Chemicals commonly found in food packaging, upholstery and carpets may be damaging women's fertility, say US scientists.
A study published in the journal Human Reproduction measured levels of perfluorinated chemicals (PFCs) in the blood of 1,240 women.
Those with higher levels were more likely to take longer to become pregnant.
UK experts said more research was needed to confirm a link.
PFCs are useful in industry because they are resistant to heat, and have the ability to repel water and oil.
However, high concentrations have been linked to organ damage in animals, and the chemicals have the ability to persist for long periods in the body.
The researchers, from the University of California in Los Angeles, analysed blood samples taken at the time of the woman's first antenatal visit, then interviewed the women about whether the pregnancy was planned, and how long it had taken them to get pregnant.
The levels of the chemicals varied from 6.4 nanograms per millilitre of blood - a nanogram is a billionth of a gram - to 106.4 nanograms per ml.
When the group of women were divided into four groups depending on these levels, they found that, compared to women in the group with the lowest readings, the likelihood of infertility - taking more than a year or IVF to get pregnant - was significantly higher for women with higher levels of PFCs in their bloodstream.
Dr Chunyuan Fei, one of the researchers, said that earlier studies had suggested that PFCs might impair the growth of babies in the womb.
She said that more women in the groups with higher exposure to PFCs had problems with irregular menstrual cycles , which might suggest that interference with hormones was the reason.
'Tenuous link'
Professor Jorn Olsen, who led the study, said that the team were now waiting for further studies to confirm the link between fertility problems and PFCs.
Tony Rutherford, chairman of the British Fertility Society, said that the findings were "interesting".
"This research shows a tenuous link in the delay to conception in women with the highest levels of two commonly-used perfluorinated chemicals.
"It is an important finding and certainly warrants further detailed research, particularly in those trying for a family.
"The study emphasises the importance of remaining vigilant to potential environmental factors that may impact on fertility."
http://news.bbc.co.uk/2/hi/health/7855323.stm
Friday, January 30, 2009
Wednesday, January 21, 2009
Caesarean increases asthma risk
Babies born by Caesarean section are more prone to developing asthma, say Dutch researchers.
In a study of almost 3,000 children, birth by Caesarean was associated with a 80% increased risk of asthma by age eight compared with vaginal birth.
The association was even stronger in children whose parents had allergies, suggesting a genetic predisposition to the disease, it is reported in Thorax.
Previous research has linked Caesareans with the development of allergies.
In total, the team looked at 2,917 children, 247 of whom were born by caesarean.
Around 12% of the children were diagnosed with asthma for which they were treated with inhaled steroids by the time they were eight years old.
The researchers found that the 9% of children who had two allergic parents were almost three times more likely to be asthmatic by the time they were eight compared with children whose parents were not allergic.
Immunity
Study leader, Dr Caroline Roduit, now based at the Children's Hospital of Zurich, Switzerland, said rates of asthma had soared in industrialised countries in parallel with a rise in Caesarean section births, which have increased from 5% in the 1970s to more than 30% in 2000.
She suggested that one reason for the association between Caesareans and asthma could be the priming of the immune system after birth.
Other research has shown babies born by Caesarean are not exposed to microbes as soon as babies born by vaginal delivery.
Previous studies in this area have produced conflicting results but the authors said the size of the study, the long monitoring period and and the definition of asthma to include inhaled steroids, strengthened the findings.
"The increased rate of Caesarean section is partly due to maternal demand without medical reason," said Dr Roduit.
"In this situation the mother should be informed of the risk of asthma for her child, especially when the parents have a history of allergy or asthma."
Dr Mike Thomas, chief medical adviser to the charity Asthma UK, said previous studies had also suggested that Caesarean section might increase the risk of asthma.
He said: "Sometimes a Caesarean section is needed for medical reasons, but where possible a natural birth is better."
"The mother should be informed of the risk of asthma for her child, especially when the parents have a history of allergy or asthma." Dr Caroline Roduit
http://news.bbc.co.uk/2/hi/health/7755439.stm
In a study of almost 3,000 children, birth by Caesarean was associated with a 80% increased risk of asthma by age eight compared with vaginal birth.
The association was even stronger in children whose parents had allergies, suggesting a genetic predisposition to the disease, it is reported in Thorax.
Previous research has linked Caesareans with the development of allergies.
In total, the team looked at 2,917 children, 247 of whom were born by caesarean.
Around 12% of the children were diagnosed with asthma for which they were treated with inhaled steroids by the time they were eight years old.
The researchers found that the 9% of children who had two allergic parents were almost three times more likely to be asthmatic by the time they were eight compared with children whose parents were not allergic.
Immunity
Study leader, Dr Caroline Roduit, now based at the Children's Hospital of Zurich, Switzerland, said rates of asthma had soared in industrialised countries in parallel with a rise in Caesarean section births, which have increased from 5% in the 1970s to more than 30% in 2000.
She suggested that one reason for the association between Caesareans and asthma could be the priming of the immune system after birth.
Other research has shown babies born by Caesarean are not exposed to microbes as soon as babies born by vaginal delivery.
Previous studies in this area have produced conflicting results but the authors said the size of the study, the long monitoring period and and the definition of asthma to include inhaled steroids, strengthened the findings.
"The increased rate of Caesarean section is partly due to maternal demand without medical reason," said Dr Roduit.
"In this situation the mother should be informed of the risk of asthma for her child, especially when the parents have a history of allergy or asthma."
Dr Mike Thomas, chief medical adviser to the charity Asthma UK, said previous studies had also suggested that Caesarean section might increase the risk of asthma.
He said: "Sometimes a Caesarean section is needed for medical reasons, but where possible a natural birth is better."
"The mother should be informed of the risk of asthma for her child, especially when the parents have a history of allergy or asthma." Dr Caroline Roduit
http://news.bbc.co.uk/2/hi/health/7755439.stm
Study examines moms' C-section complications
By Rita Rubin, USA TODAY
As the rate of cesarean deliveries in the USA has risen, so has the rate of rare but severe complications in mothers, researchers report today.
With more than a million performed annually, C-section is the country's most common operation. In 2006, the most recent year available, 31.1% of all U.S. births were C-sections, up 50% from 1998. While a number of studies have focused on C-sections' effects on newborns, few have looked at the effects on moms.
The new study, by government researchers, examined the rate of severe complications in women who delivered in U.S. hospitals in two time periods: 1998-99 vs. 2004-05.
They found a 90% increase in blood transfusions and a 50% increase in pulmonary embolisms, or blood clots in the lungs. They also found about a 20% increase in rates of kidney failure, respiratory distress syndrome, shock and the need for a ventilator.
While the study doesn't prove that C-sections cause complications, tracking those complications could be useful, says co-author Susan Meikle, a medical officer at the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
The actual number of deliveries with at least one complication was 0.64% in 1998-99 and 0.81% in 2004-05. "Even though the absolute numbers are low, the rates are increasing. … We could do a better job at tracking these complications," says Meikle, an obstetrician. "There may be short-term trade-offs and long-term trade-offs (depending on mode of delivery). We don't know that yet."
Although the average age of women giving birth has been rising, that didn't seem to play a big role in the complication rates, the researchers write in the Journal of Obstetrics & Gynecology. But they found that the rising cesarean rate seemed to explain the hikes in kidney failure, respiratory distress syndrome and ventilation. The rise in C-sections only partially contributed to increases in shock, pulmonary embolisms and transfusions.
The authors lacked information about race and whether the women were overweight, both of which could impact the risk of complications. They also didn't know why C-sections were performed and whether moms who had them were sick beforehand.
The study used the largest U.S. inpatient care database, which in 2005 sampled hospitals from 37 states, constituting about 90% of hospital discharges in the country.
Michael Kramer, scientific director of the Canadian counterpart of Meikle's institute, notes that in some cases, a complication might have triggered a C-section, not vice-versa. Still, says Kramer, co-author of a 2007 report that found more severe maternal complications in planned C-sections than in vaginal deliveries, doctors tend to underestimate C-section risks.
DELIVERY COMPLICATIONS
Rates of severe complications in women who delivered in U.S. hospitals:
Kidney failure
• 1998-1999: 0.23%
• 2004-2005: 0.28%
Pulmonary embolism
• 1998-1999: 0.12%
• 2004-2005: 0.18%
Respiratory distress syndrome
• 1998-1999: 0.36%
• 2004-2005: 0.45%
Shock
• 1998-1999: 0.15%
• 2004-2005: 0.19%
Blood transfusion
• 1998-1999: 2.38%
• 2004-2005: 4.58%
Need for ventilation
• 1998-1999: 0.47%
• 2004-2005: 0.57%
Source: Journal of Obstetrics & Gynecology
As the rate of cesarean deliveries in the USA has risen, so has the rate of rare but severe complications in mothers, researchers report today.
With more than a million performed annually, C-section is the country's most common operation. In 2006, the most recent year available, 31.1% of all U.S. births were C-sections, up 50% from 1998. While a number of studies have focused on C-sections' effects on newborns, few have looked at the effects on moms.
The new study, by government researchers, examined the rate of severe complications in women who delivered in U.S. hospitals in two time periods: 1998-99 vs. 2004-05.
They found a 90% increase in blood transfusions and a 50% increase in pulmonary embolisms, or blood clots in the lungs. They also found about a 20% increase in rates of kidney failure, respiratory distress syndrome, shock and the need for a ventilator.
While the study doesn't prove that C-sections cause complications, tracking those complications could be useful, says co-author Susan Meikle, a medical officer at the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
The actual number of deliveries with at least one complication was 0.64% in 1998-99 and 0.81% in 2004-05. "Even though the absolute numbers are low, the rates are increasing. … We could do a better job at tracking these complications," says Meikle, an obstetrician. "There may be short-term trade-offs and long-term trade-offs (depending on mode of delivery). We don't know that yet."
Although the average age of women giving birth has been rising, that didn't seem to play a big role in the complication rates, the researchers write in the Journal of Obstetrics & Gynecology. But they found that the rising cesarean rate seemed to explain the hikes in kidney failure, respiratory distress syndrome and ventilation. The rise in C-sections only partially contributed to increases in shock, pulmonary embolisms and transfusions.
The authors lacked information about race and whether the women were overweight, both of which could impact the risk of complications. They also didn't know why C-sections were performed and whether moms who had them were sick beforehand.
The study used the largest U.S. inpatient care database, which in 2005 sampled hospitals from 37 states, constituting about 90% of hospital discharges in the country.
Michael Kramer, scientific director of the Canadian counterpart of Meikle's institute, notes that in some cases, a complication might have triggered a C-section, not vice-versa. Still, says Kramer, co-author of a 2007 report that found more severe maternal complications in planned C-sections than in vaginal deliveries, doctors tend to underestimate C-section risks.
DELIVERY COMPLICATIONS
Rates of severe complications in women who delivered in U.S. hospitals:
Kidney failure
• 1998-1999: 0.23%
• 2004-2005: 0.28%
Pulmonary embolism
• 1998-1999: 0.12%
• 2004-2005: 0.18%
Respiratory distress syndrome
• 1998-1999: 0.36%
• 2004-2005: 0.45%
Shock
• 1998-1999: 0.15%
• 2004-2005: 0.19%
Blood transfusion
• 1998-1999: 2.38%
• 2004-2005: 4.58%
Need for ventilation
• 1998-1999: 0.47%
• 2004-2005: 0.57%
Source: Journal of Obstetrics & Gynecology
Monday, January 19, 2009
Cut
I am adding this movie to my library wishlist. Looks very informative.
http://www.cutthefilm.com/Cut_Website/Home.html
http://www.cutthefilm.com/Cut_Website/Home.html
Saturday, January 17, 2009
Tuesday, January 13, 2009
NOCIRC Video
This video put out by NOCIRC is an awesome resource. All expectant parents should watch it.
Wednesday, January 7, 2009
Nighttime Parenting
Why isn't there more research into parenting regimes for infants?
