Sara Lomax-Reese: You're listening to Health Quest Live on 900am WURD on air, online and in the community. Right now we are joined in studio by the Einstein docs. We have Dr. Donee Patterson, who we are going to claim as our own Dr. Donee Patterson. She is a family medicine physician at Einstein Healthcare Network and this week we are joined by Dr. Cindy DeLago and she is the Director of Outpatient Pediatric Clinic at Einstein Hospital. Today we are going to be talking about prenatal care and its short term and long term affects on pediatric and maternal health and well being. As I was doing some of the research for this segment,I was really shocked at the wide range of longer term issues that can stay with a child who is born premature and why don't we start right at the beginning. What exactly is premature and I will ask you that Dr. DeLago.
Cindy DeLago, MD: Premature birth is when a baby is born before basically the little body is ready to be born and we have something called late preterm birth which are babies that are born 35, 36 weeks premature versus the early preterm births, which are the babies that are born even earlier, sometimes a month and a half, two months before they are ready to be born. These babies are just not well equipped to deal with life outside of the mother's womb and so can develop many complicates.
Lomax-Reese: The things like the development of their lungs, their heart, body heat that they can get extremely cold; then there is mental or brain issues. It is just like a wide range. Dr. Donee,this is a really important issue, particularly for the African American community because there is a big problem in terms of full term birth and premature and infant mortality and those kinds of things in the African American community, so why don't you give us a little background?
Donee Patterson, MD: Almost four million Americans give birth every year, but we want our children to have the best, healthiest start to life. We need you to understand, if you don't understand anything else about this segment, is that there are things that you can do to prepare before you're even thinking about getting pregnant. There are things you can do during your pregnancy to make sure that your baby is as healthy as they possibly can be. There are things that you can do afterwards and we need people to think about it that way and not just to find out that they are pregnant or just not do anything during their pregnancy, because these things can vitally change a child's life. I want Dr. DeLago and I to talk about why this is so important to Philadelphia. Dr. DeLago and I,when we were talking, we were talking about infant mortality rate. What that means is deaths per 1000 live births. In Philadelphia, the infant mortality rate is 11.4, which the infant mortality rate for PA is 7, so Philadelphia leads our state in infant mortality deaths. In African Americans, the infant mortality rate is 16 in Philadelphia. 16, whereas our Caucasian counterparts, their infant mortality rate is about 10. It is pretty high in Philadelphia and there are things that we can do. Some of these things are very preventable;not everything; but many of these things are very preventable.
Lomax-Reese: Let's talk about that because one, why is there this huge disparity? Is it a lack of access, a lack of insurance, is it obesity, is it diet, is it chronic disease? I know that African Americans in particular disproportionally affected by a host of chronic disease, obesity, and all of these things, but if you could, Dr. DeLago, identify for us why there is this major disparity specifically around infant mortality.
DeLago: All of those things; all the things you say, the answer is yes. Stress definitely adds to infant mortality; we know that people who are living in stressful situations where they have to worry about housing everyday or where there next meal is going to come from, that definitely adds to infant mortality. We also know that people who aren't planning to have a baby, who have unplanned pregnancies, if you are not ready to have a baby, that's a shock to find out and then most people's natural instinct when they don't want to accept something is to ignore it. They may not go to the doctor; they may not get prenatal care and getting prenatal care is vital, vital, because prenatal care can help a woman identify issues that may cause them to have preterm birth;something as simple as having a urinary tract infection can set a woman into preterm labor. Having high blood pressure, some people are walking around with undiagnosed high blood pressure that can be identified early on in the pregnancy and can be managed so that the baby can grow and thrive. Women who smoke a lot of cigarettes, we know that can cause babies to have low birth weight. There are a lot of things that can be identified early on if women would just seek prenatal care, even if they think they might terminate, which some women might, just start taking those prenatal vitamins because we know that folic acid, if you take folic acid early on, even before you conceive, that can prevent neural tube defects which are things like spinal bifida. So there is a lot that women can do if they would just plan their healthcare during and even before they get pregnant.
