infant mortality

Mamas on Bedrest: Standing for Little Brown Babies by Supporting Their Mamas

September 18th, 2012

Welcome to the Third Edition of the Black Birth Carnival. Hosted by Darcel of The Mahogany Way Birth Cafe and Nicole of Musings From The Mind of Sista Midwife.

The Topic: Infant Mortality Awareness: Saving OUR Babies.
Many birth workers are talking about the alarming infant mortality rates in this country, but none are talking about infant mortality in the Black Community. That’s where this Blog Carnival comes in. We will talk about statistics, try to figure out why, and most importantly what we can do to help lower our infant mortality rates. This post will be updated with live links linking back to the other participants posts


I have a real thing for little brown babies. Having had two of my own, I can honestly say that they are the most precious (and most beautiful) beings in the world to me. Having also lost two pregnancies, sadly I also know the pain of losing precious souls.

It’s hard to believe that the United States has one of the higher infant mortality rates in the world, with African American babies dying at nearly 2-3 times the rate of White and Latino infants.  According to the Office of Minority Health, a unit within the US Department of Health and Human Services,

African Americans have 2.3 times the infant mortality rate as non-Hispanic whites. They are three times as likely to die as infants due to complications related to low birth weight as compared to non-Hispanic white infants.

  • African Americans had twice the sudden infant death syndrome mortality rate as non-Hispanic whites, in 2008.
  • African American mothers were 2.3 times more likely than non-Hispanic white mothers to begin prenatal care in the 3rd trimester, or not receive prenatal care at all.
  • The infant mortality rate for African American mothers with over 13 years of education was almost three times that of Non-Hispanic White mothers in 2005.

The OMH website goes on to list all the data from the US Centers for Disease Control and Prevention regarding infant mortality in the United States. At all indices, African American infants fare far worse than their White or Latino counterparts.

The statistics are alarming, yet I encourage you to read through them. I believe that change in the African American community-whether it’s regarding infant mortality, maternal mortality, health care delivery disparities, crime, homicide or anything else-is going to have to be an inside job. It is all well and good for university researchers to study what is going on in African American communities. It is fine if news outlets want to report on activities going on in African American communities. But little to none of these analyses makes one hill of beans difference if they are doing nothing to change the situation on the ground, and by my observations they aren’t doing much. Raising awareness is good but action is imperative.

I recently wrote a blog post called, Mamas on Bedrest: I’m Pro-Action! It engendered a lot of controversy because people felt that I was politicizing birth, bringing in the Pro-Life/Pro-Choice debate. I’ll admit that I chose the term “Pro-Action” as an attention grabber, but the meaning I’ve placed behind it is entirely different.

“Pro-Action” is a term that I believe we all have to embrace. So often in our culture, we vent “righteous indignation” over one thing or another, yet we fail to act on our beliefs. I believe failure to act is in large part responsible for the demise of our communities and our culture. Being “Pro-Action” means putting movement behind the lip service and working to effect change.

After reading the statistics on infant mortality in African American infants, you might sit back with a feeling of helplessness and hopelessness. It is a daunting problem and one that as individuals cannot possibly tackle effectively. But as individuals in collective, we can make an enormous impact. So how does one become “Pro-Action”? What does that look like when working to curb infant mortality?

  • It’s working within your immediate neighborhood, community or congregation to assist mothers who are pregnant. Perhaps you give them a ride to their prenatal visits or watch their children so that they make it to visits unencumbered (we all know that even pregnant, you can move faster without the little ones along!).
  • If mamas are on bed rest (my particular soft spot), it’s going by their homes and making sure that they have healthy meals and groceries, making sure that they are comfortable, talking to them, reassuring them, helping around their homes and with their children and family responsibilities.
  • It’s talking openly and honestly to teenagers about sex and contraception. Let’s face it, the “sex outside of marriage is a sin” speech ain’t workin’ and hasn’t worked for decades. I think it’s time for a new approach (just my opinion here).
  • It’s educating teen-aged girls about why teen pregnancy is not a good idea. Again, address not only the moral arguments, but also address the concrete data in the medical literature that clearly shows that teenagers have higher rates of maternal and infant mortality. Contrary to popular beliefs, pregnancy is not a benign condition. Many things can and do go wrong and they tend to go wrong in the extremes-amongst young girls under 20 and women over 40.
  • It’s grassroots organization like Mamas of Color Rising here in Austin, TX. This group of low income African American and Latina mamas has come together to train birth attendants of color to be with mamas of color as they labor and deliver. They are supporting and training midwives of color who will attend births of low income mamas of color. They have lobbied for and are on the crest of seeing rules changes in the Medicaid laws of Texas such that Midwives will be able to care for and attend to pregnant women on Medicaid and be reimbursed for their services. And in just mere weeks, this dynamic group of mamas will see the grand opening of a free prenatal clinic for low income women of color who will be able to receive prenatal care in the midwifery model. Yes, these mamas are definitely “Pro-Action”!