Oliver James
The Guardian, Saturday 13 December 2008
When a baby is small, particularly if it's the first one, parents tend to verge on the doctrinaire regarding the best parenting approach, falling into two camps: strict routine (the schedulers) or infant-led (the huggers).
Holidaying friends with conflicting methods risk lifelong schism, yet hardly anyone bases their view on science. So what do the studies show?
The most definitive was done recently by British and Danish psychologists. They identified a sample of pregnant London mothers who intended to follow a parent-led, scheduled routine. For example, many hoped to get the baby into a cot as soon as possible, feeding and sleeping to a timetable, and planning to delay responses to crying, to teach self-soothing.
By contrast, another sample was also studied, who adopted the hugger approach. They would be keeping the baby in the bed rather than a cot, and feeding on demand. There was also a sample of Copenhagen mothers who fell between these two nurturing plans. The samples were followed until three months of age. Compared with the hugger mothers, the schedulers spent half as much time holding their babies and were four times less likely to make contact with it when fussing or crying. Twice as many schedulers had given up breastfeeding when the baby reached three months of age (85% v 37%). The results for the Copenhagen mothers generally fell between the two, though veering towards the huggers.
The consequences of this differing care were considerable. At all three ages when studied (10 days, five weeks and three months), the babies with scheduler mothers spent 50% more time fussing or crying. For example, at five weeks, the scheduler babies fussed/cried for 121 minutes of the 24 hours, compared with 82 minutes for the hugger babies.
If you take the view that persistent fussing and crying are undesirable for a baby - because they are signs of distress - then this is evidence that the scheduler regime is bad for a baby's wellbeing. If the method really does cause a 50% greater prevalence of fussing and crying in three-month-olds, innumerable other studies suggest that such distress often presages emotional insecurity, hyperactivity and conduct disorders in later childhood.
However, if scheduling was bad news for the babies, it was not all bad for their mothers. At three months (although not before that age), scheduler babies were more likely to sleep for five or more hours a night without waking or crying - significantly longer than among the huggers. However, this scheduling benefit may have been illusory. If the scheduler babies were sleeping in cots in another room, how confident could their mothers be that their babies had not woken up? Nearly all the hugger babies (84%) were in bed with their mothers and waking or crying would rarely be missed. The researchers concluded that the scheduled babies were probably waking more than their mothers realised, casting doubt on the finding.
It is pathetic that this is the only serious study of the question. We also need to know what the consequences of different regimes are in later life. For there is good evidence that as the child gets older, scheduling is increasingly effective for creating good sleep. So it may be helpful to encourage such "self-regulation" when the child is one or two, not at all good to do so at three months. But it is also possible that children who keep getting into the parental bed until middle childhood are ultimately more secure and creative. Why is this issue not at the top of the psychology profession's research agenda?
• Hugger v Scheduler study: St James-Roberts, I et al, 2006, Pediatrics, 117(6), pp e1146-55.
Oliver James
The Guardian, Saturday 13 December 2008
When a baby is small, particularly if it's the first one, parents tend to verge on the doctrinaire regarding the best parenting approach, falling into two camps: strict routine (the schedulers) or infant-led (the huggers).
Holidaying friends with conflicting methods risk lifelong schism, yet hardly anyone bases their view on science. So what do the studies show?
The most definitive was done recently by British and Danish psychologists. They identified a sample of pregnant London mothers who intended to follow a parent-led, scheduled routine. For example, many hoped to get the baby into a cot as soon as possible, feeding and sleeping to a timetable, and planning to delay responses to crying, to teach self-soothing.
By contrast, another sample was also studied, who adopted the hugger approach. They would be keeping the baby in the bed rather than a cot, and feeding on demand. There was also a sample of Copenhagen mothers who fell between these two nurturing plans. The samples were followed until three months of age. Compared with the hugger mothers, the schedulers spent half as much time holding their babies and were four times less likely to make contact with it when fussing or crying. Twice as many schedulers had given up breastfeeding when the baby reached three months of age (85% v 37%). The results for the Copenhagen mothers generally fell between the two, though veering towards the huggers.
The consequences of this differing care were considerable. At all three ages when studied (10 days, five weeks and three months), the babies with scheduler mothers spent 50% more time fussing or crying. For example, at five weeks, the scheduler babies fussed/cried for 121 minutes of the 24 hours, compared with 82 minutes for the hugger babies.
If you take the view that persistent fussing and crying are undesirable for a baby - because they are signs of distress - then this is evidence that the scheduler regime is bad for a baby's wellbeing. If the method really does cause a 50% greater prevalence of fussing and crying in three-month-olds, innumerable other studies suggest that such distress often presages emotional insecurity, hyperactivity and conduct disorders in later childhood.
However, if scheduling was bad news for the babies, it was not all bad for their mothers. At three months (although not before that age), scheduler babies were more likely to sleep for five or more hours a night without waking or crying - significantly longer than among the huggers. However, this scheduling benefit may have been illusory. If the scheduler babies were sleeping in cots in another room, how confident could their mothers be that their babies had not woken up? Nearly all the hugger babies (84%) were in bed with their mothers and waking or crying would rarely be missed. The researchers concluded that the scheduled babies were probably waking more than their mothers realised, casting doubt on the finding.
It is pathetic that this is the only serious study of the question. We also need to know what the consequences of different regimes are in later life. For there is good evidence that as the child gets older, scheduling is increasingly effective for creating good sleep. So it may be helpful to encourage such "self-regulation" when the child is one or two, not at all good to do so at three months. But it is also possible that children who keep getting into the parental bed until middle childhood are ultimately more secure and creative. Why is this issue not at the top of the psychology profession's research agenda?
• Hugger v Scheduler study: St James-Roberts, I et al, 2006, Pediatrics, 117(6), pp e1146-55.
Breastfeeding a healthy, economic choice, expert says
Breastfeeding a healthy, economic choice, expert says
January 7, 2009
Pregnant couples who dread the upcoming costs of baby care have at least one cost-saving measure they may overlook:
January 7, 2009
Pregnant couples who dread the upcoming costs of baby care have at least one cost-saving measure they may overlook:
Try breastfeeding.
CoxHealth lactation consultant and registered nurse Patty Fielding says breastfeeding has a huge impact on the family’s financial bottom line, and it’s good for baby’s and mom’s health.
The average cost to feed an infant formula varies, depending on the child’s age and the brand of formula you choose, Fielding says. But she added that a parent can expect to spend $1,300 or more in the baby's first year. “Most people have no idea how much they are actually spending to feed their child formula instead of breast milk,” she says. “In addition to the cost of formula, you have to consider the cost of bottles, additional visits to the doctor because baby is sick more and income lost when the parents are forced to miss work to care for an ill child,” she says. Breastfeeding your infant is technically free, Fielding says.
While you can choose to purchase special clothing and supplies, they’re not requirements.
But if a mother works outside the home, the purchase or rental of a high-quality breast pump does make breastfeeding more convenient, she says.
Rental of a hospital-grade breast pump costs $35 to $55 a month, including a few bottles for milk storage and feeding. This is still significantly less than the cost of formula feeding, she says.
Good quality breast pumps cost as little at $270, including bottles. The CoxHealth Women’s Center Center offers pumps for rent or purchase, nursing bras and accessories and lactation consultant services. “We want women to make the choice to breastfeed because it’s best for baby and mom. But I hope that knowing it’s best for the family’s finances will help more women make the decision to breastfeed,” Fielding says.
Childbirth Education Classes
The new year is here and Dy Gordon is starting up a new series of childbirth education classes here in my home on Wednesday, January 14th. I love the way she presents the information. This class is great for both homebirth and hospital birthing couples. It is a real comfortable atmosphere. Come in comfy clothes and bring a couple pillows.
Class 1: Why natural childbirth?, Nutrition & ExerciseClass
Class 2: Pregnancy, Belly mapping, & Stages of LaborClass
Class 3: Choosing your care provider, Birth Choices, & DoulasClass
Class 4: Hospital setting, Interventions, Unexpected situations & your Birth planClass
Class 5: Conquering Birth Fears, Relaxation, Coaching & Coping techniquesClass
Class 6: Postpartum period, Breastfeeding, Newborn care, & Baby wearing
These classes are set up in such a way that you can pick and choose which information is most important to you and attend on those days. It is not a traditional classroom setting. It's a comfortable discussion between expectant parents and an experienced childbirth professional on specific topics. Group size is small so there is time to address individual situations and concerns. Come for one night of class or come for them all. Course content focuses on understanding childbirth issues and the benefits and risks of interventions and the importance of choosing the right care provider for you. We will discuss the process of birth as well as how our current societal traditions and expectations affect birth to help you in your decision-making process. Labor coping techniques will be taught in a down-to-earth, hands-on manner incorporating many tried and true methods.A hand out packet with review information of what we have covered will be included with each class.
Preregistration is highly encouraged as walk-ins will only be permitted if space allows.
Please contact Dy Gordon at 435-215-6514 or completebeginnings@gmail.com for more information.
Class 1: Why natural childbirth?, Nutrition & ExerciseClass
Class 2: Pregnancy, Belly mapping, & Stages of LaborClass
Class 3: Choosing your care provider, Birth Choices, & DoulasClass
Class 4: Hospital setting, Interventions, Unexpected situations & your Birth planClass
Class 5: Conquering Birth Fears, Relaxation, Coaching & Coping techniquesClass
Class 6: Postpartum period, Breastfeeding, Newborn care, & Baby wearing
These classes are set up in such a way that you can pick and choose which information is most important to you and attend on those days. It is not a traditional classroom setting. It's a comfortable discussion between expectant parents and an experienced childbirth professional on specific topics. Group size is small so there is time to address individual situations and concerns. Come for one night of class or come for them all. Course content focuses on understanding childbirth issues and the benefits and risks of interventions and the importance of choosing the right care provider for you. We will discuss the process of birth as well as how our current societal traditions and expectations affect birth to help you in your decision-making process. Labor coping techniques will be taught in a down-to-earth, hands-on manner incorporating many tried and true methods.A hand out packet with review information of what we have covered will be included with each class.
Preregistration is highly encouraged as walk-ins will only be permitted if space allows.
Please contact Dy Gordon at 435-215-6514 or completebeginnings@gmail.com for more information.
Using Honey on Tears
I received this in my Midwifery Today newsletter. I had forgotten about this trick of the trade and was happy to be reminded. Thankfully, I don't see many tears at home.
Raw honey is a great remedy for first-degree [perineal] tears. Honey's thick consistency forms a barrier defending the wound from outside infections. The moistness allows skin cells to grow without creating a scar, even if a scab has already formed. Meanwhile, the sugars extract dirt and moisture from the wound, which helps prevent bacteria from growing, while the acidity of honey also slows or prevents the growth of many bacteria. An enzyme that bees add to honey reacts with the wound's fluids and breaks down into hydrogen peroxide, a disinfectant. Honey also acts as an anti-inflammatory and pain killer and prevents bandages from sticking to wounds. Laboratory studies have shown that honey has significant antibacterial qualities. Significant clinical observations have demonstrated the effectiveness of honey as a wound healing agent. Glucose converted into hyaluronic acid at the wound surface forms an extracellular matrix that encourages wound healing. Honey is also considered antimicrobial.
— Demetria ClarkExcerpted from "Herbs for Postpartum Perineum Care: Part I," The Birthkit, Issue 46
Raw honey is a great remedy for first-degree [perineal] tears. Honey's thick consistency forms a barrier defending the wound from outside infections. The moistness allows skin cells to grow without creating a scar, even if a scab has already formed. Meanwhile, the sugars extract dirt and moisture from the wound, which helps prevent bacteria from growing, while the acidity of honey also slows or prevents the growth of many bacteria. An enzyme that bees add to honey reacts with the wound's fluids and breaks down into hydrogen peroxide, a disinfectant. Honey also acts as an anti-inflammatory and pain killer and prevents bandages from sticking to wounds. Laboratory studies have shown that honey has significant antibacterial qualities. Significant clinical observations have demonstrated the effectiveness of honey as a wound healing agent. Glucose converted into hyaluronic acid at the wound surface forms an extracellular matrix that encourages wound healing. Honey is also considered antimicrobial.
