Make Time for Tummy Time

2019-11-11T05:53:38+00:00November 11th, 2019|Categories: Fertility Blog|Tags: , , , , , |

As our babies grow, they need new ways to exercise their bodies and brains. Sitting up, rolling over and putting random items in her mouth all make new connections in her brain and help her develop coordination. Making sure your baby has plenty of time out of her crib or car seat has many crucial benefits. Spending time playing on her stomach, aka Tummy Time, strengthens her neck and back muscles. Most importantly, tummy time can help your baby stay safe by reducing the risk of SIDS.

During Tummy Time your baby is lifting her head and using all the muscles in her upper body. Essentially doing a miniature baby plank. The ability to lift her head up can help your baby avoid rebreathing her air if she rolls on her stomach or gets into a tight spot. The saying “back to sleep, tummy to play” is a good way to remember to put your little one on her tummy when you or a caregiver is watching. Then always put your baby to sleep on her back without any pillows or blankets in the crib with her.

There are many reasons to let your baby play on her stomach as much as possible:

  1. Upper body strength for safety and repositioning (see above)
  2. Reduce the risk of positional plagiocephaly (flat spot on the head). Usually if a flat spot does develop, it will be on the back of the head from the pressure of her head being in contact with her crib or car seat for extended periods of time. Around 20% of babies have a flat spot on their head that resolves as they approach 1 year of age
  3. Tummy time helps your baby reach physical milestones on time since they are moving and using muscles in different ways
  4. Have an interesting toy within reach so your baby can practice moving her body, reaching and grasping

Safe tummy time tips:

  1. Tummy time should be after a nap or other time when your baby is wakeful.
  2. Carefully watch your baby, make sure she isn’t spitting up
  3. Wait 30-45 minutes after feeding to allow for digestion time
  4. Tummy time can be on your/dad’s/caregivers chest too
  5. Don’t give up if your baby gets cranky, start for 2-3 minutes at a time.

There are several other recommendations for safe sleep from the American Academy of Pediatrics. Read the full article here

40 Weeks to Freedom – It’s Worth the Wait

2019-09-23T06:19:12+00:00September 23rd, 2019|Categories: Fertility Blog|Tags: , , , , , , |

Why does it seem like the last month of pregnancy lasts longer than the previous nine? My fellow moms – I absolutely get  why you want to end it as soon as possible. The final weeks are uncomfortable and anxiety ridden. Waiting for the baby to arrive and FINALLY starting your maternity leave, plus meeting your baby is the most exciting day! It’s no wonder we want to rush to the end by inducing labor instead of allowing labor to begin naturally. Inducing labor is defined as: you or a care provider uses a drug or an action to cause labor to start before it starts on its own. Doctors and researchers don’t really understand how or why labor begins when it does, so the drugs and interventions don’t always result in labor actually beginning and progressing to delivery. One quarter of moms that are induced end up with a cesarean birth when labor stalls or goes on too long.

Researchers now believe the fetus actually signals the beginning of the labor process, possibly when the lungs have matured enough to take the first breath of air. The fetus likely signals a hormone release that relaxes the cervix and starts uterine contractions. Because of the complexity of the labor process, it is best to allow it to begin naturally even if your due date has come and past.

A due date can be misleading, the exact date of fertilization can be nearly impossible to know for sure. Also, just like babies reach milestones at different times, it’s normal to have a range of normal gestation. Anytime between 39 and 42 weeks is considered a safe time to deliver, and waiting for labor to start naturally is another reassuring signal your baby is ready to be born.

Doctors used to deliver babies earlier in pregnancy for their convenience and at mom’s request (if she was uncomfortable – what part of pregnancy IS comfortable??) Doctors noticed the number of babies that required special care for breathing problems, breastfeeding problems and inability to regulate their body temperature increased as babies were delivered earlier. The American Academy Of Pediatrics recommends waiting until 39 weeks to consider an induction. Read the AAP position statement here The Timing of Planned Delivery:Strengthening the Case for 39 Weeks

If you are thinking about trying to induce your labor at home, there are several things women have been told to try to get labor going. Unfortunately, none of the home remedies have been shown to be effective when reviewed by researchers.

