Premature Births Are Fueling Higher Rates of Infant Mortality in U.S., Report Says


Another factor in the United States, she said, is the increasing use of Caesarean sections and labor-inducing drugs to deliver babies early. The American College of Obstetricians and Gynecologists has guidelines stating that babies should not be delivered before 39 weeks without a medical reason, but doctors may be declaring a medical need more quickly than they did in the past.


High rates of premature birth are the main reason the United States has higher infant mortality than do many other rich countries, government researchers reported Tuesday in their first detailed analysis of a longstanding problem.

In Sweden, for instance, 6.3 percent of births were premature, compared with 12.4 percent in the United States in 2005, the latest year for which international rankings are available. Infant mortality also differed markedly: for every 1,000 births in the United States, 6.9 infants died before they turned 1, compared with 2.4 in Sweden. Twenty-nine other countries also had lower rates.

If the United States could match Sweden’s prematurity rate, the new report said, “nearly 8,000 infant deaths would be averted each year, and the U.S. infant mortality rate would be one-third lower.”

The first author of the report, Marian F. MacDorman, a statistician at the National Center for Health Statistics, said in an interview that the strong role prematurity played came as a surprise to her.

Dr. Alan R. Fleischman, medical director for the March of Dimes, said the new report was “an indictment of the U.S. health care system” and the poor job it had done in taking care of women and children. The report, Dr. Fleischman added, “puts together two very important issues, both of which we knew about but hadn’t linked tightly.”

Infant mortality is widely used as a way to gauge the health of a nation, and the relatively high rates in the United States have long dismayed health officials. Most European countries — as well as Australia, Canada, Hong Kong, Israel, Japan, New Zealand and Singapore — have lower rates of infant death than the United States.

Premature infants in the United States are more likely to survive than those elsewhere. Yet they are still more likely to die than full-term babies, and the sheer numbers born prematurely in the United States — more than 540,000 per year — drive up infant mortality.

The high levels of prematurity in the United States have various causes.

Dr. Fleischman said the smallest, earliest and most fragile babies were often born to poor and minority women who lacked health care and social support. The highest rates of infant mortality occur in non-Hispanic black, American Indian, Alaska Native and Puerto Rican women. But other minorities have some of the lowest infant mortality rates in the United States: Asian and Pacific Islanders, Central and South Americans, Mexicans and Cubans.

When it comes to prematurity, infertility treatments — drugs that stimulate ovulation and procedures that implant more than one embryo in the uterus — also play a role by raising the odds of twins or higher multiples, which have an increased risk of being born too soon.

Professional groups for fertility doctors recommend limiting the number of embryos transferred to avoid multiple births, but ultimately doctors and patients make their own decisions. Dr. MacDorman said that because most insurance in the United States did not cover infertility treatments, some patients chose to transfer multiple eggs in hopes that doing so would increase the odds of pregnancy and reduce expensive procedures.

“In Europe, they may have been more successful in limiting the number of embryos transferred,” Dr. MacDorman said, “because there is more national health insurance and people don’t have to pay out of pocket.”

Another factor in the United States, she said, is the increasing use of Caesarean sections and labor-inducing drugs to deliver babies early. The American College of Obstetricians and Gynecologists has guidelines stating that babies should not be delivered before 39 weeks without a medical reason, but doctors may be declaring a medical need more quickly than they did in the past.

“I don’t think there are doctors doing preterm Caesarean sections or inductions without some indications,” Dr. MacDorman said, “but there sort of has been this shift in the culture. Fifteen or 20 years ago, if a woman had high blood pressure or diabetes, she would be put in the hospital, and they would try to wait it out. It was called expectant management.

“Now I think there’s more of a tendency to take the baby out early if there’s any question at all.”

These births — called “late preterm,” which occur after 34 to 37 weeks of pregnancy, instead of the normal 38 to 42 weeks — are the fastest-growing subgroup of premature births. A late preterm baby’s risk of dying is about three times that of a full-term infant. But late preterm babies are still far more likely to survive than very premature ones, and the very early babies account for much of the death rate, Dr. Fleischman said.

Taking care of women’s illnesses and problems like drinking, drug use and smoking before and during pregnancy can help prevent prematurity, he said, adding that a state program in Kentucky to provide home visits by nurses to poor women during pregnancy had decreased preterm births.

