Posts Tagged ‘C Sections’
Maternity Leave: How Much Time Off is Healthiest for Mothers and Babies?
December 27th, 2011 | 
Author: Is 40 Weeks the Ideal Maternity Leave Length?
Long leaves are good for both babies and mothers, but extra-long leaves may not be, and other surprising lessons from Europe.
By Sharon Lerner|Posted Thursday, Dec. 22, 2011, at 7:08 AM ET
How long do working mothers stay home after having their first child? If you guessed the answer might be 12 weeks (not an unreasonable assumption, since that’s the amount of time allotted by our national family leave law), you’d be sadly mistaken. According to recently released census numbers, a majority of mothers who worked during pregnancy go back before that, some way before. More than a quarter are at work within two months of giving birth and one in 10—more than half a million women each year—go back to their jobs in four weeks or less.
Let’s take a moment to think about what’s going on just four weeks after birth. Babies haven’t even cracked their first real smiles yet. Mothers are still physically recovering from birth, particularly if they’ve had C-sections. They’re both probably getting up several times during the night to nurse. In fact, they’ve barely begun what’s supposed to be half a year of exclusive breast-feeding, according to the American Academy of Pediatrics.
Yet going back to work in such a short amount of time isn’t just tiring or unpleasant, new research demonstrates that it’s bad for both women and children. We now have enough evidence to blame the short amounts of time mothers have with newborns for developmental delays, sickness, and even death. (I say mothers because, while most leave laws apply to men and women, women are far more likely than men to take time off and, thus, are the subjects of most research.)
So leaving aside for a moment the backward politics in the United States that leave us without any paid time off, what does this growing body of knowledge tell us about how much time would actually be optimal? Some of the results are surprising. For one thing, there is some evidence that very long leaves have an economic and professional downside for women, and at best a neutral effect on children. So it’s not simply that more time off is better. Rather, certain amounts of leave may give the biggest bang, while longer periods of leave may yield diminishing returns, at best.
By looking to Europe, which has meticulous data collection practices and a history of paid leave stretching back to the 19th century, researchers have been getting a better and better handle on the extent to which varying amounts of paid leave can save kids’ lives. Two studies, one published in the Economic Journal in 2005 and another five years earlier, examined the results of the steady climb in paid leave in 16 European countries, starting in 1969. By charting death rates against those historical changes, while controlling for health care spending, health insurance, and wealth, the authors were able to attribute a 20 percent dip in infant deaths to a 10-week extension in paid leave. The biggest drop was in deaths of babies between 2 and 12 months, but deaths between 1 and 5 years also went down as paid leave went up. So what was the optimal amount of time off, according to all this research? According to Christopher Ruhm, the author of the first European study, paid leave of about 40 weeks saved the most lives. (After that point, according to Ruhm, “there may even be some partial reversal of those gains.”)
Here in the United States, the few paid leave programs we have may be too small to make much of a difference, as the authors of a study published this month suggested after being unable to find any impact of state leave policies on children’s health. Efforts to study paid leave in this country are further complicated by the fact that those American parents who do get paid time off often tend to be lucky in other ways, too. That recent census report shows that only 18 percent of mothers with less than a high school education got paid time off compared with 66 percent of women with at least a bachelor’s degree. This makes it hard to know whether differences between American families in which a parent was able to stay home and families in which the mother went right back to work might instead be attributable to poverty, education, or other factors.
Turning our eyes back to Europe, there is evidence that leave—even when it’s shorter than that apparently ideal 40-week span identified by Ruhm—has not just health effects but measurable developmental and behavioral benefits, too. One study tracked Norwegian children who were born after 1977, when that country increased its paid leave from zero to four months and its unpaid leave from three to 12 months, and found that the kids born after the change had lower high school dropout rates. Military draft data, moreover, tied lengthened leaves to increases in male IQ (and height, too).
It’s not entirely clear why having parents around would help babies grow taller or smarter, or live long longer, but the research points to a few potential advantages to kids whose mothers stay home for at least three months. In another study published in the Economic Journal in 2005, American babies whose mothers were back at work within 12 weeks were less likely to get doctors’ visits and immunizations and be breast-fed. All this makes intuitive sense, of course: Checkups can help diagnose and treat illnesses, but they are hard to schedule when you’re working. And while exclusive breast-feeding for at least six months has been shown to prevent respiratory infections, bacterial meningitis, and other illnesses, going back to work can make it difficult if not impossible.
