Addressing Maternal Fetal Health Issues to Improve Pregnancy Outcomes |
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Simon Skovgard |
simonskovgard@mycwi.cc |
English 102- 012W |
Blog Site |
5/6/2013 |
Monday, May 6, 2013
Introduction
Local
Topic
The
topic I have chosen is improving maternal health. Since my wife is currently
pregnant with our first child I have been very interested in maternal
health. I may be a nervous new parent
but I have been reading and doing research online regarding maternal and fetal
health. You hear so much conflicting information for people and in the media
that it is necessary to ask numerous questions at each prenatal visit. The
focus of my local paper will be maternal health and birth control in America
and Idaho in particular. From this project I want to learn how to better care
for my wife during her next pregnancy. Questions to answer:
- How does drinking affect an infant?
- What causes Club foot?
- What causes a cleft palate?
- How often are babies born with teeth?
- How does smoking affect an infant?
- Does caffeine negatively affect the infant?
- What is the increased risk of birth defects from maternal tobacco use?
- Is there a relation between the number and type of anomalies?
- What are the effects of eating during an epidural?
- What are the benefits of a natural birth?
- What are the effects of anesthesia during childbirth?
- What are the risks with episiotomy?
I ask these questions
because I have had some of these things happen to my family members and I want
to understand the care behind them. These questions could also help me better
understand the care my wife needs.
References
I
plan to interview Mrs. Carson because she has extensive knowledge in the
interview. Mrs. Carson worked as a Neonatal Nurse, Private Practice Obstetricians Nurse
and Labor and Delivery Nurse and is current the Boise School District Registered
Nurse. I will also be interviewing my wife’s obstetrician and/or his nurse
about the problems in our community. Our physician has traveled to Africa and
Asia and may be able to give some insight to conditions in those
countries.
The
references I already have are Idaho State Health in Welfare as well as book What to Expect When Your Expecting by
Heidi Murkoff. The resources I still
need to find are local experts on the specific questions I want answers to.
I
film I am going to analyze is No Woman No Cry (2010) by Christy Turlington
Burns. This film that follows the story of various women will bring up issues
on injustices those Third World countries face. I will have to think deeply
about how living in American drastically changes the outcome of my wife’s
maternal health. This video focuses on two of the countries I am analyzing in
my project and will discuss the maternal health issues of the countries.
Global
Topic
My global focus will be
the contrast and comparison of our country and the third world countries. The countries I will focus on are Bangladesh and
the United States. To collect knowledge on these topics I plan to write
letters, emails and read research online to gain more knowledge from different
countries.
References
I
am planning on writing a letter to the Kathleen Sebelius the Secretary
of the Department of Health and Human Services of the United States of America.
I will also contact CARE at 1825 I Street NW, Suite 300 Washington D.C.
20006, who did a learning tour in Bangladesh on Maternal Health. For
information on the foreign countries I will contact Ellen Carnevale with the
Population Reference Bureau at ecarnevale@prb.org. To find
more references I plan to write more emails to OB doctors across America so I
can have a broad span of knowledge for comparisons.
My
references to date are "Maternal
Health Supplies in Bangladesh" by Bergeson-
Lockwood, Jennifer, Elizabeth Leahy Madsen, and Jessica Bernstein http://www.who.int/pmnch/activities/commodities/201006_maternal_health_bangladesh.pdf
and "Maternal and Neonatal Health in Bangldesh." By Unite for
Children http://www.unicef.org/bangladesh/Maternal_and_Neonatal_Health.pdf .
Conclusion
I
plan to address the issues of maternal health and the outcomes of fetal
development and the risks relationship in different countries.
Bibliography
Unite for Children. "Maternal and Neonatal
Health in Bangldesh." Unicef.org.
Unicef, 2009. Web. 9 Feb. 2013.
Bergeson- Lockwood, Jennifer, Elizabeth Leahy
Madsen, and Jessica Bernstein. "Maternal Health Supplies in Bangladesh." Populationaction.org.
