December 21, 2007
Looking for a doula in Europe, check them out.
Have a great holiday season everyone!
Here are some great birth affirmations from Birth Ecology
December 16, 2007
Help a Women's Shelter Rebuild After Arson
December 14, 2007
Article
5 Reasons Why You Need a Doula
December 12, 2007
Article that ran in the Casper Tribune about doulas.
December 4, 2007
Hathor the Cow Goddess
The Story of the Zoops
Cute little animation
You Won't Remember This
November 4 2007
Be sure to see
Business of Being Born
Documentary by Ricki Lake
I am looking into how to get it shown in Basel.
Birth Arts has classes in Europe, Hawaii and all over the US, check it out or host a class.
The Great Birthing Partner Debate..
Irish Hospital's refusal of Doulas and Additional Birth Partners
"Every woman deserves to have her mother in the delivery room with her" I remember reading these words on rollercoaster.ie years ago from a young scared Irish woman due with her first baby. Her heartfelt plea for help.her desperation for ANY suggestion ..of ANY possible way that she could persuade her maternity hospital to make the exception to the rule and allow her mother and husband in with her for the labour and birth. Likewise I remember the replies of other women.women who have gone through it before.women who dripped with cynicism because they too would have liked this choice but knew what her outcome would be. The pain, confusion and fear of that sad, sad post have stayed with me over the years.
Unfortunately it looks like very little has changed for women in some areas of Ireland. While many maternity units around the country are receptive of additional birthing partners and Doulas, the Dublin hospitals remain unresponsive.
AIMS Ireland has decided to look deeper into this issue.
Background information
Female birthing partners
The desire to have our mothers, sisters or female friends with us in labour is a primal and instinctual example of women's abilities to act on intuition. For centuries women have given birth with the support and understanding of elder women who have the life experience to guide the labouring woman through her birth. It makes absolute sense that women would chose to labour with their mother or sister in addition to their husband or partner. Women are naturally empathetic, supportive and strong.
Research has shown that the use of an additional birthing partner or Doulas is extremely beneficial for the labouring woman. According to some research, midwives and nurses only are able to give 10% of their time in 'supportive roles' in labour and birth. It is not surprising then that women feel the need to find additional emotional support either in a family member, friend or through hiring a Doula.
Research has found that women who laboured and birthed with a female partner showed extensive benefits to those who did not. Women had more spontaneous vaginal deliveries (91% to 71%), less analgesia use during labor (53% to 73%), less oxytocin (13% to 30%), fewer amniotomies to augment labor (30% to 54%), fewer vacuum extractions (4% to 16%) and fewer cesarean sections (6% to 13%) compared to the control group. The support of a female relative while in labor is shown to have fewer interventions and increased frequency of normal vaginal deliveries. (1)
Similar findings show that the use of a professional Doulas also highly beneficial for labouring women.
What's a Doula?
Doula (Greek) is a woman experienced in childbirth who provides continuous emotional support to the labouring mother and her partner. A Doula's primary role is to the mother. Their sole focus is on the emotional well-being of the woman in labour. Unlike a midwife who may be assigned several labouring women and whose focus in on physiological/medical birth issues, the Doula's primary focus is on one woman and is undivided emotional support. This support is reflected in the Doula ideology and Doula promises.
Research has shown that due to the individual emotional support provided that women labouring with a Doula may prosper from a range of benefits.
Evidenced Based Benefits
Research showed:
. women using a Doula have a 50% reduction rate in cesarean section
. women using a Doula have a 40% reduction in the rate of forceps deliveries
. women using a Doula have a 60% reduction in request for the epidural
. women who used a Doula had a decrease in labour length by 25% (2)
Closer to Home
Doula Association of Ireland - face to face
With all the talk of Doulas and hospital policy it became apparent that there is a lack of understanding with hospital administration and some members of the public as to what a Doula's role is in Ireland. To gain greater insight I recently attended a Doula training seminar and interviewed several Doulas working in Ireland.
Doulas in Ireland work independently or with the support of an organisation called The Doula Association of Ireland. The Doula Association of Ireland is a voluntary organization founded in March of 2006. The Association follows a Constitution mirroring ethics from DONA (an international and highly respected Doula Association) and is run by an elective committee. The Doula Association is a self-regulating professional support network for Doulas working in Ireland.
From meeting with the Doulas it was clear that there is a great need for additional support when giving birth in Ireland. As a Doula is not providing clinical care her role is not diluted. She is a comforting and supportive continuous presence for the labouring woman which benefits midwives who are often over stretched in Ireland's maternity units. "Our midwives are under tremendous pressure. Midwives are trying to provide both clinical care and emotional support in labour - sometimes to more than one woman," describes one of the Doulas. Another adds, "Also.midwives take lunch breaks, they go home when their shift ends. As Doulas our support is continuous for the labour and birth.this is extremely important to most women."
A Doula does not replace the partner but rather encourages the partner to be as involved as his comfort level allows. As one mum describes, "My husband wasn't initially sure about using a Doula but on the day he found it a great relief to have her there. It meant he could go through this with me - he could have his own experience knowing that my Doula would provide all the emotional support I needed. It took the pressure off of him - he was really worried about how he would perform on the day."
As an outsider with little experience of Doulas, the Doula training was simply inspiring. Listening to the principals and stories from these enthusiastic women truly brought home the degree in which we are failing women in our sterile maternity units. The room buzzed with hope, emotion, empathy, support, and sadness over the stories we heard about birth in modern Ireland. There was an overwhelming sense of normality in the stories we heard relating to Doula births - it struck me as ironic that in the attempt to promote 'normal' birth in Ireland, many hospitals were purposely opposing a fundamental normal birth practice. From the short time I spent in the Doula training I came away with a real sense of hope and inner calm.a feeling of relief that these new recruits would make some woman's experience that much more manageable as she will have the extra support of her Doula. In my final moments in the training the DONA instructors explained an overview of the principals which encapsulate the level of emotional care that Doulas offer. These are called the Doula Promises.
Promises of a Doula
1. You cannot hurt my feelings in labour
2. I won't lie to you in labour
3. I will do everything in my power so you do not suffer
4. I will help you feel safe
5. I cannot speak for you but I will make sure that you have a voice and I will make sure you are heard
Ireland is continuously training Doulas and most of Ireland's maternity units have open policy of acceptance of Doulas. Unfortunately, due to hospital policies, women in the Dublin area who wish to have a Doula must attend Our Lady of Lourdes, Drogheda (which has an open acceptance of Doulas) as the Dublin hospitals no longer are permitting women to exercise this choice.
Hospital policy
The issue of Doulas and additional birthing partners has a tempestuous history in Ireland's maternity hospitals - Dublin in particular. The policy used to stand that women who desired the use of an additional birthing partner could alternate between the two as she needed them in labour. Not an ideal situation, but better than the alternative. However, recently the decision was taken by the Dublin hospitals to re-evaluate their policy on Doulas and alternating birth partners. New policy states that women are no longer 'allowed' the use of alternating birthing partners and that Doulas may only attend as a birthing partner (not "allowed" to call themselves a Doula). To further illustrate their policy, it was decided that there would be a full ban on the word 'Doula' in the magazine sponsored by the 3 Dublin Hospitals and a ban on any advertising within the magazine by Doulas. Sadly, it appears that hospital 'policy' has outweighed women's desires once again.
