By Rebecca Dekker, PhD, RN, APRN

Many news outlets and social media venues have been disseminating information on the Ebola virus and the impact on populations both in West Africa as well as the potential impact on developed nations, including the USA. The expectant families that you work with may have shared concerns for themselves, their children and their unborn baby with you? How have you responded? Did you feel like you had the information that you needed to provide them with facts to calm their concerns? Occaisonal contributor Rebecca Dekker of EvidenceBasedBirth.com takes a look at the facts about the Ebola virus and shares resources and information applicable to pregnant and breastfeeding families that you can share. - Sharon Muza, Community Manager, Science & Sensibility

What's the childbirth educator got to fear about Ebola? How do you address your students and clients' fears?

Well, if you live in the U.S. or in any other country other than Africa - right now, there's really not much to actually fear. That is, if you're only worried about yourself and your own community.

The truth is, here in the U.S., there are so many more things that are more likely to kill you than Ebola - other infectious diseases such as influenza, motor vehicle accidents, smoking, secondhand smoke exposure, cardiovascular disease, cancer, even radon - an odorless, colorless gas that exists in many of our homes in the Southeast and can cause lung cancer - you name it, and it's probably more likely to harm you than Ebola.

So why all the fear here in the U.S.?

Ebola is a rare but deadly disease, and it has been ravaging West Africa. In developed countries, we feel fear because cases of the disease have finally reached our own shores, when in fact we should have paid attention much sooner to what is happening to our brothers and sisters in Liberia, Guinea, and Sierra Leone.

Does all this fear of Ebola do any good?

Personally, I believe that the fact that so much attention has been drawn to Ebola in developed countries may be a good thing. Fear here means that our governments have finally begun to put energy and resources into stopping the epidemic in Africa - not necessarily for humanitarian reasons - but to prevent the spread of this disease to us.

The Ebola epidemic that has affected parts of West Africa has been a fast-moving event that is only just now showing signs of slowing down. Researchers have conclusive evidence that this is the largest, most severe and most complex Ebola epidemic that we have witnessed since Ebola was first discovered nearly 40 years ago. The number of cases and deaths in this epidemic is many times larger than all past Ebola outbreaks combined.

Before the current epidemic, the Ebola virus had mostly been contained to small outbreaks in rural communities. This time, all of the capital cities in in Liberia, Guinea, and Sierra Leone have experienced large outbreaks.

For the first time, Ebola has entered communities like West Point, in Monrovia, Liberia. According to the World Health Organization, 'West Point is West Africa's largest and most notorious slum: more than 70,000 people crowded together on a peninsula, with no running water, sanitation or garbage collection. The number of Ebola deaths in that slum will likely never be known, as bodies have simply been thrown into the two nearby rivers.'

Ebola has been especially hard-hitting on health care workers. Health workers on the front lines are often exposed to very infectious bodily fluids - blood, vomit, and diarrhea. The fact that health care workers can be at high risk for catching and dying from Ebola was first discovered during the very first Ebola outbreaks that took place in Zaire and Sudan in 1978. Fortunately, researchers have found that proper use and training with personal protective equipment can drastically lower health care workers' chances of catching the virus. It's probable that the cases we saw in the U.S. among nurses were due to improper training, inadequate protection equipment, or both.

Interestingly, Ebola actually isn't as contagious as many other infectious diseases. Measles is an airborne disease, and it is highly contagious. Someone with measles can walk through a room, and another person can walk through that same room two hours later and catch the same measles infection. For every one person who has measles and lives among an unvaccinated population, they will - on average - infect 18 more people.

© CDC

In contrast, one person with Ebola infects two other people on average, usually people who have had close, prolonged contact with that person. And the research we have on humans so far shows that Ebola is not airborne - although there have been a few primate studies that suggested otherwise(but some researchers think that maybe the monkeys were spitting on each other!)

One reason Ebola has spread so widely in West Africa - in spite of the fact that this virus is relatively hard to catch compared to other infectious diseases'is that the countries affected are extremely poor. Many people lack running water and soap in their homes.

This means that in West Africa, if one family member comes down with Ebola, there's a good chance that others in the home will become infected, especially if patients bleed and vomit profusely. Families without modern toilets and washing machines have trouble cleaning up after patients who lose control of their bowels and produce huge amounts of diarrhea. Even burying the dead can spread Ebola in these countries, because common burial rites involve washing the dead and preparing the bodies. However, news organizations are reporting that communities have begun adhering to recommendations to refrain from traditional burial practices that expose more people to the disease.

