prenatal care

Mamas on Bedrest: September is Infant Mortality Awareness Month!

September 8th, 2015
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Photo by Racha Tahani Lawler, Los Angeles, CA

Mamas,

Did you know that September is Infant Mortality Awareness Month?

Globally, The United States spends more on healthcare than any other country. Yet, it has worse birth outcomes than many other countries globally. Despite recent declines in infant mortality, the United States ranked 26th among the 29 Organization for Economic Co-operation and Development (OECD) countries in 2010, behind most European countries as well as Japan, Korea, Israel, Australia, and New Zealand (1). The U.S. infant mortality rate of 6.1 infant deaths per 1,000 live births was more than twice that for Japan and Finland (both 2.3), the countries with the lowest rates. Twenty-one of the 26 OECD countries studied had infant mortality rates below 5.0.

Overall in the United States, white infants die at a rate of 5-6/1000 births and Hispanic infants have a similar infant mortality rate. African American Infants die at a rate of approximately 11.4/1000 births. I’m here in Texas and our infant mortality rate for white and hispanic infants is 5.5/1000 births while it is 11.4/1000 for African American Infants. In Travis County (the Greater Austin Area where I live), African American Infants have an infant mortality rate of 11.5/1000 births, whereas white infants have an infant mortality rate of 3.7/1000 births and Hispanic infants 6/1000 births.(2) What is the cause of this disparity?

Researchers and public health officials have numerous speculations as to why the IMR for African American infants is so poor,

  • Delayed initiation of prenatal care among African American women
  • Lack of access to quality prenatal care
  • Lack of insurance
  • Poverty
  • Preterm labor/Prematurity
  • Low birth weight
  • Birth Defect
  • SIDS
  • Maternal health complications

However Dr. Michael Lu, an obstetrician and gynecologist at the David Geffen School of Medicine at UCLA and a professor in the Department of Community Health Sciences and the Center for Healthier Children, Families and Communities at UCLA School of Public Health has proposed other reasons for the birth outcome disparities. In his groundbreaking  research paper “Closing the Black-White Gap in Birth Outcomes: A Life-Course Approach (3) Dr Lu and his colleagues point to systemic racism in American culture as the underlying cause of the birth outcome disparities. Lu and his colleagues point out that racism passed down through generations, as well as repeated racial slights in the daily lives of African American women has created an allostatic load of stress on African American women that is affecting their overall health, but in particular, their reproductive health and causing the negative birth outcomes we see in African American women and infants. To address these social determinants of health, Lu and his colleagues propose a 12 point Life-Course approach to closing the racial gap in birth outcomes.

  1. Provide Inter-conception care for women with prior adverse pregnancy outcomes
  2. Increase access to preconception care for African American women
  3. Improve the quality of prenatal care for African American women
  4. Expand healthcare access over the life course for African American women
  5. Strengthen father involvement in African American families
  6. Enhance systems coordination and integration for family support services
  7. Create reproductive social capital in African American communities
  8. Invest in community building and urban renewal
  9. Close the education gap
  10. Reduce poverty among African American families
  11. Support working mothers and families
  12. Undo Racism

Lu and his colleagues have presented an approach that not only address issues surrounding pregnancy and childbearing, but also addresses the social issues affecting African American families and communities. Lu makes some very bold statements, ones that some people may be loathe to accept and even less likely to act upon. But as Lu says in his publication,

“We will not close the Black-White gap in birth outcomes without political will to do so. Political will is the ability to command resources to make things happen (i.e. implement the 12 points).”

As the saying goes, “Where there is a will, there is a way!” The question now becomes do we the American people have the will, the actual desire to close this gap?

 

References

MacDorman MF, Mathews TJ, Mohangoo AD, Zeitlin J. International comparisons of infant mortality and related factors: United States and Europe, 2010. National vital statistics reports; vol 63 no 5. Hyattsville, MD: National Center for Health Statistics. 2014.

Austin Travis County Health and Human Services Department. Infant Mortality Rate Causes of Death for Travis County, 2000-2011. Data Source, Center for Health Statistics, Texas Department of State Health Services. Texas Behavioral Risk Factor Surveillance System (BRFSS) 2011-2012

Lu, M.C., MD, MPH, Kotelchuck, M., PhD, MPH, Hogan, V., DrPH, Jones, L., MA, Wright, K., PhD, MPH, Halfon, N., MD, MPH. “Closing The Black-White Gap in Birth Outcomes: A Life-Course Approach” Ethnicity and Disease, Volume 20, Winter 2010.

Mamas on Bedrest: Beating Back Bedrest Stress-An Interview with Parijat Deshpande

February 9th, 2015

Hello Mamas,

Today we have another powerhouse podcast. Our guest expert is Parijat Deshpande, a Health and Wellness Counselor and Clinical Psychologist. While Parijat’s expertise spans marriage and family counseling, fertility counseling and stress management, she also comes to us as a former Mama on Bedrest and contributor to “From Mamas to Mamas: The Essential Guide to Suriving Bedrest”. Today Parijat is sharing tips and tools to beat back bedrest stress.

Parijat is well versed in stress management and shares a wealth of information on this podcast. Tell us what you think in the comments section below and if you have a question, post it and we’ll get it to her for a response. And don’t forget to read Parijat’s story about her preterm infant in “From Mamas to Mamas: The Essential Guide to Surviving Bedrest”. 

 

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.