السبت، 20 أغسطس 2016

Texas has highest maternal mortality rate in developed world, study finds

As the Republican-led state legislature has slashed funding to reproductive healthcare clinics, the maternal mortality rate doubled over just a two-year period

The rate of Texas women who died from complications related to their pregnancy doubled from 2010 to 2014, a new study has found, for an estimated maternal mortality rate that is unmatched in any other state and the rest of the developed world.

The finding comes from a report, appearing in the September issue of the journal Obstetrics and Gynecology, that the maternal mortality rate in the United States increased between 2000 and 2014, even while the rest of the world succeeded in reducing its rate. Excluding California, where maternal mortality declined, and Texas, where it surged, the estimated number of maternal deaths per 100,000 births rose to 23.8 in 2014 from 18.8 in 2000 – or about 27%.

Related: The biggest US city without an abortion clinic: El Paso's sole facility faces closure

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الجمعة، 19 أغسطس 2016

Pregnancy and mental health: the hidden pain of giving birth

The range of mental health problems experienced around pregnancy and childbirth is vast and often isn’t spoken about. Here, we share your stories

Magda, a 29-year-old software developer, regularly fends off questions about when she will have her first child. Coming from a close-knit family and having been with her boyfriend for a decade, the topic is brought up regularly. But Magda grimaces in response, only to be told: “Don’t leave it too late.”

For Magda, the question of when she wants to have a child is complex. There is a serious history of depression and psychosis in her family on both sides. In fact, her mother was sectioned for a long time after giving birth to her.

A lot of times my days are coping minute to minute. I don’t know if that puts me in a good position to raise a child

When it comes to having children I have two thoughts. One, genetically I don’t like the idea of gambling and seeing whether I pass it on... Second, should that child not have to deal with that, they will have to deal with me as their father and a lot of times my days are coping minute to minute. I don’t know if that puts me in a good position to raise a child in the best way.

Giving birth was much more painful and difficult than I ever imagined it would be

I have been told that I may need medication for life to treat my anxiety and depression. When I decided to have a baby, my main fear was that the drugs would be dangerous and I’d have to come off them. I was scared of falling ill, which had happened when I came off medication before – when I was at my worst I had extreme panic attacks about 10 times a day.

My dad, who is a doctor, assured me that citalopram is generally considered OK during pregnancy. But babies born to depressed mothers can have worse growth and general health.

I have borderline personality disorder and a social anxiety disorder. I stopped taking my medication (Escitalopram) when I was pregnant because I was worried about the health of my baby. Some doctors thought it was better I stay on the drug, while others disagreed, and because of this varying advice I stopped. However, coming off it caused me a lot of problems. I started self-harming, for example, and worried about everything. I ended up hiding in my house, which meant I couldn’t go back to work. With borderline personality disorder I can go very quickly from being level-headed to mentally unstable. Being pregnant made it harder to cope with this. I didn’t feel like my body was my own. I couldn’t harm myself physically to rid my mind of distressing thoughts.

I was referred to a mental health assessment team and put back on medication on a low dosage. I had one visit with the assessment team but found the nurse dismissive and unhelpful. They didn’t realise I’d had past mental health problems and were treating me as if I had just turned up with thoughts of harming myself. Once I explained to them that I presented before pregnancy I hoped they’d adjust their attitude towards me, perhaps offer more contact, but they didn’t.

I started to have horrible thoughts about my baby – thinking I had made a terrible mistake and wanted to get rid of it

I have never experienced mental health issues other than while I was pregnant. When I was around eight weeks, I started to feel upset. The baby hadn’t been planned, but I was ecstatic at first. However, depression soon took over. As the weeks went on it got worse – I hated people talking about the pregnancy and wanted to pretend it wasn’t happening. I started to have horrible thoughts about my baby – thinking I had made a terrible mistake and wanted to get rid of it. Bizarrely, I also decided that when the baby was born, I would swap it with another child in the hospital, and at least then they wouldn’t be my responsibility any more.

Fortunately by the time I was heavily pregnant, I didn’t feel negatively any more. I only felt sad that this thinking had ruined my early pregnancy for me. I now have a huge amount of sympathy for anyone who experiences depression.

I finally admitted to myself that I was seriously ill after weeks of considering throwing myself under the train

I finally admitted to myself that I was seriously ill after weeks of considering throwing myself under the train on my way to work, followed by weeks of not being able to get out of bed. I lacked the motivation to do anything: get dressed, wash my hair, let alone make any preparation for a new baby. There is a hormonal trigger to perinatal depression and the more the pregnancy progresses the greater the influence of hormones.

