Friday, February 27, 2015

How to Handle a Home Birth Debate in 5 Steps

Step 1: When you hear: “There are plenty of studies that show that home birth is as safe as hospital birth.”

Kindly remind them that home birth studies performed in other countries do not apply to home births in the United States due to our vastly different midwifery training requirements and health care systems.

And then share with them that in the United States.... (click here to continue reading)

Thursday, February 26, 2015

Infant Mortality and Maternal Mortality

Let's clear up a little confusion. Are the infant mortality and maternal mortality rates in the USA reasons for women to be afraid to give birth in a hospital here?


Here's why:

Infant mortality refers to the death of a baby within the first year of life. Infant mortality refers only to babies born alive that die before they turn one. If a baby dies at 4 days old or 364 days old it will affect the infant mortality rate. So yes, it includes pregnancy and birth-related issues that may later cause a death like birth defects, low birth weight and neonatal hemorrhage but also includes things like accidents, disease, and SIDS… those are all encompassed (and more) in the infant mortality rate.

Perinatal mortality refers to death around the time of delivery and includes both fetal deaths (of at least 20 weeks of gestation) and neonatal deaths (death during the first 28 days after live birth). Neonatal mortality is encompassed within perinatal mortality.

Infant mortality is not the correct mortality rate to use to gauge safety of obstetrics / maternity care. 

Perinatal mortality is a much more accurate measure for maternity care (even the World Health Organization acknowledges this). It includes prematurity, fetal mortality (death of baby in utero), intrapartum mortality (death of baby during labor and delivery) and neonatal mortality (death of baby during first 27 days of life).

So why don’t the leaders of the home birth movement discuss perinatal mortality? Because the United States does very well with perinatal mortality, tied with countries like France and Japan, and actually better than countries like the Netherlands and the UK.

The USA unfortunately does rank poorly for infant mortality. Why is that? You might be surprised to hear that it is not due to obstetrics. It is mainly due to two factors:

1. We include micro preemies in our infant morality rate while other countries would consider them to be miscarriages or stillbirths. In other words, it's not a matter of more babies dying in the USA, it's a matter of us recording deaths that other countries would not. (this also affects our neonatal mortality rate... read more about that in the article below). Infant deaths within the first month of life are less frequent in the USA than they are in Finland, which has the lowest infant mortality rate in the world.

2. Socio-economic issues is unfortunately the other issue, families lacking means to have what they need to safely raise a baby in their home (for example, not being able to afford to take their child to the doctor or hospital if the child is sick). Unfortunately, there are a lot of deaths happen after the first month of life but before the first birthday.

You can read this short but informative article that expands on these issues here, the studies are included within this piece: new infant mortality studies

There is also the neonatal mortality rate. Neonatal refers to the newborn period of life, specifically the first month. Neonatal mortality rate refers to the death of a baby any time after live birth and through the first 27 days. If a baby dies prior to labor or prior to birth, the baby will not be included in the neonatal mortality rate. Only babies born alive but die some time in those first full 27 days are included in the neonatal mortality rate. Neonatal mortality rates can be broken up into early neonatal (death in the first week) and late neonatal (death after the first week but before the 28th day). 

We have an excellent neonatal mortality rate in the USA. The overall neonatal mortality rate for the United States is 4/1000 (4 deaths for every 1000 live births -- which is the same neonatal mortality rate as Canada). This rate includes all gestational ages (including extreme prematurity), all risks, all complications, lethal anomalies, etc. If you are looking at full-term, low risk women and exclude lethal anomalies, the neonatal mortality rate is much lower than 4/1000... it is currently approximately 0.3/1000.

Maternal mortality - why does the USA have a rising maternal mortality rate? Unfortunately, the real issue in our country is health of pregnant women. Maternal death is very rare (which is why it's measured per 100,000). And it's even more rare for healthy, low risk women.

Our number one pregnancy-related killer for women in the USA is cardiovascular disease.

