Study: Many kids in Katrina trailer park anemic

Date: 11/25/2008

By JANET McCONNAUGHEY
Associated Press Writer

NEW ORLEANS (AP) _ Dozens of infants and toddlers who lived in Louisiana's biggest trailer park for those displaced by Hurricane Katrina were anemic because of poor diets, at a rate more than four times the national average.

About 41 percent of 77 children under the age of 4 suffered from the condition this year, according to a study released Monday by the Children's Health Fund. Most, and possibly all, lived in the Renaissance Village trailer park in Baker.

Iron deficiency anemia can cause fatigue and learning problems. Severe deficiency in young children can delay growth and development and even cause heart murmurs.

The national rate for children that young is below 10 percent. Louisiana has one of the nation's highest anemia rates, with about 24 percent of all children below the age of 5 affected, according to the 2007 Pediatric Nutrition Surveillance survey.

Dr. Irwin Redlener, president of the Children's Health Fund and director of Columbia University's National Center for Disaster Preparedness, said the Renaissance Village rate was double the rate for homeless children the same age in New York City shelters.

The study used records for all 261 babies and children who lived in New Orleans until Katrina and were treated last year at CHF's mobile clinics at the trailer park and Baton Rouge schools, said Roy Grant, the organization's director of applied research and policy analysis.

While most of the affected children were storm evacuees, it was possible that a few were natives of Baton Rouge.

But studying the problem further and providing follow-up care for the children is difficult because the state closed the parks in May.

"Now it's more difficult, because they're no longer in the trailer area. They're dispersed around the state. So it's a little harder to get follow-up," said Dr. Jimmy Guidry, Louisiana's health officer.

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On the Net:

http://www.cdc.gov/nccdphp/dnpa/nutrition/nutrition_for_everyone iro n_defici ency/index.htm

Copyright 2008 The Associated Press.

Child deaths test faith-healing exemption

Date: 11/21/2008

By WILLIAM McCALL
Associated Press Writer

OREGON CITY, Ore. (AP) _ When Dr. Seth Asser saw row after row of flat headstones marking children's graves in a small cemetery not far from the end of the historic Oregon Trail, he knew many of these early deaths should not have happened.

The children's parents relied on faith healing, instead of doctors.

The pediatrician published a landmark study concluding many of the deaths could have been prevented if the children had received medical care.

"What struck me was the fact that it was obvious from the expressions on the headstones that the children were loved," Asser said. "So it was especially troublesome they were not afforded the care that most parents would give their children."

His study 10 years ago brought attention to the issue, and yet today three criminal cases — two in Oregon and one in Wisconsin — have revived concerns about exemptions that most states grant to parents who rely on faith healing instead of doctors to treat sick children.

Faith healing has deep roots in American history, and yet it may seem surprising that in the 21st century, children still die because parents choose not to seek medical help from physicians.

State laws across the nation exempt members of religious groups from prosecution if they choose faith healing over science. Asser and a colleague, Rita Swan, have been trying to get states to repeal such laws, arguing that safety should always come first, no matter what the parents believe.

"We can't legislate good parenting, but at least we shouldn't have laws allowing bad parenting," said Swan, who now heads the advocacy group Children's Healthcare.

But Swan and Asser have been lonely voices, partly because tragedies are rare and partly because legislators are loath to challenge parental rights, especially when they are intertwined with the constitutional right to freedom of religion.

"There hasn't been a groundswell of organized advocacy to get the laws changed," said Shawn Francis Peters, a University of Wisconsin professor and author of a book on faith healing. "I do think there's broad public sentiment to do it, but that doesn't get things through the meat grinder of legislation."

According to the U.S. Department of Health and Human Services, at least 30 states have specific exemption laws on the books.

What does federal law say? According to HHS, nothing in the amendments to the original 1974 Child Abuse Prevention and Treatment Act, can "be construed as establishing a federal requirement that a parent or legal guardian provide any medical service or treatment that is against the religious beliefs of the parent or legal guardian."

Five states have repealed exemption laws, Swan said: Hawaii, Maryland, Massachusetts, Nebraska and North Carolina.

