Birth Advocacy

Mamas on Bedrest: Black Infant Mortality Awareness Walk!

September 14th, 2016

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September is Infant Mortality Awareness month and on Saturday, September 24, 2016, Mamas on Bedrest & Beyond and her supporters will walk from Seton Medical Center in Austin to The Dell Seton Medical School at the University of Texas to raise awareness of Black Infant Mortality. Why are we walking?

The Numbers

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From 2000 to 2013, The National Vital Statistics Report shows the infant mortality rate (IMR) declined nationally, yet there remains a persistent 2—3 fold disparity in IMR of black infants compared to their white and hispanic counterparts. Texas follows this trend with an IMR of 5.8 overall in 2013. But looking at specific data from the Texas Department of Health and Human Services for 2013, while the overall IMR was 5.8 deaths per 1000 births, the IMR of black infants statewide was 11.9 deaths per 1000 births. The picture gets even gloomier if we look at Travis County. In 2012 (the last year for which data has been compiled) the IMR for black infants was 13.6 deaths per 1000 births, 2.85 times the death rate of white infants. In 2013, the disparity ratio for IMR of black infants to all infants in Texas was 3.02, or black infants are 3.02 times more likely to die before their first birthday than infants of other races here in Travis County.

Austin/Travis County is the state capital and one of the wealthiest counties in the state. Yet since 2000 Austin/Travis County has failed in its attempts to improve birth outcomes and survival rates for black infants to match those of infants of other races. The IMR for 2013 actually represents an increase in IMR from previous data.

The Call to Action

We believe that an IMR of 6.0 deaths per 1000 or less is attainable for black infants in Travis County, just as it has been attained for infants of other races. Here are 6 steps we could initiate to make this possible:

  • Strongly encourage the Texas Legislature to take the Medicaid Expansion funds allotted for the state by the Affordable Care Act. This alone would insure another 1.3 million Texans, many of them women and infants, and give more access to comprehensive prenatal care, post natal and pediatric care.
  • Work to increase the number of black health care providers (physicians, nurses, midwives, lactation consultants, childbirth educators and community health workers) in Austin/Travis County.
  • Include members of the black community in the conversation about Place Based health initiatives and new treatments (like 17P for the prevention of preterm labor) so that they can make informed decisions about their health care, help educate members of the community and increase utilization.
  • An aggressive community outreach campaign which includes community gatherings for conversations, presentations at churches and other community venues and even door to door health information and health education efforts by members of the community.
  • Educate and elevate. Black citizens in Travis County are not looking for a handout, but a hand up. When information is presented in a clear and understandable way, people are more receptive, more apt to listen and more likely to act.
  • Support initiatives that will help restore the infrastructure in the black community such as improved schools, jobs, affordable housing, safe and affordable childcare, additional security, public transportation and grocery stores.

What are you doing to raise awareness about Black Infant Mortality? Share your thoughts and events in our comments section below.

For more information about our walk or to get involved, e-mail us at info@mamasonbedrest.com

 

References:

The National Vital Statistics Report, Volume 64, Number 9. August 6, 2015

The Office of Minority Health and Health Equity, Infant Mortality for the State of Texas and Travis County

Mamas on Bedrest: “Widespread Insurance Coverage of Doula Care Would Reduce Costs, Improve Maternal and Infant Health”

January 14th, 2016

Hello Mamas,

As we roll into 2016 one thing is certain: We are on the brink of change in the maternity world! At no time in history have there been so many groups and so many initiatives determined to improve maternity care and birth outcomes. Below is a press release put out by two leading maternity advocacy groups, Choices in Childbirth and Childbirth Connection (a program of the National Partnership for Women and Families) to raise awareness not only of the cost benefit of doula care, but also the tremendous benefit doulas provide to mamas and infants in improving birth outcomes. A doula is “a trained birth attendant who provides non-medical emotional, physical and informational support before, during and after childbirth.” Here is more from the press release: 

“Widespread coverage of doula care is overdue,” said Michele Giordano, executive director of Choices in Childbirth. “Overwhelming evidence shows that giving women access to doula care improves their health, their infants’ health, and their satisfaction with and experience of care. Women of color and low-income women stand to benefit even more from access to doula care because they are at increased risk for poor maternal and infant outcomes. Now is the time to take concrete steps to ensure that all women can experience the benefits of doula care.”

 “Doula care is exactly the kind of value-based, patient-centered care we need to support as we transform our health care system into one that delivers better care and better outcomes at lower cost,” said Debra L. Ness, president of the National Partnership. “By expanding coverage for doula care, decision-makers at all levels and across sectors – federal and state, public and private – have an opportunity to improve maternal and infant health while reducing health care costs.”

 The brief provides key recommendations to expand insurance coverage for doula care across the country. They have also provided an informative infographic which also summarized the major points (see below).

  • Congress should designate birth doula services as a mandated Medicaid benefit for pregnant women based on evidence that doula support is a cost-effective strategy to improve birth outcomes for women and babies and reduce health disparities, with no known harms.
  • The Centers for Medicare & Medicaid Services (CMS) should develop a clear, standardized pathway for establishing reimbursement for doula services, including prenatal and postpartum visits and continuous labor support, in all state Medicaid agencies and Medicaid managed care plans. CMS should provide guidance and technical assistance to states to facilitate this coverage.
  • State Medicaid agencies should take advantage of the recent revision of the Preventive Services Rule, 42 CFR §440.130(c), to amend their state plans to cover doula support. States should also include access to doula support in new and existing Delivery System Reform Incentive Payment (DSRIP) waiver programs.
  • The U.S. Preventive Services Task Force should determine whether continuous labor support by a trained doula falls within the scope of its work and, if so, should determine whether labor support by a trained doula meets its criteria for recommended preventive services.
  • Managed care organizations and other private insurance plans as well as relevant innovative payment and delivery systems with options for enhanced benefits should include support by a trained doula as a covered service.
  • State legislatures should mandate private insurance coverage of doula services.