Looking back on it it would have been better for me to have someone to talk to [after the miscarriage] and maybe drop the stigma that men have to be strong and carry everyone around them, because something like losing a child does affect us just as much emotionally.

I’m pregnant for the second time. My husband and I lost our first child when I had a miscarriage in my first trimester. It’s not something you get over. People around you think that it’s all about getting pregnant, but the waiting for the arrival of a healthy baby now is worse than any treatment. I suffer from crippling anxiety – crying at random times, waking up from nightmares. I can’t talk about being pregnant and am still trying to hide it at almost 20 weeks.

I wish that I could be offered some counselling. My partner and I received no support whatsoever from the NHS after the D&C [a surgical procedure often performed after a first-trimester miscarriage]. Only now, from reading the Miscarriage Association’s literature am I beginning to understand that the anxiety we are going through is common.

I had my daughter a few years ago and read all the information I could get my hands on. After a difficult birth I eventually delivered my baby. I was exhausted (it took 48 hours in total) and shell-shocked. We stayed in hospital for a few days while trying to get my daughter to breastfeed. I was struggling so much with this that I refused to have any visitors as I didn’t want anyone to think I couldn’t cope. In the end I gave up so that we could all just go home. Luckily bottle feeding didn’t affect bonding with my baby.

However, my partner didn’t cope well at all. From seeing me in so much pain and out of control, he tried to take on far too much so that I could recover. His mental health spiralled as a result to the point where he couldn’t look at our baby. He couldn’t handle her crying and one day I found him crouched in a corner rocking. I got him to see a counsellor and the doctor advised that he would recover better if he moved out for a while. He went to live with his parents and we would visit, but he couldn’t cope with the guilt of leaving us.

I’d already had a baby and enjoyed being a mum, so when I fell pregnant again I never expected to experience postnatal depression.It was four months before I plucked up the courage to go and see the doctor. I kept telling myself to keep going, and that I could be a perfect mum like the ones you see plastered all over social media. Now I realise that it’s not real. To me, during the dark days that perfect picture wasn’t my life but boy did I try to achieve it. I was really struggling and I told no one. Admitting weakness was like putting my hand up and saying: “Look at me, the bad mum over here.”

The day I told my sister and my mum I was at my wits’ end. I cried the whole time. I paced the length of my house for half an hour before I finally made the call to my family. After that I went to the doctor. I thought he was going to laugh and tell me to just get on with it like every other mum, but he didn’t. He told me that this would be the last time I would feel this way and that every day, from today, I would start to feel better. Most importantly he made me realise for the first time in four months that I wasn’t a failing mother-of-two. I’d managed to keep my head above water through one of the most challenging times of my life.

I completely lost touch with reality and was convinced my phone was communicating with me in code

I started to get hyper-manic and the effect that had, in terms of behaviour, meant that I would be wide awake all night. My mind would be racing and I was really driven to do things, for example I would reorganise the kitchen cupboard at 3am to 4am in the morning. I also wrote lists compulsively and used hand gestures, which I don’t normally do … then after that I became psychotic. I completely lost touch with reality and was convinced my phone was communicating with me in code. I thought it might be my father who had died three years previously. I thought I would just will with my mind ordering a pizza and it would be delivered to the door.

My wife and I experienced the stillbirth of our first child, Andrew. It was very sudden, my wife noticed a lack of movement and we went to hospital. We saw a classic scan, but this time with no heartbeat. I carry the image with me to this day. The following days and weeks were traumatic. We were told that the chances of a future successful pregnancy were higher if my wife delivered Andrew naturally, so labour was induced gently. We then went to a dedicated maternity suite (where we were handled with exceptional care and attention by all staff). The delivery was normal, except that Andrew was not alive.

Following the stillbirth, I experienced post-traumatic stress disorder for which I have since received cognitive behavioural therapy. I had flash-backs of the traumatic delivery and the events immediately before and after, including my son’s funeral. I also suffered from an intense anxiety as we went through four more pregnancies – two ended in miscarriage and two ended inthe births of two wonderful boys. We constantly wondered about miscarriage, stillbirth and the chances of a good outcome. The mental health problems affected my work – I was constantly on high alert.

On the whole the NHS was marvellous. Their care when we lost Andrew was excellent in the circumstances

I had a traumatic first birth and my baby was in neonatal care, which left me struggling with what I know now to be PTSD and perinatal anxiety. I didn’t understand what was happening, so tried to carry on as normal. I became pregnant again 14 months later by accident and really suffered. I believed I would die, writing letters to all my family and counting down the days until I would leave this world. I had awful anxiety, flashbacks and was terrified all the time. I didn’t trust healthcare professionals, hated going to the hospital for appointments and didn’t know who I could approach for help. I became a shell, empty and full of fear.

