pregnancy
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: An interview with Author Linda Burke-Galloway, MD
June 25th, 2010I had the great fortune to interview Dr. Linda Burke-Galloway, OB/GYN and author of The Smart Mother’s Guide to a Better Pregnancy. Dr. Burke-Galloway shares with us her rigorous training at Harlem hospital, her extensive experience in management of high risk pregnancies and the series of mishaps including the death of a dear friend that lead her to not only become a vocal advocate of maternal health rights, but to write this book. I urge every prospective mother to get a copy of the book and to take Dr. Burke-Galloway’s sage advice from this podcast to heart.
