Post Partum Care
Mamas on Bedrest: Mama’s “Dream Team”
January 12th, 2012As the debate over who is the better provide of peripartum care wages on, I often wonder, has anyone ever stopped to consider what mamas want? What are mamas’ ideas of the “perfect birth scenario?” What would constitute a birth “Dream Team?” I have often contemplated what would have been my dream scenario (not that anyone ever asked me!!)? If I had to do it all over again and could have things organized around what would have served and soothed me, this would have been my “Dream Team”.
AntePartum Doula. For both of my pregnancies, especially my first, I would have loved to have had someone come to my home, perhaps once or twice a week and check on me. One of the main reasons that I was so reluctant to go on bed rest and pushed back against it was because during my first pregnancy, I was completely on my own (my husband travels for work) and for my second, I was on my own with a 3 year old. How nice it would have been to have folks stopping by, helping out around the house and making sure that I had any and all supplies that I needed. Had I been on full bed rest, helping me to be comfortable, helping me to exercise my muscles and providing massage would have also been greatly appreciated.
Birth Doula. I sort of had this my second go round (We flew in my sister and she was a HUGE source of support and relief!!), but the first time, things went south very quickly and both my husband and I could have used some support in the delivery OR. While I was bleeding profusely (don’t know if they classified it as hemorrhaged, but it wasn’t pretty) immediately post partum, to have had someone that I knew and trusted to help me calm down (they had whisked my daughter away and I was a raving maniac!!), someone who could have told me what was going on, someone to convey that I was in great pain and got me the relief that I needed immediately and not 6 hours later would have been great. I think that incessant emesis and screaming should have been a clue, but it didn’t get me any relief, so I am thinking verbal requests might have worked better.
Midwife AND Obstetrician. I think that both should be present! In the case of my daughter, things went south pretty quickly, so the obstetrician would have definitely been in command. But for my second birth, I think it would have been nice to have a trial of labor with a midwife, with an OB standing (very close) by. I had a scheduled c-section at 39 weeks, my cervix was totally closed and I had no hint of labor. While my son was and is totally fine, I think he and I both were strong enough to have “gone the distance” for a VBAC. But I guess hindsight is 20/20. I wonder if I had had a skilled midwife present could I have at least tried labor? Hmmm.
Lactation Consultant. The hospital in which I delivered my daughter (my first delivery) did well with this one and I really liked this lady! The neonatologist was all gunho on giving my daughter formula because she was unable to latch initially and she could not breathe and suck (her O2 saturation would drop into the mid to low 80’s). I refused. I wanted her to have breastmilk, but mine wasn’t in yet. The neonatologist was insisting on formula so that they could measue exactly how much my baby was getting. A very wonderful Lactation consultant arrived and asked, “Why hasn’t this mama been given a breast pump and offered donor breastmilk?” Everyone in the NICU kind of looked at her like, “Curses, foiled again!” but by the end of the day, I had a breast pump and was pumping out small amounts of colostrum and my daughter had a bottle of donor breast milk which was all we needed until my milk came in. This lovely woman also showed me the best ways to help my daughter to latch on so that she didn’t desaturate as much (just into the low 90’s) and her monitors didn’t all sceech and holler when I held her.
Social Support/Discharge Planning. Now I know that some of you reading this will say, “But most hospitals have social workers.” This is true. But neither time I delivered in either hospital (my children were born in two different hospitals) did a social worker come in and see if there was any support that I needed at home, did I have any questions or if I had any concerns. No one gave me any instructions on wound care for my c-section incisions and no one gave me, “If this happens, come back immediately” instructions or anything on the signs and symptoms of post partum depression. Interestingly, a social worker did come into my room when I had my son to offer me Medicare and WIC (foodstamps) papers. (Obviously she hadn’t read my chart and seen that I had private insurance or a well employed husband, but had merely seen “my face” and had made some pretty biases-okay, racist- assumptions. But I’ll leave that discussion for another post!)
Post Partum (Home Doula). I really needed this, especially after my second delivery! While my sister attended my birth, she had to leave the very next day. (I wasn’t even out of the hospital!) I was in the hospital most of the week following my c-section. When I went home, my parents were there, but they had already been there a week and only stayed two more. So at 3 weeks post partum, still sore and achey, I got up, got my 2 little ones ready and drove my parents to the airport. (Husband had already set off on another business trip!) I have to admit, my response timing was off and I really couldn’t adequately feel my feet to drive but I did it. And at 3 weeks post partum, I was on my own with 2 little people. At that time, I didn’t know about doulas and no one suggested one to me. A few friends stopped by, but for the most part, I was on my own. A doula would have been a Godsend! Post partum follow up is the norm in many countries. I truly believe that it needs to be standard of care in the United States!
So this would have been my dream team. This is actually the reality in many countries. Women in many countries receive this type of perinatal care as routine, and it’s covered by (often universal) insurance. Sadly, this level of care isn’t available to everyone in the US, only via private pay, so often women who need it most are least able to afford the assistance. Thankfully many doulas are able to fulfill the intrapartum, post partum and lactation duties, so you really get 3 rolled up into one. But we have a long way to go!
