Posts Tagged ‘March of Dimes’

Series: Brilliant Activities for Birth Educators – Events of Late Pregnancy and Premature Birth

November 19th, 2015 by avatar

PlaybillNovember is Prematurity Awareness Month and November 17th was World Prematurity Awareness Day. This month’s Brilliant Activities for Birth Educators post is about preventing prematurity, the events of late pregnancy and the importance of waiting for labor to begin on its own. As they do every year, the March of Dimes leads the way in recognizing the importance of preventing premature births. They have provided information and resources to bring this important problem to light.  The number one cause of death of young children worldwide is complications from being born too early, with estimates of 1.1 million deaths directly linked to being born too early.   In the United States, one in ten babies are born premature.  If you live in the USA, you can check out how your state has performed on the prematurity report card.  On the international level, you can find out how your country ranks here.  In the US, we also know that premature births and low birth weight babies are more likely to occur in families of color.

I cover premature birth in my childbirth classes in many ways, including recognizing the signs of premature labor, and facilitating a discussion around the Lamaze Healthy Birth Practice “Let Labor Begin On Its Own” as induction before a baby is ready and has started labor can unintentionally result in a premature birth if the gestational age is estimated incorrectly or even if the baby was not ready and needed some more time in utero.  Not every baby is ready to be born at the same time.

My favorite activity to do in class on this topic leaves families really understanding the benefits of letting baby start labor when they are ready (in the absence of medical complications).  In small groups – the families prepare and present a short skit on the events of late pregnancy.

When this is activity is done in class

I cover this information on week two of a seven week series, at the beginning of class.  The families are just beginning to gel and we have done quite a bit of interactive learning the week before, on class one, but this is definitely a leap of faith on their part to be doing such a “daring” activity at the start of the second class.  They have only been with me and their classmates for one 2.5 hour session.  I am asking a lot of them, but they always rise to the challenge.

© Penny Simkin

© Penny Simkin

How I introduce the topic and set up the activity

I hand out Penny Simkin’s “Events of Late Pregnancy” information sheet that is available for purchase as a tear pad from PennySimkin.com. I discuss how both pregnant person and baby are getting ready for birth in the last weeks of a pregnancy.  Many different processes are happening and systems are moving forward to have everything culminate and coordinate in the labor and birth.  Each and every process is critical to a healthy baby and a body that is ready for labor.  I divide the class into four groups and assign each group to be either a Pregnant Person, Uterus, Fetus, or the Placenta/Membranes.  I ask them to collaborate together and prepare a skit, activity, active presentation, interpretive dance, charade etc., that shares information on the changes their assigned role undergoes during the last weeks of pregnancy and through labor.  I give them around five minutes to prepare and offer to provide any props that they might need from my teaching supplies.  They gather their groups, take their tear sheet and head to four corners of the classroom to get to work.

The results of their creativity

After the small group work is completed, we gather back as a class and get ready for the “show.”  In turn, each group (and their chosen props) heads to the front of the room to do their presentation.  Everyone follows along with their info sheet.  The results are outstanding and usually quite comically.

Some of the most memorable presentations have included a newscaster holding a microphone and interviewing the fetus at different gestational ages.

Newscaster: “Hello 34 week old fetus, can you tell me what you are working on now?”

Fetus: “Well, this week, I am taking on iron and my mother’s antibodies. I need the iron to help me through my first six months and the antibodies protect me until I can make my own. ”


© Anne Geddes and March of Dimes

Other groups have created a giant pelvis with their bodies and had a “baby” assume the birth position and move through.  I recall a group ripped up red paper into confetti, and released it from up high to represent bloody show.  Just this week, one group did a hip hop dance and chanted along with the different events.  “Antibodies” have leapt through “placentas,” and fake breasts have leaked colostrum.  Giant uteri have contracted and pushed babies out.  One week, uncoordinated contractions representing Braxton-Hicks contractions “squeezed” out of sync and then got “organized” and worked in unison to represent labor contractions getting longer, stronger and closer together, flexing and squeezing like a well fabricated machine. I am continually amazed at the creativity and ingenuity of the results.  Everyone laughs and best of all, the events are memorable and easy to recall.


