Remembering the Little Ones We Have Lost

Trevor, Cooper, Hudson, David, Bethany Joy, Eliana... these are just a few of the babies who I have known who have been lost - some before they were born and some shortly after.

In my work as a nurse and midwife I have had the opportunity to walk alongside several families as they dealt with the loss of their baby or child. For many they walked into their 20 week ultrasound expecting to find out that they were having a boy or girl and some fun pictures to share with everyone. They came out knowing that their child would never live outside the womb. Others came to the hospital or the office expecting to hear the beautiful sound of their baby's heartbeat but instead it was silent.  

I wrote this in my journal after one those experiences:  Today I helped a woman give birth to her fifth child… but instead of tears of joy there were tears of sadness… instead of laughter there was crying… instead of hellos there were goodbyes. This was their fifth baby but he like all of his brothers and sisters was born still. He was perfect but too small to live. He weighed four ounces and was five and half inches long. His hands and feet were tiny and perfect as I made impressions of them in ink and clay. Together his mother and I gave him his first and only bath. We wrapped him in blue and placed the tinniest blue hat on his head. We took pictures. He will be remembered forever in his parents hearts. 

This touching and sad radio program tells the story of another midwife helping her patient through the loss of her baby and the impact it had not only on the family but the midwife.  

It has been said that when a child loses their parents, they are called an orphan. When one loses their spouse they are a called widow or widower. When a parent loses a child, there isn't a word to describe them. Every day approximately 145 babies between 20 weeks gestation and one year of age die in the United States. October 15th has been designated as Pregnancy and Infant Loss Remembrance Day. Today around the world people will light candles and release balloons to remember those who have gone too soon and their families. Today and every day please remember them in your thoughts and prayers. 

National Midwifery Week

Did you know that this week in the United States is dedicated to midwives? 

For me it makes me think of my fellow midwives. So many memories of long study sessions with fellow midwifery students both on Skype and together during Clinical Bound. We kept track of each other as we caught our 40 babies and completed the 675 hours of clinicals required for graduation. Then we sweated and worried our way through a comprehensive exam and then our board exam. Finally, we were able to add master of science in nursing (MSN) and certified nurse-midwife (CNM) after our names. Today our class cares for women and catches babies in several states and soon Indonesia. 

A late night study session at school during Clinical Bound

Yep we all passed the test of catching the mannequin's baby

 As I have traveled this journey and shared with others that I am a certified nurse-midwife, I have come to realize that many have questions about midwives. Did you know that midwives are critically important in providing care to women from adolescence to beyond menopause, but their expert knowledge of women’s health is often overlooked? Even though the general public often associates midwives exclusively with maternity care, many women visit a midwife for a range of services before and after pregnancy. That means whether you’re ready for your first pap test, planning for pregnancy, or experiencing menopause you can choose a midwife to provide your care.  

Check out this web page for more information about midwives and to hear stories from and about them: Our Moment of Truth

Breastfeeding

It is hotly debated topic in the Western world. One that usually revolves around what is most nutritious for the baby and works best for mom. In places like Indonesia though it can be a matter or life and death. One reason using formula instead of breastfeeding can be deadly is because it must be mixed with clean water, which can be hard to find or expensive to buy in Indonesia. Formula is also expensive, so parents sometimes dilute it so it will last longer, which leaves the baby malnourished. 

Research shows that 1.4 million child deaths around the world could be prevented each year by proper breastfeeding. In Indonesia between 400-500 children under the age of five die each day. In addition, less than a third of babies are exclusively breastfed until the recommended 6 months of age. It is estimated that the simple intervention of breastfeeding would save an estimated 27% of those children.

Things are changing though. New laws are being enacted which prevent formula companies from targeting advertising at parents of babies less than a year old. There are also new fines and even jail time for those who prevent moms from breastfeeding such as workplaces and public places. 

In addition, many hospitals that previously only passed out samples of formula and did little to educate new moms about breastfeeding are now adding programs that encourage bonding and breastfeeding in the first hours after birth. The hope is that these new laws and programs will help turn the tide and reduce the number of babies dying from very preventable causes.  

If you are interested in reading more, there was an article by PBS Newshour that you can read here, including a photo essay. 

Prematurity

The baby was born premature. 

What do you think of when you read that sentence? Does it make you ask questions like who and where and why? What happens if I show you this picture...

They say a picture is worth a thousand words. In this case I would guess it is at least more emotional. Really though does it answer any of your questions about who and where and why?

So let me tell you a little of his story. This little baby is David Anugerah. He was born two months early at 32 weeks. He was Natalia's third baby. For about a week, we at Bethesda Hospital struggled to help him survive. We helped him breathe, eat, and stay warm. We tried hard to protect him from infection. It was his immature lungs however that we couldn’t help. There were none of the newer drugs such as surfactant available. So we wrapped him in warm blankets and in his final moments his mom held him. He passed away just 8 short days after his life began. This left his mom, Natalia, with just one child. I don't know why he was born early. His death was one of those that helped me realize that there was more that I could do if I knew more and had more training. This led me to return to school and become a nurse-midwife. My hope is that as a nurse-midwife I can help prevent women like Natalia from having their babies so early.

