregnancy and birth. They are circulating  a survey and are not receiving the response they’d like from mamas of color. They are asking me to share ideas that may increase participation amongst minority mamas, African American mamas in particular.

I am so happy to be able to assist with this research. I truly believe that the more mamas speak out about their needs during pregnancy (bed rest???) and childbirth, the more the medical community will have no choice but to listen and make changes.

As I’ve pondered what I may say, I realized that most if not all mamas want the same things for themselves and their offspring:

  • Complication free pregnancies and childbirths that result in healthy babies.
  • Access to quality health care before, during and after their pregnancies for themselves and their babies
  • A safe and secure home
  • Healthy, nourishing food for themselves and their children/families
  • A healthy, happy family
  • A living wage (either for themselves or their spouse/partner) so that they can support and provide for their families.

It’s pretty simple really. And if you look at mamas across species, these issues are the same for all mamas. The mama bear wants a quiet, cozy cave in which to birth and nurture her cubs, and food to feed them until they can go out on their own. The mama fox wants a cozy, safe foxhole in which to nurture and rear her pups. Mama bird builds the perfect nest high up away from danger in which she hatches her eggs, feeds her birdlings and eventually will send them on their way. And if anyone even contemplates hurting one of those “young ins”…Be prepared to lose life and limb because mamas of all species (humans included) will kill you as quickly as look at you if you approach/attack their young!

Contemplating the question further I began wondering, are the surveys reaching women of color? Research studies often target a certain demographic; working mamas or mamas of a certain educational background or age. In the African American Community, it may not be enough to simply look at age or income. You may need to look at where specifically to find the women. In the African American Community think churches, salons or other social/community gathering places.

Secondly, and perhaps more importantly, how you approach women in the African American Community is critical. There is a long history in this country of African American people being used as study subjects and being subject to various treatments and interventions without their understanding or consent. Cases in point: The Tuskegee Syphilis Experiment and The Immortal Life of Henrietta Lacks. These events are very contemporary, a mere one to two generations away depending on the age of the women you are querying.  It’s hard to embrace a medical/health care system that has had such dubious behavior in the past which lead to such profound (negative) consequences for those “studied” and their families. And even though many African Americans have no direct relationship to the Tuskegee Syphilis Experiment or to Henrietta Lacks, almost every African American knows or has experienced discrimination or suboptimal treatment from the health care system in this country. So it’s really hard for African Americans to embrace medical research and the notion that “their best interests” are really going to be of utmost priority.

In the case of mamas, think of it in terms of mama bears; you are approaching her den and seeking access to her and her cubs (born and unborn). If she is not fully assured that she and her cubs are safe, she’s going to withdraw to safety first, or, if there isn’t time for that,attack! How you approach her can be the difference between life and death-of your study.

What is it going to take to lower the walls between the medical community and the African American Community? Kind of like animals we’re going to have to sniff eachothers’ butts. We’re going to have to find familiarity, a common ground upon which to establish a new foundation for relationship. It can be done. But it’s going to take time, patience and a whole lot of understanding on both sides.

Mamas on Bedrest: Cesarean Awareness Month

April 25th, 2012

April is Cesarean Awareness Month.

I have really mixed feelings about cesarean sections. Having had 2 cesarean deliveries and knowing that at least in the case of my first one, it pretty much saved my life and the life of my daughter, I can’t be entirely “anti-cesarean section”. But in the United States thousands of women have cesarean sections for bogus reasons and that is what this movement and month of awareness is really all about.

So what are the facts about cesarean sections?

  • Cesarean deliveries are one of the most commonly performed surgeries in all of medicine. The other most commonly performed surgery is a hysterectomy.
  • Cesarean deliveries currently account for some 32% of all deliveries in the United States annually.
  • Originally, Cesarean deliveries were intended to birth a fetus when the mother was dead or dying. It has since evolved to be indicated for “large babies”, uterine/placental/vaginal issues, fetal distress or shoulder dystocia
  • According to MedScape, The leading indications for cesarean delivery are previous cesarean delivery, breech presentation, dystocia, and fetal distress. These indications are responsible for 85% of all cesarean deliveries.