Some states have revised their laws, including Oregon in 1999. After a stormy debate in the Oregon Legislature, then-Gov. John Kitzhaber — a doctor — signed a compromise bill into law that eliminated the Oregon spiritual healing exemption in some manslaughter and criminal mistreatment cases.

Many of the exemption laws were enacted in the 1970s, promoted by two top advisers to former President Nixon — Bob Haldeman and John Erlichman — and an influential senator, Charles Percy of Illinois, who practiced Christian Science.

The religion, founded by Mary Baker Eddy just after the Civil War, embraces a form of faith healing its adherents say is unique and different from the way it is practiced by some fundamentalists.

The Church of Christ, Scientist, emphasizes that it does not prevent any members from seeking medical care, and it is quick to distance itself from other religious groups that demand prayer be the only method for healing.

"One of the mistakes people make is lumping all these groups together," said Stephen Lyons, a Boston attorney who has defended Christian Scientists.

Church leaders also deny their lobbying efforts with state lawmakers across the country have kept the laws on the books, even though Peters and a fellow author on faith healing, Boston College historian Alan Rogers, say the effort is intense and largely successful.

"It's remarkable," Rogers said. "Without exception, it has been the push of the Christian Science church."

Two pending criminal cases expected to test Oregon's revised law are against parents belonging to the Followers of Christ Church, the same religious sect that owns the cemetery visited by Asser in 2001.

Jeffrey Dean Beagley, 50, and his 46-year-old wife, Marci Rae Beagley, have pleaded not guilty to charges of criminally negligent homicide for failing to provide adequate medical care, in violation of their duties as parents.

Their 16-year-old son, Neil, died in June from complications of a urinary-tract blockage that triggered heart failure. Doctors said a simple procedure could have saved his life.

In the other Oregon case, Carl Brent Worthington and his wife, Raylene, have pleaded not guilty to charges of manslaughter and criminal mistreatment in the death of their 15-month-old daughter, Ava, who died at home from bacterial pneumonia and a blood infection, conditions the state medical examiner said were treatable.

The Beagleys and the Worthingtons have refused to talk to reporters, and their attorneys have declined to comment, along with prosecutors.

In a third case, in Wisconsin, Leilani and Dale Neumann face reckless homicide charges in the death of their 11-year-old daughter due to complications from diabetes.

Leilani Neumann has said the family believes in the Bible and that healing comes from God, but she said they do not belong to an organized religion or faith and have nothing against doctors.

The Followers of Christ figured prominently in a state legislative battle over the Oregon exemption that began in 1998 with the discovery of the children's graves, and the death of an 11-year-old member of the sect from complications caused by diabetes.

The political battle ended with revision of the law, but not its repeal.

"I was there" — for repeal, said Oregon Senate President Peter Courtney. And, he notes, so were churches, child health care advocates, law enforcement and plenty of parents.

What stopped the Legislature from an outright repeal of the law was an effort to protect religious freedom and parental rights and at the same time protect children.

"We tried and tried and tried to figure out a way to speak to, to be sensitive to, and balance all those influences," Courtney said. "Did we do it? I don't know."

"These are extremely sensitive cases nationally," said Josh Marquis, an Oregon district attorney who has been part of the debate over how to balance those conflicting rights. "It's where faith meets the law."

In a 1998 study published in the medical journal Pediatrics, Asser and Swan, herself a former Christian Scientist, documented 172 faith-related child deaths in the United States between 1975 and 1995. They found that 140 of the children died from conditions for which survival rates with medical care exceeded 90 percent.

Asser notes that no government agencies systematically collect data, and reliance on faith healing is not a category listed on a death certificate.

Before federal medical privacy laws were tightened, he was able to talk to medical examiners about cases, but that has become more difficult.

Asser has tracked a handful of cases that have gotten media attention in the past decade, including deaths in Philadelphia, Massachusetts and California. But he still learns about many of the deaths only through concerned friends or family members who contact him or Swan.

And death is not the only troubling outcome when children avoid doctors because of their parents' religious beliefs.

