What You Need To Know About Kangaroo Care

By Zoe Quint

Kangaroo Care is a simple yet effective non-medical intervention that can have a lasting impact on both premature infants and their parents. Through a method of skin-to-skin contact between mother and child, a baby is placed with their naked body nestled into their mother’s (or father’s) chest and their ear turned towards her heartbeat. Usually, the baby wears a diaper, and a cloth is draped over the infant’s back, to secure the baby to its mother, and as a way to help maintain its temperature. Kangaroo Care can be done for as many hours as possible, although even one hour a day has marked benefit.

This seemingly elementary technique has many remarkable benefits for babies:

• Promotes deep sleep: helps babies conserve their energy
• Better thermo-regulation: the baby’s temperature remains more stable against a parent’s warm body, which can even be more effective than an incubator.
• Increased stabilization: it has been proven that a baby’s heart rate, respiratory rate and oxygen saturation also tend to stabilize during skin-to-skin contact.
• Reportedly faster weight gain and overall growth

Kangaroo Care has many benefits for parents as well:

• One-on-one time with the baby allows for more early bonding with your infant
• Stress relief from the overwhelming experience of the NICU
• May help increase breast-milk production for mothers

While someone other than an infant’s mother can perform Kangaroo Care, it seems that babies respond best to this kind of care when given by their birth mothers. But bear in mind that all Kangaroo Care is good care! There have been no known negative effects of skin-to-skin contact on infants. In fact, prolonged maternal contact carries its positive affects well past the first year of life. A report published in the journal Biological Psychiatry stated that children who had experienced prolonged maternal contact as infants had noticeably mature functioning of the nervous system, better sleep habits and greater cognitive control than those children who did not have the same contact in the first months of their life.

It is also important to speak with your baby’s nurse or physician before beginning Kangaroo Care, to ensure that it’s possible to spend this time with your baby. Infants that have just undergone surgery, and are not yet free of drains or IVs (lines) may not be good candidates for Kangaroo Care. But if your infant is stable, consult with a NICU nurse to schedule this special time for you and your child in a quiet and calm space.

To learn more about this technique and its effects on you and your baby, check out “Kangaroo Care – why it’s important, the benefits and tips on how to do it well” by Susan Ludington-Hoe, or visit the resources page on the Pebbles of Hope website with videos from parents and experts discussing the benefits of this important practice.

Common Fears about Birth: What They Are and How to Deal With Them

By Zoe Quint

The phrase, “What if?” is a tricky one: it allows you to think about other possibilities, other scenarios, or what could have been. In some cases, this phrase may allow you to think up new opportunities or encourage personal growth. But more often than not, this phrase is uttered with a negative connotation, when your fears lead you to conjure up stressful and worrisome imaginary situations. This is common for moms going through the birth process, even if it is not your first pregnancy. With all the changes happening in your body, and the miracle that is developing in your womb, most expecting parents have high expectations and hopes, which go hand in hand with fear and worry.

Some frequent worries that moms have about birth include fearing the pain of childbirth, or a sense of anxiety over not being able to get to the hospital in time. These thoughts are valid, and it is very important to acknowledge these feelings during your pregnancy. For women who have experienced a premature birth in a prior pregnancy, the fears may be whether a similar complication will happen again and whether the baby will need to spend some time in the NICU (neonatal intensive care unit).  The best thing you can do for yourself is to speak with your doctor and become educated on what you can expect when you begin to go into labor.

In certain instances, the “What if?” expression can come in handy: it can help you prepare for the unexpected. This is especially important if complications arise during pregnancy or birth. This includes the potentiality of an early term birth, or complications during birth itself that result in your baby being transferred to the NICU. Pebbles of Hope has a wealth of online resources that many parents might find useful or informative.

I want to clarify that I am not encouraging that you or your partner should agonize over all the things that can potentially happen during the length of your pregnancy, your labor or delivery. Rather, I mean to emphasize that you should strive to become well informed about what could happen, and being able to think about your decisions should an unexpected choice need to be made.

