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Maternal and Child Health
Section Newsletter
Summer 2007

Message from the Chair: ENERGIZING MCH: A NEW INVOLVEMENT IN SECTION ACTIVITIES

Summer suddenly exploded on APHA with a round of busy conference calls and e-mail sessions.  Usually groups become less busy during vacation time, but these few months allow for final preparation for APHA’s Annual Meeting in November. At the same time, MCH leadership has been working to develop new communication opportunities for Section members. 

 

Maternal and Child Health, like all the other sections, SPIGS, and Caucuses, is in the middle of these arrangements.  Annual Meeting Planning Chair Carol Nelson has been successful in her negotiations with APHA.  Besides the usual number of panels and presentations, MCH is sponsoring a “by-invitation only” session for state affiliate members to encourage the idea of developing state sub-groups on maternal and child health.  Dr. Charles Mahan and Dee Jeffers of the Childs Center in Florida are the speakers for this Monday afternoon event. 

 

In addition, the timing of several of the MCH Section meetings has changed to better meet the new APHA conference format.  The main leadership meeting will be Sunday morning from 10:00 to noon, and brunch will be served.  The general membership meeting will be held from 4:00 to 6:00 on Sunday to allow attendees to go to the APHA performance by the Capitol Steps on Sunday evening.  Student orientation will occur from 2:00 to 4:00 on Sunday.

 

This change will leave Monday morning open for committee meetings, from 7:00 to 8:30.  During the recent mid year meeting, Section leadership discussed the need for task forces on advocacy, membership development, and strategic planning.  Those groups will have time to meet during this fall session.  Tuesday remains full with the Martha May Elliott noon session, and the Martha May Elliott Forum.  We are also planning a special cocktail hour gathering with the President of APHA, MCH’s own Deborah Klein-Walker.  Please start putting your convention calendar together.

 

Section Secretary Jane Pearson, assisted by Laura Kavanaugh and Shalini Tendulkar, has been working on the new Web site, which is almost ready to be launched.  Jane has also updated the MCH listserv, adding many new names.  Many of these individuals are asking to be involved in Section activities so please contact Jane if you have a task and need some help.

 

Jessica Murray, APHA intern, with the help of APHA Director of Component Affairs Fran Atkinson, did a wonderful job surveying present and lapsed MCH members.  They also produced a new MCH brochure, which we will be reviewing and publishing this summer.  Membership Chair Jessie Richardson and Section Chair-elect Joanne Fisher are working to use these tools in the MCH membership drive.  A new booth is planned, which the Section Council hopes will be funded through membership contributions. 

 

Holly Grason has been working hard as Action Board Representative.  With the help of Laura Chiu, senior Student Fellow, and other past fellows, Holly reviewed all the existing MCH policies for the Action Board.  A report on this policy development will be forthcoming at the Annual Meeting.

 

Finally, Secretary-elect Karen VanLandingham has a pool of applicants for the coming year for Student Fellows.  She is working with a committee to continue in the tradition of exciting student intern programs, which was begun by previous secretaries-elect.

 

Whew!  Time to end and get back to “lolly-gagging” (a good ol’ time Southern expression for hanging out) in the sun.  Isn’t that what the song promised, the lazy, hazy, crazy days of summer? Keep tuned in to your e-mail; there is much going on this summer in the MCH Section. 

 

 

IMPROVING PREGNANCY OUTCOMES COMMITTEE

Greetings from the Improving Pregnancy Outcomes (IPO) Committee!

 

Come join us at the APHA 135th Annual Meeting in Washington, D.C., Nov. 3-7, 2007, which focuses on "Politics, Policy, & Public Health."

 

Last year in Boston, our committee successfully submitted a Policy Position Paper that was adopted by APHA entitled Reducing Racial/Ethnic and Socioeconomic Disparities in Preterm and Low Birthweight Births”.  As you will see below, the Improving Pregnancy Outcomes Committee will again play a highly visible role at this year’s meetings.  Come join our dynamic committee which is committed to improving the health of mothers and babies.

 

IPO Committee Business Meeting:

At this yearly planning meeting, we will set our priorities and goals for the coming year and plan sessions for 2008.  You do not have to be a member of the IPO Committee to attend the meeting.  As always, new members are welcome! (Please refer to the program for exact time and location).

IPO Podium and Poster Sessions, (Washington, D.C. 2007)

We will have three IPO podium sessions and one poster session

PODIUM SESSIONS

  • 3049.0 - SCI: Monday, Nov. 5, 2007: 8:30 a.m.-10:00 a.m.
    The Role of Politics and Public Policy In Improving Pregnancy Outcomes

This session will present research on a variety of state and national programs and policies that directly or indirectly affect pregnancy outcomes, including an update on the National Healthy Start evaluation.  The importance of public-private partnerships in preventing preterm birth will also be examined.

 

  • 3342.0 - SCI: Monday, Nov. 5, 2007: 2:30 p.m.-4:00 p.m.
    Disparities In Pregnancy Outcomes: The Role of Politics and Public Policy

This session will present new work focused on systems-level innovations for addressing disparities in pregnancy outcomes.  Presentations will center on patient/provider perspectives on the quality of preconceptional, interconceptional, and prenatal care, as well as evaluations of community-based intervention programs for addressing disparities.