Population Action International,, 2010. Web. 9 Feb. 2013.
Maternal Fetal Health Issues in Idaho
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College of Western Idaho
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Maternal Fetal Health
Issues
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In Idaho
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Simon Skovgard
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English 102- 012W
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Jewkes
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3 Mar 2013
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The following addresses
the risk factors that can reduce fetal mortality and morbidity in Idaho.
Identifying the risk and eliminating them will improve maternal health care
and promote greater pregnancy outcomes. Statistical data for Idaho from local
research will be utilized. In order to
reduce the rate of infant mortality and morbidity, people must increase
maternal health outcomes by identifying and eliminating risk factors,
requiring prenatal screening tests, and diagnosing and treating fetal
anomalies.
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Reducing
maternal and infant morbidity and mortality and improving pregnancy outcomes
throughout the state of Idaho is a major concern of physicians and patients.
Morbidity refers to the incidence of disease while mortality refers to the
incidence of death or the number of deaths in Idaho. There are a large number
of indicators affecting maternal health in Idaho. Some of these are: blood
borne diseases, cancer, cardiovascular diseases, lower respiratory disease,
diabetes, enteric diseases, oral health, respiratory diseases, sexually
transmitted diseases, birth defects, and injuries. Since there is such a large
field of study, the primary focus here will be on infant mortality including
birth defects, low birth weight and sudden infant death syndrome (SIDS). In order to reduce the rate of infant
mortality and morbidity, people must increase maternal health outcomes by
identifying and eliminating risk factors, requiring prenatal screening tests,
and diagnosing and treating fetal anomalies.
Pre-conception
counseling and prenatal screening (prenatal testing) offers an opportunity to
identify maternal risk factors before pregnancy begins. There has been a great
deal of research on the risk factors that increase birth defects and infant
mortality. According to Idaho Vital Statistics, “there are 16 risk factors
listed on an Idaho birth certificate” (Center for Vital Statistics and Health
Policy 61). In a study examining the relationship between the health behavior advice
recommended by the Public Health Service Expert Panel on the Content of
Prenatal Care and the risk of low birth weight, “The Expert Panel
recommended that pregnant women receive advice in the following seven areas:
(a) breastfeeding (b) reducing or
eliminating alcohol use; (c) reducing or eliminating smoking; (d) not using
illegal drugs such as marijuana, cocaine, or crack; (e) eating the proper foods
during pregnancy; (f) taking vitamin or mineral supplements; and (g) gaining an
appropriate amount of weight during pregnancy” (Sable 3). The
study also described the type and frequency of health behavior advice offered
to a group of pregnant women. There is a
direct correlation between pregnancy outcomes and prenatal care received. There
is a great deal of statistical data presented that will help address the
magnitude of the problem and the need for more research.
Early
prenatal care can help identify risk factors and ensure proper treatment.
Patients who do not seek the advice of a physician are more likely to have
problems during labor and are at a greater risk for birth defects. Prenatal
testing can be very useful in diagnosis and treatment of fetuses as Harms says,
“still, in some instances you may wish to know specific information about your
baby’s health before his or her birth… increased risk of carrying a baby with
chromosomal problems or some other genetic disorder… certain test can help
determine the health of your baby while her or she is still in your womb” (Harms
305). In Idaho, “the highest infant mortality rates occurred to infants of
mothers who received no prenatal care (21.2 per 1,000 live births with no
prenatal care): their rates were 3.5 times as high as infants whose mothers
received prenatal care in the first trimester (6.0 per 1,000 live births with
first trimester care…)” (Center for Vital Statistics and Health Policy 77). There are many uncontrolled factors that
could also increase risk such as advanced maternal age; ethnicity of the
mother, race of the mother, and teen pregnancy. With early diagnosis of risk
through prenatal testing, the physician and patient can develop a plan for early
treatment and reducing the effect on pregnancy outcomes.
