Tuesday, May 26, 2009

The Trouble With Repeat Cesareans

The Trouble With Repeat Cesareans

A great article from TIME magazine in February on VBACs that I can't believe I missed. Sorry!

Wednesday, May 20, 2009

Great website

I went to the Midwives Association of Washington State (MAWS) conference last Friday in Seattle. It was great- I learned a ton, and was very inspired. A friend introduced me to this website you all must check out: mothersnaturally.org
It has a fabulous due date calculator, among many other helpful tools, articles and info. I will add it to my link list on the right side of the blog here.

Tuesday, May 12, 2009

Well put, Jan Tritten

Please jump on over to Midwifery Today's community forum, where midwife Jan Tritten very beautifully articulates how I feel about birth.
Click here to read "Fear not; it is a miracle"

Monday, May 11, 2009

Study reveals conflict between doctors, midwives over homebirth

CORVALLIS, Ore. – Two Oregon State University researchers have uncovered a pattern of distrust – and sometimes outright antagonism – among physicians at hospitals and midwives who are transporting their home-birth clients to the hospital because of complications.

Oregon State University assistant professor Melissa Cheyney and doctoral student Courtney Everson said their work revealed an ongoing conflict between physicians and midwives that is reflective of discord across the country.

The pair recently examined birth records in Oregon's Jackson County from 1998 through 2003, a period when that county saw higher-than-expected rates of prematurity and low birth weight in some populations. The researchers wanted to assess whether those rates were linked to midwife-attended homebirths.

The findings revealed that assisted homebirths did not appear to be contributing to the lower-than-average health outcomes and, in fact, that the homebirths documented all had successful outcomes. But even more importantly to Cheyney, discussions with doctors and midwives uncovered a deep gulf between the two groups of birthing providers, with doctors expressing the firm belief that only hospital births are safe, while midwives felt marginalized, mocked and put on the defensive when in contact with physicians.

"We've been getting insight into their world view, and it's been quite illuminating," Cheyney said.

Cheyney, who is a practicing midwife in addition to being an assistant professor of medical anthropology and reproductive biology, said she was surprised that physicians, when presented with scientifically conducted research that indicates homebirths do not increase infant mortality rates, still refuse to believe that births outside of the hospital are safe.

"Medicine is a social construct, and it's heavily politicized," she said.

Last year the American Medical Association passed Resolution 205, which states: "the safest setting for labor, delivery and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex…" The resolution was passed in direct response to media attention on home births, the AMA stated.

What is interesting, Cheyney points out, is that 99 percent of American births occur in the hospital, but the United States has one of the highest infant mortality rates of any developed country, with 6.3 deaths per 1,000 babies born. Meanwhile, the Netherlands, where a third of deliveries occur in the home with the assistance of midwives, has a lower rate of 4.73 deaths per 1,000.

One of the biggest problems Cheyney sees is that physicians only come into contact with midwives when something has gone wrong with the homebirth, and the patient has been transported to the hospital for care. There are a number of reasons why this interaction often is tension-filled and unpleasant for both sides, she says.

First is the assumption that homebirth must be dangerous, because the patient they're seeing has had to be transported to the hospital. Secondly, the physician is now taking on the risk of caring for a patient who is unknown to them, and who has a medical chart provided by a midwife which may not include the kind of information the physician is used to receiving.

And because the midwife is often feeling defensive and upset, Cheyney said, the contact between her and the physician can often be tense and unproductive. Meanwhile, the patient, whose intention was not to have a hospital birth, is already feeling upset at the change in birth plan, and is now watching her care provider come into conflict with the stranger who is about to deliver her baby.

"It's an extremely tension-fraught encounter," Cheyney said, "and something needs to be done to address it." As homebirths increase in popularity, she added, these encounters are bound to increase and a plan needs to be in place so that doctors and midwives know what protocol to follow.