In the developmental realm, the benefits of leave may be trickier to explain. That 2005 Economic Journal study of American women who returned to work within 12 weeks showed that infants whose mothers went back even earlier were likely to have more behavioral problems and lower cognitive test scores at age 4. The authors speculated that the difference might have stemmed from the superior care babies receive from parents, as opposed to other caregivers. It might also have something to do with attunement, the crucial developmental process through which parent and newborn adjust to each other.
But what about those parents—most of whom are mothers? What do we know about what the ideal length of leave time might be for them? In terms of American mothers’ mental health, the best answer for now may be simply: more. Numerous studies have tied the lack of time off to depression in working mothers. Conversely, a 2004 study found that an increase of just one week of time off decreased the number and frequency of symptoms of depression in American mothers.
It’s easy to understand why an American woman going back to work just four, eight, or even 12 weeks after birth might get depressed—especially if she looks to Europe, where at least six months of paid leave is the norm and several countries grant more than three years.
Maybe we American women can cheer ourselves with the several recent studies that have failed to find benefits of such very long leaves. It turns out that the increase from 12 to 15 months of paid leave—which Sweden made back in 1988—doesn’t have a dramatic effect on kids. There is even some evidence that laws granting more than a year and a half off paid can hinder women’s professional achievement. It may be cold comfort, but at least this is one problem that we American mothers, facing the prospect of caring for new babies while somehow holding onto our jobs, just don’t have.
Posted in Birth, Breastfeeding, Main Content, Postpartum | 
Tags: Academy Of Pediatrics, American Academy Of Pediatrics, Amount Of Time, Babies And Mothers, Birth Babies, Body Of Knowledge, Breast Feeding, C Sections, Census Numbers, Developmental Delays, Family Leave Law, Giving Birth, Half A Million, Maternity Leave, Newborns, Sharon Lerner, Smiles, Time Mothers, Women Women, Working Mothers | 
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A Surprising Downside to Epidurals
Epidural anesthesia remains the most popular form of pain relief in labor. Nurses, physicians, and many midwives like epidurals because the mother is comfortable and quiet, resulting in less work for hospital staff.
Laboring women like epidurals because they can remain awake and alert, while feeling little or no pain during labor.
Many negative aspects of epidurals have been debated among researchers. Downsides to epidurals reportedly include delay in labor, increase in vacuum/forceps deliveries, and increase in c-sections. But aren’t these possible side effects outweighed by the positive effect of a pain-free labor?
In one research study, investigators found that women who had pain eliminated during labor still reported that they suffered! Concluding that no pain did not necessarily mean no suffering, Wuitchik¹ emphasized the need for women with epidural anesthesia to have continual labor support available. In this study, women described distress over itching, numbness, and nausea–all side effects of epidural anesthetic. The women also reported concern over the baby’s well-being. A common effect of epidurals is a prolonged drop in the baby’s heart rate. While hospital staff may take this in stride, it can be very frightening to the laboring woman. Another interesting finding was that women reported feelings of incompetence and fear over being left alone once they were “comfortable”. Wuitchik concluded, “With epidurals, pain levels were reduced or eliminated. Despite having virtually no pain, these women also engaged in increased distress-related thought during active labor. The balance of coping and distress-related thought for women with epidurals was virtually identical to that of women with no analgesia”.
Women who had epidurals expressed just as much need for continued support as women who had unmedicated births, concludes another research study.² In fact, satisfaction with the support received during labor had more influence on the woman’s satisfaction with her birth experience than her level of pain relief did, according to Mother-Friendly Childbirth — Highlights of the Evidence.
If you are planning an epidural, or even if you are not planning an epidural but plan a hospital birth — do yourself a favor and hire a doula for continuous labor support. It can make a huge difference in your satisfaction with your experience. I think the fact that continuous support influenced birth satisfaction more than pain relief explains why many studies conclude that women who had unmedicated births (most often these are women who have doulas and/or midwives during labor) were happier with their experiences than those with medicated births. It’s not the medication or the absence of medication that made the difference, but the presence of someone there to give continual support. A partner may give excellent support, but partners need support, too! Partners get tired, need to eat, go to the bathroom, get discouraged, just like laboring moms do. A doula is there for both of you, and a good doula will give you your space when you need it, time for just the two of you when you need it, yet be there with just the support you need at the right moment when it is needed.
1. Wuitchik M, et al. (1990) Relationships between pain, cognitive activity, and epidural analgesia in labor. Pain 41:136-142.
