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DiversityNursing Blog

From the NICU to the Moon: Babies in Intensive Care Dream Big

Posted by Erica Bettencourt

Mon, Nov 10, 2014 @ 03:13 PM

BY CHIARA SOTTILE

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Twice a day, Michele Forth drives 45 miles to the Neonatal Intensive Care Unit to visit her 4-month-old baby she affectionately calls "Miss Madilyn." She is a 6-pound fighter in pink pajamas — but to her family and the nurses who care for her day and night, she is so much more.

"Hi, pumpkin! You just waking up?" Forth coos. Nurse Adrianna "Adri" Zimmerman, wearing purple scrubs and a warm smile, hands Madilyn to her father who is quickly surrounded by his wife and two young sons.

"She fights harder than any adult that I know, let alone a 6-pound baby," says father Shane Forth, softly stroking Madilyn's delicate left foot in his hand.

It was in that spirit that the nurses chose to see Madilyn, one of nearly 100 babies cared for in the NICU at Children’s Healthcare of Atlanta every day. "We always talk about how feisty this one is or how sweet this one is,” Zimmerman says.

That bedside chatting took on a whole new life with a photo series called "From the NICU to the Moon" that imagines what the babies dream about as they wiggle and smile in their sleep, and what they might become someday. It also aims to educate parents about safe sleep for newborns.

The nurses and hospital communications team imagined Madilyn as a physician, surrounded by stethoscopes and Band-Aids. The photo series also features Brentley, the future astronaut, Arianna, the future chef, Sofia the ballerina, and Carolina as an Olympian.

Madilyn was born two months early and has what is called vacterl association (a collection of birth defects), resulting in multiple surgeries and months in the NICU. Zimmerman remembers Madilyn's arrival in the NICU like it was her own child.

"I think she's strong and she's definitely got the will to see whatever it is through to the end, so, if that happens to be med school in a few years, I would not be surprised," says Zimmerman. "It's funny how much personality these babies have."

And Mom is happy with the depiction. "Even though Miss Madilyn does have a whole bunch of obstacles ahead of her right now," she says, "she can do amazing things and she can aspire to be anything that she wants to be."

Carolina, the tiny Olympian, is “a strong-willed patient who has a lot of heart and she is letting nothing hold her back," says Jessica Wright, a NICU Nurse with 10 years of experience. "Just because they were born early doesn't mean they cannot do whatever they want when they grow up in life."

True to her athletic depiction, Carolina is hardly ever still in her crib. Gazing up at the green alligator and orange lion of her soother, Carolina playfully kicks her feet back and forth, her bright eyes fixed on Nurse Wright. "What are you thinking about?" Wright asks, her hand on Carolina's blue and pink ensemble, "You tell 'em about it, wiggle worm."

Sofia, the ballerina in the photo series, is also on the move. Since she was photographed, Sofia was able to leave the NICU and go home with her parents, Fred and Dawnyale "Dawny" Hill.

In the pale orange light of an Atlanta sunset, Fred and Dawny cradle their daughter in their arms on the family's front porch. It's Sofia's first time outside on the porch and her longest stint outside in the evening since she went home. "What do you think? What do you think? Hill asks his daughter, holding her hand. "Interesting, huh?"

Sofia spent 157 days, 20 hours, and 6 total minutes in NICUs. Respiratory and reflux issues keep this 5 1/2-month-old on an oxygen tank and feeding tube.

"She has some accessories, as we like to refer to them as," says Mr. Hill, about the oxygen tank and tubes. "They kind of travel with her."

But in the "NICU to the Moon" photos, Sofia left all the tubes behind for the stage and curtains. "It made her seem normal. The way the pictures kind of erased all of the cords. All of the tubes," says Hill of his daughter. "I saw the innocence of Sofia as opposed to my child in the NICU."

"She's got a family full of dancers on both sides so we definitely are excited to see Miss Sofia the ballerina come about," Dawny says with a laugh. "She'll be dancing around."

But for now, the Hills cherish moments with Sofia at home, like their evening bedtime routine. Mr. Hill carries Sofia on his chest while Dawny wheels the oxygen tank and other cords towards the bedroom. "Good holding your head, Sofia. Look at you," applauds Mrs. Hill.

As they gently place her on her back in her crib, Sofia rubs her eyes.

"Hey, you had a good day. You had a good day, right? Are you sleepy?" asks her father, the machine beeping and sighing next to the crib.

"Ready? Time to pray," Mr. Hill says, kneeling over the crib next to his wife. They pray for every organ in their daughter's body and give thanks to the doctors who helped bring her home.

