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cord clamping | delayed cord clamping | newborn health | Dr. Greene | TICC TOCC
April 22, 2014

What is one of the first interventions we perform on a normal birth? What is so 'normal' that we don't even think of it as an intervention? Cutting the cord!

Dr. Greene is asking questions about this intervention... what is the evidence for immediate cord clamping? Here is a Twitter record of a Twitter chat last night on the case for delayed cord clamping. At the moment of birth one-third of the baby's blood is still in the umbilical cord or placenta. What are the potential negative effects of cutting the cord immediately? Read this rather sobering exchange to follow and then take ACTION by spreading the word.

RT @DrGreene: Interventions should have evidence! No evidence for first intervention - immediate stopping baby’s normal flow! #LTKH

A4: In some low-income countries as many as 95% of delivery clinicians practice immediate cord clamping. #LTKH

RT @DrGreene: A4: Doctors thought they were doing good by immediately clamping the cord. And exported the practice around the world. #LTKH

@CarolynHastie
DrGreene I highly recommend reading Mercer's work. Here is an interview I did w/her in 2009 scienceandsensibility.org/?p=810 #LTKH

@CarolynHastie Apr 21, 9:32pm via web
RT @DrGreene: immediate cord clamping increases risk of iron deficiency anemia up to 10x. #LTKH

A5: I did a TEDx Talk about #TICCTOCC that I’d love you all to see - drgreene.com/dr-greene-at-t… #LTKH

@DrGreene
!!!RT @midwifeamy:...

Yaari, shoulder dystocia, obstructed labor
April 02, 2014

Shoulder dystocia is form of obstructed labor. Most obstetricians and midwives will tell you that this problem strikes a bit of dread in teams attending a birth. Fortunately there are a series of clever maneuvers that can often help release a newborn's shoulder from behind the mother's pubic bone. However, in some cases the maneuvers themselves can be dangerous and in other cases they may not work. Dr. Abraham Yaari is a very experienced obstetrician (from Israel but working in the U.S. for deacdes) who has had his share of difficult deliveries. He became increasingly concerned over the last decade as babies have gotten bigger, making the risk of 'shoulder dystocia' higher.

Dr. Yaari took his concerns and created an idea. He then researched and patented that idea, a novel device to resolve shoulder dystocia. Now called the Yaari device, this ingeniously simple little mechanism is on its way to being tested and commercialized.

The consequences of unresolved shoulder dystocia can be grim. In the process of trying to dislodge the infant's shoulder, injury can occur to the brachial plexus. More disconcerting, the infant my suffer asphyxia and the mother has an increased chance of experiencing bleeding as a result of tearing and trauma.

The Yaari device is essentially two stainless steel arms attached to a silicone or medical grade fabric sling. The sling slips behind the infant's shoulder and rotates the shoulder slightly to bring it out from...

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March 19, 2014

She walks, barefooted, mile and miles to find water. She carries babies on her back and both hips. On her head is a basket. Her life is poor, hard, and often violent. Her babies die of diseases due to dirty water. There is war, civil war, and HIV, and TB, and malaria. She does not smile, she does not have hope.

This is the image we more often than not call to mind when we think of women in Africa. It is unfair, and inaccurate, in the sense that while there are millions of women for whom this is an appropriate description, there are many others for whom it is not. I’d like to offer some alternative imagery, and some inspiration, as women on this massive and resourceful continent of Africa are coming to their own rescue, and to the rescue of others. And not just surviving, but thriving.

I’d like to begin by stating the women, are by nature, resourceful and innovative. We are also natural inventors and creators, biologically designed to be so! The idea that women would, and are, leading in the fields of science and technology is not a surprise. However, African women, who’ve also been doing all of this work for millennia, are not often thought of as doing such, and are certainly not given the professional accolades for these kind of achievements on the scale that they should be.

Technology in Africa, and the role women are increasingly playing there, is an untold heroic story, and one we should know about. Consider the significance of investing in women...

anemia | pregnant women | pregnancy | iron deficiency
March 04, 2014

Those who read our blog know that we are very focused on anemia-- and for good reason (we think). Despite increasing efforts to diagnose and treat anemia worldwide, anemia affects 28% of the global population. And for the specific populations of greatest interest to the Maternova team, anemia is of tremendous relevance-- affecting as much as 42% of pregnant women and 47% of preschool aged children internationally.

But did you know that diagnosing anemia in pregnancy requires some additional information and different cutoff points? Did you know that there are trimester specific cutoff rates for anemia? Read on!

