Addressing Maternal Fetal Health Issues to Improve Pregnancy Outcomes

Simon Skovgard

simonskovgard@mycwi.cc

English 102- 012W

Blog Site

5/6/2013

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

College of Western Idaho

Maternal Fetal Health Issues

In Idaho

Simon Skovgard

English 102- 012W

Jewkes

3 Mar 2013

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.

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. 

Brochure

Helping Troy Walk

Interview

 Interview with P. Carson, RN

Below is the transcript of Interview with P. Carson, Boise School District RN, Former OBGYN RN and NICU RN.  I asked some questions but she offered so much more information with each question that the conversation just developed as we went along and I didn’t follow my script.

Q- What do you feel is the main reason for maternal and infant mortality in Idaho?

A- There is a lack of education among teenagers in Idaho and across the country. Many do not seek health care due to inability to pay or because they are scared to tell anyone about the pregnancy. Many teens are in denial about their pregnancy and try to hide it only seeking care later in the third trimester.  Teen pregnancies are higher risk and therefore early intervention produces the best outcomes.

Q- What has been your experience with educating teens?

A- Working in both a physician setting providing women’s health care and in the high school, I have been responsible for teaching sex education and providing birth control and abstinence counseling. Many parents are also in denial about children having sex. Many teens become sexually active at the age of 12 or 13 and I’ve seen girls pregnant at that age. It is important to realize that sex is occurring and try to develop methods to educate teens to practice safe sex. In Idaho, females can seek contraception and family planning advice without the consent of a parent.  When parents find out they want to place blame rather than address the issue that their son or daughter is having sex.

Q. Do you think only teens are at risk for complications and maternal mortality?

A. No. All women within childbearing age are at risk of complications. Any woman who is sexually active can become pregnant if she is not practicing safe birth control.  Women who are over 35 are considered advanced maternal age and the risk of complications and birth defects increases. Early pregnancy or teen pregnancy also increases the risk of complications.

Q. What have you witnessed as far as complications in pregnancy?

A. There are many complications during pregnancy, delivery, and the postpartum period. Many patients have a disease or illness that is aggravated during their pregnancy. Others develop conditions during pregnancy that they will recover from after delivery such as gestational diabetes or pregnancy induced hypertension. I have seen many complications and through my work in the Neonatal Intensive Care Unit I have seen many babies with a range or birth defects and prematurity issues. I have also experienced the loss of life which is very traumatic for the family as well as the staff. The hospitals provide counseling for all deliveries both positive and negative outcomes. Many women experience post partum depression after delivery and can even cause harm to themselves or their newborn.

Q-What do you think should be done to decrease infant mortality and morbidity?

A-I think that providing early prenatal care is the best way to prevent problems and making it affordable and accessible to everyone.  With proper diagnosis and treatment many complications can be prevented. Many diseases and illness can be treated during pregnancy and increase birth outcomes. There are new techniques available and operations can even be performed in utero. Most problems can be detected with blood tests and ultrasound or genetic counseling. At least if parents know prior to delivery, they are better prepared to handle the situation. Knowing that your child will be born with a birth defect gives a parent the opportunity to research and make informed decisions regarding health care.

Interview with B Schowalter, MD and Lelani,  RN

Below is the transcript of discussions with Dr Scholwater , an Orthopedic Surgeon, and his nurse Lelani  M. regarding congenital deformities of the foot and ankle such as clubfoot.  I asked some questions and gathered information regarding my topic over several visits, including diagnosis, treatment and prognosis. Dr Scholwater also presented me with a pamphlet that directing me to MayoClinic.com which provided me with a great deal of information.

Q- Do you see a lot of clubfoot cases?

A- Clubfoot is seen in about 1 in every 1,000 babies. I have so many clubfoot patients in the Treasure Valley I have a weekly 2 hour clinic.

Dr Scholwater also presented me with a pamphlet that directing me to MayoClinic.com which provided me with a great deal of information.

