Wanna go to New York City, all expenses paid for you and a lucky someone with a $1000 in spending money in your pocket?  Wanna have a free teeth whitening and day of pampering all topped off with a professional photo shoot? It could all be yours-for a smile!

The nice folks over at WhatToExpect.com have teamed up with TopDentists.com in the Who Makes You Smile Sweepstakes to offer this promotional giveaway.  It’s easy. Simply tell the good people over at TopDentists who makes you smile. Is it your kiddos? Is it your sweet significant other? Is it your puppy? Send them a photo of who makes you smile and a short (140 character blurb, i.e a “Tweet”) about who makes you smile and be entered to win the trip to New York City. Then get on all your social media sites and get people to vote for your entry on TopDentist.com.

The top 5 entries will be eligible to win the Grand Prize to New York City.  The top three voted entries within 100 miles of Beverly Hills, CA; Troy, MI; Austin, TX; Philadelphia, PA; and Aventura, FL will also be judged for prizes in their regions (Teeth Whitening sessions). Even if you don’t win the grand prize, there are daily drawings and give aways throughout the sweepstakes.

The contest is going on now and will conclude on February 24, 2012. Only one entry per person and you must be 18 years old and a US resident (the 50 states and DC!!). Photos must be your own, not professional photos. Full rules and details are available here.

This is an opportunity to win a free trip, free teeth whitening or other promotional gifts. What do I get from all of this? Zip. Nada. Nothing. But it sounded so good, I figured I’d share it with you. Besides, after being on bed rest you might want to get out and kick up your heels and what better place than New York City? What better way than with a flashy white smile? You’ve nothing to lose, so go ahead, show them your smile!!

Whether or not to vaccinate their children is a heated issue for many parents.  Many parents struggle because they don’t have adequate information with which to make their decisions.  Board certified pediatricians typically recommend that all children be vaccinated. Some naturopaths and alternative practitioners advise against vaccinating infants but may advise vaccination of older children. Some practitioners discourage parents from vaccinating their children at all, citing that vaccinations cause autism and other neurodevelopmental disorders (this citation is still controversial and we here at Mamas on Bedrest & Beyond have yet to find definitive evidence that vaccinations cause autism or any other diseases in children. If you have references, we would be happy to post them for mamas to help them make informed decisions) .  How can parents know what is best?

We here at Mamas on Bedrest & Beyond are not here to tell you how to care for your children or yourself. Whether or not to take vaccinations should be a decision based on the latest information available. So here are links to the latest recommendations from the Centers for Disease Control and Prevention. The links are divided into schedules for 0-6 years and 7-18 years.

Regardless of your opinions on vaccinations, we encourage you to at least read through the information, then speak with your health care providers, ask questions and then make your decisions.  Good Luck!!

“What would you consider essential for a mama on bed rest?”

I didn’t have to think very hard. Beyond a computer for internet access,  a tv and remote control and handy snacks, there are 4 things that I believe EVERY mama on bed rest needs. Since Valentine’s Day is right around the corner, consider giving mama one of these “Must Haves” to better her bed rest.

Help. While issues such as bleeding and preterm labor can occur emergently, the bed rest prescription often comes out of the blue and as a complete surprise to mamas. A mama arrives at the OB for what she thinks is a routine office visit, a complication is noted and then she is either sent home on bed rest or admitted to the hospital. From that point on, she is in reaction mode. She has to deal with her job, make arrangements for childcare, make arrangements for household care….Mama needs help. If you can assist mama with childcare, house keeping, shopping, or managing any of her other myriad of obligations, you will be bringing mama much needed relief.

Body Pillow. Pillow support is a must for mamas on bed rest.  At any given time I had about 6 pillows wedged around me, including a full body pillow, my “main squeeze” at the time. (Didn’t leave much room for the husband, but I was comfy!!) Body pillows have come a long way since my pregnancies but one that I like is sold by Special Addition Maternity and Nursing Store called the Snoogle (R). This large c-shaped pillow is long enough so that mama can wrap herself around the pillow and support her knees, hips, belly and neck. It is reasonably priced and can be shipped just about anywhere. Covers for Snoogles are also available. For tips on how to best position yourself while on bed rest, check out our videoblog on the subject.

