Professional Education: Intervention Strategies

Strategies for Intervention Are Available

Abstract:
We need further scientific research to isolate the underlying causes of the high rates of BIM. Still, there are guidelines for assessment and treatment, which could improve black infant survival right now by increasing the likelihood that a potentially poor outcome will be detected early. These include providing prenatal care that is both comprehensive and accessible, teaching black pregnant women to recognize the signs and symptoms of preterm labor, encouraging a positive social support environment for the pregnant mother, and testing and treatment for bacterial vaginosis. Social support should continue after birth, encouraging well-baby health visits, including recommended immunizations. To lower the risk of SIDS, mothers should, in most cases, be encouraged to put their infants to sleep on their backs.

Comprehensive and accessible prenatal care.
Lack of prenatal care is an independent risk factor for infant mortality. Furthermore, regular visits to the doctor during pregnancy increase the chance that a problem will be detected early, when there may still be a chance to intervene. See the Healthier Pregnancies section of this website for more information.

Teach your patients the signs and symptoms of preterm labor.

The earlier preterm labor is detected, the greater the chance there is of averting preterm delivery.

Uterine contractions, cramping, and low back pain

Feeling of pelvic pressure or fullness

Change in amount or character of vaginal discharge

Bloody show

Gastrointestinal upset (nausea, vomiting, diarrhea)

General sense of discomfort or unease

Stress and social support.
In their 1996 review of ten years of research on stress, social support, and pregnancy outcomes, Hoffman and Hatch found that intimate social support, such as that provided by a partner or close family member, is associated fairly consistently with improved fetal growth, regardless of a woman's level of stress.¹³ They also report evidence that chronic stressors—such as the experience of racism—pose a risk.

Wadhwa offers a physiological explanation for the impact of stress on birth outcomes. His studies show that maternal-placental-fetal neuroendocrine parameters, specifically plasma levels of ACTH (adrenocorticotropin hormone), bE (beta-endorphin) and cortisol, are significantly associated, both in magnitude and specificity, with features of maternal psychosocial functioning in pregnancy, despite the systemic alterations associated with the endocrinology of pregnancy. These findings could lead to further investigations of the role of the neuroendocrine system as a putative mediating pathway between prenatal psychosocial factors and birth outcome. Chrousos also discusses the impact of stress on the neuroendocrine system.

For these reasons, obstetrical providers should include psychosocial factors in their patient assessments and should promote healthy behaviors and lifestyle choices aimed at reducing stress. Review our section on Cultural Competency for more information.

Bacterial Vaginosis.
Bacterial vaginosis is a common genital infection of pregnant women: 12 to 22 percent have it. As stated earlier, in A Problem Still Unsolved, black women are two to three times more likely to have bacterial vaginosis than their white counterparts. This is a significant concern, since a prospective, controlled trial confirmed that the presence of bacterial vaginosis is associated with increased risks of pregnancy loss at under 22 weeks, preterm premature rupture of membranes, and preterm birth. Studies show that treatment with oral antibiotics reduces the rates of these negative outcomes.

McGregor reports that clindamycin treatment is associated with a 50 percent reduction of bacterial vaginosis-linked preterm birth and preterm premature rupture of membranes.²¹ In women with bacterial vaginosis and at increased risk for preterm delivery, Hauth observed reduced rates of preterm birth when they were treated with a combination of metronidazole and erythromycin.⁷

Women at risk for preterm birth or preterm rupture of membranes because of bacterial vaginosis or common genital tract infections should be screened, treated, reevaluated for cure, and re-treated if necessary.²¹

Sudden Infant Death Syndrome (SIDS).
According to the National Institute of Child Health and Human Development, recent research reports have documented that placing babies to sleep on their backs is associated with a reduction in the incidence of SIDS. However, sleep position in and of itself is not a cause of SIDS.

Unless specific health reasons preclude it, infants should be placed to sleep on their backs on a firm mattress. Instruct parents to avoid the use of bean bag cushions, waterbeds, soft fluffy blankets, comforters, pillows, sheepskins, stuffed toys, or other soft materials.

Other recommendations include:

Caution parents not to allow smoking around infants

Encourage breast-feeding

Encourage regular well-baby health visits including recommended immunizations

Caution parents not to overdress or overheat their infant

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