C-section Births Cause Genetic Changes That Could Increase Odds For Developing Diseases In Later Life

Swedish researchers have discovered that babies born by Caesarean section experience changes to the DNA pool in their white blood cells, which could be connected to altered stress levels during this method of delivery, according to the July issue of Acta Paediatrica.

It is thought that these genetic changes, which differ from normal vaginal deliveries, could explain why people delivered by C-section are more susceptible to immunological diseases such as diabetes and asthma in later life, when those genetic changes combine with environmental triggers.

Blood was sampled from the umbilical cords of 37 newborn infants just after delivery and then three to five days after the birth. It was analysed to see the degree of DNA-methylation in the white blood cells - a vital part of the immune system.

This showed that the 16 babies born by C-section exhibited higher DNA-methylation rates immediately after delivery than the 21 born by vaginal delivery. Three to five days after birth, DNA-methylation levels had dropped in infants delivered by C-section so that there were no longer significant differences between the two groups.

“Delivery by C-section has been associated with increased allergy, diabetes and leukaemia risks” says Professor Mikael Norman, who specialises in paediatrics at the Karolinska Institutet in Stockholm, Sweden. “Although the underlying cause is unknown, our theory is that altered birth conditions could cause a genetic imprint in the immune cells that could play a role later in life.

“That is why we were keen to look at DNA-methylation, which is an important biological mechanism in which the DNA is chemically modified to activate or shut down genes in response to changes in the external environment

. As the diseases that tend to be more common in people delivered by C-section are connected with the immune system, we decided to focus our research on early DNA changes to the white blood cells.”

The authors point out that the reason why DNA-methylation is higher after C-section deliveries is still unclear and further research is needed.

“Animal studies have shown that negative stress around birth affects methylation of the genes and therefore it is reasonable to believe that the differences in DNA-methylation that we found in human infants are linked to differences in birth stress.

“We know that the stress of being born is fundamentally different after planned C-section compared to normal vaginal delivery. When babies are delivered by C-section, they are unprepared for the birth and can become more stressed after delivery than before. This is different to a normal vaginal delivery, where the stress gradually builds up before the actual birth, helping the baby to start breathing and quickly adapt to the new environment outside the womb.”

The authors point out that the surgical procedure itself may play a role in DNA-methylation and that factors other than the delivery method need to be explored in more detail.

“In our study, neonatal DNA-methylation did not correlate to the age of the mother, length of labour, birth weight and neonatal CPR levels - proteins that provide a key marker for inflammation” says Professor Norman. “However, although there was no relation between DNA-methylation and these factors, larger studies are needed to clarify these issues.”

Professor Norman states that the Karolinska study clearly shows that gene-environment interaction through DNA-methylation is more dynamic around birth than previously known.

“The full significance of higher DNA-methylation levels after C-section is not yet understood, but it may have important clinical implications” he says.

“C-section delivery is rapidly increasing worldwide and is currently the most common surgical procedure among women of child-bearing age. Until recently, the long-term consequences of this mode of delivery had not been studied. However, reports that link C-section deliveries with increased risk for different diseases in later life are now emerging. Our results provide the first pieces of evidence that early ‘epigenetic’ programming of the immune system may have a role to play.”

The authors feel that their discovery could make a significant contribution to the ongoing debate about the health issues around C-section deliveries.

“Although we do not know yet how specific gene expression is affected after C-section deliveries, or to what extent these genetic differences related to the mode of delivery are long-lasting, we believe that our findings open up a new area of important clinical research” concludes lead author Titus Schlinzig, a research fellow at the Karolinska Institutet.

Woman Heads Effort to Stop Circumcision

Marilyn Milos, 69, of Forest Knolls was a nurse at Marin General Hospital in 1979 when she witnessed her first circumcision. The experience changed her life. After researching the procedure, she became convinced it was not only unnecessary but harmful. She says she was later fired from her job for sharing her opinions with patients and has spent the last 30 years crusading against circumcision as founder of the nonprofit National Organization of Circumcision Information Resource Centers.

Q: What do you remember about that first circumcision?

A: As we walked into the nursery, the baby was strapped down to a plastic board. I called it "the rack" when I worked there. The baby was pulling against the restraints. Then the doctor started to cut and that baby let out a scream I've never heard come out of the mouth of a human, ever, and it became louder and louder. My bottom chin began to quiver and then tears poured over my eyes, and the doctor looked at my face and said, "There is no medical reason for doing this."

Q: How did your supervisors at Marin General react when you started questioning circumcision?

A: They told me to keep my mouth shut because a couple of patients were upset that I'd told them what was going to happen to their babies. I said, "Well, the baby's a patient. No one is more upset than he is." It was my job as a nurse that when parents signed that consent form that they were truly informed.

Q: What is so important about the foreskin?

A: It covers and protects the urinary meatus so the urinary tract maintains its sterility, and it's the skin that accommodates the full erection. Circumcision is one of the reasons that men complain of tight erections, painful erections and curvature of the penis.

Q: Does circumcision reduce male sexual pleasure?

A: Well, if you cut off 20,000 to 70,000 highly erogenous, specialized nerve endings, what would your guess be? All those nerve endings are the accelerator that allows a man to ride the wave to orgasm the way a woman does. Without them, the accelerator is replaced with an off/on switch; "Oops honey sorry, it's because I'm so sensitive." It's not because you're so sensitive. It's because somebody did this to you. Somebody removed your accelerator. Men should be so pissed off about this.

Q: What is the long-term effect of the glans' exposure?

A: Initially, premature ejaculation occurs because there is no control. Later the denuded glans becomes dry, hardened and calloused. By their mid-40s, men are saying, "The head of my penis is numb. There is no sensation there."

Richard Halstead can be reached at rhalstead@marinij.com

At births done at home, we recognize the importance of allowing baby it get all of their blood through the cord. At most births, the cord is not cut until after the delivery of the placenta.

It is encouraging to see that the medical community is starting to find benefits to delayed cord clamping (even if it is less than a minute) for preemies. I just wonder when they will catch on for the full term babies.

Labor Cubes

One very effective trick (in hospitals that insist that mothers labor on "clear liquids only") is to have the mother take along a zippy bag of "labor cubes" to the hospital, storing them in her room fridge. "Labor Cubes" are ice cubes made out of very strong raspberry leaf tea (perhaps one cup herb to one quart water, simmered down to half and strained) that is heavily sweetened with honey. If the laboring mother begins to fade, energy petering out or contractions waning due to lack of nutrition, she can chomp on these satisfying slushy cubes, which usually will perk her up and kick in some great contractions in a matter of minutes.

