preterm labor and prematurity
The Preemie Primer: Recommended Reading for Mamas on Bedrest
September 2nd, 2010When you are pregnant, you are bombarded with information and advertisements for everything from infant swaddling blankets, to formulas, to cord blood banking, to strollers. Much of the information that I received in my bag at each of my first obstetrical visits was useless. They were simply little leaflets trying to sell me things that I didn’t really want or need. How much better it would have been if I had received a copy of The Preemie Primer: A Complete Guide for Parents of Premature Babies-From Birth Through the Toddler Years and Beyond.
The Preemie Primer was written by Jennifer Gunter, MD, a board certified obstetrician/gynecologist, who is also board certified in pain medicine and board certified in physical medicine and rehabilitation. At a first glance it seems like Dr. Gunter is yet another “expert” telling you what the “scientific evidence” says you should do for your baby. While Gunter offers comprehensive information on caring for a premature infant, the book is far from dry and overly ‘jargoned’. At its best it is a deeply personal account of how Jennifer Gunter, wife and mother, navigated the peaks and valleys of caring for her markedly premature boys Oliver and Victor (born at 26 weeks) while also grieving the loss of their triplet brother Aidan, born at 22 weeks. She is simply sharing what she learned and knows with other parents and has created a powerful resource for parents of preemies.
Now I don’t want to discount Dr. Gunter’s knowledge. She has done a great job of pulling together the necessary medical information pertaining to preterm labor, prematurity and caring for mom and baby (ies) post partum. But the honest truth is that much of the “medical” information is freely available-on the web and in books and texts. But The Preemie Primer is for parents of preemies who, at a time when this information is in critical need, they dont’ have a nanosecond to spare seeking it out. Part of what makes it such an excellent resource is that not only is the medical information readily at hand in one place, Dr. Gunter also includes information on self care for parents (asking for help with post partum depression for example, deep breathing, meditating…) and navigating the complex US insurance system to get the care premature babies and children desperately need. Yes, the chapters on “The Mind-Body Connection” and “Making the System Work for You” were really helpful and informative and a welcome departure from the sterile statistics, instructions and definitions.
But far and away the “precious jewel” of this book is that it is written by Jennifer Gunter, wife and mother to two 
navigated the peaks and valleys of caring for her markedly premature boys Oliver and Victor (born at 26 weeks) while also grieving the loss of their triplet brother Aidan, born at 22 weeks.premature little boys and an angel in heaven. The success of The Preemie Primer results from the fact that as I read it, I felt as if I was sitting across from Jennifer Gunter, drinking coffee and chatting as she tells her story. I think the most powerful parts of the book are the gray insets that tell her personal story, her personal struggles to care for her living boys while at the same time grieving her angel Aidan. The times she was so overwhelmed with emotions that all she could do was cry. At those times her credentials were irrelevant. She was a mom, struggling for herself and for her sons, and as vulnerable as the rest of us.
One of my favorite vignettes was her conversation with the hospital representative as she disputed charges for Aidan. Anyone who has ever had the frustration of speaking with hospital representatives who are insensitive, unyielding and basically ignorant to medical procedures will totally relate to this conversation. Gunter was arguing to have charges made for Aidan’s “care” removed from her hospital bill. You feel the pang in your own heart as you hear Gunter tell this representative that Aidan died and did not receive care as is indicated on the bill.
While I like and highly recommend The Preemie Primer (Remember, I said it should be in every new OB bag!), I realize it is a tough sell. In the same way that obstetricians don’t discuss the possibility of bed rest until a woman is having it prescribed, I doubt The Preemie Primer will become recommended reading for mainstream pregnancy. And this is unfortunate. Having had a late preterm birth, I would have loved to have had even an inkling of what to expect. As high risk as I was, no one ever even mentioned that I was at risk for preterm labor. I was never counseled about the signs and symptoms of preterm labor. When I delivered my daugher at 36 wks and 6 d, I fully expected to have her put on my chest, to nurse her and then to have her in my room. Instead she was whisked away from me by nurses and neonatologists and then admitted to the NICU (which is never mentioned or visited in hospital tours). I was completely blind-sided by the entire experience.