I could go on and on, but I think you get the picture. Pick an area that pricks your heart and then Take Action! Get out and get involved. If each one of us becomes involved in each of our respective communities, soon, our efforts and our reach will coalesce and we’ll find that we are one large collective effecting change on a grand scale.

This Blog Carnival is once such example of change in action. Let’s keep the ball rolling and all be “Pro-Action” for our mamas, our babies and our communities.

Other Posts in this Carnival

Health Programming and It’s Impact on Black Infant MortalityBy Amy Hereford

Black Infant Mortality and Your Responsibility. By Darcel of The Mahogany Way Birth Cafe

Stop The Talking…Implement Solutions! By SistaMidwife Productions


Mamas on Bedrest: How Embarrassing-The US Infant Mortality Rate

September 12th, 2012

September is National Infant Mortality Awareness Month and there are numerous events, campaigns and activities taking place all designed to raise awareness about infant mortality. The United States has an embarrassingly high infant mortality rate in contrast to many other countries. But what is even more disturbing is the fact that according to an article published in The Lancet, May 2010, the country isn’t keeping up with global gains in reducing child mortality, despite significant health care spending.

Citing an article published on DOTmed.com summarizing The Lancet publication,

According to the World Bank, the U.S. has the highest infant mortality rate among 33 countries that the International Monetary Fund defines as having “advanced economies.”

At the time of the DOTmed summary, The U.S. ranked 42nd in the world in child mortality.

“What is surprising is that the U.S. continues to fall even farther behind, while other developed countries such as Australia and New Zealand have shown much better improvements in child mortality. If we look at progress over time, we see the U.S. was ranked 29th in the world in 1990 and has dropped to 42nd now (2010). What that tells us is that we’re not making as much progress as other high income countries.”

~Julie Rajaratnam, assistant professor with IHME and one of the study’s authors.

While our infant mortality rate is dismal and not readily improving in comparison to many other nations, researchers have found that there are some identifiable reasons for our high infant mortality rate. The leading causes of infant death in America are congenital defects, preterm birth and low birth weight and sudden infant death syndrome. They believe that if the US  addresses those issues, the infant mortality rate will surely improve.

Birth Before Due Date

The US has an unusually high preterm birth rate in comparison to many other countries. According to a 2009 report by the National Center for Health Statistics, compared to Europe, America has a higher percentage of preterm births, likely the main cause of its higher IMR. (Preterm is defined as birth before 37 completed weeks of gestation.) Not only do we see many babies born before the recommended 37 weeks gestation, there are also thousands of babies born before 39 weeks gestation, the acceptable length of “term birth”. The March of Dimes has repeatedly advocated for education and policy changes within hospital and birthing centers encouraging physicians and families to do their best to allow babies 39 weeks without any sort of intervention (induction or cesarean section) unless absolutely necessary (i.e. mama or baby at risk).

Dr. Scott Berns, a pediatrician and a senior vice president with the March of Dimes Foundation reiterates that there is important development that occurs between 37 and 39 weeks gestation. Because we have gotten so accustomed to seeing “good” outcomes at 37 weeks, we’ve been lulled into a false sense of security. Dr. Berns notes that if we were to look at the overall numbers, we’d see the dip in positive outcomes in babies born before 39 weeks gestation.

The US also has a higher percentage of older mamas and mamas who have used assisted reproductive technologies. Mamas who become pregnant using ART are at increased risk of having a multiple pregnancy which carries with it an increased risk of preterm birth.