I think that most of us would agree that in a healthy mother and baby, a vaginal birth is the way to go. However, in an effort to “control the situation and avoid complications” or to “avoid the pain” or “avoid going into labor at an inconvenient time”, mothers and doctors often schedule a cesarean section “to be on the safe side”. This is the impetus behind the International Cesarean Awareness Network (ICAN) and its supporters.  ICAN and other organizations hope to raise awareness amongst women that cesarean sections are to be the exception to vaginal birth when it is unsafe for mother and baby to undergo vaginal delivery. And while most of us agree with that statement, thousands upon thousands of women often mistakenly believe that delivering vaginally will be unsafe or them and their babies and opt for the cesarean delivery.

Probably the most common reason for cesarean birth is repeat cesarean delivery. There used to be a saying, “Once a cesarean always a cesarean.” Thankfully this is no longer the case. Because of the risks associated with cesarean sections, more and more practitioners are beginning to look at VBAC (vaginal birth after cesarean section) as an option. One has to understand, a cesarean delivery involves cutting the abdominal and uterine walls, creating defects or weaknesses at the sites of the cuts and places for scar tissue to develop. The greatest concern is that in a VBAC, these areas won’t hold and the uterus will rupture causing hemorrhage and risking the lives of both mother and fetus. However, data is showing that this risk of uterine rupture is not as great as previously thought and that women who have repeat cesarean sectioins are at even greater risks. Additionally, in very healthy women having uncomplicated pregnancies and birthing with a skilled practitioner, VBAC’s are quite safe.

Another common reason for cesarean delivery is “large baby”. This is probably the most disputed reason for cesarean delivery and the most controversial. Who hasn’t heard stories of the 5 foot woman delivering an 11lb baby vaginally, or the 5ft 10 inch woman who had difficulty delivering a 5lb baby and required a cesarean section? Size of the baby is rarely the issue, but more aptly the position of the baby in the pelvis, the shape of a mama’s pelvis and how well mama and baby are faring during the delivery process.

Cesarean sections are also more common during labor inductions.  When labor is allowed to start and proceed spontaneously, babies have time to adapt and progress along the birth canal. Normal birth proponents continually state that when a baby is not ready to be born and labor is induced, the baby is rarely in the correct position in the birth canal, the baby often becomes distressed as a result of the uterine contractions, the labor fails to progress and then a cesarean section is performed.

So how does a mama decide whether or not a cesarean delivery is best for her?

  • Do your research. Know the indications for cesarean delivery
  • Talk with your health care provider. Know (as much as possible) the position of your baby in the uterus, consider the gestational age of the baby
  • Consider your obstetrical history. If you have certain complications, you may be more likely to require a cesarean delivery. Talk with your health care provider to assess your risks.

It’s a really tough decision. Even today, some six years after my last cesarean section, I often wonder if I should have tried to deliver my son. (my second child). But I had a list of obstetrical complications that would have made a VBAC quite risky. For women without my dicey history who are considering a VBAC vs. a cesarean delivery, I say, do your research, “be aware”. Only once you’ve fully informed yourself and spoken with your health care provider can you make an informed decision about whether or not to have a cesarean delivery.

Resources

The International Cesarean Awareness Network (ICAN)

MedScape

NIH Consensus Development Conference on Vaginal Birth after Cesarean: New Insights

The American Pregnancy Association

American Congress of Obstetricians and Gynecologists

About.com

Giving Birth With Confidence

Unnecesarean

My daughter at birth

Mamas on Bedrest: The CDC’s Report on Certified Professional Midwives

January 27th, 2012

Bedrest Coach Darline Turner-Lee reviews and comments on a recent press release issued by The Big Push for Midwives Campaign.

In the Press Release, the CDC notes an increase in home births in non-hispanic white women, yet decreasing or stagnat numbers amongst women of color. The press release also noted that

“The CDC report as well as other reports show that babies born to women cared for by Certified Professional Midwives (CPM’s) are far less likely to be preterm or born low birth weight, two of theprimary contributing factors not only to infant mortality, but to racial and ethnic disparities in birth outcomes.”

The Big Push for Midwives is hoping that this report from the CDC will spur action in legislation and amongst medical organizations to allow CPM’s to care for and be reimbursed for care given to women of color and low income women-women who might most benefit from CPM care.