Beth Young, a professor at the University of Central Florida, says her hip dysplasia, which could have been easily corrected when she was an infant, went unnoticed and untreated by her Christian Scientist parents. Young finally went to a doctor in her 20s to find out why it was such a struggle to walk and climb stairs.

She learned her hip joints were deteriorating — but that it was too late for a surgical fix.

"It's not going to get any better," Young said in an interview. "I think about that every day. If my parents knew how simple the treatment was, I don't think they would have ignored it. So I do feel cheated."

She added: "I can remember times when I would pray and pray and pray, and I would think that maybe I'm healed now, and then I would go check, and I'd go walk in front of a mirror or something, and then I would discover, no I'm not."

Lyons, the Boston lawyer, has drawn national attention for defending parents in faith healing cases.

He successfuly represented David and Ginger Twitchell, Christian Science parents in Boston who were acquitted of manslaughter charges in the 1986 death of their 2-year-old son from a congenital defect that caused the bowel to twist and become obstructed.

The landmark case caused enough concern to persuade Massachusetts lawmakers to abolish the religious exemption, said Jetta Bernier, executive director of Massachusetts Citizens for Children.

But even when such exemptions are abolished or revised, prosecutions can be difficult so long as parents show they are sincere in their religious beliefs, legal experts say.

"The status quo is very difficult to upset," said Jesse Choper, the Earl Warren Professor of Public Law at the University of California, Berkeley.

Copyright 2008 The Associated Press.

No infant euthanasia reported in Netherlands

Date: 11/14/2008

AMSTERDAM, Netherlands (AP) _ No cases of infant euthanasia were reported in the Netherlands in the first year after laws on mercy killings were expanded to cover newborns, Dutch officials said Friday.

The Netherlands legalized euthanasia for adults in 2001 in cases where the patients are suffering unbearable pain due to illness with no hope of recovery, and ask to die. Several doctors must agree before a lethal cocktail of sedatives and painkillers is administered.

In 2006, that policy was expanded to include newborns with extreme birth defects, who can be killed at the request of their parents.

The commission set up to vet whether guidelines are followed in such cases said doctors did not report any incidences in 2007, the commission's first year of operation.

Studies in the 1990s found that 15-20 such babies were probably euthanized illegally each year in the Netherlands, a country of 16 million people. Doctors were hardly ever prosecuted because authorities were reluctant to press charges in a country where euthanasia has been widely accepted as ethical.

The panel of medical and ethical experts wrote in a report sent to Parliament that one explanation for the absence of reported infant euthanasia cases may be that fetuses with dire defects are being detected via ultrasound examinations and aborted before the 24th week of pregnancy.

The commission said members plan to visit all neonatal intensive care units in the country this year to encourage more reporting of euthanasia.

Copyright 2008 The Associated Press.

Editorial: Infant Mortality/TimesDaily

Date: 11/13/2008

TimesDaily on infant mortality:

The infant mortality rate is inching upward in Alabama, and there is little extra money to educate and provide care to those who need it the most.

An unsettling trend that for years was being reversed has changed courses, causing concern among state health officials that money may not be available to continue combating the problem.

The Alabama Department of Public Health reports that infant mortality rates crept up slightly from 2006 to 2007, the latest year information is available. In the Shoals, the rate continues to decrease, except in Colbert County.

Numbers compiled in 2007 show that for every 1,000 live births in Alabama, 10 children did not live past their first birthday. That compares to nine deaths per 1,000 live births in 2006.

In the Shoals, the trend is less clear. Franklin County's deaths per 1,000 live births has shown a steady decline — from six in 2005 to four in 2007 — while Lauderdale County's rate dipped from nine to seven per 1,000 between 2005 and 2006, but jumped to nine in 2007. Colbert County, however, has shown a steady increase in infant mortality. The rate has increased from five in 2005 to eight in 2007.

Health officials aren't sure why the rate has increased, but lack of health care insurance may be one of the culprits. Another culprit may be the reversal of the decline in teen pregnancies. Officials say the lack of prenatal care, low education attainment, smoking, and health problems associated with teenagers becoming pregnant (some as young as 11 and 12) all contribute to the rising rates of infant mortality.

