Tag Archives: prenatal care

Prematurity – Prevention is KEY!

Inside the mind of a mother experiencing preterm labor

This is scary…
This is not how things were supposed to go.
I am WEEKS/MONTHS away from my due date!
I have heard the NICU horror stories…
I am NOT interested in writing one.

What is this? … Why is it happening?
Why now? … Why ME?!

What did I miss? … What did I do?
What could I have done differently?
Is this all my fault?

Can we stop it? … Is it too late?
Will my baby be okay?

I know this space… I know it well because I have been there. It’s definitely a scary place to be even for a “knowledgeable birth advocate” like me ;-).

It’s not a part of the plan EVER!! Today, as we recognize Prematurity Awareness Day, my heart and spirit is definitely with each of you that has been in that space.  My pregnancy ended with a birth at 25 weeks. I was not able to bring my baby home with me. Some of you, like me, were unable to bring your baby home. Some of you count your blessings and see a miracle every time you get a hug from your child. Either way, I honor you today.  Let’s keep up the fight not simply to bring awareness to the poor grades of EVERY state in this nation as it relates to prematurity; let’s work toward PREVENTION!!  We have to keep PREVENTION at the forefront.

A premature birth/prematurity is the birth of an infant before 37 completed weeks of pregnancy.  Just like pregnancy and birth in general, a preterm birth is the result of a complicated interplay between mother, fetus, and the universe.  Sometimes we can determine with relative certainty a direct cause for a preterm birth.  More often however, there are more questions than answers. And while there are times when a preterm birth is necessary i.e. when the health of either mother or infant is in jeopardy if the pregnancy continues, often times we can prevent or delay a preterm birth. When you are experiencing preterm labor, every hour, every day, and every week that you can keep your baby on the inside can create a better outcome once she is born.

There are so MANY things I could include in a post like this but here are just few thoughts from the top of my head re: Preventing Preterm Birth:

Keep your prenatal appointments – While all prenatal care is not created equal and some models create better results than others, studies have shown that getting prenatal care can reduce the incidence of preterm labor and birth. Example:  One of my most recent experiences with a mother in preterm labor happened with a mom who went in for a routine ultrasound. They noted via ultrasound that her cervix was completely effaced. She was sent to the hospital and we discovered she was having contractions every 2-3 minutes and she was 2cm dilated. Keep your appointments ladies. You never know what questions might be asked, what comments might be made that might trigger an exam and discover you have been having preterm labor.

Get adequate rest and ask for help – There is no need to be “superwoman” or “Supermom.” Sit down. Put your feet up. Take care of yourself. De-stress and detoxify your emotions. This is good for general overall health and also good for helping with preterm labor. Working is fine… exercising is great but don’t overdo it. You have to listen to your body!!!

Stay well hydrated – No matter how much water you are drinking… it’s NOT enough LOL. Drink more… Especially: in the summer months, if you are working in a dehydrating environment, if you drink coffee, tea, sodas.  I can’t tell you the number of women who arrive to the hospital with pre-term labor that is stopped with a bolus of IV hydration.  If you stay hydrated on your own… it won’t come to that. Drink WATER. Drink WATER. Drink WATER!

Have the expectation of a healthy full-term baby. – While a previous preterm birth says you may be “at risk” for a preterm birth with this pregnancy, it does NOT mean you WILL have another preterm birth. What is your expectation? It can certainly make a difference.  So often I meet a woman who says to me “All my babies are born prematurely” Is that so I think to myself… well not on my watch ;-)  I want your baby to be full term. And they look at me confused as though the last chapter has already been written. Every pregnancy and birth is different. Lets make THIS one a full term one.

Avoid an unnecessary induction. – Even though you and your provider may THINK you are full term… there is a chance that you may still deliver a premature baby. Let your baby tell you when she is ready to be born. An induction with no indication has been the cause of many NICU admissions. Babies thought to be 38 weeks have been induced and at birth found to be 36 weeks. NOT okay!! Additionally, if you are “near” term and you are found to be 2-3 cm dilated this does not mean you need to “speed things up.” You can be 2-3 cm dilated at 35 weeks and stay that way until you are 40 weeks pregnant!! Don’t get induced! Its NOT worth it. Your baby’s immediate and long term health can be altered by that decision.

In the words of Jennie Joseph, one of my favorite midwifery sheroes… may you have a “healthy full-term FAT baby”  :D

In Birth and Love
Nicole

A Few Nuggets from Black Midwives and Healers…

It’s been almost two weeks since I had the pleasure of attending the ICTC Black Midwives and Healers Conference, and I am FINALLY getting around to sharing a couple of take home nuggets. If you had the opportunity to read my previous post about the conference, you already know what the primary take home message was for me…

WE have an epidemic in OUR community. Perinatal morbidity and mortality disproportionately affect women and infants of color, specifically in the Black Community. WE suffer the most and the disparities are alarming.  WE have to save OUR babies. WE have to save OUR sisters. The saving of OUR babies and women has to be a grass roots effort. If WE don’t do it… it won’t happen so WE must take the charge to make it happen.

During the conference, this particular message was everywhere either as the direct topic or the underlying message of every session.

Preconception Care
On a very practical note, I attended a session on preconception care.  During this participatory session, we shared ideas, concepts, and specific strategies that we can use to help bring about change in these disparities through a focus on preconception care.  Lots of perinatal morbidity and mortality can be avoided or minimized if we start off in better health.  One speaker declared “We can’t have healthy babies, if we don’t have healthy mammas.”

