Nowhere to Turn: Perinatal Mental Health Resources can be Difficult to Find - The Huffington Post
Nowhere to Turn: Perinatal Mental Health Resources can be Difficult to Find - The Huffington Post
The 2013 theme for World AIDS Day is “Shared Responsibility: Strengthening Results for an AIDS-Free Generation.”
The public health message that “breast is best” has been received loud and clear. More mothers in the U.S. are breast-feeding, and they’re doing so longer than ever.
But those simple facts hide a complicated world where passions about breast milk run high, and demand has skyrocketed.
Women who have extra milk are intensively courted, by hospitals who need the breast milk for premature babies and by moms who can’t nurse their own babies and don’t want to use formula.
Courtney Helms, who works in fundraising for an educational nonprofit in Dallas, had no idea about the market for donated breast milk until her second son was born. Helms was a committed breast-feeder, but her supply dropped after recurrent bouts of strep throat. So she turned to a Facebook group to find moms who would give her extra frozen milk.
"Before I started to have kids I never would have thought of anything like this and maybe if I did, I would have thought it was weird," Helms said. "But being a wet nurse is not something we have just invented recently."
Helms wasn’t all that concerned about safety, though she met with donors in person and asked a few questions about diet, medications and caffeine intake. But mostly she just trusted them, because they were nursing their own babies.
That’s a mistake, according to people who work for breast milk banks. These banks, mostly nonprofits, carefully screen donors and also pasteurize the milk. Mothers are tested for infectious diseases like HIV and hepatitis, and the milk itself is tested for tested for bacteria, says Kim Updegrove, president of theHuman Milk Banking Association of North America.
"The practice of Internet sharing of human milk is not safe," Updegrove says. "Sharing a body fluid with all of its potential bacteria and viruses is dangerous, and it is playing Russian roulette with your child’s life."
A recent study in the journal Pediatrics now cast a light on the risks. The study compared breast milk purchased online from anonymous donors with milk donated to a milk bank by screened and trained donors. The milk sold on the Internet had higher bacteria levels, including contamination with fecal bacteria and salmonella.
In the photograph, Madison Fitzgerald, 20, holds her baby, Jake, in the neonatal intensive care unit at Texas Children’s Hospital in Houston. Jake, who was born 16 weeks too early, receives donor breast milk every three hours by mouth. (Carrie Feibel/KUHF)
Being able to decide when to have children is central to fulfilling one’s potential. In the year ahead, many women will harness this power for the first time.
The idea came to Jorge Odón as he slept. Somehow, he said, his unconscious made the leap from a YouTube video he had just seen on extracting a lost cork from a wine bottle to the realization that the same parlor trick could save a baby stuck in the birth canal.
Mr. Odón, 59, an Argentine car mechanic, built his first prototype in his kitchen, using a glass jar for a womb, his daughter’s doll for the trapped baby, and a fabric bag and sleeve sewn by his wife as his lifesaving device.
Unlikely as it seems, the idea that took shape on his counter has won the enthusiastic endorsement of the World Health Organization and major donors, and an American medical technology company has just licensed it for production.
With the Odón Device, an attendant slips a plastic bag inside a lubricated plastic sleeve around the head, inflates it to grip the head and pulls the bag until the baby emerges.
Doctors say it has enormous potential to save babies in poor countries, and perhaps to reduce cesarean section births in rich ones.
“This is very exciting,” said Dr. Mario Merialdi, the W.H.O.’s chief coordinator for improving maternal and perinatal health and an early champion of the Odón Device. “This critical moment of life is one in which there’s been very little advancement for years.”
About 10 percent of the 137 million births worldwide each year have potentially serious complications, Dr. Merialdi said. About 5.6 million babies are stillborn or die quickly, and about 260,000 women die in childbirth. Obstructed labor, which can occur when a baby’s head is too large or an exhausted mother’s contractions stop, is a major factor.
In wealthy countries, fetal distress results in a rush to the operating room. In poor, rural clinics, Dr. Merialdi said, “if the baby doesn’t come out, the woman is on her own.”
The current options in those cases are forceps — large, rounded pliers — or suction cups attached to the baby’s scalp. In untrained hands, either can cause hemorrhages, crush the baby’s head or twist its spine.
Although more testing is planned on the Odón Device, doctors said it appeared to be safe for midwives with minimal training to use.
Along the way, it has won research grants from the United States Agency for International Development and from Grand Challenges Canada. “We’ve given out $32 million for 61 different innovations, and this one is the farthest along,” said Dr. Peter A. Singer, the chief executive of Grand Challenges Canada.
The device will be manufactured by Becton, Dickinson and Company, or BD, of Franklin Lakes, N.J., which is better known for making syringes.
