Friday, January 22, 2010
May all babies be born into loving hands
From Medscape Medical News
Restricting Food and Fluid Intake During Labor May Not Be Helpful
Laurie Barclay, MD
January 20, 2010 — Restricting food and fluid intake during labor may not be helpful or necessary for women at low risk for complications, according to the results of a systematic review reported online January 20 in the Cochrane Database of Systematic Reviews.
"Since the evidence shows no benefits or harms, there is no justification for nil by mouth policies during labour, provided women are at low risk of complications," lead author Dr. Mandisa Singata, from the East London Hospital Complex in East London, South Africa, said in a news release. "Women should be able to make their own decisions about whether they want to eat or drink during labour, or not."
The authors note that in many birth settings, fluid and food restriction during labor are common and that some women are only permitted sips of water or ice chips. These restrictions may adversely affect the experience of labor for some women.
The goal of this review was to evaluate the benefits and harms of oral fluid or food restriction during labor. The reviewers searched the Cochrane Pregnancy and Childbirth Group's Trials Register through April 2009 for randomized controlled trials and quasi-randomized controlled trials of fluid and food restriction for women in labor vs women permitted to choose what they ate and drank. Two reviewers independently evaluated the studies to see if they met selection criteria, determined risk for bias, and extracted data.
Five trials were identified, enrolling a total of 3130 women, all of whom were in active labor and at low risk of potentially requiring a general anesthetic. One study looked at complete restriction vs liberty to eat and drink as desired, 2 studies compared water only vs specific fluids and foods, and 2 studies compared water only vs carbohydrate drinks.
The meta-analysis was dominated by 1 study performed in a highly medicalized environment. No statistically significant differences were found in cesarean deliveries (average risk ratio [RR], 0.89; 95% confidence interval [CI], 0.63 - 1.25; 5 studies; n = 3103), operative vaginal births (average RR, 0.98; 95% CI, 0.88 - 1.10; 5 studies; n = 3103), Apgar scores of less than 7 at 5 minutes (average RR, 1.43; 95% CI, 0.77 - 2.68; 3 studies; n = 2574), nor in any of the other outcomes examined.
The pooled data were not sufficient to determine the incidence of Mendelson's syndrome, nor were women's views evaluated. One study did show a significant increase in cesarean deliveries for women drinking carbohydrate solutions vs water only, but the sample size was small.
"While it is important to try to prevent Mendelson's syndrome, it is very rare and not the best way to assess whether eating and drinking during labour is beneficial for the majority of patients," Dr. Singata said. "It might be better to look at ways of preventing regurgitation during anaesthesia for those patients who do require it."
Limitations of this study include domination of the meta-analysis by a single study, failure to assess women's views, and potential bias in the review process.
"Since the evidence shows no benefits or harms, there is no justification for the restriction of fluids and food in labour for women at low risk of complications," the review authors conclude. "No studies looked specifically at women at increased risk of complications, hence there is no evidence to support restrictions in this group of women. Conflicting evidence on carbohydrate solutions means further studies are needed and it is critical in any future studies to assess women’s views."
The National Institute for Health Research, United Kingdom, supported this study.
Cochrane Database Syst Rev. Published online January 20, 2010.
Authors and Disclosures
Laurie Barclay, MD
Freelance writer and reviewer, Medscape, LLC
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Friday, January 15, 2010
From Reuters Health Information
C-Sections, Necessary or Not, Increase Maternal Morbidity and Mortality
NEW YORK (Reuters Health) Jan 11 - All cesarean sections put women at increased risk of adverse events, including death, according to the World Health Organization's Global Survey on Maternal and Perinatal Health Research Group.
The group urges that cesareans be done only when medically indicated for the mother or the baby.
The article, published online January 12 in The Lancet, reports the third phase of the WHO global survey, which was conducted in 9 Asian countries in 2007 and 2008: Cambodia, China, India, Japan, Nepal, Philippines, Sri Lanka, Thailand, and Vietnam. It covers the outcomes of nearly 108,000 deliveries in 122 hospitals.
Earlier reports have come from Latin American and Africa.
According to first author Dr. Pisake Lumbiganon from Khon Kaen University, Thailand, and associates, the overall rate of cesarean sections was 27.3%, and the rate of operative vaginal delivery was 3.2%. The most common indications for cesarean section were previous c-section, cephalopelvic disproportion, fetal distress, and abnormal presentation.
China had the highest overall rate (46.2%) of cesareans, and by far the highest rate of cesareans without indication (11.7%). The country with the second highest rate of non-indicated cesareans was Vietnam, at 1%.
Compared with spontaneous vaginal deliveries, operative vaginal deliveries were associated with significantly more maternal deaths, with an adjusted odds ratio (OR) of 3.1.
Any operative procedure increased the maternal mortality and morbidity index (defined as blood transfusion, hysterectomy, internal iliac artery ligation, or death or ICU admission) to a greater extent than spontaneous delivery.
Specifically, compared with spontaneous delivery, ORs for the maternal mortality or morbidity index were 2.1 for operative vaginal delivery, 2.7 for antepartum cesarean without indications, 10.6 for antepartum cesarean with indications, 14.2 for intrapartum cesarean without indications, and 14.5 for intrapartum cesarean with indications.
For neonates, the risk of mortality was significantly increased with operative vaginal delivery (OR 1.6) and intrapartum cesarean with indications (OR 1.5), but decreased with antepartum cesarean without indications (OR 0.3).