 

  • 5181.0 - SCI: Wednesday, Nov. 7, 2007: 2:30 p.m.-4:00 p.m.
    Improving Pregnancy Outcomes: Cutting Edge Research

This session presents cutting edge research on health literacy and beliefs, mental health issues, and new medical treatments to reduce adverse birth outcomes among socially and/or medically high-risk pregnant women. Attendees will gain understanding of emerging practices that may assist their efforts in reducing preterm birth and low birthweight.

 

POSTER SESSION

  • 4274.0 - PS-SCI: Tuesday, Nov. 6, 2007: 4:30 p.m.-5:30 p.m.
    Improving Pregnancy Outcomes: Politics, Disparities, and Cutting Edge Research

This poster session will present work centered on improving pregnancy outcomes in high-risk populations that disproportionately suffer from poor birth outcomes.  Posters present results of new research on labor induction, modifiable risk factors, and community-based and policy-based interventions for improving pregnancy outcomes and reducing disparities.

 

The Improving Pregnancy Outcomes Committee is an active committee in the Maternal and Child Health Section.  We welcome your participation and input.  If you would like more information about our work or would like to become a member, please email one of the committee co-chairs. 

 

With Warmest Regards from your co-chairs,

 

Judith Katzburg        Tyan Parker-Dominguez       Janine Lewis
jkatzbur@ucla.edu    tyanpark@usc.edu              jlewis6@uic.edu

RUTH LUBIC FEATURED IN WASHINGTON POST MAGAZINE

Babe Magnet , the long-awaited article on the creation of the Family Health and Birth Center founded by Ruth Lubic, was the cover story for the Washington Post Magazine on Sunday, May 27, 2007.  The article covers the Birth Center, and in particular its success in reducing the rates of premature birth, low birth weight, and cesarean section for the primarily black families being served at the FHBC, while at the same time effecting remarkable cost-savings.  Ruth Lubic has spent the last four decades defying doctors to change the way American women give birth.  Hundreds of babies in Washington, D.C., owe their healthy starts in life to Ruth and her childbirth center, which was opened in 2000 after Ruth received a $375,000 MacArthur Foundation “genius” award.  But the cost of malpractice coverage, coupled with low Medicaid rates, threaten the very existence of the clinic, even though the services are desperately needed in the underserved Northeast D.C. neighborhood where the clinic is located.   Ruth’s story is both inspiring and cautionary, and as she nears her 80th birthday, far from done.  You can read the complete article at:  http://www.washingtonpost.com/wp-dyn/content/article/2007/05/23/AR2007052301294.html?referrer=emailarticle

REBIRTH IN NEW ORLEANS: THE NATIONAL PERINATAL ASSOCIATION, SEPTEMBER 27-29, 2007

The National Perinatal Association invites private and public maternal and child health professionals from across the United States to join NPA members for our 2007 Annual Clinical Conference: New Beginnings for Perinatal Health: Medical, Social and Community Integration which will be held in New Orleans from Sept. 27 – 29, 2007 at the Marriott Hotel at the Convention Center. 

 

The conference faculty includes many nationally-recognized experts on various perinatal and other health topics including NPA founder Dr. Stanley Graven, as well as Dr. Ira Chasnoff, Dr. Hani Atrash, Dr. Al Brann, Karla Damus, PhD. and many more.  Topics to be covered include fetal imaging, near term pregnancies and outcomes, perinatal alcohol use, preconception care, the NICU environment and infant development, disaster preparedness for perinatal patients, and many more.   The learning environment will be complemented by the abstract and poster presentations selected through a competitive peer review process. 

 

The NPA Conference Planning Committee specifically selected New Orleans as the site for the 2007 conference to honor the continuing rebuilding process and the continuing need in New Orleans and the southern states affected by Hurricane Katrina.  Our goal is to promote awareness of the newest and emerging best practices in perinatal health care in an environment which is also on the verge of a re-emergence so that our conference participants have a rewarding experience, both personally and professionally.

 

Conference registration fees range from $250 to $400 per participant (dependent on early registration, member status, etc.).  Reduced overnight rates for the Marriott have been specially negotiated for the conference @ $119/night.  For more information on the conference or to receive a copy of the conference brochure, please contact the NPA office at (888) 971-3295 or by e-mail at npa@nationalperinatal.org.  A copy of the Call for Abstracts or Save the Date flyer is also available on the NPA Web site, www.nationalperinatal.org.

 

The National Perinatal Association is a multi-disciplinary organization of individuals and organizations concerned with perinatal issues from preconception through infancy within a multicultural perspective.  We foster optimal perinatal care by promoting education, supporting research, influencing national priorities and encouraging collaboration among all constituencies, including health care providers and consumers.  We invite you to join the more than 1,000 individuals who choose to join their voices through NPA to strive for continued improvement in perinatal health and birth outcomes. 

 

Join us for the 2007 conference in New Orleans! 

