Friday, March 27, 2009

Help Needed!

Ok, so I am winding down my work week and crossing my fingers that I will get to catch a baby this weekend. Funny how you really miss catching after an extended period of time without any births. My midwife partner (Leigh) caught the last two, so now I think it is my turn! I am doing some updates on the website (for those of you who read my blog through the blogging website). I am in need of more Bamberg birthing stories. I have had several people through the website e-mail me to tell me how much they enjoyed reading the intimate details of births that have taken place here in Bamberg. If any of my dear patient's are reading--please feel free to submit! Also, I would LOVE to have more pictures to display on the website! So moms and dads get on the ball and e-mail me some pics of your offspring! :) I am attaching a super cool article that was forwarded to me through facebook--please do read!


His big hand holds a tiny one as Robbie Goodrich sings in a deep voice, soothing his infant son Moses. The little guy observes his father's every move, focusing on his lips that produce those comforting sounds. Watching him, one may wonder how much 2-month-old Moses already knows about the bittersweet beginning of his life.

Charles Moses Martin Goodrich was born at 3:26 a.m. Jan. 11 at Marquette General Hospital. Eleven hours after giving birth, his mother Susan Goodrich, 46, died of amniotic fluid embolism - a rare obstetric emergency that is not age-related, Goodrich said. Moses is the Goodrich's second child - Julia was born in 2007 - and Susan's fourth. Still in shock over his wife's death, Goodrich realized he had to figure out a way to feed his newborn son.

"They didn't carry any breast milk," the history professor said about the hospital, so a nurse looked into getting some for Moses. As it turned out, the nearest place to get breast milk was in Kalamazoo, and it would take several days to have it delivered to Marquette.

In the meantime, Goodrich received a phone call from family friend Laura Janowski of Marquette, who was still nursing her fourth child, 1-year-old Emily. In her message, Janowski offered Goodrich to nurse Moses.

"That's when it clicked in my head," he said. "I wanted the baby to be nursed. That's something that Susan would have wanted."

One thing led to another when family friend Nicoletta Fraire of Marquette began organizing a group of women who may want to help feed Moses.

"Basically, a couple of phone calls were enough," she said. "I just had to leave my name and phone number and calls started to come in."

She also made contact with Sally Keskey, founder of the Yooper Nursers - a local breast feeding support group. Within a brief time, nearly 20 women were found who offered to breast-feed Moses. Many of them belong to the support group and had never met the Goodrich family before.

"These women are advocates of breast feeding," Goodrich said.

A schedule was put together with feeding times at 9 a.m., noon, 1:30 , 4 , 6:30 and 8 p.m. Six times a day a different mother has been feeding Moses for the past two months. During the night, Goodrich bottle-feeds his son breast milk that was pumped by the women.

"What amazes me is they are so committed," Fraire said. "They would do it for anyone because they believe in this. They didn't take it lightly and they don't miss a day."

Goodrich added: "It's commitment, passion - it's love. It's an act of love."

What these women are doing "is an example of group cross-nursing," Goodrich explained. "It's organized. That's what you don't find anymore."

Goodrich and Fraire did some research to find similar groups in the United States. They were not successful. They heard of friends sharing their babies, which is called cross-nursing, and of course wet nurses get paid for nursing someone else's baby.

"The first literary reference in western literature to wet nursing is Moses' (biblical) story," Goodrich said.

In the beginning, Goodrich and Fraire discussed whether they should have the women tested to be sure they are healthy. In the end, "we just decided to trust them," Fraire said. "The women deeply care about their health and the health of their babies."

And so far, their trust has been validated. Moses has not been sick since he was born.

"He's getting the strongest mix of antibodies in the county," Goodrich said.

But being fed and healthy aren't the only benefits for Moses, his father said.

"It's about the nurturing aspect, being held," he said. "He is happy. He rarely cries."

Goodrich said having the women come to his house to nurse Moses, often bringing their own children, has been good for him.

"These are deeply caring individuals who spend time and work with me," he said. "They've all treated me with the utmost graciousness and empathy."

Goodrich said, if he can find enough mothers willing to provide breast milk, he hopes to continue nursing Moses until he is a year old.

Thursday, March 26, 2009

The battle of the bulge...