Our culture likes to “stay positive” and always “look on the bright side”. But turning a blind eye to potential catastrophe is just plain stupid. No woman wants bed rest, a premature infant or, heaven forbid, to have a stillbirth. But the reality is that these events happen. Just because we don’t talk about them or “don’t have that in my family or medical history” doesn’t mean that they can’t happen to us. Obstetricians and midwives should talk about them (at the very least) and give parents tools and resources that they can readily access in the event that the most awful and unexpected happens. So yes, I do think that The Preemie Primer should be put in OB bags-or made readily available in OB offices, hospital gift shops, family resource centers and the like.
We have to face the fact that not everyone has the picture perfect pregnancy, labor and delivery. But things needn’t spiral completely out of control. Research shows that patients who feel that their health care providers are honest and up front with them, explaining every test and treatment and potential outcome are far less likely to come away with ill feelings or to sue their providers. We have to have the hard conversations. But if OB’s and midwives don’t want to do that, or feel uncomfortable or as if they are “scaring” their patients, then have resources readily available. As Dr. Gunter said herself during our podcast interview, “Plan for the worst but expect the best”.
The Preemie Primer is available on this website via our Amazon.com store in the Infancy/Childhood section. We respectfully ask that if you decide to purchase The Preemie Primer as a result of reading this blog post or listening to the podcast interview with Dr. Gunter that you do so via our store as it helps to fund the operation of this website.
Share your stories of preterm labor and caring for a premature infant below.
How the “Affordable Care Act” Could Benefit All Mamas on Bedrest
July 28th, 2010The Affordable Care Act
On June 10, 2010, the Health Resources and Services Administration (HRSA), in collaboration with the Administration for Children and Families (ACF) announced that some $90 million dollars has been allocated for the Affordable Care Act (ACA). ACA provides funding for the Maternal, Infant, and Early Childhood Home Visiting Programs.
I was thrilled that “the powers that be” are recognizing that if effort and energy (as well as funds) are expended preventively to provide care and support to high risk pregnant women and subsequently to families that have infants and children with special needs, then millions of dollars and many maternal, infant and children’s lives can be saved.
Evidence-based research reveals that women who are at risk for preterm labor and families with children with special needs that receive home visits fare better. Maternal and infant morbidity and mortality go down. Other countries have known this and have successful, effective home care programs that have existed for years. Let’s hope that this study will finally bring the United States in line with other countries
High risk pregnacy affects a wide variety of women-regardless of race, socioeconomic status or age. While it is common knowledge that women who don’t receive good prenatal care are at increased risk for pregnancy complications, young women, older women, African American women and women who have utilized assisted reproductive technologies in order to become pregnant are also at increased risk for pregnancy complications, going into preterm labor and delivering premature infants who in turn often have behavioral and developmental problems. Evidence-based research has proven that early intervention, such as home visits and supportive services, improves outcomes. So if pregnant women prescribed bed rest receive home visits and their needs are identified and met, then perhaps we can reduce maternal and infant rates in this country-rates that are higher than in many industrialized and “developing” nations.
African American Women have the highest perinatal mortality rate of all American women, regardless of age, socioeconomic status or prenatal care. According to the California Maternity Quality Care Collaborative, in California alone,
“In 2004, there were 13.6 maternal deaths per 100,000 live births, above the national rate of 13.1 and well above the Healthy People 2010 target of 4.3 maternal deaths per 100,000 live births. Pregnancy-related deaths among African-American women in California were 3 times higher than rates for Whites or Hispanics (37.6 deaths per 100,000 live births for African-Americans versus 12.0 and 11.9 for Whites and Hispanics, respectively). In addition, when researchers examined mortality rates in African American women due to the five major complications of pregnancy, they learned that these complications did not occur at higher rates in this population but African American women were 2-3 times more likely to die from the complications than were White women in the US. (Tucker, AJPH, 2007)”
ACA can provide invaluable services to high risk pregnant African American women, but it may also provide insight into why African American women have such high morbidity and mortality and ways to lower these rates.
The Affordable Care Act is a good thing. It has the potential to lower maternal, infant and child morbidity and mortality in the United States. It has the potential to provide insight into why some women are at increased risk for complications and why others are not. It has the potential to completely change the way high risk pregnant women are managed. If this 5 year program definitively proves that home visits by skilled medical professionals reduces pregnancy complications and lowers maternal and infant mortality, surely home visits will be made available to all high risk American women and new standards of care will be established.
Currently, the funds can only be accessed by federal, state and local agencies, so we here at Mamas on Bedrest & Beyond are busily working to strengthen collaborations and alliances so that we may be able to qualify for these grant and in turn, be able to serve more women. Initial inquiries have been made and we will keep you, our mamas on bedrest, informed.
