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Maternal Health

Parents Matter. We Need to Stop Telling Them They Don’t.

By July 30, 2015 2 Comments
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At my 22-week checkup my Obstetrician had a frank discussion with me about “how I’m doing.” This wasn’t a discussion I ever had with my previous OB during my first pregnancy so I was a little surprised when it happened.

Before having been pregnant, I had expectations of loving the experience. Friends had said the time had some “uncomfortable” aspects, but that they felt better, healthier, and more in touch with their bodies during pregnancy. Meanwhile I was all of eight weeks pregnant with my first when I sobbed to my husband, “I don’t know if I can do this for another seven months!”

I went into this pregnancy expecting it to be different.  I knew what to expect this time and how to work around it, or so I thought.  And while the first few weeks were much better than my first pregnancy, I soon experienced terrible morning sickness that lasted until week 17 and have never really bounced back from it.

So, when my OB asked me how I was doing my response was, “I’m pregnant. I’ve been better.”

He broke the news to me that I was anemic, which didn’t shock me as anemia runs in my family. “So, iron supplements?” I asked, thinking this would be a simple solution. He said yes, but he also wanted me to take vitamin C and take care of myself because he could tell I wasn’t. How could he tell I wasn’t taking care of myself? I was showered, my hair was combed, I had on clean clothes, I was gaining weight, my prenatal tests were all normal.

What I realize now is that he was trying to tell me that I looked like I’d been hit in the face with a frying pan, and while I wasn’t aware of it at the time, I felt like I had too. He ordered that I get more sleep, eat healthier, and that my in-laws take my son for the weekend so I could fully rest. He even offered to write the last order down on a prescription pad.

Our conversation completely threw me. It was not a conversation I was expecting to have with my OB and for sure one I hadn’t come prepared to have that day.  I thought I had been taking care of myself. I took my prenatal vitamins, I was going to the gym whenever I could, and I was sleeping better than I had in my first pregnancy. My husband had taken on a huge chunk of the child care and housework, and my in-laws even watched my toddler son once a week, sometimes twice.

I told him that I had a lot more help than many women do. His response was that having help wasn’t the same as having enough help.

How Leslie usually spends her evenings.

How Leslie usually spends her evenings.

He asked me what I thought at the time were a series of unrelated questions.  What did I usually eat for breakfast? If I got breakfast it was usually a granola bar. How often did I eat? Three times a day, usually a snack before bed. What did I eat for dinner? Lean protein. What did I do when my in-laws took my son? Client work. Why was I still doing cardio at the gym despite ligament pain? It was best for the baby. How often did I wake up at night? How many fingers do you have? How was my energy level? I’m pregnant, I’m tired all the time. Did I ever have dizzy spells? Yes, a few times a day but I’m pregnant, that’s par for the course. When was the last time I did something for myself like take a long bath, read a book or have dinner with friends? I’m a parent and pregnant again, those aren’t things I have time for.

His words rung in my head as he said them, “pregnancy is not just about the baby. You matter too.”

During my first pregnancy when I’d brought up complaints of feeling excessively tired or not having the capacity to eat as healthily as I’d like, my previous OB’s response was that pregnancy was hard, nothing was out of the ordinary, and it was all about doing what was necessary to have a healthy baby at the end. After my son was born, family joked, “nobody cares about you now, we’re all here for the baby.” It took a week for my milk to come in and in the hospital when I fed my hungry son some formula to supplement what I couldn’t produce, a nurse admonished me, “you’re doing what’s easiest for you, not what’s best for him.”

The message was clear: You don’t matter.

I didn’t realize how closely I’d taken that message to heart until my new OB pointed out that much of what I’d categorized as taking care of myself was actually taking care of others.

I held back tears long enough to get out of the office and into my car, and bawled the entire way home. A blubbering mess, I arrived home to a very confused but concerned husband.

“But it’s just anemia, you can take a pill for it, right?” he asked,

“It’s so much more than that!” I sobbed.

Until that day I don’t think I’d processed how much the overt and implied messaging from those around me had truly impacted how I viewed myself. I really didn’t think that I mattered and trying to make myself matter to me involved a significant mental shift.

Since surviving my son’s first colicky few weeks I have said repeatedly that Western society does a terrible job of supporting new parents, but I hadn’t taken my own message to heart. From healthcare infrastructure to family structure, to societal expectations, we essentially give new parents a pamphlet on swimming, throw them into the deep end, and act confused when they start to drown or annoyed when they ask for a life raft.