Socioeconomic Disparities

Many experts also draw links between America’s vast socioeconomic disparities and infant death. According to Dr. Gregory, half of U.S. births are to mamas on Medicaid. While both preterm birth and SIDS can happen to any family, these conditions are more prevalent among poorer families. Additionally, a 2008 NCHS report found that the infant mortality rate for black women was 2.4 times the rate for white women in 2005 (and this disparity exists today!!).

According to IHME’s Rajaratnam, looking at the U.S. child mortality rates by counties would likely identify areas that are performing just as well as Europe, and others on par with the world’s poorest countries.

“We are starting to do some of that local level research now and those results will help us get closer to putting our finger on what needs to change in order to save more lives.”

Both Dr. Gregory and Dr Rajaratnam admit that socioeconomic factors and access to care can’t account for the entire higher infant mortality amongst lower income ethnic minorities. However, they play a major role and must be addressed if infant mortality rates are to be lowered nationwide.

More Research

Both Drs. Gregory and Rajaratnam agree that there needs to be more research into the possible causes of infant mortality and both advocate that the National Institutes of Health, the National Institute of Child Health and Human Development and other research and policy organizations allocate funds and research efforts into infant mortality.

It must also be noted that advances in treatments, such as the use of progesterone injections for preterm birth, Magnesium Sulfate’s impact on protection of preterm infant brains, improvements in neonatal intensive care and improving access to perinatal health care will all improve infant outcomes.

References

DOTmed.com

Neonatal, postneonatal, childhood, and under 5 mortality for 187 countries, 1970-2010; a systematic analysis of progress towards Millennium Development Goal 4. Julie Knoll Rajaratnam PhD et al. The Lancet, Volume 375, Issue 9730, Pages 1988 – 2008, 5 June 2010.  doi:10.1016/S0140-6736(10)60703-9

Mamas on Bedrest: Urine Tests May Predict Pre-Eclampsia

December 6th, 2010

The Discovery

Recently, two different groups of researchers identified urine proteins that can detect pre-eclampsia in early pregnancy. Pre-Eclampsia affects 5% of all pregnancies worldwide and is a leading cause of maternal and fetal morbidity and mortality. Symptoms of pre-eclampsia (hypertension, proteinuria and edema) typically manifest late in pregnancy, but the protein markers which the researchers have identified are present by 18 weeks gestation. Researchers theorize that abnormal development and function of the placenta is the central cause of pre-eclampsia.  This abnormal development gives rise to certain proteins which can be found in maternal urine. The presence of these proteins can predict whether or not a woman is at risk for, or actually developing pre-eclampsia.

Congo Red Dot Urine Test

The first study was conducted by Irina Buhimschi, MD, Associated Professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at Yale University and the data was presented in February 2010 at the Society for Maternal and Fetal Medicine 30th Annual Meeting: The Pregnancy Meeting.* Dr. Bahimschi and her colleagues sought to create and confirm the Congo Red Dot Test as a way to assess for pre-eclampsia. Their rationale was that pre-eclampsia is frequently diagnosed and often over treated in the United States, primarily due to litigation fears. Yet pre-eclampsia is often underdiagnosed and undertreated in developing countries due to the lack of diagnostic resources.  They chose to use the Congo Red Dot test as a screening test because the test is quick (results are available in 10-15 minutes) and the test does not require any technical equipment so it can be done anywhere. The results of the Congo tests are easy to determine and are based on the percentage of Congo Red Retained in target proteins. The researchers compared Congo Red Retained as a predictor of delivery for pre-eclampsia with two other tests, one for urine protein and another for the ratio of high soluble fms-like tyrosine kinase 1 t placental growth factor (sFlt1/PIGF). Dr. Buhimschi and her colleagues found:

  • 61% (211/347) of the subjects had an indicated delivery for pre-eclampsia, with the highest percentages in those with superimposed pre-eclampsia (100%), severe pre-eclampsia (99%), and mild pre-eclampsia (69%); in the control group, the rate was 4%.
  • CRR levels were higher in women with mild pre-eclampsia than in those with gestational hypertension, and were even higher in women with severe and superimposed pre-eclampsia.
  • 11% (4/35) of the asymptomatic women evaluated longitudinally with Congo Red Dot urine testing had preterm indications for delivery for pre-eclampsia and elevated CRR levels before they developed symptoms.
  • CRR levels more accurately predicted and indicated delivery for pre-eclampsia than the more intensive urine protein test (P < .001) and sFlt1/PlGF (P = 0.014).

