European Stars and Stripes (Newspaper) - September 11, 1990, Darmstadt, Hesse                                Infant Mort Auty . Only 20th in infant mortality infant deaths per 1,000 live births Shorter bars show better rates 0 2 4 6 8 10 12 i i i i i i 1  1 i a in Japan Sweden Finland Switzerland Canada Ireland Netherlands France Denmark w. Germany noway e. Germany Spain Australia great Britain Belgium Italy Austria new zealand United states Israel Greece 2 3 1987 figures for developed nations 10.1 . Infant mortality improved slightly in the 1980s source National committee to prevent infant mortality continued from Page 13 liver and immune system. The causes of prematurity Are not Well understood. Some Are known such As maternal hypertension diabetes or heart disease. Haemorrhage which can occur if the Placenta separates from the uterus can also be a cause. But 40 percent of All premature births go unexplained. Quot we put so much Faith in our doctors Quot Sheryl Shapiro mused bitterly. Quot in a sure it s a cliche to say that we treat them As gods but we do. Here i was in the Hospital about to lose a child and i m still believing a i m Here i m Safe Quot at first drugs seemed to slow the contractions. But late in the night of March 6, they resumed. The baby was born shortly after Midnight weighing Little More than a Pound. Because his lungs were insufficiently developed he could barely breathe. Shapiro remembers asking for him holding him kissing him As he died a slowly while doctors worked Between her legs to extricate her Placenta. She remembers collapsing wailing in hysterical grief then sedation. When she recovered the baby was gone. Quot the doctor came in to talk the next Day Quot she says. Quot i just kept going Why Over and Over. A what happened a after you put so much Faith and Trust in these people to hear an i Don t know does no to Cut it. Well Damn it i want to know. Find out Why Quot the pathology tests on the Placenta came out negative. There was absolutely physically nothing wrong. Which almost makes me angry. It s like i want something to be wrong. I want to blame this on something. I want to direct my anger  William Crosby was born three months Early and weighed 21/2 pounds. His 24-year-old Mother had had no prenatal care. When she turned up in labor at the Hospital on june 27,1988, she had traces of cocaine in her system. She called the baby William for a couple of Days. Then she renamed him Brandon after the Man she had concluded was his father. Later the baby s Foster parents changed his name again to Rusty. The baby spent his first two months attached to a Respirator in a neonatal intensive care unit. He had respiratory distress syndrome a condition common in premature babies in which their tiny barely developed lungs leave them with a life threatening shortage of oxygen. Three times physicians tried to wean him from the Respirator. Each time they failed. Fearing that his Throat was narrowing from a combination of causes his doctors Cut a Hole in his Windpipe and slipped in a tube. He was finally Able to breathe on his own. By 2 months old Rusty had grown to three pounds 10 ounces. He fit in the Palm of his Foster fathers hand. When the baby s weight inched up a month later to five pounds the Hospital allowed the Foster parents Rod and merry Lloyd to take him Home. It was t an easy life. But after All it was life. His prematurity had left Rusty with serious problems with his heart and his breathing from time to time one or the other would Stop. A Monitor strapped to his Chest would set off an alarm that sounded something like the timer on a microwave oven. He also turned out to have a double hernia requiring surgery. There was More abdominal surgery after that pneumonia and More hospitalization. He needed special breathing equipment and the Lloyds kept a Small pharmacy near the spice rack in the Kitchen. But As the year wound Down Rusty grew. He discovered baby Oatmeal and applesauce. The tube in his Throat prevented him from uttering a sound but merry Lloyd says hopefully Quot i think if he could have cooed he would have. There were times when he was  once a camera captured Rusty smiling a a Small boy with deep Brown eyes arched brows and a Valentine shaped Mouth. And on new year s Day 1989, at nearly 6v2 months old Rusty did for the first time what others do at half his age he reached for a toy. Ten Days later he was dead. An autopsy traced the death to the Many consequences of prematurity complicated by what the Coroner called a history of neonatal cocaine withdrawal. The child simply stopped breathing while curled in Rod Lloyd s Lap. Paramedics spirited the dying baby to the nearest Hospital. An ominous message and an empty House greeted merry upon her return from work. She raced to the Hospital and into the emergency room. By the time she arrived her child was beyond Hope. Quot when i burst in they said a we re sorry we did All we could Quot merry Lloyd remembers tears tumbling off her Cheeks into her Lap. Quot and the doctor said this baby should t have lived this  i wanted to turn around and slug  Janet and Rod Jones lost their 10-week-old son Patrick in february to a form of congenital heart disease that affects 50 in 100,000 babies. Colleagues have since veered out of their Way to avoid Rod. Some have wondered Why he keeps a picture of his son at work. Well at least he was Young people say in a bumbling Stab at Consolation. At least you did t have him that Long. It happened for a reason. If he had lived there would have been problems. Parents have arrived at mortuaries to find their children barely recognizable from the autopsies done on unexplained infant deaths. Skulls have been hacked open and awkwardly stitched. One woman found her twins stuffed in a single too Small coffin. And As Rod Lloyd sat outside the Hospital emergency room awaiting word on his Foster child Rusty he recalls one of the paramedics who had transported the baby walking past Quot his comment was a you need to trim those Bushes on your drive. They scratched my Van Quot Tracey Johnson 27, lives in a Public housing. Development in Long Beach Calif. She dropped out of High school at age 16 to give birth to her son now 