HAWAII TRAINS THE MCH LEADERS OF TOMORROW

The HRSA-funded Hawaii MCH Leadership Program, Office of Public Health Studies, John A. Burns School of Medicine, University of Hawaii at Manoa, strengthens student skills in MCH programming, policy, needs assessment, evaluation, and ability to interpret and communicate data. The program helps prepare emerging and experienced public health practitioners to become effective MCH leaders.

 

The 16 to 17 credit hour coursework focuses on cross-cultural understanding and promotion of greater diversity in public health via outreach to rural Hawaii and Pacific Island practitioners and under-represented ethnic groups. The Program coursework can be fulfilled concurrently with an MPH/MS degree.  All students completing the required coursework will receive a certificate of completion. This program is currently in the process of seeking formal Graduate Certificate status with UH-Manoa.

 

The MCH Leadership Program offers scholarship opportunities, distance education classes and worker-friendly class scheduling, as well as contacts with MCH community resources.  The curriculum currently includes the following courses:

  • Analytic Approaches to MCH
  • Needs Assessment & Program Planning
  • Community and PH Practice
  • Policies & Programs in MCH Services
  • Program Evaluation
  • Integrative Seminar

For more information on the Hawaii MCH Leadership Program, please contact Program Director Nancy Partika via e-mail at nantika@hawaii.edu or by phone at (808) 956-5756.

CHILD CARE HEALTH CONSULTANT TRAINERS COURSE AT CHAPEL HILL

Professionals interested in becoming child care health consultant trainers can now take a continuing education course offered by the National Training Institute for Child Care Health Consultants (NTI). The course is held on-site in Chapel Hill, N.C., and includes a distance learning component using Blackboard.  Qualifications to participate include:

  • must be an active child health, child care, and/or early childhood education professional.
  • must have recent experience in or with out-of-home child care .
  • Should work as part of a system, either public or private, with the potential for supporting a child care health consultant training program on a regional, state or local level.
  • must have experience in face-to-face training of child health, child care, or early childhood education professionals.

NTI is a cooperative undertaking of the School of Public Health's Department of Maternal and Child Health and the Frank Porter Graham Child Development Institute, at the University of North Carolina at Chapel Hill.  NTI is funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration, U.S. Department of Health and Human Services.  For more information about the program, visit www.sph.unc.edu/courses/childcare.

BRIDGING THE GAP IN RACIAL/ETHNIC HEALTH DISPARITIES: THE ROLE OF COMMUNITY HEALTH WORKERS

Racial/ethnic health disparities are pervasive.  There are a number of factors stemming from patient-provider relationships that may contribute to the disparate rates of health conditions that disproportionately affect communities of color, including factors such as lack of trust, race/ethnic disconnect or cultural divide and patient fear of being criticized.  It is therefore critical to identify a method that will increase cultural competence and the efficiency of care.  What method can provide the means to solving such a complex problem?  The answer is simple:  Community Health Workers (CHWs), which represent an often overlooked member of the health care team that has demonstrated effectiveness in delivering prevention messages to racial/ethnic populations.

 

The Black Infant Mortality Reduction Resource (BIMRR) Center of the Northern New Jersey Maternal Child Health Consortium is one of many organizations that have embraced the challenge to eliminate racial/ethnic health disparities through strategies including the use of CHWs.  The mission of the BIMRR Center is to decrease death rates among infants of African descent through provider and consumer education, as well as health policy, advocacy, and promoting health disparity agendas.

 

There’s a Meeting in the Village”, a CHW training program, was developed by the BIMRR Center and funded by the March of Dimes.  The program was designed to prevent adverse perinatal outcomes and to provide a model for culturally competent care among at-risk populations.  The “train-the-trainer” workshops included one-day educational sessions that enhance the knowledge base and skill level of the CHWs about the inverse relationship between stress and pregnancy for women of color.  Throughout the workshop, the CHWs learn about the increased risk of preterm birth and low birth weight among women of color, stress reduction techniques, and coping strategies.  Upon completion of the training, the CHWs are asked to share this information with 10 clients to reduce adverse birth outcomes and promote stress management and reduction techniques.

 

Program evaluations received from more than 150 participants have illustrated the positive effects of the training and the impact on their collective knowledge base.  The data show that 100 percent of the participants increased their knowledge of stress reduction and coping techniques and their awareness of the impact stress has on pregnancy, and 99 percent of the participants increased their knowledge of pre-term birth.  Furthermore, surveys received from approximately 600 clients showed that close to 90 percent increased their knowledge of preterm birth and low birth weight as risk factors for infant mortality and 85 percent learned the correct definition of preterm or premature birth. 

 

There’s a Meeting in the Village” is a program that was developed based on the invaluable skills of CHWs and their linkage to the communities they serve.  CHWs are culturally appropriate communicators of vital health information, helping patients develop the knowledge they need to make healthy choices that can minimize negative outcomes.  In addition, CHWs typically resemble their clients in terms of ethnicity, race, language, and lifestyle, enabling them to educate providers and other health care professionals about the cultural norms of the communities they serve.  Increasing cultural understanding helps develop productive relationships between patients and providers.  Through their first-hand experience and understanding of underserved and marginalized communities, CHWs are able to tackle the socio-economic and cultural differences that often result in disparities in health and health care. (Ro et.al, 2003). 