While this sounds like basic common sense, many unhealthy women become pregnant and as a result they have poor pregnancy outcomes.  Leading causes of maternal morbidity and mortality include high blood pressure, obesity, diabetes, and poor general health both physiologically and psychologically.  The leading causes of infant morbidity and mortality in the Black community include prematurity and low birth weight both of which are directly related to the health of the mother.

The fallacy is that we only need to plan for pregnancy when we are “ready” to get pregnant. The reality is 50% of pregnancies are unplanned. With that in mind, if we are choosing to engage in sexual relations with men, it is imperative that we plan for pregnancy at all times. It’s important to create a healthy lifestyle: exercise, learn to eat healthy, take a daily vitamin with folic acid, avoid binge drinking and drug use.  It’s important to take care of our chronic diseases:  Are you diabetic, or do you have high blood pressure? Are you taking meds for weight loss, chronic depression or anxiety?  Do you have Sickle Cell or Lupus or any other autoimmune disorder? If you do, you need to speak with your midwife, your OB/GYN, and/or your primary care provider NOW about the risks you may encounter. Learn what you can do NOW to minimize those risks and to be healthy.

As health care providers, we need to speak with our female patients about pre-conception planning. We can’t make the mistake of thinking because she is not “planning’ a pregnancy that she won’t get pregnant.  We must always remember the 50%.  One really GREAT suggestion that came from that session: partner with the churches in your community. Speak with the pastors about adding preconception counseling to the pre-marital counseling curriculum.  What better time to discuss parenting and pregnancy than this time.

Access to Prenatal Care
Increasing access to prenatal care has often been suggested as a solution to eliminating perinatal disparities.  As a result, various clinics have been erected, mobile clinics have been employed and hours have been extended. Unfortunately these things alone do not work to change outcomes.  This was made clear when I attended a session conducted by Jennie Joseph, one of my personal midwifery sheroes.  Jennie has a style of prenatal care dubbed “The JJ Way.” Through practicing “The JJ Way,” she has documented a significant decrease in preterm birth/low birth weight in the Florida county where she cares for many African American women.

Ms. Joseph reminded us that access to prenatal CARE has little to do with location, or hours of operation.  Access to prenatal CARE is NOT the presence of a building and a provider that can measure a belly and listen to fetal heart tones. That’s the myth and the reason why so many “build it and they will come” efforts have failed.  Prenatal CARE is provided when a woman feels like she is accepted and respected.  Prenatal CARE takes place in an environment where women and their families are treated with DIGNITY without judgment. So often we remember the prenatal yet we forget the CARE.

Do you want to participate in grassroots efforts to help effect change in the perinatal outcomes in the African American community?  Remember this… Women are not oblivious to the true feelings of a provider. It’s not enough to “mean well.”  We have to practice well, to treat women well, to do well.  We have to provide women with genuine CARE that is not filled with empty smiles and sympathy/empathy. We must have genuine compassion.

The Weathering Phenomena
While there were many more things discussed at this conference I want to end this post with information shared by Sister Oya who traveled from Tanzania to bring us a message that was at once fascinating, enlightening and depressing. She helped us connect more dots to understanding the effect racism has on African American women at the cellular level and how it directly affects our perinatal outcomes.  While in general this concept was not new to those of us in the audience, for many of us it was the first time that we had heard directly of the phenomena called Weathering as put forth by Arline T. Geronimus. From Wikipedia:  Weathering in geology is the breaking down of Earth’s rocks, soils, and minerals through direct contact with the planet’s atmosphere. According to Dr. Geronimus weathering for black men and women is the breaking down of our physiological/biological systems due to direct contact with our “atmosphere” – a society steeped in racism and discrimination.

Through decades of research Dr. Geronimus has documented how a lifetime of living in this type of society creates a chronic stress that makes us less healthy with each passing year. She has actually measured the affect of this weathering using various biochemical markers and has found that BLACK WOMEN show evidence of the greatest amount of weathering across all educational and socioeconomic lines.  As Sister Oya presented actual data, which included detailed information about those various biochemical markers and hormones, it became increasingly clear how at the cellular level we are affected by this long standing systematic racism.  Even women who appear by all other accounts to be healthy show signs of this weathering.  As our internal environment shifts, not only does the growth environment shift for our unborn children but their internal stress hormones and biochemical markers are changed as well.  As a result our babies are unable to grow, thrive, and be born healthy…Stressed before they even exit the womb.

Unfortunately, there is no easy or fast solution to remove weathering from our lives. Until we live in a society that does not use race, color, religion, sexuality, gender, economics, and education to discriminate, weathering will be present.

So where does this leave us???

It leaves us with the knowledge that we have to create more supportive environments. We have to get into our communities in more creative ways.  We have to be more genuine in our efforts as we care for Black Women and we have to be more interested in their TOTAL well being, not just the numbers.

We have to take care of ourselves before, during and after pregnancy.  We have to encourage and support each other through all of our challenges. WE have to take care of OURSELVES and encourage our sisters, aunts, cousins, and sister friends to do the same.  And so I end this post basically the way I started it:

WE have an epidemic in OUR community. Perinatal morbidity and mortality disproportionately affects women and infants of color, specifically in the Black Community. WE suffer the most and the disparities are alarming.  WE have to save OUR babies. WE have to save OUR sisters. The saving of OUR babies and women has to be a grass roots effort. If WE don’t do it… it won’t happen so WE must take the charge to make it happen.

In Birth and Love
Nicole