Alternative Birth Services

Potty Pail Review

2011-04-11T11:24:00.002-06:00

I have cloth diapered for years. I love almost every aspect of it - the soft padded feeling of my baby's bum, the cute styles, saving money (lots of it too - I will have saved about $10,000 + by they time my little one potty trains), the convenience of never being out of diapers... What I have not loved is the toddler poop issues. Over the years, I have tried the diaper sprayer, just rolling it into the toilet, throwing it all in the washer and dunking. The diaper sprayer got the most off, but I always had over spray issues with it, no matter how much I adjusted the pressure. The other techniques weren't ideal either.
A couple months ago, I was introduced to the Potty Pail by a client who swore by it. I was intrigued. Essentially, it is a modified 5 gallon bucket that you can put on your toilet to rinse out poopy diapers. It seemed like a great solution to my poop issues, but since I was going to need the whole system (I had long since given my sprayer away), I didn't purchase it right away.
Finally, I decided to make the investment and I am so glad I did. This is by far the best cloth diapering investment I have ever made. When I have a poopy diaper, I place it in the pail and put the lid on it. When it is washing day, I rinse all the poopy diapers at once and into the washer they go. No more over spray issues because the pail prevents it.
It was well worth the investment!
Take a look!

Short Survey

2011-03-20T19:44:00.002-06:00

Please take a moment to fill out this short survey for us. We are thinking of adding a basic physical exam and well woman care to our services and are wondering if there is interest in it.

http://www.surveymonkey.com/s/F8JGV3P

2010 Stats

2011-02-13T12:17:00.002-07:00

I meant to post this last month after I did the math, but time got away from me and I forgot.
Here are our stats for 2010. It was a great year!

Boy/Girl Babies - 42.9%/57.1%

Average Age of Mother - 28

Waterbirth - 50%

Birthstool Birth - 33%

Births with Intact Perineums or Just Abrasions - 85.7%

Episiotomies - 0%

C-sections - 0%

First Time Mothers - 21.4%

Transfer of Care (prior to the onset of labor - when pregnancy is no longer considered low risk) - 7.1%

Transport (during labor) - 7.1%

Thrift Store Find Giveaway

2011-01-24T13:50:00.001-07:00

I came across a "hooter hider" style nursing cover today while at a local thrift shop. I won't use it, nor do I like the idea of them (breastfeeding is normal - no need to cover!), but I know some moms love them. Leave a comment if you would like to be entered in the drawing for it. I will even cover shipping - so you don't have to be local.

Childbirth Classes

2011-01-20T16:55:00.002-07:00

Our six week series starts this coming Wednesday night - January 26th. These are great for anyone - whether you are planning a homebirth or hospital birth.
Cost is $200 (free if you are a homebirth client of ours).

Class 1: Why natural childbirth?, Nutrition & Exercise
Class 2: Pregnancy, Belly Mapping, & Stages of Labor
Class 3: Choosing your Care Provider, Birth Choices, & Doulas
Class 4: Hospital setting, Interventions, Unexpected Situations & your Birth Plan
Class 5: Conquering Birth Fears, Relaxation, Coaching & Coping techniques
Class 6: Postpartum Period, Breastfeeding, Newborn Care, & Babywearing

Email me at alternativebirthservices@gmail.com if you are interested.

The Business of Being Born $5.49

2010-12-13T15:07:00.002-07:00

I just got a second copy for my lending library. Would make a great gift for the expectant mommy in your life. Grab one while you can - I have never seen it so cheap!

The Business of Being Born

Another Girl!

2010-12-10T09:27:00.004-07:00

Funny how babies seem to come in bunches! Birthday seemed bunched or it's all girls or all boys. We are on a girl roll right now!

Evie Quinn was born 12/8/10 one minute after Dy and I arrived. 8 lbs of pure perfections!

Welcome Tilly Grace

2010-12-10T09:15:00.004-07:00

Tilly Grace was born this past Saturday morning - 12/4/10. She weighed 7 lb 14 oz and is adored by her parents and older siblings Troy and Dasha.

Welcome Katherine

2010-11-30T21:10:00.003-07:00

We had our first Thanksgiving Day baby born this past Thursday. Little Katherine was born in the early morning weighing 7 lb 4 oz.

Solace for Mothers - Birth Trauma Support Group

2010-11-14T10:19:00.003-07:00

There is a new support group starting here for Southern Utah women that have suffered from birth trauma. This group is open to hospital birthers, birth center birthers, homebirthers - those who went natural, medicated or had a surgical delivery. The group meets the third Tuesday of every month (this coming Tuesday) at the St. George Library at 6 pm. Contact birthtraumarecovery@gmail.com if you have any questions.

Meet the Midwives

2010-10-30T12:51:00.002-06:00

Last Thursday night, Vickie Sorensen hosted a Meet the Midwives event in Cedar City. I took a carload up of women from St. George and we had a great time. Since it was such a success, I am going to host one down here in St. George.

Come join us on November 10 from 7-9 pm at Red Cliffs Inn in Washington (912 Red Cliffs Drive) to learn about your childbirth option. Local midwives, doulas, childbirth educators and other natural practitioners will be there to answer your questions. There will be food, door prizes and many raffles too.

Hope to see you there!

Did you know?

2010-10-30T09:19:00.004-06:00

Our six week childbirth preparation class ($200 value) is included in your birth package fee for all first time moms, first time natural birthing moms and VBAC mamas! Dy teaches these classes and they are awesome! New series starting soon. Contact me for more details.

Another Boy!

2010-10-05T16:07:00.002-06:00

Sweet Zaden Ray made his appearance among the lightening, thunder and rain from yesterday. It was such a beautiful backdrop for his birth. He weighed 8 lbs 8 oz and was 20.5 inches long. Another waterbirth baby! Congrats "E" family on your newest addition!

3 New Babies

2010-09-27T21:45:00.004-06:00

This past month has brought three new babies into our world. Josiah was born on 8/21, Bryant was born on 9/19 and Sophie was born on 9/25.

I haven't had a chance to get a picture with Josiah yet!

Here is Dy and I with Bryant's family. He is the first boy after three girls.

Sophie's parents drove over 1000 miles to birth with Dy and I. They wanted a natural, intervention free VBAC and was not able to do that at their hospital there. Here is a peak into Sophie's entrance!

Sophie's Birth

If you are local and interested in birth photography like this - email me at alternativebirthservices@gmail.com for contact info for Sarah Braun. She has the ability to capture priceless moments!

Utah's Most Popular Names - June 2010

2010-08-15T19:28:00.004-06:00

Girls
Olivia
Elizabeth
Abigail
Evelyn
Sophia
Ava
Ella
Addison
Emma
Samantha

Boys
William
Samuel
Ethan
Isaac
Jacob
Joshua
Luke
Mason
Carter
James

Facebook

2010-07-19T17:55:00.002-06:00

Seems like everyone is on Facebook these days. I love the network it provides. I seem to have a hard time keeping up my blog at times, but I can post of Facebook much faster. If you have an account, please "like" my business page. I post a lot of informative articles, pictures, etc.

Alternative Birth Services Facebook Page

Postpartum Visit

2010-07-04T18:08:00.006-06:00

As promised here is a picture of Dy and I with Lil' Miss Avangeline at her one day postpartum visit.

Postpartum care is very important to me as a midwife. I typically see my clients at 1 day, 3 days, 1 week, 3 weeks and 6 weeks postpartum. Sometimes more, if needed. The 1 day and 3 days are always back in their home. Depending on how mom is feeling, the 1 week can be as well.

During postpartum visits, we check both mom and baby's vitals, make sure breastfeeding is going well, that mom is feeling good emotionally and best of all, get to snuggle with the new little one.

I just love the time I am able to spend with the new moms and babies.

Treating tongue tie could help more babies breastfeed

2010-07-01T13:43:00.002-06:00

This study just came out and confirms what most of us who are breastfeeding activists already knew. Clipping a tongue tied baby does help the breastfeeding relationship!

Two of my babies have been born tongue tied. My first was very severe and it prevented her from being able to nurse and get milk. We were in CA at the time and had a hard time finding a medical professional who believed that frenotomies were beneficial. Finally at a week old, we were able to get hers done. It was a short, simple procedure and she was able to nurse immediately afterward and my pain was greatly diminished.

My last baby was also born tongue tied. His was not as severe as my first's, but after two weeks of trying to ignore the pain and hope that his frenulum would stretch, we had his clipped as well. Once again, nursing was no longer painful.

Tongue ties tend to run in families (both my dad was and my husband is) and are more common among males.

Checking for tongue tie is one of the many things we check during the newborn exam, so if it is a problem, it can be taken care of quickly.

Another Birthday!

2010-06-30T12:01:00.002-06:00

Avangeline Dixie joined the world this morning at 3:08 am. Her mom and dad labored for many hours, but stuck through it all to birth her peacefully into her daddy's waiting hands. She was 7 lbs on the dot and 18 inches long.
Dy and I didn't get a picture with the new little one. We were all exhausted after a long day and night up, but will get one at her 1 day postpartum visit.

Cloth Diaper Loan Program

2010-06-27T09:33:00.002-06:00

Over the years, I have collected many books, videos, baby carriers, birth balls, nursing pillows and more that I can loan out to clients to try out. I love to be able to provide this to them to allow them to try out things before buying.
Camden outgrew his newborn size cloth diapers months ago. I was planning on selling them, but haven't gotten around to doing it. I have decided that I am going to add these to my Resource Center and loan them out to clients. I am going to ask for a $10 donation so that I can continue to add and replenish the collection.
If you are a current client, let me know if you are interested and I will reserve them for you for when your baby is due and you can keep them up until your 6 week postpartum visit.

Interested in becoming a doula?

2010-06-27T09:31:00.003-06:00

There will be a DONA Doula training here in St. George August 26-28 (Thursday
5pm-10pm, Friday and Saturday 8am-6pm). The cost is $350 which includes syllabus, meals and snacks. Contact Melissa Chappell at melissa@rawmelissa.com if you are interested. She accepts credit cards and payment plans for those that need it.

An Eventful Day!

2010-06-13T22:07:00.003-06:00

Today Dy and I helped welcome Jace Alexander to the world. It was such an honor to witness his parents labor and birth together. Jace weighs 9 lbs and is 21 1/2 inches long. I love these sweet chubby babies!
Not only did we catch a baby today, but we also caught a chicken! While giving the parents-to-be a chance to labor alone, we left their home and went to see another client. On the way there, we stopped at my church to nurse Cam. In the parking lot, there was a loose chicken (hen? rooster? we aren't sure...). Since it is in an industrial area and didn't have anywhere to go, Dy decided to catch it and bring it home. Twenty minutes later and a lot of running around and this guy was caught!

Why Choose Cloth Diapers?

2010-06-09T09:20:00.003-06:00

I came across this great article on the benefits of cloth diapering earlier today. I have used cloth diapers exclusively for my last four children and we absolutely love it! Cloth diapering is so much different and easier than what was available when we were children. And the savings?!?! I estimate that we have saved $8,000 on diapers. Wow!
Right now, our stash is mostly pocket diapers like Bum Genius, Fuzzi Bunz and Tweedle Bugs. These are not the cheapest way to cloth diaper, but I love how I can adjust the absorbancy level and how user friendly it is.
For locals, I have a bunch of sample diapers for you to come and take a look at to see your options, if you are interested. Just let me know!
Check out Diaper Pin and New To Cloth Diapers for more info.

New Waterbirth Tub Coming!!!

2010-05-31T08:21:00.002-06:00

I am so excited to announce that starting in July, I will be able to offer the Aquaborn Professional Waterbirth Tub to my clients - at no additional cost to them (except the cost of a disposable liner). I have wanted to be able to offer the option of waterbirth to all my clients for a long time, but it was cost inhibitive. I worked out a barter agreement with one of my clients and now I will have one. I just love doing trade! This pool is the deepest inflatable birth tub on the market and has 6 different handles to allow complete choice and freedom of movement. It also has a lid that helps keep the heat in and debris out!
Laboring and giving birth in water has been shown to reduce pain for mom and be more gentle for baby. Check out Waterbirth International for more info on waterbirth.

Business of Being Born - only $7.99

2010-05-26T14:47:00.003-06:00

Amazon is selling The Business of Being Born for only $7.99. This is a must see for all pregnant couples! I have a copy in my loaner library and am thinking of getting another because it is always checked out. In case, you want a copy for yourself, here is the link - The Business of Being Born

Another Beautiful Birth

2010-05-26T14:44:00.003-06:00

Dy and I had the privilege of attending another client's birth yesterday morning. Sweet little guy was born at 2:25 am on 5/25/10. Pretty neat birthday, huh?
Congrats C & A and thanks for allowing us to be present for such a miracle!

New Babies

2010-05-21T11:14:00.004-06:00

Sorry I have neglected this blog...lots has gone on in the past months.
The biggest thing in my life was the arrival of our fifth baby - Camden Lee made his appearance on 3/9/10 weighing 8 lb 12 oz. He has been such an amazing addition to our family. We couldn't be more in love. Here is a picture at birth and a current one. Isn't he sweet?

I took 10 weeks off of births after Camden was born and really enjoyed the time. Last Saturday (my husband and my 11th anniversary), my "maternity leave" was over. Baby Lilah made her appearance weighing 9 lbs 8 oz! She is just beautiful. Welcome baby Lilah!
We have a busy summer with lots of babies coming. I am so excited to be able to share these moments with my precious clients!

