I didn’t know suctioning newborns was considered a controversial practice. I’m actually surprised because it seemed to me that most hospitals suctioned newborns once they’re born. At Dekalb Medical, a bulb syringe in the crib is part of their safety protocol and must be charted as present, along with the newborn’s security band, patient bands, etc. Apparently though, suctioning can induce adverse effects in the newborn such as bradycardia and apnea, and this practice may not even be as effective as people think. This study (http://www.sciencedirect.com/science/article/pii/S0140673613607758) compares the use of bulb suctioning a newborn with wiping the newborn’s mouth and nose with a towel. According to this study, both methods essentially have the same outcomes. However, more serious aspiration such as meconium aspiration was excluded from the study. So, suctioning still has a place in the care of newborns, but it is a practice that may need to become less prevalent.

Reference:

Kelleher, J., Bhat, R., Salas, A., Addis, D., Mills, E. C., Mallick, H.,…& Carlo, W. (2013). Oronasopharyngeal suction versus wiping of the mouth and nose at birth: A randomised equivalency trial. The Lancet, 382(9889), 326-330. doi: 10.1016/S0140-6736(13)60775-8

The readings and discussions from our past couple of classes have focused on maternal mortality as a political priority. Reading the Shiffman article, I thought back to a presentation given at the nursing school on October 6th by Dr. Christine Morton, a research sociologist who is part of the California Maternal Quality Care Collaborative (CMQCC). CMQCC was founded in 2006, when a study at UCLA revealed that the maternal mortality rate had increased almost 50% since 2001. The California Department of Public Health, Maternal, Child, and Adolescent Health Program and the California Perinatal Quality Care Collaborative teamed up to create CMQCC, to find reasons for this increase and how to prevent future maternal deaths. They analyzed data from many hospitals, formed a quality improvement panel, communicated using newsletters, meetings, and conferences, and formed partnerships with the government, CDC, and other funders, whom they refer to as “champions”. So far, they’ve recorded vast amounts of data for births in California, brought in many stakeholders (such as the American College of Nurse Midwives, Kaiser Health System, and California Office of Statewide Health Planning and Development), developed the California Pregnancy-Reated Morality Review Task-force, instituted quality improvement programs in hospitals, and reviewed hospitals.

This reminded me of our discussions because Dr. Morton discussed the importance of the 5C framework in their beginning stages. The 5C framework includes common purpose, cooperative structure, critical mass, collective intelligence, and community building. Their goal was to involve diverse types of organizations and individuals to bring different ideas to the table and collectively solve the problem. Various branches o CMQCC would have small group meetings with key maternity leaders throughout the state where they shared new information and pitched their ideas to obtain funding and support. This approach helped them gain the support and funding from many powerful “actors” in California. Today, they are a very successful organization with many branches working to reduce maternal mortality in California one step at a time.

Here is a link to their website for more information: https://www.cmqcc.org

The presentation about pregnant incarcerated women raised some pretty interesting questions about motherhood in prison. It’s something I never considered until that one presentation. The idea of sort of creating a “home-like” prison environment where mothers can be with their children is a little bit controversial for me. On the one hand, mothers can be with their children and continue to develop healthy relationships without the trauma of prolonged separation, which is great. But on the other hand…to me it almost seems like having a privilege that other people who commit the same minor crime, but do not have children, would not have. I wonder if that’s fair?

However, this could be a case where the benefits to the child and family overrule the other questions about fairness and justice. This article (http://aspe.hhs.gov/hsp/prison2home02/hairston.htm#Parent) discusses the effects of incarceration and reentry on children, families, and communities. If one scrolls down or clicks on the “Parent-child Relationships and Children’s Care” section, one will find that there are a lot of problems associated with separation due to incarceration. But the interesting part is even the mindset of the incarcerated may play a major role in the problems surrounding family breakdown, rather than just the separation itself. Overall, I think this article makes a strong case for at least increased visits for families in prison (as well as mothers), but perhaps also gearing toward a prison structure that’s more conducive to preserving the family.

