Behavioural Assessments

In case you have not read my blog for a long time, my third son has language delays which we have addressed with additional support through a program called GRIT (Getting Ready for Inclusion Today) which provides him with a half time DS (developmental specialist) who works with him one on one and who is supported by a team of professionals (speech therapist, occupational therapist, etc.).

One of the concerns of the team leader was our son's behaviour when working with his DS in the beginning, which they have long since dealt with and they are working together well now. In addressing this concern, we were asked if we wanted a behavioural specialist come in and assess their working together. I didn't see a problem with this, our DS was fine with it and our son was used to these type of assessments by now so it wasn't an issue for him. I am always open to ideas too, anything to benefit my children IMO.

Anyway, this very personal and highly recommended assessor came and spent an afternoon unobstrusively watching them, ironically on a day when our son was not very cooperative. His DS and I saw it as an opportunity however to address some of his weaknesses...

Well his return with "answers" was interesting indeed. He basically said that our son had issues that we could not address at home (he knew we planned on homeschooling) and that it would be in his best interest to put him into school and that we should start looking for an appropriate institution soon, given that many open houses would be happening in the near future. At first I was feeling rather gloomy about this, then I realized something... he was hired by GRIT which in essence readies preschoolers with disabilities for school. I had been lead to believe that this assessor worked in the psychology field and in fact he told me he had obtained his masters degree a few year prior. Stupid me, I failed to ask in what field! He handed me his card and guess what? His masters is in education. No wonder he is wanting him to be "corrected" by an institution, he can't see outside of that box. Oh well, lesson learned, for us at least. Don't bother utilizing the professionals unless they are working towards the same goal as you and able to see your vision with an open mind. Otherwise you are wasting their time and yours.

Pre-eclampsia and Calcium link

How exciting that AJOG has published an article linking nutrition with pre-eclampsia. Of course the study was done in Switzerland (where they obviously see a bigger link between nutrition and the increasingly common problems such as pre-eclampsia, gestational diabetes and so on) as North American physicians have essentially no training and precious little knowledge about the impact of nutrition on expectant mothers.

Calcium supplements reduce pregnancy complications
Source: American Journal of Obstetrics and Gynecology 2006; Not yet available online

Investigating the effect of calcium supplements on pre-eclampisa, its complications, and death linked to the condition.

Calcium supplements could help prevent the serious complications of pre-eclampsia and, in young women, preterm delivery, research suggests.

Although a treatment to prevent pre-eclampsia remains elusive, a link to calcium deficiency has been suggested.

To explore this possibility further, José Villar (World Health Organization, Geneva, Switzerland) and co-workers recruited 8300 women who consumed less than half of the amount of calcium recommended during pregnancy. Half of the women were given a 1.5 g calcium supplement each day, while half received placebo.

The incidence of pre-eclampsia was comparable between the two groups, but rates of eclampsia, other severe complications of pre-eclampsia, and severe gestational hypertension were significantly lower in the supplemented women. The "severe maternal morbidity and mortality index" was also significantly reduced with calcium supplementation, as was neonatal mortality.

In women less than 20 years of age - those at highest risk for low calcium and pre-eclampsia complications - calcium supplements tended to protect against preterm and very preterm delivery.

"This large randomized trial in populations with low calcium intake demonstrates that while supplementation with 1.5 g calcium/day did not result in a statistically significant decrease in the overall incidence of pre-eclampsia, calcium significantly increased the risk of its more serious complications," the team concludes.

I hope that this study and others will not only continue to confirm the unflagging lifelong work that the late obstetrician Dr. Brewer has done on the link between nutrition (especially protein, calcium) and pregnancy induced hypertension (PIH), pre-eclampsia, eclampsia/toxemia and HELLP.

Auschwitz Midwife

I blogged about the rivetting book Night here and at the back of my mind I have been thinking about a story I read of an Auschwitz midwife the whole time I read it. The tireless work of a Catholic midwife in the depths of hell. I finally found the article, Midwife at Auschwitz. Here is an exerpt:

During her imprisonment, Stanislawa helped deliver over 3,000 babies. But there was something even more remarkable than her trying to cope amidst these hostile conditions. As she explained to her son, the Lagerarzt ordered her to make a report on the infections and mortality rate for mothers and infants. She replied, "I have not had a single case of death, either among the mothers or the newborns." The Lagerarzt's response was a look of disbelief. "He said that even the most perfectly handled clinics of German universities cannot claim such success. In his eyes I read anger and envy." In a self-deprecating manner, Stanislawa attributed this to fact that "the emaciated organisms were too barren a medium for bacteria." However, her children and fellow inmates ascribe this miraculous record to causes more than natural.