  • Hypnosis: not effective, compared with doing nothing
  • Homeopathy: not effective, compared with doing nothing
  • Sexual intercourse: not effective, compared with doing nothing
  • Sweeping/stripping membranes (office procedure done with a vaginal exam): not effective, compared with doing nothing
  • Acupuncture: not effective, compared with doing nothing
  • Breast stimulation: increases the likelihood of starting labor, but more research is needed to understand safety (there are concerns that strong contractions could reduce oxygen flow to the fetus, although the study that raised this concern was done in women with high-risk pregnancies)
  • Castor oil: effective at starting labor, but does not decrease the chance of having a C-section. Castor oil causes nausea and diarrhea in most women. More research is needed to understand safety.

If you feel the need to induce your labor or have any health concerns, talk with your doctor before trying any of these techniques. There are times when induction is the right choice for you and your baby.


Vernix and the First Bath

2019-09-01T03:12:00+00:00September 1st, 2019|Categories: Fertility Blog|Tags: , , , , |

Babies are born needing a good wipedown. They are usually covered in amniotic fluid, a little blood and a waxy covering called vernix. The whitish vernix protects your baby’s tender new skin from soaking in amniotic fluid during your pregnancy. Vernix may look like onion dip all over your baby, but it serves an important purpose. Just look at your pruney fingers after soaking in the tub for 30 minutes and then imagine the wrinkled raisin you would have after 40 weeks.

Vernix does more than just create a barrier to protect your baby’s skin it has other beneficial properties too:

  • It protects your baby’s skin from injury and infections after birth. The antimicrobial properties of vernix help keeps any open areas from becoming inflamed or painful
  • Regulates body temperature, vernix can act as an insulator and keep your baby comfortable and reduce chilling
  • It acts as lubrication and reduces friction as your baby moves through the birth canal

The amount of vernix on your baby decreases as she matures and gets closer to her due date. Some full term babies are born with very little vernix while premature babies may have much more.

Delaying your baby’s first bath keeps the vernix in place, protecting your baby through the first hours of life. New evidence even suggest delaying your baby’s first bath can improve your breastfeeding experience. When a hospital in Ohio changed their policy so a baby’s first bath occurred after 12 hours instead of 2 hours, the exclusive breastfeeding rate of their new moms jumped from 59% to 68%. Researchers don’t know the exact reason for the increased breastfeeding rate but suggested that keeping mom and baby together gets breastfeeding off to the best possible start.

Instead of a bath, ask your nurse to wipe your baby with a towel and not too thoroughly, leave some vernix behind to moisturize your baby’s skin. Place your baby skin to skin to share your good bacteria and body heat along with your colostrum and kisses.


Sore Nipple Strategies

2019-08-17T22:50:34+00:00August 17th, 2019|Categories: Fertility Blog|Tags: , , , |

.Most of us had an idea in our head about how breastfeeding would go. You probably pictured the serene moments gazing into each other’s eyes, then your milk drunk baby slipping off to sleep in your arms.  The reality of the early days of breastfeeding can be surprising, as those of us that have lived them can attest. For 80-90% of moms, nipple and breast pain is part of their new mom life, at least in the short term since almost all nipple pain resolves in the first 2 weeks.

Nipple pain it’s not just for new moms, it can re-emerge with each baby. Issues like a shallow latch, slow let-down and tongue tie are unique to each baby. Although your breastfeeding experience will help you solve these problems much faster the second time around.

If you are suffering from nipple pain, here is a list of possible reasons and solutions:

-Shallow latch. You baby should have a wide open mouth before latching onto the nipple and surrounding areola, not just the nipple. Top and bottom lips should both be curled back and the chin firmly pressed on the breast. This position allows the nose to remain unobstructed with correct positioning.

– Pulling your baby off before breaking suction. When you are ready to take your baby off the breast, place a finger in the side of the mouth to release the suction first. Otherwise you stretch and strain tender nipple tissue.

-Slow milk flow. Your baby may be spending extra time on your breast or try to suck with greater force if your let-down reflex takes a while. To speed it up, self express a bit of milk before feeding to get milk flowing and soften up your breast before latching your baby. Once your baby is on the breast, use breast compression to keep milk flowing quickly without much suction from your baby.