Research

2010-03-19T09:46:00.001-06:00

US Study Highlights Homebirth Safety

Chalk up another win for the safety of homebirth. A study of low-risk births in select US birth facilities published in the January 2010 issue of the American Journal of Obstetrics and Gynecology concludes that homebirths are "associated with a number of less frequent adverse perinatal outcomes" when compared to births that occurred in a hospital facility.

The study, which examined 745,690 low-risk births that occurred in various US facilities during the year 2006, compared the outcomes according to birth site: 97% of the births were in a hospital; 0.6% occurred in a birth center; and 0.9% were at home.

Homebirth babies in this study experienced more frequent 5-minute Apgar scores of less than 7 and researchers noted that "compared to hospital deliveries, home and birthing center deliveries were associated with more frequent prolonged and precipitous labors."

Researchers concluded that the home and birthing center births "were associated with less frequent chorioamnionitis, fetal intolerance of labor, meconium staining, assisted ventilation, neonatal intensive care unit admission, and [low] birth weight."

— Wax JR, Pinette MG, Cartin A, et al. "Maternal and newborn morbidity by birth facility among selected United States 2006 low-risk births." Am J Obstet Gynecol 2010 202:152.e1-5

Lactation Cookies

2010-02-05T11:09:00.001-07:00

A yummy way to help boost your milk supply...

Ingredients

1 C butter
1 C sugar
1 C brown sugar
4 T water
2 T flaxseed meal (no subs)
2 Lg eggs
1 t vanilla
2 C flour
1 t baking soda
1 t salt
3 C Thick cut oats
1 C Chocolate chips
2 T to 4T Brewers Yeast (no substitutions)

Preparation

Preheat oven at 375.

Mix 2 T of flaxseed meal and water, set aside 3-5 minutes.
Cream butter and sugar.
Add eggs or vegan substitutes.
Stir flaxseed mix into butter mix and add vanilla.
Beat until well blended.
Sift: dry ingredients, except oats and choc chips.
Add butter mix to dry ingredients.
Stir in the oats and then the choc chips.
Drop on parchment paper on baking sheet.
Bake 8-12 minutes

Antidepressants May Complicate Breast-Feeding

2010-01-29T13:59:00.002-07:00

Antidepressant May Complicate Breast-Feeding

Babies who are Breastfed as Infants Make Better Teens

2010-01-29T13:57:00.000-07:00

After conducting an extensive study, which has managed to reveal that there is a link between breastfeeding and a child's mental health, researchers are now urging mothers to breastfeed their new-born, at least till the age of 6 months.

The large-scale study followed about 3,000 women for a long period of 14 years, across Western Australia. The researchers tracked the development of children of these women from the time they were infants to when they hit early adolescence.

Out of all women participating in the study, some had breastfed for varying lengths of time, and some had not done so at all. Analysis of the data thus collected helped researchers reach the hypothesis of the study.

"What we found was that for each additional month that a child was breastfed [the] behavior in teenagers improved. We can say clearly that breastfeeding for six months or longer is positively associated with mental health and wellbeing in children and adolescents", said Sven Silburn from the Menzies School of Health Research, one of the researchers.

Details of the study have been study published in the Journal of Paediatrics.

Hypnobabies Homestudy Course Drawing

2010-01-25T16:22:00.001-07:00

Check out this blog - she is hosting a give away for the Hypnobabies Homestudy Course. I have only heard great things about this course. Hurry up and enter!

Pot smoking during pregnancy may stunt fetal growth

2010-01-24T21:44:00.000-07:00

NEW YORK (Reuters Health) - Women who smoke marijuana during pregnancy may impair their baby's growth and development in the womb, a new study suggests.

Poor fetal growth and reduced head circumference at birth are linked to an increased risk of problems with thinking, memory and behavior in childhood. Cigarette smoking during pregnancy is known to impair fetal growth, but studies on the potential effects of marijuana have been inconclusive.

For the new study, researchers in the Netherlands followed more than 7,000 pregnant women, 3 percent of whom acknowledged smoking marijuana at least during early pregnancy. They found that babies born to marijuana users tended to weigh less and have smaller heads than other infants.

What's more, the study found, the longer a woman had used marijuana during pregnancy, the stronger the impact on birth size -- suggesting that the drug itself was to blame.

And while most marijuana users in the study also smoked cigarettes, the drug appeared to have effects over and above those of tobacco. In fact, marijuana showed stronger effects on birth size than tobacco, the investigators report in the Journal of the American Academy of Child and Adolescent Psychiatry.

The findings suggest that marijuana use, even restricted to early pregnancy, may have irreversible effects on fetal growth, write the researchers, led by Hannan El Marroun of Erasmus University Medical Center in Rotterdam.

To prevent this, they add, women who smoke marijuana should quit before becoming pregnant.

The study included almost 7,500 pregnant women who were surveyed on their use of alcohol, tobacco and drugs, and had ultrasounds to chart fetal growth during the first, second and third trimesters.

Overall, 214 women said they had used marijuana before and during early pregnancy; 81 percent quit after learning they were pregnant, but 41 women continued to smoke marijuana throughout pregnancy.

The researchers found that, on average, marijuana users gave birth to smaller babies, particularly those who had used throughout pregnancy.

Women who had smoked only during early pregnancy had babies who were

156 grams -- about 5.5 ounces -- lighter than infants born to women who had not used the drug. Women who had continued to smoke past early pregnancy had babies who were 277 grams, or nearly 10 ounces, smaller.

Based on ultrasound, marijuana use only in early pregnancy impaired fetal growth by about 11 grams per week, while use throughout pregnancy slowed fetal growth by roughly 14 grams per week. That compared with a deficit of 4 grams per week with tobacco use, the researchers found.

Similar patterns were seen when the researchers looked at fetal head circumference.

According to El Marroun's team, mothers' marijuana use could stunt fetal growth for several reasons. Like tobacco smoking, it may deprive the fetus of oxygen. It is also possible that the byproducts of marijuana directly affect the developing nervous and hormonal systems of the fetus.

Finally, the researchers note, pregnant women who use marijuana may have other factors in their lives - such as a less-than-healthy diet or chronic stress -- that could contribute to poor fetal growth.

SOURCE: Journal of the American Academy of Child and Adolescent Psychiatry, December 2009.

Birth Drugs Impair Breastfeeding

2010-01-24T12:45:00.001-07:00

Sunday, January 24, 2010 by: David Gutierrez

(NaturalNews) Drugs commonly given during hospital labor may impair a woman's ability to breastfeed, according to a study conducted by researchers from Swansea University and published in the journal BJOG.

"A lot of women are not given enough information about the medications that might be given to them during childbirth, and women at low risk of bleeding may not need to take these drugs," said Rosemary Dodds of the National (British) Childbirth Trust, who was not involved in the study. "It is important that women understand the risks and can give their informed consent before they go into labor."

Researchers examined data from 45,000 births in South Wales, finding that women who were given either oxytocin (also marketed as pitocin and syntocinon) or ergometrine (also known as ergonovine) were significantly less likely to begin breastfeeding within 48 hours of birth than women who were not given the drugs.

Oxytocin and ergometrine are regularly given to women in order to reduce their risk of postpartum hemorrhaging, even when the risk is already low. Oxytocin is also used in labor in order to stimulate contractions, but this use was not examined in the current study.

Among women who had not been given either drug following the delivery of their child, 65.5 percent began breastfeeding within 48 hours. Among women who had received oxytocin, only 59.1 percent did so, while only 54.6 percent of women who received both drugs began breastfeeding within 2 days.

The researchers suggested that the anti-bleeding drugs could interfere with milk production, thus making breastfeeding more difficult and causing new mothers to give up in frustration.

The study also found that high doses of painkillers known as epidurals also reduce a woman's chance of breastfeeding. Prior studies have also found this connection.

Breastfeeding has been linked to a number of significant lifelong health benefits for both mothers and infants.

Sources for this story include: news.bbc.co.uk.

No need for pregnant women to fast during labor

2010-01-23T21:27:00.002-07:00

This one seems like an obvious one, but I guess it takes a medical review to confirm it. At home, we encourage you to eat as you desire. How can you expect to run the marathon of labor, if you are not well nourished?

NEW YORK (Reuters Health) -

There is no reason why pregnant women at low risk for complications during delivery should be denied fluids and food during labor, a new Cochrane research review concludes.

"Women should be free to eat and drink in labor, or not, as they wish," the authors of the review wrote in the Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research.

Dr. Jennifer Milosavljevic, a specialist in obstetrics and gynecology at Henry Ford Health System, Detroit, who was not involved in the Cochrane Review, agrees that pregnant women should be allowed to eat and/or drink during labor.

"In my experience," she told Reuters Health in an email, "most pregnant patients at Henry Ford are placed on a clear liquid diet during labor which includes water, apple juice, cranberry juice, broth, and jello. If a patient is brought in for a prolonged induction of labor, she will typically be permitted to eat a regular diet and order anything off the menu in between different induction modalities."

Milosavlievic has "not seen any adverse outcomes by allowing women the option of liquids and/or a regular diet in labor."

Standard hospital policy for many decades has been to allow only tiny sips of water or ice chips for pregnant women in labor if they were thirsty. Why? It was feared, and some studies in the 1940s showed, that if a woman needed to undergo general anesthesia for a cesarean delivery, she might inhale regurgitated liquids or food particles that could lead to pneumonia and other lung damage.

But anesthesia practices have changed and improved since the 1940s, with more use of regional anesthesia and safer general anesthesia.

And recently, attitudes on food and drink during labor have begun to relax. Last September, the American College of Obstetricians and Gynecologists (ACOG) released a "Committee Opinion" advising doctors that women with a normal, uncomplicated labor may drink modest amounts of clear liquids such as water, fruit juice without pulp, carbonated beverages, clear tea, black coffee, and sports drinks. They fell short of saying food was okay, however, advising that women should avoid fluids with solid particles, such as soup.

"As for the continued restriction on food, the reality is that eating is the last thing most women are going to want to do since nausea and vomiting during labor is quite common," Dr. William H. Barth, Jr., chair of ACOGs Committee on Obstetric Practice, noted in a written statement at the time.

But based on the evidence, Mandisa Singata of the East London Hospital Complex in East London, South Africa, an author on the new Cochrane Review, says "women should be able to make their own decisions about whether they want to eat or drink during labor, or not."

Singata and colleagues systematically reviewed five studies involving more than 3100 pregnant that looked at the evidence for restricting food and drink in women who were considered unlikely to need anesthesia. One study looked at complete restriction versus giving women the freedom to eat and drink at will; two studies looked at water only versus giving women specific fluids and foods and two studies looked at water only versus giving women carbohydrate drinks.

The evidence showed no benefits or harms of restricting foods and fluids during labor in women at low risk of needing anesthesia.

Singata and colleagues acknowledge that many women may not feel like eating or drinking during labor. However, research has shown that some women find the food and drink restriction unpleasant. Poor nutritional balance may be also associated with longer and more painful labors. Drinking clear liquids in limited quantities has been found to bring comfort to women in labor and does not increase labor complications.

The researchers emphasize that they did not find any studies that assessed the risks of eating and drinking for women with a higher risk of needing anesthesia and so further research is need before specific recommendations can be made for this group.

SOURCE: Cochrane Library, 2010.

Why Rearfacing is Better

2010-01-22T11:42:00.004-07:00

Just came across this blog on extended rearfacing - I love how all the info is in this one place.

We keep our kids rearfacing until they are around 3 - because it is all they know, there are no arguments about it. If they want to ride in the car, which is non negotiable, they must be properly restrained.

Study finds breast milk has longer shelf life than previously thought

2010-01-22T07:47:00.001-07:00

January 2, 2010 By Delthia Ricks

Breast milk can be safely stored in a refrigerator for four days without the threat of bacterial contamination or loss of nutritional value, Long Island scientists have found in a groundbreaking study.

The small research project at Schneider Children's Hospital of the North Shore-Long Island Jewish Health System essentially asked a question that had not been asked before: Can breast milk remain potent and germ-free for four days?

Prior to the analysis, which involved 36 new mothers whose premature babies were being treated in the neonatal intensive care unit, doctors at most hospitals would not allow the milk to remain in storage for more than 72 hours.

Dr. Richard Schanler, chief of neonatal medicine at Schneider Children's Hospital, said there were even stricter rules at his institution.

"We didn't like to store it longer than 48 hours and that prompted us to do this study, and we found there really weren't many changes (in nutritional integrity or bacterial presence) up to 96 hours," he said.

He hopes the discovery will lead to a paradigm shift for hospitals everywhere.

Human milk management and storage are huge concerns in neonatal intensive care units, Schanler said. Previous studies have addressed these issues, but they mostly focused on the amount of bacteria in stored milk.

Although the new research focused on hospital milk storage, Schanler said it also is relevant for working moms who must balance infant feedings and a job away from home.

The research, which suggests maintaining human milk in glass containers or plastic ones free of bisphenol A (BPA), is reported in the January issue of The Journal of Pediatrics. Schanler and his colleagues recommend a temperature of 39 degrees Fahrenheit, or cooler, and placing milk in the rear of the refrigerator.

He said the analysis was designed to answer many of the pressing questions about milk storage and usage in neonatal intensive care units where premature infants are treated. New moms must routinely pump milk for feedings and the milk is refrigerated.

