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.
Showing posts with label studies. Show all posts
Showing posts with label studies. Show all posts
Thursday, July 1, 2010
Friday, March 19, 2010
Research
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
Friday, January 29, 2010
Babies who are Breastfed as Infants Make Better Teens
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.
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.
Sunday, January 24, 2010
Pot smoking during pregnancy may stunt fetal growth
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.
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.
Saturday, January 23, 2010
No need for pregnant women to fast during labor
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.
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.
Sunday, January 3, 2010
Sunday, December 13, 2009
Breastfeeding lowers diabetes risk in new moms
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.
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
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)
Wednesday, October 21, 2009
Lengthy pacifier use can lead to speech problems
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.
___________________________________________________________
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
Monday, September 28, 2009
New studies say spanking lowers IQ
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.
Sunday, September 27, 2009
CDC Says Cesarean Triples Neonatal Death Risk
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
Costumes | Party Ideas | Kids and Safety | Movies and Music | Scary Stories | More »
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
Costumes | Party Ideas | Kids and Safety | Movies and Music | Scary Stories | More »
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.
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
Costumes | Party Ideas | Kids and Safety | Movies and Music | Scary Stories | More »
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
Costumes | Party Ideas | Kids and Safety | Movies and Music | Scary Stories | More »
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.
Friday, August 14, 2009
Low Choline Level in Pregnancy Tied to Birth Defects
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.
Monday, July 27, 2009
Fruits, Vegetables May Protect Against Upper Respiratory Tract Infection During Pregnancy
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.
Saturday, June 20, 2009
Acupuncture Soothes Heartburn in Pregnant Women
I have used acupuncture in my practice in the past with great results. Never had I thought to recommend it for heartburn - which most of my clients suffer from at some point in their pregnancies. Good to know!
___________________________________________________________________
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."
___________________________________________________________________
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."
Thursday, June 18, 2009
Is the Cord Around the Baby's Neck Really Dangerous?
May 19, 2008 by Misha Safranski
As a confirmed birth junkie, I have heard over and over again birth stories where the baby was born by cesarean for either fetal distress or failure to descend, and the difficulties are blamed on "the cord was around the baby's neck". Is this condition - scientifically termed "nuchal
cord" - actually dangerous? A new study backs up previous research showing that nuchal cord is not the threat it's perceived to be.
A study published this year in the Journal of Perinatal Medicine showed there were no statistically significant differences in outcomes of post-term pregnancies involving a nuchal cord verses no nuchal cord. Drs. Ghosh and Gudmundsson performed color ultrasound on 202 women with post-term pregnancies. Nuchal cords were detected in 69 of the women. There were no significant differences in Apgar scores, umbilical cord anomalies, cesarean section, perinatal death or admission of the baby to the NICU (neonatal intensive care unit).
These findings confirm what has been found in most of the past research on nuchal cord outcomes. A 2006 study from the Archives of Obstetrics and Gynecology was on a much larger scale, looking at the outcomes of 166,318 deliveries during a 15 year study period, 24,392 of which had a documented nuchal cord at birth. The authors, Sheiner et. Al, conclude: "Nuchal cord is not associated with adverse perinatal outcome. Thus, labor induction in such cases is probably unnecessary."
The interesting thing about the Sheiner study is that despite the equivalent outcomes among nuchal cord babies and those without the cord wrapped around the neck, there were higher rates of labor induction and non-reassuring fetal heart tones during labor among the nuchal cord cases.
These two factors are most likely related. We know without a doubt that induction of labor can cause fetal distress. The fact that there were higher induction rates in the nuchal cord group could very well explain the higher rate of transient fetal distress. Induction is nearly always accompanied by AROM (artificial rupture of membranes), which can cause undue pressure on the cord, which can in turn result in blips in the hearttones. Regardless of the cause, the outcomes were still good.