Urine Test to Detect Pre-Eclampsia in Early Pregnancy

Matt Hall, MBChB, Leicester General Hospital and The University of Leicester in the United Kingdom reported that urine samples obtained before 20 weeks gestation allowed them to identify 5 protein peaks that predict pre-eclampsia with 92% accuracy,  87% sensitivity and 82% specificity for the proteins in question.

Urine samples were obtained from woman at 20 weeks gestation and analyzed the same day using surface enhanced laser desorption/ionization time-of-flight mass spectrometry. The results of the urine samples were compared with the pregnancy outcomes (those who had pre-eclampsia and those who did not) at birth. Pre-Eclampsia was defined by the International society for the Study of Hypertension in Pregnancy, 2001 criteria.

Hall and his colleagues also noted, as did Buhimschi, that because placental development is complete by 18 weeks gestation, urinary protein changes early in pregnancy as a result can be used to predict subsequent development of pre-eclampsia. The findings were presented at the Renal Week 2010: American Society of Nephrology 43rd Annual Meeting.**

Implications for Mamas on Bedrest

Pre-Eclampsia is one of the leading reasons that pregnant women are prescribed bed rest and carries with it significant morbidity and mortality for both mamas and babies. To date, pregnant women diagnosed with pre-eclampsia are prescribed bed rest and their blood pressure is monitored carefully. If their blood pressures remains high, they are often given Magnesium Sulfate to prevent the pre-eclampsia from progressing to eclampsia or HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelet Count) Syndrome. Magnesium Sulfate is also used to prevent women from developing hypertension induced seizures. While Magnesium Sulfate has been used for some 60 years for the treatment of pre-eclampsia, it has some pretty uncomfortable side effects.

  • Flushing
  • Nausea
  • Vomiting
  • Palpitations
  • Headache
  • General muscle weakness
  • Lethargy
  • Constipation

Magnesium Sulfate can cause these dangerous complications:

  • Cardiac arrest
  • Pulmonary edema (lungs fill with fluid; can be fatal)
  • Chest pain
  • Cardiac conduction defects
  • Low blood pressure
  • Low calcium
  • Increased urinary calcium
  • Visual disturbances
  • Decreased bone density
  • Respiratory depression (difficulty breathing)
  • Muscular hyperexcitability

Rare, Severe Complications

  • Profound muscular paralysis
  • Paralytic ileus (intestinal obstruction)

(NOTE: The side effects and complications of Magnesium Sulfate are intensified by kidney failure, a common complication of pre-eclampsia. Your obstetrician should monitor your kidney function carefully if you develop pre-eclampsia, and even more so if you are prescribed Magnesium Sulfate.)

If the urine tests  mentioned in the studies could be performed early in pregnancy to detect which women are in imminent danger of developing pre-eclampsia or who may already have the early stages of pre-eclampsia, the prevalence of pre-eclampsia could be significantly reduced. Women experiencing the horrible side effects of pre-eclampsia could be spared the discomfort of treatment and the risk to their lives and the risk to the lives of their babies. These tests could make pre-eclampsia and bed rest for pre-eclampsia a thing of the past-or at the very least, a rare occurrence.

Clearly more research is necessary in order to confirm these study findings. However, the implications of these studies is extremely exciting for mamas on bed rest. Each year thousands of women are prescribed bed rest as part of the treatment for pre-eclampsia, yet there is no documented proof that bed rest aids in the treatment of pre-eclampsia.  Additionally as it has been stated here, once a woman begins to exhibit the signs and symptoms of pre-eclampsia, she and her baby are already in danger. If tests could be made available to detect pre-eclampsia early or even before it even develops, thousands, maybe even millions of women and their babies could be spared the trauma of pre-eclampsia and the potentially life threatening treatments and consequences.

* From MedScape Medical News: Congo Red Dot Urine Test Can Predict, Diagnose Pre-Eclampsia.

**From MedScape Medical News: Urine Test Early in Pregnancy Can Predict Pre-Eclampsia.