Massage. Contrary to popular belief, being on bed rest is not fun nor is it restful or comfortable. Even with a body pillow for support, mamas develop various aches, pains and stiffness. Additionally, since they are not very mobile, they don’t have their usual circulation and may develop distal extremity swelling. If at all possible, I recommend that mamas on bed rest have massages at least once a month-2 times  a month or even weekly if possible (but that can be pricey, I know!!). A skilled prenatal massage therapist can not only soothe mama’s sore and achey muscles, she can stimulate circulation so that blood is flowing back up towards the heart and reduce swelling-especially in mama’s lower legs and feet. A skilled massage therapist can also massage to stimulate lymphatic drainage, again moving fluid out of the distal extremities (hands and feet) where it tends to pool.

Bedrest Fitness. Mamas on bed rest, like all mamas need to move. The problem is they are on restricted activity so most mamas have no idea what they can do. When I was facing bed rest, this was one of my major concerns, especially since I was a prenatal fitness instructor. So I produced Bedrest Fitness, a set of modified prenatal exercises for women on prescribed bed rest. To see a sample of what Bedrest Fitness is all about, click here. You can purchase a copy here.

So those are the 4 “Must Haves” for Mamas on Bedrest. Of course there are other things that will only make her bed rest situation better, but the aforementioned items are the minimum. Mamas, what are your “Must Haves” for a better bed rest? Be the first to Share your comments below and receive a gift card. We’d love to hear from you and your suggestion may be just what another mama needs.

Mamas, if you are so lead, show your support for Planned Parenthood and ALL the women’s health services they provide. If you want to support Planned Parenthood, you can make a donation towards its breast cancer screening program here.

Well no news there, yet that is what the presenter, Mr. Michael Zumpano, opened with today at a parent education seminar offered at my son’s Montessori school. “Mr. Michael” as the children call him, has a Master’s in Education and specializes in physical education and the educational needs of boys. He teaches physical education to the children at my son’s school and provides particular insight into the education of boys. I’ve seen him in action and have been impressed at how well he engages and redirects children who are on the verge of “acting out”.  And although I try to limit “scheduling” things on the weekends (as quite frankly I need a break from scheduled activities) when I saw the notice for this seminar, I was drawn to it and I’m really glad that I went.

The purpose of Mr. Michael’s presentation is to help us as a community (parents, teachers and other family members and workers) to come together to better support boys. He related how in his own life, his father died when he was 8, yet he has lots of support from family who lived close by, neighbors and other men in his community who mentored and guided him. He emphasized that today many boys are growing up without their dads in the home or in their lives and without extended family or a close knit community. The result is that graduation rates for boys are down and risk taking behavior is up. We as a society and as communities have to step in and step up for our boys to ensure that they develop as fully mature men.

So what did Mr. Michael teach me about interacting with my son (and my daughter)?

1. Male and female brains are different. Male brains are larger than female brains and are composed more of gray matter than white matter. What this means is that males are more adept at performing spatial tasks. Males can focus on one thing for quite some time, sticking with it until they master it, but have a much harder time transitioning to another task than females. Females brains are composed of more white matter. Female brains circulate more blood and have more neurologic connections between the sides of the brain. As a result, females have better verbal skills, are more relational and are able to move more easily from one task to another.
2. Testosterone and Oxytocin. Male brains are under heavy influence of testosterone while female brains are under the influence of oxytocin. Now these are generalizations as both sexes contain both hormones and we all know of men who are great multi-taskers and communicators and women who are more aggressive and confrontational. But in general, Male brains are primarily influenced by testosterone and female brains are influenced by oxytocin. So what does this mean for behavior?Testosterone is what causes boys to be more aggressive and to take risks. It’s an action taking hormone. It also makes it more difficult for them to take in a lot of information. When trying to get your son (or husband) to do something, give them “just the facts”, visual cues/pictures and direct tasks. Don’t infer and don’t assume they’ll “get it” because you allude to something. If you didn’t clearly say it, they may not have received your message.

   Oxytocin is a nurturing hormone. The dominant influence in the female brain girls respond to verbal cues, direct eye contact and empathy.