Freezing has been an additional approach. But the freezing of breast milk causes the destruction of key infection-fighting cells that can protect the milk from bacterial colonization, Schanler said. There also are nutritional losses when breast milk is frozen.

"Certain immune components, proteins and enzymes are decreased in frozen milk," Schanler said.

The Human Milk Banking Association of North America has suggested that human milk remains viable refrigerated for up to eight days, but that long-term storage raises serious health questions in hospitals.

Schanler and Dr. Meredith Slutzah, also of Schneider Children's Hospital, tackled the storage issue because there were questions beyond that of bacteria, such as human milk's nutritional value.

In the study, scientists from Schneider's and Yeshiva University's Albert Einstein College of Medicine required the mothers to collect milk with a breast pump. Researchers stored the milk at 39 degrees Fahrenheit and tested it after 24, 48, 72 and 96 hours. Even after the 96 hours, there was virtually no bacterial contamination, Schanler said, because the other components in the milk remained viable.

Elective cesarean sections are too risky, WHO study says

2010-01-21T18:52:00.000-07:00

By Katherine Harmon

Despite medical advances and increasing access to improved obstetric care across the globe, surgical childbirths are still more risky for both mother and baby, according to an ongoing international survey by the World Health Organization (WHO).

A new report from the survey, which was published online today in the medical journal The Lancet, found that in Asia—in both developed and developing nations—cesarean section births only reduced risks of major complications for mother and child if they were medically recommended. Elected surgical deliveries, on the other hand, put both at greater risk.

"Cesarean section should be done only when there is a medical indication to improve the outcome for the mother or the baby," the authors of the report concluded. Common reasons for a recommendation for cesarean delivery included a previous cesarean section, cephalopelvic disproportion (when the baby's head cannot fit through the mother's pelvic opening) and fetal distress.

In the nine countries studied (Cambodia, China, India, Japan, Nepal, the Philippines, Sri Lanka, Thailand and Vietnam), more than a quarter of the 107,950 births analyzed (27.3 percent) were C-sections, and in China, which had the highest rate of operations, nearly half (46.2 percent) of the births in the survey were cesarean. With these surgeries comes increased risk of maternal death, infant death, admission into an intensive care unit, blood transfusion, hysterectomy or internal iliac artery ligation (to control bleeding in the pelvis) compared to spontaneous vaginal delivery, according to the report.

But these risks have not necessarily been absorbed into popular, or even medical culture. The rates of cesarean section procedures are on the rise in many countries across the globe, the authors report, and in some countries they "have reached epidemic proportions." Among the nations studied, China had the highest rate of cesarean sections that were performed without medical indication—11.7 percent; the overall rate for the facilities studied had a rate of 1.9 percent.

Most cesarean sections (15.8 percent of births) were begun during labor, as opposed to before it starts. But these later procedures—both elected (0.5 percent) and medically required (15.3 percent)—also carry the most risks for adverse outcomes, the authors found.

In a commentary accompanying the report, Yap-Seng Chong of the National University of Medicine in Singapore and Kenneth Y C Kwek of the KK Women's and Children's Hospital also in Singapore call the results "surprising and chilling." The findings, they say "should help us to prioritize our strategies to reduce unnecessary interventions in childbirth," they wrote. "There is little wrong with medical interventions when indicated, but for those who are still inclined to consider caesarean delivery a harmless option, they need to take a cold hard look at the evidence against unnecessary cesarean section."

The investigators were able to analyze some 96 percent of the births reported in the 122 hospitals that participated in the survey over two to three months between 2007 and 2008. Facilities were located in the capital city of each country and two randomly chosen regions. To qualify for the survey, hospitals had to be delivering at least 1,000 babies a year and performing cesarean surgeries, so as the authors noted, "the results therefore cannot be generalized to smaller facilities" or to the countries overall.

Despite the increased risks associated with cesarean deliveries, no mothers or babies in the study died after an elected cesarean before hospital release. The most dangerous form of childbirth proved to be vaginal operative delivery, which includes using forceps or a vacuum to assist in delivery and is more rare, occurring in just 3.2 percent of the births analyzed.

The findings confirm a previous WHO report published in 2006 in The Lancet, analyzing the rates and safety of various childbirth approaches in Latin America, where the investigators found that "increasing rates of cesarean section do not necessarily lead to improved outcomes and could be associated with harm." Taking the two reports together, the authors concluded, lends "strong multiregional support for the recommendation of avoiding unnecessary cesarean sections."

Surgical childbirth also requires more resources than a natural vaginal delivery, the authors note. Especially in countries where money, medical practitioners or proper equipment is more limited, unnecessary cesarean sections can drain resources away from those cases in which it can improve the chances of a healthy mother and baby.

http://www.scientificamerican.com/blog/post.cfm?id=elective-cesarean-sections-are-too-2010-01-11

Free EPT at Walmart

2010-01-21T18:45:00.001-07:00

$5/1 EPT Pregnancy Tests = Free at Walmart

The $5 off any e.p.t. Pregnancy Test printable (IE) or printable (FF) is available again. You should be able to score free pregnancy tests at Walmart with this coupon.

Common antibiotics tied to birth defects

2010-01-03T13:40:00.000-07:00

Study: Drugs to treat urinary infections could cause heart, brain problems

Her Survival Was a “Christmas Miracle,” but the Disaster Was Man-Made

2010-01-03T13:32:00.000-07:00

Her Survival Was a “Christmas Miracle,” but the Disaster Was Man-Made

Mass Media Childbirth vs The Real Thing

2010-01-03T13:30:00.001-07:00

Hospital Scrubs are a Germy, Deadly Mess

2009-12-30T12:40:00.002-07:00

Seems like common sense, but obviously this is a huge problem.

An excerpt from the article -
"The problem is that some medical personnel wear the same unlaundered uniforms to work day after day. They start their shift already carrying germs such as C.diff, drug-resistant enterococcus or staphylococcus. Doctors' lab coats are probably the dirtiest. At the University of Maryland, 65% of medical personnel confess they change their lab coat less than once a week, though they know it's contaminated. Fifteen percent admit they change it less than once a month. Superbugs such as staph can live on these polyester coats for up to 56 days."

I couldn't imagine wearing the same thing to multiple births. When I get called to a birth, I take a quick shower, throw on clean birth clothes and then head out. As soon as I get home - I strip down, clothes go straight in the washer and I hop back in the shower.

Read the whole article here.

Breastfeeding is Budget Friendly

2009-12-28T20:09:00.001-07:00

Breastfeeding is Budget Friendly

Seems like a no brainer Ü

Beautiful Waterbirth Montage

2009-12-28T19:58:00.001-07:00

Just came across this on another midwife's blog and thought it was too beautiful not to share! I love how hands off this midwife is and allows the birth to be mom's and the baby's.

A Midwife's Perspective on Money

2009-12-18T14:50:00.003-07:00

I have read this blog for quite some time now and just came across this new post today. She has put into words what most midwives deal with on a regular basis. I appreciate her frankness and honesty.

Belly Hugger

2009-12-15T10:46:00.001-07:00

Belly Hugger

The Belly Hugger is now selling their $18 Belly Huggers for only $5.50 a piece! While stock lasts, colors/sizes limited, so get yours now!

Breastfeeding lowers diabetes risk in new moms

2009-12-13T10:20:00.001-07:00

A new study finds breastfeeding can lower the mother's risk of developing metabolic syndrome in the long run.

According to the study published in Diabetes, breastfeeding reduces the risk of metabolic syndrome — a cluster of risk factors such as elevated blood pressure, insulin resistance, and abdominal obesity linked to diabetes and heart disease — in the new mother.

Women who breastfeed tend to adopt a healthier lifestyle than new mothers who do not breastfeed and therefore lose the weight gained during pregnancy faster.

Breastfeeding for longer than nine months lowers the risk of developing metabolic syndrome by 56 percent. Each year of breastfeeding is associated with a 15 percent reduction in diabetes risk within the next 15 years.

As for women who have developed gestational diabetes during one or more pregnancies, lactation is believed to lower the risk of metabolic syndrome by 86 percent.

Scientists concluded that nursing for as little as a month or two is effective, adding that the longer a woman breastfeeds the higher the protection level will become.

Insect repellent use in early pregnancy linked to birth defect risk

2009-12-13T10:17:00.001-07:00

The use of insect repellent during the first three months of pregnancy may boost the risk of the penile birth defect hypospadias, suggests research published online today.

The condition is thought to affect around one to two male births in every 500. But despite its prevalence, relatively little is known about the environmental risk factors for hypospadias, although it has been variously associated with low birthweight, a history of stillbirth, older mothers, poor fertility and smoking, among other things.

The researchers base their findings on 471 babies with the condition, who were born between January 1997 and September 1998 and referred to surgeons in the South East of England.

The researchers also included 490 randomly selected babies born during the same period to act as a comparison group.

The mothers of all the babies were quizzed about their lifestyles and certain environmental factors, including the use of insect repellents and biocides, such as pesticides or weedkillers, during pregnancy.

Exposure was scored from zero to eight to create a total biocide score, based on adding up positive responses to questions, such as living within a mile of a field used for agriculture; use of garden pesticides; use of fly strips or sprays/ant powder/rat poison; use of insect spray on plants; flea treatment of pets; and use of nit shampoo.

Individual biocides did not seem to be associated with an increased risk of hypospadias, but use of several biocides was associated with a 73% increased risk.

After taking account of factors likely to influence the results, the authors found that use of insect repellents during the first three months of pregnancy was associated with an 81% increased risk of hypospadias.

Insect repellents can contain N,N-diethyl-m-toluamide also known as DEET, permethrin, or other products. High doses of DEET are throught to be harmful, and the chemical can cross the placenta and enter the bloodstream of the developing fetus, say the authors.

But they caution that their study did not look specifically at the type, content, and frequency of use of insect repellents, and this should be investigated further before firm conclusions can be drawn.

The research is published in Occupational and Environmental Medicine (Online First Occup Environ Med 2009; doi 10.1136/oem.2009.047373)

The H1N1 Primer for Pregnant Women

2009-12-13T10:02:00.002-07:00

I haven't personally seen a case of H1N1 with any of my clients and hoping it stays that way. I have encouraged good nutrition, sleep, elderberry, vit d3 and vit c in hopes to keep it away, if symptoms are showing. So far so good.

Read here for more detailed information on H1N1, the vaccine and preventative measures.

Quote

2009-12-13T09:59:00.002-07:00

I just came across this quote in a Midwifery Today Newsletter. I think it states so eloquently who I aim to be for my clients at their births.

"You are a midwife. You are assisting at someone else's birth. Do good without show or fuss. Facilitate what is happening rather than what you think ought to be happening. If you must, take the lead. Lead so that the mother is helped, yet still free and in charge. When the babe is born the mother will rightly say, 'We did it ourselves.'"

— Lao Tzu, in Tao Te Ching

Problems and Hazards of Induction of Labor

2009-11-24T17:05:00.002-07:00

Check out this great article on the problems and hazards of induction of labor.

Great Quote

2009-11-20T20:53:00.000-07:00

"By medicalizing birth, that is separating the woman from her own environment and surrounding her with strange people using strange machines to do strange things to her, the woman's state of mind and body are so altered that her way of carrying through this intimate act must also be altered."
~Marsden Wagner~

Community Service Project

2009-11-20T14:32:00.002-07:00

Bring your kids for a free child identification kit including: fingerprints, height and weight, photo and DNA samples tomorrow, Saturday, November 21, 10 am - 2 pm in front of the Bloomington Walmart.

I will be bringing my bunch!

Birth Defects Associated with Use of Antibiotics During Pregnancy

2009-11-20T14:20:00.000-07:00

Sulfonamides and nitrofurantoins were associated with birth defects.

Antibacterial drugs are among the most commonly used medications during pregnancy. Investigators analyzed data from a national birth defects study to compare antibiotic use in 13,155 mothers of infants with at least one major birth defect and 4941 randomly selected mothers of infants without birth defects from the same geographic region and born during the same period (1997–2003). Antibiotic use was determined by telephone interview 6 weeks to 2 years after the pregnancy. Exposure to antibiotics was defined as reported use during the month before the estimated date of conception through the end of the first trimester; 14% of cases and 13% of controls used antibiotics during this interval.

Sulfonamides were associated with six major birth defects, including anencephaly (odds ratio, 3.4) and hypoplastic left heart syndrome (OR, 3.2). Nitrofurantoins were associated with four birth defects (including hypoplastic left heart syndrome; OR, 4.2), and erythromycins were associated with two defects. Penicillins, cephalosporins, and quinolones each were associated with one defect.

Comment: The authors note the limitations of this retrospective study, including the major limitation that causality cannot be determined. However, the results are reassuring. Penicillins, erythromycins, and cephalosporins appear to be safe. Sulfonamides and nitrofurantoins appear to be associated with several birth defects and should be avoided if possible. Quinolones, used infrequently by women in this study, are not recommended for use during pregnancy.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine November 18, 2009

Citation(s):

Crider KS et al. Antibacterial medication use during pregnancy and risk of birth defects: National Birth Defects Prevention Study. Arch Pediatr Adolesc Med 2009 Nov; 163:978.