Read the entire Issue Brief Here. For more information, visit Choices in Childbirth or Childbirth Connection.

 

 

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Mamas on Bedrest: To end the bedrest debate, we need more healthy mamas!

September 22nd, 2015

Greetings Mamas!!

The bedrest debate continues as more and more studies are advocating treatment of the causes of bedrest in lieu of activity restriction. However, there are those that are convinced that bedrest is an effective treatment for preterm labor and prolongs pregnancy. Let’s take a look at the evidence.

For over 25 years, Judith Maloni, RN, PhD researched bedrest and found that the practice has no apparent benefit and has been shown to be harmful to pregnant women. Her publication, “AntepartumBed Rest for Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth”(1), Maloni denounced the bedrest prescription because there was no evidence to support the practice.

In 2007. NASA released an article which showed that female astronauts in space lost bone mass and muscle mass and strength in as little as 2 weeks of inactivity, and the effects were even more pronounced at 60 days.(2) They recommended that if women do have to be on limited activity for an extended period of time, they should engage in a modified exercise program to maintain bone and muscle integrity.

The World Health Organization and Amnesty International have both denounced the bed rest prescription and have had sharp criticism of the United States-which boasts the highest costs of maternity care than any other country in the world, yet has some of the highest rates of complications, bed rest, interventions, cesarean sections and maternal and infant morbidity and mortality-to rethink their maternity care practices and to bring their maternity statistics in line with the rest of the world.

In 2013, physicians in the American Congress of Obstetricians and Gynecologists began questioning the practice of prescribed bedrest and Christina McCall, MD (3) and Joseph Biggio, Jr., MD (4) both called on their ACOG colleagues to stop the practice of bedrest citing the harm that is poses to pregnant women.

However, bedrest remains a mainstay in obstetrical practice. Here in Austin, the 2 major hospital systems each have large antepartum units which cater to women experiencing pregnancy complications. My colleague Angela Davids, founder of Keepemcookin.com, recently blogged about an article by Drs. Christine Piette Durrance and Melanie Guldi (5) in which the authors concluded after an extensive review of PRAMS (Pregnancy Risk Assessment Monitoring System) data of some 200,000 women, that limited inactivity does reduce preterm birth before 33 weeks by 7.7% and low birth weight infants (weighing less that 1500 grams) by 15.4%.

So what are mamas to think? Should they abandon bedrest? Remain on bedrest? Is there a way to not have to go on bedrest, to not encounter the complications that lead to the bedrest prescription?

At this juncture if you are a mama on bedrest, I WOULD NOT recommend abandoning the care plan that your provider has put into place for you. If you have questions about whether or not bedrest is necessary in your case, speak with your provider and voice your concerns. I am a firm believer that if you have hired (chosen) a provider for services, then you should follow their directions. Now if you are having reservations about being on bed rest, its efficacy and whether or not it is doing harm to you, you must have a candid conversation with your OB and get your questions answered so that you can make an informed decision.

I myself am a proponent of mamas getting off bedrest. I believe the way to do it is to help women to be in the best shape BEFORE they ever think about getting pregnant so that when they are pregnant they are strong and healthy. Many of you reading this may be saying, “Well fat lot of good that does me now!” I sense your frustration. There is nothing we mamas on bedrest do better than second guess ourselves! But what you did in the past (no matter how recent) is of no consequence. As Dr. Maya Angelou eloquently said, “When you know better, you do better.” You know better right now, so begin taking exquisite care of yourself right now! As much as possible,

  • Eat healthy, nutrient dense foods.
  • Drink lots of water (1/2 your current body weight but in ounces).
  • Rest (I know that sounds ridiculous, but many mamas on bedrest are so stressed out they don’t sleep well and don’t rest. Your body is not only maintaining you, it is also growing another fully complete human being. That most certainly deserves a nap!
  • Do stretches t keep your muscles supple and limber. (BedrestFitness!)
  • Keep your spirits up

I don’t know what is to become of bedrest and the bedrest prescription. I do know for the nearly 1 million women who will experience bedrest, you have to take care of yourself. If you are in the Austin, TX area, look me up! I always enjoy mixing with mamas and would be happy to serve you.

How are you surviving bedrest? Share your tips and comments section below.

 

References

Judith Maloni, Ph.D.  AntepartumBed Rest for Pregnancy Complications: Efficacy and Safety for Preventing Preterm Birth (Biological Research for Nursing 12(2) 106-124)

Mark Ransford. NASA-Funded Study finds Exercise Could Help Women on Bedrest November 15, 2007

Christina McCall, MD, “Therapeutic” Bed Rest in Pregnancy, Unethical and Unsupported by Data”, vol 121, No.6 June 2013, 1305-1308

Joseph Biggio, Jr., MD.“Bed Rest in Pregnancy, Time to Put the Issue to Rest!” vol 121 No. 6, June 2013, 1158-1160

Christine Piette Durrance and Melanie Guldi. Maternal Bedrest and Infant Health.