3. Nurturing: Empathy vs. Aggression. As mamas, our natural instinct is to “nurture” our babies. But as our little boys grow, we may need to nurture them less and handle them with a “firmer” hand. This is not to say that you should beat your boys. But because of how their brains are designed, they are going to respond better to lower/deeper pitched (voice) tones and a strong touch. So if your son is playing a video game and its time for dinner, you are going to have to approach him (and if he is calm) look him in the eye, lower the pitch of your voice, speak firmly, perhaps with your hand on his, and say, “its time to stop and get ready for dinner.” Mr. Michael also reminded us that this will be a tough transition for a boy as he is deeply engrossed in what he is doing and doesn’t easily transition. He advised perhaps saying, “Son, 5 minutes more and then its time to stop.” He even advised a step down approach, “Son, 3 more minutes, then its time to stop.”  (Now as a mama, I have to admit that I was a bit put off by this. Sometimes I need my son to do what I need him to do when I ask him to do it! But I will take this information  into consideration!)A very interesting point Mr. Michael shared is that when your son is not calm, i.e. when tempers are rising and you find yourself in a confrontation with your son, that is not the time to make eye contact. In males, eye contact is a sign of aggression, an invitation to spar, kind of like a dare. Your son will see your behavior as a sign of aggression and will meet your “aggression” with aggression of his own! This is primal behavior (seen even in boys as young as toddlers) not your son trying to sass you or be headstrong. If your son is agitated and you are trying to get him to do something, approach him from the side, lower the pitch of your voice, perhaps put your hand firmly on his shoulder and then state clearly and directly what you want him to do.

   Finally, when your son falls, your first instinct may be to run to him and say, “Are you ok? Aw, it’s okay baby.” This may be okay for a baby boy, but as they get older, it’s important that boys be nurtured in a more aggressive fashion. If they fall, make sure they are not hurt, but assure them that they are okay and encourage them to “get back into the game”. As they get older and may be feeling skiddish about making a mistake or poor performance, we must encourage them to stick with the task, honor their commitment (especially if it is to a team) and to try again at the activity. This type of nurturing tends to help a boy rally faster and to get back to tasks at hand. Boys that are “nurtured” too much won’t develop the necessary skills to press through adversity and complete tasks and this can become a hindrance in later development and in life.

4. Before you Assess….One thing that I am always concerned about is how quickly people (schools, teachers, relatives, etc…) are ready to label children and medicate children. I came away from this workshop more convinced than ever that there are children (boys especially) out there labeled as ADHD and behavior problems when they simply need different guidance and direction and a different teaching style. Boys are not made neurologically to sit for long periods of time. After a time boys go into what Mr. Michael called “Active Brain Rests” where they seem to zone out and/or fidget. Boys need to move. Frequent movement breaks enable boys to better focus when they are approaching tasks. Before you have your son assessed, ask these questions:
   • Are they getting enough water? Dehydration makes it difficult to focus. If you son is asking for water, he is already dehydrated.
   • Is he getting enough sleep? Children who are sleep deprived have more difficulty focusing. Speak with your pediatrician and find out how much sleep your son needs and be sure he gets it.
   • Make sure your son is getting a nutrient dense diet. This can be hard, especially when children refuse to eat certain foods. But make sure your child is getting the nutrition he needs and discuss supplementation with his pediatrician if you have questions.
   • Make sure your son is getting enough natural sun light. This will not only improve his mood, but also help make sure he is getting enough vitamin D
   • Make sure you son is getting enough Omega 3 Fatty Acids. Omega 3 Fatty acids help with brain function.
   • Make sure your son is getting enough exercise, a natural neurochemical booster.

I came away with a lot of food for thought and a lot of reading that I want to do. I have to admit, I am in the dark when it comes to raising a boy. I am the last of 3 girls and had a daughter first. This boy thing is all new territory for me. But I am very thankful to Mr. Michael for sharing his expertise and insight into the brains of boys with me today.

Mamas on Bedrest, if you know you are having a baby boy and this is your first intimate experience raising a boy, here are some resources for you. This list is by no means exhaustive and this summary of this workshop is by no means “the gospel” on how to raise your sons. But I hope that this is a starting point, some food for thought, which will stimulate you to explore more. That is what this workshop did for me. I learned a bit, but learned more about what I don’t know and about what I would like to learn more. If you know of  or come across great resources, please share them in the comments section below. You can also send us an e-mail at info@mamasonbedrest.com. You can also “tweet” us on Twitter (@mamasonbedrest) or post a resource on our Facebook Page. Subscribe to our blog by clicking on the orange circle in the upper right hand corner of our webpage. If you are interested in learning more about supplements appropriate for your children, send e-mail to info@mamasonbedrest.com to schedule a consultation.

Resources

Michael Gurian, Gurian Institute, Gender Differences www.michaelgurian.com. www.gurianinstitute.com

Daniel Amen, MD, Neuroscience/Brain research. www.amenclinics.com

Michael Thompson, books on boys. www.michaelthompson-phd.com

Leonard Sax, Books on Boys and Girls. www.leonardsax.com

Dr. T. Berry Brazelton, ages and stages of development www.touchpoints.org

Louise Bates Ames, psychologist who studies characteristics of each age

William Sears, MD and Martha Sears, RN medical and diet.  www.askdrsears.com

“The Way of the Superior Man” (book) By David Deida.