-Using the same breastfeeding position every time. Depending on the angle, you baby’s mouth can apply pressure in different parts of your breast and nipple. If you have a tender spot when using the football hold, try lying on your side next time you feed.

-Dry, cracked nipple tissue. Your nipple has natural lubrication from the oils released by your Montgomery Glands, the little bumps that surround your areola. But the friction of your baby’s mouth can strip away your natural oils leaving your nipples red and cracked. There are several nipple creams available that can help your tender tissue heal. Check out our Milkies Nipple Nurture Balm  for an organic olive oil based cream that doesn’t need to be removed prior to putting your baby to breast.

Your nipple pain should taper off and go away entirely by day 14. If your nipple pain lasts longer or is accompanied by other breastfeeding problems like full breasts or a frequently fussy baby, see your lactation consultant.


Products Moms Will Love in 2019

2019-01-21T21:48:04+00:00January 3rd, 2019|Categories: Fertility Blog|Tags: , , , , , |

Each year baby gear gets cooler, smarter and more parent-friendly. 2019 will be no exception, there are some ingenious products launching this year and I wanted to share my favorites.

My criteria for choosing the best products is simple, I ask myself “would I buy this?” I am notoriously cheap and like to keep clutter to a minimum, so I set the bar high for things I let into my house.

My top 5 products in no particular order are:

1. Keenz & Stroller wagonKeenz 7s Stroller Wagon (Grey)

I love how this folds down small enough to keep in your trunk but is roomy enough for a couple of kids and their gear. The roof would keep the sun or rain off little faces and looks like a rolling room. Tires are rugged enough for off-roading at the beach or hiking trails.

2. Little Martin’s Feeding Lamp

Little Martin’s Night Light for Baby Breastfeeding (Pink)

This soft light lamp is perfect for night time feedings. You can adjust the brightness by stretching the lamp upward for more light, or compacting it down for less. The LED light uses a USB cord so you can charge it and use it anywhere. And it comes in pink or blue to match your decor.

3. The Shrunks Bed Tent


We live in the Pacific North West and camping is a part of every summer. Having a designated bed would be so convenient and safer too since sleeping arrangements can be tricky in a tent. This little bed tent would be great for living room or back yard camping too. The toddler bed would work well for road trips or anytime you have to travel with your little one. I wish they made this in my size.

4. Osprey Pack Kid Carrier

Osprey Packs - Poco AG 20L Kid Carrier - Seaside Blue

We used this all the time! My husband would wear it with our daughter in it when cooking dinner, I used it for taking walks with friends. We both like to hike and strollers aren’t practical everywhere, but this went everywhere with us. It really freed us up and strengthened our legs at the same time. We used a friend’s then gave it back when our daughter outgrew the seat, I am sure it has carried 2 or 3 more babies by now.

5. Milk-Saver On The Go

Collect and store more milk? Yes please. As a leaky mom, products that kept me dry and helped me collect more breast milk were always worth the price. As the creator of the original Milk-Saver this product is near to my heart. Moms left us hundreds of comments and reviews. Based on those, we created a product that could protect sore nipples and collect more than an ounce at a time. Easy to use and discreet, no one will even know you are wearing them.

There you have it folks, these are my favorite new baby products – I will be watching for more amazing products in stores this year.  Enjoy!

Five Tips for Exclusively Pumping Moms

2018-11-20T19:50:21+00:00October 17th, 2018|Categories: Fertility Blog|Tags: , , , , |

Breastfeeding isn’t defined by putting your baby to breast. Many moms choose to pump and use a bottle to feed. By choice or necessity exclusive pumping is growing in popularity as pump technology improves and moms are heading back to work with the intention to continue feeding breast milk. There are many reasons for exclusively pumping (EP). Some moms don’t feel comfortable putting their baby to breast or a baby may be born with a condition that makes breastfeeding impossible, like a cleft palate.

While exclusive pumping can be done, it takes some additional preparation to be successful and keep your milk supply strong. Here are some time-tested tips to help you meet your exclusive pumping goals.