 

BIMRR firmly believes that CHWs serve as a bridge in eliminating the gaps in racial/ethnic health disparities.  BIMRRC continues to value their services as community leaders.  For more information on our training program or to schedule a training workshop at your organization, please contact Kweli Walker, BIMRR Director at (201)843-5177 ext. 13.

 

Source: Ro, M., Treadwell, H., & Northridge, M. Community Health Workers and Community Voices: Promoting Good Health: A Community Voices Publication. National Center for Primary Care, Morehouse School of Medicine, 2003.

PREGNANCY-RELATED DEATHS DURING THE POSTPARTUM PERIOD, 1999-2004: PREGNANCY-ASSOCIATED MORTALITY REVIEW

In 1996, the Florida Department of Health initiated the Pregnancy-Associated Mortality Review (PAMR), to improve surveillance and analysis of pregnancy-related mortality.  A pregnancy-related death is a death resulting from one of the following:

  • complications of the pregnancy itself .
  • the chain of events initiated by the pregnancy that led to death.
  • aggravation of an unrelated condition by the physiologic or pharmacologic effects of the pregnancy that subsequently caused death.1

The Pregnancy-Associated Mortality Review (PAMR) is a case review process aimed at reducing Florida’s maternal mortality rate to the Healthy People 2010 objective of 3.3 deaths per 100,000 live births.  The Project seeks to elucidate gaps in care, identify systemic service delivery problems, and recommend areas in which linkages between community resources can be improved to facilitate improvements in the system of care.  The Project is loosely modeled after the National Fetal Infant Mortality Review (NFIMR) Project and borrows some concepts from the Centers for Disease Control and Prevention’s National Pregnancy Mortality Surveillance Project.

 

Why is the PAMR needed:  Between 1985-1995, there was no systematic review of maternal deaths in Florida.  In 1996, the PAMR Project began in Florida, using the CDC and American College of Obstetricians and Gynecologists’ expanded definition of maternal mortality to one of “pregnancy-associated deaths” that includes “death of a woman, from any cause, while she is pregnant or within 1 year of termination of pregnancy, regardless of duration and site of the pregnancy.”  Using this definition, we found significant increases in the number of maternal deaths in Florida.  The CDC and several other states have noted similar occurrences when the data were examined with similar methods.  This means we may have been lulled into a false assumption that the rates of death have been low and therefore were not in need of scrutiny.  It should be noted that these deaths may or may not be directly related to the pregnancy, but are associated with the pregnancy by time.  The multidisciplinary case review process used by PAMR determines whether the death of each woman was directly related to the pregnancy or simply associated with the pregnancy by time. 

 

How does PAMR work:  After cases of maternal deaths are identified, they are sorted by a physician/nurse subcommittee and initially deemed pregnancy-related, possibly pregnancy-related, or not related.  Cases are then selected for abstraction and review; all of the pregnancy-related and some of the possibly and not related are abstracted and reviewed each quarter.  Upon completion of the abstraction, a multidisciplinary panel of health care practitioners and administrators from across the state assemble to review and analyze the reported de-identified findings.  The multidisciplinary PAMR review team makes recommendations to organizations and groups who can best develop strategies to address the issues identified.

 

Data:  In Florida, PAMR has shown that the pregnancy-related mortality ratio has remained fairly consistent ranging from 20.3 in 1999 to 23.0 in 2004.  The Healthy People 2010 goal is to reduce maternal mortality to 3.3 maternal deaths per 100,000 live births.  During 1999-2004, the PAMR team classified 234 cases as pregnancy-related deaths.  The majority of the deaths (179; 76 percent) occurred during the postpartum period. 

 

 

Many complications can occur in six to eight weeks or within one year following a pregnancy.  The early postpartum period is critical to maternal survival.  The American Academy of Pediatrics, American College of Obstetricians, and Gynecologists, and the American College of Nurse Midwives recommend that every postpartum woman should follow-up with her physician within four to six weeks after delivery or within 7-14 days after a cesarean delivery or complicated delivery.2

 

Of the 179 postpartum deaths, the number of days from date of live birth or fetal death was known for 160 cases.  During this postpartum period, 139 (87 percent) were early postpartum deaths (0-42 days), and 21 (13 percent) were late postpartum deaths (43-365 days), as shown in Figure 2.  The majority of these deaths occurred during the early postpartum period; within the recommended four to six week postpartum check-up.  Sixty-five percent of the deaths occurred within two weeks of their live birth or fetal demise.

 

  

Of the 104 (65 percent) women dying during the first two weeks of their live birth or fetal demise, 30 percent were discharged and 70 percent were not discharged from the hospital.  The leading causes of death were hypertension and embolism for those not discharged and cardiomyopathy, infection, and embolism for those discharged from the hospital. 

