New study: 400,000 infants born to depressed mothers. What can we do?

Pregnancy is supposed to be a happy time. Those glossy pregnancy magazines would make you think every pregnant woman is running through green meadows with unmitigated joy.

But we all know the real deal. Broken relationships, economic hardships, thwarted life plans or just bad timing can create so much anxiety during pregnancy and can crowd out any joy you may want to feel. We'd like to think this sadder side of pregnancy is the exception to most experiences, but a new study says otherwise.

A recent report by American Academy of Pediatrics says every year, more than 400,000 infants are born to mothers who are depressed, which makes perinatal depression the most under-diagnosed obstetric complication in America.

That's big news.

With so many babies being born to depressed mothers, what does that mean for the level of early bonding and care that they receive? When you're depressed you are probably less likely to breastfeed, especially when it can be very physically and emotionally demanding in the early days and months. And what about the moms? How healthy are their eating habits, also linked to their likelihood to breastfeed, if they are depressed?

The point is, sad moms are even sadder news for babies.

What can be done? For one, there needs to be a broader dialogue about depression during pregnancy and post partum. It would be great if we didn't only portray one pregnancy experience as the "right" pregnancy experience, doing so keeps moms in the closet about their real feelings and prevents them from getting the help they need.

In our community, we need to do more talking. Black people are socialized not to air dirty laundry, so to speak, so we are often reluctant to share our problems, particularly with strangers. But talk to your doctor, a friend or trusted relative. If this is difficult, call an anonymous hotline, if you must. Just don't try to face depression alone.

If you're depressed, take off the strong black woman superhero outfit and pack it away. If your belief system says, I'm strong and I should be able to handle all situations, when the occasion inevitably arises that you can't do these things, you think of yourself as a failure. Those feelings can only lead to deeper depression.

Can you lighten your load? Cut down on your chores, errands for others, and other stressful activities. Try to do more things that will help you relax and regroup.

And there's nothing wrong with a little couch time with a culturally competent therapist--one who understands the complexities of a black woman's life.

Our babies have enough challenges in this world, let's do our part to make sure our children are born to moms who are as happy and mentally healthy as possible.

Talking Midwives in Midtown: an Aha! Moment

Yesterday, I met an old friend for breakfast. We met at Norma's in Le Parker Meridien hotel. As we noshed on a delicious breakfast, pondered who has actually ordered the $1,000 caviar breakfast item, we had a ground shaking conversation about the role of midwives in changing the landscape for maternal health.

My fellow diner was my good friend Shirley McAlpine, a beautifully statuesque British woman. She became my friend when I lived in London and is now doing some amazing work in the U.K and U.S. about prenatal education and natural childbirth through her popular Birthwise DVD http://birthwisedvd.com/us/ and consulting work. The tagline for Birthwise is "Your Creation. Your Choice." I love that.

Shirley had just returned from the Midwives Alliance of North American conference in the Nashville, Tenn., area and she was buzzing. Her energy was infectious. And while we are both involved with maternal health issues across the board, as two black women we are also particularly concerned about the issues in our community. So the questions began to roll. Could midwives be key to helping reduce the high pre-term birth and low birth-weight baby rate that continue to plague black women of all socioeconomic levels? Could midwives help reverse the high exceptionally C-section rates among black women and reduce the shamefully rising maternal mortality rates among black women?

Shirley and I are convinced, yes. And birth center models like The Birth Place, http://thebirthplace.org an unique midwifery and women's health center in Winter Garden, Florida run by Jenni Joseph, show impressive results in reducing pre –term births.

But, why? The answer, as it unfolded before us, was in the education that midwives provide. Expecting moms who work with midwives are more informed about the birth process than women who work with doctors only. We all know that most doctors prefer that you know less, and trust them more, so that they can do what works best for them and not deal with any pesky little questions about your own life that you may have.

After all knowledge is power.

So when a woman who has had a midwife is told she needs to be induced. She knows she can ask why, if the baby's heart rate is fine and other measures she's been educated on are still ok.

When a woman whose water has broken is told that she must be induced, a woman with a midwife may have been taught that actually unless other indicators show otherwise a baby can be fine for up to 24 hours after the water breaks. It is Hollywood that has told us otherwise, and turned the water breaking into the mad dash to the hospital event that makes for great cinema but woefully misinformed moms to be.

And when a woman has a true (not Hollywood or doctor-friendly) understanding of how long the labor process can be, she won't stand for being told that a C section is necessary because it's been five hours and she hasn't dilated. She will also have been educated on the real signs of labor, so she won't go the hospital too soon where labor can be stunted by laying in a bed and you are more likely to be given unnecessary medical interventions.

These are key pieces to the puzzle. As we know, the answer is not in the prenatal care. Women are getting that. But that hasn't improved matters. The key is in the education--an education that often does not happen in its full measure at a traditional doctor's office. And that midwives can provide.

And that nuanced understanding of how black women end up on the operating table more and remain six times more likely to die from pregnancy-related complication is worth more the $1,000 caviar.

Black women are dying! Enough scaremongering, it's time for solutions!

Lately, I've been extremely frustrated by all the news reporting about maternal mortality. Yes, it is a terribly frightening and frighteningly embarrassing issue. Women are dying during childbirth for preventable reasons, and African American women at even more shocking rates and something must be done. Like now.