Finally, we look at yet another study which demonstrated that nuchal cord does not result in worse outcomes. In a 2005 study looking at the effects of nuchal cord on birthweight and immediate neonatal outcomes, Mastrobattista, et. Al examined the outcomes of 4426 babies, 775 of whom had a nuchal cord. They found that there were no significant differences between the two groups in birthweight, non-reassuring fetal hearttones, Apgar scores below 7, or operative vaginal deliveries. The cesarean rate was actually highest among the women whose babies did not have a nuchal cord.
The most important thing to keep in mind is that unborn babies do not breathe through their mouth and neck - they receive oxygen through the umbilical cord. This is why it normally doesn't matter if the cord is around the neck (unless the cord is being compressed too much, which is fairly rare). The baby cannot "choke to death" before she/he is born. What we can conclude from the overwhelming majority of data is that nuchal cord - or "cord around the neck" - is not pathological; that is to say, it's not an abnormality. It is a normal condition of the umbilical cord and typically causes no problems with the delivery, even though doctors frequently try to convince parents otherwise.
References:
J Perinat Med. 2008;36(2):142-4. Nuchal cord in post-term pregnancy - relationship to suspected intrapartum fetal distress indicating operative intervention. Ghosh GS, Gudmundsson S. Department of Obstetrics and Gynecology, Malmö University Hospital, Malmö, Sweden.
Arch Gynecol Obstet. 2006 May;274(2):81-3. Epub 2005 Dec 23. Nuchal cord is not associated with adverse perinatal outcome. Sheiner E, Abramowicz JS, Levy A, Silberstein T, Mazor M, Hershkovitz R. Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel. sheiner@bgu.ac.il
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
Monday, June 15, 2009
Neonatal Outcomes May Be Better With Vaginal Birth After Cesarean Delivery
News Author: Laurie Barclay, MD
CME Author: Charles Vega, MD, FAAFP
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.
Friday, June 12, 2009
Pain Medications Used in Childbirth: Effects on Mother, Baby, Breastfeeding and Bonding
June 11, 2009 by
Denise Hibben The medications most commonly used in hospital labor and delivery wards in the US are: Demerol (meperidine), Morphine, Stadol (butorphanol), Fentanyl, Nubain(nalbuphine). It should be noted that Demerol and Morphine are not commonly used as much as Stadol, Fentanyl, and Nubain. The anesthetics that are more common in epidurals are Lidocaine (xylocaine), and Bupivicaine (marcaine, marcain).
The benefits are obvious to the relief of pain in childbirth... relief of pain. If a mother has been in labor for a very long time and is exhausted, an epidural can make the difference between a vaginal birth and a cesarean section, by allowing her some relief so she can sleep and gain new strength. Pain relief can relax a laboring mother enough that her contractions become more effective and allow her labor to progress more efficiently. In the rare case of soft tissue dystocia that is purely physiological, pain medications may resolve it, as long as there are no emotional factors to consider.
Let us go over some of the general adverse effects of using pain relief and epidurals during labor and birth. Keep in mind that these are the adverse effects that are general among all of the more commonly used medications. Both mother and baby can experience these: sleepiness, sedation, dizziness, constipation, sleep problems, insomnia, nausea, vomiting, stomach pain, diarrhea, loss of appetite, memory problems, sweaty, clammy skin, headache, breastfeeding difficulties, bonding difficulties, and withdrawal symptoms.
These are the less serious side effects of the pain medications commonly used.
Some of the more serious adverse effects include: increased need to resuscitate newborns at birth, breathing difficulties in mother and newborn, very rapid heartbeat, very slow heartbeat, confusion, seizures, hallucinations, severe allergic reactions, numbing of face and extremities. These adverse effects are seen in both the mother and the baby.