Drinking excessive
alcohol while pregnant increases the risk of miscarriage and fetal death. Once
the alcohol is in the bloodstream, it passes through the placenta to the baby. It
takes the fetus twice as long as the mother to eliminate alcohol from its
system. When the mother is slightly buzzed the fetus would be at the point of
passing out. The most serious problem caused by excessive alcohol consumption
is fetal alcohol syndrome (FAS). It can also cause such birth defects as, “facial
deformities, heart problems, low birth weight and mental retardation” (Harms,
48). Fetal alcohol syndrome is sometimes described as “the hangover that lasts
a lifetime” (Murkhoff 71) and infants born with FAS may have growth problems,
attention deficit disorders and learning disabilities as well as behavioral
problems. Statewide, “2.5 percent of live births were to mothers who have used
alcohol while pregnant, according to birth certificate data. Live births to
women who reported drinking during pregnancy were twice as likely to have no
prenatal care(2.1 percent) than were live births to women who did not drink
during pregnancy (0.9 percent…)” (Center for Vital Statistics and Health
Policy 59). According to the Centers for Disease
Control and Prevention, National Center for Health Statistics, alcohol use
during pregnancy is, “substantially underreported on the birth certificate” (Center for Vital Statistics and Health
Policy 59). Patients
are less likely to admit that they drink during pregnancy and therefore the
statistical data is lower than actual outcomes.
Smoking
during pregnancy increases the chance of miscarriage and stillbirths, decreases
birth weight, increases risk for SIDS and deprives the unborn fetus of oxygen
and important nutrients. “Over 14.0 percent of Idaho resident birth
certificates indicated the mother smoked at some time during pregnancy.
Furthermore, live births to women who smoked during pregnancy were twice as
likely to have no prenatal care (91.8 percent) than were live births to women
who did not smoke during pregnancy (0.8 percent …)” (Center for Vital Statistics
and Health Policy 59). When a mother smokes during pregnancy the
fetus is enclosed in a smoke filled womb. “Cigarette smoke contains literally
thousands of harmful chemicals. Two toxins especially – carbon monoxide and
nicotine – can reduce the flow of oxygen to the developing baby” (Harms, 48).
There is strong evidence showing fetal development in the womb is adversely
affected by maternal smoking. The most widespread risks for babies of smokers
are, “low birth weight, shorter length and smaller head circumference, as well
as cleft palate or cleft lip and heart defects. And being born too small is the
major cause of infant illness and perinatal death (those that occur just
before, during, or after birth)” (Murkoff 72). Low fetal birth weight can cause
major diseases and illness throughout the child’s life.
Streets
drugs have been proven harmful to an unborn baby as well as the mother. These
illicit drugs such as marijuana, cocaine, heroin, and methamphetamine have varying
side effects on the fetus and the newborn. During pregnancy, drugs taken pass
from mother to baby. Like alcohol it takes longer for the fetus to process
these substances and therefore addition is highly likely. Drug use “can affect
the development of the fetus and the future of your child as he or she grows
up. It can also cause the death of a fetus or withdrawal symptoms in newborns
that if untreated can lead to death” (Harms 49). Even recreational drug users
should stop all use during pregnancy to reduce the risk of birth defects.
A healthy
diet is critical to ensure a healthy baby. According to the Epidemiology
Resource Center, “research has
accumulated, showing associations between birthweight and the risk of
developing obesity, cardiovascular disease, type 2 diabetes and other health
outcomes in later life” (Newnham 29). This research shows the importance of
fetal nutrition for lifelong health and has spurred an interest with policy
makers in improving maternal nutrition. Eating healthy during pregnancy is
important and can decrease the chance of complications such as anemia,
gestational diabetes and preeclampsia. A sensible diet can aid in reducing
morning sickness, constipation, fatigue as well as emotional state and crazy
mood swings. A baby requires more calories and more of certain nutrients but
the foundation is the same, “a good balanced mix of lean protein and calcium,
whole grains, a rainbow of fruit and vegetables and healthy fats” (Murkoff 89).