Some important information to read/consider:

"In the U.S., deaths from hemorrhage, sepsis (infection) and abortion (the medical definition of which includes ectopic pregnancy, miscarriage and induced abortion) are on the decline.... But deaths from medical complications that were either exacerbated by pregnancy or started during pregnancy -- things like congenital heart disease, diabetes, obesity and kidney problems, are on the rise." (my emphasis; quote from Maternal Mortality Article << this link includes a recent study on maternal mortality around the globe)

In other words, mass majority of the women dying due to pregnancy-related issues in the USA have chronic health issues and need more intervention, not less.

That should clear up the confusion. Don't let someone scare you away from a hospital birth with infant and maternal mortality rates. Now you have the information you need to know that our hospitals in the USA do quite a good job of keeping our babies and mothers safe during childbirth.

Saturday, February 7, 2015

Now is the Time to Rethink Vaccines

photo courtesy of El Alvi

The choice to vaccinate isn't just about you and your kids. We aren't talking about how you install a car seat or whether or not you breastfeed or the GMOs you choose to eat or not eat, etc..... we are bringing back diseases that shouldn't be coming back. Diseases that are being brushed off as “no big deal” because our generation hasn't seen how devastating these diseases can be, even for well-nourished individuals.

This is a public health issue. Your choice not to vaccinate affects others. Just like drunk driving isn't just about the drunk driver behind the wheel -- it's about anyone who might be on the road with the drunk driver. Drunk driving can affect a lot of people just like not vaccinating can affect a lot of people. Vaccines are not 100% effective – no one claims that they are. So those who have received the vaccines are not 100% immune. And there are children too young to receive vaccines. And there are people who have compromised immune systems. In other words, there are people who depend on others around them not contracting these diseases. I am so glad to say I'm doing my part to help protect them, though I am sad to say once upon a time I thought I “knew better” than experts around the world because I had my Dr. Sears book in hand and was armed with all kinds of pseudoscience found in his book, in internet forums and through my old friend, Dr. Google.

One can only truly claim to be "well-informed and well-educated" on vaccines if they have studied years and years through actual academic programs (not Google) in the field of infectious diseases, immunology and/or epidemiology. If you have not, then no, you do not know more than experts in these fields who unanimously agree that vaccinating ourselves and our children is the best way to prevent death and complications from vaccine-preventable diseases. What the anti-vaccine crowd is actually armed with are conspiracy theories, anecdotes that they believe trump scientific evidence, all backed by nonsense found on sites like Mercola, Natural News, Health Impact News and other website based on pseudoscience and written by quacks.

Think Big Pharma is making all kinds of money from pushing vaccines? Perhaps you should check out your own “vaccine-friendly” pediatrician. The handful of anti-vax doctors and “doctors” out there are making a LOT of money off of your fears, pushing their own products/supplements/books and charging parents oodles of money out-of-pocket for their services.

Vaccines are safe and effective. Don’t be scared by the “vaccines are full of toxins” nonsense. The real fear-mongering is coming from those who don’t understand the vaccines, don’t understand how they work and don’t really know anything about the ingredients they are trying to scare you away from.

Measles is serious. The flu is serious. Pertussis is serious. Vaccine-preventable diseases are serious. Now is the time to think twice if you have fallen into the anti-vaccine trap. I believe you mean well and you only want to do what you think is best for your children… but not vaccinating is not doing what is best for your children or your community.

Why are there more vaccines for kids now than 20 years ago? Read here and here and read this quote from here for a quick answer: "As science progresses, children and adults are protected against more and more vaccine-preventable diseases. In the 1920s, there was just one vaccine: smallpox. At that time, hundreds of thousands of children got diphtheria---many of them died from it. By the 1950s there were five vaccines, including one for diphtheria, but still tens of thousands of children got sick from bacterial diseases such as meningitis or pneumonia caused by Hib or pneumococcus. Today we have vaccines for diseases that used to affect children every day. Healthy communities prove that immunizations are working. "

Were diseases really on the decline before vaccines? Read here

Worried about the "toxins" in vaccines? Read here

My favorite, easy-to-read explanation of the facts about vaccines: read here.

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