maternal health

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Opinion: Pending Mass. Paid Leave Bill Targets An Issue Of ‘Human Dignity Violated’

Author Kate Mitchell with her newborn son, Mateo (Courtesy)

Author Kate Mitchell with her newborn son, Mateo (Courtesy)

Ten days after giving birth to my son, Mateo, I was able to walk, but not much more than a few careful steps from couch to bathroom.

I was still bleeding. I was fighting mastitis, a breast infection that delivered a high fever and the worst chills I have ever experienced. Did I mention I was breastfeeding nearly every 45 minutes around the clock? I was totally in love, and completely exhausted.

Luckily for me, I didn’t have to go back to work right after Mateo’s birth. But the same is not true for far too many American women. In fact, about one quarter of mothers in the United States have no choice but to return to work within 10 days of having a baby — many of them still bleeding, still trying to establish breastfeeding, completely exhausted, and often traumatized by leaving their newborns at a time when they need their mothers most.

“At times I feel deeply disappointed that I couldn’t manage to fight harder for what every mother, including me, deserves: time and space to heal and to bond with her new baby.”

– Katey Zeh

In an effort to learn more about the issue, I put together an informal survey that I shared on Facebook and Twitter. One respondent, Katey Zeh, a maternal health advocate with the United Methodist Church, shared her story of lacking access to family leave: In 2014, she gave birth on a Monday, returned to work emails on a Friday, and fully returned to work the following Monday.

Paid parental leave is “partially about economic justice, but it’s also about my parenting — and my family — being affirmed by our society,” Zeh said. In a blog post, she describes in a bit more detail what the lack of leave meant to her:

Now that my daughter is six months old I look back on that time with a lot of regret. If I couldn’t advocate for myself, what kind of advocate was I anyway? If I couldn’t advocate for my kid, what kind of mother did that make me? At times I feel deeply disappointed that I couldn’t manage to fight harder for what every mother, including me, deserves: time and space to heal and to bond with her new baby.

Another respondent, a Catholic school teacher from Ohio who asked that her name not be published, said she loved her work but knew she would not be ready to return to its long hours only four weeks after giving birth — the amount of partial pay leave her employer offered. She also knew that her husband’s work would not allow him to share the home responsibilities, as his job required even longer hours and offered no paternity leave benefits. She left the job she loved. Continue reading

New Moms Cite Lack Of Advice From Docs On Key Issues: Sleeping, Breastfeeding

A new study found that about 20 percent of mothers said they didn’t receive advice from their baby’s doctors about breastfeeding or the current thinking on safe placement for sleeping newborns. (Mark Humphrey/AP)

A new study found that about 20 percent of mothers said they didn’t receive advice from their baby’s doctors about breastfeeding or the current thinking on safe placement for sleeping newborns. (Mark Humphrey/AP)

After I gave birth to my kids, I was bombarded with advice from family, bestselling books and even strangers on topics ranging from how to lose the baby weight, when to have sex again and which infant toys boost IQ.

But according to a new, NIH-funded study, many sleep-deprived, hormone-addled new mothers may not be getting enough advice on critical issues from a most important source: doctors and other health care providers.

When it comes to breastfeeding, infant sleep position, immunization and pacifier use, many new moms report they get no advice at all from their children’s doctors — despite medical evidence on the benefits of certain practices, like breastfeeding and placing babies on their backs for sleep.

The new study — published in the journal Pediatrics and conducted by researchers at Boston Medical Center, Boston University and Yale University — found that about 20 percent of mothers said they didn’t receive advice from their baby’s doctors about breastfeeding or the current thinking on safe placement for sleeping newborns. And more than 50 percent of mothers told investigators that doctors did not offer guidance on where the babies should sleep.

(Of course the whole issue of where newborns should sleep is controversial. Official recommendations now say babies should “room share” with parents but not “bed share.”)

The study, part of a larger national effort called SAFE (Studies of Attitudes and Factors Effecting Infant Care Practices), surveyed more than 1,000 new mothers across the country, inquiring about infant care advice they received from different sources: doctors, nurses, family members and the media.

Dr. Staci Eisenberg, a pediatrician at Boston Medical Center and lead author of the new study, said in an interview that the number of moms who reported no advice from across the board is surprising.