When I asked other friends if they felt like they didn’t matter after having had a child the response was overwhelmingly in the affirmative. Many mentioned family that offered to help initially didn’t come through, or had nothing but ‘helpful advice’ about what was best for the baby, watched while they were struggling. Others mentioned how specific language made the feel like non-persons:

“I felt like a cow.  My family thought it was a joke to hand [my daughter] to me when she was hungry and say ‘this is your job now.’ Even when I had pumped milk in the fridge my mom refused to use it because she only wanted the best for her granddaughter.  What about her daughter?”  said one friend.

Another confided, “we had this big family dinner the night we brought [my son] home from the hospital. Everyone was there and it was this running gag for everyone to ask ‘oh are you still here?’ to my husband and I. Yes, I’m still here, cleaning up the dishes because everyone is cooing over the baby and I can’t sit down because I pushed another human out of my body 48 hours ago. Thanks for asking.”

The general state of Leslie's home office and living room over the last two weeks.

The general state of Leslie’s home office and living room over the last two weeks.  This is the definition of confessional blogging.

While these may seem like awkward jokes from friends, study after study after study has shown that new and expectant parents feel unsupported ,and that lack of support leads to poorer outcomes for the parent(s) and baby. Yet we as a society seem to persist in the mentality that in order for a baby to thrive the mother’s well-being has to be sacrificed.

The last two weeks has been a learning experience for me. I have been slowly re-learning how to take care of myself, while still working and caring for my family. It has not been easy and at times self-care has felt like one more thing on my to-do list. But I’ve noticed a difference.

Mentally, I’m more focused and my mood has improved. I have more energy and I no longer feel like I’ve been hit in the face with a frying pan. I’ve gone back to the gym, but I’ve traded in the treadmill and elliptical for the recumbent bike and am focusing on strengthening the muscles in my back and shoulders which will help me survive the impending third trimester.

Some things have had to be sacrificed. Our living room and basement perpetually look like they’ve been hit by a tornado. The laundry is washed, but hasn’t been folded and put away in two weeks and the stairs haven’t been vacuumed for the same amount of time. I’ve learned that these are signs that I am a good mother, actually. Because when I’m ok, it supports my family. Today, I feel better.

 

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Categories: Mental, Emotional, + Behavioral Health

This Post Isn’t About Bristol Palin: Why Teens Aren’t the Ones With the Unplanned Pregnancy Problem

By July 1, 2015 No Comments
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 At this point, you’ve probably heard about Bristol Palin’s second pregnancy. She announced her news via a blog post last week. She originally suggested that this pregnancy wasn’t planned but followed up that post a few days later with a second one clarifying that her pregnancy was planned…just mistimed.

Planned, unplanned, or mistimed, this post isn’t about judging Bristol Palin or her choices about sex and motherhood. She’s an adult now and deserves to have both the autonomy to make her own decisions about her own body and the privacy to go through whatever she’s dealing with. But I just cannot wrap my brain around how she found herself in this situation. Again.

Bristol’s situation brings up some interesting points that, as a 10-year veteran of reproductive health, I cannot stop considering; mainly, why in the year 2015 do women often struggle to manage their reproductive health? What I really want to talk about is unplanned pregnancy and how incredibly easy it is to prevent with just a little bit of education.

What would you say if I asked which age group has the highest rates of unplanned pregnancy in the nation? If you’re like 70% of Americans, you’d answer “teens.” And like 70% of Americans, you’d be dead wrong. Rather than skyrocketing as most US adults believe, the teen birth rate is in fact dropping like a rock. In 2014 alone, US teen births declined 9% and rates have dropped a staggering 61% since peaking in 1991.

While we like to blame teens for so many of our nation’s ills (get off my lawn!), they’re actually doing a fantastic job of not getting pregnant. The group with the highest rates of unplanned pregnancy in the US are actually right in Bristol’s demographic; young women age 18-29. Bristol is smack in the middle of the current unplanned pregnancy crisis (think crisis is too strong a word? Consider this: more than half of all unplanned pregnancies* in the US occurred for women in their 20s and, of those unplanned pregnancies, 65% were women in their early 20s). She is part of the club of women who are having sex, not effectively using birth control (or at all), and—shocker—getting pregnant before they’re ready.