 

 

Women who received no prenatal care were approximately eight times more likely to experience a postpartum pregnancy-related death.  When compared to white women, black women were five times more likely to experience a postpartum pregnancy-related death.  Additionally, women aged 35 and older (RR=2.9), who completed high school (RR=1.6), were unmarried (RR=1.2), were classified as overweight (RR=2.4) or obese I, II, or III, (RR= 4.1, 3.0, 7.4, respectively) were more likely to experience a postpartum pregnancy-related death.

 

Women significantly most at risk for a postpartum pregnancy-related death, from highest to lowest risk: received no prenatal care (CI:3.48,16.40), were classified as obese III (CI:4.24,12.89), of black race (CI:3.62,7.0), classified as obese I (CI:2.59,6.43), or obese II (CI:1.55,5.87), were aged 35 or older (CI:1.62,5.2), classified as overweight (CI:1.59,3.75), or had only a high school education (CI:1.13,2.18).

 

 

Florida’s pregnancy-related deaths have remained continually high.  The research presented here is consistent with national research from the Maternal and Child Health Bureau which indicates women of black race, women aged 35 or older, and those who receive no prenatal care are at the highest risk for death from a pregnancy-related complication.3  Continued, ongoing monitoring of systems of care as well as further prevention research of cultural, health issues, and prevention programs are warranted.

 

Florida PAMR Committee Postpartum Recommendations:

 

Self-Empowerment – Systems must be in place to ensure the health needs of postpartum women are being met.  Women and their families must know how to recognize the “danger signs,” where to access health care and what services are available.

Discharge Teaching – must be thorough, specific and education-level appropriate.  Teaching should include information on the importance of seeking care for prolonged headache, shortness of breath, swelling, redness, warmth, or pain in lower extremities, chest pain, palpitations, and syncope.  Teaching should also stress the importance of follow-up.  Additionally, women with complex medical problems during delivery need to be carefully evaluated prior to discharge and may need longer hospital stays. 

Emergency Personnel Training – to increase the awareness of potential cardio-respiratory complications in all postpartum women presenting to an emergency facility.  Women presenting with cardio-respiratory symptoms require comprehensive evaluations.

Interconception Counseling – must be provided to all women concerning family planning, baby spacing, chronic illness, nutrition, exercise, and lifestyle habits.

 

For more information about the Pregnancy-Related Mortality Review (PRMR) or this study, please contact Deborah Burch, RN, BS, CPCE, Nursing Consultant/ PAMR Coordinator, at (850) 245-4465 or Deborah_Burch@doh.state.fl.us.  The scientific portion of this report was prepared by Angel Watson, MPH, RHIA.

 

References:

1.      Berg C, Danel I, Atrash H, Zane S, Barlett L. Strategies to  reduce pregnancy-related deaths:  from identification and review to action. Atlanta: Centers for Disease Control and Prevention; 2001.

2.      Guidelines for Perinatal Care, Fifth Edition, 2002. American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, page 159.

3.      Women’s Health USA 2003: Maternal Mortality, Maternal and Child Health Bureau. Date accessed: 02/ 07/07. http://www.mchb.hrsa.gov/pages/page_55.htm.

OREGON SENATE SUPPORTS BREASTFEEDING MOTHERS

On May 17, 2007, Oregon Gov. Ted Kulongoski signed the Breastfeeding and Return to Work bill into law.  Employers of 25 or more are now mandated to provide unpaid breaks and clean, private places to express breastmilk, unless doing so would cause undue hardship.  Gov. Kulongoski was surrounded by beaming children as he picked up one ceremonial pen after another to add his signature to the law books. “This is a great day,” he told them. “It’s wonderful to finally see this passed.”

 

After the signing, the governor relinquished his chair in the ceremonial office to Diane Garrett, volunteer lobbyist with Nursing Mothers Counsel of Oregon.  Garrett has been working to improve workplace conditions for new moms since 2004, and was heartily congratulated by Reps. Tomei, Rosenbaum and Mauer for her work.  Labor Commissioner Dan Gardner and House Speaker Jeff Merkley were also present at the ceremony.

 

“There is no nutrient as important to an infant as breast milk,” said House Speaker Jeff Merkley, D-Portland.  “This law gives nursing mothers more opportunities to provide that nourishment to their children and that is something we should encourage in as many ways as possible.”

 

"I want to thank the Nursing Mothers Counsel of Oregon and Diane Garrett for all their hard work on HB 2372," said Sen. Ginny Burdick, a chief sponsor of HB2372. "This important public health legislation will make a real difference in the lives of Oregon babies and their mothers."

 

"This is a victory for working families in Oregon," said Sen. Kate Brown, D-Portland.  "We need to make sure we give families every tool they need to succeed."

 

A broad coalition of supporters, including business lobbying groups and the Bureau of Labor and Industry, have worked together to draft language that will help businesses administer the policy.  As a result, Oregon’s bill will be the most detailed breastfeeding-in-the-workplace legislation in the country.  This is a natural role for Oregon, the national leader in breastfeeding, where 87 percent of mothers initiate breastfeeding.  The precipitous fall in breastfeeding rates once mothers return to work was a red flag for health officials.

