Child Development and Public Health- Immunizations

 Immunization is a topic that often comes up for discussion at my place of work, a childcare center serving infants 6 weeks through Kindergarten.  In the state of New Jersey there are many required vaccinations for children before they enter a childcare setting or public school. The state of New Jersey in 2008 became the first state to require flu shots for any child enrolled in daycare or preschool starting at the age of 6 months through 5 years of age. Every child each year must receive their flu shot by December 31 or risk not being able to attend.

We have several parents each year that refuse to have their child immunized at all because they fear the safety of the shots. In New Jersey you are allowed to claim religious exemption for immunizations. What need to be supplied as proof may vary greatly from center to center, some accepting a note from the parents others requesting official letterhead and signature from your place of worship.

The linking of immunizations and the rise in children with autism has impacted many parents’ opinions of their safety. New Jersey has the highest autism rate in the country. A 2007 report by the CDC stated that our reporting rates may just be more accurate, therefore higher, because the state has such an aggressive program to find these children early and provide early intervention services. I have a nephew with autism and have seen the success of early intervention.

On a personal note, my oldest daughter had a severe reaction to DTaP immunization as an infant. She ran a fever of 105 degrees and I have never heard a cry, like the one coming from her, before or since that very scary night. She continued to receive the rest of her immunizations, as did my other children, adjusting her DTaP shot to avoid a reaction. I believe the risk of disease and their complications outweighs the risk of the immunizations. I believe many parents now think these diseases have been wiped out and there is no longer a need for immunizations. They only need to look at countries such as Somalia where routine immunization is not the norm to see the tragic results of not having access to something we in the United States take for granted.

The World Health Organization reported that, as of July, there were 1019 suspected cases of measles and 31 related deaths so far for 2011 in Somalia. The children there are highly susceptible to complications from measles due to poor nutrition and lack of clean drinking water. Most of the children who die or suffer the most severe complications are 5 years of age and under. There is an ongoing effort to bring the vaccine to this region and immunize more children. The stability of the region greatly affects access.

References

Injury Board National News Desk. (2009, January 5). Flu vaccine mandatory for New Jersey children. Retrieved from http://news.injuryboard.com/flu-vaccine-mandatory-for-new-jersey-children.aspx?googleid=254536

University of Medicine and Dentistry of New Jersey, (2007, February 8). CDC releases study of autism rates nationwide, including New Jersey. Retrieved fromhttp://www.umdnj.edu/about/news_events/releases/07/r020807_CDCReleases_StudyofAutismRates.htm

World Health Organization. (2011, August 19). Suspected measles cases rising steeply in south central Somalia. Retrieved from http://www.who.int/hac/crises/som/en/index.html

Childbirth Experiences

I have been blessed to give birth to three beautiful children. I am sharing the story of the birth of my first child, my daughter Rachele. My husband and I had only been married for two months when I discovered I was pregnant. We had planned on trying to conceive after being married a year and often refer to her as our insta- baby as she was at the celebration of our one year wedding anniversary. My pregnancy was uneventful and progressed normally.

On the evening I went into labor we had been out with a group of friend celebrating a birthday.  I woke my husband up around 12:00 AM to tell him it was time. I was screened upon arrival and admitted to labor and delivery. I had strong contraction and progressed well through most of the morning. I had taken Lamaze classes and was trying to have a drug free birth. The next morning my doctor arrived but my labor had stalled, although I was contracting I was not dilating. The chosen course of action was to administer Pitocin, a drug that is commonly used to enhance labor. Several minutes after it administration Rachele’s heart stopped.  I was place on my left side, then my right to see if it was possibly the umbilical cord being compressed, there was no change. It was decided that a cesarean section was needed so I was immediately wheeled to the operating room. I could hear my doctor yelling to get an anesthesiologist as I would need general anesthesia; there was no time to wait for an epidural to take effect. Because of that my husband was not allowed in the delivery room and the last thing I remember is the nurse literally pouring the antiseptic on my abdomen. I was not awake to see my first baby enter the world. Her Apgar score was a 2 but at five minutes it was a 7. My first few days as a new mom were very stressful. Rachele was in the NICU being monitored and tested and I had an infection in my incision so I was not allowed to see her. My husband found a sympathetic nurse and they snuck her out of the NICU, tubes and all, to my room for a few minutes so I could look at her. It was 3 days before I got to nurse her for the first time.

I chose this example of a personal birth experience because access to appropriate medical care is critical to improved birth rate and healthy outcome for babies. In this instance the drug most likely caused my daughters issue but without it I may have been one of those women who could not deliver or whose labor went on for too long causing harm to her or her baby. My labor stalled during my next two deliveries also. I was closely monitored and giving an epidural before the administering of Pitocin so that if I need another C-section I would be awake and my husband could be present. The C-sections were gratefully not needed. My daughter was in a hospital with a state of the art NICU and received the best of care. She is now a healthy 22 year old.

I believe the type of delivery and interventions needed afterward affect early development. As a young child my daughter couldn’t wear certain types of clothing because she found them irritating. She woke up in the middle of the night until she was 2; she went right back to sleep but just needed to know we were there. She is very independent and needs to have a sense of control, I believe this stems from her separation from me and all the poking and prodding she went through those first days of her life. Nancy Newton Verrier makes reference to this in her book The Primal Wound: Understanding the Adopted Child which I read after finding out I was adopted at 40. Verrier writes about how early trauma is carried with us forever and that NICU babies and adoptees often have similar traits. I find that interesting because people often comment that she has similar personality traits to me. Now I wonder if they are genetic or cause by the traumas surrounding our births.

I researched childbirth in Jamaica, my husband and I spent our honeymoon there. We had the opportunity to leave our opulent resort and see some of the country where the poverty level of the Jamaican people was obvious.  In a 1995 article in Midwifery Today, a midwife in Negril was highlighted. There is one clinic in the area where the expectant mothers can come for prenatal care once a week. They can wait for hours on hard wooden benches to be seen by the staff that consists of a registered nurse, a licensed midwife, a nurse practitioner and a public health nurse. Two doctors share duties four days a week. The midwife attends most of the births and travels by taxi. She has converted a room in her own home into a birthing room and sterilizes her instruments by boiling them. For equipment she has a blood pressure cuff, a stethoscope, a fetoscope and birthkit. She has no oxygen, suction equipment, fluids or emergency transportation. The nearest hospital is more than an hour away.  The Jamaican government regulates what she can get paid for attending births to about $20 US, but most can’t even afford to pay her that. This is much different to the shiny floors and comfortable birthing room I arrived to. Attending doctors being on call 24hrs a day, several nurses, anesthesiologists and others.  My bill was much different also.

References

Verrier, N. (1993). Primal Wound: Understanding the Adopted Child. LeVerne, TN: Ingram Book Company.

Whitefield, Kathleen.  (1995, June). Midwifery in Jamaica. Midwifery Today and Childbirth Education,(2), 13.  Retrieved September 8, 2011, from ProQuest Central. (Document ID: 613221471).