Family Planning

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: 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.

Mamas on Bedrest: Pregnancy Spacing Improves Long Term Health Of Mamas and Babies

September 23rd, 2011

According to a February 1999 New England Journal of Medicine article, separating pregnancies by 18-23 months is optimum to ensure the health of both mamas and babies.

The authors,  Bao-Ping Zhu and colleagues found that incidences of adverse pregnancy outcomes such as premature birth and low birth weight were less likely to occur in pregnancies in which conception occurred 18-23 months after a prior pregnancy and delivery. They also found that there were lower incidences of pregnancy complications, such as pre-eclampsia, in pregnancies which occurred 18-23 months after a previous pregnancy and delivery. Interestingly, rates of complications went up when the pregnancy intervals were longer than 23 months between pregnancy and subsequent conception. The authors admitted that while this was a first assessment, there may be likely confounding variables such as maternal age, socioeconomic status, reproductive history and others that may exert an influence on pregnancy outcome.

As you can imagine, this has not always been well received. Many people simply balk at the notion of “planning” pregnancies and feel like pregnancies occur when they are supposed to occur. Others contend that the failures of contraception account for most of the pregnancy failures and that this cannot be helped as not contraceptive method, except for abstinence, is 100% effective at preventing pregnancy.

At the 2011 Association of Reproductive Health Professions Annual Meeting, this topic was discussed and the position of the Reproductive Health professionals present is to recommend long acting contraception (LARC) to women, especially those in the highest risk groups. Robert Hatcher, MD, MPH reviewed the currently available forms of reversible contraception.

  1. Depro Provera Injection
  2. Paragard IUD
  3. Mirena IUS
  4. Implanon implants

The recommendation for LARC comes as unintended pregnancies in the United States account for approximately half of all pregnancies annually. 60% of unintended pregnancies are what is called “Mistimed Pregnancies” meaning women admit that they would have had (another) child, just not at the time of this particular pregnancy. Most women cited contraceptive failure as the primary reason for unintended pregnancy. But a closer look at contraceptive use habits revealed some interesting statistics.

James Trussell, PhD, Office of Population Research at Princeton University and The Hull York Medical School shared statistics that showed that while the rates of unintended pregnancy has dropped amongst teens, the rates have increased in women in their 20’s. Women of lower education and lower socioeconomic status account for the greatest numbers of unintended pregnancies and African American and Latina Women have the highest rates of unintended pregnancies.

What was even more alarming is that in 2001, 52% of unintended pregnancies were to women who were using no method of birth control. Further, when interviewed for a study between 2006 and 2008, 10.6% of women at risk for unintended pregnancy weren’t using any contraceptive method.

Contraceptive problems arise mostly from “typical use”. What this means is how women typically use the contraceptive method vs. “Perfect use” i.e. how the method is intended to be used. Below is a table taken from the 2011 Contraceptive Technology Handbook outlining the failure rates of contraceptives with “typical use” and “perfect use”.

Method      Typical Use      Perfect Use

Chance 85%                   85%   (Percentages are effective rates)

Condom                     18%                      2%

Pill, Patch, Ring        9%                     0.3%

Depo Provera            6%                     0.2%

Paragard IUD         0.8%                   0.6%

Mirena IUS            0.2%                    0.2%

Implanon               0.05%                0.05%

What this table shows is that methods that require consistent (daily) use have a significant failure rate and significant difference between “typical use” and “perfect use”. However, the more “reliable” methods provide no protection against sexually transmitted infections (STI’s).

Anita Nelson, MD, Professor at the David Geffen School of Medicine at Harbor-UCLA Medical Center in Manhattan Beach, CA looked specifically at the oral contraceptives or birth control pills. What she shared both from the research and from her years in clinical practice is that in a 12 month cycle, women rarely take their pills as prescribed. Women on average miss 3 pills a month and as many as 60 pills a year. Even if they take a pill when they remember, for many women, this is days later and they are already at risk for unintended pregnancy.

Nelson also reiterated a little known fact amongst many women. Pregnancy is more dangerous to a woman’s health than hypertension, blood clots in the legs or diabetes and yet pregnancy increases the risk of all of these conditions occurring and persisting throughout a woman’s life.  Pregnancy related mortality (death) in the United States between 1998 and 2005 has been higher than at any other time in the previous 20 years. 14.5 women die annually for every 100, 00o births and the rates for African American women is 3-4 times higher. Unintended pregnancy also has a higher risk of “sicker babies”.  Nelson and other researchers advocate continuous (or long acting) oral contraceptives and condoms as a way for,

  • Women to control their fertility
  • Pregnancy to occur when desired, lowering risk for complications
  • Unwanted fertility to be eliminated

Family Planning is seen by the US Centers for Disease Control and Prevention as one of the top 10 most important contributions to public health in the 20th century.

Family Planning is also seen as an important global health issue asserts Willard Cates, Jr., MD, MPH of Family Health International and The UNC Gillings School of Global Public Health. Cates presented data and information from the United Nations Population Fund, an international development agency that promotes the right of every woman, man and child to enjoy a life of health and equal opportunity. Sharing statistics from the Guttmacher Institute, family planning averts 187 million unintended pregnancies and in turn prevents:
• 54 million unplanned births
• 112 million induced abortions
• 1.2 million infant deaths
• 230,000 maternal deaths
• 71 million DALYs saved

(WHO Definition of DALY’s: DALYs = Disability Adjusted Life Years. The sum of years of potential life lost due to prematuremortality and the years of productive life lost due to disability)

Cates reiterated that Family Planning contributes to the Millinium Development Goals for the world which are:

1. End Poverty and Hunger
2. Universal Education
3. Gender Equality
4. Child Health
5. Maternal Health
6. Combat HIV/AIDS
7. Environmental Sustainability
8. Global Partnerships

Cates makes the case that only with widely available, long acting reversible family planning will the world’s goals of economic equality for women, increased educational opportunities for women, improved health and mortality for women and babies, reduced unintended pregnancy rates, reduced abortion rates, increased economic growth and stability for all nations.

What are your thoughts on contraception and unintended pregnancy? Would you ever use a long acting reversible contraceptive (LARC)? Share your comments below.