 

"This achievement was made possible through the leadership of the Nursing Mothers Counsel," said Bruce Goldberg, MD, director of the Oregon Department of Human Services. "This is a win -win for Oregon's families and businesses. Better health outcomes for our children, healthy options for breastfeeding mothers who return to work and the creation of breastfeeding friendly environments for families are all crucial parts of a strong economy."

 

Families appreciate the consideration. 

 

"Returning to work after a baby is a big transition,” said Marion Rice, managing director of Public Internet Channel. “Having an employer who supported me in providing breast milk for my child created an inclusive work environment where I felt supported.”

 

Businesses across the country have found creative ways to provide breastfeeding accommodation in a wide variety of settings and budgets.  Initial perceptions of inconvenience are offset by direct cost savings and vast public health benefits.  Research has found that for every $1 spent on breastfeeding, companies save $3.  This is because in companies that support breastfeeding:

·   Women return to work earlier.

·   Fewer health-care dollars are spent.

·   Fewer sick days are taken (for themselves or to care for an infant).

·   Employees report greater job satisfaction.

·   Companies report reduced staff turnover.

 

For more information, contact Amelia Psmythe, Executive Director, Nursing Mothers Counsel of Oregon, (503) 804-6515, amelia@nursingmotherscounsel.org.

NEWSWEEK COVERS NEW LAWS TO PROTECT BREASTFEEDING IN PUBLIC

Although everyone agrees that “breast is best” for both baby and mother, new evidence shows that the steady increase in breastfeeding over the last 30 years has taken a downturn.  Mothers and health professionals both blame the cultural environment, which does not provide nursing families with the support they need, such as information, maternity leave, and places to nurse.  A growing number of states are passing protective laws and policies to help support nursing, including New Mexico and Oregon, which give mothers lactation breaks and a clean and private area to pump.  And a bill has even been introduced in Congress to amend the Civil Rights Act of 1964 to protect breastfeeding and to give tax incentives to businesses that create lactation areas.  To read the full story, go to http://www.msnbc.msn.com/id/18999858/site/newsweek/from/ET/.

EXPLORING THE BENEFITS OF BREASTFEEDING IN PROMOTING MATERNAL AND CHILD NUTRITIONAL HEALTH: WOMEN IN GOVERNMENT REACHES OUT TO STATE LEGISLATORS

As leaders within the professional world, caretakers within the home, and advocates in various communities throughout the nation, a woman’s work is never done! This is especially true of new mothers, who also face the great responsibility of dually managing the nutritional health of their infant and themselves.  Nevertheless, new mothers can properly manage this task by staying informed and exploring options for maintaining both maternal and child nutritional health.

 

Breastfeeding has maintained its rank among researchers and health professionals alike as the preferred choice in provisional nutrition for both the infant and mother. Breastfeeding provides the essential nutritional components for adequate growth and development of infants, including fats, water, sugar, and protein (U.S. Department of Health and Human Services, The National Women’s Health Center). A beneficial form of nutrition, breastfeeding provides infants with the necessary immunity to infectious and noninfectious diseases. Breastfed infants also experience less severe cases of diarrhea, respiratory, and ear infections (HHS Blueprint for Action on Breastfeeding, 2007).  In addition, they have a reduction in risk for gastroenteritis, severe lower respiratory tract infections, eczema, asthma, obesity, Type 1 and 2 diabetes, childhood leukemia, and sudden infant death syndrome (Breastfeeding and Maternal Infant Health Outcomes in Developed Countries, April 2007). Like their infants, mothers who choose to breastfeed could also receive various health benefits. They experience less postpartum bleeding, quicker return to pre-pregnancy weight, and a reduced risk of breast and ovarian cancers, as well as osteoporosis. Breastfeeding further provides the community with various benefits in regards to health care, education, employment, and the environment.

 

Despite its great effect upon maternal and child nutritional health, many women throughout the nation remain uninformed about the benefits of breastfeeding. Statistics illustrate that breastfeeding is lowest amongst women who are younger than 20 years of age, black, less well-educated, less affluent, and living in southeastern states (Dr. Gregory Finn, The Science of Infant Nutrition, April 2007).  Furthermore, for those women who cannot or choose not to breastfeed, it is critical to provide information to mothers about other infant nutrition options, including fortified formulas. 

 

In response to these issues, Women In Government, a national nonprofit, bipartisan organization of state legislators, recently conducted an event entitled Outreach to Vulnerable Populations: States Offices of Women’s Health and Legislative Collaboration Training Sessions. During these sessions, state legislators and others were provided with expert forums and educational resources on a variety of issues including infant nutrition.  Discussions at this meeting included: choices in infant nutrition, access issues featuring the Women, Infants and Children program, socio-cultural influences on breastfeeding, and strategies to create supportive environments for new mothers. Embracing the adage that “it takes a village to raise a child,” Women In Government continues to advocate for the necessary educational resources to assist mothers and children nationwide. 

 

For more information about Women In Government’s programs, educational resources, and upcoming events, please visit www.womeningovernment.org. 

 

(This article was written by Brittany Gail Thomas, Public Policy Intern, Women In Government.)

