Friday, October 24, 2008

Petition for Preemies

The March of Dimes is sponsoring a Petition for Preemies as part of this October's Prematurity Awareness Month.

Prematurity is the leading cause of infant mortality in the US. The petition consists of 4 calls-to-action:

  • Increasing federal government support of research and data collection on prematurity, to discover the causes of prematurity, to test prevention methods, to improve outcomes and treatment options for premature infants, and to better understand the factors in premature birth

  • Expanding access to quality healthcare and devoting more resources to smoking cessation programs

  • Urging hospitals and physicians to voluntarily assess c-sections and inductions before 39 weeks to examine adherence to professional guidelines

  • Calling on businesses to support mother and infant health by respecting the March of Dimes' 14 recommendations.

To date, they have acquired 67961 signatures - what number is yours?

Thursday, October 23, 2008

Antibiotics for Preterm Labor Carry Long-Term Risk for Babies

New research shows that antibiotics given during apparent premature labor, without ruptured membranes or detectable infection, provide no benefit and may cause long-term harm to children

Cerebral palsy was present nearly twice as much in children at age 7 whose mothers received erythromycin during spontaneous preterm labor. An increase in risks was also seen with a combination of amoxicillin and clavulanate (co-amoxiclav), although it was lower. Among 1,611 children exposed in utero, 3.3% had cerebral palsy at age 7, compared with 1.7% of children in the control group or those exposed to co-amoxiclav alone.

In addition, the children were also at increased risk of functional impairment, which includes abnormalities such as difficulties with learning, walking, eyesight and other more extensive disabilities. 42.3% of children in the erythromycin group demonstrated some type of functional impairment.

For women with ruptured membranes but no signs of clinical infection, antibiotics neither improved nor increased risks.

The researchers calculated that one child would experience harm for every 64 mothers treated with erythromycin while 1 child would experience harm for every 79 mothers who received co-amoxiclav alone.

In the U.S., guidelines from ACOG recommend a combination of amoxicillin and erythromycin for women with preterm membrane rupture but neither the ACOG nor RCOG guidelines in England address the use of antibiotics for women in preterm labor whose membranes have not ruptured.

In response to the new study, Alison Bedford Russell, M.B.B.S., B.Sc., of Warwick Medical School, and P.J. Steer, M.D., of Imperial College London stated:

"The lessons to be learned seem clear: contrary to popular opinion ('might as well give them, they don't do any harm'), antibiotics are not risk free,".

The moral of the story: interventions should be used with discretion and follow the purpose to which research has shown them to be effective. More isn't always better.

Wednesday, October 22, 2008

Birth Summit To Be Held In Chicago

A Historic Birth Summit will be held in Chicago on November 8, 2008 at the O'Hare Hilton, in the hometown of the American Medical Association.

This historical summit was called in response to the ACOG/AMA joint proclamation (resolution 205 A-08), which sought to draft model legislation to outlaw homebirth and purported that "the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers".

The summit will bring together birth activists, nurses, physicians, midwives, childbirth educators, doulas, and lactation consultants to will set the evidence-based record straight regarding midwifery care and childbirth in hospital settings in the US.

Despite their strong stand and numerous requests for the reasoning behind their proclamation, the ACOG/AMA could not cite research to support their opinion that hospitals are the safest setting for childbirth, because there is simply no research to support their stance.

At the conclusion of the summit, a joint evidence-based announcement will be made to refute the AMA/ACOG proclamation, highlight its inaccuracies, and the impact that enacting such legislation would have on an expectant mother’s right to choose her caregiver and place of birth.

All I can say is, give 'em hell....

Tuesday, October 21, 2008

Impact of Initial Miscarriage on Future Pregnancies

A new study from the University of Aberdeen studied the impact that an initial miscarriage can have on a woman's next pregnancy.

Results revealed that a woman is 3.3 times as likely to have preeclampsia and 1.5 times as likely to have a premature baby. Women who previously had a miscarriage were 1.7 times as likely to experience bleeding or other signs of threatened miscarriage and 1.3 times as likely to experience bleeding later than 24 weeks gestation.