“These findings say to me, ‘Hmm, this is a time to stop and think carefully about how we communicate, and are we communicating in a clear, specific enough way, and are we being heard, especially by new moms — new parents — who are often tired and likely overwhelmed?’ ” she said. “Amidst this sea of information, what are the messages that need to be highlighted and communicated clearly?” Continue reading

The True Cost Of A Mother’s Death: Calculating The Toll On Children

A health worker interviews a client at a health care facility in Tharaka, Kenya. (Photo: Family Care International)

A health worker interviews a client at a health care facility in Tharaka, Kenya. (Photo: Family Care International)

By Emily Maistrellis
Guest contributor

Walif was only 16 and his younger sister, Nassim, just 11 when their mother died in childbirth in Butajira, Ethiopia.

Both Walif and Nassim had been promising students, especially Walif, who had hoped to score high on the national civil service exam after completing secondary school. But following the death of their mother, their father left them to go live with a second wife in the countryside. Walif dropped out of school to care for his younger siblings, as did Nassim and two other sisters, who had taken jobs as house girls in Addis Ababa and Saudi Arabia.

Nassim was married at 15, to a man for whom she bore no affection, so that she would no longer be an economic burden to the family. By the age of 17, she already had her first child. Seven years after his mother died, Walif was still caring for his younger siblings, piecing together odd jobs to pay for their food, although he could not afford the school fees.

In all, with one maternal death, four children’s lives were derailed, not just emotionally but economically.

More than 1,000 miles away, in the rural Nyanza province of Kenya, a woman in the prime of her life died while giving birth to her seventh child, leaving a void that her surviving husband struggled to fill. He juggled tending the family farm, maintaining his household, raising his children and keeping his languishing newborn son alive.

But he didn’t know how to feed his son, so he gave him cow’s milk mixed with water. At three months old, the baby was severely malnourished. A local health worker visited the father and showed him how to feed and care for the baby. That visit saved the baby’s life.

As these stories illustrate, the impact of a woman’s death in pregnancy or childbirth goes far beyond the loss of a woman in her prime, and can cause lasting damage to her children — consequences now documented in new research findings from two groups: Harvard’s FXB Center for Health and Human Rights, and a collaboration among Family Care International, the International Center for Research on Women and the KEMRI-CDC Research Collaboration.

The causes and high number of maternal deaths in Ethiopia, Malawi, Tanzania, South Africa, and Kenya — the five countries explored in the research — are well documented, but this is the first time research has catalogued the consequences of those deaths to children, families, and communities.

The studies found stark differences between the wellbeing of children whose mothers did and did not survive childbirth:

• Out of 59 maternal deaths, only 15 infants survived to two months, according to a study in Kenya.
• In Tanzania, researchers found that most newborn orphans weren’t breastfed. Fathers rarely provided emotional or financial support to their children following a maternal death, affecting their nutrition, health care, and education.
• Across the settings studied, children were called upon to help fill a mother’s role within the household following her death, which often led to their dropping out of school to take on difficult farm and household tasks beyond their age and abilities.

How to use these new research findings to advocate for greater international investment in women’s health?

Continue reading

Winning Ideas In Contest On ‘How To Make The Breast Pump Not Suck’

A team at the MIT Media Lab's "hackathon" on "How To Make The Breast Pump Not Suck" presents its ideas. (Carey Goldberg/WBUR)

A team at the MIT “hackathon” on “How To Make The Breast Pump Not Suck” presents its ideas. (Carey Goldberg/WBUR)

Anyone who’s ever had a close encounter with a breast pump knows that it sucks in multiple ways: It sucks out breast milk, and it sucks because it makes mothers feel like milk cows at the mercy of a loud, dumb, unwieldy, uncomfortable machine.

“Pumping is the worst, it really is,” said Erin Freeburger, a mother and a user-experience designer who was attending her first-ever “hackathon” this weekend: the MIT Media Lab’s “Make The Breast Pump Not Suck!” contest. “That’s why we’re all here. No one here is like, ‘What? It’s fine, how it is!’ It’s awful. But we love our babies more than we hate our pumps, so that’s why we’re motivated to be here today.”