Lastly, I want to reiterate that everyone going through pregnancy will have their own concerns, worries, thoughts, hopes and dreams for themselves and their baby as they go through this process. This is wonderful and you shouldn’t be afraid to acknowledge these emotions. But don’t let your thoughts consume you; do all that you can to prepare yourself physically and mentally for what you begin to expect, but remain open-minded. You are doing your best, and that is the greatest thing you could ever do to help welcome your child into this world.

I just had a preemie—I’m afraid to have another baby!

By Camille D. Walker, MD, FACOG

This is something that goes through every woman’s mind when she has had a premature baby. You wonder why did this happen to me, will this happen again, and what can I do to prevent this from recurring.

Unfortunately, the majority of cases of preterm delivery occur in women with no risk factors and/or risk factors that cannot be changed. In addition, science has shown there are biochemical, hormonal, anatomical and other causes for preterm delivery but there is continuing debate as to the final pathway(s) for preterm delivery.  Approximately 80% of deliveries are spontaneous (unexpected) but the other 20% are due to medical or pregnancy situations that require a preterm delivery. Some risk factors for spontaneous preterm deliveries include previous preterm delivery, twins and greater, problems with the uterus (holds the baby) and/or cervix (mouth of uterus that opens for baby to come out) and African-American heritage.

In the United States, 1 in 9 babies are born premature. About 1 preterm baby is born every minute! The subsequent risk for another preterm delivery is two fold (15 – 30%) but most women deliver at term. Some factors that increase risk for another preterm delivery include African-American heritage, short interval between pregnancies (6 – 18 months) and gestational age of preterm delivery (the earlier the delivery, the higher the risk for another preterm delivery).

What can you do prior to another pregnancy to the decrease the risk of another preemie?

• WAIT an appropriate time interval to get pregnant again (  > 12 – 18 months)
• STOP smoking or using illicit drugs such as cocaine, and decrease drinking
• Extremes of weight have been associated with preterm delivery. Weight loss or weight gain maybe recommended prior to pregnancy.
• EAT healthily—start prenatal vitamins before next pregnancy. Some studies suggest that folic acid and omega – 3 fatty acids may improve outcome (controversial).
• SPEAK with high risk pregnancy specialist (maternal fetal medicine specialist or perinatologist) prior to next pregnancy
  • To review if other risks factors, such as history of surgery on the cervix—cone biopsy or multiple abortions ( > 2)
  • To perhaps have special testing of the uterus to determine if there is a defect that increases risk for preterm delivery
  • If it was an indicated preterm delivery, the doctor may order blood work or other testing to see if there are risk factors for another preterm delivery.
  • To discuss potential management with the next pregnancy
• If your next pregnancy is going to be the result of in-vitro fertilization, ask for the transfer of one embryo to decrease risk of twins and higher.

What can be done during pregnancy to decrease risk the risk of another preemie?

• Start prenatal care very early to initiate preventative therapy
• Request to be seen by a high risk pregnancy specialist, if not seen prior to pregnancy
• If in your previous pregnancy you delivered spontaneously between 20 0/7 – 36 6/7 weeks, you are a candidate for 17- hydroxyprogesterone (17-OHP) injection (hormone injected on a weekly basis between 16 – 20 weeks until 37 weeks). Please note that some doctors may start therapy if your prior pregnancy outcome occurred between 16 – 19 6/7 weeks. Even if you have a spontaneous delivery at 36 weeks, it is still a preterm delivery and you are a candidate for the 17-OHP injections.
• Ask the doctor to start monitoring your cervix every 1 – 2 weeks between 14 – 16 weeks. If the doctor sees that the cervix is shortening and/or opening up from the inside, he/she may recommend a cerclage (stitch around the cervix to hold the baby) and/or vaginal progesterone (hormone placed in the vagina to decrease preterm delivery).  Vaginal progesterone is more likely to be used if the cervix is short and there is NO history of preterm delivery.
• Some doctors may also perform fetal fibronectin testing (swab of the vagina which can predict risk for preterm delivery) between 22- 34 weeks.
• Screening for certain infections has not been shown to decrease risk of preterm delivery. However, some studies suggest that treatment of urinary tract infections (bladder infections) can decrease risk of preterm delivery.
• Be aware of signs and symptoms associated with preterm labor/delivery such as menstrual cramps with or without diarrhea, contractions, pelvic pressure, vaginal bleeding or leakage of fluid, change or increase in vaginal discharge, or lower backache or pain. If present, contact your doctor for further instructions.
•  Reduce  moderate/severe stress level