Original article (Subscription may be required)
Medline abstract (Free)

Common antibiotics tied to birth defects

2009-11-18T17:49:00.000-07:00

Study: Drugs to treat urinary infections could cause heart, brain problems

Another Beautiful Montage

2009-11-18T16:10:00.003-07:00

Almost a month ago (wow, where has time gone?), my apprentice and good friend, Dy gave birth to her fourth baby. I was honored to be present at this amazing event. She has graciously allowed me to share it here. Enjoy - and maybe get some tissues ready!

Make an on-line slide show at www.OneTrueMedia.com

New Website

2009-11-17T09:32:00.002-07:00

After more than 2 years of trying to get my website up and running, it is finally done (well, for know). I have struggled with it and then I would let it go because of the frustration, but I am proud to say I figured it out. Without further ado...

Alternative Birth Services

Check it out - I would love input. Suggestions on things that need to be changed, etc...

Beautiful Birth Montage

2009-11-11T11:36:00.003-07:00

I had the honor of attending the birth of a client and good friend last week. Labor was harder and longer than anticipated, but mom was so committed and her husband was a rock for her. It was a beautiful event. She has granted me permission to share her birth montage here. Enjoy!

Make an on-line slide show at www.OneTrueMedia.com

Should pregnant women get H1N1 vaccine?

2009-10-27T12:01:00.000-06:00

By LANDON HALL

Dr. Bob Sears has tried to avoid controversy during the swine flu outbreak. But his recommendation that pregnant women not get the H1N1 vaccine departs from the rest of the medical community.

The federal government and most physicians have spoken in unison on the issue, and they advise pregnant women to receive the injected form of the vaccine because of the virulence of the H1N1 strain and the vulnerability of a pregnant woman's immune system. Two Orange County pregnant women are among 28 who have died nationally since the pandemic began in April. But Sears says the vaccine has never been sufficiently tested for safety on this demographic.

"As a doctor, we swear an oath to 'First, do no harm.' So I have a hard time recommending a treatment that doesn't show it causes no harm," he said. "It's not just the H1N1 vaccine that's not been tested. The regular flu vaccine has not been tested in pregnant women, either, to show that it's safe in babies. That kind of boggles my mind, because the regular flu vaccine has been around for years, and there have been plenty of opportunities for the companies to do some safety testing on them so pregnant women can feel more comfortable about them."

Dr. Felice L. Gersh, an OB/GYN at Women's Medical Group of Irvine who has been practicing for 28 years, echoes the assessment of governmental health agencies, who say the vaccine is safe and are mounting a campaign to urge pregnant women to get the H1N1 and seasonal-flu vaccines. Gersh said Sears and other doctors skeptical of the H1N1 vaccine are "going against the weight of scientific evidence."

"Sometimes in medicine, as in life, you have to go with your best guess using available data," she said. "Everything can't be signed, sealed and guaranteed. This is a judgment call. And all the data is in favor of getting the vaccine."

Christina Chambers, an epidemiologist and associate professor in the Department of Pediatrics at UC San Diego, said Sears' views "don't hold water." She added that history has shown that pregnant women are at greater risk of hospitalization and death during flu pandemics.

"One day you could be feeling fatigued and achy, the next day you could be in a coma," she said.

Because he's part of a nationally trusted brand, Sears' opinions carry great influence. His pediatrician father, Bill, and registered-nurse mother, Ruth, wrote a series of books ("The Birth Book," "The Baby Book") that have become indispensible references for expectant and new parents. Sears, his parents and his brother Jim operate out of their seaside practice in Capistrano Beach.

"Dr. Bob," as patients and staffers call him, published his first solo book, "The Vaccine Book: Making the Right Decision for Your Child," in 2007. His inclusion of an "alternate vaccination schedule" brought him criticism from some fellow doctors who see his views as anti-vaccine, an accusation he hotly denies. But in recent postings about H1N1 on the family Web site, AskDrSears.com, his neutrality might have brought more questions than reassurance.

On July 30, he was undecided about the upcoming mass-vaccination effort. But he told readers that "what you can fret about is whether or not the government will make the vaccine mandatory." The first commenter wrote: "Way to fan the hysteria fire there Dr. Bob."

The Centers for Disease Control and Prevention has stated that the H1N1 vaccine is made the same way as the seasonal-flu vaccine, which "millions of Americans have received" over the years. Sears says that's a "completely unscientific statement." He points out, correctly, that no widespread clinical trial of either vaccine has been conducted on pregnant women. The 19-page product insert issued by Sanofi Pasteur, the largest of the five companies that supply the U.S. with H1N1 vaccines, acknowledges that it's "not known whether these vaccines can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity." It adds that the vaccine "should be given to a pregnant woman only if clearly needed."

Chambers, who runs a support center out of UCSD to answer questions about H1N1 (in California, 1-800-532-3749), is gathering information for a future vaccine study. She said symptoms of H1N1 include fever, fatigue, muscle aches, headaches, runny nose, cough and sometimes vomiting and diarrhea. She urges women to get vaccinated, and if they feel symptoms to seek medical attention. Antiviral medications like Tamiflu can be prescribed within 48 hours of the symptoms arising.

"We don't know of any risk from the vaccine, but we do know the risks from getting the virus," Chambers said.

Contact the writer: lhall@ocregister.com

Lengthy pacifier use can lead to speech problems

2009-10-21T11:05:00.001-06:00

Another great reason to breastfeed!
___________________________________________________________

Questions on whether a baby should be given a pacifier or allowed to thumb-suck have existed for generations. The concerns center on whether sucking habits will impact tooth alignment and speech development. The latest evidence, published today, suggests that long-term pacifier use, thumb-sucking and even early bottle use increases the risk of speech disorders in children.

The study looked at the association between sucking behaviors and speech disorders in 128 children, ages three to five, in Chile. Delaying bottle use until at least 9 months old reduced the risk of developing a speech disorder, researchers found. But children who sucked their thumb, fingers or used a pacifier for more than three years were three times as likely to develop speech impediments. Breastfeeding did not have a detrimental effect on speech development.

The authors of the study noted that other research suggests that use of a pacifier or thumb-sucking for less than three years also increases the risk of a speech problem. The sucking motion may change the normal shape of the dental arch and bite. Breastfeeding, however, seems to promote positive oral development.

"The development of coordinated breathing, chewing, swallowing and speech articulation has been shown to be associated with breastfeeding. It is believed that breastfeeding promotes mobility, strength and posture of the speech organs," the authors wrote.

The study is published in the open access journal BMC Pediatrics.

- Shari Roan

CDC Admits Thousands May Be Harmed By Swine Flu Vaccine

2009-10-18T21:10:00.000-06:00

The Center for Disease Control and Prevention (CDC) has admitted as many as 30,000 Americans may suffer serious, potentially lethal adverse reactions to the swine flur or H1N1 vaccine, and the FDA guidelines for the vaccine only require that it work in 3 out of every 10 people. This is alarming, and even worse, the vast majority of people are unaware of this. Instead, political leaders are encouraging people to get the vaccines when they can. The public is being deliberately left in the dark about the dangers of the swine flu vaccine!

Back in 1976 during a mass vaccination campaign, 1 in every 100,000 recipients ended up with Guillain Barré syndrome (GBS), a disorder in which the body’s immune system attacks the peripheral nervous system. The result can be paralysis and death, and there is no cure for this horrible disease. At that time about 40 million Americans received the vaccine and some 4,000 ended up suffering with GBS as a result. The CDC is setting up a new intensive surveillance system so they can monitor and track GBS cases that occur from the swine flu vaccine. Guillain Barre syndrome is a debilitating and possibly fatal side effect and anyone subjecting themselves to the vaccine should be made fully aware of the risk they are taking.

As shocking as that is, it’s not even the whole story about the swine flu vaccine. According to the FDA: " a vaccine will be accepted if it creates antibodies in 4 out of 10 recipients (40%), with at least 70 percent of those 4 achieving an antibody level believed to provide benefit. This means that an acceptable vaccine candidate would provide “protection” for 28% of vaccine recipients (70% of the 40%), or less than 3 in 10 recipients. The requirement drops to 18% efficacy for those over 65 years of age (60% of 30%)."

This is outrageous!

According to the CDC:

As many as 30,000 Americans will be harmed by the H1N1 vaccine.

And according to the FDA:

The vaccine may be ineffective for at least 7 out of 10 people that receive it.

Meanwhile, dont’ expect the FDA or any government officials to suggest the public be pro active and take supplements which have antiviral properties which could prevent people from getting sick in the first place. Supplements like Vitamin D, liquid zeolte (see the link for the zeolte ebook to the right here) healthy diet and exercise, and doing all we can to maintain good health.

Sources

www.noshot.org/

www.naturalhealthnews.com

http://www.swinefluissues.com/cdc-admits-thousands-may-be-harmed-by-swine-flu-vaccine/

5 Reasons to Avoid Induction

2009-10-15T10:21:00.001-06:00

The Risk of Inducing Labor

By Robin Elise Weiss, LCCE, About.com

The induction of labor can be done for many reasons, including many valid medical reasons. However, the rise in the rate of social inductions, or elective inductions is on the rise. As the induction rate rises there are more babies and mothers placed at risk for certain complications. Here are five risks of induction that you may not know about:

1. Increased risk of abnormal fetal heart rate, shoulder dystocia and other problems with the baby in labor.
Labor induction is done by intervening in the body's natural process, typically with powerful drugs to bring on contractions or devices that are used to break the water before labor starts. Both of these types of induction can cause the baby to react in a manner that is called fetal distress as seen by fetal monitoring.

The nature of induction like contractions may also be more forceful than natural labor. This can cause your baby to assume or stay in an unfavorable position for labor making labor longer and more painful for the mother. It can also increase the need for other interventions as well.

2. Increased risk of your baby being admitted to the neonatal intensive care unit (NICU).
Babies who are born via induction have not yet sent signals to the mother to start labor. This means that they simply aren't yet ready to be born. This risk is worth it if the baby or mother's lives are in danger, but simply to take this risk for elective reasons may not be well advised.

When a baby is in the intensive care unit there is less ability for you to be with your baby or to hold your baby. Breastfeeding usually gets off to a rocky start as well. This can usually be avoided by giving birth when your body and baby say it is time.

3. Increased risk of forceps or vacuum extraction used for birth.
When labor is induced babies tend to stay in unfavorable positions, the use of epidural anesthesia is increased and therefore the need to assist the baby's birth via the use of forceps and vacuum extraction is also increased.

4. Increased risk of cesarean section.
Sometimes labor inductions don't take, but it's too late to send you home, the baby must be born. The most common cause of this is that the bags of waters has been broken, either naturally or via an amniotomy. Since the risk of infection is greater, your baby will need to be born via c-section.

A cesarean in an induced labor is also more likely for reasons of malpresentation (posterior, etc.) as well as fetal distress.

5. Increased risks to the baby of prematurity and jaundice.
Induction can be done before your baby is ready to be born, because your due date is off or because your baby simply needed more time in the womb to grow and mature their lungs. Your baby may also be more likely to suffer from jaundice at or near birth because of the induction. This can lead to other medical treatments as well as stays in the hospital for your baby.

Being born even a week or two early can result in your baby being a near term or late preterm infant. This means that your baby is likely to have more trouble breathing, eating and maintaining temperature.

Beware - H1N1 FluMist

2009-10-15T10:18:00.003-06:00

Regardless of where you stand on the vaccination issue, please be aware that both the seasonal flu and H1N1 have a nasal FluMist that is being administered to children and adults. Sometimes at schools and local grocery stores. The repercussions of this is scary!

FluMist - The Vaccine that Keeps Giving

September 23, 2009 by Sherry Tomfeld

Please Be a Responsible User!
Everyone has to be responsible for their own decisions. If you are afraid of catching the H1N1 flu this year. You may be pondering whether to get a flu shot or using the H1N1 FluMist. The FluMist is administered into your nostrils. Before making your final decision, you may want to ask some questions and think of some consequences to taking the H1N1 FluMist nasal spray.

The H1N1 FluMist is made with "live" virus. This means that the H1N1 flu will be a part of the nasal spray formula. It's supposed to be just enough to start your immunity to build defenses to it. The shot is supposed to be a killed virus.

If you take the H1N1 FluMist, you will in fact become a carrier of the H1N1 flu. Information on this drug states that you can and will shed the virus for up to 21 days. That means as you are visiting with your elderly family members, or shopping in the isles of your grocery store or sitting in church with young children and people with immune problems, YOU are going to be shedding the virus H1N1 germs.

If you are a person that cannot tolerate the shot or the FluMist for the H1N1 flu, you are a sitting duck when it comes to being around people who have taken the FluMist. The use of FluMist is for people ages 2 - 49. How many people do you come into contact each day that don't fit the age range?

Drugs.com says that you should be careful when coming into contact with "FluMist with anyone who has a weak immune system caused by disease (such as cancer, HIV, or AIDS), or by certain medicines such as steroids, cancer chemotherapy, or radiation treatment. A person with a weak immune system can become ill if they have close contact with you after you have recently received a an influenza vaccine." Pregnant women are also on this list of people who should NOT use FluMist.

What happens when anything gets in your nose? You sneeze! Please be a responsible user of the FluMist and cover your face when you sneeze and cough. Remember, you are passing the H1N1 flu germs. The flu is passed from person to person with the sneezing, the coughing and germs from your hands. So if you take FluMist for the H1N1 flu, please practice good hygiene for the rest of us and wash, wash, wash your hands!

