Strollerderby : prematurity

"Angels in Waiting" Apparently Still Waiting

Kate Tuttle — Wed, 25 Feb 2009 16:30:00 GMT

For all the ink spilled in the whole Octomom saga, not much has been written yet about the group that has offered to take over the care of the octuplets (free of charge!). Angels in Waiting, which was introduced to the drama via a Fox News interview also starring Gloria Allred, says it's willing to take the eight babies, keep them in "a home" (presumably not Suleman's), and provide the care they need as medically fragile premature newborns.

All of which sounds fairly generous -- a point repeatedly made by various bloggers who are dying for Suleman to turn over them babies! -- until you read more about them. Angels in Waiting is not devoted to helping stressed-out, possibly mentally ill mothers of multiples take care of their kids -- their goal is to prepare babies born to meth addicts to be adopted out. From their website:

Angels in Waiting is dedicated to moving these special little angels into loving homes with Registered Nurses as their foster parents and then on to adoptive homes in which they could recover or stabilize, grow and now flourish; their troubled pasts overshadowed by their hopeful futures.

Founded by a registered nurse whose own life was changed through the care and ultimate adoption of a micro-premie born to a meth-addicted mother, Angels in Waiting is clear about its mission: putting babies into homes, not with their birth parents, preferably with a foster mother who is also a nurse. And who works for Angels in Waiting!

It's a little unclear to me how this model fits into the Nadya Suleman situation. Despite the seemingly endless questions about her ability to care for these babies, she has expressed a steadfast determination to parent all her children. If she proves to be unfit, as many have predicted, I have no doubt child protective services will step in. But CPS's goal is twofold: help the children, and help support the parent so that the family can be re-united. This is not the goal of Angels in Waiting, whose website is filled with gauzily religious testimonials about "tiny ones" and "injured ones" -- and which has a "donate" button on each page. One thing not made clear on the Angels website is how many babies they have actually helped, how big their operation is, or where donated money actually goes (though they do make a big deal about the need for scrapbookers to help create memory books for the angels).

As nutty and publicity hungry as Suleman has appeared so far to be, she has some stiff competition here.

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They Say: See Your Dentist to Avoid Pre-Term Labor

Miriam Axel-Lute — Wed, 14 Jan 2009 15:00:00 GMT

A new study from the Journal of Clinical Microbiology is estimating that up to 80 percent of pre-term labors could be caused by mouth bacteria—the kind that are usually in your mouth and don't cause much trouble there, but can apparently cause an immune reaction and labor if they get into the bloodstream, say through a cut in the gum or cheek.

Assuming further research bears this out (which it may or may not), it's one of those findings that I have very mixed feelings about.

On the one hand, given all the various problems that we know prematurity, even late prematurity, causes, identifying a reason for it is huge and exciting.

On the other hand, I can just see every woman with a preemie being told it's her fault for not brushing her teeth enough. Do we need another thing for pregnant women to freak out about? Especially since this is normal mouth bacteria, and it's probably going to get into the bloodstream from time to time no matter what you do. In fact, I'll bet that obsessive attempts at oral hygeine would probably backfire (think about those bleeding gums if you haven't flossed in a while).

Of course the other approach the article mentions—prophylactic antibiotics—sounds like a prescription for resistant bugs and nasty yeast infections unless you could target high-risk people pretty carefully.

The one fairly concrete takeaway from the article is the suggestion to see a dentist before pregnancy to make sure you don't have peridontal disease, and clearing it up if you do. That could be a useful thing to add to general pre-conception recommendations. Anything else, I think I'd want a separate study showing it really worked before anyone began adding another item to the pregnancy "thou shalts."

Photo by martinhoward.

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Pre-Term Elective C-Sections Are Dangerous: So Why Insure Them?

Miriam Axel-Lute — Fri, 19 Dec 2008 15:00:00 GMT

Michael McGuire is CEO of UnitedHealth, a health-insurance provider in New Jersey. In an op-ed in the Trenton Times recently he talked intelligently about the health dangers of elective pre-term c-sections.

The evidence keeps mounting—prematurity, even by a few weeks, means higher rates of breathing problems, cerebral palsy, NICU stays, etc. When the baby's not ready to come out, it's not ready, folks.