What happens if you go into preterm labor again?

• The doctors will use tocolytic drugs (special medications stop labor) long enough for your baby to receive steroid shots (drugs to help strengthen the baby’s lungs).
• The doctor may use fetal fibronectin testing (see above) to predict risk of early delivery
• You may be transferred to a regionalized perinatal center—centers that have high risk pregnancy specialists and neonatal intensive care units ( units that take care of premature and high risk babies).
• Antibiotics may be used for a short period of time to decrease risk of infection in the baby or prolong pregnancy, if your water bag broke.
• One of the tocolytic drugs is called magnesium sulfate and has been shown in some studies to protect the baby’s brain. Some of the studies suggest that this drug be used if preterm delivery is likely. Please note there is no consensus on timing and dosing.
• If you are at high risk for delivery, speak with neonatologist (high risk baby doctor) to review issues and management after the baby is born.
• If your labor is stopped, please note that long term tocolytic drugs (usually taken by mouth) have not been shown to prolong pregnancy and are usually not used after the acute treatment of preterm delivery.
• Please note that bed rest, limited work and reduced sexual activity has not been shown to reduce preterm delivery in women at risk. However, we as healthcare providers, including myself sometimes, continue to recommend this. Some studies have shown bed rest to increase risk of gestational diabetes, excessive weight gain and thrombosis (blood clots). In addition, this can cause social and psychological disruption such as income loss.

So if you question if you should have another baby, in most cases, the answer is YES. The majority of times the next pregnancy will be a full-term delivery. Don’t wait until the next pregnancy to start evaluation. Be PROACTIVE and start before your next pregnancy. There are now certain precautions and treatments that can be used to decrease the risk of preterm delivery. As with all medical information seen on any website, please discuss and review with your healthcare provider.

Good luck with next pregnancy!

Education and Support for New Parents: Why It’s Important

By Zoe Quint

It’s expected that a general surgeon will spend years studying and training before he or she is able to operate on a patient. Similarly, a helicopter pilot must go through rigorous written exams and flight simulations before they are considered capable of maneuvering an expensive aircraft. However, when it comes to being a new mom, there’s a common belief that most women will just “know what to do.” The truth is, parenting is a skill that must be acquired. The good news is, it is a skill that nearly everyone can learn easily, particularly if you enlist the help of social networks and parent education resources.

As a new parent, your social support system and access to parenting knowledge is especially valuable when complications arise during or after pregnancy. If your baby is in the NICU, you might feel helpless and unable to provide for your newborn as you originally intended. But more than ever, you can turn to parent education as a way to empower yourself and also help you (and if applicable, your partner) to be the best parent you can be.

New parent education can be acquired through a number of ways:

1. Join a new parent support group. Pace Moms is an organization that has groups for first and second time mothers. Preemies Today (DC Metro Area) is a PreemieCare Spotlight Community Support Group, a preemie parent support group serving Northern Virginia, Maryland, and Washington DC. It is their mission to reach out and provide support to families of infants born prematurely beginning at birth and throughout childhood. Services they provide include parent support, online support, family gatherings, educational seminars, a monthly newsletter, and the sharing of ideas and experience. Similar organizations supporting parents of preemies exist in other areas of the US as well.