So why are teens kicking so much butt and young adults—who are older (and we assume?) wiser—falling so far behind?

Comparison of birth control method efficacy via The National Campaign to Prevent Teen and Unplanned Pregnancy

Comparison of birth control methods used by female family planning providers via The National Campaign to Prevent Teen and Unplanned Pregnancy

There’s no magic bullet answer to explain why the teen birth and pregnancy rates are plummeting while the rates for 20-somethings remain so stubbornly high. Some suggest that the recession forced many families to take stock of their finances and teens, who witnessed the day-to-day financial struggles their parents dealt with, and took notice—babies are pretty expensive, after all. Some suggest that shows like MTV’s 16 and Pregnant and Teen Mom have been instrumental in demonstrating the harsh reality of having a baby as a teen; rather than glamorizing these young moms, these shows provided a window into an incredibly challenging and rough time and, again, teens took notice. Some point to the recent American Academy of Pediatrics recommendation that pediatricians begin recommending long-acting methods like the IUD and implant to their teenage patients (there has been a modest uptick in adoption of these methods among teens but it’s still too early to tell if there is a causal relationship to decreases in the teen birth rate). I like to think the best answer is also the simplest: simply put, teens are having less sex AND using contraception more carefully and consistently when they do have sex. So bravo young people!

They are also, to some extent, being exposed to more education about the most effective methods of contraception available to them and they’re taking notice. In 2009, the Obama Administration signed the Consolidated Appropriations Act of 2010, which included $110 million for the President’s Teen Pregnancy Prevention Initiative (TPPI). TPPI created the first federal funding stream available for more comprehensive (ie—abstinence AND birth control) approaches to sex education. Currently, the federal government has recognized nearly 30 programs that have been rigorously evaluated and shown to help teens delay sex and/or use birth control more effectively. Since the implementation of TPPI, the teen birth rate has seen steady and sharp declines…coincidence? Maybe…but it seems unlikely.…**

So, teens are (for the moment) getting all this great education and learning about better methods and/or how to delay sex more effectively and the rates show that things are humming along nicely, but what about those 20-somethings like Bristol?

Well, as most of us know, once you hit adulthood—i.e. graduate high school—everyone assumes you’re good to go on the human body, how it works, and how it reproduces. Beyond a bowl of freebie condoms at the local clinic, there is rarely sexual health education in college curricula and there certainly isn’t much for those young people who skip college for other things. This forces 20-somethings to be proactive about their sexual health—if they want to find a better method (or ANY method) it’s on them to make it happen. For many women, this is just fine. But for many, many more, the stigma, fear, embarrassment, and other issues attached to simply admitting one is sexually active prevents them from seeking out even the simplest methods of birth control or learning about how their bodies really work. They may have grown up in a culture that forbids sex before marriage and so they wouldn’t dream of getting birth control…even when they know they may become sexually active. Or perhaps they simply rely what they know: the humble condom (that they may hate) or perhaps the pill they’ve been taking since high school (that they may not take consistently). Some think they can’t get pregnant during their periods, trust that the man is pulling out on time, they think they can’t get pregnant at that time (or that this will be the ONLY time they have sex), or they just believe that it won’t happen to them. This myth-believing and misinformation about their bodies affects all kinds of women from all different socio-economic backgrounds. Unplanned pregnancy doesn’t have a type; it can (and does) happen to anyone.

It can even happen to a young woman with a famous name, and famous mother who stands on a platform of pro-abstinence rhetoric. Because you don’t know what you don’t know and it can happen to you. So Bristol—best wishes on your new addition; I hope this next adventure is a fun and rewarding one…as a mom myself, I know just how much fun kids can be. But when you’ve had your child, please think seriously about birth control; there is nothing wrong with taking charge of your sexual health and your future and actively planning when you want to next get pregnant. – Edited by Leslie Waghorn

* In this case, “unplanned” indicates that the women themselves reported that they either did not want to get pregnant at that time or did not want to get pregnant ever.

…**As an aside, despite this remarkable progress and clear evidence that the programs funded by this money actually, you know, work, Congress is currently gunning to defund both TPPI and Title X, the nation’s low-income family planning funding stream. I could spend a whole other post detailing how those funding cuts impact millions of Americans but I’ll let this issue brief do it for me.)

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Categories: Ages + Stages, Policy, Politics, + Pop Health, Pregnancy, Birth + Family Planning, Tweens + Teens

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