“My first reaction, as soon as I saw it, was positive,” said Gary M. Cohen, the company’s executive vice president for global health. It was at the World Economic Forum in Davos, Switzerland, that Dr. Merialdi asked him to consider taking it on.
“Many inventions get to the prototype stage, but that’s maybe 15 percent of what needs to be done,” Mr. Cohen said. “There’s finalizing the design for manufacture, quality control, the regulatory work and clinical studies. Absent that, they don’t see the light of day.”
So far, the device has been safety-tested only on 30 Argentine women, all of whom were in hospitals, had given birth before and were in normal labor.
“I was glad they asked me, because it was for a good cause,” said Luciana Valle, a kindergarten teacher who was 31 two years ago when her son, Matteo, was one of the first babies extracted with the device. Because Matteo weighed almost nine pounds, “it really helped,” she said in a telephone interview. “His head came out on my second push.”
The W.H.O. will now oversee tests on 100 more women in normal labor in China, India and South Africa, and then on 170 women in obstructed labor.
He tinkers at his garage, but his previous inventions were car parts. Seven years ago, he said, employees were imitating a video showing that a cork pushed into an empty bottle can be retrieved by inserting a plastic grocery bag, blowing until it surrounds the cork, and drawing it out.
That night, he won a dinner bet on it.
At 4 a.m., he woke his wife and told her the idea that had just come to him. (His own children were born without problems, he said, but he has an aunt who suffered nerve damage from birth.)
His wife, he recalled, “said I was crazy and went back to sleep.”
The next morning, a somewhat skeptical friend introduced him to an obstetrician. “You can imagine these two guys in suits in a waiting room full of pregnant ladies,” he said.
The doctor was encouraging, so he kept working. Polyethylene replaced the bag his wife had sewn, and the jar was replaced by a plastic uterus.
With the help of a cousin, Mr. Odón met the chief of obstetrics at a major hospital in Buenos Aires. The chief had a friend at the W.H.O., who knew Dr. Merialdi, who, at a 2008 medical conference in Argentina, granted Mr. Odón 10 minutes during a coffee break.
The meeting instead lasted two hours. At the end, Dr. Merialdi declared the idea “fantastic” and arranged for testing at the Des Moines University simulation lab, which has mannequins more true-to-life than a doll and a jar.
Since then, Mr. Odón has continued to refine the device, patenting each change so he will eventually earn royalties on it.
“My daughter said, ‘And now I can have my doll back,’ ” he said.
It is too early to know what BD will charge, Mr. Cohen said, but each device should cost less than $50 to make. While the company expects to profit on all sales, it will charge poor countries less.
Dr. Merialdi said he endorsed a modest profit motive because he had seen other lifesaving ideas languish for lack of it. He cited magnesium sulfate injections, which can prevent fatal eclampsia, and corticosteroids, which speed lung development in premature infants.
“But first, this problem needed someone like Jorge,” he said. “An obstetrician would have tried to improve the forceps or the vacuum extractor, but obstructed labor needed a mechanic. And 10 years ago, this would not have been possible. Without YouTube, he never would have seen the video.”
(From The New York Times)
Even though alcohol is associated with sexual assault, it’s not actually a direct association. Getting intoxicated only leads to rape when there’s someone present to commit that rape. When you remove rapists from the equation, the risks of getting drunk — which, of course, do involve serious public health consequences — don’t include getting raped.
No more victim blaming! To stop rape, we have to stop rapists, which means we have to address rape culture.
Child Brides at Funerals
Young maternal age and quick pregnancies linked to high infant mortality in South Asia
Having children early and in rapid succession are major factors fueling high infant mortality rates in the South Asian countries of Bangladesh, India, Nepal and Pakistan where one in 14 births to young mothers ends with the death of the child within the first year, say researchers at the University of California, San Diego School of Medicine.
Writing in the current online issue of the International Journal of Gynecology & Obstetrics, Anita Raj, PhD, professor of medicine and director of the Center on Gender Equity and Health at UC San Diego, and colleagues said younger maternal age (under 18 years old) and short intervals between pregnancies (under 24 months) accounted for roughly one-quarter of the infant mortality rate among young mothers in India and Pakistan, a percentage that represents almost 200,000 infant deaths in 2012 for those two nations alone.
In Bangladesh, only the short inter-pregnancy interval was linked to infant mortality while in Nepal, only young motherhood was associated with infant death.
Infant mortality is a significant public health issue in South Asia. According to United Nations data, the infant mortality rate worldwide is 49.4 deaths per 1,000 live births. In Pakistan, it is 70.90; India, 52.91; Bangladesh, 48.98 and Nepal, 38.71. By comparison, the infant mortality rate in the United States is 6.81 and just 1.92 in Singapore, lowest in the world.
The new infant mortality findings are based upon analyses of national demographic and health surveys taken in the four countries. Raj noted the comparisons may be somewhat skewed by imperfect comparisons.