— Demetria ClarkExcerpted from "Herbs for Postpartum Perineum Care: Part I," The Birthkit, Issue 46
Orgasmic Birth: The Natural Reality Behind The Hype
Orgasmic Birth certainly is a grabber of a title. Those aren't two words normally found close together in a sentence. In our culture, other adjectives are more common. Painful Childbirth. Traumatic Childbirth.
So it's no surprise that Debra Pascalli-Bonaro's film Orgasmic Birth has become the center of some controversy. It was featured on a segment of ABC's January 2nd episode of 20/20 about "Extreme Birth" and a few weeks ago The New York Times picked a up story on the movie, which caused a flurry of comments and sent a small shockwave through the blogosphere.
Pascalli-Bonaro says she wishes some critics who just seem to see the title would actually see the film.
"It's really about the range of choices women have for experiencing birth, some of which most women aren't even aware of. There are eleven couples featured in the movie. Some use words like 'pain' and 'fear' to describe their experience but others use 'transformative', 'blissful', and 'spiritual'. Two of them use the word 'orgasmic'. This sounds strange in our culture because we're used to seeing birth dealt with on an illness model, rather than a wellness model. Birth is part of a woman's sexual life."
Laura Shanley, author of the book Unassisted Childbirth was also featured on 20/20 and agrees with the premise of the film.
"There are benefits to the mother beyond helping them rid themselves of shame, fear and guilt. An orgasm is 22 times more powerful than a tranquilizer and during sexual arousal a woman's vagina can widen as much as two inches. When women find their power during the birth experience and learn to ride the contractions, it can be an incredible, even healing experience."
The 'normal' way that women in the United States give birth - laying prone in a room full of strangers - is not the natural way. It might even be the cause of some birth problems. Shanley cites a study that showed that when a stranger enters a room where a pregnant monkey is housed, :both the heart rate and the blood pressure of her fetus goes down. Of course, in the delivery room a drop in the heart rate of the baby often triggers a Cesarean section."
Shanley says that stress and 'fight or flight' reactions cause huge changes in a woman's body. "There's a reason that animals seek seclusion in birth. Everyone understands that being in a brightly lit room with a group of people watching you wouldn't make a comfortable environment for someone going to the bathroom or having sex. But for an equally intimate, personal activity like birth, people don't make the connection. Woman don't need to choose between drugs, epidurals, and Cesarean sections on one hand and fear of a natural but painful childbirth on the other. There really is a third way and it's more natural."
Pascali-Bonaro says that many changes to make birth a more pleasurable, healthy experience for women are simple and inexpensive. "Americans spend more money than any other country on medical care but that doesn't mean we're getting the best care. Simple things like dimming lights, allowing the mother creative space to move around and having music, natural sounds or even just silence can make a huge difference."
Ultimately, Pascali-Bonaro says that she's an advocate of mothers making informed birth choices. Since making the film, she's learned orgasmic birth is more common than she thought. "We've screened the movie in 28 countries and women always come up to me and 'You know, I never thought about it before...but I think I had one, too!'"
Lee Stranahan is writer, filmmaker and teacher who blogs at LeeStranahan.com. His wife Lauren gave birth to their two children as unassisted, at-home births.
http://www.huffingtonpost.com/lee-stranahan/orgasmic-birth-the-natura_b_154934.html
So it's no surprise that Debra Pascalli-Bonaro's film Orgasmic Birth has become the center of some controversy. It was featured on a segment of ABC's January 2nd episode of 20/20 about "Extreme Birth" and a few weeks ago The New York Times picked a up story on the movie, which caused a flurry of comments and sent a small shockwave through the blogosphere.
Pascalli-Bonaro says she wishes some critics who just seem to see the title would actually see the film.
"It's really about the range of choices women have for experiencing birth, some of which most women aren't even aware of. There are eleven couples featured in the movie. Some use words like 'pain' and 'fear' to describe their experience but others use 'transformative', 'blissful', and 'spiritual'. Two of them use the word 'orgasmic'. This sounds strange in our culture because we're used to seeing birth dealt with on an illness model, rather than a wellness model. Birth is part of a woman's sexual life."
Laura Shanley, author of the book Unassisted Childbirth was also featured on 20/20 and agrees with the premise of the film.
"There are benefits to the mother beyond helping them rid themselves of shame, fear and guilt. An orgasm is 22 times more powerful than a tranquilizer and during sexual arousal a woman's vagina can widen as much as two inches. When women find their power during the birth experience and learn to ride the contractions, it can be an incredible, even healing experience."
The 'normal' way that women in the United States give birth - laying prone in a room full of strangers - is not the natural way. It might even be the cause of some birth problems. Shanley cites a study that showed that when a stranger enters a room where a pregnant monkey is housed, :both the heart rate and the blood pressure of her fetus goes down. Of course, in the delivery room a drop in the heart rate of the baby often triggers a Cesarean section."
Shanley says that stress and 'fight or flight' reactions cause huge changes in a woman's body. "There's a reason that animals seek seclusion in birth. Everyone understands that being in a brightly lit room with a group of people watching you wouldn't make a comfortable environment for someone going to the bathroom or having sex. But for an equally intimate, personal activity like birth, people don't make the connection. Woman don't need to choose between drugs, epidurals, and Cesarean sections on one hand and fear of a natural but painful childbirth on the other. There really is a third way and it's more natural."
Pascali-Bonaro says that many changes to make birth a more pleasurable, healthy experience for women are simple and inexpensive. "Americans spend more money than any other country on medical care but that doesn't mean we're getting the best care. Simple things like dimming lights, allowing the mother creative space to move around and having music, natural sounds or even just silence can make a huge difference."
Ultimately, Pascali-Bonaro says that she's an advocate of mothers making informed birth choices. Since making the film, she's learned orgasmic birth is more common than she thought. "We've screened the movie in 28 countries and women always come up to me and 'You know, I never thought about it before...but I think I had one, too!'"
Lee Stranahan is writer, filmmaker and teacher who blogs at LeeStranahan.com. His wife Lauren gave birth to their two children as unassisted, at-home births.
http://www.huffingtonpost.com/lee-stranahan/orgasmic-birth-the-natura_b_154934.html
Sharing a bed with a baby does not increase risk of cot death, research shows
Sharing a bed with a baby does not increase the risk of cot death, says study that could change the way infants are cared for.
by Laura Donnelly, Health Correspondent
23 Nov 2008
Co-sleeping does not in itself increase cot death risk
Parents across Britain have been put off sharing a bed with their new babies by official advice which says it is safer for all children under the age of six months to be put in a cot in their parents' room.
This was based on research which appeared to establish a strong link between "co-sleeping" and sudden infant death syndrome – or cot death.
But the new study found that sharing a bed with a baby was only more dangerous if other factors were also involved.
Parents drinking alcohol were the greatest danger for babies who shared their beds.
Other risk factors included parents smoking or taking drugs, use of heavy bedding, adult pillows and soft mattresses, and when parents were "excessively tired" – defined as having had less than four hours sleep the night before.
The British study also shows that infants are at the greatest risk of all if they and their parents fell asleep on sofas.
However, it parents avoided all the other risk factors, sleeping in a bed with their baby proved no more risky than putting them in a cot in their parents' room.
Childcare experts said last night that the news would be received with relief by many parents, while midwives said it would help them to provide better advice.
But experts on sudden infant death syndrome urged caution until new advice was given.
Of about 300 UK unexplained infant deaths which occur each year, 45 per cent happen in beds shared by babies and their parents,
Experts have known for some time that parents' behaviours and the type of bedroom environment alter the risk of infant death among families who co-sleep, but this is the first detailed study to examine those circumstances in detail.
It concludes that once other factors are stripped out, co-sleeping does not in itself increase the risk to the baby.
Drink, drugs and extreme tiredness are likely to mean parents fall into a deep sleep, and will be less sensitive to both their body movements and the cues of a baby in distress. Heavy bedding, adult pillows and soft mattresses could squash and restrict the infant.
Childcare experts said the findings were "extremely significant," because previous studies have found that mothers who share a bed with their baby are more likely to breast-feed for longer, boosting the child's immune systems and improving their long-term health.
Researcher Dr Peter Blair, who will present his research to a conference of the charity Unicef, in Glasgow, this week, said: "This study shows that it is not co-sleeping that is unsafe, but the circumstances under which some parents co-sleep that create risks".
He said he hoped the findings would be used to give parents better and more sophisticated advice about whether or not to share a bed with their babies.
Dr Blair, from the University of Bristol, said the study of sudden infant deaths occurring in four years across the South West of Britain, was the most detailed study yet of the factors which could make co-sleeping risky.
The new research highlights the risks for mothers who follow official advice to put their babies in a cot, but find themselves falling asleep when they rise in the night to feed or comfort their babies.
"Over the past decade, the proportion of unexplained infant deaths which occur when parent and child fell asleep on a sofa has doubled, it will show.
Prof Cathy Warwick, general secretary of the Royal College of Midwives, said: "It will be really useful to have research shedding light on an incredibly important area.
"Until now we have had a default position that in the absence of information about why co-sleeping appears to carry risks, it is best for mothers not to do it.
"This will allow us to give much more sophisticated advice, and it will reassure a lot of women who want to share a bed with their baby but feel anxious about it".
All the experts warned that parents should think carefully about the extra risks if any alcohol had been drunk.
"Unless further details emerge, we would have to assume any alcohol drunk by parents could put the baby at risk," Dr Warwick said.
Belinda Phipps, chief executive of the National Childbirth Trust, said: "The findings sound extremely significant. We are really pleased to see that evidence about the safety of co-sleeping is building, because we know it improves breastfeeding rates.
"We also know a lot of parents prefer to do it but feel guilty because they are unsure about the risks".
She said precise information about the risks attached to type of bed and bedding would be vital for parents who wanted to safely share their bed with their baby.
In the absence of clear information about what kind of bed and bedding is safe, the NCT recommends the use of "alongside cots", a three-sided enclosed cot attached to the main bed, as a good compromise.
Justine Roberts, co-founder of Mumsnet, a web discussion group for mothers, said: "I think quite a few mums will be breathing a sigh of relief about these findings. Sharing beds can mean a better night's sleep all around, and a lot of mothers feel it is part of the attachment with their baby."
However, the Foundation for the Study of Infant Deaths urged parents to be cautious until the new findings had been published and peer-reviewed. Director Joyce Epstein said that until the evidence had been fully considered, the charity would not change its advice that the safest place for a baby to sleep for the first six months is in a cot in the parents' room.
She pointed to other studies which found a small increase in the risk of sudden infant death when bed sharing, even when several known risk factors were excluded.
A spokesman for the Department of Health said: "Our advice remains that the safest place for your baby to sleep is in a cot in a room with you for the first six months. However, we will examine this research and its findings carefully."
Safely sharing a bed with your child – what to avoid
Parents sharing a bed with a baby under the age of six months is no more dangerous than putting them in their own cot, provided:
– Parents don't smoke
– Parents don't drink
– Parents don't take drugs
– Bedding doesn't include adult pillows
– Bedding is not heavy
– Mattress is not soft
– Parents are not "excessively tired" – defined as having had less than four hours sleep the night before
by Laura Donnelly, Health Correspondent
23 Nov 2008
Co-sleeping does not in itself increase cot death risk
Parents across Britain have been put off sharing a bed with their new babies by official advice which says it is safer for all children under the age of six months to be put in a cot in their parents' room.
This was based on research which appeared to establish a strong link between "co-sleeping" and sudden infant death syndrome – or cot death.
But the new study found that sharing a bed with a baby was only more dangerous if other factors were also involved.
Parents drinking alcohol were the greatest danger for babies who shared their beds.
Other risk factors included parents smoking or taking drugs, use of heavy bedding, adult pillows and soft mattresses, and when parents were "excessively tired" – defined as having had less than four hours sleep the night before.