After each group has a chance to present their section, we debrief and discuss any questions.  We bring things full circle by talking about what the impact might be for a premature birth or a birth that occurs before the baby or parent’s body is ready.  Everyone is clear that the process of birth and the transition that baby needs to make works best when baby chooses their birth day.  We admire everyone’s creativity and laugh about the mad skills that the class has!  As the series continues, I can refer back to these skits and remind them of the important steps as they come up again in class.  I am amazed that they have great recall of the progression.

What the families say about the activity

After we have finished, the feedback I receive on this activity is great!  Despite their initial hesitancy to get so far out of their comfort zone, families really remember the events, recognize how important the changes are that occur in the pregnant parent, the uterus, the baby and the placenta and membranes. They can clearly articulate why it is important to reduce the chance of a premature baby and wait for labor to start on its own.  The unique presentations really make things memorable and the families report back to me weeks later, or even at the class reunion after birth, how they often thought of this activity and it helped them to have patience to wait for baby to come.  They knew good (and important) things were happening in the last few weeks that would make for a healthy birth and baby.

How do you teach about preventing premature birth and the importance of waiting until baby starts labor?  What interactive teaching ideas do you use?  Do you think that you might try something like this in your childbirth classes?  How might you modify it.  Share your thoughts in the comments below.  I would love to hear from you.

Babies, Childbirth Education, Healthy Birth Practices, Lamaze International, Newborns, Pre-term Birth, Series: Brilliant Activities for Birth Educators , , , , ,

Critical Congenital Heart Defect Screening – A Simple Newborn Test that Saves Lives

April 24th, 2014 by avatar

 By Elias Kass, ND, CPM, LM

© Tammi Johnson

© Tammi Johnson

Critical Congenital Heart Defect screening can help identify and save the lives of newborns born with previously undetected but serious malformations of the heart that can significantly impact them as they transition to life on the outside.  Families can learn about the simple screening procedure in a childbirth education class and be prepared to discuss the screening with their health care providers.  Dr. Elias Kass, naturopath and midwife, shares information on the screening, stats on the incidence of CCHDs and how you can help spread the word on the importance of all newborns being screened. – Sharon Muza, Community Manager, Science & Sensibility 

There’s a new newborn screening being implemented in many birth settings – critical congenital heart defect screening, or CCHD. What is this screening? What does it look for, and how can you educate and prepare your childbirth education students for the screening and possible results?

Critical congenital heart defects refer to heart defects that babies are born with and that require surgical intervention within the first month (or year, depending on the defining organization). About 1 in 100 babies have heart defects (1%), and about 1 in 4 of those with a heart defect have a defect so severe that it needs to be corrected immediately (0.25% of all babies) Only some of these defects will be picked up by prenatal ultrasound, and they may not show up on exam before the baby goes home (or the midwife leaves in the case of a home birth). Depending on the defect, some babies may be able to compensate with structures that were in place during the fetal period but begin to go away after the baby is born.

Fetal circulation and changes after birth

By KellyPhD (Own work) [CC-BY-SA-3.0], via Wikimedia Commons

By KellyPhD (Own work) [CC-BY-SA-3.0], via Wikimedia Commons

Because a fetus receives oxygen through the placenta and umbilical cord, there’s no need for him to send a significant amount of blood to the lungs, so a fetus has very different heart and lung circulation than they will after making the transition to life on the outside. One of the big differences (simplified for this article) is the ductus arteriosis – this is a bypass that takes blood from the pulmonary artery and provides a shortcut to the aorta, instead of continuing on to the lungs. Another big difference is the foramen ovale – this is an oval-shaped window between the right atrium and left atrium, which allows blood to bypass being pumped out to the lungs entirely. After birth, pressure changes cause massive changes in flow. Pressure increases in the left atrium cause a flap to slam shut across the foramen ovale. Blood also finds it easier to flow to the lungs, so less blood flows through the ductus arteriosus. Over the course of days and weeks, the foramen ovale seals shut and the ductus arteriosus starts to shrivel.

