Prenatal Health Maintenance
Mamas on Bedrest: Can’t Do What You Want to Do? Consider Hiring a Doula
February 23rd, 2012Ugh! I’m having a week where I can’t get done what I want to do. It seems like everytime I sit down the phone rings, or there is some “quickie” emergency that I need to tend to. Add to that my general feeling of inertia and I’m having a less than productive week.
I realize that many of you are probably thinking, “Well at least you CAN do those things that you need to do! I can’t do what I need or want to do because I’m on bed rest!”
I hear you sisters! Bed rest is no fun. It’s frustrating, boring, a means to body aches and at times absolutely mind-numbing. Add to that the time that is sucks up from your friends, family and obligations and it’s enough to make the strongest of women batty. I have heard from countless women that they are increasingly depressed by the fact that they don’t have their nurseries ready, their existing children aren’t getting the attention they would normally receive and that they are worried that their jobs/careers may suffer as a result of bed rest.
Ladies, you aren’t going to be able to do this on your own. You need help. If you are one of the lucky ones with friends and family close by, part of a close knit neighborhood or faith community, you are way ahead of the game. But if you are like I was, you are in a new community where the neighbors are not so outgoing. You haven’t established a connection with a community of faith and in a nutshell, you are on bed rest and you are on your own. In addition to being stressful from a health care standpoint (if there is an emergency, is there someone available who can get you immediate medical attention) there is a huge psychological component. Women with high risk pregnancies are at increased risk of developing perinatal anxiety/panic disorders and depression. Don’t try to go this alone! And while I am a staunch advocate of online communities (KeepEmCookin.com, BetterBedrest.org and Sidelines.org) if you need help around your house getting things done, consider hiring a doula.
I can hear the collective gasps. “But don’t you do many of the same things that doulas do?”
Yes, this is very true, but I am in Austin, TX and I can only serve women in the Greater Austin area. Yet, at least once a week I get a call, e-mail or tweet from a woman (or loved one of a woman) on bed rest who needs help and can’t find someone in her area to help her. Ante Natal Doulas, while a true subset of doulas, are in short supply. Yet, I often suggest that women ask doulas in their areas if they’d be willing to perform some of their post partum duties in the prenatal period. According to Doulas of North America (DONA):
“Women have complex needs during childbirth and the weeks that follow. In addition to medical care and the love and companionship provided by their partners, women need consistent, continuous reassurance, comfort, encouragement and respect. They need individualized care based on their circumstances and preferences.”
This is especially true of high risk pregnant women on bed rest. Having someone who will attend to mama’s needs specifically will go a long way to keeping mama calm and stress free and on to delivering a healthy, full term infant. Women who have doula supported pregnancies and labors (according to DONA):
- tend to have shorter labors with fewer complications
- have reduced negative feelings about one’s childbirth experience
- have reduced need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans
- have fewer requests for pain medication and/or epidurals
Couples and families who have doula support:
- Feel more secure and cared for
- Are more successful in adapting to new family dynamics
- Have greater success with breastfeeding
- Have greater self-confidence
- Have less postpartum depression
- Have lower incidence of abuse
I’d love to serve every woman that calls, writes or tweets to me, but it is simply physically impossible. When women ask, “What can I do?” I have often said, “See if there are doulas in your area (DONA has a membership list) and hire a doula.”
Inevitably, the issue of funds comes up. With women being “out of work” and not having their customary income, hiring help is often the last thing on a mama’s mind. But I invite you all to consider this. Care for a preterm labor and delivery as well as for a premature infant that spends even 1 day in the NICU will quickly reach into the thousands of dollars, not all covered by insurance. A doula to help you in your home and to offer reassurance and support may cost $500. You’ll also receive the aforementioned tangible and intangible benefits. Finances always make decisions complicated. In this case, I encourage you to consider not just the immediate output of cash, but the potential long term consequences of not getting the help that you need.
If you are looking for bed rest support in the Austin area, we’re here for you. We have a several support services from throughout the US listed on our Resources Page. DONA also has an international listing of doulas.
Mamas on Bedrest: HHS offers $40M in grants to reduce preterm births!
February 10th, 2012“To help reduce the increasing number of preterm births in America and ensure more babies are born healthy, HHS Secretary Kathleen Sebelius announced more than $40 million in grants to test ways to reverse that trend, as well as a public campaign to reduce early elective deliveries.”
Thus begins the February 8, 2012 press release issued by the US Department of Health and Human Services announcing the $40Million grant program, The Strong Start Initiative. Strong Start is a joint collaboration between Centers for Medicare & Medicaid Services (CMS), the Health Resources and Services Administration (HRSA), the Administration on Children and Families (ACF), and outside groups devoted to the health of mothers and newborns. (i.e. The March of Dimes, the American College of Obstetricians and Gynecologists (ACOG), the National Partnership for Women and Families, the Society for Maternal and Fetal Medicine, American College of Nurse Midwives, Childbirth Connection, Leapfrog Group, and the National Priorities Partnership convened by the National Quality Forum and others.)