1. Be ready for pumping to take over your life for the first week. While you establish your milk supply, pump 12 or more times in each 24 hour period. This works out to pumping every 2 hours day and night, it’s tiring and your breasts may become sore. But, the early days of breastfeeding aren’t easy either, establishing your milk supply and caring for a newborn are challenges for every mom. Once you find your groove and you become a more efficient pumper, you might be able to increase your time between sessions to 4 hours.

2. Have extra pump parts and bottles. Expect the unexpected. You might find yourself without a working pump or clean parts if you have an emergency at home or your car breaks down. Have a spare (or two) of everything, even an extra pump. If your pump motor tires out or a part breaks, you still need to pump and you won’t want to run to the store in the middle of the night.

3. Washing pump parts and bottles will take some time and space in your kitchen. You may feed your baby 12 times per day – will you wash the bottle after each feeding or use a new bottle each time and wash once a day? Either way you will need set aside time each day to clean and organize bottles, nipples and other feeding supplies.

4. Your partner can take on more feedings. No breasts are required for bottle feeding and anytime your baby is hungry, milk is available to for caregivers to feed. Pump before going to bed and let your partner handle the night time feedings. Sleep helps your supply by signaling your body to release milk making hormones.

5. Use hands-on-pumping. Get a hands-free pumping bra or make your own using an old sports bra and use your hands to shorten pumping time. Once your pump is in place and turned on, push with your palms to create gentle pressure starting near your ribs and move toward the nipple. This moves more milk out of your breasts to support a strong milk supply and you finish pumping faster – double bonus!

The one thing EP moms want to share is that it gets easier. The early days of pumping, washing pump parts and bottles non-stop can be overwhelming. But as you and your partner find a system that works for you and your baby, it becomes a natural part of life.

Jaundice 101

2018-08-22T16:31:36+00:00August 22nd, 2018|Categories: Fertility Blog|Tags: , , , , |

Most infants (50-70%) develop jaundice in the first weeks of life. If your baby has jaundice, he may have yellow-tinted skin or eyes. The yellow color is the result of too much bilirubin in your baby’s blood; bilirubin is a brownish – yellow color. Typically parents notice yellowing in the face and eyes in the first 2-4 days of life; the yellowing starts in the face and moves down to the toes. Bilirubin levels typically peak between 3 to 7 days after birth.

Before birth, your baby’s body uses your placenta to remove bilirubin from his blood. But during the first days of life, your baby’s liver can be slow to begin working and bilirubin can build up. We all have bilirubin in our bodies, it is a naturally occurring waste product created when our bodies replace red blood cells (the lifespan of a red blood cell is 120 days). Usually our liver filters out the bilirubin and we excrete it in our stool. If you have ever wondered where our poop gets it is color – look no further than bilirubin!

The best way to shorten the duration of jaundice, or prevent it all together, is to breastfeed your baby early and often. Breastfeeding within the first hour of life helps your baby pass the dark, sticky poop called meconium and takes out bilirubin with it. In the first hours, your baby is drinking colostrum, which is a laxative in addition to an immune system booster. Put your baby to breast often, frequent breastfeeding helps your baby pass more stool and bilirubin too.

There are 3 common types of jaundice:

1. Physiological jaundice. It is often most noticeable when the baby is 2 to 4 days old. The most common type of jaundice, it does not cause any distress and disappears without treatment by 14 days old.

2. Breastfeeding jaundice. This type often occurs in breastfed babies during the first 7 days of life. If your baby has difficulty breastfeeding or your milk comes in after day 3, your baby may develop breastfeeding jaundice.

3. Breast milk jaundice. Develops after the first 4-7 days of life, persists longer than 14 days and has no other identifiable cause. Doctors are still unsure what causes breast milk jaundice. However, evidence suggests it is related to the interaction between some of the components in breast milk and bilirubin.

If you notice a yellow tint to your newborn’s skin or eyes, talk to your baby’s doctor about the need for testing and monitoring her bilirubin level. Bilirubin levels can be tested with a blood or skin test. A very high level of bilirubin can result in a condition known as kernicterus and brain damage.

Most cases of jaundice resolve without treatment as the liver matures and filters blood more effectively; frequent breastfeeding helps the bilirubin pass through and out in your baby’s stool. More severe jaundice may require treatment with a bili-light (or phototherapy). Phototherapy is a common and highly effective method of treatment that uses light to break down bilirubin in your baby’s body. It looks like a little tanning bed; your baby will only be in a diaper and wearing protective goggles. Absorbing the special blue-spectrum light through the skin helps your baby break down bilirubin.

While most babies develop jaundice, few need treatment. The combination of frequent breastfeeding and your baby’s liver working more effectively usually take care of the problem. See your pediatrician if your baby acts more tired than usual or you have any concerns.

Fussy or Food Allergy?

2018-06-20T03:32:32+00:00June 20th, 2018|Categories: Fertility Blog|Tags: , , , , |

Variety is the spice of life and that goes for breastfed babies too. Your milk changes as your baby grows, if either of you is sick and takes on the flavors of the foods you eat. The changing flavor of your milk can help your baby accept different tastes later and reduce your chances of having a picky eater later on. So sharing your foods with your baby through your milk is a good thing right? Maybe, but there is more to the story.

Besides the flavors, other parts of the food you eat become part of your milk. Proteins, sugars and fats are absorbed by your small intestine and enter your bloodstream to be used by your milk producing cells, or lactocytes. In rare cases, your baby may be sensitive or allergic to the parts of your food that transfer into your milk.

Most babies, except the lucky few, have fussy times. Your baby may have periods of time when he seems inconsolable – if your diet hasn’t changed and the fussiness doesn’t follow meals it’s probably not related to your diet. Instead, think growth spurt, teething or who knows? If you notice any other signs of allergy like: rash, hives, eczema, sore bottom, dry skin; wheezing or asthma; congestion or cold-like symptoms; red, itchy eyes; ear infections; irritability, fussiness, colic; intestinal upsets, vomiting, constipation and/or diarrhea, or green stools with mucus or blood, an allergic reaction may be the cause.

If your baby shows any of these symptoms and you have eliminated other potential allergens, your diet may hold the answer.The most likely food suspects are cow’s milk products, soy, wheat, corn, eggs, and peanuts.If you have a family history of allergic reaction to a certain food, it might be a problem for your baby too.

Symptoms can appear 4-24 hours after exposure to the new food. The symptoms can last for 2-4 hours then subside, except if your baby is allergic to a food you eat frequently. In that case the symptoms can persist. For example, if your baby is sensitive to dairy and you have creamer in your coffee, cheese on your salad and ice cream for dessert, your baby will be getting a steady diet of cow milk proteins and show allergy symptoms all the time.

To confirm your baby is sensitive to something you are eating, cut it from your diet for 2-3 weeks to see if your baby stops showing signs of a reaction. If the reaction symptoms stop, you may want to continue avoiding the food while breastfeeding. The 2-3 week time period matters since many foods, like cow’s milk protein, can stay in your body for 1½ – 2 weeks, and another 1½ – 2 weeks in your baby. Some moms find it helpful to keep a food journal to track symptoms and be sure to cut one food at a time to correctly identify the offender. Usually, you will notice improvement in 5-7 days although your baby may take weeks to completely get rid of all the allergy symptoms, especially if the food is one you eat frequently.

If you are eating the problem food frequently, your baby may seem to feel worse for about a week before symptoms begin to improve. You may begin to eat small amounts of the troublesome food when your baby is 9-12 months old or 6 months after you stopped exposure. If baby is only a little sensitive to a particular food, you may be able to cut back, instead of eliminating the food altogether. The exception is if your baby had breathing problems or bloody stool after exposure, talk to your pediatrician before reintroducing the problem food.

Sensitivities and allergies are rare, but they do occur. Watch for the symptoms and take the steps to identify and eliminate the offending food to help your baby, and your family, be healthy, happy and more comfortable.

The Real Scoop on Your Baby’s Poop

2018-05-21T00:45:25+00:00May 21st, 2018|Categories: Fertility Blog|Tags: , , , , , , , , |

Babies can be mysterious creatures. They have few needs but the variations on those needs can be endless. So any clues into their wellbeing are helpful. One big source of information is your baby’s diaper – your baby’s poop can help you understand what is happening inside his or her body.