Typically blood being pumped out to the body is loaded with oxygen. If there are structural problems, it’s possible that this blood would be a mix of oxygenated and deoxygenated blood – there would be less oxygen available in this blood, but at least it’s getting out to the body. Sometimes those fetal structures are what allows that mixed blood to circulate. So what if the baby was really depending on those shortcuts and bypasses? And then the shortcuts and bypasses go away? These babies may look well and do fine, until the fetal structures start to go away.

This March of Dimes article describes seven conditions considered to be part of CCHD:

  1. Hypoplastic left heart syndrome (also called HLHS)
  2. Pulmonary atresia (also called PA)
  3. Tetralogy of Fallot (also called TOF)
  4. Total anomalous pulmonary venous return (also called TAPV or TAPVR)
  5. Transposition of the great arteries (also called TGA)
  6. Tricuspid atresia (also called TA)
  7. Truncus arteriosis

See page for author [GFDL or CC-BY-SA-3.0], via Wikimedia Commons

Circulation after birth [GFDL or CC-BY-SA-3.0], via Wikimedia Commons

CCHD screening of the newborn is intended to catch babies who might need intervention, before they decompensate and their heart defects are made obvious.

The screening process

CCHD screening involves using a pulse oximeter at two locations — the right hand (or wrist), and either foot. The right arm receives its blood supply before the ductus arteriosus enters the aorta, so it’s known as “pre-ductal.” The left hand and the lower body receive “post-ductal” blood.

The pulse oximeter senses oxygen saturation by shining light through the skin. Red blood cells that are loaded with oxygen deflect light differently than red blood cells without oxygen. The opposite sensor collects the light and calculates how much was lost. By using multiple wavelengths of light, the unit can isolate arterial flow and disregard venous flow (veins return blood to the heart after the tissues have ‘used’ the oxygen the blood was carrying). For babies, an adhesive probe is typically wrapped around the hand or wrist, and then around a foot. The thin strip might be covered with a foam band to help block out the room light. Some facilities use reusable probes that are more like clips. Not all pulse oximeters are well suited for this purpose – they need to be able to sense low saturations and not be confused by an infant’s constant motion.

There are three possible results from the screening – pass, fail, and an in between, or “try again.”

If a baby’s oxygen saturation is ≥ 95% in the right hand and foot, and there is less than a 3% difference between the two readings, then she passes the screening.

For a baby whose saturation is between 90-95%, or has a greater than 3% difference between the right hand and foot, the screening test is repeated in an hour. If she still doesn’t pass or fail, she can have one more chance. If she still doesn’t pass after three tries (one initial and two retries), that’s considered a fail, and she should be evaluated.

If a baby’s oxygen saturation is under 90% in either the right hand or foot, or she didn’t pass in three tries, this is considered a fail, or a positive screening. This baby should be referred to a pediatric cardiologist who can assess her and do an echocardiogram (ultrasound of the heart), and/or other workup. Depending on her health at the time, that might mean an immediate consult, or it might mean having her scheduled for a visit soon.

In Washington state, Seattle Children’s Hospital and the other regional pediatric cardiology groups are available to talk with the clinician who has a patient with a problematic screening and help figure out when and where the baby should be seen. If there is no local pediatric cardiology group, some cardiology groups can do telemetry or read studies remotely. Before implementing screening in their practice or facility, there should be a clear process for how to obtain consultation and referral (who should be called, how to contact them, how to transmit images if able, etc). Evaluation should be arranged before the baby is discharged because a baby’s condition can deteriorate rapidly.

There are tools available to help with this algorithm. The Center for Disease Control and Prevention (CDC) has a flow chart to help guide the screening process, and Children’s Health Care of Atlanta has a web site and Pulse Ox Tool app to help guide providers.

When should the screening be done?