NIDA REPORTS VACCINE MAY REDUCE FETAL EXPOSURE TO NICOTINE

A new vaccine being developed by the National Institute for Drug Abuse to facilitate smoking cessation may also protect the fetus in utero from exposure to nicotine.  NicVax works by joining nicotine in the bloodstream to a protein to create a complex molecule that is too large to cross the blood-brain barrier.  This mechanism not only blocks nicotine penetration into the brain, but it also reduces the passage of nicotine across the placenta.  Smoking during pregnancy has many adverse effects on the development of the fetus, including increased rates of miscarriage, premature birth, low birth weight, increased rates of premature birth, early neonatal mortality, and sudden infant death syndrome. New research has also linked maternal smoking to neurobehavioral problems in children, such as attention deficit and hyperactivity.  The vaccine appears to be safe for use during pregnancy.  For more information, see the NIDA Web site at http://www.drugabuse.gov/about/welcome/Messagenicvax.html.  The source article is Nekhayeva, I.A., et al.  Effects of nicotine-specific antibodies, Nic311 and Nic-IgG, on the transfer of nicotine across the human placenta.  Biochemical Pharmacology 70(11):1664-1672, 2005.

CHRONIC ILLNESS AND MATERNITY: WOMEN WITH MULTIPLE SCLEROSIS AND THEIR LIFE WITH CHILDREN

Multiple sclerosis is a demyelinating disease of the central nervous system mainly concerning women. In Germany approximately 120,000 patients are affected. Typical age of onset is between 20 to 40 years. Patients with MS suffer from an unpredictable disease, never knowing when or if their condition will get worse and their impairments will increase. Due to the disease related psychic strain and increasing physical impairments, quality of life is often reduced. The onset of MS in women occurs in their reproductive years and receiving the diagnosis means a dramatic change in life. The unpredictability of the disease and expected handicaps make planning life very hard. Thus, uncertainty concerning family planning in both patients and health care professionals occurs. Some health care professionals still exaggerate to encourage women to limit their childbearing, fearing to overextend them with the changes that come with maternity. The belief in adverse effects of pregnancy on MS can be traced back to 1893 when Gowers suggested that ‘MS can onset during pregnancy, remain stationary until the next pregnancy, and then become progressive’. However, children can also represent a chance for those women by giving them joy and a new perspective in life, deviation from disease, and more social contact.  When advising couples afflicted by MS about family planning, several aspects should be considered. On the one hand, maternal issues, possible effects on the disease due to pregnancy and raising the child need to be considered.  On the other hand, influences of the social environment need to be addressed. Maternity research on women with MS mostly concentrates on pregnancy and its influence on the course of the disease.  However, many topics need further research (e.g. effect of medication during pregnancy, effect on child development). To our knowledge, there is also no literature concerning life conditions in MS mothers, their quality of life, and coping behavior while raising children. With our study we would like to contribute to the understanding of these areas.

 

This study looks at the circumstances, quality of life (QOL) and coping behavior in mothers with MS. Anonymous standardized questionnaires were sent to 7,050 members of a section of the German MS Association (response rate 44.8 percent). Comparison of 482 female MS patients raising children aged < 18 years with 607 childless women with MS.  No statistically significant differences concerning age, MS course, complaints or number of exacerbations were found. Mothers with MS more frequently had a relationship and a higher monthly net income.  They were also less likely to be employed, their EDSS-scales were lower, and their disease duration shorter. Some aspects of coping and QOL were rated better than in childless women but were not directly influenced by the absence of children.  The conclusion of the study was that

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women with MS should be more encouraged to use family planning and delay child-bearing.

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 Children did seem to indirectly improve the quality of life in women with MS by influencing social conditions. However, despite this likely beneficial effect on mothers, less is know about the effects on the development of children who are confronted with a chronic disease in their family. Health care professionals should consider the severity of MS, as well as social conditions of women with MS to assess the possible effects on potential children when giving advice on family planning. 

 

For more information or for a copy of the full report, contact Sabine Twork, MD, PhD, Department of Health Sciences/Public Health, Dresden Medical School, Fiedlerstr. 33, 01307 Dresden (Germany), Tel: 0049- 351- 4585018, Fax: 0049- 351- 4585338,   e-mail: sabine_twork@hotmail.com.

DR. ROWLAND L. MINDLIN, HEALTH OFFICER AND EDUCATOR IN MAJOR CITIES, DIES

Dr. Rowland L. Mindlin, whose career in pediatrics, public health and education spanned nearly half a century, died May 3 at his home in Haverford, Pa.  He was 95 years old. 

 

In his 50th year, Dr. Mindlin gave up a successful private pediatric practice in suburban Westchester County, N.Y., to devote his energies to improving the quality of public maternal and child health services, especially in economically depressed urban areas.  Over the next 25 years, he served in New York, Boston and Chicago, first as assistant health commissioner for maternal and child health in New York City (1962-67), then as director of maternal and child health for Boston (1970-74), and in administrative posts at St. Mary’s Hospital in Brooklyn, N.Y. (1974-78), and the Mile Square Health Center in Chicago (1978-86).  He also held faculty positions in pediatrics and community health at the Albert Einstein College of Medicine in New York, the Harvard School of Public Health in Boston and the Rush Medical College in Chicago.