Diet may need to be altered for vegetarian or vegan menus but it is important
to get the necessary vitamins and proteins. There are many alternative diets
for lactose intolerance and gluten free foods to ensure a healthy pregnancy.
There are
many benefits to exercise during pregnancy. Sometimes getting too much rest
makes a person feel more tired. A little exercise can provide a great energy boost. Exercise may help prevent gestational
diabetes and help aid in sleeplessness. Keeping the back and abdominal muscles
strong will help during labor and stretching will help prevent sore muscles.
There are also great benefits to the unborn baby. Researchers believe that,
“changes in heart rate and oxygen levels in exercising moms-to-be stimulate
their babies. Babies are also stimulated by the sounds and vibrations they
experience in the womb during workouts” (Murkoff 217). According to Pam Carson,
obstetrical nurse, “patients who are physically fit have an easier time during
labor and delivery. Their return to post partum weight and a faster post partum
recovery is also a benefit of staying physically fit” (Carson). A balanced diet and exercise are important
factors in prenatal health.
Over the
counter medications may have harmful side effects that create problems for the
unborn infant. It is best to stay away from all prescription and over the
counter medications during pregnancy. If they must be taken the patient needs
to consult a physician before use. Some drugs can cause miscarriages or impair
the baby’s development. There aren’t many drugs that have been proven safe
during pregnancy but sometimes the benefits of taking the medication out ways
the minimum unknown risk. Some expectant mothers have diseases that require
continuous medication like hypertension, asthma or diabetes in which case they
need to be monitored by a health care professional. Sometimes it is necessary
to switch medications or discontinue them during pregnancy because of the high
risk of birth defects. “Some medicines have been shown to be extremely harmful
to a developing fetus, even in the early weeks of pregnancy. Some of the most
dangerous medications during pregnancy include: Accutane, Thalomid, and
Soriatine” (Harms 49). Even herbal medicines can be harmful. Check with a
physician before taking any natural, over the counter or prescription
medications during pregnancy.
Physicians are concerned with low birth weight
(LBW) and reducing risk factors to increase pregnancy outcomes. As discussed in Newnham’s text, “It has long
been understood that poor birth outcomes across the whole population,
particularly rates of LBW, are associated with greater rates of morbidity
throughout life from infancy to adulthood” (21). Table 1.1 below shows birth
weight categories in correlation to the extent of prenatal advice received by mothers.
The seven types of advice given are: “advice to take a vitamin/minerals supplement;
eat the proper foods; gains an appropriate amount of weight; consider
breastfeeding; reduce or eliminate smoking; reduce or eliminate alcohol; and
not use illegal drugs as recommended by the Public Health Service Expert Panel
on the Content of Prenatal Care” (Sable 3).
On the table VLBW = very low birth weight, MLBW = moderately low birth
weight and NBW = normal birth weight. The following data was taken from the "The
Relationship between Prenatal Health Behavior Advice and Low Birth Weight" report by Sable.
As seen in
the table above, decreasing the risk factors by early detection and
intervention improves the maternal health and increases the chance of giving birth
to a healthy infant.
Infant
mortality and morbidity can be reduced with proper prenatal care. “The United
States has one of the highest overall infant mortality rates of the thirty
developed nations… The infant mortality rate represents the number of infants,
per 1,000 live births, who die before their first birthday” (Albrecht 377). There
is overwhelming evidence that supports the idea that early pregnancy diagnoses
and proper prenatal care can reduce the instances of fetal morbidity and
mortality in Idaho. It is critical to begin prenatal care during the first
trimester of pregnancy, “since
brain development begins in the womb, good prenatal care can help ensure the
healthy development of your child’s brain… Eating a balanced, healthy diet and
avoiding drugs, alcohol and tobacco are just a few steps you can take to
contribute to your child’s future health” (Shelov 144). Alcohol use, smoking and drug use all contribute to
increased birth defects. A healthy diet and exercise and prenatal screening can
aid in reducing fetal maternal problems. “Pregnancy, childbirth, and new
parenthood are too anticipated, too personal, and too important not to deserve
careful preparation, not just for their immediate and long-term effects on the
physical health of a woman and her infant but for their long term effects on
the mother’s mental health and self confidence and the family’s dynamics”
(Gabriel l viii). ). In order to reduce the rate of infant
mortality and morbidity we must encourage early prenatal care and identify and
eliminate risk factors by requiring prenatal screening tests and diagnosing and
treating fetal anomalies.
