In Honor of Pregnancy and Infant Loss Awareness Month...

By Ella Clark

In honor of National Pregnancy and Infant Loss Awareness Month, Lamaze is dedicating this blog to the difficult subject of perinatal loss.  Perinatal loss refers to the time soon before or after birth during which a newborn dies or a pregnancy is lost.  Some of the content of this blog is especially difficult, and may be potentially triggering for those who have experienced the loss of a wanted pregnancy or death of a child.

When planning to bring a new life into the world, preparing for the loss of a child is the last thing new parents usually consider.  While the number of parents who experience the loss of a wanted pregnancy or newborn is relatively high, people often keep the their grief private.  Wanted pregnancies that result in the death of a fetus, or the unexpected death of an infant, leave parents who have already begun a bonding process with that child or fetus, grieving.  After the bond breaks as a result of a death, parents express their sadness in similar ways to those who have lost an older child.  The emotional aspects of miscarriage are discussed further in Postpartum Progress’s article “13 Things You Should Know About Grief After Miscarriage or Baby Loss”, by Kate Kripke.  Kripke reminds readers of the normalcy, and validity of the complicated emotions faced after the loss of a pregnancy or new baby.  

Unfortunately, many people may not understand what suffering parents may feel in the wake of an ended pregnancy or child’s death, which is why connecting with other people who have also gone through this unique kind of loss may help parents heal.  For those living in the Ann Arbor area the Lamaze Family Center of Ann Arbor offers a free monthly support group facilitated by those experienced in dealing with infant and fetal loss.  The remainder of this blog will be used to define, and briefly explore loss related to miscarriages, stillbirths, infant death, Sudden Infant Death Syndrome, and late term abortion.  

Miscarriage (spontaneous abortion)- The loss of a pregnancy before 20 weeks in the womb.

The Our Bodies Ourselves article “Miscarriage in the First Trimester” points out that “15-20% of known pregnancies end in miscarriage”.  These numbers include only known pregnancies, meaning many other pregnancies which parents were unaware of have also ended in miscarriage.  “Miscarriage in the First Trimester” focuses on describing how most people experience the physical process of a miscarriage, letting readers know when to seek health care and the variety of miscarriage related medical choices parents must make.  

Blogger Lauren Wayne shares her miscarriage story with readers in the blog “On a First Miscarriage”.  Wayne describes, without graphic detail, the process of becoming pregnant, physically losing the pregnancy, and the emotions she experienced in the time after the loss.  Throughout the story, Wayne also discusses her interactions with others also touched by loss, keeping in mind a broader range of lived experiences.

Stillbirth- According to March of Dimes stillbirth is described as a fetal death after 20 weeks in the womb.

The March of Dimes, is a non profit devoted to helping families carry wanted pregnancies to term, while offering support for those whose pregnancies end in loss.  Their informational webpage “Pregnancy Loss” lets visitors know that 1 in 160 pregnancies ends in stillbirth.  In depth explanations of what can happen after a stillbirth diagnosis are included on the page, including what to expect from medical staff including necessary tests, the possible causes of miscarriage, and possible risk factors to keep in mind for future pregnancies.  

If you’re interested in learning more from others who have experienced stillbirth the website Still Birthday provides a wealth of information about stillbirths including, first hand accounts, what to expect, information about stillbirth support, and how to heal.

Infant death- Defined as the death of a newborn from birth through the first year.

According to the CDC website article “Infant Mortality” about “24,000 infants died in the United States in 2011”.  A majority of these deaths, the website states, are a result of birth defects, premature birth, SIDS, injuries, and complications that arose during pregnancy.  The CDC also reminds readers that the rate of infant death indicates the general health of populations as a whole.  For example, if a specific group of people experience high rates of infant death, the rest of the people in this group are also likely to experience poor general health.  