Few practices utilize both Obstetricians and midwives in the US. To me, this is where we really fall short of providing optimum care. The saying, “It takes a village to raise a child” is approriate because while takes a village to raise the child, it really takes a TEAM to bring the child into the world. It is high time that we all realize that no one provider-Obstetrician or Midwife-is better than the other. They have different skill sets, different strengths and mamas need both available to her as she brings her child (ren) into this world. It is high time that this bickering back and forth STOP and we get about the business of caring for the needs-medical, social and otherwise- of mamas and their babies.
Mamas, what is your ideal “Dream Team”? Do you have it? How can we help you get it? Share your comments below and be sure to subscribe to our RSS feed at the top right corner of this webpage.
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.
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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.
Mamas on Bedrest: Giving Life: A Risky Proposition
December 17th, 2011
Wow, I just watched Diane Sawyer’s special on ABC’s 20/20, “Giving Life: A Risky Proposition”.
First and foremost, I am really glad to see mainstream media tackling such an important global issue. Diane Sawyer and her colleagues traveled around the world to some of the most impoverished countries and witnessed some of the most horrendous conditions under which the world’s women are giving birth (and losing life!). The statistics were often staggering and disheartening,
- Girls under 15 are 5 times more likely to die in childbirth (and in many developing countries, girls even younger are giving birth!)
- In developing countries, 20% of women will give birth with no medically trained attendant.
- 1 in 21 women die in childbirth in Sierra Leon, more than in any other country in the world.
- Peripartum hemorrhage is the leading cause of maternal mortality. Misoprostol is critical to stop post partum hemorrhage and is in short supply to developing nations.
- The US ranks 50th in maternal mortality in the world. (This is the stat presented in the TV piece. “The US rank is 41st in maternal mortality” is what’s printed in the ABC News Press release.)
- Georgia has one of the highest rates if maternal mortality in the US.
- 2 women die in childbirth daily in the US. Rates are 4x higher for African American women in the US.
As one expert (sorry, I didn’t catch his name) said so eloquently,
“We have what it takes to save lives. The Question is will we decide to do it?”
I just had a similar conversation with , LM, CPM, founder and Executive Director of Common Sense Childbirth, The Birth Place, Easy Access Prenatal Clinics and creator of prenatal care “The JJ Way”. Jennie has put together an effective early access prenatal care program and is working tirelessly to bring it to women throughout central Florida, across the United States and globally where ever needed. As we talked about the issues affecting maternity care in the United States, we reached a similar conclusion; That low cost, low intervention, effective methods of delivering prenatal care are available. We have to decide as women and as a nation whether or not we are going to make the choice to make safe, accessible maternity care available to ALL women.
It really is a choice. While watching the 20/20 special, they showed a young obstetrician who had traveled to Sierra Leon and was desperately trying to help women in a nationally funded hospital that was so poorly equipped and so poorly staffed that she literally watched as a woman hemorrhaged post partum because there were so few tools available for her to intervene. Yet, there was a clinic staffed and supported by the women of Sierra Leon and there, women received supportive care and the outcomes at this locally supported clinic were far better than the outcomes for the nationally funded hospital.
In Bangladesh, maternal mortality was spiraling out of control. When skilled maternity workers realized that women were not coming to the hospitals and clinics erected, they started taking maternity services to women in their homes-the method used for centuries and the method of childbearing most familiar to the women. As a result, Bangladesh has dropped is maternal mortality rate 43%. In addition, birth workers in Bangladesh are using cell phones and an increasing rate and as a result, they are able to communicate with physicians and other workers as needed while still serving women in their most comfortable environment.
In Mexico, the government started a national campaign for contraception when birth rates and maternal and infant mortality were skyrocketing. Since implementing a contraceptive campaign and extolling the benefits of smaller families and fewer conceptions for women, Mexico has seen 76% of women using contraception. It must be noted that for all its benefit, contraception is still not widely accepted amongst men, and many still hold onto old notions of “Machismo” where the more children a man sires, the more manly he is! As a result, many women access contraception secretly in an effort to improve their opportunities in life, to have reproductive choice and to improve their overall health.
So what’s it going to be? Are we going to continue to wring our hands and lament the abysmal maternal and infant mortality numbers in this country or are we going to do something about it? Jennie Joseph is doing it. Shafia Monroe is doing it with her International Center for Traditional Childbearing.DONA International is doing it. Centering Healthcare is doing it. We can do it. Million Moms Challenge showed what can be done when we work collectively. When Johnson & Johnson pledged to donate $100,000 if the Million Moms Challenge gathered 100,000 supporters, they went to work, gathered the supporters and recouped the money. In fact, Million Moms raised more than $1.5 million dollars to support work that improves health of women, infants, children and communities.
It has been stated and shown, “We have what it takes to save lives.” The question now is, “Will we do it?”
Photo is courtesy of yfrog and printed with permission.
What will you do to improve maternal mortality in the US and abroad? What would you like to see done? Share your vision with us here, or send an e-mail to info@mamasonbedrest.com. We’re talking about it on Twitter, @mamasonbedrest, and will also take your comments on Facebook. To stay in the loop, be sure to subscribe to our blog via the RSS feed on the upper right hand corner of our pages.
