A rural hospital closed its obstetrics unit, hitting most vulnerable the hardest
By Jean Lee | November 21, 2021
"Shantell Jones gave birth in an ambulance parked on the side of a Connecticut highway. Even though she lived six blocks away from a hospital, the emergency vehicle had to drive to another one about 30 minutes away.
The closer medical center, Windham Hospital, discontinued labor and delivery services last year and is working to permanently cease childbirth services after “years of declining births and recruitment challenges,” its operator, Hartford HealthCare, has said.
But medical and public health experts say the step could potentially put pregnant women at risk if they don't have immediate access to medical attention. Losing obstetrics services, they said, could be associated with increased preterm births, emergency room births and out-of-hospital births without resources nearby, like Jones' childbirth experience.
The dilemma Jones faced is one that thousands of other pregnant women living in rural communities without obstetrics units nearby are encountering as hospitals cut back or close services to reduce costs. Nationwide, 53 rural counties lost obstetrics care from 2014 through 2018, according to a 2020 study in the Journal of the American Medical Association, which also found that out of 1,976 rural counties in the country, 1,045 never had hospitals with obstetrics services to begin with.
The problem is particularly acute in communities of color, like Windham in northeastern Connecticut, where the population is 41 percent Latino, while the statewide Latino population is only 16.9 percent, according to the U.S Census Bureau. The community is 6.2 percent Black. Local activists say they fear low-income residents will bear the brunt of the hospital’s decision because Windham has a 24.6 percent poverty rate compared to 10 percent statewide, according to the census.
The night Jones delivered her son, her mother, Michelle Jones, had called 911 because Jones was going into labor a few weeks early, and after her water broke they knew the baby was coming soon. Both expected the ambulance to drive the short distance to Windham Hospital, where Jones received her prenatal care.
But the ambulance attendant was told Windham wasn't taking labor and delivery patients and was referring people to Backus Hospital in Norwich, Jones said.
In the ambulance, she was without her mother, who was asked to follow in her car.
“I was anxious and scared and traumatized,” Jones said."
By Sarah Griffiths | April 24, 2019
"Giving birth can be one of the most painful experiences in a woman’s life, yet the long-term effects that trauma can have on millions of new mothers are still largely ignored.
It’s 03:00. My pillow is soaked with cold sweat, my body tense and shaking after waking from the same nightmare that haunts me every night. I know I’m safe in bed – that’s a fact. My life is no longer at risk, but I can’t stop replaying the terrifying scene that replayed in my head as I slept, so I remain alert, listening for any sound in the dark.
This is one of the ways I experience post-traumatic stress disorder (PTSD).
PTSD is an anxiety disorder caused by very stressful, frightening or distressing events, which are often relived through flashbacks and nightmares. The condition, formerly known as “shellshock”, first came to prominence when men returned from the trenches of World War One having witnessed unimaginable horrors. More than 100 years after the guns of that conflict fell silent, PTSD is still predominantly associated with war and as something largely experienced by men.
But millions of women worldwide develop PTSD not only from fighting on a foreign battlefield – but also from struggling to give birth, as I did. And the symptoms tend to be similar for people no matter the trauma they experienced.
“Women with trauma may feel fear, helplessness or horror about their experience and suffer recurrent, overwhelming memories, flashbacks, thoughts and nightmares about the birth, feel distressed, anxious or panicky when exposed to things which remind them of the event, and avoid anything that reminds them of the trauma, which can include talking about it," says Patrick O’Brien, a maternal mental health expert at University College Hospital and spokesman for the Royal College of Obstetricians and Gynaecologists in the UK.
Despite these potentially debilitating effects, postnatal PTSD was only formally recognised in the 1990s when the American Psychiatry Association changed its description of what constitutes a traumatic event. The association originally considered PTSD to be “something outside the range of usual human experience”, but then changed the definition to include an event where a person “witnessed or confronted serious physical threat or injury to themselves or others and in which the person responded with feelings of fear, helplessness or horror”.
This effectively implied that before this change, childbirth was deemed too common to be highly traumatic – despite the life-changing injuries, and sometimes deaths, women can suffer as they bring children into the world. According to the World Health Organization, 803 women die from complications related to pregnancy and childbirth every day.
There are few official figures for how many women suffer from postnatal PTSD, and because of the continued lack of recognition of the condition in mothers, it is difficult to say how common the condition really is. Some studies that have attempted to quantify the problem estimate that 4% of births lead to the condition. One study from 2003 found that around a third of mothers who experience a “traumatic delivery”, defined as involving complications, the use of instruments to assist delivery or near death, go on to develop PTSD.
