Health and Wellness: Raising Bakersfield

Breast-feeding combats obesity (Community Voices)

The alarming increase in the number of overweight people has affected children of all ages and socioeconomic groups.

Among low income children aged 2 to 5 in California, rates are higher than the national average. Nearly one in five is overweight and an additional one in six is at risk for being overweight.

Given that weight control programs are typically ineffective among children and weight reduction programs are contraindicated in young children, preventive interventions for our youngest children are critical tools for turning this epidemic around.

Scientific evidence has shown that breast-feeding, especially when infants are breast-fed exclusively for more than three months, reduces the risk for obesity.

Breast-fed infants may be better at self-regulating their intake. Mothers can't see how much milk their child is drinking, so they rely on their infant's behavior, not an empty bottle, to signal when their infant is full. Thus breast-fed babies might be better able to regulate their own intake.

Breast-fed infants are more likely than formula-fed infants to try and to accept new foods.

Acceptance of new foods is important because a healthy diet should include a wide variety of foods, especially fruits and vegetables.

Because breast milk contains flavors from foods eaten by the mother, breast-fed infants are exposed to a variety of tastes very early in life. In contrast, all infant formula tastes the same.

Breast-feeding has different effects than formula feeding on infant's metabolism and on hormones such as insulin, which tells the body to store fat.

The breast-feeding-obesity link is now recognized by key government agencies and professional groups, from the Center of Disease Control and Prevention to the American Academy of Pediatrics. Experts at the CDC in Atlanta estimate that 15 percent to 20 percent of obesity could be prevented through breast-feeding.

The American Academy of Pediatrics recommends exclusive breast-feeding for the first six months and continued breast-feeding with the addition of appropriate foods, up to at least 1 year of age. Increasing breast-feeding in California would mean between 36,000 to 48,000 fewer overweight children and adolescents.

The Women, Infant and Children Program serves as a primary source of breast-feeding support and nutrition education for low-income women in California.

The local Community Action WIC Program has certified lactation educators and consultants to provide breast-feeding education and support. We provide breast-feeding classes at all our WIC sites which are located throughout Kern County.

A quote from the book "The Art of Happiness: A Handbook for Living" is illustrative: "It begins at birth. Our very first act after birth is to suck our mother's milk. This is an act of affection, of compassion. Without that act, we cannot survive. That's clear. That's the way of life. That's reality."

Priya Khullar of Bakersfield is a registered dietitian and lactation consultant with the WIC Program. Community Voices is an expanded commentary that may contain up to 500 words, and is part of The Bakersfield Californian's Opinion section. The Californian reserves the right to reprint commentaries in all formats, including on its Web page.

Originally posted at http://www.bakersfield.com/opinion/letters/story/436319.html on Monday, May 5, 2008.

Expecting to expect? See your doctor

Are you expecting to be expecting? Saving conception for years down the road?

Either way, you should be in a physician's talking about prenatal and preconception care, doctors and researchers say.

"It teaches them to pay attention to their bodies," said Linda Erb, perinatal services coordinator for the county Department of Public Health.

Prenatal care, which is for the soon-to-be mom, entails health care, education and counseling about how to handle different aspects of pregnancy and identifying risks.

Preconception care helps a women get into the best health before getting pregnant.

The Centers for Disease Control and Prevention gave this focus of care a push into the foreground last year when it recommended that all women of reproductive age, meaning between their first period and menopause, treat their health as if they could be pregnant at any time.

This means taking folic acid supplements, maintaining a healthy weight and lifestyle and keeping chronic conditions like asthma and diabetes in check.

Preconception care could positively impact a baby's health during the first months of pregnancy, when many women don't even know they are pregnant, said Dr. Joel Cohen, chief of service of obstetrics and gynecology at Kaiser Permanente in Bakersfield.

"The first six to eight weeks is a critical time in development," he said. "That's when everything is forming."

But while this may improve the health of mom and baby, the link between prenatal care and preterm birth is negligible, according to a recent report.

A landmark study released last year by the National Academy of Science's Institute of Medicine found there isn't enough evidence that prenatal care prevents a premature birth.

Historically, though, avoiding preterm birth has not been a focus of prenatal programs, the report said. Several local health advocates say that is changing.