It is known that these pain medications cross the placenta and affect the baby before birth. Most women who birth in the hospital will be offered these medications sometime during their labor, unless you have specifically requested that these not be offered. Some studies show that 90% of
healthy, low-risk women who birth in hospitals will have narcotic pain medications and/or an epidural during labor. This means that 90% of healthy infants born in hospitals are born drugged! Clearly information has not been shared with these mothers of the side effects of these medications.
Babies who are exposed to narcotics have stress put on their kidneys and livers as they try to metabolize the drugs. This can cause problems as well, considering that their livers and kidneys are still immature.
Physiological effects of Epidurals in labor
Epidurals are used to numb the nerves from the waist down during childbirth. An anesthetic/narcotic combination is injected into the dural space of the spinal column via catheter, which is in place throughout labor and delivery. Granted it can be an extreme relief during the pain of labor, but it is known to increase the length of labor and the second (pushing) stage, the need for forceps or vacuum assisted birth, episiotomy, and c-section. Those have an entire range of risks in and of themselves. It is also known to cause maternal fever and low blood pressure.
Because a woman is numbed by the epidural, she is not able to get up and move around during labor. This can cause labor to last longer and she may not be able to push as effectively because she cannot feel where to push.
Pain Medications and Breastfeeding
It is known that all of the narcotic medications used in labor and birth are exuded in Breastmilk. This means not only is the newborn baby getting an adult dose during labor, but also with the first feeding. Hence the sleepy baby that is more commonly seen in hospitals. Babies born without narcotics have a better latch during breastfeeding, are more alert and responsive during the first hours after birth, have less feeding problems and crying spells in the first 8 weeks of life, and are in general healthier, happier, and more content. American Academy of Pediatrics has taken the position that it is safe to breastfeed after receiving narcotics during labor, although they have stated that if a mother is prescribed these medications after birth, while still breastfeeding, it is recommended that the risks to the baby and the benefits to the mother should be weighed before taking these medications.
Some medications are known to actually hinder successful breastfeeding; in fact the drug Fentanyl is one of these.
Pain Medications and Bonding
To put it simply, it is hard to bond with someone who is so drugged that they can't respond in a normal fashion to us. This is not to say that women who use pain medications in labor love their babies less, it is just harder to get to know them.
Babies who are exposed to pain medications during labor and birth actually spend more time away from their mothers in the first hours of life than their non-drugged counterparts. This is due to the aforementioned adverse effects caused by narcotics.
This article is not meant to be a scare tactic. It is simply meant to educate, and hopefully encourage research by pregnant women as to the medications used to relieve pain during labor and birth.
Sources
Drugs in Pregnancy and Lactation, 5th Ed
Maternal-Newborn Nursing, 7th Ed.
Medications and Mothers Milk, 12th Ed.
Varney's Midwifery, 4th Ed
www.rxlist.com
www.drugs.com
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T8N-4G0M55R-3S&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=45b0c0e06fd406bfc694e8d4aa80a0db
http://www.redorbit.com/news/health/182842/fentanyl_during_labor_may_impede_breastfeeding/
http://www.medicalnewstoday.com/articles/58772.php
Thursday, June 11, 2009
Study Suggests Breastfeeding Lowers Chance of MS Relapse
According to a new report issued by U.S. researchers, breastfeeding may help women with multiple sclerosis avoid relapses.
The researchers discovered that MS patients who nursed babies for two months, and did not use bottled formula, were less likely to relapse within a year of their child’s birth, than women who were not breastfeeding their children.
"It is well-known that women with MS have fewer relapses during pregnancy and a high risk of relapse in the postpartum period," said the researchers.
The report appears in the Archives of Neurology.
The women were also advised to not take their MS medication during pregnancy or while breastfeeding. The women could choose between nursing or using formula if they wished to restart their treatment immediately after giving birth.
It is recommended by the American Academy of Pediatrics that women breastfeed exclusively for the first six months of a baby's life and for nursing to continue for at least a year.
Dr. Annette Langer-Gould, of Kaiser Permanente Southern California in Pasadena, and her team studied 32 pregnant women with MS and 29 pregnant women without MS.