In the Press Release, the CDC notes an increase in home births in non-hispanic white women, yet decreasing or stagnat numbers amongst women of color. The press release also noted that

“The CDC report as well as other reports show that babies born to women cared for by Certified Professional Midwives (CPM’s) are far less likely to be preterm or born low birth weight, two of theprimary contributing factors not only to infant mortality, but to racial and ethnic disparities in birth outcomes.”

The Big Push for Midwives is hoping that this report from the CDC will spur action in legislation and amongst medical organizations to allow CPM’s to care for and be reimbursed for care given to women of color and low income women-women who might most benefit from CPM care.

For those of you who don’t know, Medical Billers make sure that a patient’s medical record has all of the required information, that the providers have signed the record, the all the patient’s insurance information is included and recorded properly for the best reimbursement, and that the bill is processed correctly. Medical Coders make sure that the medical records and insurance claims have the proper medical codes on them so that when they are processed by insurance companies, the claims are processed swiftly and efficiently and maximum benefits are paid. If codes are missing or incorrect, medical claims can be delayed or denied and no payments made. Skilled Medical Billers and Coders ensure that providers receive adequate compensation for their services and that patients pay only their fair portion of their medical bills.

Please take a look at the Medical Billing website and feel free to contact them if they can be of assistance. We offer this hearty thanks for their guest blog!

The 10 Best Countries for Maternity Care

In a perfect world, maternity care would be at a similarly excellent level for all moms and babies around the world, but the fact is that some countries just seem to do better than others. Government programs, medical culture, and other factors that support maternal health and finances for new families can make a big difference for moms. In this list, we’ll show you 10 countries that are clearly doing things right, where moms (and often, dads) enjoy maternity and newborn perks like house calls, baby bonuses, 100% free health care, and amazingly low rates of maternal and infant death. We’ve listed these mother-loving countries in no particular rank because we believe they’re all excellent. So read on to find out about the 10 countries that know how to treat moms right.

1. France

   Mothers in France enjoy a multitude of maternity benefits, ranging from generous paid time off to extended time in the hospital. One mom, Bindi Dupouy, enjoyed five full days of resting at her local hospital after a normal vaginal delivery, and enjoyed the entire experience. Dupouy shared, “They treat expecting mums like treasures here. They take really good care of you. The health care system is just amazing.” After leaving the hospital, Dupouy was able to take five months paid maternity leave from her job as a lawyer, and on top of that, can opt to take an additional seven months unpaid without any job disruption. With a full year available after birth, Dupouy and other French mothers certainly have the opportunity to bond and enjoy their children while they’re still small. The benefits for families continue well after infanthood, as well. France offers subsidized daycare before age three, childcare allowances, and stipends for in-home nannies, as well as universal full time preschool beginning at the age of three. Statistically, France does well for moms, with 99% of women receiving at least one pre-natal visit and delivery care coverage from a skilled attendant. The risk of maternal death is low, at 1 in 6,600, as well as an under-5 mortality rate of four. These facts are not lost on French families, who are propelling France’s “robust reproduction rate” past other European countries that are suffering from a decline in births.

2. Sweden

   Sweden is easily one of the best places in the world to have a baby, and it shows: the country has one of the highest birth rates in Europe, just edging out France’s rate of 1.8 with 1.9 children per mom. That’s largely thanks to generous parental leave laws, which allow Swedish women to easily juggle work and family. Together, Swedish couples enjoy 13 months paid leave, plus another three months at a fixed rate. Most of that time is available to be split between the two parents, so families can decide which parent would be better at home. Swedish mom Anna Eriksson enjoys this system, pointing out that it “means there’s no financial hardship, and your job is still waiting for you afterward,” thanks to a law that requires employers to hold a mother’s job during her maternity leave. Eriksson spent seven months at home with her son before her partner, Henrik Eriksson took over to become a stay at home dad. The situation works so well for the Erikssons, that they decided to have another baby shortly after their son’s birth. Perhaps even more impressive, the Erikssons are able to enjoy these benefits even though they are an unmarried couple. Health-wise, Swedish families do very well, with a maternal mortality ratio of 1 in 11,400 and a very low under-5 mortality rate.