If you take the H1N1 FluMist nasal spray, please read up on it. Please ask questions about it. And please be a responsible user of the FluMist. We're all counting on you out here!

Dr. Stuart Fischbein: Delayed Cord Clamping

2009-10-05T12:15:00.000-06:00

Journey to a VBAC

2009-10-05T11:27:00.000-06:00

My Journey to a VBAC from Lindsey Meehleis on Vimeo.

Why Cord Blood Banking Was Not The Right Choice For Our Family

2009-10-05T08:54:00.001-06:00

http://www.givingbirthnaturally.com/storing-cord-blood.html

After careful review of the research, we decided that donating or storing cord blood was NOT in the best interest of our family. Few people publish the reasons they choose not to bank their baby's cord blood. I have outlined the basis for our decision below so that others may see this issue from a different perspective.

Why We Didn't Choose Public Cord Blood Donation

Although this option may seem like the ultimate altruistic act, giving your child's cord blood so that another may have life, we could not in good conscious select this option for both moral and ethical reasons.

Moral/Ethical Implications

The first reason is that if the sample size is inadequate for transplant, it will either be disposed of or sold for medical research. In fact, about 75% of donated cord blood samples will meet this fate. While this may not be an obstacle to some, for us, it was a deal-breaker. Not that it may be disposed of, but that it may be sold for research.

Once the sample is donated, your legal rights are terminated, nor can you have a voice in how it is used. As we are morally and ethically opposed to the use of our children's cord blood for the purposes of cloning, developing biological weapons, and other such research endeavors, we could not select donation as a viable option. Since we would have no say to what purpose the cord blood stem cells were put, we could not allow the possibility for it to be used in what to us are unconcinable acts.

Why We Didn't Choose Private Cord Blood Banking

We also could not in good faith choose the option of storing cord blood privately either. The reasons here are a bit more complex.

False Advertising

The chief sin of all private cord blood banks is false advertising. Any company that touts their service as "biological
insurance", especially if they use the examples of treating future cancers, is seriously misleading you. The primary reason this is false advertising is that the chance that, after storing cord blood, it could actually be used to treat a disease in the child from which it was harvested is very, very slim. This is because any genetic diseases or disorders the child later develops will also be present in the child's cord blood. It may in turn be used to treat a sibling, but not the original child. This fact is rarely specified to parents who are then given false hope once a diagnosis is determined. Their hopes are then stripped away as they find that the umbilical cord blood will be useless in helping save their child and that all the years of "health insurance" were nothing but an empty promise.

Incompatible with Evidence-Based Practice

The current buzz about cord blood donation and storing cord blood privately has led to a perception that this cord blood is not needed by the infant at birth and has become a contributing factor to the non-evidence based practice of early cord clamping. The research evidence supports that the newborn umbilical cord should not be clamped nor cut until pulsation has ceased, which can take between 5-20 minutes, depending upon whether the birth was natural or medicated.

The practice of early cord blood clamping results in documented harm to the infant, including increasing risks of complications shortly after birth, including hemorrhage and anemia. In truth, early cord clamping can rob the infant of half its total blood volume, which can take up to 6 months to regenerate. Please reference this article detailing the benefits of delayed cord clamping and restricted umbilical cord problems.

The American Academy of Pediatrics stated "if cord clamping is done too soon after birth, the infant may be deprived of a placental blood transfusion, resulting in lower blood volume and increased risk for anemia" and it supports the practice of delayed cord clamping.

Even the American College of Obstetricians and Gynecologists, which is usually woefully out of line with the research in some of its recommendations, also supports the practice of delayed cord clamping.

Unfortunately, this is an area of obstetric care where research and practice don't meet. Despite the overwhelming research and public policy support of delayed cord clamping, many physicians do not respect this recommendation. Many believe that the cord must be early clamped for storing cord blood.

Since we were not able to locate a provider in our area who was well-versed or receptive to this practice when storing cord blood, it was also a deal-breaker for us. We firmly believe that our efforts should focus on giving our children the best possible start in life by allowing them to have an optimal transfusion of cord blood at birth rather than sacrificing their immediate health for potential future complications of which we have no family history and/or predisposition, and for which other viable treatments options may be pursued.

The Research on Storing Cord Blood Privately

Overwhelmingly, there is little support for private cord blood banking. In fact, it is illegal in Italy and France. In addition, no major medical organization even endorses the practice of private cord blood banking.

The RCOG or Royal College of Obstetricians and Gynaecologists in the UK released a 2006 position which stated, "There is still insufficient evidence to recommend directed commercial cord blood collection and stem-cell storage in low-risk families."

The American Academy of Pediatrics 2007 statement was that "private storage of cord blood as 'biological insurance' is unwise" unless there is a family member with a current or potential need to undergo a stem cell transplantation.

The American Society for Blood and Marrow Transplantation (ASBMT) also supports the position that cord blood donation may be beneficial as well as private banking if there is a family history of disease or if many risk factors are present.

Ownership After Storing Cord Blood Privately

After paying hefty fees for storing cord blood privately, it may seem a logical conclusion that the family then owns the exclusive legal rights to the banked cord blood. But this, in fact, may not be the case.

In 2007, the largest private cord blood banking facilities still do not explicitly state in their contracts that the umbilical cord blood belongs to the donor and/or family, including all the legal rights you would naturally expect with this type of arrangement. This "loophole" opens the door to open future unapproved uses which may include, but are not limited to: cloning, research and partial sale.

In addition, the standard contracts may also omit vital information on the donor's right to end their relationship with that company, especially with regard to the transfer, right to request destruction of the stored cord blood as well as to verify destruction. This also opens the door to other unapproved avenues of use in that if destruction or disposal is not defined, then release of the sample for medical research may be defined as "disposal", though not in an ethical manner.

Utlimately, it is a personal decision that you as a family must make on whether storing cord blood, either publically or privately, is the right choice for you. I hope that our reasoning sheds some light on the darker side of the cord blood banking industry so that you can make an informed decision as well.

New studies say spanking lowers IQ

2009-09-28T13:53:00.001-06:00

September 28, 9:48 AMMinneapolis Attachment Parenting ExaminerAlicia Bayer

Two new studies released last week show a link between spanking and lower IQ in children.

Both studies were headed by discipline and domestic violence expert Murray Straus, a professor of sociology and co-director of the Family Research Laboratory at the University of New Hampshire.

In the first, Straus surveyed 17,000 college students in 32 countries and found that "the higher the percent of parents who used corporal punishment, the lower the national average IQ."

The second study, which is being published in the Journal of Aggression, Maltreatment and Trauma, looked at spanking just in the United States. Straus and a fellow researcher reviewed data on IQ scores of about 1,500 young children.

Of 2- to 4-year-olds, children who were spanked had IQ scores about five points lower than those who weren't spanked at all. Spanking among 5- to 9-year-olds led to a loss of about 3 points.

According to Straus, how often parents spanked made a difference. "The more spanking, the slower the development of the child's mental ability. But even small amounts of spanking made a difference."

In a statement about his research, Straus said:

"It is time for psychologists to recognize the need to help parents end the use of corporal punishment and incorporate that objective into their teaching and clinical practice. It also is time for the United States to begin making the advantages of not spanking a public health and child welfare focus, and eventually enact federal no-spanking legislation."

For information on 130 other studies that showed negative effects of corporal punishment, see E.T. Gershoff's Report on Physical Punishment in the United States.

The Aware Parenting Institute also offers 20 alternatives to spanking.

CDC Says Cesarean Triples Neonatal Death Risk

2009-09-27T14:00:00.000-06:00

by Misha Sanfranski
While the increased risks of cesarean section to neonatal and maternal health have long been known, an even more grim issue came to light in a study released in the September, 2006 issue of Birth Journal. The CDC conducted research on cesarean section and neonatal mortality, expecting to
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find that the neonatal mortality rate (defined as death within the first 28 days of life) following cesarean section correlated directly with medical complications of the mother and baby. What they found, instead, was that regardless of risk factors, babies born by cesarean section face a risk of death nearly three times that of vaginally born babies.

MacDorman, et al. analyzed national birth and death data for 5,762,037 live infants and 11,897 neonatal deaths, for the years 1998-2001. The purpose of the study was to examine the neonatal outcomes of primary cesarean delivery in women who had no other known complications or medical risk factors. The logical result of this examination would seem to be comparable neonatal mortality rates among cesarean and vaginally born infants. In fact, what the results show is that cesarean independently raises the risk of neonatal death by almost three-fold - .62 per 1000 deaths among vaginal births versus 1.77 per 1000 infant deaths among cesarean babies.

Even more astounding than the simple fact that cesarean section raises the risk of infant death - regardless of the reason the cesarean was performed - is that even when the researchers adjusted for sociodemographic, medical and congenital factors, and removed infants with APGARs under 4, the risk of death was only reduced "moderately". A stark difference in the death rates between cesarean born infants and vaginally born infants remained even with no medical explanation.

We aren't talking about babies dying from the few, rare complications that can arise in childbirth. We're talking about healthy, low-risk mothers electing for a primary cesarean section with no medical indication resulting in a nearly three times higher rate of death than those who have a vaginal birth.

According to Marian MacDorman, the CDC's study leader, "These findings should be of concern for clinicians and policymakers who are observing the rapid growth in the number of primary Caesareans to mothers without a medical indication."

While the findings of this research on cesarean and neonatal mortality were reported by major media outlets upon its release, publicity for the issue quickly waned. It is evident that care providers and mothers have continued to discount the disturbing results of the CDC study on neonatal
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mortality and cesarean, as the rate of surgical delivery has continued to climb to a record-breaking high of 31.8% in 2007, up from 31.1% in 2006.

The World Health Organization recommends no more than a 10% cesarean rate in developed countries, based upon research indicating more harm than good to both mothers and babies when the cesarean rate tops 15%. Until mothers and obstetricians start taking the risks of elective cesarean section seriously, we will likely continue to see tragic consequences of the interference of surgery in childbirth.

References:

MacDorman MF, Declercq E, Menacker F, Malloy MH.

Division of Vital Statistics, NationalCenter for Health Statistics, Centers for Disease Control and Prevention,

Hyattsville, Maryland20782, USA. Birth. 2006 Sep;33(3):175-82.

H1N1 Vaccination

2009-09-25T09:37:00.001-06:00

Gardasil Researcher Speaks Out

2009-08-27T13:37:00.000-06:00

"Public Should Receive More Complete Warnings"

By Sharyl Attkisson

(CBS) Amid questions about the safety of the HPV vaccine Gardasil one of the lead researchers for the Merck drug is speaking out about its risks, benefits and aggressive marketing.

Dr. Diane Harper says young girls and their parents should receive more complete warnings before receiving the vaccine to prevent cervical cancer. Dr. Harper helped design and carry out the Phase II and Phase III safety and effectiveness studies to get Gardasil approved, and authored many of the published, scholarly papers about it. She has been a paid speaker and consultant to Merck. It’s highly unusual for a researcher to publicly criticize a medicine or vaccine she helped get approved.

Dr. Harper joins a number of consumer watchdogs, vaccine safety advocates, and parents who question the vaccine’s risk-versus-benefit profile. She says data available for Gardasil shows that it lasts five years; there is no data showing that it remains effective beyond five years.

This raises questions about the CDC’s recommendation that the series of shots be given to girls as young as 11-years old. “If we vaccinate 11 year olds and the protection doesn’t last... we’ve put them at harm from side effects, small but real, for no benefit,” says Dr. Harper. “The benefit to public health is nothing, there is no reduction in cervical cancers, they are just postponed, unless the protection lasts for at least 15 years, and over 70% of all sexually active females of all ages are vaccinated.” She also says that enough serious side effects have been reported after Gardasil use that the vaccine could prove riskier than the cervical cancer it purports to prevent. Cervical cancer is usually entirely curable when detected early through normal Pap screenings.

Dr. Scott Ratner and his wife, who’s also a physician, expressed similar concerns as Dr. Harper in an interview with CBS News last year. One of their teenage daughters became severely ill after her first dose of Gardasil. Dr. Ratner says she’d have been better off getting cervical cancer than the vaccination. “My daughter went from a varsity lacrosse player at Choate to a chronically ill, steroid-dependent patient with autoimmune myofasciitis. I’ve had to ask myself why I let my eldest of three daughters get an unproven vaccine against a few strains of a nonlethal virus that can be dealt with in more effective ways.”

Merck and the Centers for Disease Control and Prevention maintain Gardasil is safe and effective, and that adequate warnings are provided, cautioning about soreness at the injection site and risk of fainting after vaccination. A new study in the Journal of the American Medical Association found while the overall risk of side effects appears to be comparable to other vaccines, Gardasil has a higher incidence of blood clots reported. Merck says it continues to have confidence in Gardasil’s safety profile. Merck also says it’s looking into cases of ALS, commonly known as Lou Gehrig’s Disease, reported after vaccination. ALS is a progressive neurodegenerative disease that attacks motor neurons in the brain and spinal cord. Merck and the CDC say there is currently no evidence that Gardasil caused ALS in the cases reported. Merck is also monitoring the number of deaths reported after Gardasil: at least 32. Merck and CDC says it’s unclear whether the deaths were related to the vaccine, and that just because patients died after the shots doesn’t mean the shots were necessarily to blame.