— Beth Barbeau
Excerpted from "Tricks of the Trade: Liquids Only," Midwifery Today, Issue 81

Vitamin K at Birth: To Inject or Not

By Linda Folden Palmer, DC

Newborn infants routinely receive a vitamin K shot after birth in order to prevent (or slow) a rare problem of bleeding into the brain weeks after birth. Vitamin K promotes blood clotting. The fetus has low levels of vitamin K as well as other factors needed in clotting. The body maintains these levels very precisely.1 Supplementation of vitamin K to the pregnant mother does not change the K status of the fetus, confirming the importance of its specific levels.

Toward the end of gestation, the fetus begins developing some of the other clotting factors, developing two key factors just before term birth.2 It has recently been shown that this tight regulation of vitamin K levels helps control the rate of rapid cell division during fetal development. Apparently, high levels of vitamin K can allow cell division to get out of hand, leading to cancer.

What's the Concern?

The problem of bleeding into the brain occurs mainly from three to seven weeks after birth in just over five out of 100,000 births (without vitamin K injections); 90 percent of those cases are breastfed infants3 because formulas are supplemented with unnaturally high levels of vitamin K. Forty percent of these infants suffer permanent brain damage or death.

The cause of this bleeding trauma is generally liver disease that has not been detected until the bleeding occurs. Several liver problems can reduce the liver's ability to make blood-clotting factors out of vitamin K; therefore extra K helps this situation. Infants exposed to drugs or alcohol through any means are especially at risk, and those from mothers on anti-epileptic medications are at very high risk and need special attention.

Such complications reduce the effectiveness of vitamin K, and in these cases, a higher level of available K could prevent the tragic intracranial bleeding. This rare bleeding disorder has been found to be highly preventable by a large-dose injection of vitamin K at birth.

The downside of this practice however is a possibly 80 percent increased risk of developing childhood leukemia. While a few studies have refuted this suggestion, several tightly controlled studies have shown this correlation to be most likely.4,5 The most current analysis of six different studies suggests it is a 10 percent or 20 percent increased risk. This is still a significant number of avoidable cancers.6

Apparently the cell division that continues to be quite rapid after birth continues to depend on precise amounts of vitamin K to proceed at the proper rate. Introduction of levels that are 20,000 times the newborn level, the amount usually injected, can have devastating consequences.

The Newborn's Diet

Nursing raises the infant's vitamin K levels very gradually after birth so that no disregulation occurs that would encourage leukemia development. Additionally, the clotting system of the healthy newborn is well planned, and healthy breastfed infants do not suffer bleeding complications, even without any supplementation.7

While breastfed infants demonstrate lower blood levels of vitamin K than the "recommended" amount, they show no signs of vitamin K deficiency (leading one to wonder where the "recommended" level for infants came from). But with vitamin K injections at birth, harmful consequences of some rare disorders can be averted.

Infant formulas are supplemented with high levels of vitamin K, generally sufficient to prevent intracranial bleeding in the case of a liver disorder and in some other rare bleeding disorders. Although formula feeding is seen to increase overall childhood cancer rates by 80 percent, this is likely not related to the added vitamin K.

The Numbers

Extracting data from available literature reveals that there are 1.5 extra cases of leukemia per 100,000 children due to vitamin K injections, and 1.8 more permanent injuries or deaths per 100,000 due to brain bleeding without injections. Adding the risk of infection or damage from the injections, including a local skin disease called "scleroderma" that is seen rarely with K injections,8 and even adding the possibility of healthy survival from leukemia, the scales remain tipped toward breastfed infants receiving a prophylactic vitamin K supplementation. However, there are better options than the .5- or 1-milligram injections typically given to newborns.

A Better Solution

The breastfed infant can be supplemented with several low oral doses of liquid vitamin K1 (possibly 200 micrograms per week for five weeks, totaling 1 milligram, even more gradual introduction may be better). Alternatively, the nursing mother can take vitamin K supplements daily or twice weekly for 10 weeks. (Supplementation of the pregnant mother does not alter fetal levels but supplementation of the nursing mother does increase breastmilk and infant levels.)

Either of these provides a much safer rate of vitamin K supplementation. Maternal supplementation of 2.5 mg per day, recommended by one author, provides a higher level of vitamin K through breastmilk than does formula,10 and may be much more than necessary.

Formula provides 10 times the U.S. recommended daily allowance, and this RDA is about two times the level in unsupplemented human milk. One milligram per day for 10 weeks for mother provides a cumulative extra 1 milligram to her infant over the important period and seems reasonable. Neither mother nor infant require supplementation if the infant is injected at birth.11

The Bottom Line

There is no overwhelming reason to discontinue this routine prophylactic injection for breastfed infants. Providing information about alternatives to allow informed parents to refuse would be reasonable. These parents may then decide to provide some gradual supplementation, or, for an entirely healthy term infant, they may simply provide diligent watchfulness for any signs of jaundice (yellowing of eyes or skin) or easy bleeding.

There appears to be no harm in supplementing this vitamin in a gradual manner however. Currently, injections are provided to infants intended for formula feeding as well, although there appears to be no need as formula provides good gradual supplementation. Discontinuing routine injections for this group alone could reduce cases of leukemia.

One more curious look at childhood leukemia is the finding that when any nation lowers its rate of infant deaths, their rate of childhood leukemia increases.12 Vitamin K injections may be responsible for some part of this number, but other factors are surely involved, about which we can only speculate.

Dr. Linda Folden Palmer consults and lectures on natural infant health, optimal child nutrition and attachment parenting. After running a successful chiropractic practice focused on nutrition and women's health for more than a decade, Linda's life became transformed eight years ago by the birth of her son. Her research into his particular health challenges led her to write Baby Matters: What Your Doctor May Not Tell You About Caring for Your Baby. Extensively documented, this healthy parenting book presents the scientific evidence behind attachment parenting practices, supporting baby's immune system, preventing colic and sparing drug usage. You can visit Linda's Web site at www.babyreference.com.

For some, life begins at home

Emma Downs
The Journal Gazette

Kat Hickey was nine months pregnant – although anyone who has gone through a pregnancy knows that nine months feels a lot like 19 somehow – and ready … really ready … to deliver.

Sitting in a bathtub inside her Fort Wayne home, Hickey diligently breathed through a series of contractions and waited patiently for her certified nurse midwife to arrive.

OK. Maybe not that patiently.

“My husband asked me if I could hang on just a little longer,” Hickey says. “The midwife was just 10 minutes away.”

And then Hickey felt the crown of her soon-to-be-born daughter’s head touching her hand. So that answered that question.

Ummm … no. Huh-uh. There would be no hanging on for a little longer.

“Knowing it would just take one good push and I would have her in my arms,” Hickey says. “That was the motivation.”