The British study also shows that infants are at the greatest risk of all if they and their parents fell asleep on sofas.
However, it parents avoided all the other risk factors, sleeping in a bed with their baby proved no more risky than putting them in a cot in their parents' room.
Childcare experts said last night that the news would be received with relief by many parents, while midwives said it would help them to provide better advice.
But experts on sudden infant death syndrome urged caution until new advice was given.
Of about 300 UK unexplained infant deaths which occur each year, 45 per cent happen in beds shared by babies and their parents,
Experts have known for some time that parents' behaviours and the type of bedroom environment alter the risk of infant death among families who co-sleep, but this is the first detailed study to examine those circumstances in detail.
It concludes that once other factors are stripped out, co-sleeping does not in itself increase the risk to the baby.
Drink, drugs and extreme tiredness are likely to mean parents fall into a deep sleep, and will be less sensitive to both their body movements and the cues of a baby in distress. Heavy bedding, adult pillows and soft mattresses could squash and restrict the infant.
Childcare experts said the findings were "extremely significant," because previous studies have found that mothers who share a bed with their baby are more likely to breast-feed for longer, boosting the child's immune systems and improving their long-term health.
Researcher Dr Peter Blair, who will present his research to a conference of the charity Unicef, in Glasgow, this week, said: "This study shows that it is not co-sleeping that is unsafe, but the circumstances under which some parents co-sleep that create risks".
He said he hoped the findings would be used to give parents better and more sophisticated advice about whether or not to share a bed with their babies.
Dr Blair, from the University of Bristol, said the study of sudden infant deaths occurring in four years across the South West of Britain, was the most detailed study yet of the factors which could make co-sleeping risky.
The new research highlights the risks for mothers who follow official advice to put their babies in a cot, but find themselves falling asleep when they rise in the night to feed or comfort their babies.
"Over the past decade, the proportion of unexplained infant deaths which occur when parent and child fell asleep on a sofa has doubled, it will show.
Prof Cathy Warwick, general secretary of the Royal College of Midwives, said: "It will be really useful to have research shedding light on an incredibly important area.
"Until now we have had a default position that in the absence of information about why co-sleeping appears to carry risks, it is best for mothers not to do it.
"This will allow us to give much more sophisticated advice, and it will reassure a lot of women who want to share a bed with their baby but feel anxious about it".
All the experts warned that parents should think carefully about the extra risks if any alcohol had been drunk.
"Unless further details emerge, we would have to assume any alcohol drunk by parents could put the baby at risk," Dr Warwick said.
Belinda Phipps, chief executive of the National Childbirth Trust, said: "The findings sound extremely significant. We are really pleased to see that evidence about the safety of co-sleeping is building, because we know it improves breastfeeding rates.
"We also know a lot of parents prefer to do it but feel guilty because they are unsure about the risks".
She said precise information about the risks attached to type of bed and bedding would be vital for parents who wanted to safely share their bed with their baby.
In the absence of clear information about what kind of bed and bedding is safe, the NCT recommends the use of "alongside cots", a three-sided enclosed cot attached to the main bed, as a good compromise.
Justine Roberts, co-founder of Mumsnet, a web discussion group for mothers, said: "I think quite a few mums will be breathing a sigh of relief about these findings. Sharing beds can mean a better night's sleep all around, and a lot of mothers feel it is part of the attachment with their baby."
However, the Foundation for the Study of Infant Deaths urged parents to be cautious until the new findings had been published and peer-reviewed. Director Joyce Epstein said that until the evidence had been fully considered, the charity would not change its advice that the safest place for a baby to sleep for the first six months is in a cot in the parents' room.
She pointed to other studies which found a small increase in the risk of sudden infant death when bed sharing, even when several known risk factors were excluded.
A spokesman for the Department of Health said: "Our advice remains that the safest place for your baby to sleep is in a cot in a room with you for the first six months. However, we will examine this research and its findings carefully."
Safely sharing a bed with your child – what to avoid
Parents sharing a bed with a baby under the age of six months is no more dangerous than putting them in their own cot, provided:
– Parents don't smoke
– Parents don't drink
– Parents don't take drugs
– Bedding doesn't include adult pillows
– Bedding is not heavy
– Mattress is not soft
– Parents are not "excessively tired" – defined as having had less than four hours sleep the night before
Tuesday, January 6, 2009
Smoking During Pregnancy Fosters Aggression in Children
Smoking during pregnancy fosters aggression in children
January 06, 2009
Women who smoke during pregnancy risk delivering aggressive kids according to a new Canada-Netherlands study published in the journal Development and Psychopathology. While previous studies have shown that smoking during gestation causes low birth weight, this research shows mothers who light up during pregnancy can predispose their offspring to an additional risk: violent behaviour.
What's more, the research team found the risk of giving birth to aggressive children increases among smoking mothers whose familial income is lower than $40,000 per year. Another risk factor for aggressive behaviour in offspring was smoking mothers with a history of antisocial behaviour: run-ins with the law, high school drop-outs and illegal drug use.
Psychiatry professor and researcher Jean Séguin, of the Université de Montréal and Sainte-Justine Hospital Research Center, co-authored the study with postdoctoral fellow Stephan C. J. Huijbregts, now a researcher at Leiden University in the Netherlands, as well as colleagues from Université Laval and McGill University in Canada."Mothers-to-be whose lives have been marked by anti-social behaviour have a 67 percent chance to have a physically aggressive child if they smoke 10 cigarettes a day while pregnant, compared with 16 percent for those who are non-smokers or who smoke fewer than 10 cigarettes a day," says Dr. Séguin. "Smoking also seems to be an aggravating factor, although less pronounced, in mothers whose anti-social behaviour is negligible or zero."The research was carried out as part of a wider investigation of children, the Quebec Longitudinal Study, which examined behaviors of 1,745 children between the age of 18 months to three and a half years. Aggressive offspring were characterized by their mothers as quick to hit, bite, kick, fight and bully others.
Other risks for aggressive behaviour
Although physical aggression is most common in preschool children, the researchers identified other prenatal factors associated with aggressive behaviour in children: mothers who are younger than 21, who smoke and who coerce their children to behave. The researchers also found that children from families who earned less than $40,000 per year were at an increased risk for aggressive behaviour.In this category, heavy smokers had a 40 percent chance of having highly aggressive children, compared with 25 percent for other mothers who were moderate or non-smokers. When income was greater than $40,000 annually, the gap between heavy smokers and others fell to 8 percent.
The effect of smoking on aggression in offspring remained significant - even when other factors were removed such as divorce, depression, maternal education and the mother's age during pregnancy. Smoking during pregnancy is one factor that could be curbed to decrease risks of aggression and violent behaviour.The research team recommends that low-income women, who are heavy smokers and who have a history of anti-social behaviour become a screening criterion for prenatal testing to determine what families need extra support to prevent development of aggressive behaviour.
University of Montreal
http://www.brightsurf.com/news/headlines/42339/Smoking_during_pregnancy_fosters_aggression_in_children.html
January 06, 2009
Women who smoke during pregnancy risk delivering aggressive kids according to a new Canada-Netherlands study published in the journal Development and Psychopathology. While previous studies have shown that smoking during gestation causes low birth weight, this research shows mothers who light up during pregnancy can predispose their offspring to an additional risk: violent behaviour.
What's more, the research team found the risk of giving birth to aggressive children increases among smoking mothers whose familial income is lower than $40,000 per year. Another risk factor for aggressive behaviour in offspring was smoking mothers with a history of antisocial behaviour: run-ins with the law, high school drop-outs and illegal drug use.
Psychiatry professor and researcher Jean Séguin, of the Université de Montréal and Sainte-Justine Hospital Research Center, co-authored the study with postdoctoral fellow Stephan C. J. Huijbregts, now a researcher at Leiden University in the Netherlands, as well as colleagues from Université Laval and McGill University in Canada."Mothers-to-be whose lives have been marked by anti-social behaviour have a 67 percent chance to have a physically aggressive child if they smoke 10 cigarettes a day while pregnant, compared with 16 percent for those who are non-smokers or who smoke fewer than 10 cigarettes a day," says Dr. Séguin. "Smoking also seems to be an aggravating factor, although less pronounced, in mothers whose anti-social behaviour is negligible or zero."The research was carried out as part of a wider investigation of children, the Quebec Longitudinal Study, which examined behaviors of 1,745 children between the age of 18 months to three and a half years. Aggressive offspring were characterized by their mothers as quick to hit, bite, kick, fight and bully others.
Other risks for aggressive behaviour
Although physical aggression is most common in preschool children, the researchers identified other prenatal factors associated with aggressive behaviour in children: mothers who are younger than 21, who smoke and who coerce their children to behave. The researchers also found that children from families who earned less than $40,000 per year were at an increased risk for aggressive behaviour.In this category, heavy smokers had a 40 percent chance of having highly aggressive children, compared with 25 percent for other mothers who were moderate or non-smokers. When income was greater than $40,000 annually, the gap between heavy smokers and others fell to 8 percent.
The effect of smoking on aggression in offspring remained significant - even when other factors were removed such as divorce, depression, maternal education and the mother's age during pregnancy. Smoking during pregnancy is one factor that could be curbed to decrease risks of aggression and violent behaviour.The research team recommends that low-income women, who are heavy smokers and who have a history of anti-social behaviour become a screening criterion for prenatal testing to determine what families need extra support to prevent development of aggressive behaviour.
University of Montreal
http://www.brightsurf.com/news/headlines/42339/Smoking_during_pregnancy_fosters_aggression_in_children.html
Kids’ lungs benefit from longer breastfeeding
Kids’ lungs benefit from longer breastfeeding
Joene Hendry
Children who are breastfed for at least four months may have better lung function than children who are breast fed for shorter periods of time and children who are bottle fed, a new study suggests.
Among 10-year old children, researchers found greater lung function and capacity in those who were breast fed for four months or longer during infancy.
“The physical exercise caused by suckling at the breast – about six times daily on average for more than four months – may result in increased lung capacity and increased airflow in breast-fed children compared with bottle-fed children,” Dr Ikechukwu U. Ogbuanu said.
Dr Ogbuanu, of the University of South Carolina in Columbia, and colleagues studied the feeding practices of infants born in 1989 on the Isle of Wight in the United Kingdom. At the time, breast feeding was predominantly direct suckling from the breast rather than indirect feeding of pumped breast milk from a bottle, the researchers note.
Among the 1,033 children tested when they were 10 years old, 39 per cent had been directly breast fed four months or longer. About 40 per cent of the children had been breast fed for less than four months. Another 21 per cent were not breast fed and therefore comprised the bottle-fed group.
Standard tests showed that the lungs of children who were breast fed for four months or longer were stronger than the lungs of children who were bottle-fed.
The researchers noted no beneficial effects on lung function from shorter duration breast feeding.
The statistically significant increase in lung capacity among children breast fed for four months or longer is likely related to the physical exercise from breast feeding, the investigators say.
“At lease some of the benefits from breast milk may accrue from the process of suckling itself,” noted Dr Ogbuanu. This concept is supported by other studies noting suckling exercise is nearly twice as long during breast feeding compared with bottle feeding, and that breast feeding requires more “ventilatory” effort.
Reuters
Source: Thorax, January 2009
Joene Hendry
Children who are breastfed for at least four months may have better lung function than children who are breast fed for shorter periods of time and children who are bottle fed, a new study suggests.
Among 10-year old children, researchers found greater lung function and capacity in those who were breast fed for four months or longer during infancy.
“The physical exercise caused by suckling at the breast – about six times daily on average for more than four months – may result in increased lung capacity and increased airflow in breast-fed children compared with bottle-fed children,” Dr Ikechukwu U. Ogbuanu said.
Dr Ogbuanu, of the University of South Carolina in Columbia, and colleagues studied the feeding practices of infants born in 1989 on the Isle of Wight in the United Kingdom. At the time, breast feeding was predominantly direct suckling from the breast rather than indirect feeding of pumped breast milk from a bottle, the researchers note.