In a study of 33,000 women published in the British Journal of Obstetrics and Gynaecology, women who suffered a single miscarriage experienced nearly double the rate of inductions and 6 times as many instrumental deliveries with forceps or vacuum extraction.

Preterm birth after 34 weeks and birthweight less than 2500 grams was 1.6 times as likely.

Professor Philip Steer, BJOG editor-in-chief stated:

"The findings from this research are helpful to healthcare professionals caring for pregnant women.

"They provide us with an idea of the complications that may arise as a result of a previous miscarriage. This will help doctors in the management of the subsequent pregnancy."

One factor not assessed was the span of time between pregnancies, which does not decrease substantially until 1.5-2 years and increases with less than 6 months between pregnancies.

The moral of the story...don't let a care provider dismiss your concerns if you've suffered a past miscarriage. Most women go on to have successful pregnancies, but a past history of miscarriage can increase the risks with subsequent pregnancies.

Monday, October 20, 2008

Birth Trauma Impacts Breastfeeding

A new study shows that up to 1/3 of women reported a traumatic childbirth experience, with up to 9% reportedly experiencing Post Traumatic Stress Disorder (PTSD), which can cause women to limit future reproduction, damage their ability to bond with their babies, and leave them permanently psychologically scarred.

Results showed that women who suffered a traumatic birth experience went down two paths regarding breastfeeding: they either embraced it as a way to "prove" themselves as a good mother after a difficult birth and steeling their resolve to breastfeed, or for others, it caused intrusive flashbacks, detachment, and physical pain that ultimately caused them to cease breastfeeding.

The authors concluded that:

...intensive one-on-one support for traumatized mothers may be necessary to help them establish breastfeeding. Sensitivity and awareness by medical professionals of the traumatized mother’s needs may also be helpful.

It was also suggested that healthcare providers be more aware to the signs of a traumatic birth, including temporary amnesia, remaining detached and poor eye contact/a dazed look.

The research study: “Impact of Birth Trauma on Breastfeeding – A Tale of Two Pathways,” appears in the July/August 2008 issue of Nursing Research and was co-authored by Cheryl Tatano Beck, Board of Trustees Distinguished Professor of Nursing and Sue Watson, chairperson of the Trauma and Birth Stress charitable trust.

Sunday, October 19, 2008

New Research on Maternal Diet and Obesity in Babies

High Fat Maternal Diet Linked to Obesity in Babies

In an animal study from the University of Cincinnati and the Medical College of Georgia, researchers found that mice fed high-fat were more likely to have larger-than-average babies, which is a risk factor for being overweight or obese later in life.

They found that a high-fat causes the placenta to go into "overdrive" and sends too many nutrients to the baby developing in utero.

On a positive note, they also theorized that putting women on a high-fat diet may help to reduce the number of low birth weight babies.

In either case, this new research yet again highlights the importance of nutrition during pregnancy and the long-term effects it can have, for better or for worse, on your baby's life. Sadly, most obstetricians pay lip service to providing expectant women with detailed nutritional guidance during their pregnancies. Increased attention to nutrition could be the catalyst to preventing life-long complications for children and subsiding the obesity epidemic in many countries.

Saturday, October 18, 2008

Meta-analysis Shows VBAC Improves Outcomes over Repeat Elective Cesarean Section

Maternal Morbidity following a Trial of Labor after Cesarean Section vs Elective Repeat Cesarean Delivery: a Systematic Review with Meta-analysis

A new meta-analysis showed that while VBAC carries a greater, although still low risk (1.3%) of uterine rupture/dehiscence than repeat elective cesarean section, the risk is counterbalanced by lowered rates of maternal morbidity, uterine rupture/dehiscence and hysterectomy with successful VBACs.

The research also showed that the majority of women who attempted VBAC were successful (73%).

I have to wonder how much higher that number would be if women had true access to an evidence-based approach to childbirth without unnecessary interventions, and truely supportive providers.