With 130 million babies born around the world every year, that means that a staggering number of women may be trying to cope with the disorder with little or no recognition.
And postnatal PTSD might not only be a problem for mothers. Some research has found evidence that fathers can suffer it too after witnessing their partner go through a traumatic birth.
Regardless of the exact numbers, for those who go through these experiences, there can be a long-lasting impact on their lives. And the symptoms manifest themselves in many different ways.
"I regularly get vivid images of the birth in my head,” says Leonnie Downes, a mother from Lancashire, UK, who developed PTSD after fearing she was going to die when she developed sepsis in labour. “I constantly feel under threat, like I'm in a heightened awareness.”
Lucy Webber, another woman who developed PTSD after giving birth to her son in 2016, says she developed obsessive behaviours and become extremely anxious. “I’m not able to let my baby out of my sight or let anyone touch him,” she says. “I have intrusive thought of bad things happening to all my loved ones.”
Not all women who have difficult births will develop postnatal PTSD. According to Elizabeth Ford of Queen Mary University of London and Susan Ayers of the University of Sussex, it has a lot to do with a woman’s perception of what they went through.
"Women who feel lack of control during birth or who have poor care and support are more at risk of developing PTSD,” the researchers write.
The stories from women who have developed PTSD after giving birth seem to reflect this.
Stephanie, whose name has been changed to protect her identity, says she was poorly cared for during labour and midwives displayed a lack of empathy and compassion. A particularly difficult labour saw her being physically held down by staff as her son was delivered. “He was born completely blue and taken away to be resuscitated and I was given no information on his condition for hours.”
Medically reviewed by Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT — Written by Charlotte Lillis on September 24, 2018
"Many women experience gas during pregnancy. It usually goes away on its own, but home remedies can help ease discomfort and reduce the quantity of gas.
Raised levels of the hormone progesterone relax the intestines during pregnancy. This relaxation slows digestion, making constipation more likely and often leading to bloating, belching, and flatulence.
A woman may also experience more gas during the later stages of pregnancy, when the growing fetus places additional pressure on the abdominal cavity.
While it is impossible to prevent gas during pregnancy, several safe home remedies can reduce gas and relieve discomfort. Many of these prevent constipation, which significantly contributes to gas.
1. Drinking plenty of water
The United States National Academy of Medicine, formerly the Institute of Medicine, recommend that pregnant women drink around 10 cups, or 2.3 liters, of water a day.
Drinking water before or after a meal helps the stomach digest food. Any undigested food passes into the small intestines, where bacteria break it down, producing gas in the process. Staying hydrated can, therefore, help reduce the buildup of gas.
Hydration can also prevent constipation, another cause of gas. When a person is dehydrated, their stool becomes dry and hard. Drinking plenty of water keeps stool soft, helping it pass more easily through the colon.
Also, it is best to sip slowly, rather than gulp. People are more likely to swallow air when they gulp, which can contribute to gas.
2. Avoiding certain drinks
Some people experience gas when they drink beverages containing the following ingredients:
Carbon dioxideCarbon dioxide is a gas in a wide range of drinks, including:
The added sugars or artificial sweeteners in many carbonated drinks can also contribute to intestinal gas.
Fructose is a natural sugar that occurs in most fruits. Manufacturers often add fructose to a variety of desserts and drinks.
Some people are unable to digest fructose. In this case, the sugar can ferment in the large intestine, causing gas and bloating. The medical term for this digestive disorder is fructose malabsorption.
Sorbitol is a low-calorie sugar substitute. However, the body is unable to digest sorbitol. Some people experience abdominal pain, bloating, and gas as a result.
3. Keeping a food diary
During pregnancy, many women choose to eat a more healthful diet. Many healthful foods are rich in fiber, and adding them to the diet can increase the amount of gas in the short term.
Some high-fiber foods also contain complex carbohydrates called oligosaccharides. When bacteria in the gut break down oligosaccharides, they produce nitrogen gas. Some people are more sensitive to this effect than others.
Foods that contain oligosaccharides include:
4. Eating more fiber
Although high-fiber foods can increase gas in the short term, over time they help to reduce constipation, which is a major cause of intestinal gas.
Fiber achieves this by drawing in water and softening stool. This eases its passage through the intestines, speeding digestion and giving gas less time to build up.