Reference:

Hairston, C. F. & Addams, J. (2001). Prisoners and families: Parenting issues during incarceration. Retrieved from http://aspe.hhs.gov/hsp/prison2home02/hairston.htm

With the prevalence of depression diagnoses in the US, I think it’s time we have a honest discussion about mental health as a health risk when deciding to have a child. Physicians will inquire as to a woman’s physical health, but mental health is often overlooked. We consider weight, smoking status, and activity levels, so why should we not also consider history of mental illness when making the choice to get pregnant? With previous depressive episodes being high indicator of PPD incidence, hopeful mothers should consider their mental status carefully. With the birth of her child, a mother’s sole responsibility is no longer to herself. She must now consider the wellbeing of her baby on equal status as her own. Mental Illness seriously inhibits a woman’s ability to do so. I believe more discussion pre- and mid-pregnancy is necessary. Mental illness is often an overlooked and heavily-stigmatized aspect of health, but including it in the decision to reproduce is something I believe we can no longer afford to do.

I’ve found a couple blogs where women who have pre-existing mental illness or had serious PPD comment on their experiences and how it influences their decision regarding children. Take a read for yourself. They’re very interesing:

http://www.postpartumprogress.com/to-have-or-have-not-should-you-stop-having-children-if-youve-had-postpartum-depression

I Can’t Get Pregnant – I Have Bipolar Disorder

http://www.mommyish.com/2014/01/31/postpartum-anxiety/2/

Over the weekend I was surprised when I saw a TV commercial highlighting Chevron’s efforts to reduce mother to child HIV transmission in Nigeria. At first response, I was excited to see such a significant topic being discussed during a football game, but after further review, I began to consider some of the deeper implications of this campaign. Chevron’s actions are certainly noble, but can we really consider them altruistic? Big Oil, including Chevron, has done significant damage to communities around in the name of progress (and profit).  Elizabeth’s post about recognition made me wonder about this campaign. In our quest for maternal health issues to receive the attention they deserve, should we be prepared to partner with organizations that have clear ulterior motives? As long as we get the message out, do we need to concern ourselves with the whys behind it? Where do we draw the line between long-standing distrust and current need?

What do you think? Watch the video and sound off:

http://www.chevron.com/corporateresponsibility/community/health/

Hey, all.

As the semester comes to a close, I have reflected upon the material covered in this course. We have discussed various risk factors for birth, birth location, and cultural beliefs. Through our discussions, we have recognized the lack of resources in many regions of the world which contributes to the aforementioned topics. Furthermore, we have examined how inadequate supplies and resources affects the birth outcomes of the patients. However, we have not fully explored the idea of the relationship between the lack of resources and the healthcare workers.

According to “Moral distress in nursing practice in Malawi”, nurses experience high rates of moral distress from a variety of sources. For example, the moral distress stems from a shortage of staff members and a lack of resources, as well as mismanagement by superiors, behavior of colleagues, patients’ disrespect, and regulation violations. Furthermore, the article states, “Shortages of these resources meant that nurses cannot provide quality care thereby leading to frustration and demoralization,” (Maluwa 203). Therefore, the inadequate supplies affects not only the pregnant mothers but the healthcare workers as well.

As students in a “Birth and Global Health” course, I assume that many of us desire to pursue a career in a global context. Thus, we, as healthcare workers, will likely encounter situations in which the clinics, if one exists, do not have sufficient supplies. As a result, we may struggle with moral distress as well. Therefore, I pose the following questions to you all: How do you think the lack of resources will affect you? How would you cope with such effects, such as moral distress?

I aspire to pursue a career in humanitarian medicine. Thus, I anticipate that I will have to develop strategies to cope with the moral distress. For instance, perhaps physical activity or mediation may help me shift my focus onto what I can do rather than on the multitude of problems.

Maluwa, Veronica Mary, et al. “Moral Distress In Nursing Practice In Malawi.” Nursing Ethics 19.2 (2012): 196-207. Academic Search Complete. Web. 1 Dec. 2014.