Work Cited
Albrecht,
T, D Eaton, G Quinn, C Mahan, and SZ Kabir. "Development, Ethics, and
Prenatal Health Outcomes." Journal
of Social Philosophy. 31.4 (2000): 376-81. Print.
Carson, Pam. "Maternal Health."
Telephone interview. 15 Feb. 2013.
Center for Vital Statistics and Health Policy, Division of Health, and
Idaho Department of Health and Welfare. Pre-natal Care Resources and
Utilization in Idaho, 1984-1996. Boise, ID (450 W. State Street, 1st Floor,
Boise, ID 83720-0036): Dept. of Health and Welfare, Division of Health, Center
for Vital Statistics and Health Policy, 1998. Print.
Gabriel, Cynthia. Natural Hospital Birth. Boston:
Harvard Common, 2011. Print.
Harms, Roger W. Mayo
Clinic Guide to a Healthy Pregnancy. 1st ed. New York: Harper Resource,
2004. Print.
Idaho Department of
Health and Welfare. Idaho Health and Safety Assessment. Idaho:
IDHW, 2001. Print.
Murkoff, Heidi Eisenberg., and Sharon Mazel. What to Expect When You're
Expecting. 4th ed. New York: Workman Pub., 2008. Print.
Newnham, John P., and Michael G. Ross. Early Life Origins of Human Health
and Disease. Basel: Karger, 2009. Print.
Sable, MR, and AA
Herman. "The Relationship between Prenatal Health Behavior Advice and Low
Birth Weight." Public
Health Reports (washington, D.c. : 1974). 112.4 (1997). Print.
Shelov, Steven P. Caring
for Your Baby and Young Child: Birth to Age 5. 4th ed. New York: Bantam,
2003. Print.
Annotated
Bibliography
Blackman, Ronald G. The Mother's Encyclopedia.
2nd ed. New York, NY: Parents' Institute, 1950. Print.
The Mother’s Encyclopedia is
a collection of information for fourteen authors including many medical
physicians. It offers advice for a parent that answers many questions regarding
diseases, birth defects and growth and development. It was published by the
Parent’s Institute as an aid for mothers who had the responsibility of making
decisions regarding the health and wellbeing of her family. It offers
information on emotional development as well as education. It is not organized
like a traditional alphabetical encyclopedia rather it is organized by topics.
I have found it useful to look up information to gain a clearer understanding
or the diseases and birth defects. It has a section for babysitter information,
accident prevention, and perplexing questions that children might ask.
Carson, Pam. "Maternal Health." Telephone
Interview. 15 Feb. 2013.
Pam Carson an OB and GYN Registered nurse for 13 years. She
also worked in the Labor and Delivery and Neonatal Intensive Care units for
over 17 years. Her interview was on the Prenatal Care and her view of it as she
cared for patients. She is currently employed by the Boise School District as a
Registered Nurse where she deals with Sex education, nutrition and teen
pregnancy. As a Neonatal Intensive Care nurse she witnessed poor pregnancy
outcomes due to insufficient prenatal health. Through her extensive experience
and education she lends valuable perspective to the risks presented in my
paper.
Gabriel, Cynthia. Natural Hospital Birth. Boston:
Harvard Common, 2011. Print.
This is written for expectant mothers to offer a step by step
guide for those wishing to experience natural childbirth without intervention.
It offers a different perspective from a doula or midwife. I found it helpful
in seeing all the possible advantages of natural childbirth as well as the risk
and complications. Home deliveries are becoming an increasingly popular
alternative to hospital births. The author is well educated on the matter and
considered an expert in the field. Through her research, she provides and
educational and informative view of childbirth. “The point of view of a doula
is distinct from that of an obstetrician or midwife. Doulas notice different
things about birth than medical care providers do” (Xiii).
