Saturday, September 17, 2011

Sudden Infant Death Syndrome

Sudden Infant Death Syndrome, SIDS, is a topic that is very important to me.  I talk about SIDS quite frequently in my teen parenting class because most of the mothers, and the family of the mothers, are extremely uninformed about SIDS and the ways to prevent it.  SIDS rates are high for babies born to teenage mothers.  I talk about all the ways to prevent it including:

·         Placing babies to sleep on their backs (They argue with me, saying their babies sleep better on their stomachs.)
·         Use a firm mattress with no pillows, blankets, stuffed animals, bumper pads, or sleep positioners.  (The girls usually argue with me about the bumper pads.  They think their babies are going to get hurt or stuck in the sides of the crib.)
·         Do not sleep with the baby in the adult bed or couch.  (Many of the girls sleep with their babies anyway.)
·         Don’t over-clothe the baby or let the baby get too warm when sleeping.  Open a window or run a fan when the baby is asleep.
·         Don’t smoke in the house or around the baby.
·         Breast feed
·         Use a pacifier

I talk about the ways to prevent SIDS every time I hear news story about it.  I also make it point to revisit the topic when one of the girls is about to deliver and then again when they come back to school.  I am hoping that maybe I can prevent it from happening to them.

Rates of SIDS in the United States as compared to other countries.
In 2007, SIDS was the 3rd leading cause of death in American Infants with 2,453 cases reported.  You can see from the chart that the cases of SIDS in American have declined since the Back To Sleep campaign was started in 1994.  However, the rate of SIDS is still high in certain ethnic groups.
Chart 2. SIDS Deaths by Race and Ethnicity, 1995–2006
Chart 2. SIDS Deaths by Race and Ethnicity, 1995-2005

The rate of SIDS in the United States is higher than other developed countries. The U.S. ranked 2nd in a study of 13 countries by Fern Hauck and Kawai Tanabe.  The country with highest rate was New Zealand and the lowest were the Netherlands and Japan.  All of the countries experienced a reduction in the number of SIDS deaths after risk reduction campaigns similar the Back to Sleep campaign in the U.S.  However, the rate in the United States may be higher because a cause of death is actively sought for by performing autopsies.   In Japan, only about 1/3 of infant deaths result in an autopsy.
Chart 3. International SIDS Rates, Ordered from Lowest to Highest SIDS Rate in 2005
Chart 3. International SIDS Rates, ordered from lowest to highest SIDS rate in 2005

The information about the rate of SIDS in developing countries is not accurate.  This is due to a high infant mortality rate from identifiable causes of death, such as respiratory infections, malnutrition, and diarrhea.  Health officials are much more focused on preventing these types of deaths.

Saturday, September 10, 2011

Having a Baby in Brazil

About 40% of all births in Brazil are c-sections, most being elective.  Private hospital c-section rates are much higher with some being at 100%.  The reason given by Marsden Wagner, MD, a perinatal epidemiologist who works for the World Health is that roughly one quarter of the mothers are from upper or middle class.  Many doctors perform c-sections to receive higher payments from the insurance companies and to save time by not allowing women to go through the labor process.  Most women do not attend childbirth classes.  They receive all of their information from their doctor and tend to go along with their plan for a c-section.  In 1998 the Brazilian government instituted procedures to reduce the rate of c-sections.

My birth experience

I have two children and two birth experiences which were probably as different as birth experiences can get.  With my son, Tyler, I was completely unprepared even though I had attended the free birth classes given at the hospital and read What to Expect When You Are Expecting.  I was 27 years old and working as credit counselor for a non-profit agency.  Tyler was due on Wednesday and I was planning to work through that week because first babies are always late.  At least that was what everyone told me.  Well, early Monday morning I went into labor and woke my husband up about 5 am to take me to the hospital. We arrived at the hospital and checked into the L&D room.  I was able to get my epidural right away so it wasn't painful.  After about five hours of easy labor it was time to push.  That's when things got crazy.  Tyler's heartbeat starting dropping and the nurses gave me oxygen and made me lay on my side (which is pretty hard to do when you've had an epidural).  I couldn't see anything over the oxygen mask and got really concerned when I heard my doctor tell the nurse to get the Neonatal doctor right away.  Alarms were going off and nobody was telling me anything!  To make things worse my epidural wore off on one side on my body.  My doctor said it was too late for a c-section so he told me I needed to have a vacuum extraction.  My husband I agreed and Tyler was born (or maybe I should say ripped out of me) at almost 1 pm.  He fine and the doctor said he really couldn't explain what had made his heart rate drop like that.  I was in a lot of pain (4th degree tears to the perimeum) for a few weeks and suffered from mild post partum depression for about six weeks.

My experience with my daughter, Olivia, five years later was wonderful.  My water broke on a Sunday afternoon and we went to hospital that evening.  Because I was not having any contractions yet, the nurse administered the Pitocin to speed things up.  I was the only patient in L&D that night, so I had the full attention of my doctor and nurse.  Things were very quiet and Olivia was born at 12:37 on Monday morning after about 45 minutes of pushing.  I felt great the day she was born and was disappointed that I had to stay the mandatory 24 hours.  I was discharged on Tuesday and went home and cooked dinner for the family and resumed my normal life, only with a new baby along.

I feel my experiences were so different for several reasons.  First, I was much more prepared with Olivia.  I had gone through it before, but I was also teaching prenatal development and birth as part of my child development and teen parenting classes.  I was much more knowledgeable about the entire process and the possible complications.  Therefore, I was much more relaxed the second time.  When I had my son, my doctor had 2 other patients in labor and all the delivery rooms were full that day.  They were in and out all day and were very rushed.  It was noisy and because he was born in the daytime, there were many visitors in and out of the delivery room.  With our daughter is was just my husband and I, the nurse, and the doctor.  As for the postpartum depression, I think the fact that I was more prepared and the delivery went so well contributed to the fact that I didn't have it the second time. 

Giving birth and being a mother is the most amazing experience in the world.  Sometimes I look at my children and can't believe that these two amazing humans are mine.

I think the birth process plays a role in child development.  The experience of the mother and her feelings after birth will affect the way she mothers her child.  Post-partum depression can manifest in many ways and may be harmful to the baby.  I know that I was probably a better mother to my newborn daughter than to my newborn son simply because I was better educated and the birth process went so well. 

Olivia- 1 month; Tyler- 5 years