Among the 1,033 children tested when they were 10 years old, 39 per cent had been directly breast fed four months or longer. About 40 per cent of the children had been breast fed for less than four months. Another 21 per cent were not breast fed and therefore comprised the bottle-fed group.
Standard tests showed that the lungs of children who were breast fed for four months or longer were stronger than the lungs of children who were bottle-fed.
The researchers noted no beneficial effects on lung function from shorter duration breast feeding.
The statistically significant increase in lung capacity among children breast fed for four months or longer is likely related to the physical exercise from breast feeding, the investigators say.
“At lease some of the benefits from breast milk may accrue from the process of suckling itself,” noted Dr Ogbuanu. This concept is supported by other studies noting suckling exercise is nearly twice as long during breast feeding compared with bottle feeding, and that breast feeding requires more “ventilatory” effort.
Reuters
Source: Thorax, January 2009
Monday, January 5, 2009
Free Natural Birth Stories Book Download
Sheri Minelli, the author of this book, has graciously given the download to her book away in hopes that it will possibly someday replace What to Expect When You Are Expecting. It contains natural birth stories to encourage.
I hope you enjoy. http://www.birthingbusiness.com/Book/InspirationalBirthStories.pdf
I hope you enjoy. http://www.birthingbusiness.com/Book/InspirationalBirthStories.pdf
Movie Reviews
For Christmas, my sister got me Pregnant in America and Orgasmic Birth. I love birth related gifts!
I loved, loved, loved Pregnant in America. It was long. I think close to an hour and forty five minutes, but I was not bored for a minute. It followed a couple who were pregnant for the first time. The dad was the film maker and you could feel the love he had for his wife and baby. There were a couple times in the film that I was near tears. I love how this documentary also covered the statistics side of birth - much like The Business of Being Born. I think this is a definite see for all women of childbearing age.
Orgasmic Birth, I wasn't as thrilled with. It was a beautifully done, the music was amazing, but it isn't going to be one of my all time favorites. I felt confused as to why some of the births were put in the documentary. To be honest, I expected more.
I have both in my personal library, along with The Business of Being Born. Call me if you are interested in borrowing either.
I loved, loved, loved Pregnant in America. It was long. I think close to an hour and forty five minutes, but I was not bored for a minute. It followed a couple who were pregnant for the first time. The dad was the film maker and you could feel the love he had for his wife and baby. There were a couple times in the film that I was near tears. I love how this documentary also covered the statistics side of birth - much like The Business of Being Born. I think this is a definite see for all women of childbearing age.
Orgasmic Birth, I wasn't as thrilled with. It was a beautifully done, the music was amazing, but it isn't going to be one of my all time favorites. I felt confused as to why some of the births were put in the documentary. To be honest, I expected more.
I have both in my personal library, along with The Business of Being Born. Call me if you are interested in borrowing either.
Studies link maternity leave with fewer C-sections and increased breastfeeding
Studies link maternity leave with fewer C-sections and increased breastfeeding
Berkeley -- Two new studies led by researchers at the University of California, Berkeley, suggest that taking maternity leave before and after the birth of a baby is a good investment in terms of health benefits for both mothers and newborns.
One study found that women who started their leave in the last month of pregnancy were less likely to have cesarean deliveries, while another found that new mothers were more likely to establish breastfeeding the longer they delayed their return to work.
Both papers were part of the Juggling Work and Life During Pregnancy study, funded by the Maternal and Child Health Bureau of the U.S. Health Resources and Services Administration and led by Sylvia Guendelman, professor of maternal and child health at UC Berkeley's School of Public Health. The research takes a rare look into whether taking maternity leave can affect health outcomes in the United States.
"In the public health field, we'd like to decrease the rate of C-sections (cesarean deliveries) and increase the rate of breastfeeding," said Guendelman. "C-sections are really a costly procedure, leading to extended hospital stays and increased risks of complications from surgery, as well as longer recovery times for the mother. For babies, it is known that breastfeeding protects them from infection and may decrease the risk of SIDS (Sudden Infant Death Syndrome), allergies and obesity. What we're trying to say here is that taking maternity leave may make good health sense, as well as good economic sense."
The study on the use of antenatal leave - time off before delivery with the expectation of returning to the employer after giving birth - and the rate of C-sections is the first examination of birth outcomes in U.S. working women, the researchers said. It will appear in the January/February print edition of the journal Women's Health Issues.
The researchers analyzed data from 447 women who worked full-time in the Southern California counties of Imperial, Orange and San Diego, comparing those who took leave after the 35th week of pregnancy with those who worked throughout the pregnancy to delivery. Only women who gave birth to single babies with no congenital abnormalities were included in the analysis. They adjusted for sociodemographic factors such as income, age and type of occupation, as well as for various health measures such as high blood pressure, body mass index, amount of self-reported stress and average number of hours of sleep at night.
Using a combination of post-delivery telephone interviews and prenatal and birth records, the researchers found that women who took leave before they gave birth were almost four times less likely to have a primary C-section as women who worked through to delivery.
The study authors pointed out that the United States falls behind most industrialized countries in its support for job-protected paid maternity leave. The federal Family and Medical Leave Act provides for only unpaid leave of up to 12 weeks surrounding the birth or adoption of a child.
The bulk of studies on leave-taking and health outcomes from other countries suggest that taking leave prior to birth can be beneficial. The authors point to a macroanalysis of 17 countries in Europe that linked failure to take such leave with low birthweight and infant mortality. Rates of pre-term delivery were lower among female factory workers in France if the women took antenatal leave, and a study conducted in several industrialized countries found that paid leave, but not unpaid leave, significantly decreased low birthweight rates.
According to the U.S. Census, among working women who had their first birth between 2001 and 2003, only 28 percent took leave from their jobs before giving birth while an additional 22 percent quit their jobs. Twenty-six percent of women took no leave before birth.
"We don't have a culture in the United States of taking rest before the birth of a child because there is an assumption that the real work comes after the baby is born," said Guendelman. "People forget that mothers need restoration before delivery. In other cultures, including Latino and Asian societies, women are really expected to rest in preparation for this major life event."
The authors added that financial need may also deter women from taking leave in the last month of pregnancy. Only five states - California, Hawaii, New Jersey, New York, Rhode Island - and the territory of Puerto Rico offer some form of paid pregnancy leave, and none offer full replacement of the woman's salary.
The study on maternity leave and breastfeeding is in the January issue of the journal Pediatrics. Using data from 770 full-time working mothers in Southern California, researchers assessed whether maternity leave predicted breastfeeding establishment, defined in this study as breastfeeding for at least 30 days after delivery. Phone interviews were conducted 4.5 months, on average, after delivery.
In this study, women who had returned to work by the time of the interview took on average 10.3 weeks of maternity leave. Overall, 82 percent of mothers established breastfeeding within the first month after their babies were born. Among women who established breastfeeding, 65 percent were still breastfeeding at the time of the interview.
Researchers found that women who took less than six weeks of maternity leave had a four-fold greater risk of failure to establish breastfeeding compared with women who were still on maternity leave at the time of the interview. Women who took six to 12 weeks of maternity leave had a two-fold greater risk of failing to establish breastfeeding.
Having a managerial position or a job with autonomy and a flexible work schedule was linked with longer breastfeeding duration in the study. After 30 days, managers had a 40 percent lower chance of stopping breastfeeding, while those with an inflexible work schedule had a 50 percent higher chance of stopping.
Overall, the study found that returning to work within 12 weeks of delivery had a greater impact on breastfeeding establishment for women in non-managerial positions, with inflexible jobs or who reported high psychosocial distress, including serious arguments with a spouse or partner and unusual money problems.
"The findings suggest that if a woman postpones her return to work, she'll increase her chances of breastfeeding success, especially if she's got a job where she's on the clock and has less discretion with her time," said Guendelman. "Also, women who are in jobs where they have more authority may feel more empowered with how they use their time."
The American Academy of Pediatrics (AAP) recommends that babies be breastfed for at least the first year of life, and exclusively so for the first four to six months.
According to the AAP, increased breastfeeding has the potential for decreasing annual health costs in the U.S. by $3.6 billion and decreasing parental employee absenteeism, the environmental burden for disposal of formula cans and bottles, and energy demands for production and transport of formula.
The study authors noted that just having maternity leave benefits offered by an employer was not helpful in breastfeeding establishment unless the leave was actually used, indicating the importance of encouraging the use of maternity leave and making it economically feasible to take it.
"These new studies suggest that making it feasible for more working mothers to take maternity leave both before and after birth is a smart investment," said Guendelman.
http://www.eurekalert.org/pub_releases/2009-01/uoc--slm122308.php
Berkeley -- Two new studies led by researchers at the University of California, Berkeley, suggest that taking maternity leave before and after the birth of a baby is a good investment in terms of health benefits for both mothers and newborns.
One study found that women who started their leave in the last month of pregnancy were less likely to have cesarean deliveries, while another found that new mothers were more likely to establish breastfeeding the longer they delayed their return to work.
Both papers were part of the Juggling Work and Life During Pregnancy study, funded by the Maternal and Child Health Bureau of the U.S. Health Resources and Services Administration and led by Sylvia Guendelman, professor of maternal and child health at UC Berkeley's School of Public Health. The research takes a rare look into whether taking maternity leave can affect health outcomes in the United States.
"In the public health field, we'd like to decrease the rate of C-sections (cesarean deliveries) and increase the rate of breastfeeding," said Guendelman. "C-sections are really a costly procedure, leading to extended hospital stays and increased risks of complications from surgery, as well as longer recovery times for the mother. For babies, it is known that breastfeeding protects them from infection and may decrease the risk of SIDS (Sudden Infant Death Syndrome), allergies and obesity. What we're trying to say here is that taking maternity leave may make good health sense, as well as good economic sense."
The study on the use of antenatal leave - time off before delivery with the expectation of returning to the employer after giving birth - and the rate of C-sections is the first examination of birth outcomes in U.S. working women, the researchers said. It will appear in the January/February print edition of the journal Women's Health Issues.
The researchers analyzed data from 447 women who worked full-time in the Southern California counties of Imperial, Orange and San Diego, comparing those who took leave after the 35th week of pregnancy with those who worked throughout the pregnancy to delivery. Only women who gave birth to single babies with no congenital abnormalities were included in the analysis. They adjusted for sociodemographic factors such as income, age and type of occupation, as well as for various health measures such as high blood pressure, body mass index, amount of self-reported stress and average number of hours of sleep at night.
Using a combination of post-delivery telephone interviews and prenatal and birth records, the researchers found that women who took leave before they gave birth were almost four times less likely to have a primary C-section as women who worked through to delivery.
The study authors pointed out that the United States falls behind most industrialized countries in its support for job-protected paid maternity leave. The federal Family and Medical Leave Act provides for only unpaid leave of up to 12 weeks surrounding the birth or adoption of a child.
The bulk of studies on leave-taking and health outcomes from other countries suggest that taking leave prior to birth can be beneficial. The authors point to a macroanalysis of 17 countries in Europe that linked failure to take such leave with low birthweight and infant mortality. Rates of pre-term delivery were lower among female factory workers in France if the women took antenatal leave, and a study conducted in several industrialized countries found that paid leave, but not unpaid leave, significantly decreased low birthweight rates.
According to the U.S. Census, among working women who had their first birth between 2001 and 2003, only 28 percent took leave from their jobs before giving birth while an additional 22 percent quit their jobs. Twenty-six percent of women took no leave before birth.
"We don't have a culture in the United States of taking rest before the birth of a child because there is an assumption that the real work comes after the baby is born," said Guendelman. "People forget that mothers need restoration before delivery. In other cultures, including Latino and Asian societies, women are really expected to rest in preparation for this major life event."
The authors added that financial need may also deter women from taking leave in the last month of pregnancy. Only five states - California, Hawaii, New Jersey, New York, Rhode Island - and the territory of Puerto Rico offer some form of paid pregnancy leave, and none offer full replacement of the woman's salary.
