survival

CleanBirth.org — Saving Lives — $5 Valentine for Safe Motherhood

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As part of our mis­sion to con­tribute to safe moth­er­hood around the globe, DTP is pro­mot­ing the work of CleanBirth.org. This orga­ni­za­tion works to make birth safer in south­ern Laos, which has the high­est rates of infant and mater­nal mor­tal­i­ty in the region[1]. CB1 Mum baby red hat The vast major­i­ty of women give birth with­out a trained atten­dant or clean sup­plies, but CleanBirth.org is mak­ing a dif­fer­ence, improv­ing out­comes through sim­ple ini­tia­tives that pro­vide life-sav­ing birthing sup­plies and infor­ma­tion.

To pro­mote hygien­ic birth, CleanBirth.org part­ners with a Lao non-prof­it, Our Vil­lage Asso­ci­a­tion (OVA) to train local nurs­es to dis­trib­ute Clean Birth Kits – the life sav­ing birth sup­plies that cost a mere $5 each. The nurs­es then train a vol­un­teer from each vil­lage to dis­trib­ute and track the kits and spread infor­ma­tion about safe birthing prac­tices.

If you can, please donate to this mis­sion:

  • $5 pro­vides a life-sav­ing Clean Birth Kit
  • $100 trains a Vil­lage vol­un­teer
  • $250 spon­sors a nurse who serves as many as 1o vil­lages

Think of this as your Valen­tine present to the world. Safe Moth­er­hood is a major glob­al move­ment, and orga­ni­za­tions such as CleanBirth.org are the on-the-ground work force that is bring­ing about improve­ments in mater­nal and new­born sur­vival.

READ MORE AND SEE MORE PHOTOS AT DTP’s BLOG SITE: http://dancingthrupregnancy.wordpress.com

Thank you!!

Holiday Contributions That Make a Difference.

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This is the time of year many of us con­sid­er where to make our char­i­ta­ble con­tri­bu­tions. We have assem­bled a list of  groups to which you might want to con­sid­er giv­ing this year. By donat­ing to these orga­ni­za­tions you can help improve the lives of moth­ers, newborns,children and fam­i­lies around the world. Most will also send a card or email mes­sage to a mom in whose hon­or you give the gift.

UNICEF Inspired Gifts.  You can choose gifts that improve edu­ca­tion, water, health, nutri­tion, emer­gency care and oth­er fac­tors that affect the well-being of women and chil­dren.

White Rib­bon Alliance for Safe Moth­er­hood. You can advo­cate for every moth­er and every child in 152 nations when you give to this orga­ni­za­tion.

Inter­na­tion­al Con­fed­er­a­tion of Mid­wives. This group exists to raise aware­ness of the glob­al role of mid­wives in reduc­ing mater­nal and new­born child mor­tal­i­ty.

The Fis­tu­la Foun­da­tion. This group exists to raise aware­ness of and fund­ing for fis­tu­la treat­ment, pre­ven­tion and edu­ca­tion­al pro­grams world­wide. Fis­tu­la is the dev­as­tat­ing injury cause by untreat­ed obstruct­ed labor.

The Preeclamp­sia Foun­da­tion. This orga­ni­za­tion sup­ports research to pre­vent and treat one of the most dan­ger­ous dis­or­ders of preg­nan­cy, one that accounts for a large per­cent­age of pre­ma­ture births and low birth weight infants. Hav­ing preeclamp­sia is also a risk fac­tor for lat­er heart dis­ease for the moth­er.

Clean Birth. Clean Birth Kits are designed to pro­vide birth atten­dants and/or expect­ing moms with the tools they need to ensure a clean birthing envi­ron­ment. The Kits ensure the WHO’s “6 Cleans”: clean hands, clean per­ineum, clean deliv­ery sur­face, clean cord cut­ting imple­ment, clean cord tying, and clean cord care.

March of Dimes. The “moth­er” of all char­i­ties for help­ing pre­vent and treat dis­or­ders and dis­eases that affect chil­dren.

Peace, Love and Joy to all.

Safe Motherhood

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The chal­lenges to safe moth­er­hood vary depend­ing where in the world you live. In some areas the chal­lenge may be to get ade­quate nutri­tion or clean water; in oth­er areas, it may be to pre­vent infec­tion; and in still oth­er loca­tions it may be try­ing to avoid preg­nan­cy before your body is ready or get­ting access to pre­na­tal care. In the U.S., it may mean avoid­ing being seden­tary and mak­ing poor food choic­es, or hav­ing to deal with the high tech­nol­o­gy envi­ron­ment of med­ical birth that can sab­o­tage the innate phys­i­o­log­i­cal process of labor and birth.

Birth begins the bond­ing or unique love between moth­er and child.

The biol­o­gy of birth is a com­plex series of cause-effect process­es…baby’s brain releas­es chem­i­cal sig­nals to the moth­er and the pla­cen­ta begins to man­i­fest the mater­nal immune system’s rejec­tion of the fetus.

To help the ball get rolling, relax­ation (the trophotrop­ic response) helps pro­mote the release of oxy­tocin. With the help of grav­i­ty, the head press­es on the cervix, ampli­fy­ing the uter­ine con­trac­tions. After an ultra-dis­tance aer­o­bic endurance test, the cervix opens enough to let the baby move into the vagi­na and the mother’s dis­com­fort moves from sharp cramp­ing into the bony struc­ture as she tran­si­tions to the strength test of push­ing. She tran­si­tions. Relax­ation mod­u­lates into an ergotrop­ic — adren­al — response to gath­er her pow­er.

Push­ing is an inter­est­ing term…more mas­cu­line, I think, than the one I pre­fer:  Releas­ing. Releas­ing or let­ting go of the baby. It’s a cathar­sis. In this por­tion of the labor anoth­er set of impor­tant process­es help the baby clear its lungs of amni­ot­ic flu­id, stim­u­late its adren­al sys­tem and chal­lenge its immune sys­tem, as the con­trac­tions dri­ve the baby down­ward. The mother’s deep trans­verse abdom­i­nal mus­cles — if strong enough — squeeze the uterus like a tube of tooth paste, to aid this expul­sion. In the mean­time, the labor is help­ing set up the moth­er to fall in love and pro­duce milk. When the baby emerges and moves onto the mother’s chest, s/he smells and tastes the moth­er, rec­og­niz­ing her mother’s fla­vor and set­ting up the poten­tial for bond­ing.

Any way you slice it, there are two parts to safe moth­er­hood. One is a safe preg­nan­cy…healthy nutri­tion, phys­i­cal fit­ness, safe water, infec­tion pre­ven­tion, sup­port and a safe envi­ron­ment. The oth­er is a safe labor. In a safe labor, there is both an envi­ron­ment that pro­motes the nat­ur­al process of labor and the means nec­es­sary for med­ical assis­tance when need­ed. Women die at an alarm­ing rate from preg­nan­cy or birth-relat­ed prob­lems. Despite some progress made in recent years, women con­tin­ue to die every minute as a result of being preg­nant or giv­ing birth.

What keeps us from hav­ing a bet­ter record on moth­er­hood is often lack of care in the devel­op­ing world and too much inter­ven­tion in the U.S.. They are two sides of a coin. Moth­ers’ expe­ri­ence and health needs are not on equal foot­ing with oth­er cul­tur­al val­ues. In places where basic pre­na­tal care or fam­i­ly plan­ning are low pri­or­i­ties, at-risk women are vul­ner­a­ble to the phys­i­cal stress­es of preg­nan­cy and birth. In the U.S., machine-mea­sured data is para­mount, even if it pro­duces high rates of false pos­i­tives, unnec­es­sary inter­ven­tions or coun­ter­pro­duc­tive pro­ce­dures. We are learn­ing that obe­si­ty and seden­tary lifestyles have detri­men­tal effects, but few­er preg­nant women than their non-preg­nant coun­ter­parts exer­cise.

Despite the mon­ey spent to sup­port the tech­no­log­i­cal mod­el of preg­nan­cy and birth in the U.S., there are parts of the world with low­er rates of mater­nal deaths — espe­cial­ly Scan­di­navia, North­ern Europe and parts of the Mediter­ranean and Mid­dle East (Greece, the Unit­ed Arab Emi­rates, Israel, Italy and Croa­t­ia). In fact, in the U.S., mater­nal deaths are on the rise.

It’s a tricky busi­ness. Clear­ly West­ern med­i­cine has a lot to offer the devel­op­ing world when there are med­ical con­cerns. On the oth­er hand, import­ing the U.S. mod­el could cre­ate more prob­lems than it solves. Instead, the micro-solu­tions now being devel­oped in many loca­tions will be observed and evi­dence col­lect­ed by orga­ni­za­tions such as the White Rib­bon Alliance and UNICEF.

There is an effec­tive inter­na­tion­al mid­wives mod­el adopt­ed by JHPIEGO, the Johns Hop­kins NGO work­ing toward improved birthing out­comes. It assess­es the local pow­er struc­ture, social con­nec­tions, poten­tial for trained birth assis­tants, and loca­tion of avail­able trans­porta­tion to cre­ate a net­work so that locals will know when a labor is in trou­ble and who can get the woman to the near­est hos­pi­tal.

In the U.S., there are in-hos­pi­tal birth cen­ters that allow low-risk moth­ers the oppor­tu­ni­ty to labor and birth in a set­ting designed to encour­age the innate process­es. Women are begin­ning to vote with their feet…staying home for birth. Women are going abroad to give birth. At the same time, women are com­ing to this coun­try to give birth, believ­ing it is safer than where they are. There are sev­er­al ways these scenes could play out.

But, I’ll wager, improv­ing out­comes will involve com­pro­mise:  Watch­ful­ness and sup­port in most births, plus bet­ter ways to assess dan­ger and pro­vide tech­nol­o­gy. No mat­ter where you live in the world, the solu­tion may be essen­tial­ly the same.

The 51% Factor: Pregnancy, Power & Health

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In the U.S. and most of the devel­oped world, approx­i­mate­ly 51% of the pop­u­la­tion is female. Most females give birth at some point in their lives, although, in any year, only about 2% of the pop­u­la­tion gives birth.

No one liv­ing on earth got here any oth­er way than ges­ta­tion, so there ought to be some pow­er attached to being part of that 51%. His­tor­i­cal­ly, it might be said that the pow­er has been mere­ly for survival…the good breed­ers sur­vived long enough to pro­duce heirs and those who lived on knew where the roots and fruit grew.

Only women can make more peo­ple with their bod­ies.

Here are some things to con­sid­er:

  • Women make peo­ple
  • Women’s health and fit­ness before preg­nan­cy affects whether the preg­nan­cy is healthy
  • Women’s health and fit­ness dur­ing preg­nan­cy affects her life­time health and that of her off­spring
  • Mater­nal sur­vival is impor­tant to off­spring well-being
  • Mater­nal health and fit­ness affects mater­nal adap­ta­tion and there­by off­spring well-being

Thus, is it not a san­guine notion that the health and sur­vival of women is crit­i­cal to the health of every­one? After all, the health of nations is asso­ci­at­ed with this slight major­i­ty of females, and the wealth of nations is asso­ci­at­ed with its health.

The good news is that peo­ple work­ing from this under­stand­ing are mak­ing some head­way around the globe. Recent­ly, the World Health Orga­ni­za­tion not­ed that mater­nal death among preg­nant and birthing women world-wide has been dra­mat­i­cal­ly reduced from the 1980’s to recent­ly. This is very good news!

Here is the inter­est­ing foot­note:  Mater­nal death in the U.S. has risen 42% in the same peri­od. While the absolute num­bers remain small, this is a dis­turb­ing pic­ture. What could be caus­ing this?

Time will tell if we can fig­ure it out and fix it. I ven­ture to sug­gest some direc­tions for con­sid­er­a­tion:

  • The ele­vat­ed cesare­an birth rate with its sequel­lae of car­dio­vas­cu­lar and immune sys­tem dis­or­ders
  • Obe­si­ty
  • Meta­bol­ic syn­dromes
  • Dia­betes
  • Heart dis­ease

Why am I hope­ful, then? I see among our cur­rent edu­cat­ed gen­er­a­tion of new moms and moms-to-be a will­ing­ness to exert their influ­ence – as breed­ers – over the health care scene. They want less tech­no­log­i­cal birth. They want sup­port. They want more infor­ma­tion. They want to be healthy. These are won­der­ful things. I salute these young women…they also make my job eas­i­er in the process.

In addi­tion, I see among young health care prac­ti­tion­ers an under­stand­ing of the val­ue of these things. Among prac­ti­tion­ers work­ing in pub­lic health clin­ics there is a sense of des­per­a­tion on the one hand that the poor and indi­gent have no capac­i­ty or will to take care of them­selves. On the oth­er hand, the first step is always edu­ca­tion and there are a lot of peo­ple work­ing on this issue.

Which brings me to the clos­ing point:  How do we bring more resources and intel­li­gence to help­ing women be healthy, pre­pare for preg­nan­cy, have healthy babies, reduce preg­nan­cy com­pli­ca­tions, and improve infant and mater­nal death rates? I, for one, will keep blog­ging on this issue. You, I hope, will vote for peo­ple who under­stand this issue. The polit­i­cal pow­er and will is in our hands.

51% of us are women…some day 51% of us can set pri­or­i­ties

Pregnancy Pathway, Birth — Labor

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The First Stage of Child­birth is the long, hard labor. It is the slow process that pro­duces dila­tion, or open­ing, of the cervix — the “neck” or out­let at the bot­tom of the uterus. Once the baby’s head can fit through the open cervix, it is time for the Sec­ond Stage, but that is anoth­er top­ic for anoth­er post.

Labor is generally a long, slow process...there is no "enter" button for dilation!

Labor is gen­er­al­ly a long, slow process…there is no “enter” but­ton for dila­tion!

Before the baby can leave the mother’s body, s/he must leave the uterus. The open­ing of the cervix to let the baby out of the uterus gen­er­al­ly takes up the most time. For a first time mom it can be 10 or 12 hours…or, yes, a cou­ple of days. Of course, for some moms, this time is dif­fi­cult and for oth­ers it only becomes dif­fi­cult in the last few hours.

But, you know all this, right? What you want to know is:  Why do I have to go through this? And, if I must, how can I make it the least painful?

Why labor is impor­tant. Let’s go to anoth­er ques­tion:  How impor­tant would your off­spring be if it was no big deal to drop one out? If you were walk­ing along the side­walk and you could sim­ply drop a new­born on the pave­ment, would you even stop to pick it up if you could do it again in a few days, when, of course, it will be much more con­ve­nient?

Frankly, preg­nan­cy and labor remind us to pay atten­tion. A new­born can­not sur­vive on its own for at least two years. If we don’t pay atten­tion, it will die.

Okay, now that labor has your atten­tion, what else does it do that is ben­e­fi­cial? It stim­u­lates the baby’s stress response and teach­es the new­born to be alert dur­ing sit­u­a­tions of duress. Each con­trac­tion is pulling the cervix, help­ing it slow­ly open. If you are upright, each con­trac­tion is also alert­ing the baby to the influ­ence of grav­i­ty.

Why is labor painful? So, you need to go through this because it is the bridge from preg­nan­cy to par­ent­hood. Why does it have to be painful?

The first thing to keep in mind about pain is that pain is a com­bi­na­tion of sen­sa­tions and emo­tion, main­ly fear. Fear makes you tense; ten­sion reduces blood flow. Reduced blood flow to the uterus makes the con­trac­tions less effec­tive. In addi­tion, cor­ti­sol is released, mak­ing sen­sa­tions stronger and evok­ing greater fear.

Fear is the emo­tion of fight or flight. Inter­est­ing­ly, the oppo­site response, the relax­ation response, is very effec­tive in pro­mot­ing labor. So, relax. Breathe deeply and slow­ly, focus, move through the cen­ter of your expe­ri­ence. You don’t have to be in fear if you know what is hap­pen­ing and if you are phys­i­cal­ly fit and pre­pared. Both child­birth edu­ca­tion and phys­i­cal fit­ness teach your body to work with dis­com­fort. By includ­ing them in your prepa­ra­tion, you give your­self a tremen­dous advan­tage.

Does this mean you will nev­er feel like you want to stop in the mid­dle of labor? No, but it does mean you can do it. It is finite. The notion that the baby will not do well is also tied to your phys­i­cal fit­ness…babies of fit moth­ers less often expe­ri­ence fetal dis­tress. Your care providers will let you know if there is some fac­tor beyond your con­trol that requires med­ical inter­ven­tion.

Birth is an empow­er­ing event. But, before the baby can be born, it must escape the uterus. It is a clas­sic con­flict and the mother’s body is the venue. Give your­self over; go with it. Only women can do this.

Pregnancy Pathway — Exercise

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How lucky is this? Just a few days ago, yet anoth­er study was released and has been cir­cu­lat­ing on Med­scape and oth­er med­ical sites that indi­cates exer­cise is ben­e­fi­cial in preg­nan­cy, whether the moth­er is a pre­vi­ous exer­cis­er or not. Just in time for this entry!

Behavior Affects Pregnancy Outcome

Behav­ior Affects Preg­nan­cy Out­come

Phys­i­cal exer­tion (we call it “exer­cise” nowa­days) is a nor­mal state for healthy humans. Only in the last cen­tu­ry has the desire to rest or the need to store extra calo­ries as fat become more pos­si­ble to achieve than our need to move about to sur­vive.

Preg­nan­cy is a state in which both of these fac­tors (rest­ing and stor­ing calo­ries) are enhanced through organ­ic changes in body chem­istry, adap­ta­tions that favor fetal sur­vival. The cur­rent seden­tary lifestyle exag­ger­ates these meta­bol­ic changes and results in syn­dromes that increase the risk for a num­ber of meta­bol­ic, car­dio­vas­cu­lar and immuno­log­i­cal dis­or­ders of preg­nan­cy.

When con­front­ed by the idea that it is coun­ter­in­tu­itive to think exer­cise in preg­nan­cy might be safe (let alone ben­e­fi­cial) I am dumb­found­ed. To me, it is coun­ter­in­tu­itive to think that a seden­tary lifestyle in preg­nan­cy might be safe!

Burning Calories in Pregnancy Improves Outcomes!

Burn­ing Calo­ries in Preg­nan­cy Improves Out­comes!

What is the evi­dence that exer­cise in preg­nan­cy is ben­e­fi­cial? Keep in mind that some stud­ies have been exe­cut­ed more expert­ly than oth­ers. But, what is com­pelling is that numer­ous well-respect­ed researchers have sought to test the hypoth­e­sis that exer­cise is not safe, but come away with results that indi­cate the oppo­site!

Here are some of the major find­ings:

• The pla­cen­ta is larg­er and has more trans­port sur­face in exer­cis­ers than seden­tary women

• The fetus­es of (aer­o­bic) exer­cis­ing moth­ers make ben­e­fi­cial car­dio­vas­cu­lar adap­ta­tions

• Women who do aer­o­bic exer­cise are less like­ly to devel­op severe preeclamp­sia or ges­ta­tion­al dia­betes, and the long term health prob­lems that accom­pa­ny these dis­or­ders

• Women who are aer­o­bi­cal­ly fit recov­er from birth 10 times faster than seden­tary women (as mea­sured by time need­ed to metab­o­lize free rad­i­cals pro­duced in labor)

• Women who exer­cise in preg­nan­cy are more like­ly to be phys­i­cal­ly fit in midlife

• Babies of aer­o­bi­cal­ly fit women are at reduced risk for pre­ma­tu­ri­ty and low birth weight
DTP_mover2
So, we have arrived at the take-home mes­sage: MOVE!! Preg­nan­cy works best when you move and burn calo­ries in a mod­er­ate to vig­or­ous fash­ion. But, alter­nate this activ­i­ty with rest and good nutri­tion, and be sure to stay well hydrat­ed.
If you want more specifics and resources on this top­ic, try these:
“Women and Exer­cise” in Varney’s Mid­wifery.

Pregnancy — 50% planned; 50% unplanned

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So…are you plan­ning to become preg­nant? For the last decade, preg­nan­cy has been in a 50/50 sit­u­a­tion. That is, about half the preg­nan­cies occur­ring in the U.S. are planned. The rest? Well, not nec­es­sar­i­ly unwel­come, but def­i­nite­ly unplanned.

Will this change in the cur­rent reces­sion (or as a friend said today, Let us just call it a depres­sion and move on)? So far, it is clear that preg­nan­cy rates are not drop­ping, despite an unwill­ing­ness to spend mon­ey on many oth­er things. What does this say?

Once again, despite liv­ing in a high tech world, hav­ing babies is a pri­mal expe­ri­ence. It does not dimin­ish when resources are scarce.

So, plan to or not, if you have a baby dur­ing this depres­sion, do not waste your mon­ey. Fig­ure out how to have a healthy preg­nan­cy.

Next on the Preg­nan­cy Path­way: the act of con­cep­tion.