The solution? One of the answers is more money, which could be used to provide prenatal care to all women who don't have health care insurance. Don Williamson, state health officer, said an ideal solution would be to provide coverage to unborn children, but admits that the state would have a difficult time finding the money.

Others say the relative lack of sex education in schools — particularly safe sex and birth control information — may be contributing to the problems.

Once again, Alabama is faced with a public health problem and little money to reverse it. Budgets will be tighter than usual in the coming year, but the governor and legislators should work to find whatever extra money may be available to combat the rising infant mortality rate.

Copyright 2008 The Associated Press.

Van will bring dental services to P.G. children

Date: 11/13/2008

LARGO, Md. (AP) _ Maryland officials are getting a mobile dental office to serve needy children in Prince George's County.

The van will be named the Deamonte Driver Dental Project, after a 12-year-old county resident who lacked access to dental care and died last year from a tooth infection that spread to his brain.

Maryland's secretary of health and mental hygiene, John Colmers, says the van will visit local schools and publicize the need for children to receive dental care.

The state gave the county $288,000 to buy the van.

___

Information from: The Washington Post, http://www.washingtonpost.com

Copyright 2008 The Associated Press.

Report urges states to tackle preterm birth crisis

Date: 11/12/2008

By LAURAN NEERGAARD
AP Medical Writer

WASHINGTON (AP) _ The odds of having a premature baby are lowest in Vermont and highest in Mississippi.

The March of Dimes mapped the stark state-by-state disparities in what it called a "report card" on prematurity Wednesday — to track progress toward meeting a federal goal of lowering preterm births.

There's not much chance of meeting that goal by the original 2010 deadline, if the "D'' grade the charity bestowed on the nation is any indication. Ohio also earned a "D."

More than half a million U.S. babies — one in every eight — are born premature each year, a toll that's risen steadily for two decades. The government's goal: No more than 7.6 percent of babies born before completion of the 37th week of pregnancy.

Preterm birth can affect any mother-to-be, stressed a recent U.S. Surgeon General's meeting on the problem. Scientists don't understand all the complex causes.

But Wednesday's report highlights big geographic differences that March of Dimes president Dr. Jennifer Howse called "a dash of cold water."

In Vermont, 9 percent of babies were preemies in 2005, the latest available data. In Oregon and Connecticut, just under 10.5 percent of babies were premature.

Travel south, and prematurity steadily worsens: In West Virginia, 14.4 percent of babies were preemies; more than 15 percent in Kentucky and South Carolina; more than 16 percent in Alabama and Louisiana; and a high of 18.8 percent in Mississippi.

Ohio's had 13 percent of babies born premature.

The report urges states to address three factors that play a role:

—Lack of insurance, which translates into missed or late prenatal care. In states with the highest prematurity rates, at least one in five women of childbearing age are uninsured. Early prenatal care can identify risks for preterm labor and sometimes lower them.

—Smoking increases the risks of prematurity, low birthweight and birth defects. Government figures suggest 17 percent of women smoke during pregnancy. The new report urged targeting smoking by all women of childbearing age. About a third of those women smoke in Louisiana and West Virginia, the report says, compared with 9.3 percent and 11 percent in Utah and California, respectively.

—Then there's the trickier issue of so-called late preemies, babies born between 34 and 37 weeks. They're fueling the nation's prematurity rise. While not as devastating as a baby born months early, being even a few weeks early can cause learning or behavioral delays and other problems. And recent research suggests at least some near-term babies are due to Caesarean sections scheduled before full-term, either deliberately or because of confusion about the fetus's exact age.

Howse urged hospitals to double-check that women given an early C-section truly need one for a medical problem, as current health guidelines recommend.


Copyright 2008 The Associated Press.

Rerouting urinary nerves to help spina bifida

Date: 11/10/2008

By LAURAN NEERGAARD
AP Medical Writer

WASHINGTON (AP) _ It's a delicate and daring experiment: Could doctors switch a leg nerve to make it operate the bladder instead?

Families of a few U.S. children whose spina bifida robs them of the bladder control that most people take for granted dared to try the procedure — and early results suggest the surgery indeed may help, in at least some patients.