I wish that my traumatic birth had been acknowledged and that I had been asked how I was coping in my next pregnancy. I wish that there had been counselling, more information around having a difficult birth. I wish I’d just been asked how I was, not physically but mentally. I wish there had been continuity of care so that I had someone I trusted care for me. It took me 15 years to get a correct diagnosis after the second birth and even then there was no specialist treatment support available.

I was diagnosed with OCD following the birth of my first child. I was experiencing intrusive thoughts about my son coming to harm (and that I might actually be the one to harm him). I have suffered from recurrent depressive episodes throughout my life.This and the severe anxiety I was experiencing led me to spend a lot of my maternity leave sitting at home, waiting for something terrible to happen.

My midwife noticed during my pregnancy that I was feeling anxious and referred me to a mental health clinic at the local women’s hospital. I continued to attend there after my pregnancy and, as things spiralled out of control, I was prescribed antidepressants and given a place in a group therapy session. I was admitted to hospital – in a dedicated mother and baby unit – for two months as things failed to improve.

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الخميس، 18 أغسطس 2016

Cambodia proves fertile ground for foreign surrogacy after Thailand ban | Sarah Haaij

Surrogacy agencies outlawed in Thailand, India and Nepal have upped sticks for Cambodia, where the practice remains unregulated

After a long day of selling snacks at her son’s primary school, Kew, who is seven months pregnant, squats on the Bangkok pavement to take a rest. The single mother has no idea whose baby she is carrying, or where its future parents live. She says it makes no difference to her.

“The first time I did surrogacy, I discovered that the baby was for a Spanish couple. Two gay men,” she says. “For me it’s all the same, as long as I get paid.”

Related: Outsourcing pregnancy: a visit to India's surrogacy clinics | Julie Bindel

After they left I cried for three days straight … I miss this little girl like she is my own

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الأربعاء، 17 أغسطس 2016

Scientists study link between unhealthy pregnancy diet and ADHD

Experts examine how a diet high in fat and sugar could alter baby’s DNA in a way that might cause behavioural problems

A diet high in fat and sugar during pregnancy may be linked to attention deficit hyperactivity disorder in children with behavioural problems early in life, experts have found.

Related: Pregnancy food: what you eat can affect your child for life

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الخميس، 11 أغسطس 2016

'A baby made his first sound on the 106 bus': readers share amazing birth stories | Guardian readers and Sarah Marsh

Celebrity chef Jamie Oliver and his wife Jools let their eldest daughters watch the birth of their sibling this week. You told us about the births you’ve witnessed

Jamie Oliver’s eldest children witnessed their mother, Jools, give birth this week. It prompted us to ask readers whether they have been present at the birth of someone else’s baby. From a birth on the 106 bus to helping deliver a neighbour’s baby, here are your stories.

Related: Giving birth the Jools Oliver way – letting the kids watch

Related: How many people should watch you give birth? The crowdbirthing conundrum | Nicola Goodall

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الاثنين، 8 أغسطس 2016

I’m treating pregnant women with Zika and this is what it’s like | Christine Curry

Some women decide on termination. Others carry on, despite the risks. With so much about the virus still unknown, it’s a journey for both staff and patients

As a medical student, I remember reading books about the early days of the HIV epidemic and wondering what it was like for doctors to take care of patients who had a new, unknown disease. It seemed to me like it would be frightening for both patients and doctors alike. I didn’t expect that early in my career as an OB-GYN, I would be caught in the middle of another new disease outbreak – Zika.

Most people who catch this virus feel fine. Some will end up with a fever, rash, aches and pains and red eyes (conjunctivitis), or rarely, a serious nerve disorder called Guillain-Barre. But in pregnancy there can be very serious consequences for the baby. As of July 28, the World Health Organization reports that nearly 2,000 babies worldwide are affected with microcephaly or central nervous system malformations associated with Zika.

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الأربعاء، 3 أغسطس 2016

Fertility expert attacks critics of 62-year-old first-time mother

Woman labelled a burden on taxpayers by head of Australian Medical Association, but defended by president of Fertility Society

The president of the Fertility Society of Australia, Prof Michael Chapman, has attacked criticism of a 62-year-old Tasmanian woman who has become Australia’s oldest first-time mother.

The woman, who does not wish to be identified, received IVF overseas where she was implanted with a fertilised donor embryo. The woman gave birth via a caesarean section at 34 weeks pregnant at the Frances Perry private hospital in Melbourne on Monday, supported by her 78-year-old partner.

Related: Parents likely to block girlfriend’s attempt to access sperm from dead son

I can see many situations that might have driven her to this.

Related: Women's fertility underestimated by 68% in 'highly inaccurate' hormone test

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