Walking miracles

By Michaela Gibson Morris/NEMS Daily Journal

In 11 months, Briggs Rigby has come a long way. Born almost 10 weeks early, the Tupelo boy entered the world at 2 pounds, 6 ounces and spent weeks in neonatal intensive care at the North Mississippi Medical Center Women’s Hospital.
“He’s doing very well,” said mom Misty Rigby.
Briggs is small for his age – 15 pounds – but he’s hitting developmental milestones – like cruising around the furniture as he gets ready to walk independently.
“He’s doing very well,” said Rigby, who with husband Brian, family and friends have formed Team Briggs to raise money for the March of Dimes.
Great doctors and nurses helped deliver Briggs safely and care for him as his body struggled to survive being born too early, Rigby said.
“I had no idea the things preemies go through,” before Briggs’ birth, she said. “The research the March of Dimes provided has done so much so preemies can thrive.”
This Sunday in Oxford and May 1 in Tupelo, communities will be stepping up for babies like Briggs. But it’s not just premature babies who benefit from the March of Dimes work.
“March of Dimes does so many things for healthy babies,” said Maggie Caldwell, president of the Northeast Mississippi chapter of the March of Dimes and mom of 5-week-old Cohen Caldwell.
March of Dimes research helped establish folic acid supplements to prevent neural tube defects like spina bifida, helped advocate for expanded newborn screening which helps with early detection of genetic conditions and offers parents a reliable source of healthy pregnancy information.
“It definitely made me more aware of all the things I needed to do,” said Caldwell, who had healthy, full-term pregnancies with Cohen and his 7-year-old big sister Gracie Ann Atwood. “I was better about watching what I ate and taking care of myself for pregnancy and the long term.”
Caldwell of Mantachie initially got
involved because of the birth of her nephew McAlister Braden, now 3, who was born premature at 26 weeks gestation.
“We made it a family affair,” Caldwell said.
McAlister benefited from surfactant, a treatment developed through March of Dimes-funded research that helps premature lungs function.
“March of Dimes was a big part of his life in the very beginning,” Caldwell said.

Mississippi issue
No where else in the United States is infant mortality a bigger issue than Mississippi.
Mississippi led the nation in 2006 – the most recent year for which national statistics are available – with 10.6 deaths per 1,000 live births. The national average was 6.7 deaths.
The rate has dropped slightly for Mississippi since, down to 9.9 deaths per 1,000 births in 2008.
“This is something we really need to work on,” said State Health Officer Dr. Mary Currier, during a talk in Tupelo this week.
Mississippi leads the nation in births to teen moms, who have a higher risk of preterm labor and their babies are at risk for a host of poor outcomes. However, babies born to teen moms accounted for only about 18 percent of the infant deaths, so they aren’t the key factor driving Mississippi’s high infant mortality rate.
Mississippi leads the nation in the number of very low birthweight babies – babies born weighing less than 3.3 pounds; there were 969 of these babies in 2008.
These are the babies who are born the most premature and are at highest risk for death and long-term problems such as cerebral palsy, respiratory disease and mental retardation. More than half the babies who died in Mississippi in 2008 were very low birthweight babies, Currier said.
“This is where we can have an impact,” she said.
The Mississippi State Department of Health has started pilot programs in Jackson and in the Delta to pair moms who have previously had a low birthweight baby with a resource mom who can help take care of themselves and their baby in hopes of reducing their risk of having a second very low birthweight baby.
“We currently have 77 women enrolled,” Currier said. “The program has worked in Georgia; we’ll see if it works in Mississippi.”
The health department also was authorized to start a Nurse Family Partnership program. The national model uses specially trained nurses to visit first-time, vulnerable pregnant moms and follow them until the children are 2.
“It’s been shown to reduce the incidence of child abuse,” Currier said, as well as improve other health and well-being outcomes.
Money is available through the federal health care reform legislation to help fund programs like the Nurse Family Partnership, and the health department is waiting for word on its grant requests, Currier said.

Prevention
A healthy pregnancy starts before conception.
“Women should take folic acid before they get pregnant,” said West Point obstetrician Dr. Charlotte Magnussen.
Those early visits let doctors gather a very complete medical history and talk about important lifestyle factors like diet and exercise.
“They need to get early prenatal care so they can be assessed,” Magnussen said.
Pregnant women need to take care of themselves with good nutrition and appropriate exercise and avoid harmful substances like tobacco and alcohol.
A healthy pregnancy also includes good stress management.
“Stress is certainly a factor in healthy pregnancy and maternal well-being,” Magnussen said, but it’s not clear what is the mechanism by which it causes trouble.
Once preterm labor starts, in many cases, there’s really no stopping it, just slowing it down, Magnussen said. In many cases, doctors will try to delay labor to give time to give steroids to help the baby’s lungs mature.
In some cases, like infections or problems with the placenta, it’s not even wise to stop labor.
“It depends on why you’re having preterm labor,” Magnussen said.
Although researchers have been able to identify risk factors, exactly what causes some women to go into labor before 37 weeks is still not clear.
Certain things like age – teens and women past 30 – are more likely to have preterm labor than women in their 20s, said Tupelo neonatologist Dr. Patrick O’Mara.
Some things can be controlled, O’Mara said. It’s very important to keep pregnancies from coming too close together for both the health of the mother and the baby.
“Women who deliver prematurely are at risk for their second baby,” O’Mara said.
Although the tiniest, earliest babies have the most trouble, even babies born just a little bit early can have problems.
Typically late preterm babies born at 34 or 35 weeks have gone straight to the well-baby nursery unless they were having respiratory distress. Now that practice is changing.
“The evidence we have now is that even babies born at 35 weeks need to be in an intensive care setting, so they can be monitored closely,” O’Mara said. “We would like to err on the side of caution.”
It’s issues like drops in blood sugar, difficulty regulating body temperature and jaundice that need to be watched closely in these babies, O’Mara said.
“They’re subtle, seemingly not harmful, but they could affect a brain that is not quite mature yet,” he said.
Even if moms-to-be do everything right, there’s no guarantee that they can avoid preterm labor. However, healthy choices and good prenatal care can reduce and manage risk factors.
Good prenatal care and a strong relationship with Misty Rigby’s doctor were crucial.
“I trusted my instincts and went to my doctor. My doctor listened and we have Briggs,” Rigby said. “If I didn’t go, we don’t know what would have happened.”

Briggs’ story
Misty and Brian Rigby knew early on they had to proceed carefully.
“My blood pressure went up early in my pregnancy,” Rigby said. “I was considered high risk at 20 weeks.”
Her high blood pressure was treated aggressively and she never developed more serious conditions that could have threatened her and Briggs’ lives.
Because she had a good relationship with her obstetrician Dr. Eric Webb, and kept careful track of what was normal for her pregnancy, she cued in quickly when Briggs stopped moving during her 30th week of pregnancy.
They monitored Briggs’ heart rate, first in the doctor’s office and then at the hospital.
When Briggs’ heart rate started dropping, they delivered him by cesarean section.
The first weeks in the neonatal intensive care were very scary. Because Rigby received steroid shots during her last week of pregnancy that helped Briggs lungs mature, he never needed a ventilator, just supplemental oxygen. But he wasn’t out of the woods.
“It was like a roller coaster,” Rigby said. “He had lots of problems tolerating feeding. Their little bodies are just not ready for milk.”
After about two and a half weeks, Briggs turned the corner.
Getting more intensely involved in the March of Dimes was a natural way to give back for the care Briggs received.
“When you see a child go through that for five weeks, you have to help,” Rigby said.