Unfortunately, In Michigan there are several areas with relatively high rates of infant death, including the city of Detroit.  The large number of infant deaths in the area has been attributed to high rates of poverty, in both the city and its residents, and structural racism, which leaves many people of color without the adequate support necessary to new parents.  As pointed out by Esmé E. Deprez and Chris Christoff in “Babies Pay for Detroit’s 60-Year Slide With Mortality Above Mexico’s” most of the country has experienced a decrease in infant mortality, while Detroit’s rates have stayed relatively high.  In fact,  Detroit has the highest rates of infant death in the country, higher even than the average rates of infant death in China, Mexico, or Thailand.  Deprez and Christoff let readers know that “non-whites made up 21 percent of Michigan’s population but 43 percent of infant deaths”, meaning even though whites make up the majority of the population in Michigan almost half of all infant deaths occur in families of color.  Fortunately, there are birth professionals who devote their lives to changing this reality.  One such birth expert is Sherry L. Payne MSN RN CNE IBCLC CD(DONA) BSN,  writer of the Science and Sensibility article “Black Infant Mortality and the Role of the Childbirth Educator and Doula”.  Payne encourages birth educators and support people to keep in mind the impact of racism when working with clients, also stressing the importance of people of color working in the birth industry themselves.  In addition to concerned birth workers, the city of Detroit has also implemented the Make Your Date program designed to put soon to be parents in contact with the education, and resources they need to ensure healthy pregnancy and birth outcomes.   

Sudden Infant Death Syndrome (SIDS) or Crib Death- The unexplained, unexpected death of a child under a year old, who otherwise appeared healthy.  

According to Postpartum Progress 5,000-7,000 infants in the United States die from SIDS each year.  While the cause of SIDS is unknown it is one of the leading causes of infant death.

Risk factors for SIDS outlined by the March of Dimes page “Sudden Infant Death Syndrome” include:

The infant sleeping on the stomach or side

Soft bedding, pillows or stuffed toys in the child’s sleeping area

A hot room or too many layers of clothing on the infant

Older people sharing a sleeping space with the infant

Being a baby boy

Being Black or Native American

Being born Premature or low weight

Infants living with people who smoke, drink or use recreational drugs

Late Term Abortion- An abortion is generally considered late term once a pregnancy has reached 24 weeks or longer.  Jodi Jacobson explains in the article “Late Abortions: Facts, Stories, and Ways to Help” featured on RH Reality Check, that people who elect for late term abortions usually do so because of genetic abnormalities, which are not usually detectable until 24 weeks or later.  These parents usually experience a similar sort of grief as those who have gone through fetal or infant loss, despite the fact that late term abortions are voluntary.  In many cases, parents elect for late term abortions, for otherwise wanted pregnancies, when complications with the fetus would place an undue burden on parents or family members, severely restrict the quality of life on the child, or place the parent’s or child’s life at risk.  

As explained by the online magazine article “The Truth Behind Late-Term Abortions”, featured on the site Everyday Feminism, abortions after 20 weeks make up only about 1% of all abortions performed in the United States.  In most cases the parents who have late term abortions expected to carry their pregnancy to term, but due to unforeseen complications with the pregnancy, or physical development of the fetus, parents are faced with the difficult decision of whether or not to abort their pregnancy.  Though these pregnancies are ended voluntarily, as explained above, parents do not always view the abortion as such and will feel the effects of loss similar to parents who go through miscarriage or stillbirth.

Gretchen Voss describes her own late term abortion in the article “My Late Term Abortion” featured on the Our Bodies Ourselves website.  For those interested in connecting with others who have also had a late term abortion the online forum A Heartbreaking Choice offers support, information about the decision making process, message boards, and related medical information.

Though nothing can stem the hurt of the loss of a wanted pregnancy, a combination of healthy coping mechanisms, and an understanding of the physical and emotional stages of loss may keep your grief from becoming all consuming.  Keeping in mind that the grieving process looks different for everyone, the distinction between grief and full blown depression is fine.  By keeping track of the length and severity of your feelings associated with this difficult time may help you detect and treat any depression symptoms before they become a serious concern.  However a person chooses to express their emotions, it is important to know that you are not alone in your feelings, and that services do exist for those in need of additional support.   

Works Cited

"Baby Care 101." March of Dimes. 1 Mar. 2012. Web. 13 Oct. 2014. <http://www.marchofdimes.org/baby/sudden-infant-death-syndrome.aspx>.