So she pushed. And, with the help of her husband, a few minutes later a beautiful, healthy baby girl was staring at them with that “Whoa. What just happened?” newborn expression.

“It was beautiful. We had the baby the same way we made it,” Hickey says. “Just two idiots, in our own house.”

And as dramatic as this story sounds, this is exactly what Hickey and her husband had planned from the beginning: a home birth involving the whole family.

As with many women who choose to deliver at home, Hickey wanted to avoid what she considered to be the unnecessary medical interventions she’d encountered while delivering her first child at a hospital. For her, this had included Pitocin to speed up or regulate labor, an epidural and narcotics, an IV, a catheter, a constant fetal monitor and, eventually, forceps used to extract the baby from the birth canal.

“When it came to pushing, I could’ve been blowing my nose for all I knew,” she says. “It was a bazaar situation. It seemed like the baby had been ejected from my body. And that left me thinking, ‘Did I do that? Or did they?’ I knew that couldn’t be the best way to do it.”

Growing demand

The process of delivering at home – even in the bathtub – was transformative, Hickey says. And it convinced her to become a doula, a trained labor coach. She began assisting with home births in 2000, shortly after her daughter was born.

“One of the biggest misconceptions is that giving birth at home is not an informed choice,” Hickey says. “A lot of people who do research on birth and the risks of giving birth come to the conclusion that the risks of the medical interventions are higher than the risks of delivering naturally at home.

“And the number of women who encounter an unexpected complication – when no problems existed prenatally – is incredibly small. My husband, for instance, was mostly just worried about our carpet. I knew we could work around that.”

Hickey frequently assists in births with Laura Gilbert, a certified nurse midwife with Homebirth & Women’s Health in Goshen. Gilbert, who assists with births in Fort Wayne, has recently started to turn clients away. The demand for home births is growing for a number of reasons, she says.

“There really is a desire to avoid unnecessary medical interventions,” Gilbert says. “But there is also a drive to have the birth be a family-centered event instead of a medical-centered event.”

Gilbert performs about six deliveries a month and insists that all of her clients be single, low-risk pregnancies. Although the majority of her clients are Old Order Amish, the next largest group are conservative Christians looking to save money, she says.

“The cost is probably less than half of a natural birth in the hospital,” Gilbert says. “But despite the cost, I always tell people who are thinking about home birth to have the baby in the place where they feel most comfortable.

“For me and my clients, that’s at home. For some people, that’s the hospital. There is no right or wrong.”

‘Informed choice’

For local mom Kristin Rahn, the most comfortable place to have her most recent child was standing up next to the living room couch. Gravity, it turns out, helps more than you’d think.

“That’s the big advantage to having a baby at home,” Rahn says. “You’re on your own turf, so your fight-or-flight instinct is less likely to kick in and inhibit your labor.

“And you’re more comfortable listening to your own body. You decide whether to eat or drink, whether to stand up, squat, take a bath, take a shower. You’re not flat on your back, hooked up to an IV and a catheter.”

Rahn and her husband have four children; two born in the hospital, two born at home. And when the couple first made the decision to deliver at home, they didn’t tell all of their relatives.

The midwifery model of care treats birth as a normal occurrence, relying on the idea that biologically a woman is designed to give birth. It was easy for Rahn to trust that her body and the process of giving birth naturally would work.

But not everyone felt the same. Some people she encountered felt a home birth was innately risky, she says.

“There were people who were worried,” she says. “People who frowned and said, ‘We’ll be praying for you.’ And people who thought my decision was based on bravado and not research. And that is a misconception.

“It’s totally evidence based. It’s definitely an informed choice, not second-rate or a last choice. It’s always something consciously chosen.”

Gilbert combats the misconception that home birth is dangerous with a rundown of what’s inside the travel bag she carries with her to every home birth – a dopler to check the fetal heartbeat, injectable Pitocin, oxygen and an IV for any needed antibiotics.

Fewer than 10 percent of Gilbert’s patients end up in the hospital – most of them due to long drawn-out labors when pain relief is needed.

“It’s important for the mother and baby to be low risk,” Gilbert says. “Prenatally, we check for anything out of the norm. And thank goodness hospitals are there. It’s the best of both worlds, really. You can have a home birth, but the hospital is nearby, too.

“If you were living 600 years ago, you wouldn’t have had that choice.”

For Hickey, the birth of her daughter – at home, in the bathtub – is a story worth retelling. Every year on her birthday, Hickey and her husband tell their daughter about the day she was born.

“My husband has this visceral memory of seeing our daughter’s little face, fitting perfectly in the palm of his hand,” she says. “And it’s that – those memories. That’s the beautiful thing about home birth.”

Canadian docs to stop automatic C-sections for breech babies

Unfortunately here in St. George, there are no providers at the hospital that will do a planned vaginal breech birth. Hopefully, the US will take notice of Canada's new stance on breech birth and follow.
Vaginal breech birth is possible and surgical birth should not be the only choice. Your best chance for a vaginal breech birth, if you find yourself in that position, is a homebirth midwife. Do your research.
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By Sharon Kirkey, Canwest News Service

In a major shift in medical practice and another assault on Canada's rising cesarean section rate, Canada's delivery doctors are being told to stop automatically scheduling C-sections for breech babies and attempt a normal delivery instead — something significant numbers of obstetricians aren't trained to do.

New guidelines issued Wednesday by the Society of Obstetricians and Gynaecologists of Canada say women carrying babies in the breech, or bottom-first, position should be given the right to choose to attempt a traditional delivery when possible.

The society says that women in Canada want the choice, and that some women with breech babies are delivering at home "because they knew if they went to hospital A, B or C it would not be offered," says Dr. Andre Lalonde, executive vice-president of the obstetricians' group and an adjunct professor of obstetrics and gynecology at McGill University and the University of Ottawa.

Lalonde says the group is working aggressively to ensure future specialists are trained in breech vaginal deliveries and is organizing courses across Canada for practising doctors to refresh their training.

"Paramount is the safe birth of the child," he said.

Most babies are positioned in the head-down position when labour starts. With breech babies, the feet or buttocks come out first during birth.

Breech babies account for about three to four per cent of all pregnancies in Canada, or about 11,000 to 14,500 pregnancies each year.

"Breech pregnancies are almost always delivered using a cesarean section, to the point where the practice has become somewhat automatic," Dr. Robert Gagnon, a principal author of the new guidelines and chair of The Society of Obstetricians and Gynaecologists of Canada's maternal fetal medicine committee, said.

"What we've found is that, in some cases, vaginal breech birth is a safe option and obstetricians should be able to offer women the choice to attempt a traditional delivery."

