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Preterm Delivery

Vaginal Birth After Cesarean Section (VBAC) + Repeat C-Sections: Myths vs Reality, Part Two

By and January 27, 2016 1 Comment
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Interview with Dr. Jean-Gilles Tchabo 

In my last post (which you can read here), I talked
about my experience approaching the delivery of my second child, after having an emergency c-section for my first.

The OB/GYN I chose for my second pregnancy, Dr. Jean-Gilles Tchabo, encourages vaginal deliveries after cesarean sections (VBACs) as an option for women in my situation. In the last post we dispelled some of the myths about VBACs, and today, we delve deeper into the topic as I pose a couple of reader questions about VBACs and repeat c-sections to Dr. Tchabo.

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Categories: Pregnancy, Birth + Family Planning, Science 101 + Mythbusting

Passive Immunity 101: Will Breast Milk Protect My Baby From Getting Sick?

By January 10, 2016 14 Comments
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As a neonatal nurse specialist, mothers often ask me about the antibodies found in breast milk and how they can work to protect their babies. To explain it to them, and to you, I have to delve into immunology, and those conversations are usually too technical for most readers and mothers I meet in the NICU. Unfortunately, the information that is readily available to mothers that isn’t highly technical is a large body of conflicting information. So I’m here to talk more about this very important topic in a way that makes it straightforward! My goal is to answer very common reader questions like these:

“Why does my infant need any vaccines at all since she’s getting all the antibodies she needs from my breast milk?” and,

“Why does my seven-month old son need to get a flu shot if I received it during my pregnancy?”

Both, excellent questions! Parents, take note – there are 2 ways babies acquire immunity: through passive transfer, and active transfer (also known as acquired immunity).

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Categories: Ages + Stages, Food, Nutrition, + Infant Feeding, Infectious Disease + Vaccines, Newborns + Infants

Confessions of a Toddler School Drop-Out

By December 14, 2015 No Comments
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This post originally appeared on the Graham’s Foundation blog on December 3, 2015

Three weeks ago, my toddler dropped out of school. My husband and I didn’t anticipate it. We started in September just like everyone else…with adorable “first day of school!” pictures on our front porch and excitement for everything my son would learn, and the new friends he would make.

It was a leap of faith for us to try out a group childcare setting in his second winter of life. My son, now 21 months old, was born at 31 weeks and 6 days in January of 2014. When he was discharged from the NICU in late February of that year, we- like all preemie parents- feared colds, flu, and RSV. We limited visitors, bought stock in hand sanitizer, and checked proof of TDAP and flu vaccinations at the front door.

With a thriving toddler interested in learning and socializing, we decided to graduate from the parent-nanny caregiver model and enroll him in a Montessori program four mornings per week. We took careful note of the advice from fellow parents about sickness in the first year of school or daycare.

“He will definitely get sick, but then his immune system will be unstoppable for the rest of his educational career,” they promised.

We thought we’d see a few bad illnesses this year, but for the most part he’d just have a chronic runny nose.

Boy – were we wrong.  

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Categories: Ages + Stages, Infectious Disease + Vaccines, Toddlers + Preschoolers

My Journey to Surrogacy (Part 1) – Another Pregnancy Could Kill You

By September 2, 2015 2 Comments
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November 6, 2011 was hands down the best day of my life so far. It was the day I became a mother.

The day itself was anything but the best day of my life. I was only 26 weeks pregnant, I had been dangerously sick throughout my pregnancy and I was scared we wouldn’t be bringing our son home with us from the hospital. I would later find out that my pregnancy had put my life in danger as well.

Despite the complications and the fear, our beautiful son, Elliott Murray Fletcher, entered the world at 4:34p.m. via emergency c-section. He was just over 13 inches long. He still had one eye fused shut and not an ounce of fat on his perfectly developed little body. He had fine, fuzzy hair all over, he looked and was so fragile. My Grammy said she thought he would fit just perfectly in a two-liter berry basket, and she was right.

Elliott couldn’t breathe on his own in the first weeks of his life, so he had a C-PAP machine and oxygen around the clock. He was in an incubator for 46 days until he could maintain his own body temperature without burning too much energy, and had tubes and wires hooked all over his body to deliver nutrients, monitor his heart rate, breathing and oxygen saturation.

And this is how my husband and I turned to gestational surrogacy to complete our family.