The study on maternity leave and breastfeeding is in the January issue of the journal Pediatrics. Using data from 770 full-time working mothers in Southern California, researchers assessed whether maternity leave predicted breastfeeding establishment, defined in this study as breastfeeding for at least 30 days after delivery. Phone interviews were conducted 4.5 months, on average, after delivery.
In this study, women who had returned to work by the time of the interview took on average 10.3 weeks of maternity leave. Overall, 82 percent of mothers established breastfeeding within the first month after their babies were born. Among women who established breastfeeding, 65 percent were still breastfeeding at the time of the interview.
Researchers found that women who took less than six weeks of maternity leave had a four-fold greater risk of failure to establish breastfeeding compared with women who were still on maternity leave at the time of the interview. Women who took six to 12 weeks of maternity leave had a two-fold greater risk of failing to establish breastfeeding.
Having a managerial position or a job with autonomy and a flexible work schedule was linked with longer breastfeeding duration in the study. After 30 days, managers had a 40 percent lower chance of stopping breastfeeding, while those with an inflexible work schedule had a 50 percent higher chance of stopping.
Overall, the study found that returning to work within 12 weeks of delivery had a greater impact on breastfeeding establishment for women in non-managerial positions, with inflexible jobs or who reported high psychosocial distress, including serious arguments with a spouse or partner and unusual money problems.
"The findings suggest that if a woman postpones her return to work, she'll increase her chances of breastfeeding success, especially if she's got a job where she's on the clock and has less discretion with her time," said Guendelman. "Also, women who are in jobs where they have more authority may feel more empowered with how they use their time."
The American Academy of Pediatrics (AAP) recommends that babies be breastfed for at least the first year of life, and exclusively so for the first four to six months.
According to the AAP, increased breastfeeding has the potential for decreasing annual health costs in the U.S. by $3.6 billion and decreasing parental employee absenteeism, the environmental burden for disposal of formula cans and bottles, and energy demands for production and transport of formula.
The study authors noted that just having maternity leave benefits offered by an employer was not helpful in breastfeeding establishment unless the leave was actually used, indicating the importance of encouraging the use of maternity leave and making it economically feasible to take it.
"These new studies suggest that making it feasible for more working mothers to take maternity leave both before and after birth is a smart investment," said Guendelman.
http://www.eurekalert.org/pub_releases/2009-01/uoc--slm122308.php
Vit D Deficiency and Csections
http://www.nytimes.com/2008/12/30/science/30baby.html?_r=1
By NICHOLAS BAKALAR
Published: December 29, 2008
Vitamin D deficiency may increase the likelihood of having a Caesarean section, a new study has found.
Association Between Vitamin D Deficiency and Primary Cesarean Section (The Journal of Clinical Endocrinology & Metabolism)
At the turn of the 20th century, according to background information in the report, deformed bones in the pelvis often led to a C-section, a problem that virtually disappeared with the vitamin D fortification of milk and other foods. But this study, published online Dec. 23 in The Journal of Clinical Endocrinology & Metabolism, suggests that vitamin D deficiency in pregnancy is still a problem.
The researchers studied 253 births at a Boston hospital from 2005 to 2007. After controlling for other variables, the scientists found that women with low blood levels of vitamin D were almost four times as likely to have an emergency C-section as those with normal levels. Vitamin D deficiency has been associated with muscle weakness and high blood pressure, which might help explain the finding.
Dr. Michael Holick, a professor of medicine at Boston University and the senior author of the study, offered straightforward advice for pregnant women. “Take a thousand-unit supplement of vitamin D, available at any pharmacy, on top of any prenatal vitamins you’re taking, so that you’re getting 1,400 units a day,” he said. “There is no downside to doing this.”
By NICHOLAS BAKALAR
Published: December 29, 2008
Vitamin D deficiency may increase the likelihood of having a Caesarean section, a new study has found.
Association Between Vitamin D Deficiency and Primary Cesarean Section (The Journal of Clinical Endocrinology & Metabolism)
At the turn of the 20th century, according to background information in the report, deformed bones in the pelvis often led to a C-section, a problem that virtually disappeared with the vitamin D fortification of milk and other foods. But this study, published online Dec. 23 in The Journal of Clinical Endocrinology & Metabolism, suggests that vitamin D deficiency in pregnancy is still a problem.
The researchers studied 253 births at a Boston hospital from 2005 to 2007. After controlling for other variables, the scientists found that women with low blood levels of vitamin D were almost four times as likely to have an emergency C-section as those with normal levels. Vitamin D deficiency has been associated with muscle weakness and high blood pressure, which might help explain the finding.
Dr. Michael Holick, a professor of medicine at Boston University and the senior author of the study, offered straightforward advice for pregnant women. “Take a thousand-unit supplement of vitamin D, available at any pharmacy, on top of any prenatal vitamins you’re taking, so that you’re getting 1,400 units a day,” he said. “There is no downside to doing this.”
Postdates - Separating Fact from Fiction
My good friend and traditional midwife, Birthkeeper wrote this paper a while back. I think it has some great information in it. You can read more of her thoughts at www.midwiferyramblings.blogspot.com
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Postdates - Separating Fact from Fiction
By Birthkeeper
What is one of the first things that a pregnant woman hears once she reaches 40 weeks?
“When will your doctor induce you?”
Is there evidence behind this practice to support the routine induction of pregnancies that go beyond 40-41 weeks? What are the usual assumptions and beliefs surrounding this?
• There is a higher risk of the baby being born still
• The placenta will stop functioning
• There will be a decrease in amniotic fluid
• The baby will grow too large
We are going to take a look at the validity of these claims and beliefs, and compare them with what the research has to say. After all, your doctor would never do anything that wasn’t in your or your baby’s best interest, correct?
The first things to really look at are the definitions of the two key words with the pregnancy that goes past 40 weeks. Postdates, and Postmaturity. But is it accurate to start with these terms at 40 weeks?
• Postdates – Defined as a pregnancy that goes beyond 42 weeks, based on LMP. The problem with this is that it’s not the same for every woman. Due dates are calculated depending on LMP, but does not usually take into account a woman who has shorter or longer than 28 day cycles. The pregnancy wheel that is commonly used by doctors and midwives, is based on 28 day cycles. If you have a longer cycle, days will need to be added to your EDD ( Estimated Due Date ). This is rarely done however, and women who have longer cycles are held to the same due date estimation as women with shorter cycles. So on paper, you might be 42 weeks according to the estimated due date, when in actuality you would only be 41 weeks. A more accurate way of dating pregnancy is by solidly known conception dates.
• Postmaturity – Postmaturity, or Postmaturity Syndrome (PMS) can only be diagnosed after delivery and is defined as a postdates pregnancy accompanied with a combination of the following newborn assessments:
a) No lanugo ( fine body hair )
b) Long nails
c) Abundant hair on head
d) Calcified fetal skull
e) Hanging or wrinkled skin, with the appearance of weight loss
f) Dehydrated
g) Peeling skin
Postmaturity Syndrome also only affects less than 10% of pregnancies that go beyond 43 weeks. The vast majority of pregnant women do not go beyond 42 weeks with correct dates. Some studies show that less than 3% of women go beyond 43 weeks. So if the risk of postmaturity is less than 10% of pregnancies that go beyond 43 weeks, and the percentage of women who go beyond 43 weeks is less than 3% - how big of a risk is it really?
The problem with assessing risk for postmaturity is that modern Obstetrics, and even modern Midwifery, tends to treat all women as equal in pregnancy. Seldom is personal or familial gestation history taken into account, or abnormal cycle and ovulation schedules. These things are important to consider! How healthy would a midwife’s policy of inducing at 41 weeks , be for a woman who has a personal or familial history of going to 44 weeks? We are talking about potentially trying to induce a baby who will be 3 weeks “early” according to their own biological gestation clock. And if the induction “fails”? It will likely result in stress for both mother and baby and lead to more invasive intervention, and possibly a cesarean.
The condition of a baby and placenta all depends on the health and personal history of the mother, as well as the health of the baby – at any gestation. A placenta does not begin to deteriorate automatically beyond 42 or 43 weeks. A placenta can begin to deteriorate at 36 weeks, once again, depending on the health and over all well being of the mother and baby. I have often heard the fear in women of “placental deterioration” after 40 weeks. But as it has been seen, this has nearly nothing to do with length of gestation, as much as it has to do with overall health and maturity of the individual pregnancy and baby. I personally have seen a baby born at 43 weeks, solid dates, absolutely covered in vernix and attached to a very healthy placenta. In contrast, I attended the birth of a 37 week baby who had dry, wrinkly skin, and a calcified and very old looking placenta.
Other important factors include unhealthy habits and complications such as:
• Smoking
• Alcohol
• Drugs
• Diabetes ( Mellitus, NOT Gestational )
• Hypertension
When did 40 weeks become the magical number?
The interesting part in the discussion of postdates, postmaturity, and all that it involves, is the thought that 40 weeks is some sort of magical number. In the past, there was a general “due month”. Women were given an estimation of when they would deliver, based on the known fact that normal gestation is anywhere from 37 to 42 weeks. So when did 40 weeks become this magical number that women fret over and worry once they go beyond it? It has always been that 40 weeks is the general time frame when babies were “due”. But it wasn’t until a study by McClure-Brown came out with date collected from 1958, that showed the perinatal mortality rate doubled from 40 weeks to 42 weeks – from 10/1000 to 20/1000. So it might be logical to assume that inducing labor before 42 weeks would cut back the risk of stillbirth, correct?
The problem is, this study is inaccurate and too old to continue to be of use. Modern obstetrics contradicts the findings in the study published in 1963. And yet, the findings continue to be cited. If we accepted the outcomes in the McClure study, we would also have to accept a 10/1000 mortality rate at 40 weeks! And we know that is not correct. We know that in the 1950s, the majority of women were put under general anesthesia, or twilight sleep, and forceps were commonly used.
Modern Obstetric research actually shows there to be not much of a difference in perinatal mortality rates between 38 and 42 weeks, with a decline in between.
An identically set-up chart to the 1963 study, published in 1982 ( Williams, Creasy ) reads:
• 7/1000 at 38 weeks
• 6/1000 at 40 weeks
• 8/1000 at 41 weeks
• 9/1000 at 42 weeks
• 10/1000 at 43 weeks
• 11/1000 at 44 weeks
A graph from 1987 statistics ( Eden, Sefert ) shows:
• 6/1000 at 38 weeks
• 2/1000 at 40 weeks
• 2.3/1000 at 41 weeks
• 3/1000 at 42 weeks
• 4/1000 at 43 weeks
• 7/1000 at 44 weeks
So according to the second set of statistics gathered above, women were at higher risk of stillbirth at 38 weeks, than they were at 42. Interesting! In the first set, there was only a steady increase, resulting in a very small risk increase. Is the slightly increased risk worth the myriad risks that come with labor induction?
A large study done by Weinstein, et al. , compared nearly 1,800 reliably dated post-term pregnancies with a matched group of on-time deliveries ( between 37 and 41 weeks ). The outcomes were surprising. Perinatal mortality was similar in both groups ( 0.56 / 1000 in the post-term and 0.75 / 1000 in the on-time group ). The rates of meconium, shoulder dystocia, and cesarean were almost identical. What was most interesting, however, was that the rates of fetal distress, instrumental delivery and low Apgar scores were actually lower in the post-term group than in the on-time group.
What about the Amniotic Fluid?
There is a flawed belief that the amniotic fluid will somehow begin to “run out” beyond 40 weeks. There is a belief that women will have a “dry” birth. Let’s start with some basics.
What is amniotic fluid?
• Beyond 36 weeks, amniotic fluid is comprised of mostly fetal urine. When the baby’s kidneys are functioning properly, the baby will continuously produce and process amniotic fluid. The fluid is swallowed by the baby, and then urinated out, once processed by the kidneys.