An international, Canadian-led study reported in 2000 that the safest way for breech babies to enter the world was via C-section. The study of more than 2,000 women found babies of mothers in the cesarean group were three to four times less likely to die, or have serious problems in the first six weeks of life, compared to those in the vaginal birth group (1.6 per cent versus 5.0 per cent).

The study had widespread influence worldwide. Many doctors stopped doing vaginal deliveries for breech babies, and many medical schools stopped training doctors in how to do them.

But the doctor who led the study said the risks, while different, were never huge. "The risks were still quite low," says Dr. Mary Hannah, a professor in the department of obstetrics and gynecology at the University of Toronto and Sunnybrook Health Sciences Centre.

More recent studies, including a study of more than 8,000 French and Belgian women carrying breech babies, found no significant differences in risks to babies whether they were born vaginally or via C-section.

Hannah says that a planned vaginal delivery of breech babies can be a safe and reasonable option. But, she said, most women she knows "will still want the option that is possibly safer, and that will be a planned cesarean section."

The main concern has always been delivery of the head — that the body will deliver, but that the baby's head will get caught.

"You can push the baby all the way back up into the uterus and do a cesarean section. But that's very traumatic," Hannah says. "And by the time that you are able to do that the baby may have suffered severe hypoxia," or lack of oxygen.

The new guidelines say that many breech deliveries will still require a C-section, and that a vaginal birth is not recommended for a "footling" breech, where the baby is positioned feet-first, with one or both feet pointing directly down toward the birthing canal.

Vaginal breech births also aren't recommended if the woman's pelvis is narrow or small, if the umbilical cord is likely to become entangled or compressed during delivery, or for babies that are too big (weighing more than 4,000 grams, or 8.8 pounds) or too small (less than 2,500 grams, or 5.5 pounds).

Breech deliveries are one of the main reason for C-sections, "and, if you do one (C-section), you increase the risk for another" in future pregnancies, Lalonde says. Repeat C-sections account for 30 to 40 per cent of all cesareans.

Acupuncture Soothes Heartburn in Pregnant Women

I have used acupuncture in my practice in the past with great results. Never had I thought to recommend it for heartburn - which most of my clients suffer from at some point in their pregnancies. Good to know!
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Wednesday, June 10, 2009


Acupuncture can help ease symptoms in pregnant women with upset stomachs, a small new study from Brazil shows.

Pregnancy can cause a host of gastrointestinal woes, including heartburn, reflux, and bloating, Dr. Joao Bosco Guerreiro da Silva of Rio Preto Medical College in Sao Jose do Rio Preto and his colleagues note in their report. While many studies have looked at acupuncture for treating vomiting and nausea in pregnancy, they add, there has been no research on whether it is helpful for other pregnancy-related stomach symptoms.

To investigate, the researchers randomly assigned 42 pregnant women with dyspepsia to undergo acupuncture or standard treatment for 8 weeks.

Every 2 weeks, the researchers interviewed the women about their heartburn symptoms, how many antacid tablets they used, and how their symptoms affected their eating and sleeping.

Six women dropped out of the study, including five in the control group. Heartburn symptom intensity fell by at least half in 75 percent of the acupuncture patients and 44 percent of those in the control group. Seven women in each group used antacids; for those in the acupuncture group, average use fell by 6.3 doses, compared to an increase of 4.4 doses in the control group.

At the end of the study, 15 of the 20 women (75 percent) in the acupuncture group said they had at least a 50 percent improvement in eating, and 14 (70 percent) had this degree of improvement in sleeping. Among the control group women, 31 percent and 25 percent showed 50 percent improvement in their eating and sleeping, respectively.

There were no side effects of the treatment, and no differences between the infants born to the women in the acupuncture and control groups. The researchers caution against using acupuncture points in the lower back or lower abdomen in pregnant women, due to possible concerns that needling could trigger contractions.

"This technique should be further studied in prospective randomized studies of large populations to confirm our findings in effectiveness and the absence of adverse effects," da Silva and his team write. "It is simple to apply and if used in an appropriate manner can reduce the need for medication."

Breastfeeding linked to reduced risk of SIDS

Reuters

NEW YORK (Reuters Health) - Women who breastfeed evidently lower the chances that their baby might die of sudden infant death syndrome or SIDS, according to a German study.

Dr. M. M. Vennemann, from the University of Munster, and colleagues therefore recommend that public health messages aimed at SIDS risk-reduction should encourage women to breastfeed their infant through 6 months of age.

At present, some countries include breastfeeding recommendations in their SIDS prevention campaigns, while others do not, the investigator point out in their report in the medical journal Pediatrics. The goal of the current study was to confirm that breastfeeding is, in fact, tied to a reduced risk of SIDS.

The study included 333 infants who died of SIDS and 998 age-matched "control" infants.

At 2 weeks of age, 83 percent of controls were being breastfed compared to only 50 percent of SIDS infants. At 1 month of age, corresponding rates were 72 percent versus 40 percent

Exclusive breastfeeding at 1 month cut the risk of SIDS in half. Partial breastfeeding at this point was also tied to a reduced risk, although that could have been a chance finding.

These results add "to the body of evidence showing that breastfeeding reduces the risk of SIDS, and that this protection continues as long as the infant is breastfed," the investigators conclude.

SOURCE: Pediatrics, March 2009.

Is the Cord Around the Baby's Neck Really Dangerous?

May 19, 2008 by Misha Safranski

As a confirmed birth junkie, I have heard over and over again birth stories where the baby was born by cesarean for either fetal distress or failure to descend, and the difficulties are blamed on "the cord was around the baby's neck". Is this condition - scientifically termed "nuchal
cord" - actually dangerous? A new study backs up previous research showing that nuchal cord is not the threat it's perceived to be.

A study published this year in the Journal of Perinatal Medicine showed there were no statistically significant differences in outcomes of post-term pregnancies involving a nuchal cord verses no nuchal cord. Drs. Ghosh and Gudmundsson performed color ultrasound on 202 women with post-term pregnancies. Nuchal cords were detected in 69 of the women. There were no significant differences in Apgar scores, umbilical cord anomalies, cesarean section, perinatal death or admission of the baby to the NICU (neonatal intensive care unit).

These findings confirm what has been found in most of the past research on nuchal cord outcomes. A 2006 study from the Archives of Obstetrics and Gynecology was on a much larger scale, looking at the outcomes of 166,318 deliveries during a 15 year study period, 24,392 of which had a documented nuchal cord at birth. The authors, Sheiner et. Al, conclude: "Nuchal cord is not associated with adverse perinatal outcome. Thus, labor induction in such cases is probably unnecessary."
The interesting thing about the Sheiner study is that despite the equivalent outcomes among nuchal cord babies and those without the cord wrapped around the neck, there were higher rates of labor induction and non-reassuring fetal heart tones during labor among the nuchal cord cases.