When I was 10 years old, I was diagnosed with Type I Diabetes. All in all it wasn’t that hard to maintain decent control of my sugar levels as long as I ate properly, took my insulin, and tested my blood sugar as instructed. I was aware that I would need to try my best every day for the rest of my life to avoid complications, most importantly so I could have babies when I was ready. I even selected my profession as a dental hygienist, not only based on my love of teeth, but because office hours would be kind to managing my diabetes, and it would make it easier to work part time while also being a stay-at-home mom the rest of the time.

When it was time, I got the go ahead from my doctor to “have as many babies as I wanted.”All of my blood work came back with excellent results and there was no reason I couldn’t have a healthy, although high risk pregnancy (all diabetic pregnancies are considered high risk).

Elliott's arm while he was still in the NICU. His father's wedding band fit over his hand.

Elliott’s arm while he was still in the NICU. His father’s wedding band fit over his hand.

As soon as we made the life-altering discovery that I was pregnant, my whole life became about testing my blood (when I was pregnant I tested on average 18-22 times per day), eating and drinking copious amounts of carbohydrates to keep my sugar at a safe level,  all while trying desperately not to vomit because I was so stuffed and also suffering from “morning sickness.” I was at one doctor appointment or another at least once a week. I had ultrasounds every 2 weeks to monitor our baby. I had a high risk OB/GYN that we had to travel 4 hours to see every 2-4 weeks.  I was also very swollen, because my kidneys did not agree with my being pregnant (I had gained a total of 42 pounds when I gave birth at 26 weeks and promptly lost 32 pounds in week, which was almost entirely water weight that my kidneys didn’t have the ability to deal with).

The whole time I was pregnant, I was feeling very overwhelmed, but I didn’t mind too much, because we were going to have a baby, and I was finally going to be a Mom!! It wasn’t a walk in the park, but it was worth every moment, and I would have done it again, if my doctors weren’t so adamant that I don’t ever attempt a pregnancy again, given what was happening to me.

At 25 weeks my water broke and I was admitted to the hospital for another week to try to stave off labor. I was in the hospital for another two weeks after that as it turned out that pregnancy had caused me to suffer from acute nephritis (inflammation of the kidneys), and at that point I had lost about 60% of my kidney function.

One day in the hospital my doctor asked how many children I had. I told him just Elliott so far, and he replied,“well I think he will have to be the only one.”

He said it as gently as possible, and I just said “okay”, because I didn’t want to cry and I was also in shock, despite the circumstances. A few days later, my OB came to talk to me. Her words were “Do not ever let anyone tell you that you can try to have a baby again, another pregnancy could possibly kill you,” and told us we were extremely lucky that Elliott was thriving despite his extreme prematurity.

Elliott had a 90-day NICU stay. Fortunately, he has none of the frequently occurring long-term complications of premature birth. I still count these blessings frequently.

It took me two and a half years to feel like myself again. I was put on 7 different prescription medications to control my blood pressure and help my damaged kidneys. My blood sugar was very hard to control. I was low frequently and postpartum, I couldn’t feel it dropping (this is called hypoglycemic unawareness, and it is extremely dangerous and also life-threatening for a diabetic). On top of it all, I now had a baby to take care of.

I felt defeated. I had always had a positive outlook on being diabetic and now that was gone. I was fed up! I felt like diabetes had taken away so much from me, and it was so painful to know that I wouldn’t be able to give my husband another child, or Elliott a sibling.

But there was hope.

Hope came in the form of gestational surrogacy.

You can read Part Two of Marisa’s Story here. 

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Categories: Pregnancy, Birth + Family Planning

What Are We Telling Mothers When We Say “Breast is Best”?

By June 3, 2015 20 Comments
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When my baby boy arrived, he weighed 4 pounds, 13 ounces. He entered the world 8 weeks early and spent 29 days in the Neonatal Intensive Care Unit (NICU).

When your baby is in the NICU, there is enormous pressure to breastfeed. The nurses rolled a hospital grade pump to my bed side just hours after delivery and minutes after my first visit to my baby’s incubator in the NICU. “Breast milk is like medicine for preemies,” I was told.

Every day I pumped around the clock and delivered milk to the NICU in the insulated bags they provided … like I was packing his lunch for school. Every milliliter was carefully inventoried and measured by the NICU nurses. I always knew from the looks on their faces if I had made enough to feed him for the day. Like I said- ENORMOUS pressure.