So, it makes sense that we would fear for our fellow humans in West Africa. They are experiencing what can only be described as a humanitarian crisis. What's even more concerning is that the virus has - at least for now'crippled an already weak health care infrastructure. This has created what the World Health Organization calls, 'an emergency within an emergency.' A great example of this is that pregnant women and infants cannot receive emergency care while resources are drained by the Ebola virus epidemic.

So why are some people panicking about Ebola in the U.S., where the chances of an infection are completely remote? How do we make sense of this?

Well, when it comes to understanding how people perceive risk, and why some people are panicking about Ebola in the U.S., it may be helpful to understand some basic scientific principles behind how people perceive risk.

First of all, risk is subjective. And emotions and our mood change how we interpret risk. So facts matter less when emotions take over.

Also, many people also have an inherent lack of trust in scientists and the government - both here in the U.S. and in West Africa. People often believe their own senses and own experiences more than what scientists say. Many people don't really understand the scientific process, and have doubts about what they hear. They confuse the research evidence on Ebola with the legal system, and they think there is lots of room for reasonable doubt about whether or not Ebola is airborne, for example.

Also, it's really important to understand that people perceive a higher risk from rare events with really severe outcomes than they do for common outcomes with less severe or delayed outcomes.

[Does this sound familiar? Just take that sentence above and think about the concept of VBAC and repeat Cesarean. Obstetricians perceive a higher risk from rare events with really severe outcomes - such as uterine rupture - than they do for common outcomes with less severe or delayed outcomes'such as serious maternal infections after a planned repeat Cesarean, or placental abnormalities in future pregnancies].

People also tend to worry more over things that we can't control. We can control our driving, and getting a flu vaccine, and our diet, and cigarette smoking. But we can't control Ebola, so that scares us more.

So when we bring fear and emotion into the mix, people's risk perceptions can end up looking like they do for some people in the U.S. right now - paranoia about Ebola.

It is unfortunate that we have overblown fears of contracting Ebola in the U.S., but if we could redirect our thoughts and channel our efforts into containing the outbreak in West Africa, this is where we will make the biggest difference.

So, in summary:

• Ebola is a rare but deadly viral infection
• We are currently witnessing the largest Ebola outbreak in history.
• The chances of any one of us contracting the virus in the U.S. are extremely remote
• Fear of Ebola will hopefully trigger people in developed countries to reach out to our fellow humans in West Africa and help them fight the virus

Items of interest related to childbirth and breastfeeding

• The Centers for Disease Control has issued new guidelines on breastfeeding and Ebola
• Ebola virus infection in pregnant women usually causes miscarriage or severe pregnancy-related bleeding, and all documented births to women with Ebola virus have resulted in stillbirth or infant death
• In 2008 in Liberia, the maternal mortality rate was an alarming 994 maternal deaths per 100,000 births. This, when combined with the fact that the vast majority of Liberians live beneath the international poverty line, makes for a very harsh environment for childbearing women and children. We do not yet know what the impact of the Ebola virus has had on maternal mortality rates in West Africa. It is likely that the lack of resources (including a shortage of health care workers) caused by the epidemic will result in even higher maternal mortality rates.

How can we help?

If you're worried about Ebola, don't panic but do put your concern into action. Many health and relief organizations in West Africa are in need of resources, and you can help. This blog article has a comprehensive list of charities working in West Africa right now.

Have your clients and students asked you about Ebola? Have they expressed concern for themselves or their baby? Have families discussed the fear of entering the hospital to birth, due to their perceived risk of the hospital as being a potential source of exposure to the Ebola virus? Hopefully after reading this blog post by Rebecca, you can help provide the facts. You can also direct them to the Evidence Based Birth online class 'Ebola, Fearbola: Separating Facts from Paranoia' and the About.com article 'Five Things Pregnant Women Need to Know about Ebola' written by Robin E. Weiss. The Centers for Disease Control and Prevention also provides a wealth of information that you can access and share with the families you work with. - SM

About Rebecca Dekker

Rebecca Dekker

Rebecca Dekker, PhD, RN, APRN, is the founder of Evidence Based Birth and teaches pathophysiology at a research university. She has taught continuing education classes on HIV and recently developed an in-depth class on the pathophysiology and epidemiology of Ebola (2 nursing contact hours). To learn about how Ebola is transmitted, prevented, diagnosed, and treated, check out Rebecca's class on 'Ebola or Fearbola? Separating Facts from Paranoia,' here.

Published: November 05, 2014

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