According to Dr. Harper, assessing the true adverse event risk of Gardasil, and comparing it to the risk of cervical cancer can be tricky and complex. "The number of women who die from cervical cancer in the US every year is small but real. It is small because of the success of the Pap screening program."

"The risks of serious adverse events including death reported after Gardasil use in (the JAMA article by CDC’s Dr. Barbara Slade) were 3.4/100,000 doses distributed. The rate of serious adverse events on par with the death rate of cervical cancer. Gardasil has been associated with at least as many serious adverse events as there are deaths from cervical cancer developing each year. Indeed, the risks of vaccination are underreported in Slade's article, as they are based on a denominator of doses distributed from Merck's warehouse. Up to a third of those doses may be in refrigerators waiting to be dispensed as the autumn onslaught of vaccine messages is sent home to parents the first day of school. Should the denominator in Dr. Slade's work be adjusted to account for this, and then divided by three for the number of women who would receive all three doses, the incidence rate of serious adverse events increases up to five fold. How does a parent value that information," said Harper.

Dr. Harper agrees with Merck and the CDC that Gardasil is safe for most girls and women. But she says the side effects reported so far call for more complete disclosure to patients. She says they should be told that protection from the vaccination might not last long enough to provide a cancer protection benefit, and that its risks - “small but real” - could occur more often than the cervical cancer itself would.

"Parents and women must know that deaths occurred. Not all deaths that have been reported were represented in Dr. Slade's work, one-third of the death reports were unavailable to the CDC, leaving the parents of the deceased teenagers in despair that the CDC is ignoring the very rare but real occurrences that need not have happened if parents were given information stating that there are real, but small risks of death surrounding the administration of Gardasil."

She also worries that Merck’s aggressive marketing of the vaccine may have given women a false sense of security. "The future expectations women hold because they have received free doses of Gardasil purchased by philanthropic foundations, by public health agencies or covered by insurance is the true threat to cervical cancer in the future. Should women stop Pap screening after vaccination, the cervical cancer rate will actually increase per year. Should women believe this is preventive for all cancers - something never stated, but often inferred by many in the population-- a reduction in all health care will compound our current health crisis. Should Gardasil not be effective for more than 15 years, the most costly public health experiment in cancer control will have failed miserably."

CDC continues to recommend Gardasil for girls and young women. The agency says the vaccine’s benefits outweigh its risks and that it is an important tool in fighting a serious cancer.

Dr. Harper says the risk-benefit analysis for Gardasil in other countries may shape up differently than what she believes is true in the US. “Of course, in developing countries where there is no safety Pap screening for women repeatedly over their lifetimes, the risks of serious adverse events may be acceptable as the incidence rate of cervical cancer is five to 12 times higher than in the US, dwarfing the risk of death reported after Gardasil.”

Free Nursing Cover

2009-08-21T08:56:00.001-06:00

I have never been a fan of nursing covers for me personally. My babies always seemed to get annoyed with having something over their heads. For those that like them though - this is a great offer.

UdderCovers.com
Running a limited time promotion for 100% off ALL our covers (patterned and non-patterned)! You can get ANY of our covers for free ~ you just pay the S&H of $8.95! We know that you support breastfeeding -so if you're not currently nursing, they make great baby shower and Holiday gifts. The promo code is "backorder1".

Go to http://www.uddercovers.com/ , click on "Shop Now" where it will then display all the nursing covers we offer as well as other products and sets. Select the product you would like and you will automatically be directed to the center of the page where you can enter in the promo code! This backorder promotion will give you a $32.00 discount off your total order no matter what you put in your cart! This promotion code is valid once per transaction so order as many times as you would like. Let all your friends know too!Again, thank you! We could not have offered this discount without your past support!

Happy Shopping!!

Reducing Infant Mortality

2009-08-20T09:29:00.004-06:00

This is an awesome video on reducing infant mortality here in the states. Take the time and watch it - it is under 17 minutes long.

Reducing Infant Mortality from Debby Takikawa on Vimeo.

The Real Risk of C-Section - Medscape Interview

2009-08-14T19:13:00.002-06:00

Editor's Note:

Cesarean section (c-section) is the most commonly performed surgery in the United States. The frequency of surgical birth has increased from 4% in 1965 to about 33% today, despite World Health Organization (WHO) recommendations that a 5% to 10% rate is optimal and that a rate greater than 15% does more harm than good.^[1-3]

Reasons for this increase have been discussed profusely:

The surgical focus of obstetrics and the need to train residents;
The low priority and few practical skills for supporting women's abilities to labor and give birth naturally;
A rigid view of the duration of normal labor; and
A low threshold of definition for 'labor dystocia' (the justification for up to 60% of cesarean births^[4]).

Surgical birth is also a 'side effect' of interventions associated with actively managed labor: induction, artificial rupture of membranes, labor medications, and fetal monitoring.^[5,6] Policies against vaginal birth after cesarean (VBAC) and, increasingly, unsupported 'supply-side' justifications such as "baby seems large," also drive the trend toward cesareans. A recent report by the Lamaze Institute associates surgical birth with obstetricians' personalities -- specifically their anxiety levels.^[7-9]

The risks for birth by surgery have also come under discussion. Maternal risks include a higher overall death rate, rehospitalization for wound complications and infection, placenta accreta and percreta (both with 7% mortality rate), placenta previa, uterine rupture with subsequent pregnancy, and preterm birth, with its own set of risks and complications for the newborn.^[10-15]

Pamela K. Spry, BSN, MS, CNM, PhD, the President of Lamaze International, a leading childbirth-advocacy group, spoke with us about the risks for birth by scalpel.

Medscape: Childbirth methods are often trend-driven. In the 1960s and 1970s, there was a big push for natural childbirth. What has driven women away from that method since then?

Dr. Spry: In the 1960s, women were rebelling against twilight sleep -- childbirth under heavy narcotics that required being strapped down to the delivery table. There was also the push for fathers to be in the delivery room, which wasn't allowed, and certainly not during heavily sedated birth. Now we have a widespread availability of local and regional methods of pain relief that let women be awake and aware, share the birth with their families, and basically rely on technology to assist them at birth. I think this drive has been somewhat alleviated, but there is still a push for natural childbirth. This is the reason women are still seeking classes, making birth plans, and choosing home birth and birthing centers.

"Natural childbirth" can mean different things to different people. For Lamaze, it means a birth that's allowed to happen on its own without the use of unnecessary medical interventions, to provide women the safest and healthiest birth possible.

Medscape: Are rates of surgical delivery being driven up by women or clinicians? Is this the age of Blackberry birth -- scheduling everything ahead of time?^[16]

Dr. Spry: Actually, there are 2 parts to this question. One is, what has driven up the rate of repeat cesareans, and that answer is easy: there has been a big decrease in the availability of choosing to labor and deliver vaginally (VBAC) after having 1 or 2 previous cesarean births, causing a huge increase in the rate of surgical delivery [for repeat cesareans]. Compared with the early 1990s when VBACs were encouraged and acceptable, many hospitals, insurance companies, and clinicians now refuse to allow women to try laboring after a previous c-section because of perceived medical and legal risks.

The second part of the question is whether women or clinicians are responsible for the increase in the primary c-section rate, and I think that's more difficult to answer. In a study of more than 1500 women, we tried to determine just that. The research results indicated that only 1 woman in the study actually reported that she requested a cesarean, which leaves the decision for the vast majority of cesarean deliveries up to clinicians. So understanding when cesareans are medically necessary, as well as the risks involved, is important in achieving a safe and healthy birth.

Although it might be convenient, babies who are born before they are ready are at increased risk for major medical problems.

Medscape: Could fear be the reason for women agreeing to surgical birth? Are women enduring pain differently than in previous decades? Is the surgical scenario easier to contemplate than the unknowns of a natural labor and delivery?

Dr. Spry: Exactly. I think all of that has to do with the fact that our culture actually breeds fear around childbirth. We've got TV shows, popular culture, and horror stories from friends and families; women are taught to expect a negative experience and incredible pain. Lamaze is focused on trying to help women get the facts, know what to expect, and help take the fear out of the process. But the unknown parts, such as labor, its duration, birth, and even the unknown of when labor will start, makes it more appealing for some women to schedule a cesarean.

Medscape: The culture of hospital obstetrics seems designed for interventions, with cesarean procedures bringing in more money than natural delivery. Do you think hospital financial incentives are a reason for the rise in cesareans? Or would the costs for longer hospital stays with cesarean procedures balance out the revenues from them?^[17]

Dr. Spry: I think that sometimes financial concerns, convenience, or concerns over lawsuits do rule medical decision-making around childbirth. When women have a good understanding of what constitutes quality care, they are in a better position to ask for it from their care providers. Interestingly enough, I just returned from our nurse-midwifery convention in Seattle, and I heard a speaker address this very thing: reducing the cesarean rate. Among his suggestions was the provocative notion that providers should be reimbursed the highest rate for labor and vaginal birth after cesarean, followed by labor and vaginal birth, and the lowest reimbursement for scheduled, elective cesarean delivery. That way, providers would be compensated for their actual time involved in the process, and scheduled c-sections would have the lowest reimbursement. He thought that would make a difference.

Medscape: What are the main risks these days with c-sections? Are these risks underplayed by obstetricians, and, if so, why?

Dr. Spry: Many of them were covered in the introduction. Any time we schedule a surgery or an induction, we are assuming that we know the baby's due date. Anything that's scheduled before a woman's estimated due date could result in a baby being born before it's ready. [And iatrogenic prematurity is a reality with any scheduled birth -- that is, due dates may have been calculated wrong and inadvertently, babies are born before they are actually term.] We're getting more research looking at the near-term preemie. We find that they have breathing and developmental problems and that the risk for death is increased. Certainly, cesarean delivery increases the risk for the baby being injured from the incision. Surgery also carries risks for women, such as blood loss, clotting, infections, severe pain, and adverse anesthesia-related events. This is something that we haven't focused on, and I'm not certain that informed consent includes this information -- that there are complications during future pregnancies and that it does risk future children. There is an increased risk for stillbirth with a second or third c-section, as well as placental problems like percreta and accreta (abnormal growth and attachment of the placenta into the uterus), increasing the risk for hemorrhage. Women may experience dire complications as a result -- bladder injury, hysterectomy, and maternal death. I don't know that I would describe these risks as "underplayed" by obstetricians, but rather that women are not prepared to ask the right questions that lead to informed decision-making.

It would be interesting to read the informed-consent documents for cesarean deliveries, and see what risks are included.

Medscape: A story in The New York Times recently reported that women who have c-sections seem to have fewer children. That story provoked over 200 comments, from women who have had all of their children by planned cesarean to women who had had births at home. A strong fear-driven contingent regarded childbirth as fraught with pain and danger, and that anyone who risked giving birth outside of a hospital was committing child abuse. Can you discuss any evidence comparing the risks to mothers and children between in-hospital and at-home births?^[18]

Dr. Spry: A number of studies have looked at this. Some of the criticism of these studies has been that hospitals end up with higher-risk women, so it's an unfair comparison. But there are studies of low-risk women who had a planned home birth with a qualified birth attendant, compared with low-risk women who chose hospital births; the outcomes for home birth were better or as good as outcomes for women who birthed in hospitals.

Each study limits what kind of comparisons are made, but certainly women with previous surgical uterine scars, medical complications, or breech babies are all considered high-risk.

Medscape: The recovery period after any birth, from time immemorial known as the "lying-in" period, used to last several weeks after a birth. Now, even after surgical birth, women are up and around within a few days. Postpartum depression is another health consideration that has been much in the news lately. Do you think we have lost something with this shortened period of rest and recovery?^[19]

Dr. Spry: I do. Studies have shown that it's better for mothers and babies to stay together after birth. Experts agree that unless a medical reason exists, healthy mothers and babies should not be separated following birth. Interrupting, delaying, or limiting the time that a mother and her baby spend together may have a harmful effect on their relationship and on breast-feeding. Babies stay warm, cry less, and have a better start on breast-feeding if moms and babies are together.

[As for the question about depression], women with postpartum depression do experience difficulty bonding with their babies. But this could be a result of depression rather than the cause, so it's really hard to answer [whether a shortened period of recovery is related to causing postpartum depression]. Most people get 6 weeks off of work, but even in those 6 weeks, women are still running around [trying to take care of other children, do chores, and manage the household]. I don't know whether we, as a culture, discourage mothers and babies to be together in the postpartum period by no longer posting signs on the doors that say "Don't knock, baby sleeping!" I'm just not aware of any comparative studies on how different postpartum protocols correlate with postpartum depression.

Medscape: There's a marked trend toward inducing delivery -- vaginally or surgically -- before 40 weeks, with mounting evidence that this is risky business. Where is this coming from?^[20,21]

Dr. Spry: This increased induction rate has occurred for several reasons: the desire on the part of the women or the providers to arrange a convenient time for delivery. Again, it's a scheduling issue. Concerns about postmaturity, or a post-dates baby, with a fear of adverse outcome and litigation may have contributed to this. But despite the large number of women experiencing induction, one-half of the women who responded to the "Listening to Mothers" study said that they felt that labor should not be interfered with unless it's medically necessary. Eleven percent of the mothers also said that they had experienced some pressure from their care providers to have an induction. Lamaze gives this information to women to help them select their place of birth and communicate with their healthcare provider. These tools can assist women in having a safe and healthy birth.