The screening should be done between 24-48 hours after birth. Before 24 hours, there is an increased incidence of false positives, but a baby who passes before 24 hours is still considered to have passed (i.e., it still “counts”). If a baby is being discharged before 24 hours, the recommendation is to do it as close to discharge as possible. For babies born at home, this screening should be done at the 24-48 hour home visit, along with the metabolic screening. For the screening to be most accurate, baby should be awake and calm, but not feeding. (Feeding causes some decrease in oxygen saturation even in normal term newborns.)

What about a failed screen?

It’s helpful to know that not all babies with a failed screen have a critical congenital heart defect. Like all screening tools, this screening has false positives. The false positive rate overall is about 1/200 (0.5%), but it falls to 1/2000 (.05%) when the screening is performed after 24 hours of age according to the FAQ on the Seattle Children’s Hospital Pulse Oximetry Screening for Newborns resource page for providers. About a quarter of the babies who fail the screening truly have a Critical Congenital Heart Defect(true positive), while half have condition that causes low blood oxygen, like pneumonia and sepsis, and a quarter are well (false positive).

Who should be screened?

All babies should be screened, unless the baby is already known to have a critical congenital heart defect, identified during ultrasounds done during the pregnancy or immediately after birth. Most states mandate screening – 31 by legislation and one by executive order. An additional six states have regulations or guidance. In states without mandated screenings, most birth settings have adopted the screening, but not all. For some settings there are logistical challenges in terms of purchasing equipment (particularly independent midwives who might not have other use for the pulse oximeter, although since it was recommended to be used as part of neonatal resuscitation that has begun to change), arranging for consultation (particularly in rural areas or regions without adequate pediatric cardiology support), or logistical challenges in terms of who will do the screening and when. The Secretary of Health and Human Services (HHS) has recommended that CCHD screening be added to the newborn screening panel (like metabolic screening and hearing screening). The American Academy of Pediatrics also supports the universal adoption of this screening.

Cost can be a barrier in offering this screening. There is currently no procedure (CPT) code for this screening, and insurance companies are generally bundling it into the general newborn care (and not reimbursing for it as a separate service), though there are groups working to change this, since there is significant up-front investment and on-going costs in terms of probes and staff time to provide the screening. Most appropriate pulse oximeters start at $500 and the disposable probes around $3-5. Using reusable probes can decrease the cost of providing this screening.

If the hospital or midwife doesn’t provide this screening, parents can ask their pediatric provider to perform the screening at the baby’s first office visit. The goal is to catch these conditions as quickly as possible, ideally before the baby’s condition decompensates. Getting a screening a little later is better than not getting it at all.The screening is no less accurate later on.

The childbirth educator perspective

As a childbirth educator, you can share information about this quick screening test, when you discuss other newborn care procedures. You can encourage your students to ask their midwife or doctor about the screening, or ask on the hospital tour. If the hospital or health care provider hasn’t yet implemented this screening, families can ask why not, and if there’s anyone they can talk to encourage implementation. Facilities and providers should hear from families that they know about this screening and expect it as part of their newborn’s care.  Universal screening will go a long way to identifying those children who were not previously diagnosed with a Critical Congenital Heart Defect and who can begin to receive care for the CCHD as soon as possible by pediatric cardiologists.  Your childbirth class may be the only opportunity for these families to hear about and understand the importance of the CCHD screening test.

Are you already talking about this screening test for CCHD in your classes? If not, might you begin to share this information as a result of what you learned today?  Are providers and facilities in your area already offering this test as part of normal newborn screening? Do you know any families who have had this screening and their baby was diagnosed with an heart defect? Share your experiences in our comments and let’s discuss.- SM

References and Resources

March of Dimes, with general information about CCHD screening targeted towards families
American Academy of Pediatrics – detailed information about screening and implementation, targeted towards providers and facilities
Dr. Amy Schultz (a pediatric cardiologist at Seattle Children’s) frequently presents on CCHD screening – this presentation, with detailed information about critical congenital heart defects and screening, was recorded and can be streamed online

About Dr. Elias Kass

elias kass head shot

Elias Kass, ND, LM, CPM

Elias Kass, ND, LM, CPM, is a naturopathic physician and licensed midwife practicing as part of One Sky Family Medicine in Seattle, Washington. He provides integrative family primary care for children and their parents, including prenatal, birth and pediatric care. He loves working with babies! Practice information and Dr Kass’s contact info is available at One Sky Family Medicine.

