The Dangers of Prematurity

I have really wrestled with what to write about from the Controversies in Childbirth Conference. We've been so busy around here lately, it's given me time to mull things over.

I will reference a talk given by Lucky Jain, MD, MBA from the Conference. I feel that the information he gave was so astounding, all should be made aware. Briefly, a short biography of Dr. Jain: He is currently the Richard W. Blumberg Professor and Executive Vice Chairman for the Department of Pediatrics at Emory University School of Medicine. He also serves as the Medical Director of the Emory Children's Center. In addition, he is an investigator at the Center for Cell and Molecular Signaling and holds a joint appointment in the Department of Physiology.

Obviously, a smart and well-educated fellow.

The information he gave was so well researched, clear, and concise, they let him go over on his time. He is the only individual that was allowed this privilege. I believe that if pregnant women had this information, they would make wiser decisions during pregnancy.

The topic Dr. Jain was speaking on was "Are C-sections Causing Premature Births and Adding to NICU Costs? I think we all know the answer to that question.

Babies are presumed to be "mature" at 34 weeks. He posed the question, is it safe to deliver a baby after this time? The answer is yes and no. 50% of babies born at 34 weeks will be in NICU. While we have decreased the rate of stillbirths in this country, prematurity has dramatically risen.

What are the long term effects of prematurity? Dr. Jain had a very distinct picture of a baby's brain at 35 weeks versus the brain at 40 weeks. There was a HUGE difference. The 40 week brain was significantly more developed.

Studies have found that 74% of handicapped adults were born between 33 and 37 weeks gestation. In addition, babies born before 37 weeks are five times more likely to be in special education by the time they are in kindergarten through fifth grade.

While the baby's body looks fairly well developed in the last trimester, this is the time when the brain is developing. Cholesterol, yes, you heard me right, and good foods, including proteins, are essential in the baby's brain growing and developing. Each week, day, even hour, that a baby stays in the womb is invaluable.

Another interesting item Dr. Jain addressed was Fetal Lung Fluid. I must admit, this was the first time I've heard of this. I took comfort in seeing that most of the other people in attendance didn't seem to know much about it either! According to Dr. Jain, fetal lung fluid is produced to inflate the lungs and pours out into the amniotic fluid. This is how the lungs are checked for maturity during pregnancy by checking the amniotic fluid. When labor is allowed to start on its own (no induction!), the valve that releases this fluid is shut off. The fetal lung fluid levels gradually decrease over the course of days leading up to labor. It really is true that the baby triggers labor. If a C-section is done without the onset of labor, the baby does not receive this message. This is a contributing factor to C-section babies having a more difficult time breathing. According to Dr. Jain, a C-section should NEVER be scheduled to take place before 39 weeks and it is crucial that the dates are correct. He felt strongly that it should be later than that, if done at all. The average in the US is 38.2 weeks, however. Remember, the average means that there are many babies being born on the lower end of that number. According to United Healthcare, if a baby is born before 38 weeks, he is twice as likely to be admitted in the NICU.

I hope you will ponder this information and share it with your friends and family who might be pregnant. The womb really is the best place to grow a baby -- not an incubator in the NICU.

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The Birth Survey

For those of you who haven't heard of The Birth Survey, listen up. If you have heard of it, but haven't filled yours out, do it now! If you have filled it out, encourage your friends and family to do it too. I had heard about it, but learned so much more from Elan McAllister, President of Choices in Childbirth, who spoke at the Controversies in Childbirth Conference. This is the first item I wanted to write about from the conference because it is of the utmost importance.

All women are asked to participate who have given birth within the last three years. The Survey is gathering data on providers, doctors, midwives, hospitals, etc. When women learn they are pregnant, they will be able to go to The Birth Survey to find information about different doctors or midwives in their area. Obviously, the more women that participate, the better the data, the more information women are able to get to make informed choices about their medical care.

So far, over a third of participants have given birth with a Licensed Midwife or Certified Professional Midwife and gave birth out of the hospital. My reasoning for this is that these are the women who are excited to report about their wonderful and empowering birth experiences. This is a survey for all women and all types of births.

Here's how it works:

Share:
Take the survey. Simple.

Connect:
View the survey reports. This will include consumer feedback on the hospitals, doctors, midwives, and birth centers in your area.

Learn:
View the hospital intervention rates. This is so empowering to have this information in order to make informed decisions about where and with whom to birth your baby.

What I love about this is that it is real. No one can tamper with the results. It will speak for itself, based on actual births. It gives women a voice, who perhaps had a less-than-perfect birth, to help other women avoid the same birth attendants, etc. That is why I say that all women should participate in the survey.

The project was just started Fall 2008 by CIMS (Coalition for Improving Maternity Services) and the first results are due out the beginning of April. It will be regularly updated and will include birth surveys filled out for 5 years, so the data stays current.

So what are you waiting for? Go do the survey! Make a difference.

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Controversies in Childbirth Conference

I have spent the last 3 days at the Controversies in Childbirth Conference here in Ft. Worth. I had no idea what to expect, and I must say, it exceeded my expectations. There were roughly 200 people attending from all over the country. Midwives of all types, doulas, educators, family practice doctors, OB/GYN doctors, nurses, community health workers, attorneys, etc. It was great.

I took pages and pages of notes, so I'll be reporting on it, probably, for weeks. My house, as you can imagine, has fallen apart while I've been away, so I'll be catching up with laundry and doing some major clean up. I did want to share some of the highlights of the conference through pictures, however.


I got to meet Debra Pascali-Bonaro, the director of "Orgasmic Birth" and even eat lunch with her and some other fantastic women who are "movers and shakers" in the world of birth. She also started out as a Bradley Instructor many years ago before moving on to other things. It was fascinating to hear how the movie came about. I'll share more about that later. She was a delightful person.


I recently read a book called "Homebirth in the Hospital" by Dr. Stacey Kerr, a Family Practice doctor working in CA. I didn't realize it at the time of reading it, but she was asked to be a speaker at the conference. It was exciting to get to meet her and get to know her a bit. If all women could have a doctor like that by their side when they give birth, we'd certainly be in good hands. It's a fabulous read, for anyone interested. It also has a chapter in the back of the book written for the doctor who is interested in implementing a program like hers into his/her practice. Amazingly, I bought mine at our local Barnes and Noble.



The next person I met was the President of Choices in Childbirth in NY, Elan McAllister. You'd recognize her from "The Business of Being Born." In fact, my favorite "feel good" quote from the movie comes from her -- when she describes that moment in birth where you think you just can't do it, and then you do it, you "scale the wall." She was great. Definitely a person making a difference in a big way. She is very involved in The Birth Survey, which I will talk more about later. She said that my movie cover is the first she's ever been asked to sign! I hope it was as fun for her as it was for me.



The last person I got an autograph from and picture with was Robbie Davis-Floyd, who appears in all the recent birth movies. She is the anthropologist who gives so much history of midwifery and really helps us understand where we came from, where we are, and where we are going, in terms of birth in not just this country, but in the world. Again, I have lots to share from her talks at the conference.

It was such a privilege to meet all these women who are making such big differences in the world of birth. They truly do it for the women and the babies. Stay tuned for lots of exciting information from the Conference.

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