These two factors are most likely related. We know without a doubt that induction of labor can cause fetal distress. The fact that there were higher induction rates in the nuchal cord group could very well explain the higher rate of transient fetal distress. Induction is nearly always accompanied by AROM (artificial rupture of membranes), which can cause undue pressure on the cord, which can in turn result in blips in the hearttones. Regardless of the cause, the outcomes were still good.

Finally, we look at yet another study which demonstrated that nuchal cord does not result in worse outcomes. In a 2005 study looking at the effects of nuchal cord on birthweight and immediate neonatal outcomes, Mastrobattista, et. Al examined the outcomes of 4426 babies, 775 of whom had a nuchal cord. They found that there were no significant differences between the two groups in birthweight, non-reassuring fetal hearttones, Apgar scores below 7, or operative vaginal deliveries. The cesarean rate was actually highest among the women whose babies did not have a nuchal cord.

The most important thing to keep in mind is that unborn babies do not breathe through their mouth and neck - they receive oxygen through the umbilical cord. This is why it normally doesn't matter if the cord is around the neck (unless the cord is being compressed too much, which is fairly rare). The baby cannot "choke to death" before she/he is born. What we can conclude from the overwhelming majority of data is that nuchal cord - or "cord around the neck" - is not pathological; that is to say, it's not an abnormality. It is a normal condition of the umbilical cord and typically causes no problems with the delivery, even though doctors frequently try to convince parents otherwise.

References:
J Perinat Med. 2008;36(2):142-4. Nuchal cord in post-term pregnancy - relationship to suspected intrapartum fetal distress indicating operative intervention. Ghosh GS, Gudmundsson S. Department of Obstetrics and Gynecology, Malmö University Hospital, Malmö, Sweden.

Arch Gynecol Obstet. 2006 May;274(2):81-3. Epub 2005 Dec 23. Nuchal cord is not associated with adverse perinatal outcome. Sheiner E, Abramowicz JS, Levy A, Silberstein T, Mazor M, Hershkovitz R. Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel. sheiner@bgu.ac.il

Keep your baby rear facing longer

I am so excited to see more awareness on the carseat safety and extended rear facing. We turned our kids at 12 mos (didn't know better), 21 mos (just had a new baby and couldn't fit two rear facing seats in our truck), 3.5 years and 2.5 years.
I hear a lot of people say that their kids would never stand for being rear faced that long, but in my opinion, carseat safety is not negotiable in our house. If you want to go somewhere, you buckle up in your appropriate seat. Even now, my children don't complain. I have two in high back boosters (ages almost 10 and almost 8) and two in harnessed seats (ages almost 6 and almost 4).
We have loved our Britax seats for extended rear facing. They are a bit more costly, but are so worth it in the long run. Our seats still look like they are in great condition and one is going to expire this year. We have a Roundabout and a Marathon for our younger two girls.

Check out this article on the AAP's new stance on extended rear facing.

Keep your toddler in a rear-facing car seat until age 2 (not 1)

Lori O’Keefe
Correspondent

New research indicates that toddlers are more than five times safer riding rear-facing in a car safety seat up to their second birthday. Following are some safety tips for car seat use:

All infants should ride rear-facing in either an infant car seat or convertible seat.

If an infant car seat is used, the infant should be switched to a rear-facing convertible car seat once the maximum height (when the infant’s head is within 1 inch of the top of the seat) and weight (usually 22 pounds to 32 pounds) have been reached for that infant seat as suggested by the car seat manufacturer.

Toddlers should remain rear-facing in a convertible car seat until they have reached the maximum height and weight recommended for the model, or at least the age of 2.

To see if your car seat is installed properly and to find a certified passenger safety technician in your area, visit www.seatcheck.org or www.nhtsa.dot.gov/cps/cpsfitting/index.cfm. You also can call 866-SEATCHECK (866-732-8243) or 888-327-4236.

Homebirth Slideshow

Check out this homebirth slideshow.
The images are beautiful!

Neonatal Outcomes May Be Better With Vaginal Birth After Cesarean Delivery

News Author: Laurie Barclay, MD
CME Author: Charles Vega, MD, FAAFP

June 3, 2009 — Neonates born after elective subsequent cesarean delivery have significantly higher rates of respiratory morbidity and neonatal intensive care unit (NICU) admission and longer length of hospital stay vs those with vaginal birth after cesarean (VBAC), according to the results of a retrospective cohort study reported in the June issue of Obstetrics & Gynecology.

"Controversy remains on whether a trial of labor or an elective repeat cesarean delivery is preferable for a woman with a history of cesarean delivery," write Beena D. Kamath, MD, MPH, from the University of Colorado School of Medicine in Denver, and colleagues. "Historically, concerns regarding the increased risk of uterine rupture and perinatal asphyxia in trial of labor after cesarean compared with planned repeat cesarean have swayed obstetricians away from recommending a trial of labor after cesarean delivery; however, the absolute risk of perinatal asphyxia remains small."

The goals of this study were to compare the outcomes of neonates born by elective subsequent cesarean delivery vs VBAC in women with 1 previous cesarean delivery and to compare the cost differences between these procedures. The study cohort consisted of 672 women with 1 previous cesarean delivery and a singleton pregnancy at or after 37 weeks of gestation. Participants were categorized based on their intention to have an elective subsequent cesarean delivery or a VBAC, whether successful or failed. The main endpoints of the study were NICU admission and measures of respiratory morbidity.

Compared with the VBAC group, neonates born by cesarean delivery had higher NICU admission rates (9.3% vs 4.9%; P = .025). Rates of oxygen supplementation were also higher in the subsequent cesarean group for delivery room resuscitation (41.5% vs 23.2%; P < .01) and after NICU admission (5.8% vs 2.4%; P < .028). The rates of delivery room resuscitation with oxygen were lowest in neonates born by VBAC and highest in neonates delivered after failed VBAC.

Although the costs of elective subsequent cesarean delivery were significantly higher vs VBAC, the highest costs for the total birth experience were for failed VBAC, considering both delivery and NICU use.

"In comparison with vaginal birth after cesarean, neonates born after elective repeat cesarean delivery have significantly higher rates of respiratory morbidity and NICU-admission and longer length of hospital stay," the study authors write.

Limitations of this study include relatively short postpartum follow-up of the mothers to determine the additional costs of postsurgical complications and insufficient data to allow estimation of costs other than those for hospital care.