Babies, Childbirth Education, Guest Posts, Neonatology, Newborns , , , , ,

January is National Birth Defects Prevention Month – Are Your Resources & Information Up to Date?

January 21st, 2014 by avatar
image: NDBPN.org

image: NDBPN.org

January is National Birth Defects Prevention Month, and this year the campaign being presented is that birth defects are “Costly, Common and Critical.”  This campaign is sponsored by the non-profit organization National Birth Defects Prevention Network (NBDPN). The NBDPN is a volunteer-based collaborative non-profit that works to capture national statistics on the numbers and types of birth defects occurring in the USA, along with coordinating research and prevention efforts.  This multi-disciplinary organization is made up of public health officials, consumers and researchers working together to reduce birth defects and their short and long term consequences. They collaborate with the Center for Disease Control and Prevention and March of Dimes as well as other well known organizations and agencies.

image: NBDPN.org

image: NBDPN.org

One in 33 babies born are affected by a birth defect.  A baby with a birth defect is born every 4 1/2 minutes in the USA and these defects are responsible for one in five infant deaths. Not all birth defects are detected prior to birth, though many are identified during an ultrasound or amniocentesis.  There are some birth defects that are not detected before the newborn leaves the hospital. All birth defects are not related to genetics, some occur randomly during fetal development and others are a result of circumstances during pregnancy. Total hospital costs of children with birth defects exceed $2.6 billion. Congenital cardiac and circulatory birth defects account for $1.4 billion of these annual hospital costs.  Defects of the heart and limbs are the most common kind of birth defects. Only reasons for 30% of birth defects are known, but ongoing research is working towards identifying the unknown causes.

If you are an educator or a provider who offers a preconception class, your class is a great opportunity to share some of the resources on birth defect prevention, so that women and their partners can do what they can to reduce the likelihood of having a child with a birth defect.  That includes a discussion about getting enough folic acid, having regular medical checkups,  making sure medical conditions, such as diabetes, are under control, testing for infectious diseases and being up to date on vaccinations. Also avoiding cigarettes, alcohol and other drugs.

image: NBDPN.org

image: NBDPN.org

The NBDPN provides information and fact sheets on a variety of topics for consumers in both English and Spanish, as well as webinars that appeal to professionals, health care providers and researchers. They are also holding a virtual conference beginning in late February, that you can attend.

If you are not a health care provider, you may not know that a family in your class is carrying a baby with a birth defect.  They may disclose this information to the class, they may share with you privately or they may say nothing.  They might not even know themselves at the time.  It is imperative that you have resources available should they ask.  You may find out after the baby is born if class members stays in touch with you or there is a class reunion.  Your families may look to you for information and support.

Resources for your students and their families

Families you work with may also appreciate referrals to counselors, therapists and local support groups, to help them deal with the emotions and stress of having a baby with a birth defect, who may spend time in the NICU and be facing significant medical care, treatment and surgeries in the future.  Having a comprehensive list prepared in advance, with the appropriate local resources, will be helpful should you have a this situation.

As childbirth educators and other professionals working with an expectant family, we have an obligation to help prepare families for when things do not always go as planned.  The relationships we develop with families during the vulnerable year of pregnancy, birth and postpartum makes our role very important in helping families be ready for whatever comes.

Have you had a family in your class who delivered a baby with birth defects? Did they let you know about the circumstances?  Before or after birth? What did you do to help this family be prepared?  What resources did they find valuable?How did this affect what you said or did in your childbirth education course? Please sensitively share your experiences with our readers in the comments section so we can all be better prepared for supporting families whose child had a birth defect and their journey did not go as planned.