"We will be keeping up our bedtime routine," Mrs. Hill says, looking at her husband. "Until she can start saying her prayers," he answers.

"Any child that has to go through that much opposition from day one, there's got to be something great for them to accomplish out of life, so my hope is that she accomplishes exactly what she was sent here to do," Mr. Hill says.

And with that, the bedroom light switches off and one more former NICU baby gets to dream of her future in her own crib.

Source: www.nbcnews.com

Topics: health, family, nurses, health care, medical, hospital, NICU, intensive care unit, babies, photography

After 8 Years Of Infertility, Parents’ Shocked Reactions To Quadruplet Pregnancy Go Viral

Posted by Erica Bettencourt

Mon, Oct 06, 2014 @ 11:34 AM

Ashley and Tyson Gardner of Pleasant Grove, Utah, tried to conceive for eight years when they turned to in vitro fertilization this summer.

Boy, did it work. Or rather, girl, did it work. In July, they got the “surprise of our lives” when they went in for an ultrasound and found out they are expecting two sets of identical twins -- all girls.

A photo of the couple looking shocked while holding the ultrasound images has gone viral on their Facebook page, which also features photos of the moment they first found out Ashley was pregnant.

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"My whole goal in opening up about this is to promote infertility awareness," she said in a recent YouTube video. "It's not something that's talked about a lot and it's a really hard trial that people go through."

Ashley's fertility problems were caused by endometriosis, so the couple at first tried intrauterine insemination, she told BabyCenter.com. When that didn't work, they tried IVF, which cost them $12,000 out of their own pockets.

Ashley is now 18 weeks along and she and her husband are busy trying to pick names for their four girls.

"We were so blessed," she writes on her Facebook page.

Source: http://www.today.com

Topics: twins, ultrasound, viral, quadruplet, infertility, parents, nursing, health, pregnant, video, hospital, medicine, babies

How Scientists and Doctors Use Baby-Friendly Tricks to Study Infants

Posted by Erica Bettencourt

Mon, Aug 04, 2014 @ 04:48 PM

By GILLIAN MOHNEY

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For all the impressive advancements in medical technology, researchers and scientists still face a daunting challenge when they study the habits of the adorable but uncommunicative subjects called human infants.

In order to study infants without overwhelming them, scientists often try to mask the massive machines needed to view brain activity either by having the child sleep through it or by covering it in kid-friendly decorations. Other researchers have devised decidedly low-tech ways of reading an infant’s interest in a subject, even when they can’t say a single word.

In a study released Monday in the Proceedings of National Academy of Sciences, doctors used a special machine to examine infant brain activity as they start to learn language skills.

Patricia Kuhl, a professor of speech and hearing sciences at University of Washington and the lead author of the study, said the research indicated the area of the infants’ brain that controlled motor skills lit up when they heard certain words. The activity indicated that the infants are trying to mimic adults and speak much earlier before they say their first word.

However, Kuhl said, the study was important because of both the surprising findings and the way researchers were able to get them. To “read” the infant’s brain activity, they used the cutting-edge device called a magnetoencephalograph, that was quiet and nimble enough to read the chaotic world of infants’ brain activity.

Kuhl said unlike an MRI machine, which is extremely loud and requires a patient to be totally still, the magnetoencephalograph is nearly silent. However the infants still had to be strapped into a chair, so to keep them entertained the researchers were tasked with making silly faces and holding up toys all in the name of science.

“You want them to like the lab,” said Kuhl. “It’s decorated with fish and it’s got little stickies [on it.] It’s ... very baby friendly. We wave toys and we’re very aware and of their curiosity and of their desire to play. We do everything to make them comfortable.”

In a 2013 study published in Psychological Science, researchers used MRI machines to examine baby’s brain activity in response to different stimuli. However, to get the infants into a machine where they could not move, the researchers had the babies go in after they fell asleep naturally. They also used ear coverings so the loud MRI machine didn’t wake the infants.

MRI machines can be so distressing for patients because of claustrophobia or other fears about being in the hospital that a New York Hospital installed a pirate-themed scanner to put children (and some parents) more at ease.

“The genius is in this machine. ... There’s no noise and the baby can listen and can move,” said Kuhl of the magnetoencephalograph. “The ability for the first time to do this kind of recording in this kind of technical advanced machine ... [it’s like] we’re putting [on] a stethoscope.”

Aside from technological advancements, researchers rely on some decidedly low-tech approaches when studying infants.

Fei Xue, a professor of psychology at the University of California Berkeley, has done numerous studies examining how infants learn and react to new toys or information. She said researchers have plenty of tricks to keep babies focused on the tasks at hand.