11. She supports herself through Public assistance and has never worked. She is studying for a High school equivalency exam. Johnson a health care because she is on welfare is covered by the states medical insurance program. But she rarely sees a doctor and foregoes regular gynaecological checkups. She has had multiple abortions because of lapses in her use of birth control. In 1988, Johnson and her Boyfriend decided to try to have a second child. As Johnson tells it she became pregnant in september but did not realize it for four months. Her periods Are usually irregular and she was losing weight instead of gaining she recalls. In december Johnson began throwing up. A pregnancy test confirmed she was pregnant. She turned to the Telephone Book for an obstetrician but found that most refused to take medical patients the reimbursement rate was too Low they said and liability too High. Finally a Friend referred Johnson to her obstetrician. He agreed to deliver Johnson a baby and provide prenatal care a that crucial course of monthly biweekly and weekly visits that medical experts agree should ideally begin As soon As a woman is pregnant. In Johnson Scase it began in her fifth month. It is widely accepted that prenatal care works. But there is a scientific problem in pinpointing Why. Many studies of its effectiveness have not defined its Content clearly so it has not been possible so far to Trace its benefits to specific components. Nevertheless its Overall Benefit is Clear. Women who Don t get prenatal care Are at High risk of having a child born dangerously underweight. And Low birth weight babies born at 5.5 pounds or less face 40 times the Normal risk of dying in the first four weeks of life. Low birth weight experts believe explains much of the difference Between the infant death rates of the United states and other developed countries. But Why the Low birth weight rate in the United states might be especially High is not easily answered. Death often is the Price of being bom too soon. Father in the delivery room times contractions his wife is having coaching her breathing during labor. The prime causes of Low birth weight Are prematurity and poor fetal growth Many of the causes of those conditions Are not Well understood. What is known is that there Are a number of factors physicians use to identify women at risk of having a Low birth weight baby. For example women under 17 or Over 34 Are at risk. So Are Black women poor women unmarried women and uneducated women. So Are women with diseases like diabetes and hypertension and women who have had previous problems in bearing children. Then there Are risks that occur during pregnancy poor weight gain Early bleeding placental problems anaemia infections. Women with closely spaced pregnancies premature rupture of membranes and excessive vomiting Are also at risk. Finally there Are behavioural and environmental risks smoking drug and alcohol abuse poor nutrition High Altitude exposure to toxics. And there Are health care risks the most common of which is inadequate prenatal care. About 74,000 pregnant women in the United states received no prenatal care in 1987 a a figure that was up 50 percent from 1980. During that period the percentage of women getting very late or no prenatal care Rose from 8.8 percent to 11.1 percent among Blacks and from 4.3 to 5 percent among Whites. The reasons behind those figures Are Complex. Some women can t afford prenatal care others have insurance that does t cover it. Some can to find doctors some just done to get around to it. Others Don t understand the importance of prenatal care. By any measure Tracey Johnson was at High risk. But that first prenatal visit in late january in her fifth month of pregnancy turned out to be her Only one. Shortly afterwards on the morning of feb. 8, she awoke in pre term labor. When she telephoned the doctor she says his answering service informed her the doctor was t in. Johnson walked alone to a nearby Hospital. She Reca be quibbling with nurses Over whether she was really in labor. The baby arrived at noon weighing just 11v2 ounces. Too Small and too premature to survive chum Nice Dejanay Baker lived less than three hours. Of e experience has left Johnson bewildered and unhappy. Like Sheryl Shapiro she is frustrated with her physicians inability to explain Why it happened. In the absence of answers she blames the health care system. She does not blame herself. They went to school for this Quot Johnson complained sadly referring to doctors. Quot they should be Able to Tell me Why i went into labor or give me some kind of idea something to judge Why what happened. A because i want to know so i done to do it the next time. Maybe if i could do something different if it was me. I want to understand it better. But he says he done to  when pregnancy fails coping with grief by Rosemary Jones Allentown morning Call any woman who has Ever been pregnant can Tell you that Long before its first cry is heard in the world she has come to know her baby very Well. She has experienced the roller coaster tumbling or gentle Rollings of her infant the hiccups the occasional punch As it stretches and settles its limbs into another position the times of Day or night it is most Alert. And even before the baby begins to move the mothers mind is filled with images of what it will be like. It rapidly becomes a very real member of the family a a member that would be deeply mourned should anything go wrong with the pregnancy. Until recently though the anguish of those who suffer pregnancy losses was not fully understood even by those closest to the grieving parents. They Are Quot consoled Quot by being told a that s of. You la have another  Lori Toedter associate professor of psychology at moravian College in Bethlehem pa., had that experience when she suffered a miscarriage nine years ago. Quot i looked for literature on the subject but could t find enough to satisfy me Quot she said. Quot the data was very  at about that time Toedter met Judith Lasker professor in the department of social relations and associate Dean of the arts College at Lehigh University in Bethlehem pa., who had an unsuccessful pregnancy in 1979. Her child was