Prenatal care often falls along ethnic and economic lines, leaving out the mothers who are most at risk for preterm birth, which could also explain its diminished effect, a recent report from the Central Valley Health Policy Institute at Fresno State found.

Asian/Pacific Islander mothers were 27 percent less likely to receive care than white mothers, the study says. Black mothers were 19 percent less likely and Hispanic mothers were 17 percent less likely.

This somewhat follows the local trends for preterm birth. Black women have the highest rates of preterm birth, though, followed by Asians, Hispanics and then whites.

"In many cultures, pregnancy is considered a healthy, natural state. Why do you go to a doctor for prenatal care?" asked Mary Lou Moore, associate professor in the department of obstetrics and gynecology at North Carolina's Wake Forest University. Moore recently spoke at a perinatal health conference at Children's Hospital Central California. "The idea that we have control over nature is a very Anglo/Northern European way of life."

Prenatal care needs to be stressed regardless of its intended target problem, said Dr. Sudhir Patel, chief of neonatology at Kern Medical Center and director of neonatology at Mercy Southwest Hospital.

"If everyone received prenatal care, we may not change preterm birth," he said. "But the baby's health at birth will be better."

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Source: The Bakersfield Californian, Saturday, Apr 14 2007

County telling pregnant women to put down that glass of wine

The county's new initiative to verbally screen pregnant women for drug, alcohol and tobacco use isn't aimed at the stereotypical drug-addicted mom-to-be.

It's aimed at the casual users, the white, college-educated expectant mother who might occasionally smoke or drink.

It’s aimed at women like Nikki Garcia.

Garcia, 38, walked through the Marketplace with her mother on a recent Wednesday afternoon.

“It’s your life,” the Bakersfield mother said. “I think if you have a glass of wine every once in awhile, it’s OK.”

Called Perinatal SART — screening, assessment, referral and treatment — the program educates physicians to ask pregnant women “gender-appropriate” questions about drug use and discuss with them the risks to the baby.

The program emphasizes that there’s no safe amount.

“The safe level is zero,” said Dr. Sudhir Patel, chief of neonatology at Kern Medical Center and director of neonatology at Mercy Southwest Hospital. “The risk is there.”

So far, Kern Medical Center, Clinica Sierra Vista, National Health Services and some private practitioners are on board with the program, but Patel wants to expand it to every OB/GYN in town.

How it works

A fetus’s brain begins developing the third week of pregnancy, said Dr. c, deputy health officer and director of several maternal-child programs at county public health. So it’s important that woman see their OB/GYN soon as possible after conception.

Once in the doctor’s office, the staff will ask patients about their parents’ and partner’s drug use, along with their past or present use.

“Whenever the woman can stop, there’s going to be improvement in the child,” Choi said.

If the physician or nurse feels that there is a risk, the woman is asked more questions to gauge the type and level of exposure, said Patel, who is on the leadership group behind the initiative. A brief intervention is done, in which the potential complications from using the substances are explained.

The physicians might also refer some women to other agencies for help, but 95 percent of the time that’s not necessary, he said.

“That’s the amazing thing,” he said. “If you spend some time and you educate the women, then and there, that in itself decreases continued exposure better than anything else we can find.”

The physician is instructed to ask the women questions in a nonconfrontational way.

“This list of questions and the tool that we’re using is not new,” Patel said. The difference is that this tool is made for women.

“Almost every tool we use has been designed for a man,” including the standard one-line “Do you use drugs?” questions most pregnant women are asked, he said.

The questions are asked in a different tone, “not trying to find out some secret that will take the baby away,” Patel said.

Fear of persecution

By using a different approach, the initiative’s advocates hope to get around one of the biggest fears mothers face: having their babies taken away.

“It’s not that we want to turn people over to the law. In fact, we don’t want to do that,” Patel said. “They think that if they tell us the truth, they will get in a lot of trouble.”

Even if a pregnant woman is abusing drugs, the physician cannot legally break patient confidentiality and report her, said Heidi Carter Escudero, communications director with the county human services department, which oversees Child Protective Services.

“Mandated reporting is the only thing that comes between confidentiality and the patient,” she said. “A child does not exist yet, legally speaking, so there is no mandatory reporting.”