It is a great concern of AIMS Ireland that given the current wording and restrictions in the Dublin hospitals (No swapping in and our of birthing partners, no additional birthing partners, no Doulas), specifically in the concise policies of the Rotunda and National Maternity Hospital, the policy concerning Birthing Partners and Doulas leaves very little room for compromise in times of unusual or 'special' circumstances. AIMS Ireland's concern is with the mother in cases such as this. Our worry is that should a woman's designated birthing partner be called away for any reason or becomes unable to provide support (children at home, illness, etc) that the labouring woman will be especially vulnerable without the emotional support and continuity of a birthing partner. For many women the fear of labouring 'alone' (without a birthing partner or loved one) is extremely concerning and will induce intense feelings of panic and stress at a time when the mother should be kept focused and relaxed. Unfortunately, the reality of modern birth means that the midwife cannot provide this continuity of care and emotional support - hence the importance of the birthing partner or Doula. Another issue to consider is women who are transferring to hospital from a homebirth. Women in this situation have built a relationship with their independent midwife over the period of 9 months. The woman will already be emotionally distressed at the prospect of having to transfer to a hospital scenario for her birth and policy of only one birth partner (partner or independent midwife) will add to her distress. The Rotunda and NMH have each provided statements that in extremely 'special circumstances' the birthing partner policy would be re-visited, however, it is the decision of the hospital to determine what constitutes a 'special circumstance'..not the woman. AIMS Ireland believes that all labouring women and all labouring women's circumstances are 'special'.
Who's needs are most important?
Who's needs are the most important? .. This is the question.
AIMS Ireland is fully supportive of the CIMS Mother-friendly initiative. One of the main principals of this initiative is that women are the centre of the maternity system..she is the leader of her birth team . Not hospital staff. Not consultants. Not midwives. Not Doulas or birthing partners. The mother knows what support she needs in labour and her care should be centred on her choices to do so in a safe and encouraging manner. Women's choices should be met with respect and dignity. Women should never be fobbed off by a mantra of what is "allowed". This is after all, HER and HER baby's experience. With Dublin's current birthing partner and Doula policy in place, these hospitals are quite simply NOT mother-friendly hospitals. It is with absolute arrogance that hospital administration believes they can write policies to exclude evidence based birthing choices from women. Current hospital policy is wrongly based on the hospital administration's assumption that they can provide everything a woman needs. The Doula and birthing partner policy is a reflection on hospital administrations lack of concern for the mother's true non-medical needs - of continuity of support and emotional care. Quite simply, our Dublin hospitals have failed in remembering that women's needs come first.
So why are Irish Hospitals so reluctant to allow women the freedom of choice in birthing partners?
AIMS Ireland is at a loss to answer this question and explanations from the hospitals are watery at best!
The benefits of additional birthing partners and Doulas are evidence based something for which Irish hospitals claim credit. The Coalition for Improvements in the Maternity Services (CIMS), which is evidence based UN backed organization, has included the woman's right to choose additional birth partners and use of Doulas in its conditions for a hospital or maternity unit to gain 'Mother-Friendly' status. It is recognized worldwide the benefits and emotional importance for women to not be restricted in their choice for birthing partners. Yet, time and time again, women come up against the proverbial brick wall of 'hospital policy' when trying to exercise this very basic maternal right.
It has been suggested with Irish Hospitals that policy of one birth partner is in relation to risk of infection; MRSA. Yet research has shown that an additional birthing partner has no effect on the spread of infectious illnesses. Birthing partners do not create and spread infection.dirty hospitals do.
The Doula Association of Ireland has applied for Garda vetting but unfortunately as Doulas do not have unsupervised access to children or vulnerable adults they are low down on a long list of priorities. As Doulas are not registered with the Gardai, hospital administration has suggested that there is an increased security risk with the use of Doulas. Doulas possess no added security risk than any other birthing partner. Despite this fact, The Doula Association of Ireland recommends that all Doulas give advanced notice of their intentions on attending a birth at a hospital out of common professional courtesy and for security reasons. When AIMS Ireland looked further into this issue we found that the Doula Association of Ireland has offered on several occasions for a registration process to be set up within the hospital and each time the hospital administrations failed to engage in consultation to implement such changes. To date, representatives from the Doula Association of Ireland have been denied a face to face meeting with hospital personnel to discuss this matter further. Some individual Doulas have offered to be fingerprinted and to have background checks in order to assist with hospital security queries. We have also learned that despite failing negotiations with hospital administrators, the Doula Association of Ireland has voluntarily presented the Rotunda hospital a full detailed list of all registered members of the Doula Association of Ireland in order to assist in security maintenance. In conjunction, The Doula Association of Ireland has created a regimented Constitution and grievance procedure in which all Doulas registered with the DAI must adhere to... But again, the Dublin hospitals were not interested.
Summery
So the question is what are the REAL reasons why Dublin's Maternity Hospitals have shut the door to Doulas and additional birthing partners? One can only hazard a guess...
Fear? ...Distrust? ...Unwilling to have an independent observer present?...Lack of education and understanding on the role of a Doula?
Truth be told, it doesn't matter. All these 'issues' are simply a smokescreen in which the Dublin hospitals deter this debate from the core issue. Quite simply, Dublin hospitals are unwilling for consumers to have input on hospital policy.
The true bones of this matter are that every woman has the right to choose who comes in with her for the labour and birth of her baby. It has nothing to do with the hospital or its rules. Women-centred care means that women as consumers lead the hospital in policy relating to the care they receive.
According to the An Bord Altranai's website, The Philosophy of Midwifery includes:
A) The focus of midwifery practice is pregnant women and their families and delivering women-centred maternity services.
B) Decisions about an individual midwives scope of practice should always be made with the woman's and her family's best interest foremost and in the interest of promoting and maintaining the best quality maternity services for women.
Quite simply, why are Irish women paying the salary of maternity staff when they have no say in the type of treatment they want?
The use of additional birthing partners and Doulas is a regular and normal occurrence in the US, UK, Australia, France, Singapore, and elsewhere within our own country of Ireland (Cork, Drogheda, Etc). AIMS Ireland's final thoughts on this are that if Dublin hospitals are truly serious in promoting normal birth and normal birth practices then they must abolish this policy and embrace mother-friendly practices in their entirety. At present with current Doula and additional birthing partner restrictions in place it is a case of talking the talk without delivering on core issues.
References:
1. Madi, B.C., Sandall, J., Bennett, R., & MacLeod, C. (1999). Effects of female relative support in labor: A randomized controlled trial. Birth, 26 (1), 4.8.
2. John H Kennell, MD; PEDIATRICS Vol. 114 No. 5 November 2004, pp. 1488-1491 (doi:10.1542/peds.2004-1721R)
Resources and Information:
Birth Arts International Doula Training Organization
http://www.motherfriendly.org/resources/10Q/
http://pediatrics.aappublications.org/cgi/content/full/114/5/S2/1488
http://www.doulaassociationofireland.com/
http://www.doulaireland.com/
http://www.dohc.ie/agencies/1.html
Dismissed, disrespected, and hunted like witches, midwives are finally being recognized-but misunderstandings and myths endure
-By Marsden Wagner, Born in the USA
Utne Reader March / April 2007 Issue
Because the midwives feared God, they did not do as commanded by the king.