First let’s follow the path of normal digestion.

Food goes in the mouth and digestion actually begins here! Enzymes in our saliva start to break down the starches in cereal and bread (enzymes are chemicals that break our food down into smaller, more digestible parts).
Amazingly, your breast milk has the same enzyme, called amylase. Mixing breast milk with your first cereal feedings are a great way to help introduce a new food while using the enzymes in your milk in new ways.

Next stop is the stomach where strong acids continue the process of breaking down your milk into small pieces your baby can use. A cup of your milk contains about 2.5 grams of protein and 11 grams of fat (a study of 24 hour milk collection showed fat content was highest in mid-day and evening, lowest in the morning and late night feedings. These numbers can vary quite a bit.) Your first milk contains about 90% whey and 10% casein protein since whey is much easier for your baby to digest by an immature gut. As your baby gets grows, the type of proteins even out to about equal quantities.

As your milk exits the stomach for the small intestine and the real work of absorbing nutrients happens here. Some parts of your milk leave a protective coat on your baby’s intestines to keep illness causing germs out of the blood and moving down the digestive tract, leaving the body unharmed. Other parts of your milk are changed into glucose and absorbed into the blood, where insulin lets it in the cells to be used for energy and building new structures.

After the body has extracted all the possible nutrients from your milk, it moves to the large intestine where more water is re-absorbed and bacteria continues to break down the milk into smaller molecules that can consumed by the bacteria that live there. The food starts to look like poop by now. If your baby is exclusively breastfeed, their waste doesn’t spend much time here. Since breast milk is highly digestible, there isn’t much for the bacteria to work on and it moves to the rectum to accumulate into a bowel movement.

So what can go wrong?

Constipation – this occurs when the poop stays in the large intestine too long. If food moves too slowly, the large intestine continues to absorb more water from the poop, it gets harder, drier and more difficult to pass out of the body.

Food intolerance – if we don’t have the right enzymes, digestion can’t happen in the stomach and small intestine. Instead the bacteria in the large intestine get the job. These bacteria aren’t equipped to do the job efficiently and produce gas as a byproduct. Some gas is normal, but too much can be a sign of tummy trouble.

Spit up – there is a muscle at the top of the stomach called the cardiac sphincter (it’s near the heart, hence the name). Normally food enters the stomach and the muscle closes like a drawstring… so you can lie down and all your food doesn’t come back out. In some babies, this muscle doesn’t close completely and milk comes back up. Sometimes the milk has a sour smell due to the acidic environment of the stomach curdling your milk.

Diarrhea – when material moves too quickly through the large intestine, water and salt don’t get reabsorbed as usual. It just moves out too quickly. The body loses water and electrolytes it needs, if diarrhea is severe and goes on for more than 1-2 days, for an infant it could be fatal.

GERD – an acronym for gastroesophageal reflux disease or heartburn. Also related to a loose cardiac sphincter. The strong acid from the stomach leaks up into the esophagus and throat causing pain from the acid actually eating away to the tissue. The stomach is protected by a tough mucus coating, but no other parts of the digestive tract have this protective cover. Anytime the acid from the stomach leaks out, it can cause injury and pain to the tissue it touches.

Red blood – if you spot blood in your baby’s poop it can mean the intestines are inflamed somewhere, a small crack in the skin around the anus or an allergy to something they ate. If your baby has 1-2 bloody poops, mention it to the doctor at your next appointment. If your baby is having 1-2 bloody poops an hour, acting tired and painful, page your doctor for advice.

Black poop – black or tar-like poop is a sign of digested blood. If your nipples are bleeding or you notice pink milk or “strawberry milk” when you pump, you might notice darker poop. Supplementing your baby with extra iron can also cause darker poop. If you have ruled out the common causes and you notice consistent dark poop, talk to your baby’s doctor.

