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Special care given to families experiencing stillbirth or infant loss

A couple standing in front of a wall covered in notes Nashville, Tennessee couple Martin and Jane Wiegand add the name of their daughter, Frances Marie to a Blanchfield Army Community Hospital memorial for families who have lost a baby through miscarriage, ectopic pregnancy, intrauterine fetal demise, stillbirth or infant death. The Wiegand’s gifted BACH a Cuddle Cot earlier this year in memory of their daughter and returned to BACH Oct. 15 for a ceremony in honor of Pregnancy and Infant Loss Remembrance Day. (Photo by Maria Yager, Blanchfield Army Community Hospital.)

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For many, pregnancy is a special time culminating in the birth of a healthy baby to hold, cuddle and bond with for years to come. Those first days of life are usually spent at the hospital with mom and baby recovering from the rigors of labor and delivery.

Sadly, for some mothers this is not the case. The Centers for Disease Control and Prevention reports miscarriage occurs in about 10 to 20% of pregnancies and stillbirth occurs in about one in 100 births each year.

Miscarriage occurs before the 20th week of pregnancy and stillbirth is the death or loss of a baby after the 20th week of pregnancy before or during delivery. At 20 weeks of pregnancy, a mother may feel her baby moving in the womb. She may already know if it’s a boy or a girl and given the baby a name.

Pregnancy and infant loss is a devastating experience to endure, as was the case for Jane and Martin Wiegand, who lost their baby girl, Frances Marie, during the 32nd week of pregnancy.

“It was our first pregnancy. We had no issues during our pregnancy. We had a normal 20-week check-up. The baby’s development looked great. No signs of stress in utero, no abnormal growth or physical deformities,” said Jane, who was treated by a Nashville-based obstetrician.

Wiegand saw her provider at regular intervals and said she felt like her pregnancy was going well. Then when she and her husband went to her 32-week appointment, they received news that would forever change life as they knew it.

“At my 32-week appointment, I found out there was no heartbeat. They confirmed, no heartbeat, which was absolutely a shock. Even if something is wrong, you don’t expect THAT. It was a complete blow to us,” she said.

After tests confirmed no signs of life coming from her baby, the Wiegand’s doctor gave the couple the option to induce labor and deliver that evening or the following morning. Natural deterioration begins once a baby dies in the womb. Over time that may interfere with determining what caused the death and in some cases put the mother’s health at risk. The Wiegands chose to go home for the night and come back the next morning.

“I didn’t have a hospital bag packed. It wasn’t what we were expecting. Our families don’t live in Nashville, so we wanted for them to travel in and try to prepare as much as possible,” she said.

When they arrived at the hospital the next morning to induce labor, the medical staff already understood why they were there and went to great lengths to spare them any additional pain. Child birth is usually a happy and exciting time, but that wouldn’t be the case for the Wiegands and their baby girl. The hospital prepared a special room where medical staff who would be caring for Mrs. Wiegand knew this delivery would not have the outcome of the family’s desire. Instead they received a different, yet compassionate birth experience. The Wiegands were introduced to resources and support in the community with others who understood the heartbreaking experience they had suddenly and unexpectedly found themselves in. The chaplain visited them and shared words of comfort.

A bassinette in a hospital room, with a box that has words "Cuddle Cot" on it
A Cuddle Cot is a portable in-room cooling unit that lets families who have experienced a stillbirth keep their baby at the bedside during their hospital stay giving families extra time to say goodbye. The system consists of a cooling pad placed under the blankets in a newborn bassinet connected to a small cooling unit to help prevent natural deterioration and preserve the body. (Photo by Maria Yager, Blanchfield Army Community Hospital.)

“We delivered her at 5:34 p.m. and we weren’t sure what to expect, on her condition,” said Wiegand, who delivered her daughter Frances Marie, or Francie as they call her, in a Nashville hospital January 23, 2020. “Physically she looked perfectly fine. Beautiful. So we were able to see her and hold her. Thanks to the resources at the hospital, they have this Cuddle Cot, which I had never heard of before. It preserved her condition and that allowed her to stay in our room for the duration of the hospital stay.”

The cot is specially designed to give parents extra time with their baby. Time to bond, time to hold their baby and create lasting memories to give some comfort during their grief.

“But in instances where hospitals don’t have Cuddle Cots families are sending babies to the morgue, which is pretty traumatic. You don’t like sending your child to the morgue and also you are losing time. You can hold on to them as long as you can, but once they deteriorate you have to say goodbye,” explained Wiegand.

“Not everyone wants to extend that time, but we found it immensely valuable and it helped ease our trauma. Those 36 hours we had are some of the most precious of our lives. And allowed us to make so many memories, that if we only had 30 minutes to an hour we couldn’t have done,” said Wiegand.