-Exodus 1:17
A midwife is lectured at by committees, scolded by matrons, sworn at by surgeons, bullied by surgical dressers, talked flippantly to if middle aged and good humored, seduced if young.
-London Times, 1857
After working as a practicing physician for several years, I became a perinatologist and perinatal scientist, as well as a full-time faculty member at the Schools of Medicine and Public Health at UCLA. Then I became a director of maternal and child health for the California state health department. In that capacity, I learned that in the rural town of Madera, California, doctors had decided that they no longer wanted to attend births in the Madera County Hospital. They complained that it took too much of their time and didn't pay enough. So in 1968 the county recruited two midwives to fill the gap. After two years, the rate of babies dying around the time of birth in the hospital was cut in half. Alarmed that their style of maternity care was being made to look bad, the doctors in town agreed that they would once again attend births in the hospital if the two midwives were fired. The hospital fired the midwives, the doctors returned, and soon the rate of babies dying around birth rose to its earlier higher levels.
This natural experiment comparing the safety of doctors and midwives left me confused and full of questions, because, in spite of my years of experience as a physician, I had no real knowledge of midwifery. What are these midwives? How are they trained? Could it be that, as seen in Madera County, they are generally safer birth attendants than doctors? Through no fault of their own, Americans, including obstetricians, have little understanding of midwifery. In the early years of the 20th century, a witch hunt against midwives in the United States and Canada eliminated midwifery as a legitimate health profession. The profession has gained ground in the past two decades, but most people today have no personal experience with midwives and have been exposed to considerable misinformation about midwifery.
From California I left for Europe, where I joined the staff of the World Health Organization. There I was exposed to the essential role midwives play in maternity care in other highly industrialized countries and in developing countries.
Throughout history, there have always been women in the community to whom other women can turn for support with concerns-not just about reproductive health care but also issues such as spousal abuse. The word midwife is early English for "with woman." The French term for midwife, sage femme (wise woman), goes back thousands of years, as do the words in Danish, jordmor (earth mother), and in Icelandic, ljosmodir (mother of light).
In the fifth century B.C. Hippocrates formalized a midwifery training program in Greece. Phaenarete, the mother of Socrates, was a midwife. In the Bible, the Book of Exodus recognized the strength and independence of midwives who defied the pharaoh's command that they kill all sons born to Hebrew women. The first law to regulate midwifery in Europe was passed in Germany in 1452 and required that a midwife attend all births. Since then, every little girl in Europe has grown up with the understanding that if she has a baby, a midwife will assist her.
When Europeans migrated to the New World, midwives were among them. Midwives were a valued part of the developing health care system in colonial times, and by the mid-1880s they were teaching medical students in at least one university.
As the number of physicians increased in the United States, medical doctors attempted to monopolize health care through state medical practice acts that defined health care parameters, including who can practice. By the end of the 19th century, it was common for midwives to be accused of witchcraft and tried in court, and midwifery practice began to disappear. The case of Hanna Porn was one of the most famous and had far-reaching consequences. In Gardner, Massachusetts, in 1909, a judge sentenced Porn to three months in prison. Her crime? She was a practicing midwife. Fewer than half as many of the babies whose births she attended died as babies whose births were attended by local physicians. But the Massachusetts Supreme Judicial Court used her case to rule that midwifery was illegal in Massachusetts, based on the testimony of physicians who said that midwives were incompetent. Other states followed suit and made midwifery illegal, and it remained illegal in nearly all states for more than 50 years, until nurse-midwifery began to be legalized.
Despite this attempt to dismantle the profession in the United States and Canada, midwifery continued to thrive in Europe and other parts of the world. And while the profession was severely hampered in the United States for decades, it was not stamped out. Throughout history, every attempt at ending the practice has failed. It seems that there will always be women who want to be midwives and women who want midwives to attend them when they give birth.
When officially sanctioned midwifery was attacked in the United States, midwives went underground. Women who became known as "granny midwives" (because they tended to be older) continued to practice, especially in poor communities. In the 1920s Mary Breckinridge, a public health nurse and midwife, formed the Frontier Nursing Service to provide maternity care to families in rural areas of Appalachia. Some of the staff members formed an organization that later became the American Association of Nurse-Midwives, as well as the Frontier School of Midwifery and Family Nursing, which trained hundreds of women in what became a new profession in America, nurse-midwifery.
The number of nurse-midwives grew, and by 1977 the profession was licensed in every state. After nursing school, a nurse can elect to go on to midwifery school for about two years and become a nurse-midwife. This is not the same as becoming a labor and delivery nurse, a nursing specialization that has no training requirement and usually involves about six weeks of on-the-job training.
Women can also train as "direct-entry" midwives, going directly to midwifery school without training first in nursing. Direct-entry midwives have grown steadily in numbers and recognition. In 2006 direct-entry midwifery was legal in 24 states, "alegal" (allowed without legal interference) in 17 states, and explicitly illegal in only nine states. In the past decade, more and more states have been legalizing direct-entry midwifery. The U.S. government recognizes the training for both nurse-midwives and direct-entry midwives and has authorized the Midwifery Education Accreditation Council to accredit midwifery schools and programs.
Despite the current resurgence of midwifery in the United States, the fact that midwives were harshly persecuted for more than a century has left the profession with a legacy of public reticence and confusion that must be overcome. Many myths surround midwives, myths that are often reinforced by obstetricians who view them as competition. One is that midwives are not trained but are "hippy-dippy" lay women who attend only home births. Another is that midwives are religious zealots or witches who use magical potions. That nurse-midwives attend births only in hospitals is a common misconception, as is the idea that a midwife is a second-class doctor for women who can't afford a real obstetrician. None of these ideas is remotely true. Science has proven that for attending low-risk births (that is, births without complications), midwives are not second-class obstetricians, but rather obstetricians are second-class midwives.
Generally speaking, a fundamental difference between midwifery care and physician care at birth has to do with control. Childbirth is a complicated physiological process regulated by the woman's nervous system. Childbirth is not under the conscious control of the woman giving birth, but rather is directed by hormones and the parasympathetic portion of the autonomic nervous system. Anything that causes fear or alarm shuts down the parasympathetic system and fires up the sympathetic nervous system (adrenaline). Any intervention that increases a laboring woman's fear or anxiety will interfere with, slow down, or even stop the birth processes. A wise birth assistant, be it midwife, nurse, or doctor, knows how to facilitate these autonomic responses and not interfere with them. The key elements in the midwifery model of birth are normality, facilitation of natural processes (with minimal intervention), and the empowerment of the birthing woman.
Taking on the role of facilitator, midwives typically will reassure, calm, and encourage birthing women. Obstetricians, on the other hand, typically try to get the birth under their own control by overriding the natural processes with drugs and medical procedures and giving orders. The medical model and the midwifery model are essentially different ways of looking at women and birth. Doctors "deliver" babies and believe that having a baby is something that happens to a woman. Midwives assist at birth and believe that giving birth is something that a woman does.
Midwives tend to believe that a woman giving birth needs to be the one making decisions about her birth experience. The woman giving birth needs to believe in her own body and feel responsible for her body, while at the same time letting go of the need to control what is happening, since she cannot.
Another fundamental difference between midwives and doctors is how they view pregnancy and birth. Midwives understand that pregnancy is not an illness. They typically call the women in their care "clients," not "patients," since they are not sick and are not getting medical treatment. Though midwives know what can go wrong during pregnancy and birth and know how to identify problems early and to cooperate with doctors in managing complications, their focus is on birth as a life-enhancing experience. Although they believe it is essential to have medical assistance available when it is needed, they are trained to go beyond medical care and empower women to achieve their goals for themselves and their babies. Midwives trust in women's bodies and their capacity to give birth successfully with little or no intervention in most cases.
Obstetricians, on the other hand, tend to focus on what can go wrong during pregnancy and birth. All doctors have been trained to look for trouble (diagnose a problem) and decide what to do about it (decide on a treatment), and that is what comes naturally to obstetricians. In prenatal care they take the same approach, focusing on what can go wrong.
Another important difference between midwife-attended low-risk birth and obstetrician-attended low-risk birth is the quality of the experience for the woman. Many surveys have shown that women who have midwives as their attendants have far higher levels of satisfaction with their birth experience than women who have obstetricians attending their births. This is not hard to understand. Midwives give great attention to building close relationships with their clients and their clients' families.
Generally speaking, midwives are direct, open, and honest in their dealings with clients and take an egalitarian, intimate, woman-to-woman approach. Midwives do not guarantee a good outcome, and their honesty about their role and its limitations contributes to the level of satisfaction women feel with their services. On the other hand, in a doctor-patient relationship, there is no egalitarian tradition. Rather, the doctor's superior knowledge and status are for the most part unquestioned and there is a belief (or hope) that the doctor can perform miracles.
Midwives, like doctors, are human. They have bad days and they make mistakes. Science now tells us, however, that overall, midwives are safer than doctors for low-risk births. If a woman is among the 80 to 90 percent of all women who have normal pregnancies, the safest attendant for her hospital birth is not a doctor but a midwife.
In the past two decades we've seen a renaissance of midwifery in the United States. Each year, the number or births attended by midwives increases.
The more the practice of midwifery grows and succeeds, the more threatening midwives are to the obstetric monopoly, so, predictably, there has been an obstetric backlash. Now, a hundred years after Hanna Porn was persecuted, we have another American witch hunt against midwives. In many states, doctors are reporting midwives to various authorities as dangerous.
In many cases, these attacks are simply attempts by doctors to eliminate the competition. Cases against midwives are, with very rare exceptions, not initiated by the families the midwives serve, as is typical of litigation against obstetricians. Instead, they are initiated by physicians. In the past several years in many states, including Illinois, Utah, California, Vermont, Virginia, Nevada, Oregon, Indiana, and Ohio, police have arrested direct-entry midwives for practicing nursing or medicine without a license.
Maternity care in the United States is changing, and one of the most important changes still in progress involves who will catch the 3.5 million babies a year whose mothers have had normal pregnancies. That is, who will be the primary birth attendant for low-risk births? In the past decade, the percentage of births attended by midwives has gone from 5 percent to 10 percent, and there are a few places where it is closer to 25 percent. HMOs are hiring more and more midwives. Kaiser Permanente, one of the largest HMOs in the country, has many midwives on its staff. There are several reasons for the growth of midwifery in the United States, and a big one is money.
Midwifery is far cheaper than obstetrics for two reasons. On average, obstetricians take home a net income in the neighborhood of $200,000 a year, whereas midwives earn about one-quarter of that. Equally important, the cost of the obstetric interventions, such as induction and C-section, performed unnecessarily can easily be cut in half by having midwives, rather than obstetricians, assist at normal births. Health care in the United States is very much driven by the bottom line, and slowly but surely the insurance companies, managed health care organizations, HMOs, and even state and federal government agencies are realizing that the obstetric monopoly is wasting enormous amounts of money. The day that truth fully sinks in will be the day the obstetric monopoly is on its way out.
As midwifery becomes better established in the United States, it becomes more difficult for the obstetric establishment to perpetuate the myth that midwives are not as safe as doctors. Pushing the "safety" issue has backfired as a way for obstetricians to protect their territory. As more state legislatures look carefully at the data and realize that they have been denying families a safe maternity care option, momentum will grow and laws that support and protect midwives will spread to other states.
Another reason midwifery is going to grow: Americans believe in a free market economy with open competition. Obstetricians and midwives both offer primary maternity care.
Finally, midwifery will continue to grow as more women come to appreciate that maternity care is not primarily a health issue but a women's issue. Midwifery plays an important role in strengthening women's control over their own bodies and reproductive systems.
Excerpted from Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First (University of California, 2006).
A TEAM of midwives from the Lagan Valley Hospital have
been named the runners-up in a nationwide award scheme
run by the Royal College of Midwives to promote normal births.
Ward manager Maria Byrne and midwife Beth Harris led the team and
accepted the award from Princess Anne in London.
The Royal College is running a campaign to encourage normal births,
aiming to reduce the number of artificial interventions such as caesarean
sections.
The award was given for the progress made at Lagan Valley Hospital with
local mothers,
bringing the caesarean rate
down to just over 12%.
Zoe Boreland, Principal Midwife with Down Lisburn Trust,
explained: "Northern Ireland has the highest caesarean rate in the UK, e
ven though the majority of women are fit and healthy and capable
of giving birth normally. The average caesarean rate is 26% in our area,
with some units over 35%. Our multi-disciplinary team has brought our
rate down from 22% to just over 12% and achieved the highest normal delivery
rate in the region.
"We are also very proud that the percentage of women who have a
normal birth after a previous caesarean has more than doubled, from
22% to 58% with no added risk to mother or baby.
"We achieved this by a real team effort, a multi-disciplinary approach
to woman-centred care, with strong leadership and a non-interventionist
ethos. We couldn't have done this without great support and commitment
from our consultant obstetricians and above all the enthusiasm and support
of the women we work with."
Zoe said a practice development midwife has helped colleagues to develop
the skills and knowledge to be truly autonomous.
"Women now have continuity of care and a birth environment which is less
clinical.
We encourage them to move around during labour and adopt alternative
birthing positions" she added.
David Gorman, Chairman, Down Lisburn Trust, congratulated the Lagan Valley
team.
"Our midwives have shown real skill and initiative and we are hugely proud
of their
achievements in encouraging normal births" he said.
19 February 2007
"Ninety-six percent of the births that we attended last year - births will good outcomes - would not be permitted under these new rules,' says midwife Holly Richardson. Two years ago, the Utah Midwives Association advocated heavily for the right to be licensed and administer certain drugs in emergency birth situations. Senator Margaret Dayton - a former nurse and wife of a retired obstetrician - says she wants to narrow, but not eliminate midwifery. "I think people should have a choice of going to the ultimate high-risk consultation to staying home alone in the bathroom if they want to," says Dayton. "The bill basically helps to give a definition of what is 'essentially a normal birth.'"But Richardson says the new rules go too far - even prohibiting a midwife from delivering a baby at home if the mother has an STD or the baby is larger than eight pounds, thirteen ounces. If Dayton's bill passes as drafted, many of the 15 licensed direct-entry midwives in Utah say they will drop their license and return to being a lay midwife so they can avoid the new restrictions.
_______________I wonder why this nurse is feeling so upset and feeling as though she needs to attack midwifery in Utah, which has excellent midwifery care from what I have heard.
Volume 113 Issue 12 Page 1426 - December 2006
To cite this article: E Wiberg-Itzel, H Pettersson, S Cnattingius, L Nordstrom (2006)
Association between lactate in vaginal fluid and time to spontaneous onset of labour for women with suspected prelabour rupture of the membranes
BJOG: An International Journal of Obstetrics and Gynaecology 113 (12), 1426-1430.
doi:10.1111/j.1471-0528.2006.01088.x
Original Article
Association between lactate in vaginal fluid and time to spontaneous onset of labour for women with suspected prelabour rupture of the membranes
* E Wiberg-Itzel,aa Department of Obstetrics and Gynaecology, Söder Hospital, Stockholm, SwedenDr Eva Wiberg-Itzel, Department of Obstetrics and Gynaecology, Soder Hospital, 118 83 Stockholm, Sweden. Email eva.itzel@telia.com
* H Pettersson,bb Department of Biostatistics, Karolinska Institute at Stockholm Söder Hospital, Stockholm, Sweden
* S Cnattingius,cc Department of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden
* L Nordstromdd Department of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden
*
a Department of Obstetrics and Gynaecology, Söder Hospital, Stockholm, Sweden b Department of Biostatistics, Karolinska Institute at Stockholm Söder Hospital, Stockholm, Sweden c Department of Medical Epidemiology, Karolinska Institute, Stockholm, Sweden d Department of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden
Dr Eva Wiberg-Itzel, Department of Obstetrics and Gynaecology, Soder Hospital, 118 83 Stockholm, Sweden. Email eva.itzel@telia.com
Abstract
Objectives To assess whether lactate determination in vaginal fluid is associated with, and can predict, onset of labour for women with suspected prelabour rupture of the membranes (PROM).
Design Prospective observational study.
Setting Labour ward at Soder Hospital, Stockholm, Sweden.
Population Women with suspected PROM after 34 weeks of gestation, who later had spontaneous onset of labour (n = 179).
Methods All women underwent a speculum examination and a test for determining lactate concentration in vaginal fluid. We used logistic regression to estimate the association between lactate concentration in vaginal fluid and time to onset of labour.
Main outcome measures Time from examination to onset of labour (cervix ?4 cm), within 24 hours and 48 hours.
Results The median time interval between examination and spontaneous onset of labour was 8.4 hours for women with 'high' lactate (?4.5 mmol/l) and 54 hours for those with 'low' lactate concentrations (<4.5>
Conclusions High lactate concentration (?4.5 mmol/l) in vaginal fluid can be used to predict whether a woman with suspected PROM will commence spontaneous onset of labour within 24 or 48 hours.
Copyright C 2007 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.
Date of last Subtantial Update: August 15. 2006
Plain language summary
Regional compared with general anaesthesia for caesarean section
Caesarean section is when a baby is born through an incision in the mother's abdomen and uterine wall. This requires effective anaesthesia which can be regional (epidural or spinal) or a general anaesthetic. With regional epidural anaesthesia, the anaesthetic is infused into the space around the mother's spinal column, whilst with regional spinal anaesthesia, the drug is injected as a single dose into the mother's spinal column. With the two types of regional anaesthesia, the mother is awake for the birth but numbed from the waist down. With general anaesthesia, the mother is unconscious for the birth with the anaesthetic affecting her whole body. As well as women having a view as to whether they might wish to be awake or asleep for the caesarean birth, it is important to know the balance of the benefits and adverse effects of these different types of anaesthesia. The review of trials sought to assess these benefits and harms, and identified sixteen randomised controlled trials involving 1586 women. There were some differences which favoured general anaesthesia, for example, less nausea and vomiting. There were also some differences which favoured regional anaesthesia, for example, less blood loss and less shivering. The evidence on the differences in pain was difficult to evaluate. There were not enough participants to assess the very rare outcome of mortality for the mother, which may be an important aspect. None of the trials addressed important outcomes for women like recovery times, effects on breastfeeding, effects on the mother-child relationship and length of time before mother feels well enough to care for her baby. As there is insufficient evidence on benefits and adverse effects, women are most likely to choose anaesthesia for caesarean section, depending on whether they wish to be awake or asleep for the birth.
Abstract
Background
Regional and general anaesthesia (GA) are commonly used for caesarean section (CS) and both have advantages and disadvantages. It is important to clarify what type of anaesthesia is more efficacious.
Objectives
To compare the effects of regional anaesthesia (RA) with those of GA on the outcomes of CS.
Search strategy
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005, Issue 1), MEDLINE (1966 to December 2005), and EMBASE (1980 to December 2005).
Selection criteria
Randomised and quasi-randomised controlled trials evaluating the use of RA and GA in women who had CS for any indication.
Data collection and analysis
Two authors independently assessed trials for inclusion, data extraction and trial quality.
Main results
Sixteen studies (1586 women) were included in this review.
Women who had either epidural anaesthesia or spinal anaesthesia were found to have a significantly lower difference between pre and postoperative haematocrit (weighted mean difference (WMD) 1.70, 95% confidence interval (CI) 0.47 to 2.93, one trial, 231 women) and (WMD 3.10, 95% CI 1.73 to 4.47, one trial, 209 women). Compared to GA, women having either an epidural anaesthesia or spinal had a lower estimated maternal blood loss (WMD -126.98 millilitres, 95% CI -225.06 to -28.90, two trials, 256 women) and (WMD -84.79 millilitres, 95% CI -126.96 to -42.63, two trials, 279 women). More women preferred to have GA for subsequent procedures when compared with epidural (odds ratio (OR) 0.56, 95% CI 0.32 to 0.96, one trial, 223 women) or spinal (OR 0.44, 95% CI 0.24 to 0.81, 221 women). The incidence of nausea was also less for this group of women compared with epidural (OR 3.17, 95% CI 1.64 to 6.14, three trials, 286 women) or spinal (OR 23.22, 95% CI 8.69 to 62.03, 209 women).
No significant difference was seen in terms of neonatal Apgar scores of six or less and of four or less at one and five minutes and need for neonatal resuscitation with oxygen.
Authors' conclusions
There is no evidence from this review to show that RA is superior to GA in terms of major maternal or neonatal outcomes. Further research to evaluate neonatal morbidity and maternal outcomes, such as satisfaction with technique, will be useful.
Epidural During Birth May Negatively Affect Breast-Feeding
12.11.06, 12:00 AM ET MONDAY, Dec. 11 (HealthDay News) -- Women who receive an epidural during childbirth are more likely to have breast-feeding problems in the first week and to stop breast-feeding before the end of six months than women who don't receive an epidural, an Australian study says. The study, published in the Dec. 11 International Breastfeeding Journal, included 1,280 women who gave birth between March 1997 and October 1997. Of the 416 (33 percent) women who had an epidural, 172 (41 percent) had a Caesarean section.Researchers found that 93 percent of the women in the study breast-fed their baby in the first week after birth. However, women who had an epidural were significantly more likely to have difficulty breast-feeding during the first few days after delivery and to breast-feed less often than other women.At 24 weeks, 72 percent of women who did not have an epidural were breast-feeding, compared with 53 percent who received pethidine or epidurals containing bupivacaine and fentanyl (an opioid).The findings contribute to the growing body of evidence that the fentanyl component of epidurals may be associated with breast-feeding difficulties, the study authors said.In an accompanying commentary, Sue Jordan, senior lecturer in applied therapeutics at Swansea University, said that the effect of opioids and epidurals on breast-feeding should be regarded as an "adverse drug reaction."She called for "extra support to be offered to the most vulnerable women, to ensure that their infants are not disadvantaged by this hidden, but far-reaching, adverse drug reaction." More information The U.S. National Women's Health Information Center has more about breast-feeding.
Wednesday, August 02, 2006
New Zealand SIDS Death Rate DecreasesNew statistics released by the New Zealand Ministry of Health show that the national rate of Sudden Infant Death Syndrome (SIDS) fell by 70% after an educational campaign in wrapping mattresses with special polyethelene covers was begun. The program began after research by a NZ scientist showed a link between SIDS and the toxic fumes emitted by mattresses.According to the statistics, NZ Maori babies are 10 times more likely than NZ European (Pakeha) babies to die of SIDS.(2) Following the implementation of mattress-wrapping by the Pakeha community over the last eleven years (with an 85% reduction in their SIDS rate), New Zealand has the highest inter-ethnic SIDS disparity of any country in the world.In contrast to the US and UK, where back sleeping has been adopted as a method to prevent crib death, New Zealand began to publicize mattress-wrapping in 1994, with the practice widely adopted. Since then, the rate of deaths on unwrapped mattresses has continued to increase, while no deaths have been reported for babies sleeping on wrapped mattresses. Another advantage to this solution is that babies can sleep in a variety of positions and not suffer from plagiocephaly, or flattened heads.The results of the New Zealand mattress-wrapping program have been published in two peer-reviewed journals of environmental medicine(3) and far exceed the results of any other SIDS prevention program in the world.Notes1. Source of statistics: New Zealand Ministry of Health (final statistics to 2001; provisional statistics for 2002 and 2003; progress counts for 2004 and 2005).
2. NZ Maori SIDS rate: 2.0 deaths per 1000 live births; NZ European/Pakeha SIDS rate: 0.2 deaths per 1000 live births.
3. Journal of Nutritional & Environmental Medicine 2004;14(3): 221–232. Zeitschrift fuer Umweltmedizin 2002; 44: 18–22.For further information, see: www.cotlife2000.co.nz
Saturday, July 22, 2006
Risk of childhood asthma increases in babies given antibiotics, scientists warnRisk of childhood asthma increases in babies given antibiotics, scientists warn
Source: Daily Mail
Date: 14/03/2006
Emily Cook, health reporter in the Daily Mail, reports that scientists have warned that babies given antibiotics appear to have a much higher risk of developing childhood asthma. The suggestions come from a study undertaken at the University of British Columbia, and published in Chest, in which eight previous studies were analysed where babies given antibiotics were compared with those who were not. It was found that infants aged under one treated with antibiotic were twice as likely to develop asthma than those children who were untreated. Children who received a multiple course of antibiotics were at an increased risk, with each additional course during the first year equating to a 16% rise in risk. Dr Lyn Smurthwaite of Asthma UK said that the study "...highlights that antibiotics should always be prescribed and taken responsibly."Risk of childhood asthma increases in babies given antibiotics, scientists warnRisk of childhood asthma increases in babies given antibiotics, scientists warn
Source: Daily Mail
Date: 14/03/2006
Emily Cook, health reporter in the Daily Mail, reports that scientists have warned that babies given antibiotics appear to have a much higher risk of developing childhood asthma. The suggestions come from a study undertaken at the University of British Columbia, and published in Chest, in which eight previous studies were analysed where babies given antibiotics were compared with those who were not. It was found that infants aged under one treated with antibiotic were twice as likely to develop asthma than those children who were untreated. Children who received a multiple course of antibiotics were at an increased risk, with each additional course during the first year equating to a 16% rise in risk. Dr Lyn Smurthwaite of Asthma UK said that the study "...highlights that antibiotics should always be prescribed and taken responsibly."
Tuesday, May 16, 2006"The Independent on Sunday reported yesterday that Tony Blair's Labour Government is planning a "strategic shift" in childbirth policy away from hospital delivery and has commissioned research to support the case for homebirths and "challenge the assumption that births should take place in hospitals."If you want to read up on a few articles that were printed in Britain, follow these links:Leading Article: A Mother's Birthright
Home vs hospital: Where would you rather give birth to your baby?
Childbirth Revolution: Mummy State
New Zealand national paper The NZ Herald also followed the story here:
from email from Gloria LEmay
Saturday, May 13, 2006
Labor drug spurs protest of ACOGLabor drug spurs protest of ACOGBy Joyce Howard Price
THE WASHINGTON TIMES
May 9, 2006A grass-roots women's group wants to ban Cytotec, a popular anti-ulcer drug used to induce labor, citing drug-related injuries and deaths for mothers and babies.
Protesters marched in the rain and held a rally yesterday outside the District's convention center, where the 49,000-member American College of Obstetricians and Gynecologists (ACOG) is meeting this week. They are targeting ACOG because that group insists such severe outcomes are extremely rare.
"Cytotec (generic name: misoprostol) is now the standard of care for inducing labor, since it is fast and cheap. But it can cause violent contractions" and serious harm, said Maddy Oden of Oakland, Calif., both a marcher and speaker at the rally sponsored by WECAN, or Women Educating Cytotec Awareness Nationwide.
Mrs. Oden said her 32-year-old daughter, Tatia Oden French, and her daughter's baby both died in December 2001 when Mrs. French was given Cytotec to induce labor in a "well-known and well-respected hospital."
"My daughter had a full-term pregnancy and was totally healthy. But she was two weeks overdue, so she was given Cytotec," Mrs. Oden said.
Cytotec is not approved by the Food and Drug Administration (FDA) to induce labor and it recommends the drug not be used by pregnant women because of the "rare but serious side effects," such as a ruptured uterus.
Mrs. Oden describe what happened to her daughter and granddaughter: "Ten hours after being administered Cytotec, Tatia suffered hyper-stimulation of her uterus, an amniotic fluid embolism (clot) was released, an emergency C-section was performed because the baby was also in distress. Both Tatia and her baby, Zorah, died in the operating room."
Since 2000, the FDA has issued two alerts, warning against use of Cytotec in pregnant women. In August 2000, Cytotec's then-manufacturer, G.D. Searle & Co., warned doctors that using Cytotec to induce labor could endanger both the mother and fetus.
But on Oct. 27, 2000, ACOG took issue with Searle's conclusions in a letter to the FDA. The professional organization said its review of adverse events reported to the FDA indicated most involved high and frequent doses of Cytotec and women with prior Caesarean delivery or major uterine surgery.
"The ACOG Committee on Obstetric Practice reaffirms that misoprostol is a safe and effective agent for cervical ripening and labor induction when used appropriately," the group said.
The FDA issued this warning in May 2005: "There can be rare but serious side effects, including a torn uterus (womb), when mistoprostol is used for labor and delivery. A torn uterus may result in severe bleeding, having the uterus removed (hysterectomy), and death of the mother or baby."
Early this year, Pfizer, now the manufacturers of Cytotec, also warned against its use by pregnant women.
• Researcher Amy Baskerville contributed to this report.
Tuesday, May 09, 2006
U.S. has second worst newborn death rate ..U.S. has second worst newborn death rate in modern world, report says
Research: 2 million babies die in first 24 hours each year worldwideBy Jeff Green
CNN
http://www.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/index.html
Monday, May 08, 2006
"High-risk Lovemaking""High-risk Lovemaking"a mini-play
excerpted from Jock Doubleday'sSpontaneous Creation:
101 Reasons Not to Have Your Baby in a Hospital
(Vol. 1)www.SpontaneousCreation.orgHUSBAND and WIFE passionately take off each other's clothes. WIFE reacts with alarm to HUSBAND's potbelly.WIFE: How many French fries did you eat tonight?!HUSBAND: Oh, about 200 . . .WIFE: How many have you eaten since childhood?HUSBAND: Uh, I don't know.WIFE: You could die of a heart attack at any time! You could die tonight while we're making high-aerobic love! And I could die from a broken rib, you're so heavy!HUSBAND: I've gained a lot of weight since high school.WIFE: I don't think a heart attack for you or a punctured lung for me sounds too good, do you?HUSBAND: No.WIFE: I think our lovemaking has become just too risky, dear. I've been thinking . . .HUSBAND: You have?WIFE: Actually, no. I haven't been thinking. I've been talking with my friends. And my friends say that the best thing to do in a high-risk lovemaking situation is to go to the hospital.HUSBAND: Huh?WIFE: We're talking about life-threatening love, here, honey! Our home has become too dangerous for us safely to engage in our usual acrobatic sacred union. What better place than the hospital to make worry-free gymnastic love?HUSBAND: Uh . . .WIFE: We'll pack our things, bundle ourselves in the car, and drive to the hospital! It'll be fun, like a camping trip! We'll rent one of those hygienic operating rooms for two or three hours. Professionals will be bustling about on errands of mercy, and you and I will descend into our animal selves. Are we a zebra? Are we a lion? Nurses to take care of our every need! "Have a glass of water" . . . "Have some anesthesia." I think it would be just plain foolish to suffer painful injury just because we didn't bite the financial bullet and hire the necessary technicians to stand guard over our chandelier-swinging copulations.HUSBAND: Uh . . .WIFE: And once we feel truly safe – as one always does in the hospital – we can plumb the deep depths of our sexual natures! We can push the envelope of the sexual experience in a way that's impossible for fearful home-bound lovers to do! We can create our own Kama Sutra! We'll call it Calmly Sutured! Wow, I just made that up! I'm a neologist as well as an ideologue! ha ha! I've always loved the feel of starched sheets on my bare bottom! Talk about primal! I'm getting excited just thinking about hospital love!
Formula RecallMEAD JOHNSON RECALLS ONE BATCH OF
GENTLEASE™ POWDER INFANT FORMULA IN 24 OUNCE CANS
- Batch Number BMJ19 -
(EVANSVILLE, Ind. February 21, 2006) - In keeping with our commitment to provide safe and healthy nutritional products, Mead Johnson Nutritionals is initiating a voluntary recall of one batch of Gentlease™ powder infant formula in 24 ounce cans, batch number BMJ19. This action is being taken because a portion of the batch was found to contain metal particles.In the rare instance that an infant were to aspirate the infant formula into the lungs, some of these particles, if present, could present a serious risk to the baby’s respiratory system. There is also the small risk that these particles could damage the baby’s throat. Mead Johnson is not aware of any infants who have had any of these problems as a result of being fed infant formula from this batch. Any injuries associated with this problem would likely manifest themselves within 3 to 4 hours. If you have any concerns about your baby’s health you should consult your baby’s health professional.The batch code is located on the bottom of the can. No other Gentlease™ batch or infant formula from Mead Johnson Nutritionals is affected by this action. Consumers who have a can of Gentlease™ with this batch number should discontinue using the product from the can and call Mead Johnson toll free at
1-888-587-7275
. Consumers are asked not to return the product to their retailer.Top midwife's natural births callA higher proportion women in Wales have Caesareans than in England
Wales' first professor of midwifery says the growing number of women having Caesarean births must be reduced.Billie Hunter has been made Professor of Midwifery at Swansea University, the first such role in Wales.She said she hopes to influence policy in Wales' maternity services, including reducing the Caesarean rate and combating a shortage of midwives.Since 1996, the number of women having Caesarean births in Wales has risen from 19% to nearly 24%.'Emotional problems'The figure in Wales is higher than in England, where 22.7% of birth were Caesarean according to the most recent 2003-4 figures.Professor Hunter told BBC Wales that while Caesareans were often necessary, women frequently chose to have them because they were "frightened".
Midwives don't go into it for the pay - it's about job satisfaction
Professor Billy HunterShe added: "If it's an emergency Caesarean or there's a clinical need, then it's appropriate."But we find that women may have physical or emotional problems after having a Caesarean when it wasn't needed."My impression is that women are frightened about childbirth, they are frightened of pain and they consider a Caesarean as an option."She said she thought there was more midwives could do to help ease women's fears over natural childbirth, adding: "The relationship between midwives and women is key."'Influence policy'Prof Hunter, 52, is Wales' first professor of midwifery and one of only about a dozen in the UK.After working in midwifery for 25 years, Prof Hunter said her new role was to carry out research into maternity issues in Wales, but also to educate midwives and parents on choices.Professor Billie Hunter
Billie Hunter is Wales' first professor of midwiferyShe added that she hoped to influence policy on maternity issues.Prof Hunter said: "My main role will be research - finding out more about maternity care in Wales, understanding the issues and then helping to improve it."There's still lots we don't know about having a baby and the experience of women who are having a baby."As well as the increasing rate of Caesarean births in Wales, Prof Hunter said maternity services also faced problems of staff shortages.'Burned out'She said: "There's a big problem of recruitment and retention of midwives in Wales, as elsewhere."They get stressed and burned out after a couple of years. I need to find out why that is and help to stop it from happening."Midwives don't go into it for the pay - it's about job satisfaction."Economic and social problems also affected maternity care in Wales, Prof Hunter added."The biggest overall problem in Wales is inequality in health," she said.Home birth"It all starts with birth and how a baby is nourished in the womb has a major impact on that baby's life chances."If a midwife can get there early and influence what people eat and how they look after themselves then it can help at a very early stage."There's scope for projects working with people in economically-deprived areas, ethnic groups or asylum seekers."But Prof Hunter said she was "excited" to be taking up herrole, saying Wales was leading the way in some areas."There are more midwife-led birth units starting up and there is a policy to increase home birth to 10% of the total."