stillborn and she too had been frustrated at the Lack of information dealing with the tragedy. She took matters into her own hands and co wrote with new Jersey architect Susan Borg when pregnancy fails families coping Wilh miscarriage ectopic pregnancy Stillbirth and infant death Bantam books $8.95. Quot pregnancy loss differs from other family losses in that unlike relatives you be lived with for some time you never get to have memories of the baby Quot Lasker explained. Quot so Judy and i decided to put together a Grant proposal to do research on the subject Quot Toedter said. Quot our purpose was to look at the Range of variables of How people Deal with pregnancy loss due to miscarriages stillbirths and babies that lived up to 30 Days. And on our first try we were funded for three years by the National Institute of child health and human development an Agency under the Aegis of the National institutes of health with additional financial support from  their efforts produced the perinatal grief scale which was released this year and is included in the second edition of when pregnancy fails. It is designed to measure and help to understand the feelings of bereavement after a pregnancy loss. With the cooperation of 17 obstetrical offices four Hospital clinics a midwifery Center and the Bethlehem health Bureau Toedter and Lasker oversaw three separate interviews of 138 area women and 58 of their partners a two months after the pregnancy loss and at the one year and two year anniversaries. Among the questions for which they sought answers were who seems to Cope Best with loss and Why which reactions to loss researchers Lori Toedter and Judith Lasker who have conducted a three year study of pregnancy losses offer these tips for men and women who have suffered such a loss a done to withdraw from friends. You need their support to Cope successfully with your grief. A remember that the lost pregnancy was t your Only Chance. Within two years following the loss almost two thirds of those studied had a successful birth or were pregnant. A if you tended to have problems with depression before the pregnancy you May have particular difficulty getting Over the loss. It s important to get treatment. A for late losses ask to see and hold the baby and people have the most difficulty and what can be done to help them How different is the emotional Impact of a miscarriage from that of a Stillbirth do bereaved parents appreciate the interventions that Are being recommended for medical staff to implement How Many people s lives and relationships Are significantly changed by the loss Quot we saw so much variation Quot Lasker noted. Quot some were really distraught. One Man even attempted suicide. Some said they weren t affected at All. Another woman had her family catering to her every Beck and Call for months because of what she had been through there a no set routine that everyone  As an example of others response to pregnancy loss Toedter related How one bereaved woman s sister offhandedly told her she d get Over it that she d have another baby. Quot and she was a psychologist Quot Toedter said. Quot As soon As she said it she knew it was wrong. She told her sister my gosh i just took the experience away from you Quot according to Toedter approximately 15 percent of All recognized pregnancies end in miscarriage. The women s research showed that the further along the pregnancy the More intense the grieving process. But Early miscarriage has its own set of problems. The stress is intensified because some women Are struggling with the idea of possible infertility wondering Quot will i Ever conceive again Quot the interviewees were asked to rate a number of statements such As Quot i feel empty inside Quot or Quot i am now functioning about As Well As before the baby died Quot on a five Point scale ranging from Quot strongly agree Quot to Quot strongly  Lasker and Toedter then Analysed the results dividing responses into three categories Active grief difficulty coping and despair. At the two year interview they found few who were still despairing. However they found the grief scores of a Small number had actually risen Over time but they speculate that other circumstances a divorce or failure to become pregnant again a might have been responsible. Lasker and Toedter also concluded that those who Are better off financially better educated and who have Good support sources do better As a Rule than clinic patients who generally Are poor. A your data shows that a person with few resources is Likely to be extremely stressed out Quot Lasker said. Quot sometimes she does no to understand what happened and Why. People also tend to say about a poor person that a she has too Many kids anyway. She can t afford them on the other hand a Young professional person can be stereotyped too. Of her they la say she should be Able to handle the loss. She has so much Quot the study showed that the spouse or partner is the crucial person in determining How a woman copes in the time following a pregnancy loss followed in importance by parents in Laws and Sisters in particular. Men however also look to other children those already living or those who May be born in the future and to activities to distract them. For the most part couples said that the loss brought them closer together and made them More appreciative of each other. Toedter said Quot there were Only two or three divorces among those we followed and Only one attributed it directly to the  have a memorial service if possible. Parents who did so were much More satisfied than those who did t. A though males May not Grieve As actively immediately after the loss they re just As Likely to have a severe Long term reaction despair As women Are. Couples need to support each other. A be aware that immediately after a loss High grief scores tend to correspond with poor Overall physical health or a poor marital relationship. A As much As you want to know a medical reason for the loss remember that such explanations Aren t always possible. A remember that you will get better. Grief lessens with time. A . Page 14 a a a the stars and stripes i. To. May to. Tuesday september 11,1990 the stars and stripes a a a Page 15