Although the Cuddle Cot affords families an opportunity to care for their emotional health, they are not common in hospitals because they are not considered a medical necessity, said Wiegand. The cot that gave the Wiegands those extra hours with their daughter had been donated by another family who experienced a still birth and after their own experience the Wiegands decided to pay it forward.

“For my birthday we established a [fundraiser] to raise the money for a Cuddle Cot. Fortunately, we were able to purchase four,” she said, “We wanted them to go where people didn’t have access to one.”

Since Wiegand was born in a military hospital and raised in a military family, she and her husband contacted the labor and delivery unit at Fort Campbell’s Blanchfield Army Community Hospital, to inquire about donating a cot to the hospital for military families experiencing pregnancy and infant loss. In August and donated a cot in memory of their daughter, Francie.

“Jane and Martin have gifted Blanchfield Army Community Hospital with a resource that will allow families who are dealing with loss to have more time with their children and for that we are forever grateful,” said Army Capt. Keisha Yancey, a labor and delivery nurse at Blanchfield. Because there is official guidance in regards to federal entities accepting gifts, Yancey did the research and sought the approval for the hospital to accept the donation.

It is a gift you never want to need, Jane Wiegand stated, but if it can bring comfort to one military family than that is what we want to do.

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Pregnancies among female service members, Active component, U.S. Armed Forces, 2012 – 2016

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12/21/2017
With the increasing numbers of service women and the expansion of roles available to women within the military, understanding the epidemiology of pregnancy is important for both the health of U.S. service women and the readiness of the U.S. fighting force, two closely related issues. Between 2012 – 2016, 344,536 unique women of childbearing potential (WOCBP) served at least 1 day in the military, and of those, 132,466 spend at least 1 day as a recruit trainee. Of the 224,718 WOCBP who served at any time in 2016, 13.1% had at least one pregnancy-related event during that year. A “pregnancy-related event,” refers to a health care encounter (visit) for which the record contains a diagnosis code for either pregnancy or a positive pregnancy test. In 2016, the highest prevalence of pregnancy-related events was among service women 30-34 years of age (16.8%) and among senior enlisted women (13.7%). Pie chart displays depicting the information. The annual prevalence of pregnancy-related events decreased slightly, from 14.2% in 2012 to 13.1% in 2016. Line plot graph displays this information. FINDINGS •	Prevalence of pregnancy-related events was approximately evenly distributed among the race/ethnicity categories and military occupation groups. •	A slightly higher percentage of WOCBP in the Army (14.5%) had pregnancy-related events compared to WOCBP in the other services. •	A higher percentage of women who were married (21.4%) had a pregnancy-related event, compared with those in the single (5.7%) or “other” (8.8) categories. •	Only 0.2% of women who served during a recruit training period in any given year had a pregnancy-related event. Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to www.Health.mil/MSMR.  Graphic on infographic shows a pregnant service member.

With the increasing numbers of service women and the expansion of roles available to women within the military, understanding the epidemiology of pregnancy is important for both the health of U.S. service women and the readiness of the U.S. fighting force, two closely related issues. This infographic documents pregnancies among female service members, active component, U.S. Armed Forces from 2012 – 2016.

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Tdap vaccination coverage during pregnancy, active component service women, 2006 – 2014

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8/14/2017
Pertussis, commonly known as “whooping cough,” is a vaccine-preventable illness more common and more severe in children than in adults. Infections during the first few months of life can be particularly severe, with almost all deaths from pertussis occurring in infants less than 6 months of age. A vaccinated mother’s antibodies against pertussis protect the baby during pregnancy until it can receive the vaccine at two months of age. Approximately 400 probable and 50 confirmed cases occur annually among service members and other adult beneficiaries of the Military Health System. In 2012, the Advisory Committee on Immunization Practices recommended Tdap for every pregnancy to reduce the burden of pertussis in infants. This surveillance study assessed Tdap vaccination coverage among pregnant service women during 2006 through 2014. FINDINGS: •	There were records of a total of 137,133 live birth deliveries to service women •	Only 1%  – 3% of service women received a Tdap vaccine during pregnancy from 2006  – 2011 •	Tdap vaccination coverage increased substantially  – 8% in 2012 to 54% in 2014 •	Navy women had the highest  annual proportion of vaccine coverage at 65% in 2014 •	First deliveries had the highest vaccination coverage at 57% in 2014 •	Fourth or subsequent deliveries had the lowest coverage at 41% in 2014 More education and attention by military physicians and pregnant service women about the benefits of Tdap vaccination are needed to bring coverage closer to 100%. Learn more in MSMR Vol. 22 No. 5 May 2015 at Health.mil/MSMR  Images on graphic: •	Baby icon to depict live birth deliveries •	Pie charts showing the findings in visual form •	Line graph showing the percent vaccinated among Navy, Marine Corps, Army, Air Force and Coast Guard The line graph shows the annual percentages of active component service women with a live birth delivery who received a Tdap vaccine during pregnancy, by year of delivery and service, 2011– 2014.