2. Read a book. “Mothering the New Mother: Women’s Feelings and Needs After Childbirth (A Support and Resource Guide)” by Sally Placksin is a wonderful resource. Also, “The Birth Partner: Everything You Need to Know to Help a Woman Through Childbirth” by Penny Simkin, P.T. is a book that describes the birth process, with special emphasis on the emotional needs of the laboring woman and how to meet those needs. For parents of premature babies, “The Preemie Primer” by Jennifer Gunter is a great resource for helping parents navigate the challenges that come along with prematurity.

3. Look online. There are a number of online resources, including what is provided by Pebbles of Hope, which can educate you and your family on what it’s like to be the parent of a premature baby and various webinars on learning more about what you can do to support your baby throughout this process.

4. Reach out to family and friends. Remember that they are a wonderful source of support and can offer advice and help during difficult times.

5. Continue to maintain your relationship with your partner. With the introduction of a new baby into your family, and particularly if that baby was born prematurely, it is important that your relationship with one another remains a source of strength and comfort for you both.

6. Take care of yourself. Take a long walk or a nap if you need it. Drink a comforting cup of tea and watch your favorite movie. It’s important to give yourself the support and down time that you require to be the best version of yourself.

As a new parent, it’s common to feel anxious over the well-being of your baby and to doubt your capability to manage your new role. But just remind yourself that these fears are coming from a good place: you want to do what’s best for your child. In fact, you might find through your research and collaboration with family, friends and even support groups, that many other parents share similar concerns. However, the more you seek out education and social resources and continue to educate yourself, you will be well equipped to determine what parenting style is best for you and your family. Remember that there is not one “right way” to be a parent, but rather, parenthood itself is a process in which you can determine what beliefs and practices complement your family’s lifestyle.

The Importance of Clean Birthing Practices Worldwide

By Zoe Quint

While disparities in the quality of healthcare facilities are undoubtedly present in America, we take many standard practices, including clean birthing procedures, for granted. These practices include, but are not limited to, proper hand washing and hygiene and maintaining clean birthing rooms, tables and instruments. In the United States, we expect clean running water and electricity at all of our hospitals and healthcare facilities. In fact, it is hard to imagine a hospital that lacks access to running water, or that doesn’t have electricity 24 hours a day. Unfortunately, a basic lack of fundamental resources is a reality for many hospitals in developing countries around the world, particularly in many countries in Africa and South Asia.

Resource scarcity during labor and delivery prove to be especially difficult for preterm or low birthweight (LBW) babies. According to the World Health Organization (WHO), over 9 million LBW babies will be born in South Asia and another 3 million in sub-Saharan Africa this year. These babies are particularly vulnerable and usually need extra care to prevent their death from avoidable causes, such as hypothermia (cold), hypoglycemia (low blood sugar), or infections. Tragically, not all get the care they need and do not survive.

Expecting mothers in the U.S. might be deciding whether they want their birth to happen at home, in the hospital or in a birthing center. However in many developing countries, it is not uncommon for women, especially those in rural settings, to give birth on rags, or directly on a dirt floor. Many of these women develop sepsis (infection after prolonged vaginal delivery), which can be fatal. Sometimes, the infant can also contract sepsis as well. The biggest form of assistance that has shown a marked improvement in reducing the number of infant and maternal mortality is the introduction of clean birthing kits (CBK). A basic birthing kit aims to promote the WHO’s “6 Cleans”:

1. Clean hands
2. Clean perineum
3. Clean delivery surface
4. Clean cord cutting implement
5. Clean cord tying
6. Clean cord care

A kit will typically include a plastic sheet, plastic gloves, a clean razor and cloths. A clean razor is especially important so that umbilical cord infections can be prevented. Kits are usually provided by nonprofit aid organizations, such as Cleanbirth.org.