For breech and other abnormal presentations, cesarean section - either antepartum or intrapartum -- significantly reduced the risk of perinatal mortality but raised the risk of an extended stay in the neonatal ICU.
The perinatal mortality and morbidity index (defined as death or neonatal ICU stay of 7 days or more) was significantly higher with operative vaginal delivery (OR 1.9), antepartum cesarean with indication (OR 1.9), and intrapartum caesarean with indication (OR 2.1).
Dr. Lumbiganon and associates maintain that "the most important finding of the survey is the increased risk of maternal mortality and severe morbidity...in women who undergo caesarean section with no indication." The increased risk is primarily due to higher rates of ICU admission and blood transfusion.
"If this operation is limited to medical indications and unnecessary use is avoided, resources will be used for a need and will not be taken from other parts of the health system," the authors write.
In a commentary, Dr. Yap-Seng Chon and Dr. Kenneth Y. C. Kwek from the National University of Singapore suggest that "investment in training and clearer guidelines for vaginal birth after cesarean section, intrapartum management, fetal monitoring, and external cephalic version could have wider effect."
They continue, "There is little wrong with medical interventions when indicated, but for those who are still inclined to consider cesarean delivery a harmless option, they need to take a cold hard look at the evidence."
Rally makes pitch to be part of birthing center created from merger
First published in print: Thursday, January 14, 2010
Toting signs and babies, supporters of the birthing center at Seton Health/St. Mary's Hospital showed up in force on Tuesday at a hearing of the state Public Health Council.
Members of the subcommittee overseeing the hearing added five contingencies to Burdett's application for a operating permit: a midwife must be on the board of directors and the medical executive committee of the new center; Burdett must demonstrate it is accommodating the midwife model and that midwives are involved in policy making; the center must submit data to the state on the numbers of Cesarean-sections, vaginal births after C-sections and number of births attended by a midwife; the state will ensure compliance; and the center's initial operating permit will expire in five years so the committee can evaluate the center's compliance before approving a permanent permit.
"I don't think we could be anymore pleased," said Marisa Christiano, a doula and birthing educator from Rotterdam who refers many of her clients to Seton.
James Reed, president and CEO of Northeast Health/Samaritan Hospital, reiterated at the meeting that Samaritan supports the midwifery model.
Seton's birthing center has four midwives and a reputation of being very supportive of mothers who want to give birth naturally. The midwives and Seton families feared that their model of care would be lost in the merger, especially since Seton leaders have been left out of the planning because of conflicts with Seton's religious directives. The new center will provide some birth control services, like tubal ligations and vasectomies, which are not allowed in the Catholic hospital.
The midwives and mothers organized over the past several weeks to make their demands known, and Christiano said they were heard on Tuesday. The hearing was supposed to take 15 minutes, but it lasted more than two hours. Christiano said the committee listened to their concerns.
"We are hoping that we are now going to have a big voice in determining what the policies and procedures are going to be at the new facility," she said.
The full Public Health Council will vote on Burdett's application on Jan. 29.
Cathleen F. Crowley can be reached at 454-5348 or firstname.lastname@example.org.
Read more: http://www.timesunion.com/AspStories/story.asp?storyID=888641&category=RENSSELAER#ixzz0cg7oSBmv
Thursday, January 14, 2010
This article is from a UK epaper. It was sent to me by my first son, the one that DEMANDED meat in utero.
Bacon and eggs could help pregnant women boost their baby's intelligence
By Anny Shaw
Last updated at 10:34 AM on 06th January 2010
The traditional English breakfast is not normally associated with good health.
But scientists have found that eating a plate of bacon and eggs could help pregnant women boost the intelligence of their unborn child.
Women are usually given a list of foods to avoid during pregnancy and it is well documented that a pregnant woman's diet can affect her unborn baby.
Scientists have found that eating a plate of bacon and eggs could help pregnant women boost the intelligence of their unborn child
But the new study suggests that a chemical in pork products and eggs can help the baby's growing brain to develop.
Scientists at the University of North Carolina have discovered that the micronutrient, called choline, is vital in helping babies in the womb develop parts of their brains linked to memory and recall.
In a study of the effects of choline on the brains of baby mice, those fed small doses of choline while in the womb had genetic differences to those given large amounts.
Dr Gerald Weissmann, editor-in-chief of the Federation of American Societies for Experimental Biology journal, which published the research told The Telegraph: 'We may never be able to call bacon a health food with a straight face, but [similar studies] are already making us rethink what we consider healthy and unhealthy.'
Other foods that contain a high level of the nutrient include liver, milk, chicken and nuts.
Previous studies have suggested that large doses of choline could help protect against heart problems.
Monday, January 4, 2010
A petition has be started to show support for the model of care that has existed at the Seton Childbirth Center for the last 10 years. To see this petition, you can go to www.ipetitions.com/petition/setonmerger (you do not have to make a donation).
If you feel moved to write, speak up or otherwise make your views known, all of the following options are available: comment below, comment on the Friends of the Burdett Care Center website (above), add your name to the above petition, write to your local midwife, write to the CEO's of Seton, St Peter's and NorthEast Health (names and addresses on the FBCC site), let members of the news media know what you want/like/need concerning care during the childbearing year. If you do write letters, copies can be posted on the FBCC website. As always, fell free to call me with questions or concerns.
K. Michelle Doyle, CNM, NY LM
Local Care Midwifery