Thursday, July 1, 2010

Stress of Our Sisters

Stress kills. There has been enough research to prove that. But is stress killing our mothers and babies, especially our black mothers and babies? I say, yes!

First, here is the recent evidence of racial disparity related to maternal /child health:
• A recent NY Times article stated that black women in New York are seven times more likely to die in childbirth than white women.
• An article in a University of Wisconsin alumni magazine, said babies born in Sri Lanka have better health outcomes than black babies born in Milwaukee.
• Another study appeared in the Journal of Community Health concluding, despite socioeconomic differences, fatherless children born to black women had a seven-fold risk of death in contrast to infants born to Hispanic and white women in similar situations.

Now, a quick lesson, about how the human body copes with acute stress. Cortisol “the stress hormone” is released in increased amounts during stress and in turn, helps regulate the body’s many functions
• Proper glucose metabolism, regulation of blood pressure, insulin release for blood sugar maintenance,
   immune function, inflammatory response.

Small increases of cortisol have some positive effects:
   • a quick burst of energy for survival reasons, heightened memory functions, a burst of increase immunity,  lower sensitivity to pain, helps maintain equilibrium in the body.

The problem: while cortisol will return to normal following a stressful event, in our current high-stress culture, the body’s stress response is activated so often that it doesn’t always have a chance to return to normal, resulting in a state of chronic stress.

Most importantly, the higher and more prolonged levels of cortisol in the bloodstream (like those associated with chronic stress) the higher the negative effects, like:
• Impaired cognitive performance, suppressed thyroid function, blood sugar imbalances such as hyperglycemia, decreased bone density, decrease in muscle tissue, higher blood pressure, lowered immunity and inflammatory responses, slowed wound healing.
• Increased abdominal fat, which is associated with a greater amount of health problems than fat deposited in other areas of the body. Some of the health problems associated with increased stomach fat are heart attacks, strokes, the development of metabolic syndrome, higher levels of “bad” cholesterol (LDL) and lower levels of “good” cholesterol (HDL), which can lead to other health problems!

Now, let’s put this in context with a pregnant black woman. It doesn’t matter if she is rich or poor, good neighborhood or bad, educated or uneducated, single or partnered. It is safe to assume that most women are under emotional and physical stress when pregnant. Isn’t it telling that the same medical conditions given for the poor outcomes of pregnant black women are the same conditions resulting from high, chronic stress, for instance, obesity, high blood pressure, high blood sugar and infection? So it must be that black women exhibit or internalize stress at a higher level than their counterparts.

Now for the babies, a mother’s stress level, during pregnancy directly impacts the baby’s physical and emotional health. Research has linked this with preterm delivery, lower birth weight, “The common conception that a mother’s psychological state can influence her unborn baby is to some extent substantiated by the literature,” write Ali S. Khashan, M.Sc., of the University of Manchester, England, and colleagues. “Severe life events during pregnancy are consistently associated with an elevated risk of low birth weight and prematurity.” Chemicals released as part of the mother’s stress response may have an effect on the fetus’ developing brain.

What can be done? If we were to conclude that chronic stress leads to persistent high cortisol levels, which then leads to all these health complications for mothers and babies, how do we fix that? Can we step into someone’s life and eliminate their stress? No. But I do think we can help them limit their exposure, possibly and lessen their body’s response to stress. So they can manage their stress better.

Let’s face it. If you do not address the “inner reasons” someone overeats or is depressed, you can conduct all the nutrition classes you want but they will not work. We need to give women the tools to cope with the multitude of stressors they faces on a daily basis. People have overcome tremendously stressful situations with 12 step work so I propose “The 12 Step Program for Pregnancy”

I am thinking of a program similar to many12 step programs. Support groups for pregnant and new mothers listening and learning from each other. Basing the program on many of the slogans and doctrine of successful 12 step programs, for instance, One Day at a Time, Live and Let Live, Think, Let Go/ Let God, Keep It Simple, the serenity prayer also choosing a sponsor, having a call list and weekly meetings. These are simple and effective principals anyone can learn. Along with classes in guided imagery, journaling, self-hypnosis, exercise, yoga, music, breathing exercises and meditation in the prenatal period and postpartum for the first year.

Promoting healthy, coping skills that can be applied to anyone, at any time, would be a proactive, low cost intervention. Supporting the management of stress through finding serenity, our pregnant mothers would benefit from a new way of thinking, a new way of acting, giving them and their babies a new lease on life.