And even after the child is born, Child Protective Services won’t automatically take the baby away if the mother has a substance abuse problem, said Linda Erb, Comprehensive Perinatal Services Program coordinator for the county.

“If a woman shows that she’s doing something about it, that she’s been screened and has been referred, CPS isn’t going to walk in and take the baby,” Erb said.

Still, Carter Escudero stressed the importance of a drug-free pregnancy.

“You can never predict at what point other people will get involved in your life,” she said. “You do have a right to privacy, but your children have a right to a safe and healthy environment.”

On the coast

The program is based on the work of Dr. Ira Chasnoff, a Chicago-based expert who has started the program in several states and several counties in California.

One of those is San Luis Obispo.

“Our choice of drug here in San Luis is alcohol. We are smack in the middle of wine country,” said Jan Campbell, the county’s maternal, child and adolescent health director. “We have physicians in our county who say it is OK to drink moderately.”

An obstacle for San Luis Obispo has been getting doctors to participate.

“A lot of doctors don’t want to think that they have women who are using,” Campbell said. “But it’s not the hard-core drug users we are targeting.”

According to her group’s Web site, of the roughly 2,600 deliveries per year in San Luis Obispo County, 1,305 women were screened at their first prenatal visit in 2004.

Among these women, 42 percent had used alcohol or tobacco during early pregnancy.

“We were absolutely shocked with what we found,” she said.

Other opinions

Kern County’s Kaiser Permanente, the largest medical group in the county, said, “Thanks but no thanks,” to the initiative.

“We support what the Perinatal SART program is trying to accomplish,” said spokeswoman Natalie Erlendson. “But it wouldn’t make sense for us.”

Kaiser doesn’t approve of any alcohol or drugs during pregnancy, she said.

Plus Kaiser already asks patients about use, along with depression, said Heidi Priest, registered nurse in Kaiser’s perinatal services.

“I don’t find that most of them hide the information,” Priest said. “We have several patients who admit to using drugs, and we just get them hooked up with the resources we have.”

San Dimas Medical Group, the county’s largest OB/GYN group, also disapproves of any alcohol, tobacco or drugs during pregnancy, said Dr. Jigisha Upadhyaya, an OB/GYN and medical director of the group.

Patel has talked to the group about the program and will soon be training its doctors, she said. But she’s concerned that there’s not enough resources to refer women to if they need extra help.

“As a doctor you want to diagnose the problem, treat it and win,” Upadhyaya said. “That’s one link that’s missing in the program.”

Kern Mental Health is taking part in the initiative, Patel said.

The county has enough counselors and resources; what’s lacking is a directory to give physicians, he said. The group behind the initiative hopes to have that in the next year, along with an educational conference.

Katie Moyes, 24, said she’s heard of several alcohol and pregnancy old wives’ tales but wouldn’t follow any of them.

“Women feel intense pressure; they feel stressed and want to let loose,” said Moyes, who has no children. “But all of that’s going into your child’s body.

“If you’re going to be responsible for a life, then you need to respect that life.”

Effects of drinking alcohol

• There is no known amount of alcohol that is safe to drink while pregnant

• Drinking alcohol during pregnancy can cause many birth defects and developmental disabilities, which are known as fetal alcohol spectrum disorders. These can cause problems in how a person looks, grows, thinks and acts. They can also cause birth defects of the heart, brain and other major organs.

• Alcohol can harm a baby at any time during pregnancy, including the early weeks of pregnancy before a woman even knows she is pregnant.

Effects of smoking on babies

• Babies born to mothers who smoked during pregnancy have about 30 percent higher odds of being born prematurely.

• They are more likely to be born at a low birth weight, which is below 5.5 pounds, increasing their risk for illness or death.

• They are 1.4 to three times more likely to die of sudden infant death syndrome.

Effects of smoking on pregnant women

• Women who smoke prior to pregnancy are about twice as likely to experience a delay in conception and have about 30 percent higher odds of being infertile.

• They are also about twice as likely to experience premature rupture of membranes, placental abruption and placenta previa, which is when the placenta implants in the lower part of the uterus.

• Pregnant women who are exposed to secondhand smoke have 20 percent higher odds of giving birth to a low birth weight baby than women who are not exposed.

