preterm labor

Mamas on Bedrest: “Why Wasn’t I Prescribed Bedrest???”

January 26th, 2015

Hello Mamas.

I received the following inquiry from a Mama on Bedrest:

“Hi. I’m 24 weeks along and on my last prenatal visit, my OB noted that my cervix was short. After ultrasound evaluation, he determined that a cerclage was needed. I had the cerclage placed, but my OB has not put me on bed rest. I asked if I should limit my activity and he said only if I felt contractions or otherwise uncomfortable. 

Most other women that I know who have been in this situation were prescribed bed rest. I’m really nervous that something will go wrong and I will lose my baby. What should I do?”

This is an excellent question!! First and foremost, a Mama should always listen to and follow her health care provider’s recommendations. I say this because you have “contracted” with this person to care for you and your unborn child. It only makes sense that you follow their recommendations. Now, if you find that you disagree with your health care provider on many or at least one major decision, I suggest you first talk with your health care provider and ask why they have chosen the treatment plan that they are implementing. Make sure that you understand the ENTIRE rationale behind their decision, and that you understand and are comfortable with the treatment plan going forward, including potential adverse outcomes.

If you are still uncomfortable after speaking candidly with your health care provider, I suggest getting a second opinion. Sometimes having another assessment of your situation will put your concerns to rest. Also, sometimes another person can explain things differently so that they make more sense to you and ease your mind.

Finally, if you have spoken with your health care provider and not gotten the answers that satisfy you, and you have consulted with another provider and gotten a second opinion-regardless of whether they agree or disagree with your original health care provider, you may want/need to change providers. Now I don’t say this lightly. Changing providers mid-pregnancy is most certainly not optimum, however, if you are really feeling uncomfortable with your current provider, it is in your best interest (and that of your baby’s) to work with a provider in whom you implicitly trust, with whom you feel completely comfortable and who will consult with you every step of the way making sure that you are included in treatment decisions, that you understand all treatment decisions and with whom you can speak to freely and as often as you need. If you don’t feel completely comfortable with your health care provider and feel anxious and uncomfortable with his/her treatment plan, then you may need to consider a change. But again, I highly suggest you do all that you can to work with this person who already knows you and your case.

Now, if it isn’t a conflict with your provider and you are just concerned that you should be on bed rest and they haven’t prescribed it, trust your health care provider as they are doing you a HUGE service not placing you on bed rest if it isn’t medically indicated. In our e-book, “From Mamas to Mamas:The Essential Guide to Surviving Bedrest” I spent an entire chapter discussing how bed rest is not an evidence-based treatment and that many, many obstetricians, maternal-fetal medicine specialists and many of the medical societies caring for pregnant women and their babies are urging providers NOT to prescribe bed rest, but to instead treat the pregnancy complication without the activity restriction. It sounds like this obstetrician is doing just that. What our mama should now do is at her next prenatal visit, ask her health care provider to explain to her EXACTLY why s/he did not prescribe bed rest, what s/he expects to happen with cerclage alone, what other treatments they will implement if the cervix continues to shorten to prevent preterm birth and what she can do to improve her pregnancy outcomes. In this way, Mama will have all the information she needs to take exquisite care of herself and her baby-and hopefully have all her fears and anxieties addressed and “laid to rest.”

 

What was your response to being put on bed rest or not being prescribed bed rest? Share your experience below in our comments section.

If you want to learn more about Bedrest not being an evidence based treatment for the prevention of preterm labor and preterm birth, read all about it in our e-book, From Mamas to Mamas: The Essential Guide to Surviving Bedrest” available for immediate download from Amazon.com.

Mamas on Bedrest: Can routine cervical measuring and treatment with progesterone as indicated reduce and/or eventually eliminate bed rest?

January 6th, 2015

Hello Mamas and Happy New Year!!!

Right before we all took a much anticipated holiday break, The Society for Maternal-Fetal Medicine (SMFM) added their voice to those of  The American Congress of Obstetricians and Gynecologists (ACOG), The American College of Nurse Midwives (ACNM), The March of Dimes, Medicaid and The Perinatal Research Branch of the Eunice Kennedy Shriver Institute to recommend that preterm birth risk screening include cervical length measurements and for those women at increased risk, treatment with progesterone injections.

Why is this important? Well, if you visit our Facebook page, you will notice that a large number of the mamas in our community are on bed rest for cervical insufficiency or incompetent cervix. Cervical insufficiency is one of the leading causes of preterm labor in the US and one of the leading causes of infant mortality (infant death). The United States ranks 55th globally in infant mortality, with 26,000 infants dying annually before their first birthdays. This is a horrendous and utterly embarrassing statistic given that the US is one of the richest countries in the world with some of the most advanced health care, yet we can’t seem to save our babies. What is worse, infant mortality in the United States for African American babies is twice that of Caucasian babies, so deaths among little black infants is disproportionately high in the US.

