Category Archives: Uncategorized

Lowering the cesarean rate in Ontario

Ontario: Niagara Falls (and so do cesarean rates)

Here’s an interesting article about one hospital’s successful effort to reduce cesarean births…

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Home birth: Better for baby in the long run?

The new CDC report on home birth is everywhere, media-wise, including CNN  and NPR. Deservedly so–Marian MacDorman (from the CDC) and Eugene Declercq (Boston University School of Public Health) have teamed up on excellent studies of a number of maternity care topics, including cesarean section, VBACs, and, of course, home birth. Their work is always trustworthy and accurate.

Not mentioned in the CDC report (because it wasn’t really the subject) are the benefits to the home-born baby, particularly in terms of the development of the immune system, and lessened risk of future chronic diseases like asthma, eczema, diabetes and obesity.

As the safety issues of home birth are brought more clearly into focus–the Birthplace in England study showed that, in a well-integrated maternity care system (which most of the U.S. is not, at present), home birth for women having a second or subsequent birth is as safe as a hospital birth–the long-term health advantages for the baby should be included as a prominent part of the discussion.

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Ho-ho-ho, etc…

I’m taking a Christmas-New Year’s break this week. I’ll be back soon with more posts. Hope your holidays are warm and happy!

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Flu vaccine for pregnant women: Good idea or bad science?

Taking one for the team...

There’s a lively debate going on over at Science & Sensibility on the subject of flu vaccination for pregnant women. It’s worth checking out. There’s quite a variety of viewpoints – I’ve tossed in a couple of comments, too.

My take on it is similar to that for other vaccines: the point is risk reduction, not risk elimination, which is impossible. Babies in the 0-6 month age group are much more likely to be hospitalized than older children and adults. Influenza vaccine substantially reduces the risk of infection in those two high-risk groups.

This is something I recently wrote for an obstetrics listserv I subscribe to:

Here’s a pediatrician’s perspective. This is my 32nd flu season working with children, and I strongly recommend influenza vaccine to the pregnant women I encounter, both for their own health and that of their babies. Infants (0-6 months) with influenza have a 30-fold increased risk of hospitalization compared with children ages 5-17 years. They’re much more prone to bacterial complications too, like pneumonia, and they have the highest mortality rate of any age group except the > 65 year old demographic. If a mother catches influenza, it’s almost a given that her baby will, too.

Personal experience: We hospitalized more than a dozen children with influenza from our pediatric clinic last year – the majority were less than 6 months old and had no risk factors for severe disease. Two-thirds of the hospitalized babies were solely breast fed.

It’s good to emphasize less obvious complications as well. For example, even in milder cases influenza can disrupt breast feeding from the baby’s perspective, whether from fussiness, lack of appetite, frequent cough, nasal congestion, or general exhaustion. And a mother with influenza can easily become dehydrated, compromising her milk supply. All in all, influenza is an excellent disease to avoid, and the best way to do that is vaccination.

So if you’re pregnant, or you take care of babies, please get vaccinated! This is the time to do it – before the influenza season hits.

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Family Medicine conference in Vancouver

I’m just back from the 23rd Obstetrics Update for Family Physicians  in Vancouver. I gave the keynote speech (How Did Humans Come to Give Birth Like This? The Evolution of Human Childbirth) and another titled Inside Looking Out: A Baby’s View of Childbirth. About 300 people attended, and it was an excellent conference overall.

Interesting how differently things are approached in Canada. Home births are integrated into the larger maternal-child care system, to cite one example. And nobody yelled at me about evolution. Very refreshing!

Still waiting on the Home Birth Consensus Summit statement to be released. Should be out in the next day or two. I’ll have a lot more to say about that after release.

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About the header photo…

Easter Sunday, 1956, at my grandparents’ farm north of Hoopeston, Illinois. My brothers Steve (left) and Bernard (right), with me, just turned three, in the center. Post-church, just waiting, waiting for the egg hunt to start…

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Almost ready to go…

…later this week.

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