In Kentucky, the 2016 infant mortality rate was 6.8 deaths per 1,000 live births, somewhat higher than the national rate of 5.6 deaths per 1,000 live births. Despite over a century of medical advances in treating mothers through the cycle of pregnancy and beyond, these numbers remain at an unacceptably high level.
Infant mortality rates are even higher for certain population groups: minorities; mothers who give birth under the age of 19; and those in the lower economic strata. The rates remain high even as the newborn infant matures up to one year of age.
In this episode of Kentucky Health, Dr. Wayne Tuckson speaks with the director of nursing at the University of Louisville Hospital about the best practices for prenatal care, delivery care, and post-natal care, and also about the crucial health benefits that are formed when a mother and infant establish a physical and emotional bond soon after childbirth.
Frances E. “Libby” Smith, PhD., is the director of nursing for the Center for Women and Infants at the University of Louisville hospital. Smith says that society’s treatment of pregnancy underwent significant changes in the late 19th and early 20th centuries, as it evolved from an event that largely took place in the home to one that required hospitalization.
“In the home, you had infant mortality and you also had maternal mortality, but people accepted that that was the way it was,” Smith says. “Nowadays, those are not acceptable statistics. Healthy babies should never die, and healthy mothers should never die.”
The Best Practices for Infant Care
The majority of infant deliveries occur in hospitals today, but some births still take place at the mother’s home or in other setting. Most of these home births are safe, but a small fraction are not. The Center for Women and Infants at U of L Hospital works with the local midwife groups in the Louisville area to provide assistance to any home birth that encounters difficulties, Smith says.
Smith briefly explains the difference between doulas (birth attendants who support mothers through the delivery process but do not participate); midwives (who may have nurse certification or be lay midwives, and who do participate in delivery); and obstetricians (medical doctors who deliver babies in all situations). Midwives have a strong tradition in Kentucky. This tradition dates back to the early 20th century and the formation by Mary Breckinridge of the Frontier Nursing Group, created to assist pregnant women in the far reaches of Eastern Kentucky and other areas. Smith says that midwives back then, and some of them even today, provide a wide range of medical services that extend far beyond pre- and post-natal care.
“You’re actually talking about a continuum of care from the time a woman starts menstruating, all the way through her death,” she says. “So, you have that entire period of a woman’s life where you can use an OB-GYN or a nurse midwife as your primary care provider. Reproductive health, breast health – you name it, if it has anything to do with women and women parts, and some midwives act as primary care providers, and insurance has allowed us to do that for a number of years.”
Smith says that any woman who is of child-bearing age and who is sexually active needs to adopt lifestyle changes that will prepare both themselves and their future child for a normal, healthy pregnancy and childbirth. In particular, she advises women to take prenatal vitamins through their years of fertility, as they provide many nutrients that help to prevent birth defects.
“The best advice for any female person who is thinking of getting pregnant, or who is pregnant,” Smith says, “is to see a good health care provider, get good prenatal care – and that means every single visit, not just one or two – don’t smoke, don’t use recreational drugs, and don’t drink alcohol prior to pregnancy, during pregnancy, and not until you’re about 90. And then if you want to do those things at 90, I’m not going to object.”
The Importance of Mother-Infant Bonding
Smith says that “kangaroo care” and “skin-to-skin care” are often used to refer to the standard practice of placing a newborn infant on the mother’s chest immediately after childbirth. This is an absolutely essential first step in forming the mother-child bond, Smith says. A video clip from KET’s 2014 program “Safe and Sound” is shown that follows childbirths at the U of L Hospital’s Center for Women and Infants and further explains the process.
In the video clip, interviews with Smith and with Dr. Lawrence Wasser, M.D., who is the director of the Newborn Nursery at the center, detail how kangaroo care and the intimacy it provides help infants with body temperature control and other biological functions. For mothers, kangaroo care causes an increased release of the hormone oxytocin – the “love hormone,” Smith says – which starts the lifelong bonding process. Fathers or significant others can also participate in the skin-to-skin bonding process when the mother takes a break.
As Smith explains in the 2014 clip, research has shown that infants who are not held closely by their mothers from childbirth onward and who are not picked up and given constant face time with their parents are at a higher risk of forming developmental or behavioral problems as they get older. This contradicts earlier cultural assumptions about infants that they should be left alone to “cry it out” when upset, Smith says.
Back in the studio, Smith says that there are many important post-natal care practices that mothers and other caregivers need to be aware of. At the U of L center, a nurse is assigned to monitor each baby in the days after delivery to assist with educating the family.
Smith is a committed advocate of breast feeding as opposed to using formula, and she says that ideally, breast feeding should occur for six months to up to a year after childbirth. “Humans should not give their babies cow’s milk,” she says. “All research says that human milk is made for human babies.” She says that if mothers cannot or will not breast feed for a long duration, even one session is better than none at all, in that it helps an infant’s digestive system adjust to formula in subsequent feedings. A better substitute for formula is pasteurized donor milk, according to Smith.
As far as holding a newborn is concerned, Smith says that “the ideal place for baby when mom, dad, or significant other is awake is on mom’s chest, or on the significant other’s chest. Always make it so you can see the baby’s face. If the baby’s face is pink, and the lips are pink, the baby’s breathing.” When a baby is left in its crib to sleep, it should be always be placed on its back, and the crib should be clear of all other objects – blankets, toys, pillows – until the infant is old enough to grip and move materials around without assistance.