"Given the increasing rates of primary cesarean delivery and the concomitant decrease in VBACs, once a woman has had a primary cesarean delivery, we must consider the risks that this places on her subsequent deliveries and subsequent neonates," the study authors conclude. "Indeed, this argues for greater selectivity in performing a cesarean delivery in the first place, and certainly a greater need for counseling before a primary elective cesarean delivery. As investigators continue to search for ways to make cesarean delivery safer, we may be better served by exploring other means for reducing overall cesarean delivery rates and recognizing our own preoccupation with the individual that will be our patient, whether it be mother or neonate."

The study authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2009;113:1231-1238.

Clinical Context

The rate of cesarean delivery has reached an all-time high in the United States, and the current study provides an overview of the epidemiology of cesarean delivery. In 2006, 31.1% of all deliveries were via cesarean, and this rate was fueled by an increase in the rate of primary cesarean delivery by 60% between 1996 and 2005.

Women with a primary cesarean delivery have a greater than 90% chance of having another cesarean delivery. Overall, more than half of cesarean deliveries are performed electively, before the onset of labor.

The current study examines neonatal outcomes in women with a history of primary cesarean delivery, with the primary variable being VBAC vs subsequent elective cesarean delivery.

Study Highlights

• The study was a retrospective review of cases at 1 Colorado hospital between 2005 and 2008.
• Researchers focused on women with a history of 1 previous cesarean delivery who were pregnant with a singleton pregnancy at 37 weeks or more of gestation. 51% of these women had planned an elective subsequent cesarean delivery, and 49% had planned for VBAC.
• The primary outcome of the study was admission to the NICU. Researchers conducted a multivariate regression analysis to account for the effects of maternal demographic and disease factors as well as birth factors on the study outcome. Other outcomes included the need for neonatal resuscitation and the cost of care.
• 672 women were included in the analysis. The mean maternal age was 29 years, and approximately half of women were of Hispanic origin.
• 35.6% of the study cohort had a planned elective cesarean delivery without labor, 15.5% had an elective cesarean delivery after the onset of labor, 36.3% of women had a successful VBAC, and 12.6% had a failed VBAC requiring cesarean delivery.
• Older women and women with higher educational achievement were more likely to have an elective subsequent cesarean delivery.
• 9.3% of neonates delivered by elective subsequent cesarean delivery required admission to the NICU vs only 4.9% of neonates delivered by intended VBAC. The adjusted odds ratios for NICU admission in neonates delivered with elective subsequent cesarean delivery without and with labor vs successful VBAC delivery were 2.93 and 2.26, respectively.
• Infants in the cesarean group were more likely to require blow-by oxygen and continuous positive airway pressure after delivery vs infants delivered by VBAC, and they also had higher rates of NICU admission for hypoglycemia.
• Conversely, infants delivered by VBAC were more likely to require bag mask ventilation and endotracheal intubation after delivery.
• Infants delivered via cesarean after a failed VBAC had rates of NICU admission similar to rates of admission in the elective subsequent cesarean delivery group. However, infants delivered after failed VBAC required the most resuscitation efforts after delivery.
• Factors associated with failed VBAC included chorioamnionitis and induction of labor.
• Neonates delivered at 37 weeks of gestation required more resuscitation efforts vs more mature neonates.
• Successful VBAC was associated with the shortest hospital stay and the lowest overall cost of care. Although failed VBAC was associated with the highest cost of care from all groups, planned VBAC still cost less than planned elective subsequent cesarean delivery overall.

Clinical Implications

• The rate of cesarean deliveries in the United States was 31.1% in 2006, and an increase in the rate of primary cesarean deliveries was primarily responsible for this high rate. In addition, women with a primary cesarean delivery have a greater than 90% chance of having another cesarean delivery, and more than half of all cesarean deliveries are performed electively, before the onset of labor.
• The current study finds that the rate of NICU admission is higher in infants delivered via elective subsequent cesarean delivery vs VBAC. Overall, elective subsequent cesarean delivery was estimated to be a more costly strategy.

Beautiful HBA2C Video

Check out this beautiful HBA2C (homebirth after 2 cesarean) video.

Eye Opening

Take a look at this slide show of Tanzanian women during their births.

The pictures of the hospital and postpartum room reminds me much of my time spent in the Philippines.

Did you know in sub-Saharan Africa the lifetime risk of maternal death is 1 in 16?

Pain Medications Used in Childbirth: Effects on Mother, Baby, Breastfeeding and Bonding

June 11, 2009 by

Denise Hibben

The medications most commonly used in hospital labor and delivery wards in the US are: Demerol (meperidine), Morphine, Stadol (butorphanol), Fentanyl, Nubain(nalbuphine). It should be noted that Demerol and Morphine are not commonly used as much as Stadol, Fentanyl, and Nubain. The anesthetics that are more common in epidurals are Lidocaine (xylocaine), and Bupivicaine (marcaine, marcain).

The benefits are obvious to the relief of pain in childbirth... relief of pain. If a mother has been in labor for a very long time and is exhausted, an epidural can make the difference between a vaginal birth and a cesarean section, by allowing her some relief so she can sleep and gain new strength. Pain relief can relax a laboring mother enough that her contractions become more effective and allow her labor to progress more efficiently. In the rare case of soft tissue dystocia that is purely physiological, pain medications may resolve it, as long as there are no emotional factors to consider.

Let us go over some of the general adverse effects of using pain relief and epidurals during labor and birth. Keep in mind that these are the adverse effects that are general among all of the more commonly used medications. Both mother and baby can experience these: sleepiness, sedation, dizziness, constipation, sleep problems, insomnia, nausea, vomiting, stomach pain, diarrhea, loss of appetite, memory problems, sweaty, clammy skin, headache, breastfeeding difficulties, bonding difficulties, and withdrawal symptoms.

These are the less serious side effects of the pain medications commonly used.

Some of the more serious adverse effects include: increased need to resuscitate newborns at birth, breathing difficulties in mother and newborn, very rapid heartbeat, very slow heartbeat, confusion, seizures, hallucinations, severe allergic reactions, numbing of face and extremities. These adverse effects are seen in both the mother and the baby.

It is known that these pain medications cross the placenta and affect the baby before birth. Most women who birth in the hospital will be offered these medications sometime during their labor, unless you have specifically requested that these not be offered. Some studies show that 90% of
healthy, low-risk women who birth in hospitals will have narcotic pain medications and/or an epidural during labor. This means that 90% of healthy infants born in hospitals are born drugged! Clearly information has not been shared with these mothers of the side effects of these medications.

Babies who are exposed to narcotics have stress put on their kidneys and livers as they try to metabolize the drugs. This can cause problems as well, considering that their livers and kidneys are still immature.