Q- What causes clubfoot?

A - The cause of clubfoot is unknown (idiopathic). But scientists do know that clubfoot is can be caused by the position of the baby in the womb (fetus). In some cases, clubfoot can be associated with other abnormalities of the skeleton that are present at birth (congenital), such as spina bifida, a serious birth defect that occurs when the tissue surrounding the developing spinal cord of a fetus doesn't close properly.

Q- Will it affect his ability to walk?

A- Clubfoot typically doesn't cause any problems until your child starts to stand and walk. If the clubfoot is treated, your child will most likely walk fairly normally. He or she may have some difficulty with:

• Mobility. Your child's mobility may be slightly limited.
• Shoe size. The affected foot may be up to 1 1/2 shoe sizes smaller than the unaffected foot.

However, if not treated, clubfoot causes more-serious problems. These can include:

• Arthritis. Your child is likely to develop arthritis.
• Poor self-image. The unusual appearance of the foot may make your child's body image a concern during the teen years.
• Inability to walk normally. The twist of the ankle may not allow your child to walk on the soles of the feet. To compensate, he or she may walk on the balls of the feet, the outside of the feet or even the top of the feet in severe cases.
• Muscle development problems. These walking adjustments may prevent natural growth of the calf muscles, cause large sores or calluses on the feet, and result in an awkward gait.

Q- What can we do to treat it?

A- Because your newborn's bones and joints are extremely flexible, treatment for clubfoot usually begins in the first week or two after birth. The goal of treatment is to improve the way your child's foot looks and works before he or she learns to walk, in hopes of preventing long-term disabilities. Treatment options include:

Stretching and casting (Ponseti method)
This is the most common treatment for clubfoot. The doctor will do the following:

• Move the baby's foot into a correct position and then place it in a cast to hold it in that position
• Reposition and recast the baby's foot once or twice a week for several months
• Perform a minor surgical procedure to lengthen the Achilles tendon (percutaneous Achilles tenotomy) toward the end of this process

After the shape of the foot is realigned, parents will need to maintain it by doing one or more of the following:

• Doing stretching exercises with your baby
• Putting your child in special shoes and braces
• Making sure your child wears the shoes and braces as long as needed — usually full time for three months, and then at night for up to three years

For this method to be successful, you'll need to apply the braces according to your doctor's directions so that the foot doesn't return to its original position. The main reason that this procedure sometimes doesn't work is because the braces are not used constantly.

Stretching and taping (French method)
This approach is also called the functional method or the physiotherapy method. Working with a physical therapist, parents:

• Move the foot daily and hold it in position with adhesive tape
• Use a machine to continuously move the baby's foot while he or she sleeps
• After two months, cut treatment back to three times a week until the baby is 6 months old
• Once the shape is corrected, continue to perform daily exercises and use night splints until the baby is of walking age

This method requires a much greater time commitment than does the Ponseti method. Some caregivers combine the French method and the Ponseti method.

Surgery
In some cases, when clubfoot is severe or doesn't respond to nonsurgical treatments, babies may need more invasive surgery. An orthopedic surgeon can lengthen tendons to help ease the foot into a better position. After surgery, your child will be in a cast for up to two months, and then need to wear a brace for a year or so to prevent the clubfoot from coming back.

Even with treatment, clubfoot may not be totally correctable. But in most cases babies who are treated early grow up to wear ordinary shoes and lead normal, active lives.

For Troy’s treatment we will first use the casting process to turn the delicate bones to a more correct position at that time we will assess the progress and determine if surgery will be necessary or if a brace will work.

Q- How long will he wear the cast?

A- We will cast the foot and position it in a certain way to correct the club positioning. We change it every week for 4-6 weeks and then see where to go.

Q- How long will the brace be necessary?

A- Troy will wear his brace 23 hours a day, an hour off for bathing, for the first 3 month and from there he will wear it only at night until he is 4 years old.