Resources
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.
Be one of the first to learn about how Mamas on Bedrest & Beyond is working at the national level to serve mamas on bed rest. Sign up for our monthly newsletter to receive news, updates and special offers. Subscribe now and receive a free download of “10 lower body exercises, stretches and Kegel Exercises” pregnant women can do while on prescribed bed rest.
Want more exercises while on bed rest? Order Bedrest Fitness now! It is the first set of modified prenatal exercises designed specifically for pregnant women on prescribed bed rest.
What Exercises Can I Do With an Incompetent Cervix?
July 1st, 2010I recently received an-e-mail from a mama who had just gone on bedrest with an incompetent cervix at 30 weeks.”What exercises, if any, can I do with an incompetent cervix,” she asked?
An incompetet cervix is one of the more common reasons pregnant mamas are prescribed bed rest. While the rates of incompetent cervix are thought to be low, no one is exactly sure how many women are affected by incompetent cervices during pregnancy. An incompetent cervix can manifest in one of three ways:
- Opening of the cervical os more than 2.5 cm during the second trimester
- Thinning and shortening of the cervix (effacing) in the second trimester or early third trimester
- Thinning or opening (funneling) of the cervical opening closest to the baby
The treatment for incompetent cervix is cerclage (surgically placing a stitch through the cerix to hold it closed), bed rest, or a combination of the two.
Being prescribed bed rest puts a mama at risk for blood clots in the legs, muscle atophy and overall loss of strength and cardiovascular conditioning. Most women who are prescribed bed rest should also be prescribed-or at least advised about-exercises that they can do to maintain muscle strentgth and tone as well as to reduce the physical effects if prolonged inactivity. However, it has been my experience that many women prescribed bed rest receive little or no instruction on what they can do to exercise their bodies while on bed rest. This is due in part because many obstetricians don’t know what types of exercises are safe for women on prescribed bed rest. A lucky few mamas will have a consultation or two with physical therapists. But the vast majority of mamas who go on prescribed bed rest will receive no exercise instruction. For this reason I produced Bedrest Fitness when I was pregnant during my second pregnancy.Bedrest Fitness is a set of modified prenatal exercises designed specifically for pregnant women on prescribed bed rest.
A mama with an incompetent cervix should avoid any movements or exercises that put pressure on the cervix and many women will be instructed to remain recumbant in bed or on the sofa. But if you think about it, that leaves your arms and legs free to move. Mamas on bed rest with an incompetent cervix should perform a variety of arm and leg exercises daily to maintain steady bloodflow and adequate circulation back to the heart-especially from the legs. Leg exercises should include:
- Leg Ab/Adduction exercises
- Passive double knee raises (provided Mama can do them using an exercise band or towel to draw her knees up and not engage her abdominal muscles. If mama feels any pressure in her lower abdomen, these should be avoided!)
- Point/flex of toes to exercise the calf muscles
- Ankle circles
Upper body exercises should include (using a towel or exercise band):
- Modified flies
- Shoulder extensions with arms extended forward and to the sides
- Upright rows
- Bicep curls
- Triceps extensions (if allowed to sit up)
On Bedrest Fitness I included Cat/Cow stretches. Women with incompetent cervices can
actually do these stretches, but in my experience they often are unable to gauge how much pressure they are putting on their cervices. So unless a physical therapist or fitness professional is present, I don’t recommend that mamas with incompetent cervices perform these exercises.The same is true of the modified crunches.
Bed rest can have a profoundly negative (albeit temporary) effect on a mama’s overall physical condition. Depending on how long she was on bed rest prior to delivery and the restrictions she’d been given, a new mama can find herself unable to hold herself upright or to even hold her newborn. But if she engages in a few very simple but targeted exercises while on bed rest, mama will find that she will be less deconditioned after delivery and recover more quickly.
If you or someone you know has been prescribed bed rest during pregnancy, order a copy of Bedrest Fitness. Even if Mama can’t do all of the exercises, she will preserve muscle strength and tone in the areas she does exercise. Mama can also download a free set of lower body exercises, stretches and Kegels when she signs up for the Mamas on Bedrest e-mail list.
The Smart Mother’s Guide to a Better Pregnancy: Book Review
June 22nd, 2010
I have had the opportunity to read The Smart Mother’s Guide to a Better Pregnancy and I have to say that this is a really handy little book for expectant mothers. The book is broken down into four parts
1) Selecting the Right Healthcare Provider
2) Routine Prenatal Care and Potential Problems
3) High-Risk Problems During Pregnancy
4) Thirty-Six Weeks and Beyond
Each section really gives great practical information about how to navigate our crazy US health care system and in turn, to minimize potential misunderstandings or worse-life threatening complications to mother and baby.