With the technique, pioneered in China, the kids are supposed to scratch or pinch their thigh to signal the bladder to empty every few hours. But surprisingly, some youngsters instead are starting to feel those need-to-go sensations that their birth defect had always prevented.

"It feels like this little chill kind of thing in me," marvels 9-year-old Billy Kraser of Scranton, Pa.

"When he goes in there and he's dry and he's clean, it's such a triumph," adds his mother, Janice Kraser. "I'll hear him going, 'Yesss!'"

The U.S. pilot study consists of just nine spina bifida patients and still is tracking how they fare — no one is finished healing yet. But already desperate families are lining up for a chance at this nerve rerouting, even as William Beaumont Hospital in Royal Oak, Mich., is trying to raise money to expand the study and provide better evidence.

"If it works, it'll be a huge improvement in the management of patients with spina bifida," says Dr. Kenneth Peters, Beaumont's urology chairman, who has a waiting list of nearly 100 would-be patients.

But, "it's imperative that we prove whether this works or not" before accepting all-comers, he stresses. "I have many patients who would pay cash and have it done. I refuse to do that."

Spina bifida occurs when the spinal column fails to close properly. It's a birth defect that affects about 1,300 babies a year, with varying degrees of leg paralysis and other problems.

Because bladder and bowel function depend on nerve messages zipping to and from the brain via the spinal cord, most spina bifida patients have trouble. Some are totally incontinent, some partially. Others have the opposite problem and must empty the bladder with catheters every few hours, leaving them vulnerable to urinary tract infections and life-threatening kidney damage. There are few good treatments.

Enter Dr. Chuan-Gao Xiao of China's Hauzhong University of Science and Technology. The U.S.-trained surgeon developed a way to bypass the brain: Cut open a spot on the lower spine and sew two normally unrelated nerves together — a lumbar nerve that acts in the thigh to a sacral nerve that would normally squeeze the bladder.

If they fuse well, then scratching the thigh can send a signal directly to the bladder side of the new nerve bridge, Xiao's early research found. More than 1,000 patients in China are thought to have undergone the procedure; Xiao has reported results on only a fraction in respected urology journals.

Beaumont's Peters traveled to China to learn Xiao's technique and began the pilot study thanks to a private donor who financed the $40,000-a-patient surgery.

His nine spina bifida patients — plus an additional three adults with spinal cord injuries — emerged from surgery to anxiety: It can take months for the nerves to heal, even longer in the adults who are still waiting.

But a year later, seven spina bifida patients had their bladders contract as they scratched a leg. All those who'd needed medication for overactive bladders have quit the drugs. Some who had always needed catheters, like Billy Kraser, are starting to urinate on their own. Fecal continence is improving, too.

One patient so far is what Peters calls a home run, a 14-year-old girl who no longer suffers embarrassing leaks or needs catheters.

The main side effect: Some leg weakness after surgery, enough to put Billy in a wheelchair for a month until he could navigate his usual lower-leg braces again. Another patient developed what appears to be a permanent dragging foot.

A standing-room-only crowd packed a recent meeting of the American Urological Association to hear Beaumont's early results.

"The promise is great," says Dr. Kenneth Glassberg, a pediatric urologist at New York's Columbia University Medical Center who has long known Xiao and operated with him in China.

Glassberg, too, is getting surgery requests from U.S. families but stresses that it's not yet clear how many patients would even be candidates, depending at the very least on where the spinal column is damaged.

The Spina Bifida Association is bringing Xiao to Florida in March to address an international meeting of about 500 doctors involved in spina bifida care — but also cautions families to await the research, particularly on the procedure's safety.

Back in Pennsylvania, Janice Kraser laments the lack of research funding, saying finding a good treatment would more than pay for itself if patients avoid expensive kidney damage. She's a nurse who home-schools Billy — he can't be catheterized at schools his siblings attend — while working nights and weekends in part to raise the thousands of dollars the family has spent traveling to Beaumont for follow-up testing.

Billy can't yet completely empty his bladder, but has far fewer urinary tract infections and enough control that his mother anticipates him trying underwear soon.