Source: Centers for Disease Control and Prevention

Alcohol statistics

• About 19 percent of women who gave birth reported drinking during the first or last three months of pregnancy.

• Women with incomes over 400 percent of the federal poverty level, which is $68,680 for a family of three, were twice as likely as the poorest women to drink during the first three months of pregnancy.

• These same women were five times as likely to drink alcohol as the poorest women during the last three months of pregnancy.

• Women who had at least a college degree reported the highest rates of drinking alcohol during the first and third trimesters.

• White, non-Latina women reported the highest rate of drinking alcohol during pregnancy.

• Women 35 years and older had the highest rates of drinking in both the first and third trimesters.

Source: 2003 Maternal and Infant Health Assessment, a collaborative project between the state Department of Public Health and the University of California, San Francisco

Smoking statistics

• Smoking was the most prevalent in black and white women, at about 15 percent.

• Women in higher-income families were three times less likely to smoke during pregnancy, compared to women in low-income families.

• Pregnant women ages 15-24 had the highest rates of smoking, at about 13 percent.

• Almost twice as many women smoked when they got their first prenatal care during the second or third trimesters, compared to the women who got care during the first trimester.

Source: 2000, 2003 Maternal and Infant Health Assessment, a collaborative project between the state Department of Public Health and the University of California, San Francisco

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Source: The Bakersfield Californian, Tuesday, Nov 13 2007

Diabetes before motherhood on the rise, Calif. study shows

The number of pregnant women with pre-existing diabetes has more than doubled in seven years, a California study found, a troubling trend that means health risks for both mothers and newborns.

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And the number of diabetic teenagers giving birth grew fivefold during the same period, according to the study, the largest of its kind.

Expectant mothers who don't control their diabetes face an increased risk of miscarriage and stillbirth. Their babies have a higher chance of being born with birth defects.

"These are high-risk pregnancies," said Dr. Florence Brown, an expert on pregnancy and diabetes. "All women with pre-existing diabetes need to plan their pregnancies."

Brown is co-director of the Joslin-Beth Israel Deaconess Medical Center diabetes and pregnancy program in Boston. She had no role in the study, which was done by researchers at Kaiser Permanente, a California-based health care provider.

The researchers focused on health records from more than 175,000 ethnically diverse women who gave birth in a dozen Kaiser hospitals in Southern California from 1999 to 2005. Experts believe the findings likely reflect the overall U.S. population.

The actual number of pregnant women with pre-existing diabetes was small. In 1999, there were 245 such women; by 2005, there were 537. That translates to a rate that rose from 8 per 1,000 pregnancies to 18 per 1,000.

The diabetes prevalence was highest among 13- to 19-year-olds giving birth. The rate ballooned from about 1 per 1,000 pregnancies to 5.5 per 1,000 during the seven-year period.

Blacks, Asians and Hispanics were more likely to have diabetes before pregnancy than whites.

The rise of diabetes among women of childbearing age mirrors the prevalence of the disease in the general population. The most common form of diabetes is Type 2, which is linked to obesity.

About 15 million people in the United States are diagnosed with diabetes, and 1.5 million new cases were diagnosed in people age 20 and older in 2005, according to the American Diabetes Association.

Pre-pregnancy diabetes is different from gestational diabetes, which is developed during pregnancy and disappears later. Gestational diabetes affects 3 percent to 8 percent of pregnant women in the U.S.

In the study, Kaiser researchers did not look at whether any of the women had prenatal diabetes care or how the babies fared after birth. They also could not determine the type of diabetes the women had.

Type 2, which is linked to obesity, occurs when the body makes too little insulin or cannot use what it does produce. Type 1 occurs when the body doesn't produce insulin.

Results of the study were published online Monday in the journal Diabetes Care, a publication of American Diabetes Association, which funded the research.

"There are things women can do before they become pregnant that will increase the likelihood of them having a healthy baby," said lead author Jean Lawrence, a research scientist with Kaiser Permanente Southern California.

That includes controlling blood sugar levels with an insulin pump or maintaining a healthy diet and exercise routine. Overweight women are also encouraged to shed some pounds before getting pregnant.