We love our babies more than we hate our pumps.

– Erin Freeburger

Freeburger’s team was among ten squads of brainstormers who took on the intense weekend challenge of improving upon current breast pump designs — and her team won the first prize of $3,000 and a trip to Silicon Valley to court investors. Their concept: The “Mighty Mom” utility belt, is “a fashionable, discreet, hands-free wearable pump that automatically logs and analyzes your personal data.” Milk data, that is.

The concept, she explained, involves both hardware — the utility belt to hold pumping parts needed on the go — and software: It imagines a “smart” breast pump that would collect and track data and upload it to the cloud: milk volume, even fat and protein content as analyzed by infrared sensors. (My reaction: So it’s, like, the iPump?)

The team that would ultimately win the "Make the Breast Pump Not Suck"  hackathon with its "Mighty Mom" utility belt. (Photo: Mason Marino)

The team that would ultimately win the “Make the Breast Pump Not Suck” hackathon with its “Mighty Mom” utility belt. (Photo: Mason Marino)

Other winners, according to the contest site: Second prize of $2,000 to “a sturdy, easy-to-clean, minimal-parts, hands-free compression bra designed by nursing moms. The bra helps women manually express breastmilk (a technique proven to be as effective as electric pumps) without their hands.”

It’s not an iPhone, it’s a mortar and pestle.

– Victoria Solan

And third prize of $1,000 to “an open software and hardware platform to make the breast pumping experience smarter, more data-rich and less isolating. PumpIO puts pumping women in touch with lactation consultants and communities as they are pumping, when they have questions and to help reinforce their commitment to their baby.”

And special recognition goes to “a breast pump that mimics the way that a baby suckles with massage and compression. This team also designed soft, low-profile flanges to be worn discreetly.” And more special recognition to this winner of the popular vote:

Compress Express: A breast pump that mimics the natural and age-old art of hand expression, instead of archaic vacuum technology that dominates the market. Inspired by the simplicity of blood pressure cuffs, this project’s gentle compression technology enables efficient milk expression and creates a discreetly wearable, virtually silent and hands-free breast pumping experience.

Debra Abbaszadeh, a founder of Simple Wishes, a hands-free bra company based in San Francisco, said she thought “the whole idea of compression versus expression was really interesting. I think it requires a lot of work. I think the concepts, exactly as they are, are not quite there, but it’s a very interesting idea.”

You might think, given the huge market for breast pumps in a country where most women work and most mothers breastfeed, that pump makers would already have been racing to improve on designs.

So why should a hackathon — an intense team brainstorming session that originated in computer engineering — even be needed?

Despite the commercial efforts, clearly, “Most women are still dissatisfied,” said Victoria Solan, a historian of architecture and design who attended the hackathon. “There’s a lot of talk about how they’re painful, they’re uncomfortable, they don’t work well. So I think the organizers’ original claim — that there’s no reason that the breast pump shouldn’t be as well designed as the iPhone — is true. It’s not. It’s not an iPhone, it’s a mortar and pestle.”

But as some hackathon participants discovered, improving upon it is not necessarily easy. Continue reading

Poor Get Poorer But Babies Get Healthier, Thanks To Help For Moms

Patricia Wornum,right, is a 'home visitor' with Healthy Families. Every two weeks she check in with Keisha Harrison and her daughter, Cassidy, in their Dorchester home. (Gabrielle Emanuel/WBUR)

Patricia Wornum,right, is a ‘home visitor’ with Healthy Families. Every two weeks she check in with Keisha Harrison and her daughter, Cassidy, in their Dorchester home. (Gabrielle Emanuel/WBUR)

In elephant-print pajamas, 21-month-old Cassidy nuzzles her head into her mother’s lap and then pops up, grabs a ballpoint pen, and starts scribbling. Her squiggles decorate an important piece of paper; it contains a checklist of all the things her mother does for Cassidy, from getting her shots to daily reading aloud.

Cassidy and her mother, Keisha Harrison, are in their Dorchester living room with Patricia Wornum, a “home visitor” with Healthy Families Massachusetts. On the couch, Wornum glances at the decorated checklist and, in her perpetually upbeat manner, asks: “Any papers back from housing?”