3. Norway

   Norway is another top contender for a great place to have a baby, with excellent medical care, generous maternity leave, and low mortality rates for both mother and child. Norwegian women enjoy medical professionals present at almost all of their births, and there is only a 1 in 175 chance of losing a child before the age of five. Norway’s c-section rate is low, with just 16% of births from 2005 to 2009 delivered via c-section. Norway also enjoys a maternal mortality ratio that’s on par with other developed countries at a rate of 1 in 7,600, as well as an under-5 mortality rate of three. But perhaps the most impressive part of giving birth in Norway is that it’s 100% free, from the first check up to the delivery, due to universal health care in the country. The international organization Save the Children praised Norway for these marks, as well as “one of the most generous maternity leave policies in the developed world,” a full year of paid leave for parents to spend with their infant. Norway’s clear advantage in these departments earned them number 1 in their 2011 Top Ten Places to Be a Mother report.

4. Australia

   Australian moms don’t do too shabby either, with Australia coming in at number two according to Save the Children. The rankings were a result of figures including maternal death, access to medical resources, and the economic and political status of women. For most women, maternity care through Medicare is nearly free, with some only responsible for small co-pay amounts for doctor visits and no charge at all for hospital care. It’s not at all surprising to find out that Australian women take full advantage of this care, with statistics reporting that 100% of Australian moms have at least one pre-natal visit, and 100% have a skilled attendant at birth. C-section rates are fairly high at 30%, but that is still lower than the United States’ 31%, and the maternal mortality ratio is a reasonably low 1 in 7,400. Women, and mothers in particular, are well supported in Australia, with up to a year of shared maternity and paternity leave for parents. Previously, this was on an unpaid basis, but now, both mother and father receive 18 weeks of paid leave at federal minimum wage. For families who opt not to take part in parental leave pay, a baby bonus is available, with monthly installments paid out over the first year of the baby’s life to offset the additional costs of having a new child. The cost of having a child is further discounted through Australia’s child care benefit, which offers assistance with high day care costs.

5. Iceland

   Iceland is another country that takes good care of its moms, with extensive pre-natal care offered for free to legal residents of more than six months. Icelandic moms enjoy about ten visits before the birth of their first child, including care from both midwives and doctors, ultrasounds, and general medical examinations. The hospital birth experience is also free, with a “lying-in” period that varies from one day to several days, depending on the circumstances of the birth. Icelandic births are very safe, with just a 17% c-section rate and a 1 in 9,400 maternal mortality ratio. Iceland also provides for a midwife home birth option for mothers with favorable conditions. After delivery, nurses will actually do a home visit for the the new mother and child, helping them to get settled into their new lives together, eliminating the stress and risk of infection associated with newborn doctor office visits. Working moms and dads in Iceland are cared for financially, with 90 days at 80% of their salary for both parents, plus 90 days to be shared between the parents. This time can be taken at any point during the first 18 months of their baby’s life. Iceland also provides for quarterly child benefits, paid at a fixed amount for each child under seven years of age, and disbursed based on family size and income through 18 years of age. There is one strange drawback to having a baby in Iceland, however: you must pick your baby’s name from the National Register of Persons, otherwise, you have to appeal for a new name to be added to the list, which must not be embarrassing, and conform to the Icelandic language and customs.

6. Germany

   German moms are well cared for, with plenty of maternity benefits, and even special benefits for nursing mothers. After delivery, families are welcome to stay for what seems like a luxurious visit: 7 days for a vaginal delivery, and 7 to 14 days for a cesarean section. During this stay, moms can benefit from exercise classes to get back into shape, as well as therapeutic measures like sitting baths and sunlamps. Both pregnant and nursing mothers have extensive protection in the German workplace, and can not be scheduled to work on Sundays, or holidays, take on overtime or be required to more than 8 1/2 hours of work each day. Pregnant mothers are not expected to work during the last six weeks of their pregnancy in Germany, and new mothers are not allowed to return to work until their child is eight weeks old. Germany has strict rules about the hazardous exposures that pregnant and nursing mothers are open to, providing for adequate breaks and a ban on heavy, physical labor, as well as a ban on any conditions that might be hazardous to their health. German moms benefit from four months maternity leave, and employers are required to provide for at least three months of pay. Statistics back up Germany’s excellent policies, with an outstanding 1 in 11,100 maternal mortality ratio, and under-5 mortality rate of four.

7. Switzerland

   Women in Switzerland enjoy a wealth of choices in childbirth. Births may take place in a hospital, after which moms and babies return home in the care of a midwife if they are both well. Mothers also have the choice to have a home birth, or go to a birth house where the environment is more home-like with little to no medical interventions, attended by midwives. Maternity benefits are great, with basic birth costs covered for Swiss women. Working Swiss mothers are eligible for 14 weeks paid maternity leave, and are forbidden from working for the first eight weeks following birth. Weeks nine through 16 are optional. Maternal mortality in Switzerland is low at 1 in 7,600, and the under-5 mortality rate is 4, both of which are on par with other industrialized countries.