Medscape: Even truly full-term infants born by cesarean end up in intensive care more frequently than their vaginally born peers. Is this because such infants born by cesarean are high-risk to begin with, or is the procedure itself responsible for this?

Dr. Spry: I think that it's both. I definitely think that some medically indicated surgical deliveries do end up with babies that were higher-risk to begin with. But if you compare low-risk babies that are born by cesarean with vaginal-birth babies, vaginal-birth babies do better. There is an increased likelihood of babies born surgically having problems with fluid in the lungs and less ability to clear it. So actually going through the birth canal seems to be better for the baby.

Medscape: In 2005, surgical birth was the most common Medicaid-billed procedure, performed on women who are most likely at risk for the poorest aftercare, complications, and support. Why is this population at highest risk for c-section?^[21]

Dr. Spry: I don't think this statistic indicates that the Medicaid population is at highest risk if they were compared to the insured population. I think that a large part of the Medicaid population consists of pregnant women, because this is a time when they can get coverage. So Medicaid often ends at the 6-week postpartum exam. A childbearing woman would be more likely to be covered under Medicaid than a woman in her forties who needed gallbladder surgery.

There have been a couple of studies that looked at the cesarean delivery rate of women with private insurance delivering in private hospitals, and found that privately insured women had a higher surgical risk than the Medicaid population. The rate in New York was 30% for private vs 21% for Medicaid, if the Medicaid women delivered in a public hospital (a teaching hospital). So what has happened is that we've had somewhat of a shift of Medicaid patients moving into the private sector; they've shifted their deliveries from teaching hospitals to private institutions, and this has increased their probability for cesareans.

A study from Kaiser in California showed that this increased risk persists even after adjusting for patient demographics and clinical factors. The risk was associated not so much with Medicaid, but with delivering in a private institution. Teaching hospitals tend to follow evidence-based practice, and encourage women to deliver vaginally.

Medscape: What's your perspective on recent reports about the rate of repeat cesareans jumping from 65% to 90% between 1997 and 2006?^[22]

Dr. Spry: Again, I think it's litigation fear. There have been more and more restrictions placed on women who want to have VBACs. Some insurance companies won't cover clinicians or hospitals [if they provide a trial of labor after cesarean; and] there are certainly clinicians who won't do VBACs. Women are finding it more and more difficult to seek and have a vaginal birth after a prior cesarean.

I just went to a conference where I talked to a number of women whose previous experience was with c-section, but who wanted a vaginal birth. Some of them chose home birth for their next pregnancies because it was their only option.

Medscape: As the concept of birth transitions from a physical, sexual, and societal passage to a billable surgical procedure, placing women in a more passive role, how is the overall well-being of women affected?

Dr. Spry: Within the maternity system, there's a distinct drive toward convenience: predictable process of labor and birth, maximized reimbursement, and limited liability. All of these factors can lead any care provider to make decisions that aren't necessarily based on the mother's and baby's needs. Women's decisions are affected as well, because without maximum reimbursement, they can't select a place of birth that they can't afford. I think it's critical for every birthing woman to recognize the realities of the environment and be prepared to advocate for herself, taking a more active role in her birth. This is something that Lamaze focuses on.

Studies have been done where a woman has experienced a kind of birth that she didn't want, and she felt that she had no control over it. Penny Simkin just gave an excellent talk on the risk of posttraumatic stress syndrome resulting from a birth in which a woman felt not in control, who felt decisions were made for her and were imposed on her. I think that sense of control is really important to the mental health and to the feeling of being competent and OK after birth.

Medscape: Obstetrics is a surgical specialty. So far, the significant numbers of women now practicing in the field have done little to change the surgical view of birthing women. Do you think there will be a tipping point away from the surgical approach to birth among obstetricians?

Dr. Spry: Sometimes it takes us years to figure out what we've been doing wrong; this is an alarming aspect of surgery, and few women are aware of the poor state of maternity care that we have in the United States. Many women assume that because they're birthing in the United States, they're getting quality care. Research and outcome studies suggest that this isn't necessarily the case, but I don't think our population knows that yet. We're seeing an increased number of maternal deaths. We haven't seen an increase in maternal deaths in this country for a long time. [An example of a delay in recognizing risk of accepted treatment is, that] in the 1950s, 1960s, and 1970s, we gave diethylstilbestrol to women to prevent miscarriage. It wasn't until the next generation, and even after the next generation -- 30 years -- that we got rid of that practice. So I think change will come. And I think that we need to continue to perform research, monitor maternal morbidity, and look at these statistics, and then we'll see a shift.

The other issue is that really adverse, terrible events are rare; maternal deaths are rare, even though they are increasing. So an obstetrician having a personal experience of a maternal death is infrequent.

Essential skills are being lost in obstetrics -- for example, breech deliveries or twins. However, they are preserved in the world of midwifery.

I hope that we get the message across that women want and need a positive birthing experience, and that they will choose a birth team that will support that goal. We would like for everybody to have a safe and healthy birth.

Low Choline Level in Pregnancy Tied to Birth Defects

2009-08-14T19:08:00.001-06:00

Anencephaly, spina bifida linked to nutrient found in foods, study shows

Posted August 14, 2009

FRIDAY, Aug. 14 (HealthDay News) -- Low blood levels of the nutrient choline during pregnancy increases the risk of brain and spinal-cord defects in newborns, U.S. researchers report.

They focused on two types of neural tube birth defects -- anencephaly and spina bifida. Anencephaly is a lethal condition in which the brain and skull don't develop, and spina bifida is a spinal-cord malformation that causes paralysis and lifelong disability.

The Stanford University School of Medicine team compared pregnancy blood samples from 80 women who gave birth to children with anencephaly and spina bifida to pregnancy blood samples from 409 women whose infants had no birth defects.

The results showed that choline levels were linked to risk of neural tube defects. Choline is found in egg yolks, soy, wheat germ and meats.

Women with the lowest blood choline levels during pregnancy were 2.4 times more likely to have infants with neural tube defects than women with average blood choline levels. Women with the highest choline levels had the lowest risk.

The study appears in the Aug. 14 issue of Epidemiology.

Primary author Gary Shaw, a professor of neonatology, noted that prenatal vitamins contain little or no choline. For women planning to get pregnant

, "the best source for choline is still eating a variety of foods," he said in a university news release.

Fruits, Vegetables May Protect Against Upper Respiratory Tract Infection During Pregnancy

2009-07-27T16:15:00.000-06:00

July 16, 2009 — Consuming at least 7 servings per day of fruits and vegetables may reduce the risk for upper respiratory tract infection (URTI) during pregnancy, according to the results of a cohort study reported June 25 in the online issue of Public Health Nutrition.

"Pregnant women may require more fruits and vegetables than usual because of the extra demands on the body," senior author Martha M. Werler, MPH, ScD, from the Slone Epidemiology Center at Boston University in Massachusetts, said in a news release.

Werler, along with coauthor Lin Li, from the Department of Epidemiology at Boston University, asked 1034 North American women to report retrospectively on their fruit and vegetable consumption during the 6 months before their pregnancy and episodes of URTI during the first half of pregnancy. Cox proportional hazards models allowed calculation of multivariable-adjusted hazard ratios (HRs).

Compared with women in the lowest quartile (median, 1.91 servings per day) of total fruit and vegetable intake, those in the highest quartile (median, 8.54 servings per day) had an adjusted HR of URTI of 0.74 (95% confidence interval [CI], 0.53 - 1.05) for the 5-month follow-up and 0.61 (95% CI, 0.39 - 0.97) for the 3-month follow-up. Intake of 6.71 servings per day was associated with a moderate risk reduction for URTI.

For the 3-month, but not the 5-month, follow-up, there was a dose-related decrease in URTI risk based on quartile of fruit and vegetable intake (P for trend = .03 at 3 months). However, there was no apparent association between either fruit or vegetable intake alone and the risk for URTI at 5 months or 3 months.

"Women who consume more fruits and vegetables have a moderate reduction in risk of URTI during pregnancy, and this benefit appears to be derived from both fruits and vegetables instead of either alone," the study authors write.

Limitations of this study include reliance on recall of diet and URTI, possible misclassification of exposure because of the timing of data collection, and possible residual confounding.

"If diets enriched with fruits and vegetables truly have a preventive or protective effect against URTI in pregnant women, the public health implications may be considerable given that URTI as well as treatments for URTI symptoms may affect fetal development," the study authors conclude. "However, the limitations discussed above make it necessary to replicate our findings through studies specially designed to address this question."

The National Institute of Dental and Craniofacial Research supported this study. The study authors have disclosed no relevant financial relationships.

Public Health Nutr. Published online June 25, 2009.

Caution urged on inducing labor

2009-07-23T06:56:00.000-06:00

By TODD ACKERMAN

July 21, 2009, 12:18AM

Doctors are being advised not to induce labor for non-medical reasons prior to 39 weeks into a pregnancy under revised guidelines released today by the nation's association of obstetricians and gynecologists.

The guidelines, the first since 1999, arrive amid concern about the increase in the number of such procedures in the last two decades. The rate of induced labor has increased from 90 per 1,000 births in 1990 to 225 per 1,000 births in 2006.

“It's really become an epidemic,” said Dr. Mildred Ramirez, an author of the American College of Obstetricians and Gynecologists guidelines and professor of ob-gyn at the University of Texas Medical School at Houston. “The doctor and patient need to weigh the risks and benefits — there will be exceptions — but I hope the consequence of the guidelines is a reduction in the rate.”

But another Houston ob-gyn called the guidelines “pretty lax” and said she doubted they would have a significant effect.

Ramirez characterized the rate as “alarmingly high” in many hospitals and said there are ones in Houston where labor is induced 50 percent of the time.

While induction is relatively safe, it's been associated with increased risk of Caesarean sections. Studies have found it also leads to longer hospital stays and higher costs.

There are many occasions when there are clear-cut medical reasons for inducing, such as when health problems complicate a pregnancy and when pregnancies are more than two weeks past the due date. The health problems include diabetes or high blood pressure in the pregnant woman, premature rupture of membranes that encase the unborn baby and fetal issues such as an irregular heartbeat.

The new guidelines focus mostly on setting forth when and how to induce labor in such situations. Ramirez said there is significant new data since 1999 comparing the different regimens and their side effects.

Guidelines not set in stone

The guidelines are non-binding, but could be interpreted to make a doctor more liable if he or she doesn't follow them and something goes wrong.

Over the past 20 years, the decision to induce has increasingly involved not health concerns but convenience — for the mother, family or doctor. Patients often request induction because they're tired of the pregnancy, want to make sure their doctor is there instead of a different doctor who might have to deliver if labor occurs at night or prefer to time the delivery to most efficiently manage their allotted time off from work.

The guidelines take no position on such so-called “soft” reasons for inducing labor.

But for the first time, they stress that mature fetal lung test results before 39 weeks of gestation by themselves aren't enough to justify inducing. Such results — fetal lungs are mature at 37 weeks 90 percent of the time — sometimes have been used as a criterion to induce early.

They also call for a physician capable of performing a Caesarean to be available if induction doesn't produce a successful vaginal delivery.

The increased rate has led some hospitals around the nation in recent years to implement their own stricter guidelines on elective use of the procedure. But Dr. Damla Dryden, an ob-gyn with the Women's Specialists of Houston at Texas Children's Hospital, said the demand is so great it will take a stronger statement than the new guidelines to get more hospitals on board.

“People keep pushing to induce earlier and earlier,” said Dryden. “The new guidelines stress the issue a little more clearly than previously, but journal articles and studies have pointed out the trend for a while now and doctors still feel a lot of pressure from patients for it.”

Dryden called the trend the same one that's caused Caesarean sections to increase recently, “the idea that some patients want to get the baby out before something goes wrong.”

Ramirez said the authors didn't delve more into the overuse of labor induction because they saw the guidelines' purpose as educating physicians about the current state of knowledge given the procedure's frequency, but acknowledged it's “a valid point” that they could have used the occasion to come out more forcefully against the trend.

There is no one accepted number for the rate of inductions done for nonmedical reasons, but studies have put it from 15 percent to 55 percent of the total number.

todd.ackerman@chron.com

Cesarean vs, VBAC - a dramatic difference

2009-07-22T21:31:00.002-06:00

This is such a touching video and eye opening video. Most people do not realize the force needed to get a baby out during a cesarean section - in the second birth, a vacuum is used as well as manual force. It is 16 minutes long, but worth the time.

Cesarean vs. VBAC: A Dramatic Difference from Alexandra Orchard on Vimeo.

The unspoken risk of csections...

2009-07-22T16:35:00.002-06:00

Babies scarred as they're born: With thousands of infants injured each year due to Caesarean births, why are mothers not warned of risks?

By Tanith Carey
Last updated at 3:48 PM on 21st July 2009

Matthew Watson is only two years old, but already he has what his mother Wendy calls 'a war wound' - a 31/2in scar which runs from his eyebrow up to his hairline.

It is the legacy of an accident during his Caesarean birth when a surgeon dropped a surgical instrument on his head.

An isolated case? Far from it - Matthew is one of an estimated 3,000 newborns injured during the procedure every year in the UK, and with the Caesarean rate rising, it is likely the number affected will also increase.

Marked for life: Matthew Watson, pictured just after a Caesarean birth, has a scar across his forehead, which his mother Wendy says is not fading

Even if the injury is just a nick, it exposes the newborn to possible infection; in other cases, the wound is also deep enough to scar the child for life.