Harrison shakes her head. She hasn’t heard anything about her various applications for subsidized public housing. She and Cassidy are staying with her mom — at age 20, she has aged out of a teen shelter — so Harrison is worried they’ve lost their spot on the housing waiting list. Wornum immediately makes a plan to figure out what’s going on. “You got this!” she says.

Wornum and over a hundred other home visitors in Massachusetts are trying to combat a known phenomenon: If you are born to a poor mother, that overwhelmingly raises the chances that you will grow up to be poor. The odds are stacked against you in several ways: Poverty can mean stress and anxiety, poor nutrition and environmental toxins, higher risks of obesity and heart disease. An entire issue of the journal Science on “The Science of Inequality” this month rounded up some of that bad news.

But it also shared what Janet Currie, an economics professor at Princeton, calls a “bright spot” — though inequality has been rising, the health of newborns born into the poorest families has been improving.  TWEET The conclusion: Public policies can make a difference and improve a child’s chance of success. The “Science” article she co-authored looks at which policies are most effective, and found many that work, from early education to family planning services. Home visiting programs like Wornum’s appear to work particularly well.

“You often just hear about how things are getting worse,” Currie says. “The unfortunate consequence of that is that people are left with the impression that nothing works. We wanted to point out that there are programs that work, that they do make a difference.”

What The Statistics Say

Keisha Harrison was in high school when she found out she was pregnant. She remembers it as a clarifying moment.

“Before I was pregnant I really didn’t think I was going to graduate,” says Harrison. “And then once I got pregnant, I just kicked everything into high gear.” Continue reading

Postpartum Depression’s Lingering Toll

Postpartum depression can make you feel, quite frankly, insane.

juliedos/flickr

juliedos/flickr

Psychosis, PTSD and other serious mental illnesses have been linked to that fraught post-childbirth period. (According to the group Postpartum Support International 15-20 percent of pregnant women and new mothers will experience a maternal mental health disorder.)

Most recently, of course, Miriam Carey, a 34-year old dental hygienist, rammed her car — with her one-year old baby inside — into police barricades near the White House. We don’t know exactly what was going in in Carey’s brain — maybe she had a previous mental illness, maybe she was taking medication for it.

Whatever happened, one thing is certain: having a baby changes your brain. And under stress, those changes can be negative and long-lasting.

New research on mother rats found that exposure to chronic stress early in life (in this case an unfamiliar male intruder) “not only impairs a mother’s ability to care for her own children but can also negatively impact her daughter’s ability to provide maternal care to future offspring.”

Here are more details from the the Tufts University Cummings School of Veterinary Medicine news release:

A different male rat was placed in the cage of the first-generation mothers and their newly born pups for an hour a day for 15 days. Consistent with previous research, the lactating mother rats responded to the stress of the intruder with depressed maternal care, impaired lactation, and increased anxiety. The pups of these mothers were also exposed to the conflict between their mothers and the male intruders.

After reaching maturation, second-generation females were mated and compared to a control group where neither the mother nor the pups had been exposed to a male intruder. The second generation mothers that experienced the early life stress also displayed depressed maternal care, impaired lactation, and increased anxiety. There were also changes to hormone levels: an increase in the stress hormone corticosterone, and decreases in oxytocin, prolactin (important to both maternal behavior and lactation) and estradiol.

I asked study author Ben Nephew, an assistant professor in the department of biomedical sciences at Tufts’ Cummings School of Veterinary Medicine, about the research, Continue reading

Tracking Maternal Deaths As Leaders Assess Global Poverty

As world leaders gather at the United Nations this week to assess progress on the so-called Millenium Development Goals — a roadmap set in 2000 aimed at drastically reducing poverty and encouraging education and development around the world within 15 years — Amnesty International released a “maternal death clock” to track deaths worldwide of women and girls during pregnancy and childbirth. Most of these deaths are preventable, Amnesty International says, and are largely due to lack of access to adequate health care.

Of all the Millenium Development Goals, “cutting the maternal mortality ratio by 75% has seen by far the least progress, less than 1% per year by the most optimistic estimates,” Amnesty International says on its website. “Of all the central development issues, maternal mortality needs the most urgent action.”