 

Dr. Mindlin was born January 30, 1912, in New York, the third of four children of Henry Mindlin, a Manhattan businessman.  His brother Raymond D. Mindlin was a well-known professor of civil engineering at Columbia University whose research made seminal contributions to applied mechanics, applied physics, and engineering science; his brother Eugene S. Mindlin was a prominent builder and real estate developer who helped create the shopping mall.  The Mindlin Award at Columbia University, given annually to an outstanding graduate student, honors the achievements of all three brothers in research and practice.

 

Dr. Mindlin received his BA (cum laude) from Harvard University in 1933 and his MD in pediatrics from Harvard Medical School in 1937.  During his residency in Boston, he met a nurse, Freda Kleiman, of Lynn, Mass.; they were married in 1940. 

 

During the second World War, Dr. Mindlin was an Air Force major in England, serving as flight surgeon for the 393rd and 94th Bomb Groups. 

 

After the war, Dr. Mindlin returned to the New York area where he established a private pediatric practice in White Plains.  In addition, he held hospital appointments at the New York Hospital, Lincoln Hospital and White Plains Hospital, and teaching appointments at Cornell and Einstein Medical Schools.  His wife, Freda, became a psychiatric social worker.  They had two sons, Henry and Frederic, and lived in Scarsdale. 

 

In 1961, Dr. Mindlin gave up his practice and returned to Harvard for a master’s degree in public health, awarded in 1962. (A mid-life career change of that kind, though common today, was startling at that time.)  He then joined the New York City Health Department, first as Bureau Director for Child Health, then as Assistant Commissioner for Maternal and Child Health, overseeing the health of the 160,000 babies born in New York City each year.  In 1967, he became the director for Children and Youth Projects for the Albert Einstein College of Medicine.  In 1970, Dr. Mindlin accepted the position of director of maternal and child health for the city of Boston, and also served as a lecturer in his field at the Harvard School of Public Health. 

He returned to New York in 1974 to become Director of Ambulatory Services at St. Mary’s Hospital in Brooklyn, which served many poor and uninsured patients in the Bedford-Stuyvesant community.  He also joined the faculty of the State University of New York Downstate Medical Center as a lecturer in environmental medicine and community health.  Late that year, his wife, Freda, passed away after a long illness.

In 1976, Dr. Mindlin married Sylvia Brendler of New York, a floral designer whose stepfather was co-founder of the Simon and Shuster publishing company.  In 1978, the couple moved to Chicago where Dr. Mindlin was named vice president of professional affairs at the Mile Square Health Center, associated with the University of Illinois.  Like St. Mary’s, Mile Square serves an economically challenged urban community, the Near West Side of Chicago, and Dr. Mindlin developed and strengthened outreach programs for prenatal and perinatal care in the community.  He also served as a visiting professor at the nearby Rush Medical College of Rush University.

Dr. Mindlin retired in 1986, first to Longboat Key, Florida, and then to the Quadrangle retirement community in Haverford, Pa.  He continued to consult with colleagues around the country on pediatric and public health issues until his passing.  He was actively associated with APHA, the American Academy of Pediatrics and the American Medical Association. 

Dr. Mindlin is survived by his sister, Rosalind Elbaum of San Francisco, his sons Henry S. Mindlin, of Walnut Creek, California, and Frederic R. Mindlin, of Stamford Connecticut, his step-son, John Brendler of Swarthmore, Pa., two grandchildren and four step-grandchildren.

HEADLINES

 

·         Constipation Tougher to Treat in Overweight Kids:  In a study in Washington state, overweight children with constipation tended to fare worse than their normal weight counterparts, but the reasons may be more psychological than biological.  http://www.medpagetoday.com/MeetingCoverage/DDWMeeting/tb2/5694

·         Some Laundry Methods are Better than Others in the Fight Against Allergens:  A San Francisco study shows that, while scalding hot water in the laundry is most effective against allergens, lower temperatures may be sufficient if an extra rinse cycle is added.  http://www.medpagetoday.com/MeetingCoverage/ATS/tb2/5692

·         Strep Vaccine Helps Children Prone to Ear Infections:   In Winston-Salem, N.C., a study shows that the new pneumococcal conjugate vaccine is turning out to be a major weapon in the fight against frequent ear infections in children.  http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/tb2/5380

·         Poor Asthma Control Common Among Children:  Stop the presses!  A study out of Rochester, N.Y., confirms that inadequate asthma control remains common among children.  http://www.medpagetoday.com/AllergyImmunology/Asthma/tb2/5259

·         “A Dead Body Climbed on Top of Me”:  Parasomnia Common in Mexican Teens:  Mexican adolescents frequent experience sleep paralysis.  In a study in Minneapolis, researchers found that one in four of those interviewed said that at least once in their lives they had experienced an inability to move, an inability to speak, chest oppression, a sense of a presence and hallucinations.  In Mexican culture, this phenomenon is described as “a dead body climbed on top of me,” and it is related to further disturbed sleep conditions in adulthood.  http://www.medpagetoday.com/MeetingCoverage/APSS/tb2/5937

 

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