Patterson: We also wanted to emphasize that this is not just an issue for women. It sounds like it is, but it's not. We want the men to know to help prevent unintended pregnancy. They have apart in that too, so to help prevent these unwanted pregnancies and to encourage the women in your life, whether it is a niece or a sister or your significant other to take prenatal vitamins, take them to their doctors' visits, make sure they are following up regularly with their doctor. Make sure they are eating healthy; we want the men to take care of the women in their lives and we think that will have an impact.
Lomax-Reese: That is Dr. Donee Patterson and she is a family medicine physician at Einstein Healthcare Network and we are also talking with Dr.Cindy DeLago, who is the Director of the Outpatient Pediatric Clinic at Einstein. We are talking about prenatal care, we are talking about the long term and short term affects of early or premature birth and one of the things, there are several things that I saw that were really interesting, that there is an increased risk of autism related to premature birth and I don't know if that's something that is proved or if that is something that is more theoretical. Dr. DeLago?
DeLago: Well, anytime you have a baby born too early, there are a lot of things that can happen to their bodies and one of the things that can happen is they can get small bleeds in their brain. We know now that young children who are exposed to a lot of what we call toxic stress, which isn't just a little bit of stress, this is day to day, being exposed to things in the household that is upsetting and when you think about what a premature baby has to go through when they are in the NICU, they are attached to monitors,there are beeps and sounds that are going on all the time; they are getting stuck for blood. Imagine the stress these preterm babies have and we know that does affect, toxic stress does affect the development of the early brain architecture. I don't think you can say that absolutely that preterm birth causes autism,but I think that it definitely does have an affect on the early developing brain.
Q: Let's talk a little bit about breastfeeding because I just spent the last nine years on the Maternity Care Coalition's board, I just rotated off yesterday after nine years and they have been such advocates for breastfeeding and breastfeeding friendly businesses and they actually have an award for breastfeeding friendly businesses and I think a lot of times we really underestimate how critical breastfeeding is for the developing child, so one of you guys, take it away.
Patterson: Besides the fact that breastfeeding is free and formula is very expensive, so breastfeeding is free. It has been shown to increase the bonding with the mother and the child and there is this very large national study by the Environmental Services and they say that breastfed babies are 20% more likely to live, to not die, day 28 to one year old. So it's been proven to increase life, because the baby gets some of the mother's immune system and that is important for the baby to be able to fight infection in those very,very young days, in those early stages. It decreases the risk of SIDS, viruses, upper respiratory tract infections; there have been some studies to show that it has some affect on increased intelligence, and some studies to show that there is a decreased risk of obesity in teenage and adult years. It has major benefits; there are benefits to mom as well; decreased risk of postpartum depression and also, in addition to the bonding and everything, the longer you breastfeed it has been associated with decrease risk of ovarian cancer.
Q: Interesting; I'm glad you didn't say it helps you lose weight because I never experienced that. That's a myth. But anyway, Dr. DeLago do you want to add anything to that?
DeLago: Absolutely. One of the things we see all the time talking to brand new mothers is we ask on a post-partum floors, how are you going to feed your baby and oftentimes we get either I don't know or I'm going to do both. Both bottle and breastfeeding just doesn't work. I would implore women who are pregnant to learn about breastfeeding; to learn all the ins and outs of it because it really is a womanly art. There is a lot of things that go on with a baby and a mom right after birth that if you don't start right away with breastfeeding or if you offer the bottle in addition to the breast, it sort of sabotages your success to be able to breastfeed long term. Let me give you an example. When a baby breastfeeds, every time the baby suckles it stimulates the mother to produce the amount of milk the baby needs. At the end of the first week of life, the baby goes through a growth spurt so what do they do? About two days before they go through this growth spurt they start to suck a lot,they want to breastfeed every hour and a lot of moms who don't understand what is happening, they think they are not producing enough milk. They assume that it is not succeeding so what do they do, they stop breastfeeding, when what really is happening is the baby is telling the mother's body to make more milk because in two days that baby is going to start growing and the baby needs enough milk to support that baby's growth. What I am saying is if you read about breastfeeding and you start to understand the ins and outs of breastfeeding, you will be prepared when that baby is born to know what is going on with your body and what is going on with the baby's body and to not quit just because you are misinterpreting the signals the baby is giving you. I spend so much time on the postpartum floors trying to teach moms and trying to encourage them not to be discouraged and to understand what is really happening and I am hoping that down the road it helps our mothers to continue to breastfeed. Not only is it cheap, it is so convenient; you can get up and nurse and you are done in 15 minuets instead of having to prepare bottles and wash bottles and all that other stuff.