Xue said most studies only last between 5-10 minutes because the infants will get bored if they're longer. If they want a baby to focus on an object, they darken the room and light up the object to draw the baby's attention.

“In a way, it’s easy to work with infants,” said Xue. “They’re very curious and they’re interested in the world.”

To measure if babies are interested in an object or scene without getting verbal confirmation, Xue and her fellow researchers simply follow the infant’s eye movement. While there are special computer programs, Xue said often it just comes down to a researcher holding a stopwatch and watching the infant through a monitor.

In spite of the infants’ inability to speak, Xue said, understanding their thought process can reveal how they learn, which could eventually help shape education programs.

“When they go to preschool and elementary school ... they will help us to know how to structure the school system,” said Xue of her young subjects. “Understanding these really young humans is important.”

Source: http://abcnews.go.com

 

Topics: study, infants, happy, tricks, doctors, medicine, hospitals, babies

Government Shutdown Baby Boom: Real or Coincidence?

Posted by Erica Bettencourt

Mon, Jul 14, 2014 @ 01:43 PM

By KATIE MOISSE

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It’s been nine months since the government shutdown, and some D.C. area hospitals are reporting a surprising development: Babies. Lots of them.

Sibley Memorial Hospital in Washington, D.C., has seen an additional three births per day in July, according to spokesman Gary Stephenson.

“We’re at near-capacity right now,” said Stephenson, joking that some furloughed workers “apparently found ways to amuse themselves.”

Virginia Hospital Center in Arlington delivered 99 more babies in April, May and June than they did in the same stretch last year, according to spokeswoman Maryanne Boster.

Both hospitals stopped short of crediting the two-week shutdown in October 2013 for the spike in births, stressing that the apparent link was purely anecdotal. But it’s not the first time a local baby boom has been blamed –- albeit anecdotally –- on an event nine months prior.

“It’s just so appealing to think, ‘Oh, it’s a full moon,’ or ‘it’s nine months after a blackout or Hurricane Sandy,’” said Dr. Marjorie Greenfield, chief of obstetrics and gynecology at University Hospitals Case Medical Center in Cleveland. “But there’s a lot of natural fluctuation.”

Some days Greenfield has 20 women in labor, she said. Other days, there are four.

“There are so many things that play into whether someone gets pregnant,” she said, explaining that a small proportion of furloughed couples would be fertile –- not to mention eager to conceive -– during the two-week shutdown.

“It’s such a sexy topic,” she said of the big event-baby boom link. “It just doesn’t appear to be real.”

But other OBs say they not only see an uptick in births nine months after unusual events like blizzards and blackouts, their patients say those events are why they got pregnant.

“I can say that I've definitely seen spikes after things like hurricanes, blackouts and blizzards,” said Dr. Jennifer Ashton, ABC News’ senior medical contributor and a practicing OB/GYN. “I’m not aware of any hard data on this, but anecdotally, many obstetricians will ask their patients about the events nine months prior, and many women will say 'Yes, we conceived during the blackout.'"

Ashton said it’s definitely possible that the link is coincidental, and said there tend to be seasonal fluctuations in birth rates as well.

Boster of Virginia Hospital Center said they expect to see the baby boom continue through the summer months “after the long, snowy winter.”

Source: http://abcnews.go.com


Topics: government shutdown, baby boom, hospitals, babies

Coming to U.S. for Baby, and Womb to Carry It

Posted by Erica Bettencourt

Wed, Jul 09, 2014 @ 11:15 AM

By 

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At home in Lisbon, a gay couple invited friends over to a birthday celebration, and at the end of the evening shared a surprise — an ultrasound image of their baby, moving around in the belly of a woman in Pennsylvania being paid to carry their child.

“Everyone was shocked, and asked everything about how we do this,” said Paulo, who spoke on the condition that neither his last name nor that of his husband, João, be used since what they were doing is a crime in Portugal.

While babies through surrogacy have become increasingly common in the United States, with celebrities like Elton John, Sarah Jessica Parker and Jimmy Fallon openly discussing how they started a family, the situation is quite different in Portugal — as it is in most of the world where the hiring of a woman to carry a child is forbidden. And as Paulo and João have discovered, even bringing home a baby born abroad through surrogacy can be complicated.

In an era of globalization, the market for children crosses national borders; witness the longtime flow of Americans who have gone overseas to adopt babies from South Korea, China, Russia and Guatemala.

Other than the United States, only a few countries — among them India, Thailand, Ukraine and Mexico — allow paid surrogacy. As a result, there is an increasing flow in the opposite direction, with the United States drawing affluent couples from Europe, Asia and Australia. Indeed, many large surrogacy agencies in the United States say international clients — gay, straight, married or single — provide the bulk of their business.