Babies, Childbirth Education, Newborns, Research , , , , , , , ,

Ten Facts on the State of Premature Birth – Honoring World Prematurity Day

November 19th, 2013 by avatar

November 17th is recognized as World Prematurity Day and many maternal-infant health organizations share research, blog posts, information, fact sheets, videos and other resources on the topic to be used by professionals and consumers alike. The purpose of the  international effort has been to focus on the the impact that premature birth has on the babies themselves, families and society.  This year marks the third annual event.

The four worlds into which 135 million newborns are born each year. © Born Too Soon: The Global Action Report on Preterm Birth.

Here are 10 facts about premature birth that you may not have known:

1. 15 million babies are born prematurely every year out of the 135 million babies worldwide. This number is equal to the entire population of Guatemala or Kazakhstan.

2. 1 million of those babies born early die due to prematurity and account for 1/3 of the world’s newborn deaths.

3. Boys are 14 percent more likely than girls to be born prematurely, and preterm boys have a greater risk of disability and death than preterm girls.  This may be because mothers are more likely to have pre-eclampsia, placental problems and gestational hypertension if they are carrying a boy.  These conditions are more likely to result in a preterm birth.

4. Preterm girls are more likely than boys to die in the first month of life in some countries where girls receive less nutrition and medical care than boys.

5. The USA has seen a 30 percent increase in preterm births in the past 20 years, reaching a high in 2006 at 12.8% of all births in the USA.

6. 450,000 babies in the USA are born too soon, around 1 out of 9 babies.  The USA has a prematurity rate that is higher than most other developed nations.

7. Three states, Louisiana, Mississippi and Alabama, along with Puerto Rico receive a grade of “F” for their prematurity rates; Preterm birth rate greater than or equal to 14.6%

8. In the United States, African-American and Native American babies have the highest neonatal death rate associated with prematurity.  Yet another unfortunate consequence of the health disparities and inequities that families of color face in the USA.another way that racial disparities and inequities in health care.

9. 10% of premature babies born before 28 weeks die in high-income countries, while 90% of premature babies born before 28 weeks die in low-income countries.

10. “Three quarters of the 1 million babies who die each year from complications associated with prematurity could have been saved with cost-effective interventions, even without intensive care facilities.” – UN Secretary General Ban Ki-moon.  These two interventions are antenatal steroids and Kangaroo Care.

Lamaze International is working alongside other national and international organizations to educate women about preterm births, how to identify premature labor and who is at risk.  In that vein, on Thursday, Lamaze International will reveal a brand new infographic here on the blog covering the topic of induction for professionals to use with their students, clients and patients.  Lamaze International is proud to be doing their part to help reduce needless newborn deaths and increase awareness on the topic.

Resources and References 

Every Newborn

Healthy Babies are Worth the Wait


March of Dimes

March of Dimes Prematurity Infographic

Lawn, Joy E., Blencowe, Hannah, Darmstadt, Garly L., Bhutta, Zulfigar A. Beyond newborn survival; the world you are born into determines your risk of disability-free survival.  Pediatric Research, International Pediatric Research Foundation, Inc. 2013/11/15.


Babies, Childbirth Education, Maternity Care, Newborns, Push for Your Baby , , , , ,

The Unexpected Project: Pre-eclampsia Researched, Revealed and Reviewed. Part II of an interview with Jennifer Carney

February 7th, 2013 by avatar

By: Walker Karraa

Regular contributor Walker Karraa wraps up her interview with Jennifer Carney, who became active with The Preeclampsia Foundation and the Unexpected Project after suffering from eclampsia while pregnant with her second child.  Have you had to answer any questions in your classes or with your clients and patients after the recent episode of Downton Abbey, where one of the characters developed eclampsia?  What have you shared with your pregnant families? Part one of Walker’s interview with Jennifer Carney can be found here. – Sharon Muza, Community Manager.  

Walker: What do you see are the common myths regarding pre-eclampsia?