The mission of The Strong Start Initiative is two-fold:
- A test of a nationwide public-private partnership and awareness campaign to spread the adoption of best practices that can reduce the rate of early elective deliveries prior to 39 weeks for all populations; and
- An initiative to reduce the rate of preterm births for women who are at-risk for preterm birth and covered by Medicaid through testing enhanced prenatal care models.
According to the HHS press release,
“More than half a million infants are born prematurely in America each year, a trend that has skyrocketed by 36 percent over the last 20 years. Children born preterm require additional medical attention and often require early intervention services, special education and have conditions that may affect their productivity as adults.
The funds will be awarded to organizations and providers that serve women on Medicaid and will be used to test and implement treatments and protocols that will reduce preterm birth and improve outcomes amongst this population. This is great news for such organizations as Centering Healthcare, CommonSense Childbirth, The International Center for Traditional Childbearing and The Indian Health Services and others which serve large populations of women on Medicaid. These organizations, with their proven methods of prenatal care and lower incidences of complications and preterm births are poised to teach the rest of the health care industry how to provide care to women in a compassionate and culturally sensitive manner all the while improving outcomes.
In addition to preventable preterm births, the Strong Start initiative will also focus on reducing early elective deliveries, which can lead to a variety of health problems for mothers and infants. Up to 10 percent of all deliveries are scheduled as induced or surgical deliveries before 39 weeks that are not medically indicated. It has been well established that elective delivery before 39 weeks gestation is asssociated with increased complications to both mother and baby in the immediate intrapartum and for many years post partum. The Strong Start Initiative seeks to significantly reduce the incidence of elective preterm birth and its associated morbidities in mothers and infants.
Finally, The Strong Start Initiative is poised to save money for the health care system. It is estimated that medical care in the first year of life for preterm babies covered by the Medicaid program averages $20,000 compared to $2,100 for full-term infants. Medicaid pays for slightly less than half of the nation’s births each year. Even a 10 percent reduction in deliveries occurring prior to 39 weeks would generate over $75 million in annual Medicaid savings. Such savings could be poured back into the Medicaid program to further the health of its recipients and reduce the ever escalating costs of health care in the Medicaid population.
References
The US Department of Health and Human Services
The Center for Medicare and Medicaid Innovation
Mamas on Bedrest: Priorities for Maternal and Child Health Identified
December 21st, 2011
Click to take the postpartum depression survey conducted by Case Western Reserve University http://filer.case.edu/~axp335/postpartdep.htm Thank you very much for your consideration.
.
.
On the heels of the 20/20 special segment, “Giving Life: A Risky Proposition” World Health Organization (WHO) has released Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health. This comprehensive document outlines the necessary steps and guidelines nations (developing low and mid income nations in particular) must adopt in order to further reduce maternal, infant and child mortality and to have a chance of reaching Millennium Development Goals .
Maternal, Infant and Child mortality is a global issue. According to the report,
Annually, 358,000 women die worldwide during pregnancy and childbirth. Approximately 7.6 million children die before the age of 5 years, and those in low-income countries are about 18 times more likely to die during that time than children in high-income countries. Under-5 mortality rates are highest in sub-Saharan Africa and Southern Asia.
Maternal, newborn, and under-5 mortality rates have declined in accordance with Millennium Development Goals 4 (reduce the under-5 mortality rate by two thirds between 1990 and 2015) and 5 (reduce the maternal mortality ratio by three quarters between 1990 and 2015). However, the improvements are not occurring quickly enough to reach the 2015 targets.
WHO and its partners The AGA Khan University (in Pakistan) and The Partnership for Maternal, Newborn and Child Health performed a survey of more than 50,000 review papers to determine what steps are necessary to critically impact maternal, newborn and child health. Their goal was to identify key interventions that low and middle income countries can implement that are cost effective, will maximize resources and maximize the health and mortality of women, infants and children and thus help these countries reach worldwide millennium health and development goals. Their research has revealed some 56 key evidence-based interventions that when implemented, will have a significant impact on maternal, newborn and child health.
Rather than try and list all the interventions here, I refer you to their report, Essential Interventions, Commodities and Guidelines for Reproductive, Maternal, Newborn and Child Health.
For each intervention, the authors indicated whether they recommend the intervention be delivered,
- Through the community or in the home-These health care workers are often community volunteers and/or influential outreach workers who have knowledge of the local community and are trusted by the community.
- Via healthcare professionals, outreach workers, or community health workers-Health care providers at this level are skilled professionals as well as outreach workers.
- In hospitals-Either local hospitals or regional referral hospitals that can provide higher levels of intervention and care.
The interventions were classified broadly as adolescents/prepregnancy, pregnancy, childbirth, postnatal (mother), postnatal (newborn), infancy and childhood, and cross-cutting community strategies.
Researchers believe that the recommendations in this report will help low and middle income countries’ health care workers best utilize their resources in an effort to reduce Maternal, Newborn and Child deaths. These guidelines will also help countries develop policies and regulations that will not only benefit women and children’s health, but also take into consideration the health care and policy environments of the countries so that all citizens will benefit.