It is important for caregivers to be aware if the laboring mother begins to have obstetric complications. This often proves difficult, as many women in developing countries give birth without a skilled provider by their side. This can prove fatal if emergency resuscitation or another intervention is needed for the infant. While most babies are able to begin breathing independently at birth, up to 10 percent of newborns require some form of assistance to initiate breathing. Failure to breathe at birth most often occurs with preterm babies.

Helping Babies Breathe is an educational initiative that is overseen by the American Academy of Pediatrics, WHO, USAID and a number of other global health organizations. It is geared towards helping teach neonatal resuscitation to skilled birth attendants in resource-limited areas.

Overall, regardless of where you are in the world, clean birth practices are integral to ensuring a safe birth for both mother and infant. Clean birthing kits are helpful, but there must also be educational intervention at the individual, community and healthcare facility levels. A successful birth, natural, preterm or otherwise, is nearly always a communal and supportive effort.

Tips for Stress Management during Pregnancy

By Zoe Quint

While stress is a part of life, it is also believed to be one of the leading causes of premature labor during pregnancy. Long-term stress can have detrimental effects on your immune system and your overall health. While stress can come from a soon-to-be mother’s own personal anxieties and worries, stress can also be due to a number of reasons, such as work and home environment, personal relationships and even societal issues, such as an ongoing war or an economic recession.

The good news is that there are a number of effective ways to lower one’s physiological and emotional response to stressful situations. As a birth doula, it is my role to work with pregnant women, advocate for them and find ways to alleviate their stress during pregnancy and the birthing process. Read on to find a list of the top hints that I find most helpful during pregnancy and to help promote a healthy and happy mother and baby!

1. It is very important to seek out a strong support network during your pregnancy and after birth. This includes, but is not limited to, spouses, partners, family members and friends. While mothers and women in general are amazing, it is always nice to have a helping hand (or three!) It’s important to also use resources such as doulas, caretakers and other pre- and post-birth education resources (such as Pebbles of Hope) to have as references.

2. Regular exercise is also very integral to reducing stress. Popular forms of exercise during pregnancy are walking, calisthenics, and prenatal yoga. I like to encourage building strength in your legs and hips through squats and lunges. Prenatal massage is also encouraged for women experiencing back and hip pain. It is always important to consult your healthcare provider before starting massage sessions or an exercise regimen.

3. Deep breathing is a good stress reliever whether or not you are pregnant! It is good to do alone, or with your partner or friend. Focus on breathing in slowing and deeply through your nose, feeling your lungs fill with air. Slowly release your breath and exhale completely through your mouth, pushing out as much of the air as you can. Deep breathing helps calm your immune system and quiets your mind.

4. A healthy and nutritious diet is key during pregnancy—remember, you are eating for two! Also remember to avoid alcohol and caffeine. A well-balanced diet will be beneficial not only for your baby, but will also help you feel your best.

5. Educating yourself about pregnancy and the process can be both calming and empowering for soon-to-be parents. Knowing about what you can expect and all of your options is definitely advisable. It is also recommended to educate yourself about possible complications, such as premature birth. While you shouldn’t necessarily plan for complications, you will thank yourself for doing your “homework.”

6. For expectant moms (and dads), loving yourself and self-care, which means cultivating a good relationship with yourself both physically and mentally, is vital. While exercise during pregnancy is certainly encouraged, it is important to remember that your body is going through many changes; it is important to listen to your body and make sure you are also getting the appropriate rest that you need, sans guilt!

I want to reiterate that: It’s not about getting every little thing done perfectly, but doing the best that you can. Whether it’s something as simple as encountering bad traffic on the way to the hospital, or even when faced with emergency birth complications, such as preterm labor, remember that even though we cannot control every single event, we can do our best by educating and empowering ourselves. For our partners, family and friends, I encourage them to learn about how to be supportive in times of need. Setting intentions can serve as a means of both comfort and assurance when the future is sometimes unknown.  In fact, stressful situations may even help you to challenge yourself and grow in ways you never thought possible. While the stresses of life are not going to go away anytime soon, what’s most important is how we handle all the events that life presents to us.