Holding Pattern

If I, no we, continue in this holding pattern I think one of us is going to lose it.

Allan and I have been hanging on here, wanting to provide a bit of stabilization for our children by not moving, again, in following Allan's career. We have turned down two transfer requests to Grande Prairie and instead Allan was moved to the Spruce Grove store, much to our dismay. I know that it sounds ideal because we are like four blocks from the store. But in the grande scheme of things Wal-Mart it wasn't a good move in terms of promotion.

We have been looking at other career options and the one we had been really interested in was construction. But then those of you who read my blog would know about that. We had almost been ready to jump off the big ol' Wal-Mart ship to dive into this opportunity, but Allan's potential employer is concerned that he won't be able to provide the income he wants to give us. He is an incredible man who has become a friend and knows clearly what it is like to raise a family with four children. He did it himself not too long ago, his youngest is in his early 20's.

So, the short story is, if we don't go the construction path very soon, we will be accepting the transfer opportunity to Grande Prairie and putting our eggs in that basket wholeheartedly, without a second job to interfere with Allan's focus on his career. To be honest, I don't care either way as long as the decision is made so we can move in a clear direction, one way or another. Sure I will miss Spruce Grove and all of our friends here if we do move... especially from our homeschool group and church (and Deanna!), but if that is the path, let us forge ahead!

The Horrors of Auschwitz

I just finished reading the riveting book Night (revised 2006) by Elie Wiesel. Once again I was brought back to Auschwitz and the stark horrors faced by those who were sent to the concentration camps, the work camps, the chimneys. The first time I learned of the attempted extermination of the Jews by Nazi Germans was when I read Corrie Ten Boom's The Hiding Place. It forever changed my perceptions of our world, of justice and humanity.

I still cannot fathom the depths of depravity those in charge were capable of. I am in awe of the strength their victims had and the horrible decisions they faced every day in order to survive emotionally and physically. On Thursday my great friend Deanna and I were talking about the concentration camps and of the opening of Sophie's Choice. As parents we contemplated the thought of having to choose between our children, who lived and who died. I cannot imagine what mothers, fathers, children, and grandchildren must have gone through, knowing their family were murdered by the most horrible means. Choking on gases, shot in the back of the neck, thrown into flaming trenches, and so much worse. I pray our children, our children's children and their children's children never face this evil. Let us ponder together the famous quote from George Santayana:

Those who cannot learn from history are doomed to repeat it.

Predicting Cesareans

Well, leave it to some bored researchers to try and find the crystal ball answers to why their cesarean rates are so high. Don't look at the obvious, prophilactic induction for postdate pregnancies which is clearly not evidence based, that would be to simple. No, let's look for reasons we can cause more iatrogenic cesarean outcomes!

New risk score predicts cesarean after induction
Source: Obstetrics & Gynecology 2006; 107: 227-33

Simple scoring system may help decision-making when considering induction of labor.

The risk of cesarean delivery after induction of labor can be predicted reasonably accurately using four simple measures, British obstetricians report.

Elisabeth Peregrine and team from University College London Hospitals sought to develop a clinical model for predicting the outcome of labor induction. They evaluated maternal and ultrasound parameters in 267 women at 36 or more weeks of gestation immediately before induction of labor.

The most frequent indication for induction was postdates, and 30 percent of the cohort subsequently required a cesarean delivery.

In logistic regression analysis, four factors emerged as significant predictors of cesarean delivery: parity (odds ratio [OR] = 20.56), body mass index (OR = 6.17), height (OR = 0.94), and ultrasonic transvaginal cervical length (OR = 1.07).

Peregrine's team used these to develop a simple risk scoring system, whereby a score of -65 to -55 indicates a more than 80 percent likelihood of cesarean delivery, and a score of -165 to -146 indicates a less than 1 percent chance.

The model has "reasonably good discriminatory ability," say the investigators, who conclude that it may allow more accurate counseling and better informed consent in the decision-making process when considering induction of labor.

Posted: 22 February 2006

I am receiving the study today via email from LWW because my online access is not working properly, but two of these are no-brainers IMO. Parity and cervical length (aka Bishop's Scores) are obvious. Primips have been proven to gestate longer than multips (average gestation 41 weeks), hello! As for BMI and height, this has piqued my interest greatly, especially in light of all of my maternal female relatives have all given birth very close to 40 weeks and my sister, the only one who is bordering on morbidly obese, who gave birth between 2 and 3 weeks postdates. Hmmm.