The traffic highlights a divide between the United States and much of the world over fundamental questions about what constitutes a family, who is considered a legal parent, who is eligible for citizenship and whether paid childbirth is a service or exploitation.

In many nations, a situation that splits motherhood between the biological mother and a surrogate carrier is widely believed to be against the child’s best interests. And even more so when three women are involved: the genetic mother, whose egg is used; the mother who carries the baby; and the one who commissioned and will raise the child.

Many countries forbid advertising foreign or domestic surrogacy services and allow only what is known as altruistic surrogacy, in which the woman carrying the baby receives payment only for her expenses. Those countries abhor what they call the commercialization of baby making and view commercial surrogacy as inherently exploitive of poor women, noting that affluent women generally do not rent out their wombs.

But while many states, including New York, ban surrogacy, others, like California, welcome it as a legitimate business. Together, domestic and international couples will have more than 2,000 babies through gestational surrogacy in the United States this year, almost three times as many as a decade ago. Ads galore seek egg donors, would-be parents, would-be surrogates. Many surrogates and intended parents find each other on the Internet and make their arrangements independently, sometimes without a lawyer or a formal contract.

The agencies that match intended parents and surrogates are unregulated, creating a marketplace where vulnerable clients yearning for a baby can be preyed upon by the unscrupulous or incompetent. Some agencies pop up briefly, then disappear. Others have taken money that was supposed to be in escrow for the surrogate, or failed to pay the fees the money was to cover.

Surrogacy began in the United States more than 30 years ago, soon after the first baby was born through in vitro fertilization in England. At the time, most surrogates were also the genetic mothers, becoming pregnant through artificial insemination with the sperm of the intended father. But that changed after the Baby M case in 1986, in which the surrogate, Mary Beth Whitehead, refused to give the baby to the biological father and his wife. In the wake of the spectacle of two families fighting over a baby who belonged to both of them, traditional surrogacy gave way to gestational surrogacy, in which an embryo is created in the laboratory — sometimes using eggs and sperm from the parents, sometimes from donors — and transferred to a surrogate who has no genetic link to the baby.

But thorny questions remain: How much extra will the surrogate be paid for a cesarean section, multiple births — or loss of her uterus? What if the intended parents die during the pregnancy? How long will the surrogate abstain from sex? If she needs bed rest, how much will the intended parents pay to replace her paycheck, and cover child care and housekeeping?

“The gestational carrier has to agree to follow medical advice, but there has to be some level of trust,” said Andrew W. Vorzimer, a Los Angeles surrogacy lawyer who advises on many arrangements that have gone awry. “Once everyone goes home and the doors are closed, there’s no way to really monitor what’s going on.”

Since the Baby M case, the common wisdom has been that the main risk for parents is the surrogate’s changing her mind. But Mr. Vorzimer, who has tracked problem cases in the United States over the years, said it was the reverse: Trouble most often starts with the intended parents. One intended mother decided, well into the pregnancy, that she could not raise a child that was not genetically hers. Another couple, after a divorce, offered the surrogate mother money to have an abortion.

Over the decades, Mr. Vorzimer said, there have been 81 cases of intended parents who changed their minds and 35 in which the surrogate did — 24 of them traditional surrogates who both provided the egg and carried the baby.

Surrogacy remains controversial, even in the United States, despite the rapid proliferation of clinics, doctors and agencies. When all goes well, supporters say, the arrival of a baby to parents with no other path to a biological child is an unparalleled joy.

Opponents tend to focus on the cases in which the surrogate suffers health problems or is abandoned by the intended parents, or in which the fetus has serious defects. Abortion politics hang heavily over the issue: Often, surrogacy involves twin or triplet pregnancies, with the possibility of selective reduction.

Critics sometimes draw an analogy to prostitution, another subject that raises debate over whether making money off a woman’s body represents empowerment or exploitation.

In Canada, as in Britain, payment for surrogacy is limited to expenses.

“Just like we don’t pay for blood or semen, we don’t pay for eggs or sperm or babies,” said Abby Lippman, an emeritus professor at McGill University in Montreal who studies reproductive technology. “There’s a very general consensus that paying surrogates would commodify women and their bodies. I think in the United States, it’s so consumer-oriented, so commercially oriented, so caught up in this ‘It’s my right to have a baby’ approach, that people gloss over some big issues.”

Germany flatly prohibits surrogacy, with an Embryo Protection Act that forbids implanting embryos in anyone but the woman who provided the egg. Ingrid Schneider of the University of Hamburg’s Research Center for Biotechnology, Society and the Environment said it is in children’s best interest to know that they have just one mother.