"It's very cool," Billy says of the study. "I did good and was a trouper."

___

EDITOR's NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.

Copyright 2008 The Associated Press.

Huntsville girl conquers spina bifida

Date: 11/3/2008 4:00 AM

By YVONNE BETOWT
The Huntsville Times


HUNTSVILLE, Ala. (AP) — On a recent Brownie outing to earn a disability awareness badge, Trish Switzer let her troop choose from blindfolds, ear plugs, leg weights, wheelchairs and walkers so they could be "disabled" during a scavenger hunt.

"After all the girls made their choices, (her daughter) Sarah said: 'I want a disability,'" said Switzer with a laugh.

Sarah, 9, was born with spina bifida and walks with the help of braces on the lower parts of her legs. But she doesn't accept the fact she is disabled.

Spina bifida is an opening in the spinal cord that causes full or partial paralysis, nervous system complications, bladder and bowel control problems, learning disabilities, depression and other issues.

The condition affects 70,000 Americans and was once considered a death sentence. But many, like Sarah, are leading near-normal lives.

Today, a pink Barbie wheelchair helps Sarah go long distances. She also is constantly accompanied by her Canine Companion dog, Bakari.

The Heritage Elementary School third-grader also enjoys water skiing, bowling and horseback riding.

After learning about Sarah's birth defect, the Switzers had little time to mourn. That day they were told about an experimental fetal surgery in which doctors take the baby from the womb, perform the operation to close the opening in the spine, and return the baby to the womb so it can continue developing.

The surgeries took place on July 1, 1999, at Vanderbilt in Nashville. Sarah was born again on Aug. 22.

Trish and Sarah were featured in Life magazine because of the risky pioneering procedure.

Today, the surgery is still performed, both before and after birth, but the verdict is still out on which provides the best results. A study is under way by the National Institute of Child Heath and Human Development to determine the most beneficial surgery to prevent problems associated with spina bifida.

When the Switzers first learned Sarah had spina bifida, their world was shattered, along with Bob and Judy Switzer, Sarah's paternal grandparents.

Several decades ago, Judy Switzer was a nurse at Johns Hopkins Hospital in Baltimore where she saw many babies with spina bifida.

"No one knew much about it 50 years ago," she said. "Many babies with it went home and became infected and died."

Her husband, Bob Switzer, said the news was "devastating" at first.

But now he and Judy, who moved to Madison to be near their only grandchild, are enjoying watching Sarah grow and take part in a variety of activities.

"She recently water skied for 16 miles without stopping," said the proud grandfather. "Sarah knows what she can and can't do."

Trish Switzer had never heard of spina bifida until she became pregnant with Sarah.

"I was as healthy as you could be," said Switzer, who was 35 when Sarah was born. "I did everything I was supposed to do (to have a healthy child). I took folic acid, ate healthy and exercised."

Folic acid, a vitamin B supplement doctors recommend to reduce the risk of brain-related problems such as spina bifida/hydrocephalus (fluid on the brain), didn't work in Switzer's case.

But as president of the Spina Bifida Association of Alabama, Switzer is still a big advocate of folic acid which is used to make the extra blood needed during pregnancy and creates healthy cells.

"Folic acid is not a 100 percent guarantee to prevent birth defects," said Switzer, who is trying to educate the public about the debilitating condition during October, Spina Bifida Awareness Month. "But we believe it reduces some of the problems that can occur during a pregnancy."

Dr. Debra Williams with the Madison County Health Department agrees.

"Every woman of pregnancy age should be taking folic acid each day," said Williams. "It can prevent neural tube defects such as spina bifida or any disease that is brain related."

According to the Spina Bifida Association of America, the exact cause of spina bifida is not known, but genetics and environmental factors do play a part in causing the condition that affects one of every 1,000 newborns in the U.S.

While it was almost a certain death sentence 30 years ago, today 80 to 90 percent of infants born with spina bifida survive and live a normal life expectancy.

After moving from England where her husband, Michael, was stationed with the U.S. Army, to Madison in 2005, Switzer attempted to find support for the family as it maneuvered the difficult maze of disability.

