Suctioning Newborns

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

Maternal Health as a Priority: CMQCC

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 Effect of Incarceration and Reentry on Children, Families, and Communities

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

Mental Health and the Choice to Have a Child

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

http://natashatracy.com/bipolar-disorder/cant-pregnant-bipolar-disorder/

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

Mothers, Babies, and Chevron

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/

Moral Distress in Healthcare Workers

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.

Maternal Health Recognition

In honor of World Aids Day, which happens to be tomorrow, and Brenna’s presentation last Monday, I was doing a little reading about HIV/AIDS and PMTCT. It’s amazing to read how far we have come in the past 20 years against fighting this virus. Even though we still have a ways to go before eliminating it, it’s amazing to think what impact has already been made. Even “UNICEF believes that the elimination of mother-to-child transmission of HIV is possible by 2015, this means reducing the MTCT rate to below 5% and the number of children contracting HIV from their mothers by 90%” (Mbabazi, 2014). I couldn’t help but think about how we can start to make a similar impact on maternal health and why it is so difficult to raise awareness about this general problem seen globally. Why is it that everyone knows what the red and pink ribbons are for, but they can’t seem to remember what the white ribbon is for? What can we do to change this? What if there was an organization that helped to draw attention to safe motherhood on the coattails of other causes that reach peoples attention. Maternal health is affected by most health situations and so why not have a group that highlights how the big things affect maternal health?

I looked up online top 10 global health issues and came across this article titled “Top 10 Global Health Issues to Watch in 2014.” The top three were 1) Youth, 2) The lasting damage of war, and 3) Universal health coverage. We have talked about all of these things throughout the semester. It is clear to me that maternal health is embedded throughout all global health aspects. What can we do to highlight this fact to the rest of the world?

Mbabazi, D. (November, 2014). World Aids Day: How effective is PMTCT? The NewTimes. Retrieved from http://www.newtimes.co.rw/section/article/2014-11-24/183346/

Top 10 Global Health Issues to Watch in 2014. (January, 2014). IntraHealth International. Retrieved from http://www.intrahealth.org/page/top-10-global-health-issues-to-watch-in-2014

Breast is Best?

Is breast best?

We have touched upon the highly controversial debate of breast milk versus formula, but we have not discussed the matter in detail. Thus, I want to provide the forum to share thoughts and opinions about breastfeeding a baby or formula feeding a baby.

Many argue that mothers should breastfeed their baby. To begin with, breast milk can improve the child’s health, for the mother passes antibodies from herself to the child through the breast milk. As a result, the child builds his or her immune system to help fight off infections. In addition, due to the nature of the breast milk, the baby digests the milk more easily than formula. Moreover, the act of breastfeeding benefits not only the child but the mother as well. For example, through breastfeeding, the mother can bond with the child, which can improve the mother’s emotional health. Although breastfeeding appears as an ideal option for feeding an infant, various problems exist. For instance, as we discussed on Monday, the mother can pass harmful chemicals or viruses through the breast milk as well. Thus, the breast milk could actually cause the child more harm than good.

Individuals argue the aforementioned point about transmitting substances to the child to promote the use of formula for feeding the child. For example, the formula would provide the child with the necessary nutrients without the risk of transmitting fatal viruses. In addition, the mother can consume anything that she wants or needs, such as alcohol or medication, without the fear of passing it along to her infant. Furthermore, formula-feeding would enable both parents to develop a bond with the baby, for both partners can feed with a bottle. On the other hand, however, formula-feeding presents obstacles. For instance, parents must pay for the formula, which may cause financial stress. In addition, a mother can access breastmilk at any time, limited by the debate over breastfeeding in public, but she must travel to the store to purchase formula.

Thus, with all of the aforementioned information in mind, what would you all recommend: breastfeeding or formula-feeding? I would argue that a simple answer does not exist. Personally, I would follow the American Academy of Pediatrics’ recommendation of feeding a baby breastmilk until the age of one year old. However, this recommendation alludes to the debate about the age at which a child should stop breastfeeding. Moreover, mothers who abuse drugs or alcohol should use formula instead of breastmilk to eliminate the risk of transmitting the chemicals in the substances to the baby.

http://www.webmd.com/baby/breastfeeding-vs-formula-feeding?page=2

Maternal Health Policy Advocation

In reading the article by Shiffman and Smith that was on our course reserves it reminded me of our discussion about getting a political group in place solely for advocating on the behalf of women and their maternal needs. Having a focused group that would be there in place just for policies that would benefit mothers and potential mothers will be a step in the right direction. That said, there is one point of discussion that Smith and Shiffman express in their articles that I found to be disappointing. In the article the two address why certain global health initiatives receive more attention and success then others. They break  down the reasons down to 4 distinct categories for frameworks on determinants of political priority. One of the categories mentioned is Actors, otherwise known as the strength of individuals or organizations concerned with the issues. For safe motherhood the actors are of course the mothers and mothers to-be. However these women globally do not have much political power locally or globally. Another thing mentioned was that there is no historic or powerful organization that behaves as an actor when it comes to safe motherhood. I had to ponder this notion, and I was not able to think of any large over aching entity or institution that has advocated for safe motherhood. There are NGO’s and community organizations certainly, but no big well known name putting mothers on their list of things to be concerned about globally. With that stated, I am just wondering what kind of company/organization could you all see fit to take the issue of safe motherhood and make it a global priority? Do you think that it is even possible with just one?

Maternity Leave around the World

Hey, all.

We briefly touched upon the idea of maternal or family leave after childbirth in Cami’s presentation about Sweden. As she explained, Sweden implements a paid maternity leave policy for several weeks, something that we all envied. As a result, I decided to investigate the policies on maternity leave or parental leave around the world.

The first link shows an infographic for paid maternity leave in various countries. The following data really made an impression on me: Uzbekistan with 114 weeks, Mongolia with 156 weeks, Azerbaijan with 165 weeks, and Ukraine with 166 weeks. Due to the countries’ economic status within the world, I did not expect the aforementioned countries to implement such paid policies for multiple weeks. Furthermore, Finland surpassed all of the other countries with its policy of 167 weeks of paid maternity leave. Finland, a high-income country with a healthcare ranking of 31 according to the World Health Organization, offers an attractive maternity leave policy without compromising the economy or health care of the country, two common criticisms of paid maternity leave.

Unfortunately for us, not only does the United States rank lower on the health care list, but they also fail to provide paid maternity leave. According to the infographic, the United States offers ZERO WEEKS of paid maternity leave. This statistic confused me, for we discussed the maternity leave, minimal but existent, in the United States during Cami’s presentation. Thus, I inquired about the leave in the United States. During my research, I discovered the difference between our country and the rest of the countries in the world. According to the United States Department of Labor and the Family Medical Leave Act passed by President Bill Clinton, companies must provide employees with 12 WEEKS OF UNPAID maternity leave. Therefore, although the United States may offer more maternity leave than the Philippines (nine weeks paid) or the United Arab Emirates (six weeks paid), the latter two pay their employees unlike the United States. Thus, I pose the following question to you all: What influences the maternity or family leave policies in various countries? I believe that the culture in the United States contributes to the current policy in the country.

http://www.buzzfeed.com/laraparker/this-is-what-paid-maternity-leave-looks-like-around-the-worl

https://www.cia.gov/library/publications/the-world-factbook/geos/fi.html

http://www.businessinsider.com/best-healthcare-systems-in-the-world-2012-6?op=1

http://www.dol.gov/dol/topic/benefits-leave/fmla.htm