Harms, Roger W. Mayo Clinic Guide to a Healthy
Pregnancy. 1st ed. New York: Harper Resource, 2004. Print.
This text was written by two OBGYN Specialists at Mayo Clinic
who are also parents. It provides a proactive approach to healthy pregnancy to
offer a wonderful beginning to a child’s life. It offers a month to month guide
for pregnancy including what to expect and weekly and monthly insights into
baby’s development. It also addresses decisions to be made during pregnancy
regarding anesthesia, diet, activity, working, traveling, etc. I found it
helpful as it discusses these decisions and the pros and cons of each. It takes
a week by week approach during pregnancy and then addresses possible delivery
options including cesarean section. Finally it describes the newborn,
complications and treatments. Prenatal testing can be very useful in diagnosis
and treatment of fetuses “Still, in some instances you may wish to know
specific information about your baby’s health before his or her birth…
increased risk of carrying a baby with chromosomal problem or some other
genetic disorder… certain test can help determine the health of your baby while
her or she is still in your womb” (305). This explains the value of prenatal
testing to determine the treatment plan.
Murkoff, Heidi Eisenberg., and Sharon Mazel. What to
Expect When You're Expecting. 4th ed. New York: Workman Pub., 2008. Print.
This book is provided by almost all obstetricians to their
patients in the Treasure Valley. The book discusses what you will feel and see
throughout your pregnancy. The book starts at the first prediction of
pregnancy; with each chapter follows you through the months of pregnancy and
even follows up in the postpartum stage. Published by Workman Publishing
Company this non-fiction book provides details, sources and information to new
and old mothers alike. The author Heidi Murkoff is not only a world's
best-selling author of pregnancy and parenting series books but is the sole
creator of WhatToExpect.com a helpful website that provides information to
women without access to the book. She also is founder of the What to Expect
Foundation which helps underprivileged women get the Health care they need
during pregnancy, they also provide parenting classes to ensure health happy
babies.
Sable, MR, and AA Herman. "The Relationship between
Prenatal Health Behavior Advice and Low Birth Weight." Public
Health Reports (Washington, D.C. : 1974). 112.4 (1997). Print.
The study examined the relationship between the health
behavior advice recommended by the Public Health Service Expert Panel on the
Content of Prenatal Care and the risk of low birth weight. It also described
the type and frequency of health behavior advice offered to a group of pregnant
women. The study contained valuable research to my topic. A possible
quote I may use in my introduction is, “The Expert Panel recommended that
pregnant women receive advice in the following seven areas: (a) breastfeeding
(b) reducing or eliminating alcohol use; (c) reducing or eliminating smoking;
(d) not using illegal drugs such as marijuana, cocaine, or crack; (e) eating
the proper foods during pregnancy; (f) taking vitamin or mineral supplements;
and (g) gaining an appropriate amount of weight during pregnancy”(3). This
quotation supports my thesis by validating the claims I am making. There is a
lot of statistical data presented that will help address the magnitude of the
problem and the need for more research.
Shelov, Steven P. Caring for Your Baby and Young
Child: Birth to Age 5. 4th ed. New York: Bantam, 2003. Print.
This is a collection of advice for parents and caregivers
from The American Academy of Pediatrics. It covers all aspects of child care
from infancy to age five including: diseases, prevention, safety and emotional
wellbeing. It offers explanations on many of the diseases and the causes of
birth defects. It offers a brief glimpse into maternal health on outcomes of
birth defects. I found it a useful tool to define and explain areas of interest
in lay terms. I plan to use information to help make my points understandable
to the lay person and not so technical. “Since brain development begins in the
womb, good prenatal care can help ensure the healthy development of your
child’s brain… Eating a balanced, healthy diet and avoiding drugs, alcohol and
tobacco are just a few steps you can take to contribute to your child’s future
health” (144) this quote brings but specific attributes that could have a birth
defect or other disorders during prenatal care.