8. Japan

   Japanese families benefit from a similar situation to the Swiss. Moms in Japan can choose from hospitals, the most popular choice, midwife clinics with a home-like atmosphere, or a home birth. Two prenatal checkups are provided free of charge, and there are free childbirth classes available. Drawbacks do exist, however. Some women feel it is a bit over-medicalized, with too many tests, but most doctors are happy to scale it back on request. There are also some unusual restrictions for pregnancy that women in other parts of the world might not understand, like keeping your feet warm, wrapping your belly to keep it warm, and not driving after the eighth month of pregnancy. But for most women, these quirks are worth enduring for the world class medical care available. Japan’s maternal mortality ratio is among the best in the world at 1 in 12,200, and 100% of births have a skilled attendant of some kind present. Japan’s postnatal care is excellent, and most hospitals expect new families to stay about a week, however, families can leave earlier if they feel they are up to it. Families are expected to pay for their own medical costs, but after the birth will receive a standard payout, presumably to apply to medical bills. Financial support after the birth is reasonable, with moms receiving 60% of their usual pay for 14 weeks. Moms and dads can both take up to a year off for parental leave, offering Japanese families plenty of time to bond and adjust to their new lives together.

9. Italy

   If you’re strictly concerned with maternal health, Italy is the place to be. In 2010, the country was rated the safest place to have a baby, with just 4 maternal deaths per 100,000 births. Amazingly, this incredibly safe maternity environment is completely free, in a system where families do not have to pay for prenatal visits or the hospital birth. Moms also benefit from 22 weeks of leave paid at 80% of their salary, and 2 weeks to relax and prepare for birth. And to encourage more children in the country, Italy has begun to offer a 1,000 Euro baby bonus to families with newborns. However, despite Italy’s benefits and safe delivery environment, it does have a high rate of c-sections: 40%. This may not necessarily be a reflection of poor care however, as many Italian women wait until they are older to have children, and advanced maternal age can come with higher risks for birth that may lead to c-section. The high rate of c-sections may also be tied to the excellent safety rating of the maternal health system, in which doctors do not hesitate to take drastic measures (as in a necessary c-section) to protect the lives of Italian mothers.

10. The Netherlands

    Women who are interested in natural childbirth just might want to head to the Netherlands. The Dutch believe in keeping it natural, avoiding treating pregnant women as patients with a medical condition. That is not to say that they aren’t taken care of, though. Moms in the Netherlands do have excellent support, with 100% of births taking place with a skilled attendant present, which can mean either an OB-GYN or midwife. Home births are common, with 30% of births in the Netherlands taking place at home, the highest rate of home births in the world. Women are safe giving birth in the Netherlands with a low maternal mortality ratio (1 in 7,100). Just 10% of women in the Netherlands use pain relief, and no traditional pain relief is available at Dutch home births. Instead, moms are taught natural methods of pain management in prenatal classes, including yoga techniques. Moms who deliver in hospitals are typically home within hours, sent with a maternity care assistant to stay for at least a week to help out and support the family. This assistant is known as a kraamzorg, and offers an amazing amount of help to new moms with guidance on breastfeeding, baby care, as well as duties including light cleaning and babysitting older children. The help continues, as Dutch moms get 16 weeks maternity leave paid at 100% of their salary. Fathers only get two days leave paid at 100%, but both parents have up to 26 weeks available to take unpaid from employers, and through tax breaks, receive 50% of the national minimum wage.

We’re sure you’re wondering why the US is not a part of this list. In a recent ranking by Save the Children, the US came in at #31 on the Mothers’ Index, and it’s not difficult to see why. Safety for infants is an issue, with an under-5 mortality rate of 8, compared with the 4 or fewer seen in most other industrialized countries. The maternal mortality rate is similarly disturbing, with a ratio of 1 in 2,100 versus a typical 1 in about 7,500 often found in other industrialized countries. The US has a high c-section rate of 31%, double the World Health Organization’s recommendation of 15%. But beyond medical care, American moms still get the short end of the stick, with no paid maternity leave, a benefit that even moms in Afghanistan enjoy (90 days at 100%), the country rated the absolute worst for mothers at #164. In fact, the US is the only country in the developed world without a mandatory paid maternity leave. While it isn’t the worst place in the world to give birth, the US is a long way from making our top 10 list.