“We regard surrogacy as exploitation of women and their reproductive capacities,” Dr. Schneider said. “In our view, the bonding process between a mother and her child starts earlier than at the moment of giving birth. It is an ongoing process during pregnancy itself, in which an intense relationship is being built between a woman and her child-to-be. These bonds are essential for creating the grounds for a successful parenthood, and in our view, they protect both the mother and the child.”

With all that is known about adopted children’s seeking out their biological parents, other European experts say, it is wrongheaded to create children whose relationship with the woman who provided the egg or carried them will be severed.

Emotional and Financial Costs

The restrictions in many countries have been a boost for American surrogacy. For overseas couples, the big draw is the knowledge that many states have sophisticated fertility clinics, experienced lawyers, a large pool of egg donors and surrogates, and, especially, established legal precedent.

“We chose the United States because of the certainty of the legal process,” said Paulo, an engineer and scrub nurse. “Surrogacy is very secretive in Portugal. People don’t talk about surrogacy, and it’s hard to get any information. In the United States it is all clear.”

But it is not cheap. International would-be parents often pay $150,000 or more, an amount that rises rapidly for those who do not get a viable pregnancy on their first try. Prices vary by region, but surrogates usually receive $20,000 to $30,000, egg donors $5,000 to $10,000 (more for the Ivy League student-athlete, or model), the fertility clinic and doctor $30,000, the surrogacy agency $20,000 and the lawyers $10,000. In addition, the intended parents pay for insurance, fertility medication, and incidentals like the surrogate’s travel and maternity clothes.

Because surrogacy is so expensive in the United States, many couples travel to India, Thailand or Mexico, where the total process costs half or less. But complications have arisen — as in the case of a couple stuck in India for six years, trying to take home a baby boy, whom genetic testing had found not to be related to them, apparently because of a mix-up with the sperm donation.

Four years ago, according to Stuart Bell, the chief executive of Growing Generations, a Los Angeles surrogacy agency, only about 20 percent of its clients came from overseas, but now international clients are more than half. Other agencies report the same trend.

“Anyone who can afford it chooses the United States,” said Lesa A. Slaughter, a fertility lawyer in Los Angeles.

Some lawyers who handle surrogacy tell of ethical problems with intended parents from abroad. Melissa Brisman, a New Jersey lawyer who handled Paulo and João’s surrogacy, had a prospective client from China who wanted to use five simultaneous gestational surrogates. She turned him down.

Mr. Vorzimer, in California, had an international client who wanted six embryos implanted.

“He wanted to keep two babies, and put the rest up for adoption,” Mr. Vorzimer said. “I said, ‘What, like the pick of the litter?’ and he said, ‘That’s right.’ I told him I wouldn’t work with him.”

Probably the most agonizing cases, though, are those in which the intended parents and the surrogate do not agree on what to do about a fetus with severe defects.

Heather Rice, an Arizona mother of three, said her first surrogacy was “an experience so great I knew I wanted to do it again.” She had a very different experience the second time, when, after two miscarriages, a routine ultrasound showed that the 21-week-old fetus had a cleft in his brain.

“Mom walked out of the room, left me lying there, and I thought: ‘This is not my baby. I should not be dealing with this by myself,' ” she said. “But I told Mom, ‘I’ll respect your decision, whatever you decide, because this is your baby.’ A couple days later, they called and told me they didn’t want their little boy so I should get an abortion.”

With only days left before an abortion would become illegal under Arizona law, Ms. Rice found herself unwilling to kill the fetus.

“I think my motherly instincts kicked in when they didn’t want him,” she said. “I told them I just couldn’t do it. Dad told me God was going to punish me for disobeying them.”

Ms. Rice found a woman whose child had the same condition who wanted the baby. And on the 28-week ultrasound, the brain looked somewhat better. When Ms. Rice called and told the intended parents that someone would take the baby, they said they had decided they wanted him after all. At the delivery, though, the mother did not show up.

“When I called, she said Dad had been in the waiting room all night,” Ms. Rice said. “I was crying. I said he has to come in; he’s the father; he should be here. He came in, he cut the cord. He took the baby. And that’s the last I ever heard from them.”

Ms. Rice said she had no idea how the baby was doing, or even whether his biological parents had kept him.

“I found them on Facebook, and there’s no trace of him, so I think they gave him up for adoption,” she said. “I don’t know where he is, and it kills me every day.”

Many women who have had a fulfilling surrogate experience go on to carry a second, or third, child for the same couple, finding pleasure in being pregnant and conferring the gift of a child and a continuing connection with another family, while earning money in the process. Kelly, a licensed practical nurse in Pennsylvania with two children who asked not to have her last name used to protect her privacy, delivered a baby, Nico, for two German men, Thomas Reuss and Dennis Reuther, in 2012, and is now pregnant with their twins, two more boys.