Anemia is accompanied by symptoms including weakness, fatigue, difficulty concentrating, and
an unusual rapid heart beat. Health consequences heavily afflict pregnant women, leading to poor pregnancy outcomes and contributing to 20% of maternal deaths. Preferably, anemia is diagnosed through a complete blood count (CBC) assessment. In developing countries, methods of administering this test are costly and unattainable. Efficient testing methods have been developed in order to diagnose anemia in developing countries and primarily rely on analysis of hemoglobin levels. Haemoglobin (Hb) is a protein that is contained in red blood cells. Anemia occurs when the body does not have enough healthy red blood cells, which causes insufficient Hb resulting in an inadequate delivery of oxygen to cells in the body.

Haemoglobin levels are subject to...

ORS | diarrhea | calcutta kids | child mortality | rehydration
February 24, 2014

In the video, the Haitian child was listless: his eyes were sunken and his shriveled body was limp. His mouth curled, turtle-like, to prepare to cry, but no tears came. A gloved hand, arm hairs poking out, reached for the skin around the child’s abdomen. The hand of the clinician pulled gathered skin to form a sinusoid mound. Then, instead of snapping into place as skin normally does, the mound slowly melted back like silly putty. The words “SKIN PINCH” scrolled across the bottom of the video.

The skin pinch is one of the main diagnostic criteria for testing severe dehydration. In those severe cases in which the body has lost more than 15% of essential fluids, the little fluid left in the body rushes to the skin to cause the counterintuitive effect of swelling. Taped during a cholera epidemic in Haiti, this CDC video was showing how to best manage dehydration. The child had become severely dehydrated from the watery diarrhea that is a common and deadly symptom of cholera infection. By the end of the video, thanks to provision of the best possible treatment, the child was healthy and alert.

This “best practice” is something Calcutta Kids is replicating in the slums of Fakir Bagan with the new Rehydration Unit. The Rehydration Unit allows us to tackle the terrible effects of diarrhea on the children under the age of three in our area. I reviewed over this CDC video to train our community health workers to diagnose and deliver key messages in the Rehydration...

misoprostol | Life for African Mothers | postpartum hemorrhage
February 07, 2014

This is a short story about Life for African Mothers connecting the dots-- for compassionate providers and women in the lowest resource countries.

When we first spoke to Angela Gorman of Life for African Mothers we were really intrigued by her model and inspired commitment to women globally. First, like Maternova, she was interested in connecting Product A to Point B. She realized that women were dying, thousands each day, for lack of a tiny pill that costs just 30 cents.That pill? misoprostol. With bureaucracy and counterfeiters making it nearly impossible to obtain locally, Angela devised a brilliant plan to carry in this lifesaving medicine in person.

But with all great plans that are hatched, there's always details to consider; like should she open a clinic in country, or carry in small quantities through her own donation, Neither of these options struck Angela as the right one.

Angela's model was to raise funds to send the misoprostol tablets directly to trusted health personnel. It was devilishly simple. Why trusted health personnel? She needed to find people who had only an interest in saving women's lives-- not in reselling the pills or using them for relatives or letting them simply sit on the office shelves.

We were very intrigued. And furthermore, Life for African mothers has a very interesting philosophy-- they do not share with women the fact that these medicines were donated from another country. They do not want the women...

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January 28, 2014

Since I graduated with my Master of Public Health in 2012, I have been working at a community-based program in infectious disease epidemiology. It is not the global focused job I had originally hoped for, but I was newbie in the public health sectors (who were heavily walloped by budget cuts at the time) and was happy to get a job in public service that fell in line with my future goals. While I am still entirely content at my current position, I find myself frequently daydreaming about the day when I will return to Cambodia and continue to improve the health of those people I met during my public health field study in 2011. Needless to say, this experience transformed me into a more passionate person and is one of the fundamental reasons I find myself back at Maternova today.

Village to village we went for three months and inspected maternal and child health clinics for adequate and accessible management, services, resources, and hygiene. It did not take long for me to fall in line with the reality of the daily struggles of being a mother in rural Cambodia. Not only has access to these health clinics made an impact in maternal and infant mortality, they have also provided these Khmer mother’s an empowering place with medical supplies, medicine, and proper talent. The more we completed the Quality Improvement (QI) Assessments evaluating these measures, the more I realized just how far these clinics had to go, particularly in hygiene. We were told that this...