The North Shore-Long Island Jewish Health System in New York has a special program to help moms-to-be manage their diabetes.

Women are encouraged to seek medical help at least three months before they plan to have a baby so doctors can help them control their blood sugar and increase their intake of folic acid, said program manager Marie Frazzitta.

"By the time a woman knows she is pregnant, the (baby's) heart is already developed," Frazzitta said. At that point, "there's not much we can do."

Michelle Cangemi, who has Type 1 diabetes, was among those who sought care at North Shore before she become pregnant with her first child in 2005.

Cangemi, who had good control of her blood sugar before pregnancy, kept an even closer eye on it while expecting. As someone who normally checked her blood sugar four times a day, she checked 15 times a day during her pregnancy.

"It was definitely something that worried me throughout my pregnancy," said the 29-year-old dietitian whose daughter turned out healthy. "You don't know how the blood sugar levels are going to affect a child that's developing."

Now Cangemi is seven months pregnant with her second child. This time she's less nervous.

"There's so much monitoring that it makes me feel better that everything is going to be fine," she said.

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Source: The Bakersfield Californian, April 27, 2008

Breast-feeding is best spurring nefarious baby formula marketing

They’re at it again. Or, I guess they’ve never stopped: I just haven’t had contact with their nefarious ways for a while.

I’m talking about the corporations that manufacture and market infant formula, and the subtle methods they use to undermine a new mother’s decision to breast-feed her baby. It is, after all, in their interest that as few women as possible breast-feed successfully or for any length of time: Every time a woman sits down and nurses her baby with her own, homegrown breast milk, the formula hawkers are losing money.

I’ve got my Irish up because of the unsolicited literature and free samples that formula companies have been sending my sister, who will birth her first child any day now. Upon casual reading, the literature seems to support breast-feeding wholeheartedly, in positively glowing terms. But upon a closer read, the words make breast-feeding a baby seem like a choice for a superwoman, not a regular woman.

My sister, like all new mothers, is excited about the future, but understandably apprehensive of the unknown. She plans to breast-feed because she knows it is the healthiest choice for her and her baby. But then she hears the nursing horror stories that other new mothers love to tell, and she gets nervous. Can it be painful? Can your nipples really crack and bleed? Can your breasts really get infected, or come to resemble boulders of hardest rock? It’s all a bit intimidating.

Imagine that you are pregnant, susceptible to the scary sagas of your peers. You worry that you will be the woman who endures those complications and hardships while trying to breast-feed your baby. Then a package comes in the mail, full of free powdered formula, accompanied by carefully written sympathy. There, there, soothes the literature, we all know breast-feeding is best, and noble, and even heroic, but it’s a little tricky.

You may not be able to manage it. But don’t worry: When you fail at this difficult endeavor, we will be there with synthetic food for your baby. Or, you can supplement with our formula; just a feeding here and there; just a few moments for yourself. What the brochure doesn’t tell you is that, statistically, once you start supplementing, your nursing days are numbered. The goal of their lovely prose is to get your baby weaned off of your breast and onto their expensive, inferior stuff.

I am intentionally demonizing the formula companies because I do believe they take marketing tips from the serpent in the Garden of Eden. They use our own fears and misgivings against us, and cast their product in the role of savior.

The fact is, formula and breast milk are not interchangeable! Human breast milk is the perfect, irreplaceable food for human babies. My sister, and just about any new mom, can breast-feed successfully: The female breast is marvelously designed to nourish infants. But breast milk doesn’t add a single dollar to the formula makers’ bottom lines. And so they declare war.

Source: The Bakersfield Californian, Friday, Mar 21 2008

Oh, baby! U.S. Navy nurse gives new meaning to multi-tasking

Birthdays are special, and birth days — hospitals, backless gowns, labor pains and hearing that first cry — are special, too, but not just for the parents. Imagine the euphoria of seeing a baby born. Now imagine that feeling times a hundred.

When Teresa Lee McFarland was 34, she and a neighbor decided that they needed a diversion from the monotony of everyday life. Raising kids isn’t easy work, and if you’re raising five young boys, like McFarland, then life can seem downright taxing at times.