“I love being pregnant, but I don’t want to have any more children — oh, getting up in the middle of the night; oh, day care; oh, I’m done,” she said. “It’s great to see Thomas and Dennis with Nico, and how excited they are about twins. The money is nice, but we could manage without it, and it’s not why I’m doing this.”

Undeterred by Local Laws

For the Portuguese couple, the journey began when Paulo saw a television report about surrogacy, showing a gay couple who were unidentifiable in the shadows. The next day, he went to the television studio to ask how to find the two men. The producer would not share their names, but on rewatching, Paulo and João saw the name of the Connecticut fertility clinic.

Two years later, they were in a hotel in central Pennsylvania for the birth of their son, Diogo. His American passport had arrived. The bittersweet farewell dinner with the surrogate and her family was over, and the flight home was booked for the next day. All that was left to do was gaze at their sleeping baby, angelic in his white onesie, his starfish hands extended.

“It’s like a miracle,” said Paulo. “I cried when I saw the flight booking on the computer. I said: ‘Look, João. It’s not us two anymore. We are three.' ”

Getting to three was long, stressful and expensive, with problems at almost every turn — and one large hurdle remaining, as they apply for Diogo’s Portuguese citizenship.

After speaking to the Connecticut clinic, they chose a surrogacy agency that asked them to wire $100,000 up front. On the verge of sending the money, João decided that was too much. Without telling Paulo, he went back to his online research, and discovered complaints against that agency. Their second agency did not work, either: After months of back and forth, the agency turned them down, apparently because of concerns over their finances.

“They wasted almost a year of our time,” Paulo said.

Even with an agency they praise as responsible and responsive — an agency owned by Ms. Brisman, the New Jersey lawyer — obstacles continued. Their first donor’s eggs did not produce a pregnancy. The second had a genetic disorder that did not show up in the initial paperwork. A third produced a good supply of eggs, but after the first embryo was implanted, the surrogate miscarried. Their next surrogate did not get pregnant on the first try.

Through it all, the bills mounted. João and Paulo said they planned to burn them so their son would never have to think about the price, which they acknowledged was hundreds of thousands of dollars.

They have also decided not to answer any questions about which of them is the father — embryos that were inseminated by each were implanted — unless Diogo is the one asking.

“The information belongs to him,” Paolo said.

In the end, their warm relationship with the woman who bore their child was about the smoothest part of the process. The night before they were to take Diogo home, she sent an emotional text: “I know I’m doing well because I haven’t cried yet,” she said. “But I know I will.”

João and Paulo, like most international couples using an American surrogate, want their baby to be a citizen of their home country. But many Chinese parents take a different tack, keeping the American citizenship automatically conferred on every baby born here. Some hope the baby will attend an American university or help the family to live and work in the United States. But for Chinese clients, too, overseas surrogacy carries a complication, making it difficult for the baby to get a hukou, or household registration card, granting access to local schools and hospitals.

And there is another issue in China: restrictions on the number of children per family. Some Chinese couples, particularly older couples, turn to American surrogacy for a second child, whose American citizenship might clear the family from scrutiny.

But most surrogacy agencies say they will work only with intended parents who cannot carry their own baby, as recommended by the guidelines of the American Society for Reproductive Medicine. So Chinese clients who seek an overseas surrogate to get around the one-child rule create a dilemma.

“We usually only take clients who have a medical need for surrogacy, but in December, we decided to bend that rule, for Chinese people, government officials, who would be in trouble if they break the one-child rule,” said Karen Synesiou, chief executive of the Center for Surrogate Parenting, in Encino, Calif. “We’re thinking of it as political surrogacy.”

Then, too, agencies and lawyers say, there has been a recent uptick in the number of clients seeking “social surrogacy” — that is, having someone else carry their baby so as not to damage their career, or their figure. And not all agencies follow the guidelines.

“We don’t feel like we should be the gatekeepers when it comes to that,” said Saira Jhutty, chief executive of Conceptual Options, a California agency.

Final Hurdles at Home

For all the intimacy of carrying a baby for someone else, there is no template for the relationship between intended parents and the woman who will bear their child. Most contracts contain a clause requiring confidentiality unless both parties agree otherwise. And most stipulate that there will be an abortion if the fetus has serious defects, or a reduction in case of triplets or quadruplets. While no court would force a woman to have an abortion, lawyers say, a surrogate who refused to honor the agreement, and proceeded to carry a baby to term against the intended parents’ wishes, could perhaps be made to pay the costs of rearing the child, under the legal concept of wrongful birth. As surrogacy spreads, lawyers say, litigation over such issues may erupt.