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Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Active Component, U.S. Armed Forces, 2016

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6/19/2017
Did you know  … ? In 2016, essential hypertension accounted for 52,586 encounters for health care among 29,612 active component service members in the U.S. Armed Forces. Of all cardiovascular diseases, essential hypertension is by far the most common specific condition diagnosed among active duty service members. Untreated hypertension increases the risks of subsequent ischemic heart disease (heart attack), cerebrovascular disease (stroke), and kidney failure. CHART: Healthcare burdens attributable to cardiovascular diseases, active component, U.S. Armed Forces, 2016 Major condition: •	For all other cardiovascular the number of medical encounters was 70,781, Rank 29, number of individuals affected was 35,794 with a rank of 30. The number of bed days was 4,285 with a rank of 21. •	For essential hypertension the number of medical encounters was 52,586, rank 35, number of individuals affected was 29,612 with a rank of 35. The number of bed days was 151 with a rank of 86. •	For cerebrovascular disease the number of medical encounters was 7,772, rank 79, number of individuals affected was 1,708, with a rank of 96. The number of bed days was 2,107 with a rank of 32. •	For ischemic heart disease the number of medical encounters was 6,629, rank 83, number of individuals affected 2,399 with a rank of 87. The number of bed days was 1,140 with a rank of 42. •	For inflammatory the number of medical encounters was 2,221, rank 106, number of individuals affected 1,302 with a rank of 97. The number of bed days was 297 with a rank of 72. •	For rheumatic heart disease the number of medical encounters was 319, rank 125, number of individuals affected 261, with a rank of 121. The number of bed days was 2 with a rank of 133. Learn more about healthcare burdens attributable to various diseases and injuries by visiting Health.mil/MSMRArchives. #LoveYourHeart Infogaphic graphic features transparent graphic of a man’s heart illuminated within his chest.

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Erectile Dysfunction among Male Active Component Service members

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5/25/2017
Erectile dysfunction (ED) is defined as the persistent inability to achieve and sustain an erection that is adequate for sexual intercourse. ED can result from a problem with any of the above: •	Hormones •	Emotions •	Nerves •	Muscles •	Blood vessels These factors are required for an erection include. Picture is a brain (left) and a male figure (right) showing the heart and main arteries of the body. The top three most common ED diagnoses are: 1.	Psychosexual dysfunction 2.	Hypoactive sexual desire disorder 3.	Male orgasmic disorder Image shows a couple outside together during sunset. House displays in background. Causes of ED (Shows cut out of male body highlighting areas of the body where causes happen) •	Unrealistic sexual expectations •	Depression/ Anxiety/ Stress or other mental health issues •	High blood pressure •	Diabetes •	Obesity •	Injuries that affect the pelvic area or spinal cord •	Low testosterone •	Aging, Substance Abuse Demographics: •	Incidence rate of erectile dysfunction are higher among black, non-Hispanic servicemen when compared to other race/ethnicity groups. •	Black non-Hispanic service members have higher incidence rates of several conditions known to be risk factors for erectile dysfunction, including hypertension, obesity and diabetes. •	Separated, divorced and widowed servicemen had a higher incidence rate of ED than servicemen never married. •	Servicemen never deployed had the highest crude incidence rate of erectile dysfunction. Get the facts •	Erectile dysfunction is the most common sexual complaint reported by men to healthcare providers •	Among male service members nearly half of erectile dysfunction cases related predominantly or exclusively to psychological factors. •	Incidence rates of psychogenic erectile dysfunction are greater than organic erectile dysfunction for service members. •	Organic erectile dysfunction can result from physical factors such as obesity, smoking, diabetes, cardiovascular disease or medication use. •	Highest incidence rates were observed in those aged 60 years or older. •	Those 40 years or older are most commonly diagnosed with erectile dysfunction. Effective against erectile dysfunction •	Regular exercise  ( Shows soldier running) •	Psychological counseling (Shows two soldiers engaging in mental health counseling. They are seating on a couch).  •	Quit smoking ( shows lit cigarette)  •	Stop substance abuse ( Shows to shot glasses filled with alcohol) •	Nutritional supplements ( Shows open pill bottle of supplements) •	Surgical treatment ( Shows surgical instruments) Talk to your partner Although Erectile Dysfunction (ED) is a difficult issue for sex partners to discuss, talking openly can often be the best way to resolve stress and discover underlying causes. If you are experiencing erectile dysfunction, explore treatment options with your doctor. Learn more about ED by reading ‘Erectile Dysfunction Among Male Active Component Service Members, U.S. Armed Forces, 2004 – 2013.’ Medical Surveillance Monthly Report (MSMR) Vol. 21 No. 9 – September 2014 at www.Health.mil/MSMRArchives. Follow us on Twitter at AFHSBPAGE. #MensHealth

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5 Major Categories of Abdominal Hernia

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