Casper, Monica J. "The Color of Infant Mortality." Truthout. 4 Sept. 2014. Web. 13 Oct. 2014. <http://www.truth-out.org/opinion/item/25975-the-color-of-infant-mortality>.

Deprez, Esmé E., and Chris Christoff. "Babies Pay for Detroit's 60-Year Slide With Mortality Above Mexico's." Bloomberg. Bloomberg, 11 June 2014. Web. 13 Oct. 2014. <http://www.bloomberg.com/news/2014-06-11/babies-pay-for-detroit-s-fall-with-mortality-above-mexico.html>.

"A Heartbreaking Choice." A Heartbreaking Choice. Web. 13 Oct. 2014. <http://aheartbreakingchoice.net/>.

"Infant Mortality." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 12 Aug. 2014. Web. 13 Oct. 2014. <http://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm>.

Kripke, Kate. "13 Things You Should Know About Grief After Miscarriage or Baby Loss."Postpartum Progress. WordPress, 16 May 2013. Web. 13 Oct. 2014. <http://www.postpartumprogress.com/13-things-you-should-know-about-grief-after-miscarriage-or-baby-loss>.

Kacere, Laura. "The Truth Behind Late-Term Abortions." Everyday Feminism. 6 June 2014. Web. 13 Oct. 2014. <http://everydayfeminism.com/2014/06/truth-late-term-abortions/>.

"Late Abortions: Facts, Stories, and Ways to Help." RH Reality Check. Web. 13 Oct. 2014. <http://rhrealitycheck.org/article/2009/06/02/lateterm-abortions-facts-stories-and-ways-help/>.

"Make Your Date." Make Your Date. See Quinn. Web. 13 Oct. 2014. <https://makeyourdate.org/>.

"The Mary G. Schuman Miscarriage & Newborn Loss Support Group." Lamaze Family Center Ann Arbor. Design Hub. Web. 13 Oct. 2014. <http://www.lamazefamilycenter.org/?module=Class&class=Group&groupID=4>.

"Miscarriage in the First Trimester - Our Bodies Ourselves." Our Bodies Ourselves. Cornershop Creative, 9 Apr. 2014. Web. 13 Oct. 2014. <http://www.ourbodiesourselves.org/health-info/miscarriage-in-the-first-trimester/>.

Muza, Sharom. "Black Infant Mortality and the Role of the Childbirth Educator and Doula."Science and Sensibility: A Research Blog About Healthy Pregnancy, Birth & Beyond. 16 Sept. 2014. Web. 13 Oct. 2014. <http://www.scienceandsensibility.org/?p=8682>.

"Pregnancy Loss." March of Dimes. 1 Feb. 2010. Web. 13 Oct. 2014. <http://www.marchofdimes.org/loss/stillbirth.aspx>.

Stone, Katherine. "What Is the Difference Between Grief & Depression After Pregnancy Loss?" Postpartum Progress. 2 Sept. 2009. Web. 13 Oct. 2014. <http://www.postpartumprogress.com/what-is-the-difference-between-grief-depression-after-pregnancy-loss>.

Voss, Gretchen. "My Late-term Abortion - Our Bodies Ourselves." Our Bodies Ourselves. 11 Jan. 2011. Web. 13 Oct. 2014. <http://www.ourbodiesourselves.org/stories/my-late-term-abortion/>.

Wayne, Lauren. "On a First Miscarriage." Hobo Mama. 4 May 2010. Web. 15 Oct. 2014. <http://www.hobomama.com/2010/05/on-first-miscarriage.html>.

How Do You Overcome a Fear of Labor and Delivery?

By Ella Clark

Anxious About an Upcoming Birth?

No Need to Fear, Lamaze is Here

Normal anxieties about an upcoming birth turn into the phobia known as tokophobia when fears about birth begin interrupting your daily life.  Symptoms of tokophobia include trouble sleeping, constantly thinking about the possible negative outcomes of birth, and panic attacks, which are commonly associated with the additional symptoms of rapid breathing, shortness of breath, an increased heart rate, and an extreme feeling of dread or fear.   A recent article “Explaining tokophobia, the phobia of pregnancy and childbirth” by Monique Robinson published on The Independent’s website explains that tokophobia affects about 3-8% of pregnant people.  Robinson explains that those with tokophobia are more likely to request cesarean sections, and epidurals than those without.  While there are many reasons why someone might develop tokophobia, such as having experienced any type of abuse, sexual trauma, or a history of anxiety and depression, Robinson goes onto explain that a negative experience with previous births may also play a role in its development.  