McGuire makes the impressive assertion that when he explained this carefully to a "pilot group" of physicians and hospitals and they stopped scheduling c-sections before 39 weeks, there was a 46 percent drop in NICU stays. Those are results to write home about. As he writes, "That's almost half the number of newborns with potential health problems, almost half the number of distraught parents, al most half the number of potential tragedies. The cost savings to these hospitals, the parents and the health-care system is enormous."

He notes carefully, as do I, that sometimes a pre-term c-section is medically necessary for health of mother and/or baby. Obviously, that is not what I'm talking about. But I would include c-sections that are planned for medical reasons,* but where there is no medical reason not to carry the baby to term. I think those are far, far more common than the over-hyped "too posh to push" phenomenon.

So here's what I want to know: If it's documented to be such a health risk, why don't McGuire and his colleagues just stop paying for c-sections that are unnecessarily scheduled at an unsafe time?

Insurers already go out of their way to not cover things they claim are optional (including some that are emphatically not), not to mention dangerous. Usually I question their judgment, but the evidence is pretty compelling on this one.

I'm all for educating docs, but it seems to me the insurers could stop this practice cold with their purse strings.

Photo by César Rincón.

*(Of course, many of those "medical reasons," like a previous c-sections or breech presentations, don't actually require a c-section, but that's a separate post.)

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They Say: Even Late Preemies at Higher Risk

Kate Tuttle — Mon, 15 Dec 2008 18:02:00 GMT

While it's long been known that premature babies face a much higher incidence of cerebral palsy and other medical problems, most of the infants thought to be at risk were those born before 34 weeks -- the tiny babies, notably premature, whose entire bodies can fit into the palm of their father's hands. But new research suggests that even bigger, healthier-seeming babies, when born before term, are much more likely to fall victim to the health problems of prematurity. And at a time when more and more women are giving birth early due to inductions or scheduled C-sections, that risk needs to be better communicated, according to the doctors who authored the study.

The study, which examined the circumstances of more than 140,000 babies born at 30 weeks or later, concluded that babies born from 34 to 36 weeks' gestation, although often appearing as big and healthy as full-term newborns, were three times more likely to have cerebral palsy than babies born at 37 weeks, and up to 25% more likely to face mental retardation and other developmental delays. Because the babies in the study have not yet entered elementary school, the authors point out, it's too early to know whether other learning-based problems will be detected.

While overall rates of prematurity are fairly steady, the number of babies born from 34-36 weeks is growing, and currently represents one in 11 births in the US. The study did not look into the reasons for the late preterm births, and some surely were medically indicated (pre-eclampsia, for instance, pretty much demands that a baby be born early, to save both lives).According to the study's authors, however, some of those "late preterm" births were due to early inductions or C-sections that were not medically necessary (remember that the next time a Hollywood starlet says she's due "sometime in the fall" and has a six-pounder).

Pre-term Elective C-Sections Are Dangerous: So Why Insure Them?

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Eat Chocolate, Protect Your Baby

Amy Kuras — Wed, 30 Apr 2008 18:33:00 GMT

Finally, some good news about pregnancy and what we might choose to eat or drink during those nine loooonnnngggg months.

Researchers at Yale University studied more than 2200 pregnant women between January 1996 and September 2000, and found those who reported eating at least five servings of chocolate a week were 40 percent less likely to develop pre-eclampsia than those who consumed less than one serving a week.

Preeclampsia is rare but serious, sending the mother's blood pressure soaring and often leading to premature deliveries and babies at serious risk of dying. It's scary stuff and the cause is unclear.

Researchers believe the chemical theobromine , which occurs naturally in chocolate, could be responsible for the protective effect. They tested the levels of theobromine in the umbilical-cord blood of babies born to mothers in the study. It found a correlation between women who consumed the most chocolate, therefore those whose babies had the highest concentration of theobromine, and a significantly reduced incidence of preeclampsia.

And this is my favorite pregnancy-eating quote ever from any expert, ever: Lead researcher Dr Elizabeth W. Triche said, "Because of the importance of preeclampsia as a major complication of pregnancy, a detailed assessment of chocolate consumption is warranted."

I'm anecdotal proof: Two pregnancies, a preexisting love for chocolate and carte blanche to indulge (what? It made the baby move), and no preeclampsia either time – low-ish blood pressure and overdue babies, actually. Almost makes me want to get pregnant again so I can justify my sweet tooth.