Dr. MacDorman said prematurity was not the only factor behind infant mortality in the United States. She said full-term babies in this country also had higher death rates than those in Europe from sudden infant death syndrome, accidents, assaults and homicides.


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Writing a Book

Well, I am writing a book. Yes, I can actually see the light at the end of the tunnel. I am going to pull this off while being a stay-at-home mom with a 3-month old and a 3-year old. I don't even have a babysitter. Although I am looking if you know anyone. It's me and boys all day every day. I love it! I picked the hardest time of my life to accomplish a goal that I've had since I was 10-years old. I love food and cooking, but it turns out that my book is about neither. It's about birth. It's about my polar opposite experiences giving birth to two children. One was a planned hospital natural birth (aka. no drugs) that went wrong and ended in a lot of drugs and the icing on the cake, a cesarean. And, the other one was a planned home birth that changed my life forever.

All this to say that I am not doing a lot of creative cooking right now because I am sooooo busy with the kids and my book at night. I did make a pumpkin pie last night which turned out great. I'll post that soon.

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Birth by the Numbers: Video

In Birth by the Numbers, Eugene R. Declercq, PhD, Professor of Maternal and Child Health, Boston University School of Public Health, presents the sobering statistics of birth in the United States today.

I think that you have to wait for it to download, but it is sure worth the wait. I love the stats on how mothers requesting cesarean sections aren't the reason why cesarean rates have sky rocketed. In reality, that number is so so small. Yeah! Mothers aren't blame.


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I just am

I love my niece, Emily, so much. She was the first baby in my life. I spoke French to her until she was three, something I didn't do with my own son. She turned seven this month and I wanted to share my thoughts on life with her. So, I wrote her this little story and slipped it into her birthday card. Would anyone like to share a story that they have written for their children about life?


There lived a little girl named Penelope. She was seven years old. Although she was only in first grade, everyone always asked her, "What do you want to be when you grow-up?" She never knew what to say because she didn't know who she was yet. She wished for the future and to be big so that she would finally be able to answer the question.

Many years later when she was married, had a house, and a dog, she realized that she still didn't know who she was nor what she wanted to be when she grew-up. Yet she was grown-up and had a job. Where were the answers?

Then one day, while observing a flower blow in the wind, all her other thoughts stopped. She felt calmness flood over her. She felt so alive and at peace. Her existence wasn't much different from the flower that she watched. She felt the wind tickle her skin and move her hair. She put her hand on her chest and felt her heart beat. "I just am," she said.

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A Short Film: Reducing Infant Mortlity

Our infant mortality ranking is 42nd on the world stage which means 41 countries have better statistics. This places us right in the middle of the following countries: Guam, Cuba, Croatia and Belarus, with over double the infant deaths compared to the top 10 countries of the world. (CIA World Factbook).

Here is a short video on reducing infant mortality and improving the health of babies in the United States. One of the producers is Shelley Campbell from San Rafael: Learn more about the film here.



Does smiling really matter?

I don't look happy in our vacation video. I felt happy but the pictures show a stone faced and serious mom. My lips are so tightly closed that I can see lines where they bunch together. Zack took a video of Mikey eating spaghetti because it was hilarious. Mikey was naked (think hot Mexico) and working so hard to stuff one strand of spaghetti into his month. He was covered in red sauce. When the camera shows me, my eyes are so wide that it looks like I don't have eyelids. I am so focused on feeding Mikey that I am missing the comedy of the whole scene. But I swear, I wasn't. I was happy and giddy the whole time. I guess it was on the inside because my face showed a totally different story.

[Previously published for]

I've decided to start forcing a smile. Not like a fake smile but more of a relaxed face smile. I've heard laughing is therapeutic and in Bali they meditate with a smile. So I've decided to practice relaxing my face, parting my lips slightly, and curling up the ends of my mouth as often as I think about it.

Now that I am aware of my tight face syndrome, I can feel it. I felt it driving towards the Laurel Village parking lot, and then I loosened it and found a parking spot right away. I felt my lips tighten and pucker while picking poultry at the grocery store. I relaxed and felt happier instantly. I smile when I do the dishes. I smile when I type on the computer. I smile when I play with Mikey.

Being a mom is sometimes so intense that I have to stay focused and on task, but now I am doing it with a smile.



Why save candles for birthdays?