Thanks again to Medical Billing and Coding for this really informative post. Please share your comments below. You can also chat with us on Twitter (@mamasonbedrest) and on our Facebook Page. Want to read our blogs as soon as they are posted? Subscribe to our RSS feed in the top right hand corner of our webpage!!

The LifeWrap (generic name: Non-pneumatic Anti-shock Garment or NASG) is a first-aid device used to stabilize women who are suffering from obstetric hemorrhage and shock.  According to the LifeWrap website,

“The leading cause of maternal mortality (deaths from pregnancy and childbirth related complications) is obstetric hemorrhage in which a woman bleeds heavily, most often immediately after giving birth. A woman somewhere in the world dies every 4 minutes from this kind of complication.”

LifeWrap has been studied extensively by SuEllen Miller, CNM, Ph.D, professor at UCSF and the director of the Safe Motherhood Project at UCSF. As Miller shares with KGO TV in San Francisco,

“If they (women) bleed they’re (often) very far from skilled care. They need something to buy them time so they can get to the kind of facility where they can get a blood transfusion or get surgery and that’s what the anti-shock garment does. It (LifeWrap) buys time.”

The LifeWrap is made of neoprene and Velcro^TM and looks like the lower half of a wetsuit cut into segments. The LifeWrap reverses shock by returning blood to the heart, lungs and brain. This restores the woman’s consciousness, pulse and blood pressure. Additionally, the LifeWrap decreases bleeding from the parts of the body compressed under it. Recent research has identified that the pressure applied by the LifeWrap serves to significantly increase the resistive index (i. e. increase the tone and help reduce free flow of blood) of the internal iliac artery (which is responsible for supplying the majority of blood flow to the uterus via the uterine arteries). Best of all, LifeWrap is a very low-tech device and can be applied by anyone after a short, simple training. It is very low cost, approximately $300 per suit, so it can be readily accessible by purchase or donation to countries and practices in need.

According to the Interview with KGO TV in San Francisco,

“The UCSF team is hoping to present results from its current clinical trial to the World Health Organization (WHO). If the LifeWrap is added to the organization’s approved medical device list, it would clear the way for donors to provide it to poorer countries, potentially saving thousands of lives.”

This is truly ground breaking news and research! It will be wonderful to live in a world where all mamas can safely give birth and actually live to see their babies.

An actual LifeWrap being used in Zambia. This image comes from the LifeWrap website.

Resources

The LifeWrap Website

KGO TV News Report with Carolyn Johnson

WikiPedia: The Non-Pneumatic anti-shock garment

What is Twin to Twin Transfusion Syndrome (TTTS)?

TTTS is a very specific condition that occurs in twins under very specific conditions. According to the Texas Children’s Hospital,

In two-thirds of identical twins, each twin has its own amniotic sac but shares a common placenta. This type of monozygotic (identical) twinning is called monochorionic, diamniotic since there is an inner layer surrounding the amniotic sac of each twin, but there is only one common outer layer (chorion) surrounding both of the sacs.

TTTS occurs in monochorionic, diamniotic twins. In almost all of these pregnancies, the single placenta contains blood vessel connections between the twins. For reasons that are not clear, in 15 percent to 20 percent of monochorionic, diamniotic twins, the blood flow through these blood vessel connections becomes unbalanced, resulting in a condition known as twin-twin transfusion syndrome (TTTS).

In TTTS, the smaller twin (often called the donor twin) does not get enough blood while the larger twin (often called the recipient twin) becomes overloaded with too much blood. In an attempt to reduce its blood volume, the recipient twin will increase the urine it makes. This will eventually result in the twin having a very large bladder on ultrasound, as well as too much amniotic fluid around this twin. At the same time, the donor twin will produce less than the usual amount of urine. The amniotic fluid around the donor twin will become very low or absent.

In some severe cases of TTTS, Twin Reversed Arterial Perfusion (TRAP) sequence occurs.  TRAP sequence or acardiac twinning is a very rare problem, occurring in approximately 1% of twins sharing one placenta. One twin is usually structurally completely normal. The other is an abnormal mass of tissue, consisting usually of legs and a lower body, but no upper body, head or heart. Because of the absent heart, the term “acardiac twin” is used to describe this mass. The normal fetus is referred to as the “pump twin” because its heart is used to pump blood to the abnormal mass. The “acardiac twin” has no chance of survival.