Living in the South seems to go hand in hand with obesity. We can't seem to get enough of sweet tea, fried foods, and lots of sweets! I have noticed that in my personal social circle and in my midwifery practice that people are getting bigger--unfortunately, it's not muscle mass they are gaining it's body fat. It is estimated that nearly two-thirds of Americans are considered overweight and one in three are obese, meaning they have a body mass index of 30 or greater. Since more and more Americans are obese we (as midwives) are now beginning to see the effects of obesity on the childbearing woman. Compared with normal-weight women, obese women have a greater risk of developing complications during pregnancy. Their babies are also more likely to be admitted to neonatal intensive care units. I have spent today(during my spare time:) researching the complications of obesity in women's health and childbirth.

To begin with, I found that obesity contributes to infertility. Research has shown that women who were severely obese were 43% less likely to achieve pregnancy than normal-weight women or women who were considered overweight but not obese. While your ovaries are trying to behave and cycle normally, the steady input of estrone (a type of estrogen created from fat cells) will interfere blunting the peaks and valleys of the ovary's function, which ultimately interferes with ovulation and can cause infertility.

Secondly, I found out that women who are obese are more likely to have C-Sections. There are several reasons why obesity increases the chance of a C-section. One of these is a longer labor time. A University of North Carolina at Chapel Hill study showed larger women have naturally longer active labors – defined as the time going from 4 centimeters to 10 – between one and one and a half hours longer. The study goes on to say that many of these women, if allowed to continue to progress, can have successful vaginal births, but many physicians are unaware of this study, so women who could probably deliver vaginally instead end up on the operating table because they exceed the usual time limits for labor. Another reason for C-sections is that larger women also often have larger babies, either because of gestational diabetes, genetic reasons or because of weight gain during pregnancy, and larger babies are more difficult to deliver vaginally.

Thirdly, I found that obesity is linked to neural tube defects. The most common neural tube defect is spina bifida, which is the leading cause of childhood paralysis. The research suggests a doubling of risk for babies born to obese women, compared with those born to normal-weight women. And while folic acid supplementation helps protect against this birth defect, obese women who get enough folic acid are still twice as likely as normal-weight women who also get enough to deliver babies with neural tube defects.

Lastly, I found that obesity is obviously correlated to hypertension and gestaional diabetes during pregnancy.

I now realize that I must make more of an effort in taking a direct approach in assessing my clients healthcare risk. Even though I find myself at times uncomfortable with discussing the topic of obesity, I must do what's best for the wellbeing of my mothers.

Wednesday, March 18, 2009

Wordless Wednesday

I have been pondering in the past ten days about what I should blog about. I have considered everything from V-BACs to cloth diapers. Rest assured, these topics will eventually be blogged. While seeing a patient today, I realized there is a topic that is much more important to be blogged on. Intially, this question may appear a bit simple and rudimentary. What is a Certified Nurse Midwife? Many people (unfortunately) don't know the answer. Ok, so back to my story about seeing the patient earlier today. Earlier this morning I saw one of my patients from Beaufort. We were talking while I measured her fundus (top of her uterus) and listened to the baby's heartbeat. I could tell that something was bothering her so I questioned what was on her mind. She said she was tired of having to explain to friends and family members what a Certified Nurse Midwife was. I thought to myself, "You and me both!" She said that the simple mention of the name "midwife" automatically had people raising eyebrows and saying, "Oh, yea that sounds really risky" or "I didn't know midwives even existed anymore." At times, (I as a nurse midwife) feel like people think I have a mysterious job or don't just quite "get it." You can alomost see the wheels turning when you explain you deliver babies for a living and provide women's healthcare and you are not an OBGYN. I remember when I was in grad. school at MUSC and my professor Lee Horton told us that there was one thing that we as upcoming Certified Nurse Midwives must get used to--no one will ever truly understand what it is a nurse midwife does. How incredibly true this statement still remains. I feel like everytime someone ask me what I do for a living I have to go into a spill about my job role. How amazingily inviting it is when I meet someone who actually knows what a nurse midwife is! Sometimes I wish I could remain wordless and just present a book entitled, This is What I do . Included in the book would be the following information: No, I am not a Labor and Delivery Nurse, Yes we actually deliver the baby (not the MD, actually the MD isn't usually even there unless we need him ie C-section, assisted deliveries, etc ), Yes I can write prescriptions, yes we still exist, no I don't deliver babies at home (although Licensed Midwives do!), yes I see my own patients, and no I didn't consider going to medical school. Sometimes, it is hard to even put words as a defination to a job title. So much of midwifery is an art--a true longing to be "with woman." I guess my upmost desire would be for the United States to have a better understanding of what midwifery is. So, I guess for that to happen I can't remain wordless....