According to a recent journal article “Why Are Young Canadians Afraid of Birth? A Survey Study of Childbirth Fear and Birth Preferences among Canadian University Students", published in Midwifery, and as mentioned by Robinson, a fear of childbirth can sometimes be associated with a lack of understanding of what to expect, especially if the majority of your information about birth comes from popular media like television.  Unfortunately, most TV shows that feature birth stories focus on those who have dangerous, and obscure complications, rather than the more common low risk birth.  However, people who learn about birth from family members, and personal acquaintances who have experienced low risk birth are less likely to fear birth.  Another way of reducing fears associated with pregnancy, and birth, mentioned by both articles, was providing people with accurate, evidence based information about birth, and pregnancy.  

Some of the ways Robinson’s article suggests for those seeking to overcome tokophobia include, education about birth, and pregnancy, understanding what went wrong if you have experienced a negative birth, finding others to offer emotional support, and experiencing a positive birth.  Fortunately, Lamaze offers a wide range of classes focused on providing the most up to date, and accurate information about childbearing possible.  If you’re strapped for time, interested in a childbirth refresher course, or are want to get to know Lamaze without committing to a full four week childbirth class, our Low-Down on Labor, and Labor Support classes are a great option.  Low-Down on Labor deals with understanding the realities of low risk birth, and the importance of understanding the changes your body goes through during pregnancy, and delivery.  Labor Support focuses on coping with pain, and learning how to stay relaxed during childbirth.  Together, both classes are perfect for partners interested in learning more about what their partner will experience, and how to take a hands on approach to assisting a birthing person.  Both classes are only two hours long, and offered at the low price of $50 each.  

References

Robinson, Monique. "Explaining Tokophobia, the Phobia of Pregnancy and Childbirth." The Independent 11 Sept. 2014. Web. 22 Sept. 2014.

Stoll PhD, Kathrin, Wendy Hall RN, PhD, Patricia Janssen PhD, and Elaine Carty CNM, SciD. "Why Are Young Canadians Afraid of Birth? A Survey Study of Childbirth Fear and Birth Preferences among Canadian University Students." Midwifery 30 (2013): 220-26. Web. 1 Aug. 2014.

Maternal Quality Improvement Program

Blog post by Ella Clark, Lamaze Family Center intern

ACOG and ASA Team Up to Create a Maternal Quality Improvement Program

                                       

The American Congress of Obstetricians and Gynecologists (ACOG), and the American Society of Anesthesiologists (ASA) are currently working together to create a unified system of reporting and measuring the results of maternity care in the United States, which will be known as the Maternal Quality Improvement Program.  By tracking the quality and outcomes of care on a national level health officials hope this will encourage transparency among hospitals, and help researchers learn which medical practices result in the fewest medical complications for mothers and babies, which health officials hope will result in a raise in the standard of care across the country.  

A University of Rochester's research study published in the August issue of Health Affairs prompted an increased interest in the creation of a national reporting system.  According to the Rochester study, complications related to c-sections performed in hospitals which were considered low performing happened at five times the rate of hospitals that were considered high performing.  For mothers who delivered vaginally, complications in hospitals that were considered low performing happened at twice the rate of hospitals that were considered high performing.   Though most of the complications mentioned in the Rochester study were not considered life threatening, it is important to note that a steep divide in the outcomes of maternal care still exists between hospitals, a divide that the Maternal Quality Improvement Program hopes to gap.  As ACOG pointed out in a recent statement on the Rochester study, hard data proving that extreme difference in care exists between hospitals proves the value of creating resources such as the Maternal Quality Improvement Program.  