For those from abroad, getting an American-born baby home can involve tangled immigration problems. Some countries require a new birth certificate, a parental order or an adoption. Some will not accept an American birth certificate with two fathers listed as the parents. Occasionally, a baby can be denied entry into the parents’ home country.

But international law is catching up with social practice: On June 26, in a case involving two sets of children born to American surrogates, the European Court of Human Rights ruled that France had violated the European Convention on Human Rights, and undermined the children’s identity, by refusing to recognize their biological father as their legal parent, easing the way to French citizenship.

The decision will most likely smooth the path for Paulo, João and their son, who entered Portugal on his American passport. So far, efforts to register Diogo in Portugal have failed, because the Portuguese process requires that a mother be named. Meanwhile, they have been advised to seek a residence card for him.

“They told us to wait three months for an answer,” Paulo said in a recent email. “We still do not know how this will end.”

Source: nytimes.com

 


 

 

Topics: US, surrogate, babies

Overweight and Pregnant

Posted by Erica Bettencourt

Wed, Jul 09, 2014 @ 11:01 AM

Pregnancy, or the desire to become pregnant, often inspires women to take better care of themselves — quitting smoking, for example, or eating more nutritiously.

But now many women face an increasingly common problem: obesity, which affects 36 percent of women of childbearing age. In addition to hindering conception, obesity — defined as a body mass index above 30 — is linked to a host of difficulties during pregnancy, labor and delivery.

These range from gestational diabetes, hypertension and pre-eclampsia to miscarriage, premature birth, emergency cesarean delivery and stillbirth.

The infants of obese women are more likely to have congenital defects, and they are at greater risk of dying at or soon after birth. Babies who survive are more likely to develop hypertension and obesity as adults.

To be sure, most babies born to overweight and obese women are healthy. Yet a recently published analysis of 38 studies found that even modest increases in a woman’s pre-pregnancy weight raised the risks of fetal death, stillbirth and infant death.

Personal biases and concerns about professional liability lead some obstetricians to avoid obese patients. But Dr. Sigal Klipstein, chairwoman of the committee on ethics of the American College of Obstetricians and Gynecologists, says it is time for doctors to push aside prejudice and fear. They must take more positive steps to treat obese women who are pregnant or want to become pregnant.

Dr. Klipstein and her colleagues recently issued a report on ethical issues in caring for obese women. Obesity is commonly viewed as a personal failing that can be prevented or reversed through motivation and willpower. But the facts suggest otherwise.

Although some people manage to shed as much as 100 pounds and keep them off without surgery, many obese patients say they’ve tried everything, and nothing has worked. “Most obese women are not intentionally overeating or eating the wrong foods,” Dr. Klipstein said. “Obstetricians should address the problem, not abandon patients because they think they’re doing something wrong.”

Dr. Klipstein is a reproductive endocrinologist at InVia Fertility Specialists in Northbrook, Ill. In her experience, the women who manage to lose weight are usually highly motivated and use a commercial diet plan.

“But many fail even though they are very anxious to get pregnant and have a healthy pregnancy,” she said. “This is the new reality, and obstetricians have to be aware of that and know how to treat patients with weight issues.”

The committee report emphasizes that “obese patients should not be viewed differently from other patient populations that require additional care or who have increased risks of adverse medical outcomes.” Obese patients should be cared for “in a nonjudgmental manner,” it says, adding that it is unethical for doctors to refuse care within the scope of their expertise “solely because the patient is obese.”

Obstetricians should discuss the medical risks associated with obesity with their patients and “avoid blaming the patient for her increased weight,” the committee says. Any doctor who feels unable to provide effective care for an obese patient should seek a consultation or refer the woman to another doctor.

Obesity rates are highest among women “of lower socioeconomic status,” the report notes, and many obese women lack “access to healthy food choices and opportunities for regular exercise that would help them maintain a normal weight.”

Nonetheless, obese women who want to have a baby should not abandon all efforts to lose weight. Obstetricians who lack expertise in weight management can refer patients to dietitians who specialize in treating weight problems without relying on gimmicks or crash diets, which have their own health risks.

Weight loss is best attempted before a pregnancy. Last year, the college’s committee on obstetric practice advised obstetricians to “provide education about possible complications and encourage obese patients to undertake a weight-reduction program, including diet, exercise, and behavior modification, before attempting pregnancy.”

An obese woman who becomes pregnant should aim to gain less weight than would a normal-weight woman. The Institute of Medicine suggests a pregnancy weight gain of 15 to 25 pounds for overweight women and 11 to 20 pounds for obese women.