Sunday, March 8, 2009

A Gift.

Two weeks ago for the first time I was involved with the delivery of a baby diagnosed with Down Syndrome. His name was Daniel. Daniel had the strongest spirit and will to live that I have ever experienced in a newly born babe. Daniel is now stable at Richland Hospital. After this amazing experience, I began to think more about what it would be like to have a child with Down Syndrome. My dear friend Mike would like to share with you his personal experience with his beloved Kiernan.

By Mike Burgess:
My son is perfect. He has the most beautiful eyes I’ve ever seen and a smile that could melt the heart of Satan himself. His laugh is infectious and my heart breaks every time he cries. He consumes every free moment I have and manages to soak through every brand of diaper on the market. He can suck down 40 ounces of formula in the course of 24 hours and still have room for his fruits and veggies four times a day. He weighs a ton and doesn’t like to be left alone for more than a few minutes. In my eyes, he’s just like every other infant I’ve ever met, with one small exception: Kiernan has Down syndrome.What does that mean? Nothing, really. He goes to the doctor a little more than other children, and some of his development is a little delayed. Beyond that, I view him no differently than I did my five siblings. He loves to beheld or rocked, and normally he is comatose the minute the car starts moving. If he can hold something, then it invariably ends up in his mouth. He discovered his volume control at the most inopportune moment, cooing at the top of his lungs in the middle of a crowded restaurant. He has learned the game of fetch, knowing that if he throws his toys that daddy will pick them up and give them back to him. For me, he is just a little boy, and the center of his daddy’s universe.And yet, when others find out that he has Down syndrome, they are conflicted. Some extend their apologies. Others babble on about how he “looks so normal”. A third group feels the need to recount a story about the special needs child of a friend of a friend with whom they are acquainted. My favorite, though, are those who respond with a simple “so” or “okay”, and move on. For me, they get it. They realize that yes, things may be a little different for Kiernan, but that’s okay. He’ll grow up just like everyone else. He’ll fall in and out of love, he’ll screw up, he’ll succeed, he’ll be embarrassed by his parents. He’ll go to school, he’ll make friends, and he’ll even make enemies. Most importantly, he’ll live. Ultimately, that’s what we all want: to live life. And that’s what I’ve promised to my son: to help him live his life to the fullest, whatever it takes.

Friday, March 6, 2009

Should I Vaccinate My Baby?

This is the question I am daily asked when seeing my newly born neonate patients. During the past three years I have noticed a progressive fear towards vaccines that seem to be overcoming my new mothers. Being that I see the babies that I deliver for the first couple of months, I have made an effort to more adequately understand vaccines. Here is some interesting information that I have learned. Before I start, I must give a disclaimer and say that I respect and believe that everyone has the right to their own opinion.

I have often wondered where and when vaccines came about. There is kinda a funny story as to where the name "vaccine" actually came from. Vaccines all started in the 1700's with Edward Jenner and a milkmaid. Jenner noticed a relationship between the disease known as "grease" and a disease known as "cow pox." He saw that farmers who treated horses with grease lesions often saw the development of cow pox in their cows, complete with blisters similar to those seen in smallpox infection. Unlike lethal smallpox, however, the cowpox blisters eventually disappeared, leaving only a small scar at the site of each blister. Jenner became intrigued when a milkmaid told him that she could not catch smallpox because she had had cowpox. Jenner then began to notice that there were many people like the milkmaid. With this in mind, Jenner undertook a daring experiment in 1796: he infected a young boy with cowpox in hopes of preventing subsequent smallpox infection. After allowing the boy to recover fully from cowpox, Jenner - in an experiment that would be considered unethical by today's scientific community - intentionally infected the boy with smallpox by injecting pus from a smallpox lesion directly under his skin. As Jenner had predicted, the boy did not contract smallpox.

Ok lets fastforwad to 1999- a cable news network aired a program on which the parents of three-year-old stated that he had developed autism two weeks after receiving measles, mumps and rubella (MMR) vaccine. An American Academy of Pediatrics official explained why there was no reason to believe that a link exists between autism and vaccination. However, dramatic before-and-after videotapes of the child probably had enough impact to persuade many parents to avoid having their children vaccinated. The program's narrator stated there had been "a puzzling jump in the number of children being diagnosed with autism." However, the number being diagnosed may reflect increased reporting of cases rather than an increase in actual incidence.