Of course, it isn’t unusual for women to seek bonding time away from their children. McFarland is not unique because she acted on a whim and decided to do something for herself. Some women join Bunco or reading groups, some play bridge.

McFarland joined the U.S. Navy.

She became a reservist on weekends — in her spare time between raising five sons as a single parent, driving a school bus and attending college classes to become a nurse.

McFarland, now 49, was born into an Air Force family but said that she and her neighbor joined the Navy because, “Navy boot camp was only two weeks.” The Air Force required six.

With so much going on, it would have been easy for McFarland to fail at something. She didn’t.

“Her name means ‘industrious,’ and it is a perfect fit,” said Staff Sgt. Jesse Tait, McFarland’s son, who is currently serving the U.S. Army in Okinawa, Japan. “Teresa has backpacked in Yosemite, rebuilt engines, poured foundations, framed houses, tarred roofs, soldered plumbing and driven bulldozers and school buses.”

McFarland did something else, too. It took her nine years, but she earned her bachelor’s degree in nursing from Cal State Bakersfield. And she did it mostly from the Kern County mountain community of Frazier Park.

In those earlier years, a typical day for McFarland was to rise early, strap her youngest child in his pajamas to a seat in the school bus and start her route, making her last stop the day care facility. She would then attend classes at College of the Canyons.

After classes, McFarland would go back to work driving the late bus, get home and switch hats from bus driver/student to Mom.

When she was finally able to transfer to CSUB, McFarland moved to the Northwest, to a city she considers her home.

“People in Bakersfield are generous, helpful, friendly and genuine. They are a bit quirky, but that’s one of the reasons I fit in so well!” said McFarland.

She fit in well somewhere else, too: the Navy Reserves.

In July 2005, McFarland had graduated with her degree in nursing and was working as a public health nurse when she received a phone call that would change her life.

“I learned that I had been activated to serve during Operation Enduring Freedom,” she said. Her date to report: Sept. 11, 2006.

McFarland packed all her belongings into storage, put her two llamas up for adoption and moved to San Diego to serve as a Navy reserve nurse for her 16-month deployment.

McFarland, now a lieutenant, was assigned to the Navy Medical Center San Diego (NMCSD) as a labor and delivery nurse.

Moving away from everyone she loved wasn’t easy. Well aware of her fortune to be in a city highly regarded for its tourism, and not in the desert or on a ship, McFarland counted herself lucky.

To battle the inevitable loneliness that accompanies any deployment, she volunteered to work nights, weekends and holidays so that her coworkers could spend time with their families. She ate from a Crock-Pot in a motel room and baked cookies (four at a time) in a toaster oven to share with the security guards on duty.

McFarland also helped deliver a lot of babies.

“One night shift, we delivered 16 babies, and six of those by cesarean section,” she said. Although McFarland wasn’t really counting officially, she had a feeling she was getting close to her 100th birth.

In July 2007, something made her go back and count. McFarland discovered that when she arrived to work on Aug. 1, she would have the opportunity to help deliver her 100th baby.

It was a special day, to be sure. Special for the military parents having the baby — and special for McFarland.

Aug. 1, 2007 would also be her 49th birthday.

In all, McFarland estimates that she delivered nearly 160 babies before returning to Bakersfield in January. When she got home, she discovered that she was a changed person.

“I am amazed by the high caliber of men and women — some of them quite young — that are putting their lives on hold or even on the line to actually do something for a purpose that is far more than just personal,” said McFarland.

The overall sense of patriotism, she said, is what lingers after her 16-month deployment. That, and her faith in America’s youth.

“I feel good that the country is in the capable hands of these young people.”

Although she isn’t the type to take credit, McFarland has served this country as well as the young mothers she currently mentors and the five boys she raised on her own, while she worked and went to college.

Some might even call her a hero, including her son.

“Dreams cannot be realized idly, waiting for the right circumstances or a serendipitous stroke of luck,” wrote Tait, McFarland’s son, in an e-mail. “Faith, loyalty, determination, and perseverance are required to achieve your goals and arrive there happy.

“Throughout my life, I have known only a handful of people that embody this truth. The greatest example is, by far, Teresa Lee McFarland.”

Originally published at http://www.northwestvoice.com/home/ViewPost/54896 on Wednesday, April 9, 2008.