As long as the mother is adequately hydrated, and there are no congenital abnormalities in the baby, the baby will continue to create amniotic fluid until birth. Whether this be at 37 weeks, or 44. If decreased amniotic fluid is suspected through palpation, an ultrasound can be done to measure the volume found. However, this is not an exact science, as the volume found can – and usually will – vary from ultrasound technician to ultrasound technician, and can also sometimes be dependent on baby’s position. If the levels are found to be on the low side, evidence based protocols suggest having mom orally re-hydrate and return within 24 hours for another AFI ( Amniotic Fluid Index ), preferably by a different technician. This has shown repeatedly to have improved outcomes, versus immediate induction for low AFI levels.
A study published in the Journal of Reproductive Medicine found a significant increase in amniotic fluid after maternal oral rehydration, as well as intravenous hydration, with neither one better than the other. In all, 62.5% and 44.0% demonstrated improved AFI levels.
What if the baby grows too large?
First, who defines “too large”? What is “too large” for one woman, might be the next woman’s smallest baby size. The most important thing to remember is that there is no fool proof way of knowing whether or not your body can naturally birth a baby of whatever size, until you have tried. Ultrasound has a 20% error rate in either direction, and many women have allowed an induction after being told that their baby would be nearly 10 pounds, only to give birth to an 8 pound baby. And, there is no reason for a woman to doubt her ability to birth a 10 pound baby unless she tries. I, for one, never would have believed that I could have birthed my nearly 11 pound baby, especially because I was told that I could not safely birth my 8 ½ pound baby that I was scared into a cesarean with. You never know until you give it a full chance.
Women are often told that a baby will gain approximately a ½ pound per week in the end of pregnancy. However, this is simply an approximation. Once again, this is NOT the same for every woman, or for every baby.
According to a fetal growth rate chart comprised by four studies, a baby will only put on approximately 0.56 pounds – that’s just over half of a pound – between 40 weeks and 43 weeks. And since we’ve shown that most women go into labor before 43 weeks, it can be assumed that it is even less than that. Babies hit a plateau with weight gain around 40 weeks. So really, is there a huge concern to be had over a baby being birthable at 40 weeks, but not at 42 if we’re talking about less than half of a pound? And, does less than half of a pound change the shoulder width or head size of a baby? Hardly. It may give baby chubbier cheeks, or chubbier buns, but will not change the overall structure of the baby, making baby automatically “too large” to birth between those two weeks.
When Should Monitoring a “Post Dates” Pregnancy Begin?
This may be different for each individual pregnancy, each individual woman, which makes cookie cutter policies surrounding post dates, arbitrary. To begin, we have now shown that according to research, doctors, and all basic “rules” that a pregnancy is not even considered postdates until after 42 weeks. Not 40. So if the pregnancy is not postdates until 40 weeks, why do doctors often begin Non-Stress Tests ( NSTs ), Biophysical Profiles ( BPPs ), and Amniotic Fluid Index ( AFI ) at 40 weeks? It goes back to the very flawed study from 1963.
It is up to each individual woman to decide if she is comfortable waiting on monitoring, but if a woman understands that there is virtually no risk difference from 38 weeks to 42 weeks, it should clarify that testing before 42 weeks is mainly unnecessary unless other pregnancy complications are present (i.e. Hypertension, Diabetes Mellitus, IUGR suspicion, Congenital Abnormalities ).
So, let’s take a look at what type of monitoring is available, and how effective they are in finding possible problems.
• Biophysical Profile ( BPP ) – A BPP checks fetal body tone, fetal movement, amniotic fluid volume, and fetal “breathing” practices. Each of these are given a score, and then it is added up to give an overall score. A high score of 8-10 usually shows a baby in good health, while a baby who scores 0-4 indicates a baby who needs to be more closely monitored, or needs to be outside of the womb. Scores in between will usually come with more monitoring, including another BPP within 24 hours.
According to Enkin et al., in A Guide to Effective Care in Pregnancy:
There is some evidence that these tests can detect pregnancies in which there is 'something wrong,' but less evidence that their use improves outcome, or can eliminate the additional risk of post-term pregnancy. The only controlled trial shows no advantages of complex fetal monitoring with computerized cardiotocography, amniotic fluid index, assessment of fetal breathing tone, and gross body movements over simple monitoring with standard cardiotocography and ultrasound measurement using maximum amniotic fluid pool depth.
So as you can see, even the detailed testing may not prevent issues that may arise.
According to several studies that researched the accuracy of the BPP, the false positive rates were quite high, resulting in unnecessary induction or further monitoring.
One in particular showed a 21.3% false positive rate for the BPP, and a 39.3% false positive rate for the Non-Stress Test ( NST ). More studies have shown much higher false positive rates for the Non-Stress Test, which is the most common for women who go beyond 40 weeks in care under an Obstetrician.
• Amniotic Fluid Index ( AFI ) – An AFI is basically a mini Biophysical Profile. It measures the maximum amniotic fluid pool depth in the uterus. However, as was shown in the beginning of this article, the AFI in a pregnancy can be contingent on several factors. Being dehydrated can lessen the AFI found. The baby’s position can affect how much amniotic fluid is seen. The skill of an ultrasonographer can make a difference in the AFI level found. It was also shown that AFI levels can be improved with maternal oral rehydration. Often in modern obstetrics, this protocol is ignored, and induction is recommended very much against proven evidence.
• Non-Stress Test ( NST ) – The NST is the most commonly used test with women who go beyond 40/41 weeks pregnant, under the average Obstetric care. An NST is electronic fetal monitoring for contractions, fetal heart rate variability, and overall heart rate strength. If a baby is found to be sleeping, stimulation is often used in the form of vibration, a cold drink with sugar ( such as orange juice or soda ), or palpation stimulation.
The NST comes with the highest false positive rates of all of the tests, which is why it has become a controversial test amongst some groups.
Studies have been done that conclude anywhere from a 50%-75% false positive rate on average, sometimes reaching as high as 80-90%. False positives will lead to more testing, more stress, and possibly unnecessary intervention in the pregnancy.
Conclusion
Facts:
• A pregnancy is NOT “Postdates” until after 42 weeks.
• The risk of stillbirth is nearly a flat line between 38 weeks and 43.
• Amniotic fluid is dependent on maternal hydration, in the absence of congenital abnormalities.
• A baby’s weight virtually plateaus after 40 weeks.
Some things to think about :
• If I am not “overdue” until after 42 weeks, should I allow testing or intervention before this point?
• If NSTs come with very high false-positive rates, is it a test worth submitting to?
• If my baby will not put on much weight within a 3 week period, is it logical to worry about my baby being “too large” within a probable 2 week period?
Please, please always do your own research. Question what you are told - and go study the subject – regardless of whether your OB, Midwife, Family Member, or Friends are the ones giving you the information. Make informed decisions, and take charge of your prenatal care!
_______________________________________________________________________________________
McClure-Browne, J.C. 1963. Comparison of perinatal mortality rates versus gestational age through the past three decades. Postmaturity, Am J Obstet Gynecol 85: 573–82.
Journal of Fetal Medicine 1996 Sep-Oct. 5(5): 293-97. Expectant Management of Post-Term Patients: Observations and Outcome. Weinstein D. et al.
Journal of Reproductive Medicine 2000 volume 4 pp 337-340. Effect of Oral and intravenous hydration on oligohydramnios. CHANDRA P. C.; SCHIAVELLO H. J. ; LEWANDOWSKI M. A. ;
(1)Doublet PM, Benson CB, Nadel AS, et al: "Improved birth weight table for neonates developed from gestations dated by early ultrasonography." Journal of Ultrasound Medicine. 16:241, 1997.
(2)Hadlock FP, Shah YP, Kanon DJ, et al. "Fetal crown rump length: Reevaluation of relation to menstrual age with high resolution real-time US Radiology." 182:501, 1992.
(3)Usher R, McLean F. "Intrauterine growth of live-born Caucasian infants at sea level: Standards obtained from measurements in 7 dimensions of infants born between 25 and 44 weeks of gestation." Pediatrics. v.74, 1969.
(4)Wigglesworth JS. Perinatal Pathology, Second Edition. W.B. Saunders Company. 1996. page 24.
Hassan S. Kamel, Ahmed M. Makhlouf, Alaaeldin A. Youssef. Gynecol Obstet Invest 1999; 47: 223-228
Evertson LR, Gauuthier RJ, Schifrin BS, et al., Antepartum fetal heart rate testing. I. Evolution of the non-stress test. Am J Obstet Gynecol 1979;133:29-33
Miller, David A MD; Rabello, Yolanda A MSEd; Paul, Richard H. MD. Americal Journal of Obstet and Gynec. 174(3):812-817, March 1996.
____________________________________________________________________________________
Postdates - Separating Fact from Fiction
By Birthkeeper
What is one of the first things that a pregnant woman hears once she reaches 40 weeks?
“When will your doctor induce you?”
Is there evidence behind this practice to support the routine induction of pregnancies that go beyond 40-41 weeks? What are the usual assumptions and beliefs surrounding this?
• There is a higher risk of the baby being born still
• The placenta will stop functioning
• There will be a decrease in amniotic fluid
• The baby will grow too large
We are going to take a look at the validity of these claims and beliefs, and compare them with what the research has to say. After all, your doctor would never do anything that wasn’t in your or your baby’s best interest, correct?
The first things to really look at are the definitions of the two key words with the pregnancy that goes past 40 weeks. Postdates, and Postmaturity. But is it accurate to start with these terms at 40 weeks?
• Postdates – Defined as a pregnancy that goes beyond 42 weeks, based on LMP. The problem with this is that it’s not the same for every woman. Due dates are calculated depending on LMP, but does not usually take into account a woman who has shorter or longer than 28 day cycles. The pregnancy wheel that is commonly used by doctors and midwives, is based on 28 day cycles. If you have a longer cycle, days will need to be added to your EDD ( Estimated Due Date ). This is rarely done however, and women who have longer cycles are held to the same due date estimation as women with shorter cycles. So on paper, you might be 42 weeks according to the estimated due date, when in actuality you would only be 41 weeks. A more accurate way of dating pregnancy is by solidly known conception dates.
• Postmaturity – Postmaturity, or Postmaturity Syndrome (PMS) can only be diagnosed after delivery and is defined as a postdates pregnancy accompanied with a combination of the following newborn assessments:
a) No lanugo ( fine body hair )
b) Long nails
c) Abundant hair on head
d) Calcified fetal skull
e) Hanging or wrinkled skin, with the appearance of weight loss
f) Dehydrated
g) Peeling skin
Postmaturity Syndrome also only affects less than 10% of pregnancies that go beyond 43 weeks. The vast majority of pregnant women do not go beyond 42 weeks with correct dates. Some studies show that less than 3% of women go beyond 43 weeks. So if the risk of postmaturity is less than 10% of pregnancies that go beyond 43 weeks, and the percentage of women who go beyond 43 weeks is less than 3% - how big of a risk is it really?
The problem with assessing risk for postmaturity is that modern Obstetrics, and even modern Midwifery, tends to treat all women as equal in pregnancy. Seldom is personal or familial gestation history taken into account, or abnormal cycle and ovulation schedules. These things are important to consider! How healthy would a midwife’s policy of inducing at 41 weeks , be for a woman who has a personal or familial history of going to 44 weeks? We are talking about potentially trying to induce a baby who will be 3 weeks “early” according to their own biological gestation clock. And if the induction “fails”? It will likely result in stress for both mother and baby and lead to more invasive intervention, and possibly a cesarean.
The condition of a baby and placenta all depends on the health and personal history of the mother, as well as the health of the baby – at any gestation. A placenta does not begin to deteriorate automatically beyond 42 or 43 weeks. A placenta can begin to deteriorate at 36 weeks, once again, depending on the health and over all well being of the mother and baby. I have often heard the fear in women of “placental deterioration” after 40 weeks. But as it has been seen, this has nearly nothing to do with length of gestation, as much as it has to do with overall health and maturity of the individual pregnancy and baby. I personally have seen a baby born at 43 weeks, solid dates, absolutely covered in vernix and attached to a very healthy placenta. In contrast, I attended the birth of a 37 week baby who had dry, wrinkly skin, and a calcified and very old looking placenta.