Regardless, the evidence continues to overwhelm with support that VBAC should be a viable option in the majority of cases and that repeat elective cesarean section carries risks greater than or equal to VBAC.

It's time to lay the "once a c-section, always a c-section" myth to rest. Period.

Friday, October 17, 2008

Hidden Risks of Down Syndrome Screening

Down Syndrome Screening Causes 2 Miscarriages for Every 3 Cases Detected

New research to be published in the Down's Syndrome Research and Practice Journal found that the miscarriage risk from amniocentesis and chorionic villus sampling (CVS) carried a 1-2% risk of miscarriage of typically developing infants.

The tests are usually only offered to women considered at risk; however due to the wide initial screening threshold, over 95% of women determined to be at risk will go on to have the tests and find that the results are negative.

The mindset behind the screenings is to "help women make informed decisions about their pregnancies". The research also called the skill and experience of those administering the procedures into question.

Before consenting to these or other procedures, ask yourself if knowing about the condition would change your plan of action for the pregnancy. If the answer is no, then consider refusing such screenings.

Many women choose the screenings to give themselves time to mentally and emotionally prepare to care for a child with special needs. However, due to false positives, some families are told their infants will have such conditions only to find that after months on end of worry, their fears were unfounded.

The moral of the story is to make informed decisions. If you know the risks of the screenings outweigh the benefits to your family, then don't hesitate to refuse them. You are your child's first advocate. Parenting begins with the decisions you make in pregnancy.

Choose well, choose wisely.

Saturday, October 11, 2008

Upcoming Special on Out-of-Hospital Birth

I received the query below for an upcoming special on out-of-hospital birth. If you can help or know someone who would be interested in sharing their story, please spread the word:

My name is Zach Marion and I work at Video Arts Studios in Fargo, ND. We produced the series House of Babies for the Discovery Health Network. Under the guidance of master midwife, Sheri Daniels, at the Miami Maternity Center, the show follows couples during their pregnancy and ends with the delivery of their baby. It was very instrumental in raising awareness about non-clinical birthing practices on a national level.

Recently we have been approached to create a one-hour special on unique birthing practices worldwide. We are looking for families that would like to share their story on camera from pregnancy to delivery. Ideal candidates are expecting mothers due in and around early January that are planning to give birth outside of a clinic or birth center. This includes home births and beyond. The point of the show is to raise awareness about the alternative birthing options in the U.S. with the help of a midwife. Hopefully, the special creates a healthy dialogue among midwives, doctors, to-be parents, and the general public. Stories that are of particular interest are those that include interesting traditions during pregnancy and unique backdrops during delivery. For example, a Hindu family that wants to deliver outside or a family of hippies that are pursuing a home birth in a tent.

As you can imagine, access is usually the greatest struggle. Our presence at the birth goes nearly unnoticed. This unobtrusive nature was learned through experience gained while producing 26 episodes of House of Babies.

Do any clients spring to mind that might want to be a part of this project? Any and all contact leads are much appreciated. Feel free to contact me by phone with inquiries or information. I am available during weekdays between 8 and 5 CST. Thank you for your time.

Zach Marion
Video Arts Studios
1440 4th Avenue North
Fargo, ND 58102
(701) 232-3393

Saturday, October 4, 2008

Dr. Diabolic and the God Complex

Recently, I happened upon a heated discussion (or rant) by a physician [and I do use the term loosely] on the "unfortunate" occurrence of women having a say in their childbirth choices. His post and the comments of fellow physicians crystallize the flaws in our current system and its misogynistic treatment of women.

My response to their litany appears below:

Yes, there is plenty of clinical research going on....but what good is research if OBs don't follow the evidence in their practice.