Currently, the Michigan Health and Hospital Association (MHA) Keystone Center is working together with participating Michigan hospitals to create an environment of transparency and accountability for hospitals in our state.  Each hospital involved with the MHA Keystone project makes use of evidence-based practices which has resulted in lower rates of early elective birth as well as lower rates of neonatal ICU admissions.  The MHA Keystone website provides information on how to select a hospital that’s right for you, and includes information on how your hospital’s performance compares to that of other participating Michigan hospitals, as well as select hospitals nationwide.  

Though a comprehensive national hospital reporting program does not currently exist, people expecting a child and those supporting them can work independently to educate themselves about the care providers and birthing facilities in their area.  Taking a tour of local hospitals and birthing centers is one way of gathering information similar to what the Maternity Quality Improvement Program will provide in the future.  The Lamaze International site offers a few suggestions on the types of questions to ask during your tour:

-What supportive measures does the facility provide (ex: pain management, birthing balls, birthing tubs, doulas etc.)

-What interventions are considered routine

-What interventions are available

-What are the rates of specific interventions

-Does this facility support your birth philosophy

-What sort of breastfeeding support does the facility offer

For a more indepth look at hospital tours Lamaze International published a webinar on the subject.  Speaker Allison Walsh, a Lamaze Certified Childbirth Educator, Board Certified Lactation Consultant, and Manager of Parent Education and Lactation Services at Beth Israel Hospital New York discusses the importance of tours, the best questions to ask tour guides and how to communicate your needs to your care providers.

Happy World Breastfeeding Week and Welcome Ella!

This fall Lamaze Family Center welcomes our student intern, Ella Clark. Ella is a senior at EMU majoring in Women's Studies. As part of her internship she will be researching and writing occasional blog posts here on the Lamaze Family Center blog. In honor of World Breastfeeding Week, she has compiled some information and resources which you can find below. Welcome Ella, and happy World Breastfeeding Week to all the breastfeeding moms past, present, and future out there!

Breastfeeding Awareness Week 2014: “A Winning Goal For Life!”

August 1st 2014 marked the beginning of the 22nd annual World Breastfeeding Week (WBW), sponsored by the World Alliance for Breastfeeding Action (WABA).  The United States is one of 175 countries to participate in this yearly event which seeks to promote and encourage breastfeeding worldwide.  Groups of breastfeeding mothers and their supporters have participated in WBW events across Michigan, including Kalamazoo’s second annual event known as the Big Latch On where over 100 women publically breastfed their children in unison. Women who choose to breastfeed in public, such as those who attended the Kalamazoo event, have recently gained more protection from the state.  Mid June of this year, the Michigan Legislature passed the Breastfeeding Antidiscrimination Act, which states that women have the right to breastfeed in any public location throughout Michigan without fear of penalty or repercussion.  Demonstrations such as the Big Latch On and the recent passing of the breastfeeding bill show that Michigan’s residents have made strides toward accepting breastfeeding as a normal part of childrearing.  In fact, a recent report by The Detroit Free Press indicates that the number of infants breastfed in Michigan is increasing.    

According to the Michigan Department of Community Health and the World Health Organization (WHO) breastfeeding has a wide range of benefits:  

-Breast milk changes with your child's nutritional needs

-Breast milk protects children against certain allergies and illnesses including obesity, diabetes and pneumonia

-Breastfeeding produces no waste  

-Breastfeeding saves the family money that would be spent on formula

-Breast milk is clean

-Reducing the Mother’s risk of type 2 diabetes and certain forms of cancer

-Breastfeeding strengthens the bond between mother and child

Along with understanding the benefits of breastfeeding it is important that women who choose to breastfeed also feel their decision to do so is supported by those around them.   In honor of World Breastfeeding Week the WHO has created several informational posters about supporting a mother’s decision to breastfeed.

For those in the Ann Arbor area, the Lamaze Family Center of Ann Arbor hosts a number of classes designed to assist women and their partners who wish learn the breastfeeding basics and how to continuing breastfeeding through your transition back to the workplace.  If you are a Lamaze educator or would like to learn more about Lamaze International’s role in Breastfeeding Awareness Week take a look at what Lamaze’s Science and Sensibility blog has to say.