If a person is switching to a high-fiber diet, the following strategies can help prevent temporary increases in gas:
By Stephanie Collier, MD, MPH, Contributor
"Pregnancy is an exciting time. You will soon become a parent to an adorable, tiny human. You may expect to experience the rollercoaster of emotions during pregnancy, or emotions may catch you off guard. Some women feel joy at every flutter or kick, marveling at their changing bodies. For other women, pregnancy is hard, giving no reprieve as it brings severe fatigue, mood changes, and constant worries. You may notice that with every passing month, your thoughts are spiraling out of control, affecting your performance at work and your relationships at home. But how do you manage your anxiety, and should you treat it?
What causes anxiety during pregnancy?
Worries during pregnancy are universal. Hormonal changes of pregnancy, prior heartbreaking miscarriages, and sleep difficulties may all contribute to anxiety for mothers-to-be. You may worry about how a baby will affect your relationships with friends or family members, the health of your future child, the delivery experience, or the financial burden of an additional family member. All of these worries are completely normal. For humans, a certain amount of anxiety is protective; how else could we motivate ourselves to complete our work or run away from a bear?
What are the symptoms of anxiety disorders during pregnancy?
Although it’s normal to be worried about the health of your baby, in some cases this worry becomes debilitating and may require further attention. Thoughts about the health of the baby may become obsessive, even when doctors are reassuring. Worries may also appear as physical symptoms, such as a rapid heartbeat, difficulty breathing, or panic attacks. If this is the first time you experience a high level of anxiety, this may be frightening in itself. When anxiety starts to interfere with your day-to-day functioning, relationships, or job performance, it may be classified as an anxiety disorder — if your doctor picks up on it.
Anxiety can occur at any time during pregnancy, or it may first appear after delivery (perinatal anxiety is the term used for anxiety during pregnancy and after delivery). The rates of generalized anxiety disorder appear to be highest in the first trimester, likely due to hormonal changes. The most common symptoms of anxiety include constant worrying, restlessness, muscle tension, irritability, feeling dread, an inability to concentrate, and difficulties falling asleep due to worries. Some women also experience symptoms as a result of other anxiety disorders, including panic disorder, obsessive-compulsive disorder, or post-traumatic stress disorder.
Unfortunately, two of the most common mental health screening tools in pregnancy (the Edinburgh Postnatal Depression Screen and Generalized Anxiety Disorder 7-item Scale) are not great at detecting anxiety in pregnancy. Although underdiagnosed, anxiety disorders during pregnancy and in the postpartum period are common, and may affect up to one in five women. Many women suffer in silence.
What are the effects of untreated anxiety on the fetus?
When thinking about management of anxiety, it is important to consider both the risks of treatment as well as the harms of untreated anxiety. Although less studied than depression, research suggests that anxiety may negatively affect both the mother and the fetus. Anxiety increases the risk for preterm birth, low birthweight, earlier gestational age, and a smaller head circumference (which is related to brain size).
What are some treatments for anxiety during pregnancy?
Fortunately, there are many treatments that can reduce anxiety during pregnancy and help you feel better. For many women, anti-anxiety medication is not an option during pregnancy, as there is little information on the safety of such medication on the fetus. Some women who had previously taken medications for anxiety may wish to discontinue medications during pregnancy for personal reasons.
Therapies such as cognitive behavior therapy (CBT) demonstrate promise in the peripartum period (the period shortly before, during, and after giving birth). CBT focuses on challenging maladaptive thoughts, emotions, and actions, and it uses anxiety management strategies such as diaphragmatic breathing (adapted to pregnancy).
If your anxiety is severe, medications may be an option for you. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for depression and anxiety during pregnancy and after delivery. It does not appear that SSRIs are associated with an increased risk of major congenital malformations. However, SSRIs may be associated with transient neonatal symptoms such as jitteriness, tremor, crying, and trouble feeding, which resolve on their own in a few days.
The use of benzodiazepines such as lorazepam (Ativan) and alprazolam (Xanax) during pregnancy has long been a controversial topic. Although older studies showed an association between their use and an increased risk for cleft lip and palate, a more recent study looking at benzodiazepine use during pregnancy did not show this link when these medications were used alone (although there may be an increased risk when combined with antidepressants)."
By: Cindy & James Mindful Relaxation
"Meditation For Pregnancy is a comforting and relaxing meditation that can be done at any time but works best before sleep. It's a super-effective way to reduce anxiety and connect with your baby."