Other important factors include unhealthy habits and complications such as:
• Smoking
• Alcohol
• Drugs
• Diabetes ( Mellitus, NOT Gestational )
• Hypertension
When did 40 weeks become the magical number?
The interesting part in the discussion of postdates, postmaturity, and all that it involves, is the thought that 40 weeks is some sort of magical number. In the past, there was a general “due month”. Women were given an estimation of when they would deliver, based on the known fact that normal gestation is anywhere from 37 to 42 weeks. So when did 40 weeks become this magical number that women fret over and worry once they go beyond it? It has always been that 40 weeks is the general time frame when babies were “due”. But it wasn’t until a study by McClure-Brown came out with date collected from 1958, that showed the perinatal mortality rate doubled from 40 weeks to 42 weeks – from 10/1000 to 20/1000. So it might be logical to assume that inducing labor before 42 weeks would cut back the risk of stillbirth, correct?
The problem is, this study is inaccurate and too old to continue to be of use. Modern obstetrics contradicts the findings in the study published in 1963. And yet, the findings continue to be cited. If we accepted the outcomes in the McClure study, we would also have to accept a 10/1000 mortality rate at 40 weeks! And we know that is not correct. We know that in the 1950s, the majority of women were put under general anesthesia, or twilight sleep, and forceps were commonly used.
Modern Obstetric research actually shows there to be not much of a difference in perinatal mortality rates between 38 and 42 weeks, with a decline in between.
An identically set-up chart to the 1963 study, published in 1982 ( Williams, Creasy ) reads:
• 7/1000 at 38 weeks
• 6/1000 at 40 weeks
• 8/1000 at 41 weeks
• 9/1000 at 42 weeks
• 10/1000 at 43 weeks
• 11/1000 at 44 weeks
A graph from 1987 statistics ( Eden, Sefert ) shows:
• 6/1000 at 38 weeks
• 2/1000 at 40 weeks
• 2.3/1000 at 41 weeks
• 3/1000 at 42 weeks
• 4/1000 at 43 weeks
• 7/1000 at 44 weeks
So according to the second set of statistics gathered above, women were at higher risk of stillbirth at 38 weeks, than they were at 42. Interesting! In the first set, there was only a steady increase, resulting in a very small risk increase. Is the slightly increased risk worth the myriad risks that come with labor induction?
A large study done by Weinstein, et al. , compared nearly 1,800 reliably dated post-term pregnancies with a matched group of on-time deliveries ( between 37 and 41 weeks ). The outcomes were surprising. Perinatal mortality was similar in both groups ( 0.56 / 1000 in the post-term and 0.75 / 1000 in the on-time group ). The rates of meconium, shoulder dystocia, and cesarean were almost identical. What was most interesting, however, was that the rates of fetal distress, instrumental delivery and low Apgar scores were actually lower in the post-term group than in the on-time group.
What about the Amniotic Fluid?
There is a flawed belief that the amniotic fluid will somehow begin to “run out” beyond 40 weeks. There is a belief that women will have a “dry” birth. Let’s start with some basics.
What is amniotic fluid?
• Beyond 36 weeks, amniotic fluid is comprised of mostly fetal urine. When the baby’s kidneys are functioning properly, the baby will continuously produce and process amniotic fluid. The fluid is swallowed by the baby, and then urinated out, once processed by the kidneys.
As long as the mother is adequately hydrated, and there are no congenital abnormalities in the baby, the baby will continue to create amniotic fluid until birth. Whether this be at 37 weeks, or 44. If decreased amniotic fluid is suspected through palpation, an ultrasound can be done to measure the volume found. However, this is not an exact science, as the volume found can – and usually will – vary from ultrasound technician to ultrasound technician, and can also sometimes be dependent on baby’s position. If the levels are found to be on the low side, evidence based protocols suggest having mom orally re-hydrate and return within 24 hours for another AFI ( Amniotic Fluid Index ), preferably by a different technician. This has shown repeatedly to have improved outcomes, versus immediate induction for low AFI levels.
A study published in the Journal of Reproductive Medicine found a significant increase in amniotic fluid after maternal oral rehydration, as well as intravenous hydration, with neither one better than the other. In all, 62.5% and 44.0% demonstrated improved AFI levels.
What if the baby grows too large?
First, who defines “too large”? What is “too large” for one woman, might be the next woman’s smallest baby size. The most important thing to remember is that there is no fool proof way of knowing whether or not your body can naturally birth a baby of whatever size, until you have tried. Ultrasound has a 20% error rate in either direction, and many women have allowed an induction after being told that their baby would be nearly 10 pounds, only to give birth to an 8 pound baby. And, there is no reason for a woman to doubt her ability to birth a 10 pound baby unless she tries. I, for one, never would have believed that I could have birthed my nearly 11 pound baby, especially because I was told that I could not safely birth my 8 ½ pound baby that I was scared into a cesarean with. You never know until you give it a full chance.
Women are often told that a baby will gain approximately a ½ pound per week in the end of pregnancy. However, this is simply an approximation. Once again, this is NOT the same for every woman, or for every baby.
According to a fetal growth rate chart comprised by four studies, a baby will only put on approximately 0.56 pounds – that’s just over half of a pound – between 40 weeks and 43 weeks. And since we’ve shown that most women go into labor before 43 weeks, it can be assumed that it is even less than that. Babies hit a plateau with weight gain around 40 weeks. So really, is there a huge concern to be had over a baby being birthable at 40 weeks, but not at 42 if we’re talking about less than half of a pound? And, does less than half of a pound change the shoulder width or head size of a baby? Hardly. It may give baby chubbier cheeks, or chubbier buns, but will not change the overall structure of the baby, making baby automatically “too large” to birth between those two weeks.
When Should Monitoring a “Post Dates” Pregnancy Begin?
This may be different for each individual pregnancy, each individual woman, which makes cookie cutter policies surrounding post dates, arbitrary. To begin, we have now shown that according to research, doctors, and all basic “rules” that a pregnancy is not even considered postdates until after 42 weeks. Not 40. So if the pregnancy is not postdates until 40 weeks, why do doctors often begin Non-Stress Tests ( NSTs ), Biophysical Profiles ( BPPs ), and Amniotic Fluid Index ( AFI ) at 40 weeks? It goes back to the very flawed study from 1963.
It is up to each individual woman to decide if she is comfortable waiting on monitoring, but if a woman understands that there is virtually no risk difference from 38 weeks to 42 weeks, it should clarify that testing before 42 weeks is mainly unnecessary unless other pregnancy complications are present (i.e. Hypertension, Diabetes Mellitus, IUGR suspicion, Congenital Abnormalities ).
So, let’s take a look at what type of monitoring is available, and how effective they are in finding possible problems.
• Biophysical Profile ( BPP ) – A BPP checks fetal body tone, fetal movement, amniotic fluid volume, and fetal “breathing” practices. Each of these are given a score, and then it is added up to give an overall score. A high score of 8-10 usually shows a baby in good health, while a baby who scores 0-4 indicates a baby who needs to be more closely monitored, or needs to be outside of the womb. Scores in between will usually come with more monitoring, including another BPP within 24 hours.
According to Enkin et al., in A Guide to Effective Care in Pregnancy:
There is some evidence that these tests can detect pregnancies in which there is 'something wrong,' but less evidence that their use improves outcome, or can eliminate the additional risk of post-term pregnancy. The only controlled trial shows no advantages of complex fetal monitoring with computerized cardiotocography, amniotic fluid index, assessment of fetal breathing tone, and gross body movements over simple monitoring with standard cardiotocography and ultrasound measurement using maximum amniotic fluid pool depth.
So as you can see, even the detailed testing may not prevent issues that may arise.
According to several studies that researched the accuracy of the BPP, the false positive rates were quite high, resulting in unnecessary induction or further monitoring.
One in particular showed a 21.3% false positive rate for the BPP, and a 39.3% false positive rate for the Non-Stress Test ( NST ). More studies have shown much higher false positive rates for the Non-Stress Test, which is the most common for women who go beyond 40 weeks in care under an Obstetrician.
• Amniotic Fluid Index ( AFI ) – An AFI is basically a mini Biophysical Profile. It measures the maximum amniotic fluid pool depth in the uterus. However, as was shown in the beginning of this article, the AFI in a pregnancy can be contingent on several factors. Being dehydrated can lessen the AFI found. The baby’s position can affect how much amniotic fluid is seen. The skill of an ultrasonographer can make a difference in the AFI level found. It was also shown that AFI levels can be improved with maternal oral rehydration. Often in modern obstetrics, this protocol is ignored, and induction is recommended very much against proven evidence.
• Non-Stress Test ( NST ) – The NST is the most commonly used test with women who go beyond 40/41 weeks pregnant, under the average Obstetric care. An NST is electronic fetal monitoring for contractions, fetal heart rate variability, and overall heart rate strength. If a baby is found to be sleeping, stimulation is often used in the form of vibration, a cold drink with sugar ( such as orange juice or soda ), or palpation stimulation.
The NST comes with the highest false positive rates of all of the tests, which is why it has become a controversial test amongst some groups.
Studies have been done that conclude anywhere from a 50%-75% false positive rate on average, sometimes reaching as high as 80-90%. False positives will lead to more testing, more stress, and possibly unnecessary intervention in the pregnancy.
Conclusion
Facts:
• A pregnancy is NOT “Postdates” until after 42 weeks.
• The risk of stillbirth is nearly a flat line between 38 weeks and 43.
• Amniotic fluid is dependent on maternal hydration, in the absence of congenital abnormalities.
• A baby’s weight virtually plateaus after 40 weeks.
Some things to think about :
• If I am not “overdue” until after 42 weeks, should I allow testing or intervention before this point?
• If NSTs come with very high false-positive rates, is it a test worth submitting to?
• If my baby will not put on much weight within a 3 week period, is it logical to worry about my baby being “too large” within a probable 2 week period?
Please, please always do your own research. Question what you are told - and go study the subject – regardless of whether your OB, Midwife, Family Member, or Friends are the ones giving you the information. Make informed decisions, and take charge of your prenatal care!
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McClure-Browne, J.C. 1963. Comparison of perinatal mortality rates versus gestational age through the past three decades. Postmaturity, Am J Obstet Gynecol 85: 573–82.
Journal of Fetal Medicine 1996 Sep-Oct. 5(5): 293-97. Expectant Management of Post-Term Patients: Observations and Outcome. Weinstein D. et al.
Journal of Reproductive Medicine 2000 volume 4 pp 337-340. Effect of Oral and intravenous hydration on oligohydramnios. CHANDRA P. C.; SCHIAVELLO H. J. ; LEWANDOWSKI M. A. ;
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(2)Hadlock FP, Shah YP, Kanon DJ, et al. "Fetal crown rump length: Reevaluation of relation to menstrual age with high resolution real-time US Radiology." 182:501, 1992.
(3)Usher R, McLean F. "Intrauterine growth of live-born Caucasian infants at sea level: Standards obtained from measurements in 7 dimensions of infants born between 25 and 44 weeks of gestation." Pediatrics. v.74, 1969.
(4)Wigglesworth JS. Perinatal Pathology, Second Edition. W.B. Saunders Company. 1996. page 24.
Hassan S. Kamel, Ahmed M. Makhlouf, Alaaeldin A. Youssef. Gynecol Obstet Invest 1999; 47: 223-228
Evertson LR, Gauuthier RJ, Schifrin BS, et al., Antepartum fetal heart rate testing. I. Evolution of the non-stress test. Am J Obstet Gynecol 1979;133:29-33
Miller, David A MD; Rabello, Yolanda A MSEd; Paul, Richard H. MD. Americal Journal of Obstet and Gynec. 174(3):812-817, March 1996.
Sunday, January 4, 2009
20/20 Segment on Orgasmic Birth
I DVR'ed the whole episode and to be honest, I was pretty disappointed. The segments on homebirth, unassisted birth and extended nursing were so negative and just not very thorough. The segment on Orgasmic Birth was pretty decent though.
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