JC: Common myths? Oh, there are so many. A lot of people seem to think they know what causes preeclampsia and how to cure it. There’s a whole faction of advocates who buy into the work of Dr. Tom Brewer, who in the 1960’s, devised a very high protein diet for mothers based on the idea that preeclampsia is caused by malnutrition. This isn’t supported by the current research, but it gets repeated all the time. Other people argue that preeclampsia is a so-called “lifestyle” disease – caused by obesity and poor prenatal care. Obesity is a risk factor, but it is only one of many and poor prenatal care can cause the disease to go undetected, but it will not cause it to happen in the first place. There are also a lot of people who think that the delivery of the baby will end the risk to the mother – and while it’s true that the removal of the placenta is essential, preeclampsia or eclampsia can still happen up to 6 weeks after delivery. There are other myths, but it strikes me that so many of these myths are rooted in a desire to control pregnancy. If we can blame preeclampsia on one central cause or on the women who develop it themselves, then we can reassure ourselves that we won’t develop it, too. There are risk factors that can increase a woman’s chances of developing the disease, but women without any known risk factors have developed it, too.

It’s not comforting to think that no one is safe, but with knowledge of the signs and symptoms – a woman can react to it promptly and receive the care that she needs. But this will only happen if women get the information and understand that it CAN happen to them. I am blown away by the ways in which preeclampsia and other serious complications are downplayed and dismissed in pregnancy books, online and even by some medical practitioners. Preeclampsia CAN happen to you – but you can deal with it IF you know the signs and the symptoms.

Walker: Can you share with our readers what you are doing with Anne Garrett Addison at The Unexpected Project?

JC: The Unexpected Project is a documentary, website, and book project that will examine the rate of maternal deaths and near-misses in the United States. Anne Garrett Addison, who founded the Preeclampsia Foundation, and I are both classified as near-misses due to preeclampsia. With Unexpected, we want to take a look at all maternal deaths regardless of the cause – preeclampsia, amniotic fluid embolism, hemorrhage, placenta previa, placental abruption, infection, suicide, and any other causes. We also want to look at the women who survived these complications because the line between surviving and dying is in these cases, often quite thin. Every case is different and there is no one factor to blame for the maternal death rate in the US. We will look at interventions and cesarean sections, but we will also look at the lack of information available to women and the tendency of some birth activists to minimize the dangers of serious birth complications.

Current Preeclampsia/Eclampsia StatisticsMaternal mortality and morbidity are, unfortunately, a part of the pregnancy and childbirth experience for women and their families in the US and the world.  While most (99%) of maternal mortalities occur in the developing world, the 1% that occur in developed countries like the US are still of concern to maternity care providers and advocates.  Indeed, U.S. still ranks 50th in the world for its maternal mortality rate (1).

More common than a maternal death, are severe short- or long-term morbidities due to obstetric complications (2).  Some estimate that unexpected complications occur in up to 15% of women who are otherwise healthy at term (2).  

In particular, hypertensive disorders of pregnancy, including elevated blood pressure, preeclampsia, eclampsia and HELLP syndrome are estimated to affect 12-22% of pregnant women and their babies worldwide each year. (3)  Adverse neonatal outcomes are higher for infants born to women with pregnancies complicated by hypertension.  

In the U.S., upwards of 8 percent or 300,000 pregnant or postpartum women develop preeclampsia or the related condition, HELLP syndrome each year. This number is growing as more women enter pregnancy already hypertensive (cite).  Preeclampsia is still a leading cause of pregnancy-related death in the US and one of the most preventable.  Annually, approximately 300 women die and another 75,000 women experience “near misses” – severe complications and injury such as organ failure, massive blood loss, permanent disability, and premature birth or death of their babies.  Usually, the disease resolves with the birth of the baby and placenta. But, it can occur postpartum–indeed, most maternal deaths occur after delivery.

Recent statistics from Christine Morton, PhD.

The trend toward “normal” or “natural” birth does not seem to allow a lot of space for our stories to be heard or to be told. This has the effect of making survivors feel marginalized – as though their experience is somehow too far outside “normal” to be a part of the overall conversation. The one constant of all of our stories is that none of us expected to become statistics. Our birth plans did not include emergency cesarean sections, seizures, ICUs, blood transfusions, strokes, hysterectomies, CPR, prematurity, PTSD, depression, or death. No one was more surprised than us. This isn’t about assigning blame – this is about finding answers, improving birth for ALL moms to come, and learning to live with the unexpected.