What do you think of the Affordable Care Act (ACA)? Please add your comments below and share this post with other women who may be affected or assisted by this program.
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The Mind/Body Connection: What it Means For Mamas on Bedrest
June 24th, 2010Yesterday was my oldest sister’s birthday. She turned 52. She may not be too happy to know that I have blasted her age
to the masses, yet her birthday is truly an extraordinary event. My sister was a preemie. She was born at 6 1/2 months (they didn’t really do weeks back then according to my mother) and weighed a mere 3 lbs. She subsequently dropped down to 1 pound and everyone in the neonatal unit was sure that she wasn’t going to make it. But my parents, the wide-eyed teens that they were, never for one moment doubted that she would make it and yesterday’s birthday is a testament to that fact. My mom says that “I just never even thought about her dying.” I believe it’s that spirit that kept my sister alive. My mom also says that every time she visited my sister in the NICU, my sister would move and squirm. The doctors believed that this movement helped her to deep breathe and contributed to her survival.
We don’t talk much about my sister’s birth but it is still a clear memory for my mother. I realized this 8 years ago when I had my daughter at 36 weeks and 6 days and she was admitted to the NICU. My mother came down to support me and as we entered the NICU she stopped just inside and was momentarily frozen. I didn’t think much about it then but I now realize that my mother, in that moment, was reliving her own experience of entering the NICU to visit my sister. 44 years later, the NICU still had the power to halt (albeit momentarily) my mother.
Back in 1958 when my mother had my sister I am sure that no one discussed the mind/body connection and what it could mean for premature infants and their parents. But researchers now know that there is a very strong connection between the mind and the body-not only within an individual but also between people, especially between premature infants and their parents.
Last night I had the great fortune to attend a parent discussion group hosted by Hand to Hold, a non-profit organization dedicated to supporting parents of premature infants and children utilizing a mentoring model. New preemie parents are paired with “veteran” preemie parents so that the vets can help the new parents navigated the complicated hospital system, cope with the myriad of peaks and valleys that constitute caring for a fragile child and to be a support and a caring, comforting ear. Dr. Jennifer Gunter, OB/GYN, Physiatrist, pain medicine specialist and author of The Preemie Primer spoke about the mind/body connection and how it can have a huge impact on premature infants as well as their parents. She talked at great length about her own experience carrying triplets, losing one at 22 weeks and subsequently delivering the two remaining boys at 26 weeks. “Everyday I would say to myself and to the babies, Not today, not until 26 weeks.” She actually gave birth to her boys at exactly 26 weeks. Dr. Gunter also offered several good, simple techniques for parents 
to use when they are feeling overwhelmed.
- Take a deep breath that expands the belly not just the chest
- Go for a walk, outside if possible. Walking eases tension, forces you to take deep breaths and the fresh air and sunshine will help lighten your mood
- Use positive affirmations. Positive affirmations change the brain’s chemistry and actually affect how the body reacts. Dr. Gunter keep telling herself and her boys “not until 26 weeks” and helped delay her delivery. My mom kept talking to my infant sister and held it in her own mind that her baby would come home and she did.
- Yoga. Yoga is a great stress reliever and helps with breathing and calming the mind
- Dr. Gunter recommends that parents of preemies be screened for post partum depression 2 weeks after the birth of their child. This is also a good idea for parents who had a traumatic birth.
Mamas on Bedrest are at risk for delivery complications and premature delivery. This knowledge can be very troubling causing mamas to worry and fret. This is no good for you or your baby. As Dr. Gunter said, the emotional state of the mother does influence the baby. Worry releases brain chemicals that can have negative effects on both mama and baby’s health. Likewise, a positive attitude along with positive affirmations will release brain chemicals that have a calming and health enhancing effect on mama and her infant. I encourage you to begin cultivating a positive attitude towards your pregnancy, labor and delivery. Speaking positively about your child’s health-not only to yourself, but to your child. Studies have shown that babies in utero and out respond to their parent’s voices and to their environment. Keep the environment as calming, soothing and positive as possible. Read to your baby, sing to your baby, play music or just talk lovingly to your baby. This will release calming, positive brain chemicals into your blood stream that will subsequently make the in utero environment calmer and more health enhancing as well.
You’re doing very Important work, Mamas on Bedrest! Here’s to you and to healthy, full term pregnancies, safe and uncomplicated labors and deliveries and to healthy, happy babies.!