When I realized what my mama would be facing, I had to share it here. While the vast majority of twin pregnancies proceed with few complications, i.e. each twin has its own placenta and sac, its a staunch reminder that multiple pregnancies carry their own inherent risks. While Mother Nature in her marvelous wisdom allows for these wondrous births, sometimes things don’t proceed as planned.

Diagnosis and Evaluation of TTTS

So how would a mama know if her babies were having TTTS? Many times mama has no idea at all. Then when she has an ultrasound, the imbalance in amniotic sacs is noted, there is growth retardation in one baby or develpmental abnormalities in one twin. On occasion, mama may notice that she is increasing in girth quickly. This often happens when the “recipient” twin in TTTS is putting out too much urine in an attempt to normalize its fluid volume, so mama’s belly is getting larger more quickly. The Diagnosis of TTTS is made via ultrasound and the severity is determined by the timing in the pregnancy (the earlier it is detected, the more severe it tends to be), the development of the fetuses and the status of the amniotic sacs and placentas. To better determine the severity of TTTS in the twins, doctors at the UCSF Fetal Treatment Center also evaluate the babies hearts via echocardiogram, their kidneys, bladders and arterial blood flow via the umbilical cords.

Treatments for TTTS

Amnioreduction. Amnioreduction is a minimally invasive treatment in which some of the excess amniotic fluid produced by the recipient twin is removed via amniocentesis. While this was at one time the standard treatment for TTTS, it has been replaced by laser treatments that have superior results and birth outcomes for both twins. It is still effective in some lower risk, very specific cases.

Septostomy

In some cases, the imbalance in amniotic fluid levels is balanced by making a small hole in the membrane separating the two fetuses, called a septosomy. With a septosomy, excess fluid from the recipient twin can flow back into the sac of the donor twin who has low amniotic fluid levels. Complications include all the complications associated with amniocentesis (infection, preterm labor and/or premature rupture of membranes), widening or complete rupture of the septosomy in which case both twins would share one sac, subsequent tangling of the fetal umbilical cords, fetal death (s).

Laser Ablation of Placental Blood Vessels

In more advanced stages of TTTS, laser ablation of the blood vessels on the placenta found to communicate between the twins are closed using laser light energy. If done at the appropriate time and on the appropriate blood vessels, Laser ablation can be a curative procedure. According to the Texas Children’s Hospital,

Laser ablation has been shown to result in the survival of at least one twin in 70 percent to  80 percent of cases and both twins in one-third of cases.Should one fetus die after the procedure, the likelihood that the surviving fetus will develop complications is reduced from 35 percent to approximately 7 percent, because the babies are no longer sharing blood vessels between them. In one-third of cases, neither twin will survive.

Selective Cord Coagulation. Unfortunately, some parents are faced with the heartbreaking decision of whether or not to end the life of one twin to save the life of the other. This decision often has to be made in cases where laser ablation is not an option and/or the survival of one twin is questionable at best. By stopping the flow in the cord of the dying twin, the other twin can is protected from any adverse events as a result of the iminent demise of its twin and be given the best chance of survival. Survival of the one remaining fetus can be expected in 85 percent of cases.

Radiofrequency Ablation.

This procedure is usually reserved for TRAP sequence. In this procedure, a specialized needle is passed into the amniotic fluid and then into the body of the acardiac fetus. A special current is then applied to the needle to burn the area around the major blood vessel in the abnormal fetus. This will stop the blood flow and allow the pump twin (normal twin) to no longer have to send blood to the acardiac twin. Complications of infection, premature contractions and premature rupture of the membranes can occur as in any needle procedure. In one series, the risk for premature rupture of the membranes was 8 percent.  In this same series, the chance for a successful live birth for the pump twin was 90 percent.

Truly this is overwhelming information and parents faced with TTTS face some unheard of decisions. However, in today’s technological world, there are more treatment options and more opportunities for successful live births. Hopefully, this brief and very simplistic overview of TTTS will help some parents cope with a very difficult situation and make very difficult choices.

Do you have experience with TTTS? Please share your experience with our Mamas on Bedrest in the comments section below or by sending an e-mail to info@mamasonbedrest.com.

More information can be found at The Twin to Twin Transfusion Syndrome Foundation, The UCSF Fetal Treatment Center, The Texas Children’s Hospital Website.

Note: A huge thanks to Ms. Jenya Cassidy for sharing her story about TTTS. Jenya shared an invaluable resource, Dr. Julian De Lia. Dr. De Lia is pioneer in laser surgery treatment for TTTS and has also done extensive research into the nutritional needs of women with high risk pregnancy. Here is his contact information: