Guest Post: Popular Drugs Pose Serious Risks When Taken During Pregnancy

My thanks to DrugWatch.com, a comprehensive website database that includes up-to-date information about prescription and over-the-counter medications and potential side effects to aid in the protection of patients and consumers, for this week's guest post:

Popular Drugs Pose Serious Risks When Taken During Pregnancy

According to the Centers for Disease Control and Prevention, approximately one in every 33 babies is born with a birth defect. A disturbing number of these are caused by the use of dangerous medications during pregnancy, and many can be prevented through greater awareness and safer practices.


Throughout the history of modern medicine, a number of popular medications have been linked to serious birth defects and fetal death after they have been on the market for quite some time. Some of the most widely prescribed include thalidomide, a medication used during the mid 1900s as a sedative and antiemetic agent, and Accutane, a medication used since the 1980s to treat severe acne. Clinical studies have shown that even a single dose of these medications taken during pregnancy can result in birth defects.


Many women who have suffered because of these medications have sought legal recourse against drug manufacturers through the use of a Thalidomide or Accutane lawyer. Consumer advocates have argued that in a number of instances, negligent drug companies have hidden or downplayed serious risks posed to pregnant women by their medications.


Even as efforts to protect pregnant women against such dangerous medications have grown, many measures taken by drug companies and the U.S. Food and Drug Administration (FDA) have fallen short. In the case of Accutane, even after the FDA required women taking the medication to use two forms of birth control and enroll in a mandatory registry, approximately 120 enrolled women reported pregnancies every year.


Experts around the nation continue to express astonishment and concern over the amount of dangerous drugs used by many pregnant women today. In today's environment of ubiquitous medication use, health care professionals are instructing women to speak with their doctor before taking any new medication, regardless of whether it is available by prescription or over-the-counter. Because even common pain medications such as Aleve and Aspirin can cause harm to a developing baby, patient advocates are warning women to air on the side of caution for their own safety and the safety of their baby.


For more information on drugs that can cause harmful effects during pregnancy, visit DrugWatch.com.

ACOG Steps Up the Anti-Homebirth Game

If ACOG were a dog breed, it would be a pit bull - tenacious and aggressive when threatened.


Their latest tactics include soliciting failed homebirth stories, with or without negative outcomes, via their website. It speaks volumes about their commitment to impartial, evidence-based policies backed in rigorous research evidence, doesn't it, that they aren't also asking for statistics on successful homebirths. It's a one-sided petition that suits their politics perfectly.


From the ACOG site:

Reporting of Unsuccessful Attempts at Home Delivery with or without Adverse Consequences

In 2006 there were 24,970 home deliveries reported in the United States[1]. Obstetrician-gynecologists and other members of the medical community may be faced with the presentation of an obstetrical patient who has attempted home delivery unsuccessfully. The need exists to quantitate the frequency and information of these events. The goal of this registry is to attempt to quantitate when home delivery is unsuccessful and what the outcomes are. To be HIPPA-compliant, no identifying information will be requested. Data points include the state of occurrence, as well as the month and year of delivery, maternal and gestation age, gravidity and parity and obstetric or neonatal complications. An attempt to identify the home attendant type if known will also be useful data.

ACOG appreciates your recognition of this issue and your utilization of this registry to assist us in data collection.

In a backlash they never saw coming, ACOG got data - just not the data they expected.


Their collection form was instead flooded with the positive homebirth stories of mothers nationwide who've had enough of their unfounded attacks on homebirth, midwifery and women's rights in general, and decided to fight back.


After this outpouring of positive homebirth support, ACOG put their submission form on a members-only, login page: http://www.acog.org/survey/hdComplications.cfm


Maybe they'll take the hint and put their self-interested policies locked far, far away from women, right where they belong.


If they do make the form public again, rest assured that the positive flood of homebirth stories will resume - they'll get the message one way or another, eventually.

New Product to Help with C-Section Recovery

A new product, Vitagel, is being used to assist mothers recovering from c-sections.

While I completely support minimizing recovery time and maximizing patient comfort and safety, I can't help but wonder if this new product will be used to market c-sections by downplaying the fact that c-section remains a major abdominal surgery that should be a last resort.

Only time will tell, but I can see the great potential for an increase in c-sections due to a public perception of safety and greater convenience due to a shorter, easier recovery time.

The answer isn't to take a product like this off the market, because all mothers should have access to the safest, quickest, most comfortable recovery possible, but to promote the evidence-based practices that reduce the incidence of c-sections and thus, the need for such a product.

This will be on my radar for 2009 - I'll be interested to see where it leads.

CDC Stats are In: C-Sections are Again on the Rise

Today, the CDC released preliminary birth data for 2007. While some statistics were encouraging, namely that preterm birth, the leading cause of infant mortality in the US, decreased for the first time in over 20 years, other statistics were not so encouraging:

For the 11th straight year, c-section rates continued to climb, from 31.1% in 2006 to 31.8% in 2007.

Pre-terms births, defined as infants delivered at less than 37 weeks of pregnancy, fell 1% in 2007 to 12.7% of all births. Per the March of Dimes, the improvement is largely due to a reduction in deliveries taking place before 39 weeks.

I've posted in the past on the mounting research outlining the dangers of induction and c-section before 39 weeks and the large number of pre-term births that could be prevented by doing so, which is a position also supported by the March of Dimes.

The CDC stats confirm that the efforts of the March of Dimes and other such advocacy efforts are helping to delay c-sections and inductions until closer to 40 weeks, but have as yet been unsuccessful in reducing the number of c-sections needlessly performed each year.

I find it so ironic that the key to improving birth outcomes for babies is forcing doctors to adhere more strictly to evidence-based guidelines. The incidence of pre-terms births was reduced, not by some great technical advance in medicine, but by making doctors stop performing potentially harmful procedures too soon.

In short, when doctors follow the evidence, birth outcomes improve.

The real conundrum lies in why is it so difficult to make modern maternity care practices follow what the evidence proves is best for mothers and babies...

Time to Take a Page from the NHS Book...

The National Health Service (NHS) Institute for Innovation and Improvement recently released a new initiative and toolkit to "to assist maternity units in achieving low caesarean section rates while maintaining safe outcomes for mothers and babies."


According to this article, after only 18 months, c-section rates dropped from 24% in 2007 to a mere 16% in November 2008.


The idea of a 16% c-section rate is the US seems like a dream. That is half our current c-section rate and very close to the World Health Organization's (WHO) target rate of 10-15% or less.


The truly intriguing aspect of the toolkit is that it is one of introspection. The NHS created a tool to help providers and maternity care units self-evaluate their practices against evidence-based standards, to see how their actions impacted the number of cesarean births and how altering those practices could help or hinder birth outcomes.


The American College of Obstetricians & Gynecologist's (ACOG) has stated that they are "committed" to reducing the number of c-sections. However, their approach, in sharp contrast to the NHS, has been to simply blame the mother - we're too fat, too lazy, too old, too small, or even "that's what they wanted" and so on and so forth...ad nauseam...


If ACOG is truly committed to lowering c-section rates nationwide, it's time for them to take a page from the NHS's book: start implementing the necessary steps to create the change you want to see.


Namely, start practicing evidence-based medicine and the rest will follow...

Common Chemicals May Delay Pregnancy

Another recently-published study has found a link between exposure to common chemicals and the time it takes a woman to conceive as well as birth defects and growth restriction in fetuses. It's yet another example of how the expansion of technological options can have unintended side effects on our species.

The most disturbing fact is that the chemicals were known toxins in the process of being phased out. While it's encouraging that they are being removed from products, the reality is that the damage has been done; while they will no longer be present in newly-manufactured items, there presence will linger in landfills, water supplies, and our bodies for decades to come.


We must remember that our actions today force the outcomes of tomorrow. More due diligence is needed on the safety of such technologies before they are used to prevent this seemingly never-ending cycle of self-destruction through industrialization.

Understanding the Dangers of Cesarean Birth: Making Informed Decisions

Understanding the Dangers of Cesarean Birth: Making Informed Decisions, a new book by Nicette Jukelevics, MA, ICCE of the wonderful resource on vaginal birth after cesarean section, VBAC.com has just been published.


You can learn more about the book and view the table of contents at: http://www.dangersofcesareanbirth.com


I haven't had a chance to read it yet, but I'm certain it will move onto my list of recommended resources.


Buy your copy from Amazon using GoodSearch and the vendor will donate to the Coalition for Improving Maternity Services (CIMS). Go to www.goodsearch.com/goodshop.aspx, choose CIMS as your charity, then choose Amazon and enter Dangers of Cesarean Birth in the Amazon search bar.


This is a timely book I'm sure will help empower and inform mothers to help stem the tide of ever-increasing c-sections without improved outcomes for mothers and babies.


Please pass this along to all the mothers in your life.

New Research on Predicting Pre-eclampsia

Researchers at the University of Bristol have conducted a new study which may help predict which mothers are at risk of later developing pre-eclampsia.

Flaxseed Oil and Risk of Pre-term Birth

New study finds link between flaxseed oil consumption in pregnancy and pre-term birth



An interesting read....

Mother-Friendly Childbirth Forum to Gather in San Diego

The Coalition for Improving Maternity Services' (CIMS) 2009 Mother-Friendly Childbirth Forum and Annual Meeting will be held March 5-7, in San Diego, California. The program includes 24 sessions that will cover a broad range of issues affecting childbearing women.

The 2009 CIMS Forum will cover topics ranging from "Racial and Ethnic Disparities in Birth Outcomes," to the findings of a new national report, "New Mothers Speak Out," on the physical and mental health challenges faced by new mothers, to "The Case Against Elective Repeat Cesarean Surgery," to "Why Transparency in Maternity Care Matters."

This is sure to be an eye-opening event and one that is truly crucial to affecting change through the modern maternity machine. The key to accomplishing true change in the system is through widespread public awareness, not only of the shortcomings of the current system, but of simple ways it could be changed for the benefit of mothers and babies.

The full press release is available here.

The Pitfalls of Impatience

A new study published in the November, 2008 issue of Obstetrics and Gynecology, conducted by researchers at the University of California, San Francisco, found that over 130,000 cesareans could be avoided each year by simply waiting an extra two hours for labor to progress normally.


The study focused on the all-too-common "failure to progress" c-section. The study was longitudinal over 1991-2001 and examined outcomes for 1,014 women having their first child at the UCSF.


Current ACOG guidelines state that physicians should wait two hours once an active labor arrest, or a period of time when dilation and effacement have ceased, before moving to a c-section. However, the article states that while this is the standard of care, many physicians currently ignore the guideline and move straight to an avoidable, unnecesarean.



Currently, 1/3 of all c-sections performed each year are for "failure to progress".



The study also highlights the dangers of a primary c-section, which are so often overlooked and were well outlined by the head author:

"Cesarean delivery is associated with significantly increased risk of maternal hemorrhage, requiring a blood transfusion, and postpartum infection," Caughey said. "After a cesarean, women also have a higher risk in future pregnancies of experiencing abnormal placental location, surgical complications, and uterine rupture."

Results of the study also found that women who had c-sections had increased rates of postpartum hemorrhage, chorioamnionitis infections and endomyometritis infections.


However, no significant difference in the health outcomes of the infants was found.


The most refreshing factor about this study is that ultimately, it highlights the dangers of primary and repeat c-sections as well as highlighting the role of physician non-compliance with the outlined standard of care.


Ultimately, the study shows that if physicians follow evidence-based guidelines in their practice, maternal outcomes are improved.


Despite the fact that this is a new study, this is not new information. The two hour wait time was already the standard of care when this study was undertaken. The real issue is getting physicians to respect the evidence and stop rushing to a c-section at the earliest convenience.


I have to wonder what will have to happen before physicians start using evidence-based practice in maternity care.


Despite study after study extolling the pitfalls of procedures such as episiotomy, lithotomy position, EFM, failure to progress c-section, restricted movement and arbitrary time limits on labor, these harmful practices are still standard across much of the US.


Perhaps a punitive approach would work: fine physicians for each non evidence-based procedure: $500 for an episiotomy, $1000 for EFM, $3000 for each unnecesarean.


That, I think, would be an effective approach at gaining adherence to evidence-based medicine and focus on maximizing reimbursement for quality care, not convenience.

Ten Americans

This will give you chills...




Disturbing to say the least.


In this same vein, the Primal Health Research Centre, led by Dr. Michel Odent, is exploring the correlations between the 'primal period' (fetal life, perinatal period and year following birth) and health and personality traits in later life.


On their site, PrimalHealthResearch.com they have compiled the Primal Health Research Databank, which includes studies that focus on the primal period of development. It's a wonderful resource for evidence-based information.


Hopefully, the efforts of such organizations as the Environmental Working Group and the Primal Health Research Centre will affect system-wide change for both our environment...and our babies.

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?

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.

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.

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.

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.

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.

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.

New Study on Bonding and Natural Birth

Natural Birth May Aid in Infant Bonding

A new study conducted at Yale looked at the differences in maternal responsiveness to a baby's cry between mothers who gave birth naturally and those who chose an elective c-section and found that mothers who gave birth naturally were more responsive to their newborn's cries.


While the study is far too small to drawn any real conclusions, the results may peak more interest into research in the pitfalls of maternal-request cesarean section. Hopefully, some solid evidence will steer women away from making this decision lightly out of fear of labor or just plain old convenience.

While I don't personally agree with maternal request c-section, I still believe it is a valid choice that women should have, just as we should also have the right to homebirth with the provider of our choice.


What I don't believe is that insurance should have to pay for a maternal request c-section with no medical or emotional indications, since it is shown to increase the risks to both mothers and babies.


Unlike homebirth, which has been proven to be both a safe and cost-effective option, elective c-section can boast no such claims. This study is yet another piece of recent evidence that demonstrates the hidden risks of surgical birth.