Archive for the 'children' Category

Caring for Mothers and Babies

Sunday, October 22nd, 2017

I’m retired now, but one of the parts of my profession that I liked the most was delivering a healthy baby, giving the baby to the mother and then watching the new mom hold and love the new life. I miss that, although I must say that I like to sleep all night without having to wake up for a delivery!

This picture is not recent, but I like it because the people are special to me. The new mom was born breech in the middle of a very foggy night in January; the baby was born exactly 18 years later–on the mother’s birthday! I am still in touch with mother and son, and both are doing well.

It has been a privilege to be with people at the special time of birth. I am concerned, however, that the babies that I have helped birth will know a world that is very different from the world I have enjoyed. My goal is to do my best to help them and all people to be happy and healthy–the same goal as I had for the 40+ years that I practiced medicine.

Richard

Keep Children Healthy

Saturday, September 23rd, 2017

I am writing this column in Northern Ghana, where 1 in 16 children dies before 5 years of age. Although that number is high when compared to developed countries, there has been amazing progress since 1960 when one in 5 died.

The under-five mortality rate is a valuable statistic because it gives an overall idea about the state of health and healthcare in a country. It reflects the social, economic and environmental conditions in which children live. It is defined as the number of children who die before their 5th birthday per 1000 live births, and is also called the child mortality rate.

The UN set 8 Millennium Development Goals, one of which was to: “Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate.” In Ghana during that period the rate went from 127 to 62 deaths per 1000 births. This halving reflects global progress; worldwide child mortality dropped from 90 to 45 in this period. Although we didn’t hit the goal, cutting the death rate in half is still an amazing accomplishment. Sadly, worldwide almost 6 million young children still die each year.

There is hope, however. Ghana recently trained several thousand Community Health Workers (CHWs). These “barefoot doctors” live close to the people they serve and treat illnesses as well as advocating prevention.

I traveled with a midwifery training-team to a village clinic. This part of the country has more than its share of maternal and infant deaths. Two midwives from the Baptist Medical Centre did an excellent job of teaching the clinic’s staff, which included 2 midwives and 3 midwifery students. Two rooms away another student midwife performed a delivery so quietly that I was amazed when a nurse brought out the healthy baby who was just minutes old.

While in the health center I saw a bottle of high-potency vitamin A capsules and was reminded of a remarkable study performed in this region. The overall death rate of children was lowered by 20% if they were given vitamin A supplementation. It appears the vitamin helps children fight infections such as measles and diarrhea, even where vitamin A deficiency is not prevalent.

If we are concerned about overpopulation, why should the death of children trouble us? Of course there are humanitarian reasons to keep children alive and healthy—they are our future! Demographers have found that people choose to have large families where there is a high child mortality rate.

It may appear paradoxical that preventing deaths will help eventually to slow population growth, but it is true. One of the best-known demographers of Africa, John Caldwell, cited three requirements before people will choose to have smaller families: educating girls and women, making effective contraception available and reducing the under-five mortality. He said that people only consider having a small family when child mortality is less than 130 per 1000. I could understand that number better when I converted it to a percentage—13%. That means that one in seven children dies—the thought is distressing!

In addition to training midwives, Ghana has instituted other ways to have healthier children. As I walk to the hospital I pass a nutrition center where small children are fed healthy, local food. Young kids with kwashiorkor (protein deficiency) and marasmus (severe malnutrition) are referred from the hospital, from outlying clinics and by CHWs. They spend 2 weeks or longer there being fed; many are still breast feeding. Every child is accompanied by a parent who is taught many ways to promote health, including nutrition and good hygiene.

Three days ago a young pregnant woman came to the hospital complaining of headache. Her blood pressure was elevated and the doctor noticed that she kept bumping into things, as though she couldn’t see well. Her mother gave the history that the patient had had an episode of shaking—a seizure. The doctor diagnosed eclampsia, the worst form of Pregnancy Induced Hypertension (PIH), with cortical blindness—a type of stroke. It was necessary to induce labor to save the mother’s life and hopefully her vision will improve. Unfortunately the very premature baby didn’t survive.