All of the following procedures/routines have been shown to be at best, unnecessary, and at worst, harmful, to birthing women, yet they are still standard practice for much of the OB community:

  • Episiotomy

  • Pushing in Lithotomy position

  • Cytotec for Induction or PPH

  • Continuous Electronic Fetal Monitoring

  • Routine Induction before 42 wks

  • Manual Cord Traction

  • Early Cord Clamping

  • C-section for "Big Babies"

  • Late Term Ultrasound for Fetal Weight Estimates

to name a very few. I have to wonder how the physicians above can claim to practice "science based medicine" when standard practice is rife with such non-evidence based procedures.

By even referencing the first example of the woman whose baby was "too big to fit" as a defense of their position that women should just shut-up-and-listen-to-everything-the-big-smart-doctor-says, these medical professionals have proven how fallible they truly are.

There is no evidence to support that suspected fetal macrosomia can reliably be diagnosed without a trial of labor [and one that does not have a woman flat down on her back tethered to an IV with an EFM belt strapped to her abdomen]. Furthermore, there is no evidence to support that weight is a predictor of which babies will fit, as the circumference of the head and shoulders is a more accurate indication than weight alone.

As posted above, the indication would have been shoulder dystocia, which most appropriately could have been resolved with use of the Gaskin maneuver (gasp! an evidence-based procedure from midwife Ina May Gaskin), which could have prevented the baby from being born floppy and requiring resuscitation.

But rather than employ evidence-based medicine, the physician in question had a tantrum about the patient delaying/refusing a [non-evidence based] c-section. He did not attempt to employ any other methods to prevent problems from occuring since he had already [inaccurately] determined a c-section to be the fast, easy and sole solution, the only one acceptable to him. Rather than acknowledging his own errors in judgment, he then blamed the patient for wanting a certain "experience" over a healthy baby.

The plain truth is that her motivations most likely did not arise from any desire for a certain experience, but in a desire to escape non evidence-based interventions.

With evidence-based care, she could have had both a positive experience and a healthy baby.


Contrary to expecting perfection, it is my realization that doctors and specifically to this discussion, OBs, are mere mortals - as human as the next person - which makes me question their recommendations, just as any good consumer would do.

They are just as prone to make decisions based on their own comfort and agenda as the rest of us. There is no higher standard to which they hold themselves, nor should we. They lie to get want they want and to force an outcome in their best interest, which is something all humans are guilty of at one point or another.

It is this realization, that OBs don't always provide care based on the best interests of the patient [because they are fallible humans by nature] nor that their advice is always based on the evidence, whether intentional or not, which makes me question their judgment and motives when providing maternity care.

Women cannot accept their doctor's advice at face value, which is something doctors should acknowledge and accept of them as consumers. In no other arena would people be expected to take what is said as the gospel truth, infallible and without question.

However, physicians are creating a double standard by arguing their humanity while condemning women for questioning their judgment. These two principles are mutually exclusive. One cannot claim infallibility while professing humanity.


To address the issue of litigiousness and liability, I can't help but think physicians have spawned this monster. By perpetuating the use of non evidence-based practices [some of which are proven to cause harm], they create complications that wouldn't have presented otherwise, including failure to progress, fetal distress by aggressive induction, PPH by manual cord traction, and the list goes on.

By asserting that women are not capable of fully understanding and making their own healthcare decisions, they are by extension saying that a doctor's judgment is paramount. Thus, any and all bad outcomes would be the doctor's responsibility, as they are claiming women don't have the ability to make these informed decisions.

In actuality, it is the doctor's responsibility to obtain true informed consent from his patients before any and all procedures by explaining the risks and benefits in a way she can understand. If a woman does not understand her options, it is because the doctor has not done his job.

In either case, the physician is responsible, for either taking the decision out of her hands, ingnoring her decision when it conflicts with his own, or denying true access to informed consent so that an informed decision can be made, even one that is contrary to the physican's determination of "doctor knows best".


Until the system is changed to give the locus of control back to birthing women, we will continue to see this downward spiral in the quality of our maternity care, of excessive infant mortality rates, increasing maternal mortality rates and skyrocketing rates of interventions as standard practice.

For a country that spends in excess of $50 billion per annum on maternity care, more than any other nation in the world, we have pathetic outcomes to show for it.

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