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)

Break the Silence

Many of you reading this post are women who have given birth. What do you remember about that experience? Most women remember it for the rest of their lives. Just ask any mom out there about her births and she can pretty much recount them moment-by-moment. That is one of reasons it is so special to be part of that time in a women's life, because they remember you and your care forever.

Throughout the world today however many women are not experiencing the care you would want for yourself during those special moments. This happens in poor countries as well as rich. A number of organizations, including White Ribbon Alliance have recently started a campaign to highlight the need for respectful maternity care around the world.

I have experienced situations both here in the US and in Indonesia where women were not respected during those very vulnerable moments. One moment sticks in my memory from Indonesia. I was present at a birth (not at Bethesda) where the midwife slapped and yelled at the women giving birth about not getting prenatal care or coming to the hospital when her labor started. The situation was made all the worse by the fact that the women was delivering her baby who had already died at the time.

Here in the US jaded by those we see as "unfit mothers" (including those frequently abusing alcohol or drugs during their pregnancy) we don't treat every woman with the respect she deserves. I cannot tell you how many times I have gotten report and been told "she is one of those patients" or we picked you to be her nurse because "she and/or her family needs lots of patience." I know I have said some of the same things before during a long 12-hour shift. In reality though, that is no excuse and I have to admit reading through the charter and watching this film was convicting for me.

The 7 Universal Rights of the Childbearing Women

1. Every woman has the right to be free from harm and ill treatment. 

No one can physically abuse you. 

2.  Every woman has the right to information, informed consent and refusal, and respect for her choices and preferences, including companionship during maternity care. 

No one can force you to do or do things to you without your knowledge and consent.

3. Every woman has the right to privacy and confidentiality. 

No one can expose your or your personal information.

4. Every woman has the right to be treated with dignity and respect. 

No one can humiliate or verbally abuse you.

5. Every woman has the right to equality, freedom from discrimination, and equitable care. 

No one can discriminate because of something they don't like about you.

6. Every woman has the right to healthcare and the highest attainable level of health. 

No one can prevent you from getting the maternity care you need.

7. Every woman has the right to liberty, autonomy, self-determination, and freedom from coercion. No one can detain your or your baby without legal authority.  

International Women's Day

Today, March 8th, is International Women's Day. This is the 100th year the world has celebrated International Women's Day. It has grown to become a global day of recognition and celebration across developed and developing countries alike. There are thousands of events scheduled around the world, some big and some small including everything from photos to petitions.

One of the events that caught my eye will be held in England during the Women of the World Festival. It is a series of photographs from around the world highlighting women with the theme Dreams for My Daughter. This theme was chosen after Hadhya Yahya Mohamed Al‐Zawm from Yemen said the following at an event highlighting the issue of early marriage... 

“Every mother in the world dreams that her daughter will have a better life than she has. My mother was married at age 9 and had her first child at age 13. She wants more for me”

This video includes many of the photographs that will be displayed as well as quotes from mothers around the world about the dreams they have for their daughters. 

Maybe it is because I am one of four girls, but it made me start to think about how moms have so many dreams for their daughters... dreams for a better life, an easier life, more than what she had. This is especially true in the developing world where so often girls face a life with little education, early marriage and a higher risk of maternal mortality. There are things we can do to change this though. Simple things like helping girls stay in school, getting them good health care, and helping them support themselves. Each small change effects the next generation, with each generation building on the progress of the previous generation. Check out this video about "The Girl Effect" for more information. 

 

(for those of you reading this in an RSS reader or your email you may have to click on "read more" to make the videos visible and play them)