[Previously published for]

I can think of one good reason. Fire isn't a game and I shouldn't be teaching Mikey that lighting matches and birthday candles over and over is fun. Nonetheless, this candle game happened organically this morning and Mikey loved it.

He found the box where I keep the leftover candles from birthday cakes (all two of them) and wanted to light one. Mikey wasn't able to blow out his second birthday cake's candle. He almost scorched his eyebrows trying. So I thought maybe he could use a little practice. A pear was handy, so I sliced the pear and stuck the candle in it. I sang, "Happy Birthday too you..." and he blew it out right on cue. His face glowed like he had won Wimbleton. Then he wanted to do the next candle and the next. Soon he didn't wait for me to finish singing and by the end I wasn't singing at all. He was blowing out the candle and the match with one big puff. He was done with the game when we had lit and blew out each candle in the box. I used this opportunity to review colors and numbers and other things listed below:

The Candle Game

1) Discuss the difference between smoke and steam.
2) Practice blowing which isn't an obvious skill.
3) Use fine motor skills by putting the candles in the pear hole.
4) Name each candle color.
5) Teach about matches and that he is not to play with them without me. Fire is dangerous.
6) Sing Happy Birthday which boosts self-esteem and makes a child feel special even on an ordinary day.
7) Count the candles and matches.

Candles can stand in anything. It doesn't have to be a cake or cupcake.



Can my two-year old understand me?

[Previously published for]

Mikey is going through a very frustrating developmental period for me. He is unhappy mostly everywhere except home. And at home, I can't even finish unloading the dishwasher before he says, "Mama come." He needs my full attention all the time. I really enjoy hanging out with him but lately it's been difficult. I didn't realize how drained a felt, until Mikey's papa came home tonight, and I scurried off into the office and closed the door.

I was hoping for a little peace. My goal was three minutes. I didn't even make it three minutes alone before Mikey started screaming for me on the other side of the door. I heard Zack saying, "Let's go play in the yard." But, by that point Mikey was so worked up nothing would satisfy him apart from being in his mommy's arms. I opened the door and grabbed my keys. I needed out. I felt trapped and I needed some space. My decision didn't help the volume of screaming and Zack didn't know what to do, so he followed me down to the garage with our wailing child.

At this point, Mikey was so red and horse from crying that I couldn't leave him. Nonetheless, I was still upset and needed a walk. So, I took him and marched off into the street with no idea where I was going. Zack stood on the steps with no shoes and the whole house open, "Where are you going?" he asked. I turned to look but didn't respond. I just didn't know.

I held Mikey tight in my arms and walked in silence. Tears dripped down from under my sunglasses. When we reached the Panhandle park, I let Mikey down to walk. He reached for my hand and held it as we crossed the bike lane. Mikey never wants to hold my hand when we walk. He swats it away every time. But tonight it was his hand that held mine. "He is holding my hand to comfort me," I thought.

His hand transmitted so much love that I came out of my depressed state and into the present moment. It was a warm San Francisco Friday night. A woman sat on the grass with her newborn baby. Dogs ran after balls. Crows cawed loudly in the trees. Bikes zipped back and forth on the path. The warm offshore breeze dried my tears.

We continued to walk hand-in-hand without talking. Mikey would pick up a leaf or an acorn and show it to me. I would nod or smile. Just as soon as he'd let go of my hand he'd say, "hand, hand," and want it back. But this time, it wasn't for him, it was for me.

He maintained a steady walk. Normally, he can barely walk up our small street in under an hour and getting him to walk up the stairs to our apartment is about as frustrating as it gets. But in that moment, he walked. We stopped briefly to watch the basketball game and the skateboarders, and then we headed out of the park and back up the hill to the house.

We passed the newly painted orange Buddhist meditation house and Mikey looked up at me and said, "Orange." When I looked back into his eyes they weren't the eyes of a two-year old. He held my gaze with the most beautiful smile that I have ever seen. For a brief moment, my son knew more than I. He was all knowing, comforting, loving, and still. Mikey held my hand all the way home and he didn't let me go.

Zack caught up to us on the bike just before we turned onto our street. I ran a lavender bath as soon as I walked in the door. Mikey climbed in and Zack leaned over the side of the tub and washed him while I relaxed and enjoyed their company.



Why do parents who don't need the money go back to work?