I am in Ghana studying PIH because it is more common here than in the USA. PIH can endanger the mother’s health and life, and has no treatment other than delivery of the baby. It is one of the most common causes of loss of life for babies and mothers, yet is poorly understood. Perhaps my study will shed light on this cause of obstetrical tragedies.

© Richard Grossman MD, 2017

Ask Young Women One Key Question

Sunday, July 23rd, 2017

What can health-care providers, friends and parents do to help young women focus on their reproductive goals? Ask “one key question,” which is: “Would you like to become pregnant in the next year?”

Obviously this takes a special relationship with the women. That relationship is assumed with a doctor or other health-care provider, but may not be practical with some other relationships. However, if you do have such a relationship with a young woman, asking this question may help her clarify her goals.

One advantage of this question is that it is nonjudgmental. Furthermore, it doesn’t ask about the distant future, but only asks about the next 12 months. These are both reasons that it is a well-accepted way of opening an important conversation.

How have women responded? Apparently many women already have a pregnancy plan and know what their reproductive goals are for the next year. If the woman wishes to conceive, the discussion can then go toward having a healthy baby. Among other actions, she should start on prenatal vitamins, eat a healthy diet and avoid tobacco, alcohol and drugs.

If the woman responds that she does not want to become pregnant in the next year, or if she is unsure, there is a follow-up question: “Are you currently using a contraceptive method that you are satisfied with?” When the reply is, yes, she is happy with her birth control method, she is reminded about emergency contraception (EC). However, if a woman answers that she is not pleased with her contraceptive method, or is not using any birth control, this is a perfect time for contraceptive counseling—including a reminder about EC.

EC pills such as Plan B are now available without prescription and are safe, although not 100% effective. They are good up to 3 days after unprotected sex, and work best if taken within 12 hours of exposure. There is a relatively new EC pill, ella® (ulipristal); it has the advantage of being more effective (especially for heavy women), and works up to 5 days after sex. Neither of these will cause an abortion if a pregnancy is already established.

Most effective is an IUD which contains copper, such as the Paragard®. It works as EC for up to 5 days after sex—and can provide protection against pregnancy for as long as a decade.

Now you can now purchase Plan B and Ella® on the Internet! Go to www.prjktruby.com and you will find both of these are available (they sell a generic equivalent of Plan B). In addition, women can get “the pill” through this same website. The world of reproductive health is changing!

The yearly Pap smear is a thing of the past. Now women can go several years without seeing a provider for reproductive health care, if ever. Although this saves the embarrassment of a pelvic exam and saves money, it also means that women may not have the opportunity to update their knowledge about contraception. In addition, birth control pills are available without a provider visit, including at Planned Parenthood, through www.prjktruby.com and in some states.

Both Oregon and California have passed laws that allow women to purchase oral contraceptives (if they are in good health) just by speaking with a pharmacist. Do you remember when ibuprofen was only available with a prescription? Fortunately there is a way to petition to make a prescription medication available “over the counter”. This is what happened to Plan B as well as ibuprofen. Oral contraceptives are so safe that there is pressure on the FDA to make them available without prescription in all 50 states.

As the barriers to family planning are overcome it is important to be certain that women are aware of the method that is best for them. This is why the “one key question” is important. In Oregon, where this campaign got started, it is recommended that all family practice doctors and other practitioners who care for women of reproductive ages routinely inquire if they plan to conceive in the next year.

The birth rate in the USA is dropping, but still almost half of the pregnancies conceived are unplanned. This one key question could help to decrease the numbers of unintended pregnancies, and of abortions.

Recently a reader was kind enough to suggest that I write about “one key question”, and I am happy to follow up on the suggestion. I welcome feedback from readers, whether you like what I have written or hate it. My email address is: richard@population-matters.org; please remember the hyphen!

             © Richard Grossman MD, 2017

Creative Commons Attribution 3.0 United States
This work is licensed under a Creative Commons Attribution 3.0 United States.