February 17, 2005 Study: Low Level of Amniotic Fluid No Reason to Induce Labor By Janice Billingsley, HealthScoutNews Reporter.
(Note: to increase amniotic fluid, the mother should drink lots of water! --Gloria)
FRIDAY, Feb. 7, 2003 (HealthScoutNews) -- A low level of amniotic fluid in the last trimester of a pregnancy, often thought to be sufficient cause to induce delivery, is not reason enough to do so.
Johns Hopkins researchers who studied the health of more than 250 babies born at 37 weeks of gestation say they found that babies whose mothers had low levels of amniotic fluid were of normal size. And the babies had no greater risk for health problems than babies whose mothers had normal levels of amniotic fluid.
"This study indicates that we don't want to intervene because of a Amniotic Fluid Index (AFI) of less than five if everything else is normal," says study author Dr. Ernest M. Graham, an assistant professor of gynecology and obstetrics at Johns Hopkins University.
Graham presented the results of his study on Feb. 7 at the annual meeting of the Society for Maternal-Fetal Medicine in San Francisco.
Amniotic fluid is a clear, slightly yellowish liquid that surrounds
the fetus during pregnancy; it is contained in the amniotic sac. Normal levels of fluid indicate proper functioning of the developing fetus, while low levels can be associated with incomplete lung development and poor fetal growth. Measured by depths in centimeters, normal amounts range from five to 25 centimeters; below that is considered low.
The American College of Obstetrics and Gynecology recommends the Amniotic Fluid Index should be only one measure of assessing fetal health. Heart monitors and sonograms are others. However, doctors often induce delivery -- especially at 37 weeks -- based largely on a low AFI, says Dr. Siobhan Dolan, assistant medical director of the March of Dimes. Normal gestation lasts approximately 37 to 40 weeks, according to the March of Dimes, which last week launched a $75 million campaign to address the high incidence of premature babies born before 37 weeks.
"In general, there's a tendency, at 37 weeks, to deliver the baby," Dolan says. "But this is a good study because it gives people reassurance to manage the pregnancy with careful monitoring and observation. You don't have to go immediately to the labor room."
For the study, Graham and his colleagues studied 262 women who gave birth at Johns Hopkins Hospital from 1999 to 2002, comparing the babies' health at birth. One hundred thirty-one women had had a low AFI during their third trimester, a condition called oligohydramnios.
The other 131 women had normal amounts of amniotic fluid at the end of their pregnancies. Women with low AFI levels had their labor induced sooner due to their condition, but were less likely to have Caesarean sections, Graham says. The babies born to these women were normal size, and were at no increased risk for respiratory problems, immature intestines or brain disorders, he says.
"We've always thought that AFI was correlated with blood flow in the fetus, that a low AFI meant there wasn't a good blood flow, but we found that AFI is a very poor indicator of that," Graham says. The finding should give doctors pause before using AFI test results as a reason to induce delivery, he adds.
"If a low AFI is the only thing determining an early intervention in a pregnancy, that is not a reason to do so," he says.
February 14, 2006 Breastfeeding protects mums from diabetes
by Peter Lavelle <http://www.abc.net.au/health/bio/lavelle_p.htm>
Published 08/12/2005
Australian Broadcasting Company
------------------------------------------------------------------------
There's no doubt that a child who is breastfed is likely to be a
healthier child. Here are some of the advantages of breastfeeding:
* It reduces infections in children (and they're less likely to get
allergies)
* Kids are less likely to become overweight as they get older
* Because they're less likely to be overweight, they're less likely
to develop diabetes.
Now it seems that breastfeeding will help mum avoid diabetes too.
Researchers have found that women who breastfeed for a continuous
six-month period (or more) are less likely to develop diabetes than
women who don't.
Researchers studied a group of 230,000 female nurses between 25 and 55
years old, who were part of the ongoing Nurses' Health Study run by
Harvard Medical School in the US.
The study involved the women filling out questionnaires about different
aspects of their health, which they updated every two years. The
researchers looked at whether or not they had breastfed (if they'd given
birth to children), and whether or not they went on to develop Type 2
diabetes.
Of the 230,000, about 6,200 went on to develop Type 2 diabetes. After
allowing for other risk factors - things like diet, exercise, smoking,
and being overweight - the researchers calculated that having breastfed
within the past 15 years was strongly protective against developing Type
2 diabetes.
The longer a woman breastfed, the stronger the protection. For each year
they breastfed, the women reduced their risk of diabetes by 15 per cent.
So a woman with two children, who breastfed each of them for a year,
reduced her risk of diabetes by nearly a third.
Sustained breastfeeding of one baby gave more protection than
breastfeeding several children for short periods, the researchers found.
A woman had to breastfeed for at least six months to get the benefit -
less than six months, and there was no reduced risk of diabetes.
Also, the reduction in risk only lasted about 15 years. Beyond this, a
woman's risk was the same as if she'd never breastfed. And women who had
developed gestational diabetes - that is, diabetes during pregnancy only
- didn't get any later protection against diabetes from breastfeeding.
Why did breastfeeding confer this protective effect? Previous studies
have shown that breastfeeding makes the body's metabolism more sensitive
to insulin, and tends to stabilise glucose levels, the researchers say.
Just why this happens isn't fully understood. It may be because when the
mother manufactures milk she uses energy - about 500 calories (2100
kilojoules) a day, or about the equivalent of a 6-8 kilometre jog. This
makes the mother absorb more glucose from the blood and keeps glucose
levels from fluctuating outside normal ranges.
Is it worth breasfeeding simply for this protective benefit? That's up
to the mother to decide. But diabetes is a condition well worth avoiding
- it's a risk factor for serious conditions like heart disease, kidney
disease and disorders of the eye. And then there are the other benefits
to mum of breastfeeding - it establishes a bond between mother and
child, and it's clean, convenient and cheap.
The Public Health Association of Australia recommends breastfeeding
ideally for two years, with no solids for the first six months.
More info
* Stuebe A at al, Duration of lactation and incidence of Type 2
diabetes - Journal of the American Medical Association, 2005, vol
294 pp 2601-2610
<http://jama.ama-assn.org/cgi/content/short/294/20/2601>
* Australian Breastfeeding Association
<http://www.breastfeeding.asn.au/>
* Public Health Association of Australia - Breastfeeding policy
<http://www.phaa.net.au/policy/BREASTFEEDINGF.htm>
* Diabetes fact file - Health Library A-Z
<http://abc.net.au/health/library/diabetes_ff.htm>
* Women's health - Health Library A-Z
<http://www.abc.net.au/health/library/womenshealth.htm>
February 5th, 2006New research is out. Take a look at it at www.birthworks.org/primalhealth PRIMAL HEALTH RESEARCHA NEW ERA IN HEALTH RESEARCHPublished quarterly by Primal Health Research Centre
Charity No.328090
72, Savernake Road, London NW3 2JRModent@aol.com
January 25, 2006C-section, Breastfeedings and Bugs for your baby.