Tag Archives: Pregnancy

“Birth Day” is out in paperback!

Better than Hemingway

Better than Hemingway

And now, time for some shameless self-promotion…

At long last, Birth Day is out in paperback! What a great gift for you, your partner, your pregnant friends, your non-pregnant friends, your friends with ten kids, your friends who swear they’ll never have kids…basically, Birth Day is a great gift for anyone who has ever been born. (Am I forgetting anybody?)

Birth Day is available from Amazon and other online booksellers, or you can get a signed-by-me copy by ordering directly from my website. It’ll set you back $12.99 plus shipping, but hey, it’s a darned good book:

From the Washington Post:

“Sloan is a graceful writer, and his narrative, like the works of Jerome Groopman, flows easily between memoir, anecdotal reporting and hard science. Birth Day has a natural audience in curious, new and expectant parents. But anyone interested in the complex and, yes, miraculous way we all make it into this world will find lots to wonder over and ponder here, too.”

Aw, shucks…

Okay, commercial’s over! Back to blogging.

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Flu shots help prevent preterm birth

5278448067_f76b92377cA research team in Georgia recently published a study that shows the protective effect of flu vaccine for pregnant women.

Led by Dr. Saad Omer of Emory University, the team examined the records of more than 3,300 pregnant women between April 2009 and 2010. They found that those women who received influenza vaccine overall had a 40% lower likelihood of giving birth before 37 weeks of pregnancy than women who were not vaccinated. That protection increased to 72% during the peak of the flu season.

The protection extended to birthweight as well. Vaccinated women were 69% less likely to have a small for gestational age baby than were the unvaccinated women.

Dr. Omer’s study underscores the importance of flu shots for pregnant women. Keep that in mind come next October, when the 2013-2014 vaccine  comes out!

(Photo credit: International Ladies Garment Workers Union Photographs, 1885-1985)

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Filed under Infectious diseases, Maternal-child health, Vaccines

Birth centers: Safe, economical, and great places for low-risk births

2852282606_22551640c8An American woman with a low-risk pregnancy who chooses a midwifery-led birth center for her maternity care is four times less likely to have a cesarean than if she chooses a hospital birth, according to a review published today in the Journal of Midwifery & Women’s Health.

The review highlights the findings of the National Birth Center Study II (NBCSII), which followed 15,574 women who planned and were eligible for birth center births at onset of labor.

Among the NBCSII’s findings:

  • 84% of women who planned and were eligible for a birth center birth at onset of labor were successful in having one.
  • Only 6% of women intending a birth center birth ultimately required a cesarean section, compared with nearly 24% of comparably low-risk women receiving care in hospitals.
  • Emergency transfers from birth center to hospital were uncommon.
  • Fetal and newborn deaths were rare, and comparable to those in low-risk births in hospital settings.
  • There were no maternal deaths.
  • