Maternal Mortality Issues

Goals come with challenges. Federal and state government, teaching hospitals, and OB clinics are working to improve maternal health risks. Using the World Health organization ‘s definition, maternal death is death during pregnancy or related to the pregnancy and up to 42 days following delivery. However, other definitions (like the September 2016 issue of Obstet Gynecol) define maternal mortality as “the death of a woman while pregnant or during the one-year period following the date of the end of pregnancy.”  So who is right?  And although many stats show a steady increase in maternal death “the provisional number of births for the United States in 2017 was 3,853,472” (per CDC); therefore women are taking on the challenges of pregnancy with its possible risks and are reaching their goal of carrying and delivering a new little person.

Here are some risks occurring in South Carolina (2011-2015):

—- There are demographic disparities including a “substantial racial disparity” for care.  Non-Hispanic Black women were 3.7 times more likely to die in pregnancy and child birth compared to non-Hispanic White women.

—-Women of all categories 35 years of age or older were at higher risk.

—-South Carolina’s 64 total deaths’ causes were broken down into seven categories:  Medical conditions complicating pregnancies tops the list at 21 deaths.

Cardiovascular disease and hypertension were the next two causes, followed by complications of labor and delivery, ectopic pregnancy issues, disease of the cerebral vascular system and last was other unspecified causes.

In California, the state with the highest number of babies born, the researchers and clinicians have found ways needed to decrease the risk of death from hemorrhaging and pre-eclampsia. Treating hypertension aggressively is one. Educating nurses and doctors to know what preventative actions to use quickly and to use special online toolkits an OB professor developed is another. (See California Quality Care Collaborative)

Still awaiting passage by the US Congress, The Maternal Health Accountability Act S-112 facilitates states’ maternal care and also provides federal funding for their maternal care review boards to prevent deaths from occurring because of flawed care or lack of care.

Another important issue is caring for women considering abortion, during abortion and after abortion is vital. Medical issues directly related to an abortion exist such as hemorrhage. Others are difficulties with future pregnancies, lowering of mental health (including PTSD, accidents, and higher suicide rate) and even a lower life expectancy. Women who’ve had multiple abortions may have a higher risk developing breast cancer.

Care given for both a woman wanting to carry her pregnancy or one that does not is life-giving. Hopefully success in care will help more goals to be attained for both mother and baby.

Sources:

MacDorman M, Declercq E, Cabral H, Morton C.  Is the United States Maternal Mortality Rate Increasing?  Disentangling trends from measurement issues.  U.S. Maternal Mortality Trends.  Obstet Gynecol. 2016 Sep; 128 (3): 447-455.

www.ncbi.wlm.nih.gov/pmc/articles

NCHS is the principal agency of the US Federal statistical system and operates under the CDC

http://www.reviewtoaction.org/sites/default/files/portal_resources/South

%20Carolina%20VR%20Data_Maternal%20Mortality%202011-

2015%20Poster.pdf

Maternal Health Accountability Act of 2017

“Lost Mothers” N. Martin, R. Montagne NPR/Propublica article

Elliot Institute. (2003). “Our Mission & Ministry.” Elliot Institute. N.p.,

2003. Web. 18 Jun 2011. http://afterabortion.org/2011

Rue et. al. (2004). “Induced abortion and traumatic stress: A preliminary comparison of American and Russian women,” Medical Science Monitor 10(10): SR5-16 (2004) http://www.artsenverbond.nl/abortion.pdf

Abortion Breast Cancer Coalition. (2010). “Stop the Cover-up!” Abortion Breast Cancer Coalition,  http://www.abortionbreastcancer.com/

ps/bhb 11/2018

Postpartum Depression & Anxiety

Because Piedmont Women’s Center (PWC) deals mainly with pregnancy versus post-birth, we do not see a lot of postpartum depression in our clinics. However, this is something that affects many women, and it can be very serious. It is important for expectant parents and new parents to be aware of the signs and symptoms of postpartum struggles so that adequate help can be given.

According to the Mayo Clinic, there are three tiers on the postpartum continuum. The first category is “postpartum baby blues,” which begins as early as twenty-four hours after childbirth and can last up to two weeks. This can include mood swings, crying, trouble sleeping, and anxious thoughts. It is believed that as many as eighty percent of new moms will experience this to some degree.

The next tier is postpartum depression. This is more severe and can begin up to six months after childbirth, lasting for possibly many months. Women who struggle with this type of depression are often impeded in their ability to complete daily tasks. The symptoms are similar to postpartum baby blues, but intensified. Other symptoms include difficulty bonding with the child, lack of interest in activities, and possibly even suicidal thoughts. According to Suicide.org, as many as fifteen percent of women can develop postpartum depression after delivery.

A woman can also experience postpartum psychosis, the most extreme tier on this continuum. This usually develops within a week after delivery and can become increasingly worse as time goes on. Women with postpartum psychosis are in danger of harming themselves and/or their baby. They may become confused and suffer from hallucinations. As many as one in one thousand women will experience this form of psychosis.

Usually postpartum issues are due to physical bodily changes, such as hormone production or the emotional changes that come with the life change of raising a baby. Those that have a history of mental illness, a traumatic delivery, or even lacking in a strong support system could potentially be at a higher risk for developing postpartum depression.

Postpartum struggles affect the whole family. Interestingly enough, the Mayo Clinic suggests that dads are at a higher risk of depression after childbirth, and that could be exacerbated by postpartum issues in the mother. Children can also suffer. Many researchers argue that moms with postpartum depression or anxiety tend to have children with more ADHD struggles, along with other behavioral issues.

The CDC notes that it is also proven that moms who suffer miscarriage, stillbirth, and infant loss face similar struggles. We also know that abortion can cause post-abortion distress, which has some overlapping symptoms of postpartum depression.

Many people do not like to talk about postpartum depression because the stigma of shame is associated with this struggle. Women do not often report their symptoms because they fear being labeled a bad mom. When families do not get the help they need, lives are at risk. Left untreated, moms could be in danger of harming themselves and/or their children.

At PWC, we believe that every mom matters. We want families to feel empowered and strong as they raise their children. There is no shame in having a hard time and asking for help. Having the courage to talk to someone is extremely brave and freeing. We view that as being an example of a wonderful mom! Shame often keeps us in bondage, but there is freedom in reaching out!

Sources:

Caruso, K. Postpartum depression and suicide – suicide.Org. Retrieved September 1, 2016, from Suicide.org, http://www.suicide.org/postpartum-depression-and-suicide.html

Mayo Clinic. (2015, August 11). Postpartum depression complications. Retrieved September 1, 2016, from Mayo Clinic, http://www.mayoclinic.org/diseases-conditions/postpartum-depression/basics/complications/con-20029130

Canadian Paediatric Society (2004). Maternal depression and child development. Pediatrics & Child Health9(8), Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724169/

CDC. (2016, August 18). Depression among women. Retrieved September 1, 2016, from Centers for Disease Control and Prevention, http://www.cdc.gov/reproductivehealth/depression/

Resources for Domestic Abuse Victims in the Greenville, SC Area

What is domestic abuse? 

“Abuse is a repetitive pattern of behaviors to maintain power and control over an intimate partner. These are behaviors that physically harm, arouse fear, prevent a partner from doing what they wish or force them to behave in ways they do not want. Abuse includes the use of physical and sexual violence, threats and intimidation, emotional abuse and economic deprivation. Many of these different forms of abuse can be going on at any one time.” (“Abuse Defined”. The National Domestic Violence Hotline. N.p., n.d. Web. 12 Aug. 2016.)

Sometimes, during a pregnancy, a troubled partner may turn to these types of behaviors. Do not wait until pregnancy to get help if you have reason to think signs of any of these behaviors are present. Use all the lists on this blog for help.

Call 911 if you are in immediate danger.

A relationship is abusive if your partner (for example: boyfriend, girlfriend, spouse) has a repetitive pattern with any of the following behaviors:

  • Embarrassing you or making fun of you in front of your friends, family, or teachers.
  • Putting down your accomplishments or goals.
  • Controlling your finances against your will.
  • Making you feel like he/she is smarter and that you are unable to make decisions.
  • Using intimidation or threats to get his/her way.
  • Telling you that you are nothing without him/her.
  • Treating you roughly (for example: grabbing, pushing, pinching, shoving, or hitting you).
  • Intimidating you with objects that could cause harm (for example: knives, belts, guns).
  • Calling you several times a night or showing up unexpectedly to check on you.
  • Using drugs or alcohol as an excuse for saying hurtful things or abusing you.
  • Blaming you for how he/she feels.
  • Pressuring you sexually for things you are not ready for.
  • Pressuring you to do self-harming things (for example: drugs, alcohol).
  • Making you feel like there is no way out of the relationship.
  • Hurting your pets or threatening to do so.
  • Defacing or destroying your personal property.
  • Preventing you from going or doing things you want with your friends or by yourself.
  • Trying to keep you from leaving after a fight.
  • Making you feel like everything that does not go right is your fault.

(“Abuse Defined”. The National Domestic Violence Hotline. N.p., n.d. Web. 12 Aug. 2016.)

Domestic Violence Safety Tips:

  • During an argument, or if you feel tension building, avoid areas in your home where weapons might be available (for example: the kitchen, bathroom, bedroom, or workshops).
  • If there are weapons in your household, such as firearms, lock them up.
  • Know where there is a safe exit from your home (for example: a window, elevator, or stairwell).
  • Discuss the situation with a trusted neighbor if you can. Ask him/her to call 911 if he/she hears a disturbance. Find a code word to use with them if you need the police.
  • Always keep a packed bag ready.
  • Know where you would go to be safe if you have to leave, even if you don’t really think you need to.

Resources in the Greenville, SC Area for Domestic Abuse Victims

1 (800) 799-SAFE

1 (864) 467-3633 (24/7 Crisis Hotline)

1 (800) 291-2139 (24-Hour Crisis Line)

1 (864) 242-6933

1 (864) 268-5589

1 (864) 235-4803

1 (864) 232-6463

Marijuana Use During Pregnancy

Marijuana (also known as pot or weed) is formally known as cannabis sativa. It is used in a variety of ways to obtain a pleasant feeling or even encourage food intake. The active part of the drug, tetrahydrocannabinol (THC), passes easily into the body’s bloodstream. It makes its way into the brain to cause the high and other sometimes not so desired effects. In a pregnant user, besides affecting her, it also affects the unborn child. If you have questions regarding marijuana use, please contact us for a FREE appointment. Our women’s clinic can educate you on health factors related to marijuana use in pregnancy.

As more is desired, the woman may be led to more potent drugs with even more dangerous effects. Addiction leads to poor performance and the risk of auto accidents increases. The high becomes very costly to the woman in every way possible, including her normal responsibilities. More physically dangerous actions occur, and effects become uncontrollable. The little person in the womb needs only nourishment from his/her mother, but he/she does not need the likely negative effects from a questionable drug.

Hospital studies have been done of marijuana users who were intoxicated and/or mentally impaired. Emergency room (ER) admissions show its most negative effects as some of these ER patients had dangerously combined marijuana with other drugs. Synthetic cannabinoids (synthetic marijuana) use has become another reason for ER visits. Dangerous results made by poor judgment were likely increased or caused by the marijuana’s effects. Younger age concerns exist in this picture. “Marijuana was the most commonly reported primary substance of abuse among admissions that initiated substance use at the age of 14 or younger” (SAMHSA Treatment Episode Data 2011).

What about brain formation concerns in the baby? Although findings are not all in, here is an example of what is known. A Swedish researcher’s finding was that circuit pathways in the brain can be permanently damaged from drugs. He explained that this damage occurs to a part (an axon) of a nerve cell. The process that sends impulses to another nerve cell does not happen in some pathways. Even if these pathways are not used for a long period of time, these axons can cause the brain’s nerves in those pathways to not properly communicate. Studies have shown increased incidence of mental illnesses and addiction tendencies in children that were exposed to cannabis while in the womb. For this reason, the respected medical researcher made the statement that “cannabis should be avoided during pregnancy” (Healthline News, 01/28/2014).

The British Medical Journal Open published an article earlier this year regarding effects of marijuana on fetal outcome, and from the 24 studies in this review, researchers concluded that exposure to marijuana in utero may affect the baby after delivery, although not structural birth defects, but effects such as low birth weight or need for NICU (BMJ Open, 04/05/2016).

The American Congress of Obstetricians and Gynecologists (ACOG) reported in July 2015 that 48-60% of female marijuana users continue their use of marijuana during pregnancy, because they may believe that marijuana use is not putting them or their baby in any danger. However, according to ACOG, studies suggest that marijuana exposure in utero may affect the child’s attention span and school performance, as well as possibly contributing to behavioral problems down the road. ACOG recommends that all pregnant women discontinue marijuana use.

Get OB care for your pregnancy, and follow your doctor’s guidance for going off drugs safely. Refusing marijuana and other drugs of abuse presented to you before and while pregnant is a major way to provide health for you, your pregnancy, and your child.

Source of information and quotes:

Barclay, Rachel; Healthline News (http://www.healthline.com/health-news/children-cannabis-impairs-fetal-brain-development-012814), quote by professor Tibor Harkany  at Karolinka Institutet in Stockholm, Sweden.

National Alliance on Mental Illness (http://www.nami.org/Learn-More/mental-health-Conditions/Related-Conditions/Dual-Diagnosis).

SAMHSA (www.samhsa.gov); this agency can offer help to deal with substance abuse and addiction.

Gunn, J.K.L., Rosales, C.B., Center, K.B., Nunez, A., Gibson, S.J., Christ, C., Ehirir, J.E. British Medical Journal Open. Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis. http://bmjopen.bmj.com/content/6/4/e009986.full?sid=695c8cf2-ab2f-4f33-834e-4898c16b6a3a), 04/05/2016.

The American Congress of Obstetricians and Gynecologists. Committee Opinion: Marijuana Use During Pregnancy and Lactation. Number 637, July 2015. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Marijuana-Use-During-Pregnancy-and-Lactation.

Resources for parents to find specialized care for their children:

Child Development Services is a link between several different agencies in the City of Greenville, SC and Greenville County (http://www.cdservices.org).

SC First Steps (http://scfirststeps.com/babynet/)

Nurse-Family Partnership (www.nursefamilypartnership.org)

Substance Abuse and Mental Health Services Administration (SAMHSA, http://www.samhsa.gov/)

How does the morning-after pill work?

After the sperm penetrates and fertilizes the egg, 46 human chromosomes come together in a one-of-a-kind genetic design that determines a person’s eye and hair color, gender, skin tone, height and even the intricate swirl of the fingerprints.

Depending on where you are in your menstrual cycle, the pill could affect you in one of three ways:

  • It may prevent ovulation: The egg will not be released to meet the sperm—so fertilization, sometimes known as conception, can’t occur.
  • It may affect the lining of your fallopian tubes so that sperm cannot reach the egg. This also prevents fertilization.
  • It may irritate the lining of your uterus. If an egg has already been released and fertilized by the sperm, this irritation could make it harder for the embryo to implant in your uterus.

Source: © 2009, 2012 Focus on the Family “The Morning-After Pill” pamphlet

Footnote 1: FDA Prescribing and Label Information for Plan B One-Step®, Rev. July 2009; pp. 13-14; www.accessdata.fda.gov/drugsatfda_docs/label/2009/021998lbl.pdf

Footnote 2: FDA Prescribing and Label Information for Plan B One-Step®, Rev. July 2009, p. 13; See footnote 1