One of the first people Switzer met was Bill Whatley of Huntsville, believed to be the oldest active person with spina bifida in the United States at age 78. Now retired, Whatley was head of Huntsville Aviation for three decades. He continues to be a local, state and national advocate for the condition which nearly claimed his life as a child.

The Switzers and Whatley have become close friends since meeting three years ago.

Whatley calls Sarah a "miracle child."

He should know. He's living proof miracles happen.

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Information from: The Huntsville Times, http://www.al.com/hsvtimes/hsv.html

Copyright 2008 The Associated Press.

Experts: Trial will help focus on mental illness

Date: 11/2/2008 6:41 PM

Experts: Trial will help focus on mental illness

DES MOINES, Iowa (AP) — Experts believe a new trial for a Des Moines woman could reopen discussion about postpartum psychosis.

Last month, the Iowa Supreme Court ordered a new trial for Heidi Anfinson, who was previously convicted of killing her 2-week-old son.

She faces a new trial on murder charges next year.

Some experts are praising the decision to grant Anfinson a new trial.

Attorney George Parnham, who represented Houston mother Andrea Yates, who killed her five children in 2001 but was ruled not guilty by reason of insanity, says the new trial marks a significant step in the right direction by recognizing postpartum psychosis as an issue.

The trial, "marks a very significant move in the right direction," Parnham said.

As Yates' attorney, Parnham argued that she suffered from severe postpartum psychosis when she drowned her children, who ranged from 6 months to 7 years old, in a bathtub.

Experts say each case involving a mother who kills their children is different. But they say that each case merits a complete investigation — both for the sake of the mother and to prevent future tragedies in the home.

"Women's health has never been at the forefront of attention," said Darlene Gibson, nurse manager in maternity services at Iowa Methodist Medical Center in Des Moines. "But until we educate ourselves, we're going to have this going on."

Iowa Methodist is part of the Iowa Health System, which recently began screening all new mothers for postpartum depression.

In Anfinson's case, the family suspected postpartum problems, though that was not initially argued in court. In 1998, more than one Des Moines police officer found it odd that Anfinson showed little emotion when questioned about her missing baby.

The new mother, who was then 38, cried when — after intense questioning — she led officers to the limp body of her son Jacob at the Sandpiper Recreational Area.

Her lawyer in her first two trials, Bill Kutmus, argued that Jacob drowned when Anfinson neglectfully walked away from the infant's bath to use the telephone.

Kutmus argued that Anfinson then panicked and drove the baby to a recreation area near Saylorville Lake. After questioning, she eventually led police to water about a foot deep, where Jacob was found weighed down with 25 pounds of rocks.

In a post-conviction relief petition, Anfinson's family argued that her lawyer did not pursue evidence of postpartum psychosis and Anfinson's history of childbirth-related mental problems.

Kutmus represented Anfinson in her first trial in 1999, which ended in a hung jury, and the 2000 trial at which she was convicted.

"I could just tell something wasn't right after Jacob was born," said Irv Hoffbauer, Heidi Anfinson's father. "She wasn't eating right. Her memory was flaky.

"I was the one person in the family at the time who thought so. I brought up to her sisters that I thought somebody should stay with her, and they all just thought I was imagining things. But they were so enamored with the fact that they were going to have a nephew. ..."

Experts and medical organizations have blamed a slew of biological and environmental factors for the mood swings and anxiousness typically associated with the "baby blues" and more rare and potentially life-threatening forms of major depression or psychosis women experience after childbirth.

Postpartum depression reportedly affects one to four mothers in every 1,000. Postpartum depression usually begins within the first two weeks after childbirth. In recent years, celebrities such as Brooke Shields and Marie Osmond have been praised for raising awareness about postpartum depression, a condition that can affect as many as 15 percent of new mothers.

Joyce McConnell, dean of the West Virginia College of Law, who has researched the medical and psychological reasons women harm their children, said experts still aren't clear on the causes of postpartum psychosis.

"It's only within the last six years that researchers have begun to take this seriously and done more research," McConnell said.

___

Information from: The Des Moines Register, http://www.desmoinesregister.com

Copyright 2008 The Associated Press.