Bibliography
Albrecht, T, D Eaton, G Quinn, C Mahan, and SZ Kabir.
"Development, Ethics, and Prenatal Health Outcomes." Journal
of Social Philosophy. 31.4 (2000): 376-81. Print.
Blackman, Ronald G. The Mother's Encyclopedia.
2nd ed. New York, NY: Parents' Institute, 1950. Print.
Carson, Pam. "Maternal Health." Telephone
interview. 15 Feb. 2013.
Center for Vital Statistics and Health Policy, Division of
Health, and Idaho Department of Health and Welfare. Pre-natal Care
Resources and Utilization in Idaho, 1984-1996. Boise, ID (450 W. State
Street, 1st Floor, Boise, ID 83720-0036): Dept. of Health and Welfare, Division
of Health, Center for Vital Statistics and Health Policy, 1998. Print.
Gabriel, Cynthia. Natural Hospital Birth. Boston:
Harvard Common, 2011. Print.
Harms, Roger W. Mayo Clinic Guide to a Healthy
Pregnancy. 1st ed. New York: Harper Resource, 2004. Print.
Idaho Department of Health and Welfare. Idaho Health
and Safety Assessment. Idaho: IDHW, 2001. Print.
Miedzybrodzka, Zosia. "Congenital Talipes Equinovarus
(clubfoot): a Disorder of the Foot but Not the Hand." Journal of
Anatomy. 202.1 (2003): 37-42. Print.
Murkoff, Heidi Eisenberg., and Sharon Mazel. What to
Expect When You're Expecting. 4th ed.
Newnham, John P., and Michael G. Ross. Early Life
Origins of Human Health and Disease. Basel: Karger, 2009. Print.
“Our Mission." Idahoperinatal.org/. Idaho
Perinatal Project, n.d. Web. 12 Feb. 2013.
Sable, MR, and AA Herman. "The Relationship between
Prenatal Health Behavior Advice and Low Birth Weight." Public
Health Reports (Washington, D.C. : 1974). 112.4 (1997). Print.
Shelov, Steven P. Caring for Your Baby and Young
Child: Birth to Age 5. 4th ed. New York: Bantam, 2003. Print.
Swamy, R, B Reichert, K Lincoln, and M Lal. "Foetal and
Congenital Talipes: Interventions and Outcome." Acta Paediatrica
(oslo, Norway : 1992). 98.5 (2009): 804-6. Print.
Letter to My Son
Dear Little Troy,
By the time you are able to read this letter you will not
even realize what a struggle you went through to be able to walk normally so I
decided to write you a letter and explain what we know thus far. The day you
were born was the happiest day of my life but the next day was filled with fear
and anticipation. We were told you had been born with a birth defect, you have a
clubbed foot. Your mom thought for a week that your foot was just squished and
would straighten out on its own. After
three weeks we finally got a consultation with Dr. Schowalter and he told us
you have idiopathic club foot and he felt that he could correct it so that you
will be able to walk. He felt that your mom was so tiny when she got pregnant
that you we too crowded in her tummy and your foot got stuck in that position
and didn’t develop properly. He said it doesn’t hurt you and by gradually
rotating it back in place it will give you the best chance for a complete
recovery.
At your
first appointment he put a cast on your left foot up to your thigh. You were
trying to finish your bottle and weren’t very happy. We had to take your diaper
off so they could fit the cast and being the little Skovgard that you are, you proceeded
to fill your pants the table and the doctor’s arm. This became your signature
move each week as you got a new cast put on. Your doctor and his nurse Lelani were
such good sports but just in case they scheduled you at the end of the day each
week! We joked that girls like boys in casts so even at this age you are a
ladies’ man like your dad. The first few times they removed the casts the
buzzing of the saw startled you but you didn’t cry. By the last week when she
turned it on you began to fuzz even before she touched you. After the last cast
came off your little leg was so tiny, so much smaller than the right one. You
had a large lump on your thigh which the doctor quickly explained was your big
muscle that had developed from you tossing the cast around. Your Aunt Heather
and grandma encouraged me to take pictures each time so one day you will be
able to see the weekly progress. I don’t
think the cast hurts you because you seem quite content and I’m glad it was not
summer so you won’t sweat in the heat. There have been times that I know you
are uncomfortable and I wish I could take that away.