Although women should not try to lose weight during pregnancy, “a woman who weighs 300 pounds shouldn’t gain at all,” Dr. Klipstein said. “This is not harmful to the fetus.”

Dr. Klipstein also noted that obesity produces physiological changes that can affect pregnancy, starting with irregular ovulation that can result in infertility.

Obese women are more likely to have problems processing blood sugar, which raises the risk of birth defects and miscarriage. There is also a greater likelihood that their baby will be too large for a vaginal delivery, requiring a cesarean delivery that has its own risks involving anesthesia and surgery.

The babies of obese women are more likely to develop neural tube defects — spina bifida and anencephaly — and to suffer birth injuries like shoulder dystocia, which may occur when the infant is very large.

High blood pressure, more common in obesity, can result in pre-eclampsia during pregnancy, which can damage the mother’s kidneys and cause fetal complications like low birth weight, prematurity and stillbirth.

It is also harder to obtain reliable images on a sonogram when the woman is obese. This can delay detection of fetal or pregnancy abnormalities that require careful monitoring or medical intervention.

Topics: women, obese, health, pregnant, babies

Dirty Baby, Healthy Baby? Early Filth May Reduce Allergies

Posted by Erica Bettencourt

Mon, Jun 09, 2014 @ 01:06 PM

BY LINDA CARROLL

dirty babies (5)

Want a healthy baby? You may want to roll her around in dirt.

For decades, parents have shielded infants from bacteria and other possible triggers for illness, allergies and asthma.

But a surprising new study suggests that exposure to cat dander, a wide variety of household bacteria — and even rodent and roach allergens — may help protect infants against future allergies and wheezing.

Interestingly, contact with bacteria and dander after age 1 was not protective — it actually increased the risk.

“It was the opposite of what we expected,” said Dr. Robert Wood, chief of the division of allergy and immunology at the Johns Hopkins Children’s Center and co-author of the study in the Journal of Allergy and Clinical Immunology. “We’re not promoting bringing rodents and cockroaches into the home, but this data does suggest that being too clean may not be good.”

 The new findings may help explain some contradictions in research on the so-called hygiene hypothesis, which suggested that kids growing up in a super clean environment were more likely to develop allergies.

“This doesn't completely resolve the controversy, but it does add a big piece of the puzzle,” said Dr. Jonathan Spergel, a professor of pediatrics and chief of allergy at the Children’s Hospital of Philadelphia.

The hygiene hypothesis was developed after researchers noticed that farm kids were less likely to have allergies. Dirty environments, experts suggested, might be protective. The hypothesis seemed to explain why developed countries had skyrocketing rates of allergies and asthma.

“We’re not promoting bringing rodents and cockroaches into the home, but this data does suggest that being too clean may not be good.”

The theory “is that as we clean up our environment, our immune system moves away from being geared toward fighting bacteria and parasites,” said Dr. Maria Garcia Lloret, an assistant clinical professor of pediatric allergy and immunology at the Mattel Children’s Hospital at the University of California, Los Angeles. “It then has nothing to do and starts to react against things that are normally not harmful, like dust mites, or cat dander or cockroaches or peanuts.”

A chink in the hygiene hypothesis seemed to be the high rates of allergy and asthma in inner-city environments. But the new study may help explain the contradictions by showing that early exposure is crucial.

“It’s all about being exposed to the right bacteria at the right time,” Spergel said.

Wood and his colleagues followed 467 newborns for three years, screening them for allergies annually and testing the dust in the houses where they lived for allergens and bacteria. To the researchers’ surprise, kids who were exposed before their first birthday to mouse and cat dander along with cockroach droppings had lower rates of allergies and wheezing by age 3, compared to those who were not exposed so early on.

 In fact, wheezing was three times as common among children who had less exposure to those allergens early in life.

The protective effect of early exposure to allergens was amplified if the home also contained a wide variety of bacteria.

The reason may be that “a lot of immune system development that may lead someone down the path to allergies and asthma may be set down early in life,” Wood said.

Researchers aren’t ready to try to translate the new findings into practical advice for parents. But, Lloret said, we now know that “strict avoidance of allergens from the beginning does not protect you, and early exposure in the right context may make the difference between disease and tolerance. You could say that this is the downside of cleanliness.”

The new findings may upend advice experts have been giving to parents on the topic of pets and newborns.

“Twenty years ago we used to tell parents to get the cats and dogs out of the house,” Wood said. “This shows that the younger the child is when you get a pet, the better.”

Source: nbcnews.com

Topics: allergies, health, babies, clean, dirt

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