A recent study by Amnesty International, entitled "Deadly Delivery", reports that deaths from pregnancy and childbirth in the United States have doubled in the past 20 years--from 6.6 per 100,000 live births in 1987 to 13.3 deaths per 100,000 live births in 2006. Pregnant women and new mothers are dying because of "systemic failures" in the current health system, the Amnesty report said.

The alarming data on maternal mortality is even more shocking for African- American women. We are three to four times more likely to die during childbirth than white American women. And even wealthy black American women have a higher rate of mortality during childbirth than wealthy white women.

Yeah. It's serious.

Now I understand the power of fear as a coercive tool in the media world and in political circles, but my personal fear is that all the negative reports and doom and gloom coverage makes the situation seem hopeless. It makes women, particularly Black women, feel powerless to a force that no one can succinctly explain or otherwise tell them how to prevent.

People don't get behind hopeless. Research money doesn't come to hopeless. And the right kind of awareness that actually empowers women to have healthy childbirths and live healthier lives overall doesn't come from hopeless. It comes from hope.

That's why I'm so excited about the work of Dr. Michael Lu, an associate professor in both the UCLA School of Public Health and the David Geffen School of Medicine at UCLA, and one of the influential thought leaders who's talking about new solutions to the maternal health problem. It's pretty clear the old ones aren't working.

Dr. Lu's work focuses on the "life course perspective," a simple yet groundbreaking premise that rests on one simple truth: you cannot correct the outcomes of childbirth simply by looking at the 40 week gestational period. Saying that black women need better prenatal care is a start but not the complete answer. We need a longer term "life course perspective" to address the issue, which includes rethinking how healthcare is delivered, how we look at life stressors and how we get back to focusing on mothers and communities.

I've been a fan of Dr. Lu for some time. In fact, his work was one of the research inspirations for writing my first book, The Mocha Manual to a Fabulous Pregnancy (Amistad/HarperCollins). At the time, it was the first-of-its-kind book for African American women that looked beyond the nine months of pregnancy to offer advice on all areas of life that could affect a woman's pregnancy outcome from her finances, relationships, life stressors, cultural taboos and her medical history. It was the "all you" approach to pregnancy for black women, and I'm grateful to Dr. Lu's work for inspiring me to develop that concept.

I'm also very grateful and excited that Dr. Lu will be speaking this week at our Black Maternal Health conference and sharing his insights and answering your questions on what we need to do now to close the gap in maternal and infant health disparities for African American women.

Please join us on April 28th at our NYC offices at 12:30 p.m.(simply rsvp with your name and affiliation to rosemary@womensenews.org) or click here http://www.ustream.tv/channel/wenews to watch live via our webcast.

We've read the depressing headlines. It's time we start talking about solutions. Please be a part of the conversation.

Folic Acid and You—What Every Woman of Color Needs to Know

It’s the New Year! And who knows what 2010 will bring. According to recent stats approximately 50 percent of women aged 15-44 have at least one unplanned pregnancy in their lives. That means a good number of us may have an surprise in 2010.

 

That also means every woman of childbearing age, should be thinking about their health all day, every day. That’s why I wanted to tell you that this week, January 4-10^th, is Folic Acid Awareness Week. Sponsored by the National Council on Folic Acid (NCFA) http://www.folicacidinfo.org/pages/folicacid_info.php, the week is intended to educate all women about folic acid. If taken before and during early pregnancy from a multi-vitamin or fortified foods, folic acid can prevent from 50 percent to 70 percent of some forms of serious birth defects of the brain and spine, called neural tube defects (NTD).

 

Getting the right amount of folic acid is particularly important to Black and Latina women. Not only do Latinas have higher rates of NTD-affected pregnancies, they also have the lowest awareness about folic acid than women of other ethnic groups, and lower consumption of folic acid than white non-Hispanic women, according to recent studies.

 

In addition to preventing NTDs, increased folic acid has been linked to preventing preeclampsia, a form of severe high blood pressure that usually occurs after 37 weeks of pregnancy. The potentially fatal condition is more common in black women. Studies indicate that when black women have preeclampsia they tend to have a severe form of the disorder and experience it as early as six months in the pregnancy compared to the typical ninth month. 

 

Doctors have not yet pinpointed exactly why this disparity exists, however, one study found that black women had less folic acid and more of a certain amino acid than white women as a pre-existing condition, which put them at a higher risk during pregnancy. The findings suggest that black women take more folic acid before and during pregnancy and as early as possible. (http://www.msnbc.msn.com/id/4781703 )

 

The easiest way to make sure you’re getting enough folic acid all the time is by taking a multi-vitamin, B vitamin complex pill or folic acid pill and eating fortified foods like grains, pastas or breakfast cereals. Folate is found naturally in foods such as leafy green vegetables, beans, liver and some fruit. But for some reason, scientists have found that folic acid, the synthetic version of folate, is actually easier for your body to absorb than folate.

 

Even if you don’t have a planned or unplanned pregnancy in the cards, folic acid is pretty important to your healthy living. Studies show that folic acid reduces the risk of certain cancers; cardiovascular diseases including coronary heart disease and stroke; and cognitive diseases or mental conditions such as Alzheimer's disease, age-related dementia or cognitive decline and depression. We can all use that.