Almost 96 percent of the healthy women nursed their children, while 69 percent of the MS patients nursed.
The researchers found that 87 percent of the women with MS who did not nurse, or used formula within the first two months, had a relapse, while only 36 percent of those who breastfed for at least two months relapsed.
The women who nursed exclusively delayed normal menstruation, and did not see MS symptoms return.
"Studies of immunity and breastfeeding, while plentiful, are predominantly focused on breast milk content and health benefits to the infant. Little is known about maternal immunity during breastfeeding," the researchers noted.
Multiple sclerosis occurs when the immune system attacks the sheath protecting nerve cells.
The disease affects 2.5 million people worldwide, causing mild illness in some, and permanent disabilities in others.
The researchers discovered that MS patients who nursed babies for two months, and did not use bottled formula, were less likely to relapse within a year of their child’s birth, than women who were not breastfeeding their children.
"It is well-known that women with MS have fewer relapses during pregnancy and a high risk of relapse in the postpartum period," said the researchers.
The report appears in the Archives of Neurology.
The women were also advised to not take their MS medication during pregnancy or while breastfeeding. The women could choose between nursing or using formula if they wished to restart their treatment immediately after giving birth.
It is recommended by the American Academy of Pediatrics that women breastfeed exclusively for the first six months of a baby's life and for nursing to continue for at least a year.
Dr. Annette Langer-Gould, of Kaiser Permanente Southern California in Pasadena, and her team studied 32 pregnant women with MS and 29 pregnant women without MS.
Almost 96 percent of the healthy women nursed their children, while 69 percent of the MS patients nursed.
The researchers found that 87 percent of the women with MS who did not nurse, or used formula within the first two months, had a relapse, while only 36 percent of those who breastfed for at least two months relapsed.
The women who nursed exclusively delayed normal menstruation, and did not see MS symptoms return.
"Studies of immunity and breastfeeding, while plentiful, are predominantly focused on breast milk content and health benefits to the infant. Little is known about maternal immunity during breastfeeding," the researchers noted.
Multiple sclerosis occurs when the immune system attacks the sheath protecting nerve cells.
The disease affects 2.5 million people worldwide, causing mild illness in some, and permanent disabilities in others.
Study Links Breastfeeding to Better Academic Performance
Newswise — Breastfeeding leads to better academic achievement in high school and an increased likelihood of attending college, according to a new study by American University professor Joseph Sabia and University of Colorado Denver professor Daniel Rees.
The study, published June 11 in the Journal of Human Capital, looked at the academic achievement of siblings—one of whom was breastfed as an infant and one of whom was not—and discovered that an additional month of breastfeeding was associated with an increase in high school GPA of 0.019 points and an increase in the probability of college attendance of 0.014.
According to the study, which used data from the National Longitudinal Study of Adolescent Health, more than one half of the estimated effect of being breastfed on high school grades and approximately one-fifth of the estimated effect on college attendance can be linked to improvements in cognitive ability and health.
“The results of our study suggest that the cognitive and health benefits of breastfeeding may lead to important long-run educational benefits for children,” said Sabia, a professor of public policy in AU’s School of Public Affairs whose research focuses on health economics. “But this is just a start. Much work remains to be done to establish a definitive causal link.”
Professors Sabia and Rees examined the breastfeeding histories and high school grades of 126 siblings from 59 families. Information on high school completion and college attendance data was obtained from 191 siblings belonging to 90 families.
By comparing the academic achievement of siblings, this study was able to account for the influence of a variety of difficult-to-measure factors such as maternal intelligence and the quality of the home environment. This is the first study to use sibling data in order to examine the effect of breastfeeding on high school completion and college attendance.
“By focusing on differences between siblings, we can rule out the possibility that family-level factors such as socioeconomic status are driving the relationship between having been breastfed and educational attainment,” said Rees, an economics professor.
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