[Previously published for]

I was talking to a mom at a baby shower who explained why she chose to go back to work even though she didn't need the money. As she told me the story, tears swelled up in her eyes. She works at a company that offers a year maternity leave (amazing, I know). She took the full year with her first child but returned to work after three months with the second. She said that she couldn't handle it. Two kids were too much for her. She felt like she would snap at any moment. So she hired someone to do the job for her. She said that she feels really guiltly about her decision.

The reality of her situation saddens me. People have kids but don't want to do the work or feel someone else could do a better job. She loves her children but she can't be with them all day long. My interest in her story stems from my own mom not wanting to be with me or my two siblings. My mom left my dad and the three of us young children when I was only four years old. She gave my dad custody and went to live in Florida to get her Ph.D.

Maybe it's good that my friend at the baby shower went to work. If that's what keeps a family together, then so be it.



Diaper Free Baby. Well, Not Yet!

I swear, once you start to put your baby on the potty, you'll never turn back. I have bought a ton of different types of diapers: custom cloth from San Francisco's East Bay Jessica


, cheapish cloth diapers from Green Mountain Diapers


, biodegradable diapers


, and


from Lucky's down the street. And, nothing compares to NO diapers at all!

When West has to go poop, he works on it for a good hour and sometimes three hours if he is on his back in bed. I was getting no sleep listening to him grunt and moan for three hours. At first, I thought that he needed to burp. So, I picked him up for a burp and he pooped. It turns out that laying flat on your back isn't the best position for pushing a poop out or a baby for that matter. Plus apparently, we can't pee or poop in our sleep. We have to be awake for the bowels to open. I believe it. If I potty West right when he wakes-up, his diaper is often dry.

It all started when


told me about a friend of hers who pees her baby in her sink when she comes over for a visit. It sounds completely unladylike but putting manners aside for a moment, pee is sterile and is okay for the kitchen sink. So, no big deal?

I asked Lydia if she knew of any books on the subject and she pointed me to

Diapers Free

, which she remembered seeing at her

pediatrician's office

. I checked it out from the library and read it. Serendipitously, I received an email about an Elimination Communication (i.e. Diapers Free) workshop in San Francisco by

Willow Lune

. I signed up. I was curious.

I decided to do a 24-hour trial period before the workshop. My first goal was to "catch" West's nighttime poop so that I could get some sleep. So, when he woke me up in the middle of the night with his groaning and moaning, I took off his diaper and held him in a squat position over a cloth diaper. I can tell if he has to go because his penis is sticking up and looks full. Sure enough, he pooped and peed right away and we happily went back to sleep. I didn't have to clean up a sloppy mess of poop smeared all over his butt either. Now I use a potty and not the cloth diaper and I have less laundry!

Once he is over the toilet, he poops. It's like he waits for it. I don't catch a lot of his pees right now, but I am hoping to as I get use to this new method of diapering or should I say not diapering. I catch the obvious pees like after nursing and first thing in the morning.

Ah yes, I have been pooped and peed on, but it has only been once or twice and isn't much worse than a diaper blowout, which I just had to clean up this morning because I was too tired to poop West in the potty. After changing the bed and doing laundry, I'm motivated again to listen to his cues and put him on the potty. Putting West on the potty isn't much different than reminding a toddler to go to the bathroom at key transitions in the day like before leaving the house, before bed and in the morning.

The concept seems outlandish, but when I started thinking about what most of the world does for diapering babies, it totally makes sense. Most places don't have a Lucky's down the street with


. And the people living in these places don't have the money to spend on diapers. They carry their babies close to them and learn their signs for peeing and pooping.

Yes, I realize that we don't live in India or Tibet but baby instincts are the same. Babies don't want to defecate on themselves. What animal pees and poops on themselves and sits in it for hours.

When I asked Zack this question, he answered, "worms." I responded, "I think worms are insects." Actually, we are both wrong. In any case, I think that we can agree that worms are a far cry from human babies.

I mean really, the more that I think about it, the more that it grosses me out. Would I want to sit in my poop? Diapers are a convenience of modern life for adults. I bet if the babies could talk, they would have something to say about it.

West is five weeks old and wears diapers. I take them off like I would pants when he has to pee or poop. He still sits in his pee sometimes if he is sleeping but it's less now. And, I do hope to have him out of diapers by his first birthday.

Now if only I can get my three-year old out of his nighttime diaper.



Should I Follow My Own Rules?