Physiological effects of Epidurals in labor

Epidurals are used to numb the nerves from the waist down during childbirth. An anesthetic/narcotic combination is injected into the dural space of the spinal column via catheter, which is in place throughout labor and delivery. Granted it can be an extreme relief during the pain of labor, but it is known to increase the length of labor and the second (pushing) stage, the need for forceps or vacuum assisted birth, episiotomy, and c-section. Those have an entire range of risks in and of themselves. It is also known to cause maternal fever and low blood pressure.
Because a woman is numbed by the epidural, she is not able to get up and move around during labor. This can cause labor to last longer and she may not be able to push as effectively because she cannot feel where to push.

Pain Medications and Breastfeeding

It is known that all of the narcotic medications used in labor and birth are exuded in Breastmilk. This means not only is the newborn baby getting an adult dose during labor, but also with the first feeding. Hence the sleepy baby that is more commonly seen in hospitals. Babies born without narcotics have a better latch during breastfeeding, are more alert and responsive during the first hours after birth, have less feeding problems and crying spells in the first 8 weeks of life, and are in general healthier, happier, and more content. American Academy of Pediatrics has taken the position that it is safe to breastfeed after receiving narcotics during labor, although they have stated that if a mother is prescribed these medications after birth, while still breastfeeding, it is recommended that the risks to the baby and the benefits to the mother should be weighed before taking these medications.

Some medications are known to actually hinder successful breastfeeding; in fact the drug Fentanyl is one of these.

Pain Medications and Bonding

To put it simply, it is hard to bond with someone who is so drugged that they can't respond in a normal fashion to us. This is not to say that women who use pain medications in labor love their babies less, it is just harder to get to know them.

Babies who are exposed to pain medications during labor and birth actually spend more time away from their mothers in the first hours of life than their non-drugged counterparts. This is due to the aforementioned adverse effects caused by narcotics.

This article is not meant to be a scare tactic. It is simply meant to educate, and hopefully encourage research by pregnant women as to the medications used to relieve pain during labor and birth.

Sources
Drugs in Pregnancy and Lactation, 5th Ed
Maternal-Newborn Nursing, 7th Ed.
Medications and Mothers Milk, 12th Ed.
Varney's Midwifery, 4th Ed
www.rxlist.com
www.drugs.com
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T8N-4G0M55R-3S&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=45b0c0e06fd406bfc694e8d4aa80a0db
http://www.redorbit.com/news/health/182842/fentanyl_during_labor_may_impede_breastfeeding/
http://www.medicalnewstoday.com/articles/58772.php

Delivering baby underwater eases pain

Check out this article on waterbirth helping ease the pain of childbirth.

Utah's Most Popular Names 4/09

I just got done reading the report from the Vital Records Office here in Utah. Here are the top 10 boys and girls names for the month of April 2009.

Boys:
William
Ethan
Alexander
Samuel
Jackson
Noah
Aiden
Benjamin
Gavin
Isaac

Girls:
Elizabeth
Olivia
Brooklyn
Addison
Emily
Grace
Abigail
Lily
Ava
Emma

Study Suggests Breastfeeding Lowers Chance of MS Relapse

According to a new report issued by U.S. researchers, breastfeeding may help women with multiple sclerosis avoid relapses.

The researchers discovered that MS patients who nursed babies for two months, and did not use bottled formula, were less likely to relapse within a year of their child’s birth, than women who were not breastfeeding their children.

"It is well-known that women with MS have fewer relapses during pregnancy and a high risk of relapse in the postpartum period," said the researchers.

The report appears in the Archives of Neurology.

The women were also advised to not take their MS medication during pregnancy or while breastfeeding. The women could choose between nursing or using formula if they wished to restart their treatment immediately after giving birth.

It is recommended by the American Academy of Pediatrics that women breastfeed exclusively for the first six months of a baby's life and for nursing to continue for at least a year.

Dr. Annette Langer-Gould, of Kaiser Permanente Southern California in Pasadena, and her team studied 32 pregnant women with MS and 29 pregnant women without MS.

Almost 96 percent of the healthy women nursed their children, while 69 percent of the MS patients nursed.

The researchers found that 87 percent of the women with MS who did not nurse, or used formula within the first two months, had a relapse, while only 36 percent of those who breastfed for at least two months relapsed.

The women who nursed exclusively delayed normal menstruation, and did not see MS symptoms return.

"Studies of immunity and breastfeeding, while plentiful, are predominantly focused on breast milk content and health benefits to the infant. Little is known about maternal immunity during breastfeeding," the researchers noted.

Multiple sclerosis occurs when the immune system attacks the sheath protecting nerve cells.

The disease affects 2.5 million people worldwide, causing mild illness in some, and permanent disabilities in others.

Study Links Breastfeeding to Better Academic Performance

Newswise — Breastfeeding leads to better academic achievement in high school and an increased likelihood of attending college, according to a new study by American University professor Joseph Sabia and University of Colorado Denver professor Daniel Rees.

The study, published June 11 in the Journal of Human Capital, looked at the academic achievement of siblings—one of whom was breastfed as an infant and one of whom was not—and discovered that an additional month of breastfeeding was associated with an increase in high school GPA of 0.019 points and an increase in the probability of college attendance of 0.014.

According to the study, which used data from the National Longitudinal Study of Adolescent Health, more than one half of the estimated effect of being breastfed on high school grades and approximately one-fifth of the estimated effect on college attendance can be linked to improvements in cognitive ability and health.

“The results of our study suggest that the cognitive and health benefits of breastfeeding may lead to important long-run educational benefits for children,” said Sabia, a professor of public policy in AU’s School of Public Affairs whose research focuses on health economics. “But this is just a start. Much work remains to be done to establish a definitive causal link.”

Professors Sabia and Rees examined the breastfeeding histories and high school grades of 126 siblings from 59 families. Information on high school completion and college attendance data was obtained from 191 siblings belonging to 90 families.

By comparing the academic achievement of siblings, this study was able to account for the influence of a variety of difficult-to-measure factors such as maternal intelligence and the quality of the home environment. This is the first study to use sibling data in order to examine the effect of breastfeeding on high school completion and college attendance.

“By focusing on differences between siblings, we can rule out the possibility that family-level factors such as socioeconomic status are driving the relationship between having been breastfed and educational attainment,” said Rees, an economics professor.

Check out this article on a study done on why women choose to stay home for their births in the US.

Staying Home to Give Birth: Why Women in the United States Choose Home Birth

Here is a quick snippet...