Some parents of children with autism believe that there is a link between measles, mumps, rubella (MMR) vaccine and autism. Typically, symptoms of autism are first noted by parents as their child begins to have difficulty with delays in speaking after age one. MMR vaccine is first given to children at 12-15 months of age. Since this is also an age when autism commonly becomes apparent, it is not surprising that autism follows MMR immunization in some cases. However, the most logical explanation is coincidence, not cause-and-effect.

If measles vaccine or any other vaccine causes autism, it would have to be a very rare occurrence, because millions of children have received vaccines without ill health effects. The only evidence linking MMR vaccine and autism was published in the British journal Lancet in 1998. An editorial published in the same issue, however, discussed concerns about the validity of the study. Based on data from 12 patients, Dr. Andrew Wakefield (a British gastroenterologist) and colleagues speculated that MMR vaccine may have been the possible cause of bowel problems which led to a decreased absorption of essential vitamins and nutrients which resulted in developmental disorders like autism. No scientific analyses were reported, however, to substantiate the theory. Whether this series of 12 cases represent an unusual or unique clinical syndrome is difficult to judge without knowing the size of the patient population and time period over which the cases were identified. If there happened to be selective referral of patients with autism to the researchers' practice, for example, the reported case series may simply reflect such referral bias. Moreover, the theory that autism may be caused by poor absorption of nutrients due to bowel inflammation is not supported by the clinical data. In at least 4 of the 12 cases, behavioral problems appeared before the onset of symptoms of inflammatory bowel disease. Furthermore, since publication of their original report in February of 1998, Wakefield and colleagues have published another study in which highly specific laboratory assays in patients with inflammatory bowel disease, the posited mechanism for autism after MMR vaccination, were negative for the measles virus.

One question I am asking myself...the known number of Autism cases has been increasing since 1979, but why was there no jump after the introduction of MMR vaccine in 1988? Interesting food for thought..

Ok, so now..what about the Diptheria, Tetanus, and Pertusis vaccine? And the oral polio vaccine? In January 1990, an Institute of Medicine committee examining possible health effects associated with DPT vaccine concluded that there was no evidence to indicate a causal relation between DPT vaccine or the pertussis component of DPT vaccine and autism. Also, data obtained from CDC's Monitoring System for Adverse Events Following Immunization system, showed no reports of autism occurring within 28 days of DPT immunization from 1978-1990, a period in which approximately 80.1 million doses of DPT vaccine were administered in the United States. From January 1990 through February 1998, only 15 cases of autism behavior disorder after immunization were reported to the Vaccine Adverse Events Reporting System. Because of the small number of reports over an 8-year period, the cases reported are likely to represent unrelated chance occurrences that happened around the time of vaccination. now I guess you are thinking I am hard core on vaccinations! Actually, I prefer the more middle of the road approach so to speak....I believe vaccines are very important and have played a tremendous role in limiting many serious diseases in our country. However, more and more parents are concerned and want to take an approach that varies from the regular CDC schedule. I believe that if more and more doctors offer parents such options, we will have better vaccination rates than we are seeing now. Some options for parents...

Don’t give the Hepatitis B vaccine to newborns in the hospital.This shot can cause fever, lethargy, and poor feeding (problems you don’t want to see in a newborn),one could delay this shot until the first two months of life, especially since the disease doesn’t even occur in newborns (it’s a sexually-transmitted disease).

Checking “titers” (blood immunity levels) for various shots before doing boosters. Some kids don’t need some of the booster shots at age 5 years because their original infant series may still be working just fine. While this is a costly and time-consuming approach, some parents prefer it instead of automatically getting all the boosters.

Getting fewer shots at each infant checkup and spreading the shots out over more time. This is the hallmark of Dr. Sear's Alternative Vaccine Schedule. I reallllly like this schedule! The MMR is the most criticized culprits of autism, but this schedule divides them up at 1, 2, and 3 years old.

Limiting large combination shots. Some parents prefer to split some of the combo shots into separate components to decrease the chance of a reaction. While we don’t know if this precaution even helps, it is an option that some doctors like to provide for concerned parents.

The bottom line is that more and more parents want options. If we don’t provide them with options they are comfortable with, more parents will opt out of vaccines altogether. We will then see more and more disease fatalities and complications.