Walker: How did you get involved with researching for the Preeclampsia Foundation?

JC: I started out volunteering with the March of Dimes in the spring following my son’s birth. I started a walk team and raised money, hoping that I would be able to meet other moms who had been through something similar. I felt very alone in the months following his birth. I was dealing with postpartum depression (PPD) and post-traumatic stress disorder (PTSD) symptoms and struggling to feel normal again. I had a premature infant – which meant sleeping through the night was a problem for a long time. When I returned to work, I was greeted by a coworker who declared that she now no longer wanted to have children because of what I had gone through. This weighed heavily on me – and I felt like I was the cautionary tale, the one bad pregnancy story that everyone knows. I know I had never heard a story as bad as mine – so I felt deflated, flattened by the whole thing.

With the March of Dimes, I found moms to help me deal with the preemie part of it. As he matured and grew out of the preemie issues, I found that I still had a lot of issues to deal with regarding my own health – both physically and mentally. I decided to volunteer with the Preeclampsia Foundation after they merged with the HELLP Syndrome Society.  The Preeclampsia Foundation is much smaller than the March of Dimes, which allowed me to be much more active as a volunteer. I was able to use my writing and editing skills to work on the newsletter – and when I suggested that someone do a review of the available pregnancy literature based on how well they cover preeclampsia, I was given the opportunity to conduct that research and write the report myself. This was something I had been doing informally in bookstores for a while anyway, so it felt good to be able to look at the literature and confirm that the information really is severely lacking if not downright misleading in a large number of so-called comprehensive books. It really isn’t my fault that I missed the symptoms.

This year, I am coordinating the Orange County, California Promise Walk in Irvine as part of the foundation’s main fundraising campaign on May 18. I am hoping to bring a mental health expert from the California Maternal Mental Health Collaborative out to the walk to talk to the moms about dealing with the emotional impact of their birth experiences.  Many of these moms lost babies, delivered preemies, or suffered severe health issues of their own. Our community as a whole is at a very high risk for mental health issues, myself included.

It wasn’t until this year – 6 years after the birth of my son – that I finally sought professional help dealing with the PTSD from the very difficult birth experience. I feel that the volunteer work helped fill that spot for the past 6 years and brought me to the point where I can now process the trauma in a healthy way. I am not happy that I had eclampsia, but I am beyond grateful for all of the great people that it has indirectly brought into my life.

Closing Thoughts

To have to wait 6 years to receive the vital treatment for PTSD is a travesty. We are so thankful that Jennifer survived both the initial trauma, but endured its legacy of traumatic stress that lingers today. Unfortunately, PTSD subsequent to traumatic childbirth is growing in prevalence, and under-recognized by the majority of women’s health and maternity care providers.  I have learned a great deal from Jennifer and look forward to the work she and her colleagues will continue to do for the benefit of all women.


1.  WHO. Trends in maternal mortality: 1990 to 2008 estimates developed by WHO, UNICEF, UNFPA and The World Bank, World Health Organization 2010, Annex 1. 2010. http://whqlibdoc.who.int/publications/2010/9789241500265_eng.pdf. Last accessed:January 3, 2011.

2. Guise, J-M.  Anticipating and responding to obstetric emergencies.  Best Practice and Research Clinical Obstetrics and Gynaecology. 2007; 21 (4): 625-638

3. American College of Obstetricians and Gynecologists. Diagnosis and management of preeclampsia and eclampsia; ACOG Practice Bulletin No. 33. Obstetrics & Gynecology. 2002;99:159-167. 


Birth Trauma, Childbirth Education, Depression, Guest Posts, Maternal Mental Health, Maternal Mortality, Maternity Care, News about Pregnancy, Postpartum Depression, Pre-eclampsia, Pre-term Birth, Pregnancy Complications, PTSD , , , , , , , , , , ,

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