Women who participated in the study were mostly married (91%) and white (87%). The majority (62%) had a college education. Our analysis revealed 508 separate statements about why these women chose home birth. Responses were coded and categorized into 26 common themes. The most common reasons given for wanting to birth at home were: 1) safety (n = 38); 2) avoidance of unnecessary medical interventions common in hospital births (n = 38); 3) previous negative hospital experience (n = 37); 4) more control (n = 35); and 5) comfortable, familiar environment (n = 30). Another dominant theme was women's trust in the birth process (n = 25). Women equated medical intervention with reduced safety and trusted their bodies' inherent ability to give birth without interference.

Study: Breastfeeding Moms Less Likely to Develop Risk Factors for Heart Disease and Diabetes

Study: Breastfeeding Moms Less Likely to Develop Risk Factors for Heart Disease and Diabetes
By Miranda Hitti

WebMD Health News Reviewed by Louise Chang, MD June 8, 2009 --

Women who breastfeed their babies may be less likely to develop metabolic syndrome, a cluster of risk factors that makes heart disease and diabetes more likely.

So say researchers who studied data from a study of 1,390 women who were followed for 20 years, starting when they were 18-30 years old.

Metabolic syndrome is diagnosed when people have at least three of the following traits:

Large waist size: 40 inches or larger for men; 35 inches or larger for women
High triglycerides: 150 mg/dL or higher or use of a cholesterol medicine
Low HDL "good" cholesterol: Less than 40 mg/dL for men, less than 50 mg/dL for women, or use of a cholesterol medicine
High blood pressure: 130/85 or greater, or use of a high blood pressure medicine
High fasting glucose level: 100 mg/dL or higher
None of the women had metabolic syndrome when the study began in 1985-1986. When the study ended 20 years later, 704 of the women had had at least one baby, and 120 women had been diagnosed with metabolic syndrome.

Metabolic syndrome was rarer among women who reported breastfeeding their babies. The longer they breastfed their babies during the first nine months after birth, the less likely they were to be diagnosed with metabolic syndrome during the 20-year study.

The reason for that isn't clear, but the findings held regardless of the women's preconception measurements, body mass index (BMI), lifestyle, and socioeconomic factors. The results were stronger for women who had gestational diabetes during pregnancy.

"Women who had breastfed babies for longer than one month were less likely in subsequent years to develop the metabolic syndrome," Erica Gunderson, PhD, tells WebMD in an email. "An additional new finding from this study is that breastfeeding also conferred long-term health benefits for women with a history of gestational diabetes mellitus."

Gunderson's team presented their findings on June 6 in New Orleans at the American Diabetes Association's 69th annual Scientific Sessions meeting.

The Lie of the EDD: Why Your Due Date Isn't when You Think

September 24, 2008 by Misha Safranski

We have it ingrained in our heads throughout our entire adult lives-pregnancy is 40 weeks. The "due date" we are given at that first prenatal visit is based upon that 40 weeks, and we look forward to it with great anticipation. When we are still pregnant after that magical date, we call ourselves "overdue" and the days seem to drag on like years. The problem with this belief about the 40 week EDD is that it is not based in fact. It is one of many pregnancy and childbirth myths which has wormed its way into the standard of practice over the years-something that is still believed because "that's the way it's always been done".
The folly of Naegele's Rule

The 40 week due date is based upon Naegele's Rule. This theory was originated by Harmanni Boerhaave, a botanist who in 1744 came up with a method of calculating the EDD based upon evidence in the Bible that human gestation lasts approximately 10 lunar months. The formula was publicized around 1812 by German obstetrician Franz Naegele and since has become the accepted norm for calculating the due date. There is one glaring flaw in Naegele's rule. Strictly speaking, a lunar (or synodic - from new moon to new moon) month is actually 29.53 days, which makes 10 lunar months roughly 295 days, a full 15 days longer than the 280 days gestation we've been lead to believe is average. In fact, if left alone, 50-80% of mothers will gestate beyond 40 weeks.

Variants in cycle length

Aside from the gross miscalculation of the lunar due date, there is another common problem associated with formulating a woman's EDD: most methods of calculating gestational length are based upon a 28 day cycle. Not all women have a 28 day cycle; some are longer, some are shorter, and even those with a 28 day cycle do not always ovulate right on day 14. If a woman has a cycle which is significantly longer than 28 days and the baby is forced out too soon because her due date is calculated according to her LMP (last menstrual period), this can result in a premature baby with potential health problems at birth.

The inaccuracy of ultrasound

First trimester: 7 days

14 - 20 weeks: 10 days

21 - 30 weeks: 14 days

31 - 42 weeks: 21 days

Calculating an accurate EDD

Recent research offers a more accurate method of approximating gestational length. In 1990 Mittendorf et Al. undertook a study to calculate the average length of uncomplicated human pregnancy. They found that for first time mothers (nulliparas) pregnancy lasted an average of 288 days (41 weeks 1 day). For multiparas, mothers who had previously given birth, the average gestational length was 283 days or 40 weeks 3 days. To easily calculate this EDD formula, a nullipara would take the LMP, subtract 3 months, then add 15 days. Multiparas start with LMP, subtract 3 months and add 10 days. The best way to determine an accurate due date, no matter which method you use, is to chart your cycles so that you know what day you ovulate. There are online programs available for this purpose. Complete classes on tracking your cycle are also available through the Couple to Couple League.

ACOG and postdates

One of the most vital pieces of information to know when you are expecting is that ACOG itself (American College of Obstetricians and Gynecologists) does not recommend interfering with a normal pregnancy before 42 completed weeks. This is why knowing your true conception date and EDD is very important; if you come under pressure from a care provider to deliver at a certain point, you can be armed with ACOG's official recommendations as well as your own exact due date. This can help you and your baby avoid much unnecessary trauma throughout the labor and delivery. Remember, babies can't read calendars; they come on their own time and almost always without complication when left alone to be born when they are truly ready.

Sources:

Mittendorf, R. et al., "The length of uncomplicated human gestation," OB/GYN, Vol. 75, No., 6 June, 1990, pp. 907-932.

ACOG Practice Bulletin #55: Clinical Management of Post-term Pregnancy

New Babies

This past week turned out busier than I anticipated.
All three of my June moms had their babies on or before my first June mom's due date. That never happens. All three babes and new mommies are doing great.

Baby Boy - still to be named
born 5/28/09
9 lbs

Baby Mercedes
born 6/1/09
6 lb 12 oz

Baby Jada
born 6/4/09
5 lb 5 oz

Hand Expression of Breastmilk

Check out this link for an awesome tutorial on hand expression of breastmilk. Hand expression is such a useful tool for breastfeeding mothers.

2 Babies - 4 Days

It has been a busy couple of days. Two sweet babies have made their entrances into this world. One on Friday and one last night. One boy - 9 lbs and one girl - 6 lb 12 oz. Both are still unnamed.

I am truly blessed.