In recent years, there has been an increasing focus on preterm birth and its effect on countries around the world, rich and poor. A recent report by 50 international organizations is shedding new light on the topic and giving us current research. Here are some of the fascinating facts I found when reading the report:

• Preterm birth rates are increasing in almost all countries with reliable data.
• Prematurity is the leading cause of newborn deaths (babies in the first 4 weeks of life) and now the second-leading cause of death after pneumonia in children under the age of 5.
• Half of the babies born at 24 weeks (4 months early) survive in high-income countries, but in low-income settings, half the babies born at 32 weeks (two months early) continue to die due to a lack of feasible, cost-effective care, such as warmth, breastfeeding support, and basic care for infections and breathing difficulties.
• 15 million babies are born too soon each year. Over 1 million children die each year due to complications of preterm birth. 

The map above shows which countries are struggling the most with high rates of preterm birth. Indonesia is in red, which indicates that for every 100 babies born more than 15 of them are born early. There are several known causes of preterm birth and many that are not fully understood. There are several simple interventions that can help decrease preterm birth, even in places with less resources like Indonesia. For example:

• Decreasing the rate of adolescent pregnancies and increasing the time interval between children.
• Prevention and treatment of infections such as malaria and HIV before or early in the pregnancy. 
• Improve the health of women suffering from chronic illness like diabetes, asthma, and thyroid disease before they get pregnant. 
• Improve the nutritional status of women before they get pregnant and early in the pregnancy by helping them gain or lose weight as appropriate. Help those with nutritional deficiencies like iron-deficiency anemia get the nutrients they need.

There is a lot of work to do in places like Indonesia, but also in places like the United States. You can read a lot more and the report here, if you are interested. 

Mother's Day

This weekend here in the United States we are getting ready to celebrate our mothers. I remember once when my dad was working for the phone company he told me that one of the busiest day for phone calls all year was Mother's Day.

Our mothers hold a special place in our hearts and memories. What do you think of or remember when you think of your mom? I remember notes in my school lunches signed with her distinctive heart signature. I remember her letting me talk through my options and listening to her words of wisdom as I considered where to go to college or get a job or one of those other "big" decisions of life. I remember when the tears would come she would let me have a good cry and then tell me to go wash my face and brush my teeth and go to bed because everything looks better in the morning. The first time I shared those same words of wisdom with a patient, I am pretty sure I could hear the echo of my mom's voice.  

This Mother's Day as we celebrate and remember those moments I want us to also remember that this day and every day there is a tragedy happening to mothers around the world. This Mother's Day, 1,000 mothers will die. They will die not from old age or cancer but because of complications during pregnancy or childbirth. 90% of these complications are preventable. The line at the end of this video says it all... "because out there, there is a mother that needs you, right now." So get more information and get involved. Organizations like Every Mother Counts and White Ribbon Alliance are a good place to start.

  (For those reading this in your email or via RSS you might need to click on the link to the blog to be able to watch the video)

International Day of the Midwife 2012

I love May! Flowers are blooming and we get to celebrate nurses, midwives and mothers!! Tomorrow, May 5th, is International Day of the Midwife.

No mother should have to risk her life or that of her unborn baby by going through childbirth
without expert care. The consequences of this are tragic. Over 350,000 women die each year as a result of preventable maternal causes. Millions more suffer infection and disability. Families are devastated.

Every year over 800,000 newborn babies die during childbirth, and more than 3 million babies die
before they are one month old. More than 7.6 million children die before the age of 5. Almost all
of this is readily preventable with proper midwifery care.

It is why the world needs midwives now more than ever. Midwives save lives.

Today and tomorrow those passionate about midwifery will be meeting both locally and virtually to celebrate and learn. One of my favorites is virtual and it starts shortly and runs for the next 24 hours. It is hosted in New Zealand, so it starts at 3 pm PST. Each hour brings a new topic by different speakers. With topics ranging from "Birthing at Home Regardless of Risk: Educated Choice or Extreme Sport" to "Nuchal Cords: Ritual and Routine" and "Working in War-Torn and Post-Conflict Countries" there is a topic for just about everyone. You can find out more by watching this YouTube video or by checking out this web page for the schedule and times where you live. The presentations are also recorded and will be available afterwards to watch if you aren't able to attend the live conference.

 

(For those reading this in your RSS reader or email you might need to click on the link to the blog to see the video)

Worldviews and Latrines

I spent last week in Florida attending a Health, Agriculture, Culture, and Community Workshop hosted by ECHO and MedSend. This workshop was a requirement as part of my grant from MedSend (more on that soon on my other blog). I will be honest I had no idea what to expect of this workshop but I have to say I learned a lot and met a lot of great people. 

The workshop brought together nurses, physician-assistants, physicians, nurse-practitioners, a midwife, and a veterinarian who have all dedicated to serve in an area of need around the world and in the United States. We came from a variety of backgrounds and are serving with several different organizations, so it was great to compare notes and learn from each other. It was amazing to hear their stories and about the ministries God has planned for them. 

The workshop was led for the most part by Dr. Dan Fountain. He served as a doctor in the Congo for several decades. We covered a lot of topics in the five days we were together. Much of it was practical information and ideas that we can adapt and apply to our own work. We heard lots and lots of stories from Dr. Fountain about his years of service. One of the important things I have been learning is the importance of not just importing my culture and worldview but instead using a Biblical worldview. We also spent several hours each day hearing from the experts at ECHO. They taught us about plants, animals, and appropriate technologies we can use in our respective areas of service to improve the health and nutrition of the people we are serving. I really consider myself pretty much lacking a green thumb, but they provided numerous simple resources and ideas for us. Here are a few pictures from the week...

Learning in the Classroom

Learning on the Farm

Learning about appropriate technologies we can use to improve community health

Hands-on learning about practical techniques to use in community health

Our Group (minus one)