[Published previously for]

I think that everyone can agree that one kid grabbing a toy from another kid's hands is a big "no,no." Now I ask, what about me (mommy) snatching an open magic marker from Mikey? I have done it before. But it felt hypocritical. Why should I expect him not to take what he wants when I demonstrate the opposite? If it's not life threatening, it can be a perfect learning opportunity and a way to treat him like a sensitive human being.

If I really believe in talking it out and asking for things rather than taking them, then I need to practice what I preach. And so, now I do.

I put my hands together like I am begging for food and kneel down right in front of him. I look at him in the eyes and I am very serious. I say, "Mikey, please give mommy the marker. We only draw on paper. Mommy wants to put the marker away until art time. Please give mommy the marker." He normally drops it gently into my open hands and I say, "thank you." Or, he says, "thank you, Mikey," which means that I should say it. If he refuses then I tell him that I am going to take it on the count of three if he doesn't give it to me. It isn't quite playground rules but I do recognize that I do need to make executive decisions sometimes.

These moments allow me to practice being present. I stop whatever I am doing and embrace the moment. I remain separated emotionally but completely focused on it. These moments don't last more than a few minutes but they are intense and a great spiritual practice. It takes a lot of will power for Mikey to give up the marker and for me not to take the easy way out and grab it from him. Mikey always runs away from the ordeal quite happy and content with himself. And, I save my walls. It's a win win!



Helping with the dishes


If Mikey is begging me to play and the dishes are piling up, I put him to work. Including him in everyday chores is easy and he loves it. In this picture, I am just to his left washing dishes. I made a tub of soapy water and pass him dishes. When he starts getting bored of a dish I say, "Thanks, that one looks done; here's another one. " Sometimes it morphs into water play with two objects. Often, I finish the dishes and he still wants to play with his tub of water.

I always put a towel under him because water never stays in the tub.



Good Communication Skills

[Published previously for]

If Mikey wants something and it conflicts with what I want, I can be sure that the conversation won't end there.

Here's a scenerio: Mikey is standing on a foot stool in the pantry holding the jar of fig bars. We are just about to sit down to dinner and he wants yet another fig bar. So, I say, "Mikey wants another fig bar. Yep, I hear you sweety, you want another bar." His shoulders relax and his face softens and he nods his head. Then I say, "Mikey, you've already had two fig bars, no more, just two."

Most of the time he'll repeat back, "just two." And sometimes we'll do the scenerio again or I'll have to look for a compromise like asking him if he'd like to start eating dinner a little before papa gets home.

What amazes me about this scene is that it works every time no matter what the conflict. By just repeating back to him what he wants, he is soothed into listening. The poor guy just wants to know that he is understood. Don't we all!



Write for Choice!

Here's me on KPOO radio yesterday campaigning for Certified Professional Midwives to be included in the Obama Health Care Reform bill. That's my cute little red-headed baby with me.

When looking into using a midwife for my pregnancy and delivery, I wondered what the difference was between a Certified Professional Midwife and a Certified Nurse Midwife. Here's my unofficial knowledge of the differences:

Certified Professional Midwives specialize in out-of-hospital births like at a birth center or a private home. Certified Professional Midwives can only work outside of hospitals; and therefore, have a lot of experience with low-tech, unmedicated births.

Certified Nurse Midwives specialize in hospital births and are licensed to work in hospitals. Certified Nurse Midwives have gone through more schooling than Certified Professional Midwives. The extra schooling allows them to work in hospitals. Most of their experience comes from working with mamas in a hospital setting, so they are more familiar hospital births than out-of-hospital births.


Health Care Reform

Certified Nurse Midwives are currently included in the first draft of the Health Care Reform bill, but Certified Professional Midwives are not. Certified Professional Midwives are licensed by their states and should be added to the list of Medicaid-eligible providers recognized at the federal level.

Because I had such a fabulous prenatal, birth, and postnatal experience with a Certified Professional Midwife, I would like to see them included in Obama's Health Care Reform bill. Around 50% of births are paid for by Medicaid users. Medicaid only covers Certified Nurse Midwives not Certified Professional Midwives.

I would like to see women given more choice. And so, I am working to get Certified Professional Midwives covered by Medicaid. It's one sentence in the bill. If you're interested in helping, please go


to the MAMA Campaign to send a letter to Boxer, Feinstein, and Pelosi.

Please send your letter this weekend because they're moving fast on the hill and we want our voices heard.

More choices for women!