But despite all this doom and gloom, the upside is that all of these medical societies have looked at the data as well as at available treatments and they have all come to the same conclusion: If there is more screening for preterm labor in pregnant women-measurement of the cervix and in those women at risk, the initiation of progesterone injections-the rates of preterm labor can be reduced 40-50% in mamas having just one baby and no prior history of preterm birth. And if every pregnant woman is screened for shortened cervix and those at risk identified and started on progesterone shots, medical costs associated with preterm labor, premature birth and subsequent medical and developmental support could be reduced by $750 million annually. Given that preterm labor and prematurity currently costs the US in excess of $26.2 billion annually, this is substantial savings. All of the medical societies are also in agreement that if a woman is noted to have a shortened cervix and is less than 24 weeks gestation, she should have a cerclage (a surgical stitich placed to hold the cervix closed) placed.

Preterm labor and prematurity are major issues in Maternal and Infant health and the leading cause of infant death before one year in the United States. If by simply screening and measuring cervical length early on with ultrasound and providing treatment with progesterone and cerclage can reduce preterm labor and prematurity and save the lives of babies, then we should be adopting these recommendations.

The elephant in the room for us here is will these practices negate the need for prescribed bed rest? That subject was not addressed in these recommendations, however, many of these same professional medical societies are recommending that bed rest not be routinely prescribed due to the negative effects that is has on Mamas’ bodies. So it will be very interesting to see how these recommendations are implemented and their effect on the overall preterm labor and prematurity rates. My guess is that if rates start dropping, we my in fact see a reduction in the bed rest prescription. Now wouldn’t that be exciting???

Mamas, share this information with your health care providers and see what they have to say. If you’ve been screened for a shortened cervix and started on progesterone, let us know in the comments section below. We would love to share the journey with you (join our Facebook Community!!)! And if you are prescribed the progesterone and/or cerclage without bedrest, do let us know how you fare and when you deliver your baby.

Reference

Society for Maternal-Fetal Medicine Joins with Other Organizations to Brief Congress on Need for Medical Protocols that will Save the Lives of Infants in the US by Reducing Preterm Birth. (Press Release December 17, 2014, Washington, D.C. Society for Maternal-Fetal Medicine. www.smfm.org

Mamas on Bedrest: Do You Know The Signs and Symptoms of Preterm Labor?

November 10th, 2014

March of Dimes Promo ImageMarch of Dimes Promo ImageHello Mamas!

November is Prematurity Awareness Month. Spearheaded by the March of Dimes, perinatal organizations nationally and globally are sponsoring educational events and presentations to raise awareness of the issue of preterm labor and premature birth. As an industrialized nation, the United States fares poorly on the global scene when it comes to preterm births, earning a C grade on the global stage. This is one of  the worst grades amongst industrialized nations. According to the March of Dimes, there are 450,000 babies born too soon annually in the United States. That is 1 out of every 9 babies!

There is much being done to reduce the number of babies being born too soon. American obstetricians and hospitals have revised their protocols so that there are fewer preterm labor inductions and fewer unnecessary cesarean sections. However, the large number of infants born prior to 39 weeks persists.

African American women have the highest rates of preterm labor and premature births in the US, ranging anywhere from 2-4 times the rate of preterm labor and preamature birth in white women. Researchers and public health officials are implementing some very targeted perinatal health care programs to address the disparities in access to care, affordability of care and the quality of care provided, especially as it pertains to lower income women who are on government subsidized health care plans . Two non-government organizations with whom  Mamas on Bedrest & Beyond is partnered with are The Birthing Project USA and The National Perinatal Task Force. The Birthing Project pairs African American support volunteers “Sister Friends” with pregnant mamas to help them navigate the health care system, gain access to resources and to be a support and birth attendant if necessary. The success of this program comes from the fact that the less experienced mama has a direct resource to ask questions,  seek assistance and who is often (but not required to be) present when mama delivers her baby. The National Perinatal Task Force is a group of perinatal health care workers who are dedicated to improving birth outcomes in African American Women and babies by being a very visible presence in the African American Community and providing information, resource referrals and support to mamas in need. Both programs provide African American women culturally sensitive care and support that has translated to improved birth outcomes.

The important key to reducing the rates of preterm labor and premature births is education. If you ask a cross section of pregnant women what are the signs and symptoms of preterm labor, many don’t know. This alone may account for many premature births. A woman experiencing intermittent contractions that are not particularly strong, or if she has an above average pain threshold, she may not recognize that she is in preterm labor. Other non specific symptoms such as diarrhea or back pain may be misconstrued as gastrointestinal upset or simply a normal ache from pregnancy respectively. Since it is imperative to be able to recognize the signs and symptoms of preterm labor and to seek medical attention immediately (as preterm labor immediately addressed can often be stopped!), here are the most common signs and symptoms of preterm labor. Please make a note of these symptoms and contact your health care provider IMMEDIATELY if you are or have recently experienced any of these symptoms.

  • Contractions (your belly tightens like a fist) every 10 minutes or more often
  • Change in vaginal discharge (leaking fluid or bleeding from your vagina)
  • Pelvic pressure—the feeling that your baby is pushing down
  • Low, dull backache
  • Cramps that feel like your period
  • Belly cramps with or without diarrhea

Again, the March of Dimes has educational events taking place all this month throughout the United States. Check the March of Dimes Website for state chapter information as well as the calendar of events in your area.

Have other questions? Schedule a Complimentary 30 Minute Bedrest Breakthrough Session to find the solution! Schedule yours today!