Green frothy poop – the usual cause is too much foremilk. If your baby falls asleep at the breast before emptying it or fills up before getting to the hind milk later in the feed – try to keep your baby on one breast until it’s is empty, then switch to the second breast. Green poop can also be a sign of iron supplementation so consider this as well.

If you ever have any questions or concerns, collect a sample to bring to the doctor’s office. Your baby’s poop may not be your favorite surprise (especially an outfit wrecking blowout!) but it provides a valuable look into the workings of their little body.

Health Risks of Motherhood Are Higher for African Americans

2018-04-22T04:23:04+00:00April 22nd, 2018|Categories: Fertility Blog|Tags: , , , , , |

As healthcare providers we strive to provide the same care to all of our patients and see good health outcomes across the lifespan, income level and educational status. Mostly, we have been successful – more mothers are insured, home visiting programs have shown promising results and more infants getting their vaccines on time. But as many health disparities are shrinking, one is growing. African American mothers in the U.S. die at three to four times the rate of white mothers, one of the widest of all racial disparities in women’s health. Compared to a white woman, an African American woman is 22 percent more likely to die from heart disease, 71 percent more likely to die from cervical cancer, but 243 percent more likely to die from pregnancy- or childbirth-related causes.

In a national study of five medical complications that are common causes of maternal death and injury, African American mothers were two to three times more likely to die than white women who had the same condition. African American mothers are 49 percent more likely than whites to deliver prematurely (and, closely related, their infants are twice as likely as white babies to die before their first birthday). And the number of complications is rising.
The high maternal mortality rate of African-Americans is the main reason the U.S. maternal mortality rate is so much higher than that of other developed countries. African American pregnant and new mothers in the U.S. die at about the same rate as women in countries such as Mexico and Uzbekistan, according to the World Health Organization.

Experts do not know why African American mothers and babies are dying more than others. In the past, the researchers have assumed poverty, lack of education or low access to quality health care as some of the culprits. But educated African American mothers also have poor outcomes too. One study done in NYC showed college educated African American mothers had worse outcomes than white mothers that had never graduated from high school. According to the CDC affluent and educated black women are more likely to lose their newborn than uneducated white women who’ve had little or no prenatal care. African American women suffer the highest infant and maternal-mortality rates of any race, according to the CDC.

As public health experts try to pinpoint the reason for the disturbing difference in health outcomes, some researchers are taking a new look at racism and the stress it causes across the lifespan. Arline Geronimus, a professor at the University of Michigan – School of Public Health, coined the term “weathering” for stress-induced wear and tear on the body. Weathering “causes a lot of different health vulnerabilities and increases susceptibility to infection,” she said, “but also early onset of chronic diseases, in particular, hypertension and diabetes” — conditions that disproportionately affect African American mothers. Her research even suggests weathering accelerates aging at the molecular level; in a 2010 study Geronimus and colleagues conducted, the telomeres (chromosomal markers of aging) of African American women in their 40s and 50s appeared 7 1/2 years older on average than those of whites.

Weathering may play a part in pregnancy complications too. Pregnancy is the most physiologically complex and emotionally vulnerable time in a woman’s life. As we get older, our risk for complications goes up. The data shows the rate of complications increases for white women in their 40s and for African American women in their 30s. This means that many high risk pregnancies are not monitored as closely as they should be, and more pregnancy complications go undiagnosed in African American mothers.

The risks to mother’s health do not disappear with delivery, according to the most recent CDC data, more than half of maternal deaths occur in the postpartum period, and one-third happen seven or more days after delivery. For mothers with hypertensive disorders, diabetes and peripartum cardiomyopathy the postpartum period should be closely monitored. African American mothers have 25% higher rates of C-section than white mothers and are more than twice as likely to be readmitted to the hospital in the month following the surgery. They are also twice as likely as white women to have postpartum depression, which contributes to poor outcomes, but they are much less likely to receive mental health treatment for the condition. For all of these reasons, new African American mothers need careful monitoring as they recover from childbirth, establish breastfeeding and adjust to motherhood.

Poverty, access to care, culture, communication and decision-making all contribute to health outcomes for mothers and their infants. As researchers continue to discover more about the differences in health outcomes for mothers from all backgrounds, watch for more recommendations to best help our patients.

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