Q: But there are people who have difficulty and there is the whole guilt factor of you hear all about these benefits of breastfeeding and you just can't get it together, it just doesn't work for you,so we definitely want those women to feel like they are not shirking their responsibilities.
DeLago: Oh absolutely, but I think part of it is educate yourself. Learn about it and then give it a real try but you are absolutely right; you would never want somebody to feel bad about the decision that they made. It is a very personal decision.
Q: Absolutely. We talked about premature babies and how vulnerable they are in those first days of their lives. Can they breast feed? It seems like that is probably one of the most healing things that can happen to them in that vulnerable state but are they able to latch on; are they able to?
DeLago: It is sometimes a lot of work and some premature babies they really just barely can maintain their own body temperature let alone suck a bottle or a breast. So a lot of times these babies have to be tube fed, but that's ok, a woman can pump and produce the breast milk and we know that premature babies that are feed breast milk are less likely to develop something called necrotizing enterocolitis which is a bad problem with their gut where they actually have to often times get surgery and be on antibiotics and they can lose part of their gut. We know that babies that are fed breast milk versus formula are less likely to have that problem, so there are definitely benefits even in a preterm baby.
Q: We only have a few minutes left; let's talk about those children that are born premature and their long term health prognosis. It'snot all bad news because I know children who were born premature who seem to be pretty good; they seem to be fine. What are some of the things that parents can do if they do have a premature child to make sure they get the best opportunity, the best shot?
DeLago: I love to talk about this.
Patterson: They absolutely have to follow up with their primary care doctor and use the resources around. If they bring them in and continue to do the follow up that we recommend there are so many things, so many interventions that can be done.
DeLago: Parents can even help their baby while the baby is in the NICU. I can't emphasize this enough, they can ask a lot of questions, they can encourage the NICU staff to teach them how to hold and handle the baby because a lot of times when a baby is born, especially very early, a lot of parents in the beginning are afraid to bond because they are afraid the baby may die. We know that happens, but after a while when it looks like the baby is going to live, by that time you have this whole army of people who are taking care of the baby in the NICU and the parents sort of take a back seat and they let the medical staff handle and take care of the baby and then, oh my God, low and behold, tomorrow the baby is going home and I don't know what to do; I never held this baby. Encourage the physicians and the nurses to let you holdthe baby; to let you bond with the baby. They are more than happy,it's jut that we all have our jobs to do and sometimes we don't understand where the parent is in terms of bonding part.
Q: Or if the parent feels like they are ready but if you ask questions. For the grandmothers out there and the men out there, encourage yourself or encourage your significant other to participate in the care so you can learn.
Patterson: I just want to make sure we get this in. I need people to know that prenatal care is more than taking a vitamin. It is before, during and after pregnancy, that is prenatal care, so before hand, good diet, no smoking, no second hand smoke, don't be around smokers, exercise, be well-hydrated, take your vitamins and learn about breastfeeding. Also, decide who your pediatrician is going to be, you decide that beforehand, before you ever deliver, you want to know that ahead of time and maybe even interview that pediatrician or at least visit the office. During, you want to make sure you are going to all your regular visits; your doctor will tell you how often you should go. Avoid chemical toxins; let your doctor know about any medicines or any herbal things and if possible, learn more about breastfeeding and get the family support around you. Afterwards, be aware of postpartum depression. It is very common. Get regular check ups, watch for developmental delays, breastfeed and interact with your child. There are so many things that we can do to help our children be healthier.
Q: Absolutely. Dr. DeLago, do you want to add anything before we close up?
DeLago: I think Donee pretty much summed it up very nicely. I think the more that we participate in the care of our children and rival in our children's successes I think that is so important that we celebrate this new life.
Q: Donee, do you want to give the website or Facebook?
Patterson: You can go to Einstein's Facebook page and post comments there; you can also reach us at 1-800-EINSTEIN, or you can look on the web at Einstein.edu. You can also follow me on Twitter@DrDonee….