Like many mothers-to-be, Wendy Watson had no idea that Caesareans carried this risk. Wendy, 32, from Kent, had an emergency C-section after her labour failed to progress.

'Suddenly, during the operation, the surgeon started shouting and swearing at his colleague from the other side of the surgical screen,' says Wendy. 'The surgeon was saying: "Buck your ideas up. Can't you see the position we are in with this patient?''

'It turned out that his assistant, who had been holding the instrument keeping the incision open, had lost his grip and dropped the tool on Matthew's head as he was being delivered.'

But it wasn't until Wendy was handed her baby an hour later that she discovered what had happened.

'Then the surgeon came to apologise for his colleague - he even had a couple of tears in his eyes as he talked to us,' says Wendy, who is married and works as a government finance officer.

'At the time, I'd had such a difficult labour that we were just relieved to have a healthy baby. I was also taken very ill shortly afterwards, with blood clots on my lungs, so it was never discussed any further.'

Newborns: An estimated 3,000 babies are injured during the Caesarean procedure, including cuts that leave deep scars

But far from fading with age as his parents expected, Matthew's scar has stretched as his skull has grown. Wendy says: 'He's too young to notice it and it's currently covered by hair, but he will probably have it for ever now.'

At least the surgeon apologised. In some cases, parents are simply not told about the injuries.

Sarah Fitch was given a Caesarean after her baby was found to be breach at her 40-week check-up.

'It wasn't until I changed Sophia's nappy for the first time that I noticed the cut on her bottom - about 2cm long, and looking fairly deep.

'It was a shock. She was a brand new baby. She was crying all the time, and all I could think was: "You poor little thing. No wonder you're screaming."

'I was really worried because the cut was on her bottom and it could easily have got infected from her nappy,' says Sarah, 32, a financial advisor from Hornchurch, Essex.

'There was no explanation or apology. I had to phone the hospital a week later because the wound had not closed properly and it didn't heal for ten days.'

Dangers: Mothers have complained that they were not warned of the riskis of having a Caesarean birth

For some children, the damage is even more serious. Tyler Robinson, now five, was awarded £10,000 in damages after she suffered a 5.3in cut into the muscle of her thigh and buttocks.

It's not just the babies who suffer - the experience can also prove traumatic for their mothers. Janet Davies was so horrified by the injury to her second child, Lucius, she suffered post-natal stress.

'As soon as he was lifted out of my tummy, I noticed there were several people huddled over him,' says Janet, 39, a project manager from Trafford, Manchester.

'When they eventually brought him over to me, I was shocked to see he had a plaster across his cheek, almost up to his eye.

'Initially I was told it was just a nick from when the doctors had cut through the final layer to get Lucius out. But a week later the plaster came off and I saw a huge cut. I was heartbroken.

'When I finally got through to one of the senior midwives at the hospital, she told me: "You took the risk by wanting to have a C-section."

'Then she reminded me that I had signed a consent form - as if I had signed away all my rights. The main priority seemed to be to fend off lawsuits.

'In the weeks after, I became very depressed. At first, I was diagnosed with post-natal depression. But when I started having flashbacks and nightmares about the birth, I was diagnosed with post-traumatic stress.

'Every time I saw the scar - and it became clear it would never fade - it all came flooding back. For the first year, I hardly ever took pictures of him because I found it so upsetting. In the sunlight it's very clear; it's a real ridge at the top of his cheek.'

The risk of a baby being injured during a Caesarean is about 2 per cent, according to the Royal College of Obstetricians and Gynaecologists. Although many of these injuries are superficial, experts say deeper cuts can also put babies at risk of superbug infections such as MRSA.

The problem usually occurs during emergency Caesareans, explains Pat O'Brien from the Royal College.

Occupational hazard: More experienced surgeons are better at judging the thickness of the womb lining

This is because when a woman has been in labour for a long time, her womb lining becomes very thin - as little as a few millimetres thick. And if her waters have also broken, there is no cushion to protect the baby when the incision is made.

Surgeons often have difficulty telling the wall of the uterus and the baby's skin apart - and heavy bleeding can make it difficult to see what they are cutting.

Sailesh Kumar, a consultant obstetrician and gynaecologist at the country's leading maternity hospital, Queen Charlotte's in London, says cuts to babies are more likely during emergency Caesareans because of the rush to get the baby out.

'Cuts are an occupational hazard,' he says. 'Anyone who has done a lot of C-sections and hasn't seen it happen has been very lucky.'

However, the seniority of the surgeon plays a large part, adds Mr Kumar - more experienced surgeons are better at judging the thickness of the womb lining.

There are also techniques that can be used to reduce the risk, he says. For example, the surgeon can use a finger, rather than a scalpel, to pull apart the final layer of the womb.

Another technique is to gently cut along the womb lining with a pair of scissors - while running a finger under the blade to avoid hurting the baby.

For consultant Pat O'Brien - who performs around 200 Caesareans a year - training is the best way to cut the number of injuries.

'Any cut is one too many. It is important to educate junior doctors so they are cautious during that last incision - and they know to use their fingers rather than a knife. Also, the greater the consultant presence on labour wards, the better.'

Mr O'Brien said the issue of whether mothers should be warned beforehand that babies can be cut was a difficult one.

He said: 'There has to be a balance. Women are warned about many other dangers already. You have to be honest and open, but you don't want to scare women witless.

'But what is absolutely clear is that if a mistake of this sort is made, patients should be told and get an apology.'

• www.babycentre.co.uk

Children 'should sleep with parents until they're five'

2009-07-13T20:48:00.001-06:00

This is an older article - but so good.
___________________________________________________________________

May 14, 2006
Sian Griffiths

Margot Sunderland, director of education at the Centre for Child Mental Health in London, says the practice, known as “co-sleeping”, makes children more likely to grow up as calm, healthy adults.

Sunderland, author of 20 books, outlines her advice in The Science of Parenting, to be published later this month.

She is so sure of the findings in the new book, based on 800 scientific studies, that she is calling for health visitors to be issued with fact sheets to educate parents about co-sleeping.

“These studies should be widely disseminated to parents,” said Sunderland. “I am sympathetic to parenting gurus — why should they know the science? Ninety per cent of it is so new they bloody well need to know it now. There is absolutely no study saying it is good to let your child cry.”

She argues that the practice common in Britain of training children to sleep alone from a few weeks old is harmful because any separation from parents increases the flow of stress hormones such as cortisol.

Her findings are based on advances in scientific understanding over the past 20 years of how children’s brains develop, and on studies using scans to analyse how they react in particular circumstances.

For example, a neurological study three years ago showed that a child separated from a parent experienced similar brain activity to one in physical pain.

Sunderland also believes current practice is based on social attitudes that should be abandoned. “There is a taboo in this country about children sleeping with their parents,” she said.

“What I have done in this book is present the science. Studies from around the world show that co-sleeping until the age of five is an investment for the child. They can have separation anxiety up to the age of five and beyond, which can affect them in later life. This is calmed by co-sleeping.”

Symptoms can also be physical. Sunderland quotes one study that found some 70% of women who had not been comforted when they cried as children developed digestive difficulties as adults.

Sunderland’s book puts her at odds with widely read parenting gurus such as Gina Ford, whose advice is followed by thousands.

Ford advocates establishing sleep routines for babies from a very early age in cots “away from the rest of the house” and teaching babies to sleep “without the assistance of adults”.

In her book The Complete Sleep Guide for Contented Babies and Toddlers she writes that parents need time by themselves: “Bed sharing . . . more often than not ends up with parents sleeping in separate rooms” and exhausted mothers, a situation that “puts enormous pressure on the family as a whole”.

Annette Mountford, chief executive of the parenting organisation Family Links, confirmed that the norm for children in Britain was to be encouraged to sleep in cots and beds, often in separate bedrooms, from an early age. “Parents need their space,” she said. “There are definite benefits from encouraging children into their own sleep routine in their own space.”

Sunderland says moving children to their own beds from a few weeks old, even if they cry in the night, has been shown to increase the flow of cortisol.

Studies of children under five have shown that for more than 90%, cortisol rises when they go to nursery. For 75%, it falls whenever they go home.

Professor Jaak Panksepp, a neuroscientist at Washington State University, who has written a foreword to the book, said Sunderland’s arguments were “a coherent story that is consistent with neuroscience. A wise society will take it to heart”.

Sunderland argues that putting children to sleep alone is a peculiarly western phenomenon that may increase the chance of cot death, also known as sudden infant death syndrome (Sids). This may be because the child misses the calming effect on breathing and heart function of lying next to its mother.

“In the UK, 500 children a year die of Sids,” Sunderland writes. “In China, where it [co-sleeping] is taken for granted, Sids is so rare it does not have a name.”

Increase pregnancy chances with a maca root supplement

2009-07-09T19:17:00.000-06:00

Struggling with fertility issues? Recent studies indicate a root vegetable in the form of a tablet or powder may increase chances of conception when added to a couple’s diet.

Another natural and organic supplement that makes claims of successfully increasing fertility is called maca (Lepidium meyenii). It comes in the form of a tablet or powder and appears to be receiving high accolades. This root-like vegetable, shaped like a turnip grows at 12,000 feet above sea level. It is grown in the higher altitudes of the Andes.

Native Peruvians have successfully used maca root for hundreds of years in an effort to affect fertility at higher altitudes. This supplement can be used by both the man and woman.

Numerous small studies have been conducted on the use of maca. One study included nine men who received maca tablets between 1500 and 3000 mg/day) for 4 months depending upon their weight and size. Their levels were measured before and after treatment.

After using a maca supplement for four months, their seminal volume increased as did their sperm count per ejaculation. Sperm motility showed positive response as well.

Progesterone levels in women are essential to carry a healthy pregnancy to term. Maca root supplements work for women by attempting to control estrogen levels from becoming too high, thus causing progesterone levels to plummet possibly leading to miscarriage.

Increasing egg health and viability, normalizing hormonal balance, increasing seminal volume, increasing sperm count and motility may be as simple as adding this supplement to one’s diet. The cost for 100 tablets runs approximately $25 and about $20 for the powder.

Author: Cindy Ferda

Why Cindy Crawford Chose Homebirth

2009-07-09T10:15:00.001-06:00

Check out this short video on how Cindy Crawford came to the homebirth choice.

Breastfeeding Protects Tiny Intestines

2009-07-03T09:31:00.000-06:00

(Ivanhoe Newswire) – An ingredient found in breast milk produced in the first few days after birth helps protect tiny intestines and get them ready for a lifetime of eating and drinking.

British researchers discovered the effect of pancreatic secretory trypsin inhibitor – or PSTI – by first testing breast milk samples for the ingredient and then assessing its ability to affect intestinal cells in the lab.

While PSTI continued to be found in breast milk throughout breastfeeding, it was seven times more concentrated in the early milk, known as colostrum. When intestinal cells were damaged in the lab, PSTI helped to form a protective layer over the damaged area and, what’s more, prevented further damage from occurring.

PSTI has been known for its role in the pancreas for years, where it helps protect the organ from digestive enzymes.

“This study is important because it shows that a component of breast milk protects and repairs the babies’ delicate intestines in readiness for the onslaught of all the food and drink that are to come,” study author Ray Playford, from the University of London, was quoted as saying. “It reinforces the benefits of breastfeeding, especially in the first few days after birth.”

SOURCE: American Journal of Physiology. Gastrointestinal and Liver Physiology, published online June 29, 2009

Why the Chickenpox Vaccine is Nuts

2009-07-02T07:59:00.002-06:00

Another great article on a common vaccine that many of us give our babies without thinking twice.

Like I have said before - I am in no ways anti-vaccine. I am pro-know what you are injecting in your child, what the potential side effects are, and what is the success rate of that particular vaccine.

An Alternative View of Whooping Cough

2009-07-02T07:48:00.003-06:00

Check out this great article on whooping cough and the vaccine used against it.

Our family dealt with whooping cough in the fall of '03. My fully vaccinated daughter came down with it and then passed it on to her siblings, the youngest of which was just under 4 mos old and 10 lbs. The baby spent one week in the PICU (she was never left alone) at my request for monitoring, but recovered completely.

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

2009-06-30T08:44:00.000-06:00

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

2009-06-29T18:08:00.002-06:00

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

2009-06-28T08:58:00.002-06:00

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

2009-06-27T08:58:00.001-06:00

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

2009-06-23T10:13:00.000-06:00

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

2009-06-22T01:34:00.000-06:00

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

2009-06-21T05:19:00.000-06:00

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.
___________________________________________________________________

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

2009-06-20T17:12:00.001-06:00

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!
___________________________________________________________________

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

2009-06-19T10:47:00.001-06:00

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?

2009-06-18T13:23:00.002-06:00

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

2009-06-18T11:27:00.003-06:00

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 timessafer riding rear-facing in a car safety seat up to their secondbirthday. Following are some safety tips for car seat use:

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

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

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

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

Homebirth Slideshow

2009-06-17T14:23:00.001-06:00

Check out this homebirth slideshow.
The images are beautiful!

Neonatal Outcomes May Be Better With Vaginal Birth After Cesarean Delivery

2009-06-15T15:08:00.001-06:00

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

2009-06-15T10:41:00.003-06:00

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

Eye Opening

2009-06-13T01:27:00.001-06:00

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?