Last
week you were fitted for a brace that you have to wear 23 hours a day for the
next three months. You have little custom made shoes that fit into a bar that
the doctor can manipulate to rotate your feet. After three months you will only
have to wear it at night. If all goes as planned, you will not need surgery to
correct the tendon. We are excited that the brace will be off before you start
to crawl however the doctor said many kids crawl with the brace. I know this is
going to be a struggle but we are going to do everything possible to make sure
you can walk. You are such a happy baby and have brought so much joy to our
lives.
I love you to the moon and back!
Daddy
Personal Experience with Birth Defects
February 7, 2013 was a day that
changed my life forever. My wife had a
weekly prenatal visit scheduled that morning. About three in the morning she
began having labor pains that continued for the next few hours. As the pain increased and time between contractions
decreased, we made a decision to call the doctor. Within an hour we arrived at St. Luke’s Labor
and Delivery and by eight the nurse informed us that she was definitely in
labor and we would be having a baby today. Around noon the doctor came in and broke her
water and started getting us prepared. As the day wore on, she was finally
ready to push. After two hours of pushing, she delivered a baby boy at 7:10pm. There
were no sounds as he arrived and the cord was wrapped around his neck, my wife
could see the look of panic on my face. Within seconds the doctor spun his
little body like a football and lifted him up for me to cut the cord. Words
cannot describe the emotion I felt, it seemed as if God reached down and
breathed life into him. Troy Thomas entered the world weighing 7 pounds 10
ounces and was 21 inches long.
When I opened my hand to hold my
new born son on his birthday I was speechless as he squirmed in my arms. My
wife and I, with God’s blessing had created this amazing child. Wrapped in a
warm blanket he was passed around to family members to adore. We were all
oblivious to the fact that he had a birth defect, a crooked little foot. The
next day nurses and doctors began explaining that he had a club foot. My heart
nearly stopped beating and fear swept over me as they explained the cost, casts,
braces and possible surgery needed to give him a chance to walk. My son who was
born in America, in a sterile hospital with the best medical care available,
and his mom had early prenatal care, was born with a birth defect. We couldn’t
help but wonder if it was something we did wrong as parents. Did my wife eat
the wrong food, take the wrong medication, was it heredity? Hundreds of
questions filled my mind.
It was three weeks until we were
able to meet with the orthopedic specialist to evaluate him. He said it looked really good and we were
lucky it was only one foot. The plan was to cast it for a series of five weeks,
each week rotating the foot position. After five casts we would reevaluate and
see if he needed to have surgery. I left home with a baby with a crooked foot
and hundreds of questions. I returned with my child in a cast up to his hip and
hope for the future that this birth defect could be repaired and he will have
full function in both his feet. He will run and jump and play like other kids.
The type of clubfoot he has is
idiopathic or positional. Basically his mother was so small and he was too
crowded and did not have room to move about. The clubfoot was a result of the
position his foot was stuck in during the later part of the pregnancy that inhibited
the foot from developing properly. There was nothing we could have done
differently and we are very fortunate that with advanced technology and proper medical
care he can completely recover.
As of today we have completed the
series of casts and rather than surgery the doctor felt he could use a mechanical
brace. He is required to wear the brace 23 hours a day for the first three
months. After that, if everything goes as planned, he will only have to wear
the brace at night until he is four years old. He was fitted with two sandal
type shoes that position on a bar that is shoulder width. The bar allows the
doctor to manipulate the rotation of the foot. The next few years will be
filled with doctor appointments, medical bills and shoe fittings but in the end
when my son takes his first step the struggle will all be worthwhile.
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