2. Lally JE, et al. (2008) More in hope than expectation: A systematic review of women’s expectations and experience of pain relief in labour. http://www.biomedcentral.com/1741-7015/6/7/abstract
Posted in Birth, Main Content |
Tags: Anesthetic, Birth Issues, C Sections, Deliveries, Downside, Epidural Anesthesia, Epidurals, Feelings, Heart Rate, Hospital Staff, Incompetence, Labor Nurses, Midwives, Nausea, Negative Aspects, Numbness, Pain Relief, Study Investigators, Study Women, Vacuum |
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Protect your newborn from sickness:
Newborn immune systems are undeveloped and need antibodies from their mother’s milk to stay healthy. Studies have shown that artificially fed babies are up to 15 times more likely to be hospitalized in their first year. Breastfed babies receive a whole arsenal of immune components while formula fed babies receive none. So how to do make sure that you will be able to breastfeed? We commonly hear from mothers share that “I didn’t have enough milk” or “My baby liked the bottle better”, etc. Lacation experts say the one reason women have troubles breastfeeding is lack of support and education. Follow these steps to make sure you reach your breastfeeding goals:
- Get good information: Go to a breastfeeding class and bring your partner, family members and other care givers. It’s important they learn the basics so they can help you and won’t unintentionally sabotage your efforts. Read a breastfeeding book like “Breastfeeding Made Simple” or “The Womanly Art of Breastfeeding”. Check out www.breastfeeding.com for great articles and advice.
- Connect with nursing moms: Spend time and befriend women who successfully breastfed. Don’t take advice from people who didn’t. (I know it sounds obvious, but I made that mistake!) Look for a mother to mother support group or La Leche League meeting. Make these connections before you have your baby.
- Choose your birth location carefully: Deliver at a “Baby Friendly” hospital, birthing center or at home. Ask the hospital if they have lactation consultants to help you. Some staff nurses don’t have much lactation training and/or have never breastfed themselves. We were told by a mom recently that when she asked for help at an Anchorage hospital they gave her a bottle instead. Not good. And don’t keep any formula samples you get in the mail or from the hospital. It’s too tempting to have it in the house.
- Plan a drug free, normal birth: IVs, epidurals, c-sections and narcotic drugs in labor all make breastfeeding harder. The more drugs, fluids and painful incisions you have, the harder it will be for the baby to latch on and the longer it will take for you to produce milk. Choose midwife or obstetrician that supports natural birth. Learn about and practice mental and spiritual techniques like non-focused awareness, prayer, hypnobirthing, and visualization. Take a childbirth education class that focuses on natural birth. Find out if you will have access to a birthing tub, shower, birthing ball, food during labor, etc. Hire a doula. If you do need pain medications, ask for the lowest dosage.
- If you have concerns, get professional lactation support immediately: WIC offers free breastfeeding support for their clients. Some pediatric offices have lactation consultants on staff . You can call the hospital where you delivered and get phone help. Most home birth and birthing center midwives will visit you in your home. ANMC has a program where they will come to your house and help you as well. LLL leaders and members are another great resource. Don’t wait to get help if things aren’t going well. Pick up the phone instead of a bottle.
- Pediatrician or nurse practitioner: Find a provider that not only supports breastfeeding but that can give you specific help and advice. Some medical schools offer ZERO lactation education. Other pediatricians have done extensive training and have breastfed their own children. Ask about their training, experience and philosophy. Consider using a nurse practicioner or naturopathic physician.
- Plan for pumping at work: Delay returning to work as long as possible. Try to arrange for job sharing, part-time, work from home or creative scheduling. Nurse your baby at night to make up for lost nursing and cuddle time. Make sure to find a place to pump before you take maternity leave. We know women who have left their jobs to go to others that were more breastfeeding friendly.
Going back to work and maintaining milk supply is a major challenge for women. Remember that even a little breastmilk is valuable and better than none at all. With enough support, you can do it!
Posted in Uncategorized |
Tags: Antibodies, Babies, Baby Babies, Baby Friendly Hospital, Birth Location, Breast Milk, Breastfeeding Book, Breastfeeding Class, Breastfeeding Goals, Breastfeeding Mother, C Sections, Care Givers, Cdc, Custom Antibodies, Eating Healthy Foods, Epidurals, Formula Manufacturers, Formula Samples, H1n1, Human Milk, Immune Boosters, Immune Systems, La Leche League, Lactation Consultants, Living A Healthy Lifestyle, Location Care, Mail, Many Mothers, Milk Breast, Mother Support Group, Mother To Mother, Mothers Share, Narcotic Drugs, New Baby, Newborn Babies, Newborns, Normal Birth, Partner Family Members, Pregnant Women, Reason Women, Respiratory Infections, Staff Nurses, Vaccination, Vitamin D, Womanly Art |
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