Linda Burke-Galloway, MD, is the author and she really knows her stuff. She has specialized in high risk pregnancy for much of her career and has a particular interest in public health and safety. This passion is evident as you read through the book. She repeatedly provides vignettes pertaining to prenatal care and often provides real life stories of “what went wrong” to substantiate her recommendations. Several of her insights can only come from someone who has been there. This is especially true in “Selecting the Right Healthcare Provider”. Dr. Burke-Galloway gives step by step instructions on how to research a provider, including checking their credentials as well as investigating whether or not they have any legal judgments against them-past or present. She addresses the danger of selecting a provider from an insurance directory list without performing these crucial checks and she gives vital advice on how to deal with a provider who has decided not to obtain medical malpractice insurance as well as those with numerous satellite offices. An unknowing woman could easily fall prey to pitfalls of these practices, but with this book, they are educated, 
prepared and quite possibly protected.
My favorite section is, of course, the section on “High Risk Problems During Pregnancy.” Dr. Burke-Galloway gives very good explanations of chronic hypertension and pre-eclampsia. I have to disagree with her about incompetent cervix, however. She states that this is a fairly uncommon problem. Now perhaps it’s because most of the women that I work with are on bed rest or its this age of assisted reproductive technologies, but I see a lot of women with incompetent cervices. Now I don’t have over 20 years of experience like Dr. Burke-Galloway has, but in my observation and with the women with whom I am dealing, incompetent cervix is not “infrequent”.
One of the best parts of the book is the list of references at the end. Dr. Burke-Galloway gives an extensive list of resources for women to be able to do the research and to ask the questions that she suggests.
I was a little disappointed that Dr. Burke-Galloway did not address VBAC at all. There was no mention of giving a woman a trial of labor after a c-section or what to do if you wanted to try for VBAC. While Dr. Burke-Galloway may not be a VBAC advocate herself, I do think that this topic-so prominent in today’s health care debate and in discussions on how to reduce maternal mortality-at least deserved a mention. I was also disappointed that she did not mention methods of labor relaxation such as showering, using a birth ball or other tools, massage or other means of relaxation. It seemed like she was only advocating a “mechanized” labor and delivery-in hospital, in bed, fetal monitor attached. This tone will likely turn off a lot of women.
I was also surprised that Dr. Burke-Galloway did not speak more about post partum depression. She gave some important facts and statistics, but didn’t really delve into the etiology of post partum depression. I really think that it would have been helpful if she had talked about a patient of hers that had had post partum depression, how she diagnosed it and how she treated it.
Which brings me to my final comment about this book. I am a physician assistant by training so much of this book was a good review for me. Yes, I did learn some new things while reading it but much of it was review. As I read the book, I felt a real distance from the author. This is not a “warm read”. Now granted, these aren’t “warm and fuzzy” topics about which Dr. Burke-Galloway is speaking. Yet, for a book that is directed at mothers-and I am assuming laywomen-this book was too formal. For example, Dr. Burke-Galloway uses the term “Labor Assistant” in the section on labor and delivery. Why not use “doula”? I realize that there are more than one type of labor coach. It could be a spouse or family member. But in my experience, when women think of a labor coach or assistant, they are referring to a doula.
In some ways the book reminded me of a Grand Rounds presentation (a presentation where one health care professional is speaking to a group of other health care professionals). Much of this book made sense to me because I have previous education and experience from which to draw. My concern is that many women who may read this book may miss a few of the points that Dr. Burke-Galloway is trying to make because they won’t have the frame of reference in which to place the topic. For example, in one section, She talks about having “spirited discussion” over a case with another provider. Why not say “We argued”? In fact, if she could have shared some of the argument, I think it would have given meat to what she was trying to say. Much of her stories are bare bones facts and it would be nice to have more “flesh” to be able to draw a fuller mental picture. In one section she talks about a colleague who was delivering. Why not give her a name (even a pseudonym) and refer to her by name instead of as “my colleague”? She talks about feeling relieved after such a difficult delivery, but it would have had more impact if she had given just a few more details, let us know how concerned she was, the specific perils she faced and how she managed them and then talked about the relief she felt after.
These last comments are purely stylistic and in no way take away from this book. I am simply suggesting that if Dr. Burke-Galloway writes subsequent editions (which she says she wants to do in the forward and afterward) that she make the text more conversational. It is a good book and I think that it will help a lot of women-especially a woman who may be relocating to another area and needs to find a new provider or a woman who become s pregnant unexpectedly and is really unprepared for what she needs to do to take care of herself and her baby. However, I think that for a number of women, the cool tone and the lack of attention to more holistic methods will be a turn off.