She is working with Lane County obstetrician Dr. Paul Qualtere-Burcher to draft guidelines that would help midwives and their clients decide when they need to seek medical help, based in large part on Cheyney's research, and another that would ask physicians to recognize midwives as legitimate caregivers.

Qualtere-Burcher said creating an open channel of communication isn't easy.

"I do get some pushback from physician friends who say that I'm too open and too supportive," he said. "My answer, to quote (President) Obama, is that dialogue is always a good idea."

Qualtere-Burcher said he believes that if midwives felt more comfortable contacting physicians with medical questions or concerns, there would be a greater chance that women would get medical help when they needed it.

"Treat (midwives) with respect, as colleagues, and they'll not be afraid to call," he said.

Qualtere-Burcher doesn't expect immediate buy-in, but hopes that if a small group on each side agrees to the plan, it will provide more evidence that a stronger relationship between physicians and midwives will lead to better outcomes for mothers and infants.

"We're having a meeting in early May to propose a draft for a model of collaborative care that might be the first of its kind in the United States," Cheyney said.

Cheyney is also pushing to get hospitals and the state records division to better track homebirths. The department of vital records had no way to indicate whether a birth occurred at home until 2008, and without being able to pull data, Cheyney said it's hard to explore the nature of home birth in Oregon.

She's also working on education programs for midwives in rural areas, including a cultural competency piece as demographics in Oregon continue to change.


The research was funded by Oregon State University's Department of Anthropology Summer Writing Fellowship, the Center for the Study of Women and Society, and the Stanton Women's Health Fellowship.

Widespread Use Of Labour Induction Potentially Harmful To Woman And Baby

11 May 2009

Induction of labor is on the rise in the U.S., standing at 41% according to a large national survey of women who gave birth in 2005. But, a new study published in the April issue of BJOG, the peer-reviewed journal of the Royal College of Obstetricians and Gynaecologists, finds that the best available evidence does not support many reasons medical providers give for using drugs or other measures to cause labor to begin.

The investigators found support only for inducing labor at or beyond 41 completed weeks of gestation and under some conditions when a woman's membranes break before labor. However, there is not good evidence for inducing labor in many other situations, including when the fetus is believed to be large or to have restricted growth, or when a woman is pregnant with twins, has insulin-dependent diabetes, or has low levels of amniotic fluid.

The study's lead author, Dr. Ellen Mozurkewich, a maternal-fetal medicine specialist at the University of Michigan, said, "The best available evidence does not support routine inductions in many situations for which induction is currently being recommended to patients. More research is necessary to clarify the risks and benefits of induction in these situations."

Many pregnant women may be receiving inappropriate care. For example, 17% of women who participated in Childbirth Connection's national Listening to Mothers II survey in 2005 said they had been induced because their caregiver was concerned that their baby was too big. However, best evidence suggests that labor induction is not beneficial in this case.

"We now know that every week of gestation counts in terms of brain and lung development. When there is no good reason to end pregnancy, mothers and babies benefit from waiting for labor to begin on its own," said Carol Sakala, Director of Programs, Childbirth Connection. "Starting labor early can lead to negative outcomes for the woman and/or baby."

To foster high quality maternity care, Childbirth Connection, a research and advocacy organization, commissioned this study through a grant from the Transforming Birth Fund of the New Hampshire Charitable Foundation.

Concerns about inducing labor without an established medical rationale include increased risk of cesarean section for some mothers (e.g., first-time mothers and women with a cervix that is firm and closed), and babies who are born before full lung and brain maturation. Estimates of how long a fetus has been developing can be off by up to two weeks, and labor induction can unwittingly end with a preterm birth.

Childbirth Connection

Friday, May 8, 2009

Brain Maturation In Preemies May Be Delayed By Iron Deficiency In Womb

(Terri here- all the more reason to be eating lots of leafy greens, liver, lentils and blackstrap molasses during your pregnancy. I'm serious!)

05 May 2009

Iron plays a large role in brain development in the womb, and new University of Rochester Medical Center research shows an iron deficiency may delay the development of auditory nervous system in preemies. This delay could affect babies ability to process sound which is critical for later language development in early childhood.

The study evaluated 80 infants over 18 months, testing their cord blood for iron levels and using a non-invasive tool -- auditory brainstem-evoked response (ABR) -- to measure the maturity of the brain's auditory nervous system soon after birth. The study found that the brains of infants with low iron levels in their cord blood had abnormal maturation of auditory system compared to infants with normal cord iron levels.

"Sound isn't transmitted as well through the immature auditory pathway in the brains of premature babies who are deficient in iron as compared to premature babies who have enough iron," said Sanjiv Amin, M.D., associate professor of Pediatrics at the University of Rochester Medical Center and author of the abstract presented today at the Pediatric Academic Society meeting in Baltimore. "We suspect that if the auditory neural system is affected during developmental phase, then other parts of the brain could also be affected in the presence of iron deficiency."

As many as 20 to 30 percent of pregnant women with lower socio-economic status are iron deficient. Iron deficiency in pregnant woman can cause anemia, a condition in which there are not enough red blood cells to carry oxygen around the body. Anemia can cause a range of problems in pregnancy from exhaustion to preterm labor and low birth weight. But physicians didn't know that an iron deficiency in a fetus may also delay auditory neural maturation. which could lead to language problems.

"We are concerned by these findings because of its potential implications for language development," Amin said. "More study is needed to fully understand what this delay in maturation means. This finding at least underscores an already understood need to monitor iron levels in pregnant women."

Heather Hare
University of Rochester Medical Center

Local Pregnancy and Birth Event

Dayspring Midwifery (the Coeur d'Alene Birth Center) is holding an event at the CDA public library tomorrow, Friday, May 8th from 11am-5pm. This is being held to promote community awareness and in celebration of International Midwives Day. Come by to introduce yourself, and say hi!

Can you see the baby?

Thursday, May 7, 2009

Foster mom-nurse charged in baby's death

Terri here- warning: this story will make you sick. It should make you sick! This foster mom, who was working as a NICU nurse (taking care of babies as her job!), loaded this 9-month-old baby up with Benadryl, taped a pacifier to his mouth, and left him on an adult bed where he suffocated to death.
Here is the story.

Taking probiotics during pregnancy 'can reduce obesity in mothers'

May 7, 2009

Pregnant woman


Researchers found adiposity in 25 per cent of the women who received the probiotics along with dietary counselling, compared with 43 per cent of the women who received diet advice alone

Women who take probiotics during their first trimester of pregnancy may be less likely to suffer from the most unhealthy form of obesity after giving birth, according to research.

A study by scientists at the University of Turku in Finland suggests that manipulating the balance of bacteria in the gut may help to fight obesity.

Probiotics are bacteria that help to maintain a bacterial balance in the digestive tract by reducing the growth of harmful bacteria. They are part of the normal digestive system and play a role in controlling inflammation.

Researchers have for many years been studying the potential of using probiotic supplementation to address a number of intestinal diseases. More recently, obesity researchers have investigated whether the balance of bacteria in the gut might play a role in making people fat.

Kirsi Laitinen, a nutritionist and senior lecturer at the University of Turku, said that the results of the study, presented today at the European Congress on Obesity, were an encouraging sign of the impact of a diet supplemented with probiotics on adiposity. Adiposity, or central obesity, is a particularly unhealthy form of obesity associated with fat bellies.

“The women who got the probiotics fared best,” she said. “One year after childbirth, they had the lowest levels of central obesity as well as the lowest body fat percentage.

“We found [adiposity] in 25 per cent of the women who had received the probiotics along with dietary counselling, compared with 43 per cent of the women who received diet advice alone.”

In the study, 256 women were randomly divided into three groups during the first trimester of pregnancy.

Two of the groups received dietary counselling consistent with what is recommended during pregnancy for healthy weight gain and optimal foetal development. They were also given food such as spreads and salad dressings with monounsaturated and polyunsaturated fatty acids, as well as fibre-enriched pasta and breakfast cereal to take home.

One of those groups also received daily capsules of probiotics containing Lactobacillus and Bifidobacterium, which are the most commonly used probiotics. The other group received dummy capsules.

A third group received dummy capsules and no dietary counselling. The capsules were continued until the women stopped exclusive breastfeeding, after up to six months.

The researchers weighed the women at the start of the study, which was funded by the Social Insurance Institution of Finland, the Academy of Finland and the Sigrid Jusélius Foundation, a medical research charity.

At the end of the study they weighed them again and measured their waist circumference and skin fold thickness.

Central obesity — defined as a body mass index (BMI) of 30 or more or a waist circumference over 80 centimetres — was found in 25 per cent of the women who had been given the probiotics as well as diet advice.

That compared with 43 per cent of the women who got dietary counselling alone and 40 per cent of the women who got neither diet advice nor probiotics. The average body fat percentage in the probiotics group was 28 per cent, compared with 29 per cent in the diet advice only group and 30 per cent in the third group.

Ms Laitinen said that further research was needed to confirm the potential role of probiotics in fighting obesity. One of the limitations of the study was that it did not take into account the mothers’ weight before pregnancy, which may influence how fat they later become.

She said that she and her colleagues would continue to follow the women and their babies to see whether giving probiotics during pregnancy had any influence on the health of the women’s children.

“The advantage of studying pregnant women to investigate the potential link between probiotics and obesity is that it allows us to see the effects not only in the women, but also in their children,” she said.

“Particularly during pregnancy, the impacts of obesity can be immense, with the effects seen both in the mother and the child. Bacteria are passed from mother to child through the birth canal, as well as through breast milk, and research indicates that early nutrition may influence the risk of obesity later in life. There is growing evidence that this approach might open a new angle on the fight against obesity, either through prevention or treatment.”

Maternal Depression Has Negative Effect on Infants' Sleep

Wed May 6, 11:48 pm ET

WEDNESDAY, May 6 (HealthDay News) -- Women battling depression when their children are born are more likely to have infants with significant sleep issues and who run a higher risk of having early-onset depression during childhood, a new study says.

In the first six months of life, babies born to depressed mothers took longer to fall asleep at night, slept in shorter bursts and less soundly than infants born to mothers not experiencing depression. These high-risk infants also had more frequent but much shorter periods of sleep during the day, according to the findings published in the May 1 issue of Sleep.

Though unsure of the cause of these disruptive sleep patterns, the researchers said they believe the condition and its consequences could be reversed in the child.

"We do think that we could develop a behavioral and environmental intervention to improve entrainment of sleep and circadian rhythms in the high-risk infants," study lead author Roseanne Armitage, director of the Sleep and Chronophysiology Laboratory at the University of Michigan Depression Center, said in an American Academy of Sleep Medicine news release. "They may still be modifiable, since brain regulation is very plastic and responsive in childhood."

Past studies suggest that cortisol, a stress hormone produced in greater amounts by depressed women during pregnancy and after delivery, may affect the infant's ability to sleep.

If infant sleep problems are not addressed, they can become long-term issues that can affect not only the child's mental and physical health, but also the mother's, past studies have shown. This is a particular issue among people with maternal depression. The mother's health could further deteriorate if her child's sleep issues also cause her to lose valuable rest time.

Over six months starting at two weeks following birth, the researchers monitored the sleep of 18 full-term born children and their mothers for periods of seven consecutive days once a month. The mothers -- some of whom had no personal or family history of depression and others who had been diagnosed with depression or elevated depression symptoms -- also kept journals about daily sleeping and waking patterns.

The researchers said they think future studies should examine whether infant sleep patterns can be modified and what are the best conditions for nighttime sleep.

90-year-old woman catches her great-granddaughter

What a great family story!

Read about it here.