Things were going okay until about 10 days after delivery. I developed mastitis on the right breast. For those unfamiliar, mastitis is an infection of the breast tissue. I had pain, high fever, and chills. After two antibiotics it resolved. Then I developed a second mastitis infection on the other side. The pain was excruciating. The infections did a number on my body, my sleep, and my milk production (and yes we worked with lactation consultants and did all sorts of tricks to try and increase production).

I was exhausted, emotionally raw and in extreme pain.  My husband and I made the decision to switch my son to formula at 3 weeks old. We did it for his health, my health, and my ability to care for him when he was discharged. I can easily say it was the best decision we could have made. My sweet boy absolutely thrived on his special preemie formula. He tolerated it very well, grew, and got stronger. We are incredibly grateful for formula. We consider it an amazing public health innovation. Formula fed our baby when I could not.

I’m a public health practitioner, so I’ve known for years that “breast is best,” but I’m also now a proud formula-feeding mom so I think this gives me a unique view on how we, in public health, talk about breastfeeding.  A recurring theme for me is concern about the language being used in these campaigns. Somehow public health has not found an effective way to promote breastfeeding without stigmatizing formula feeding.

For example:

  • Memes like this can make women unable to breastfeed feel like failures, when, in fact, breastfeeding isn't possible for all women.

    Memes like this can make women unable to breastfeed feel like failures, when, in fact, breastfeeding isn’t possible for all women.

    All birthing hospitals in Philadelphia (where we live) have officially discontinued the practice of giving free formula to new mothers. While I understand that this strategy is supported by evidence, it is part of a larger international initiative to make hospitals “Baby Friendly”. So using that logic, providing formula is “unfriendly” to babies? This message was reinforced by Nurse McGinn who was interviewed for the philly.com story. She reports that she “was given free formula and threw it out”. Quotes like these reinforce the message that feeding with formula is equivalent to giving your kid something bad. Every mother wants to do what’s best for their child, no mother wants to harm their child.

  • A friend sent me a link to a wonderful story about supporting formula feeding moms during World Breastfeeding Week. This article does a great job of examining the language being used in their recent campaign. The terms connect breastfeeding with “winning” and achieving “goals.” So is the flip side “losing” and “falling short of your goals”? This can be a rough reminder for formula-feeding moms. For many women, the switch to formula was made after extreme pain, guilt, and feelings of failure. Around the same time a public health colleague tweeted that we should use the language “breastfeeding is normal” instead of “breast is best” Although it was not her intention, I read that as meaning that anything other than breastfeeding is abnormal. So formula feeding is abnormal?!
Model Nicole Trunfio graced the cover of Elle Magazine last month breastfeeding her son.

Model Nicole Trunfio graced the cover of Elle Magazine last month breastfeeding her son.

We also see many efforts promoting the message that “breastfeeding is natural”. In the Olivia Wilde photo spread for Glamour Magazine which includes a photo of her feeding her son, she says “Breastfeeding is the most natural thing…” In the June 2015 issue of Australian Elle, we see model Nicole Trunfio breastfeeding her son on the cover.  According to US Magazine, “the powerful cover shot by Georges Antoni captures the natural moment between mom and child.” And while of course breastfeeding is natural…we have to think about the flip side of this message- are we telling parents that formula feeding is an unnatural act?

When thinking about health communication, we need to not only test the key terms for our campaigns but we need to consider their antonyms. Normal-Abnormal. Natural-Unnatural. Public health practitioners are (or should be) familiar with the theory of unintended consequences, but it seems that when it comes to infant feeding we aren’t thinking about the unintended consequences of our messaging.
So I ask readers

(1) While these breastfeeding and baby-friendly campaigns have well-intentioned public health goals (which I support):

  • What are the unintended consequences of their language and communication choices?
  • Do they help reinforce the divide between formula feeding and breastfeeding mothers?
  • What about the women who both formula feed and breastfeed? Where do they fit in?

(2) What are your suggestions for more effective language? How can we simultaneously promote breastfeeding without stigmatizing formula feeding?

Readers can comment below! 

*An earlier version of this post was published on Pop Health on August 7, 2014.

 

 

 

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Categories: Food, Nutrition, + Infant Feeding, Mental, Emotional, + Behavioral Health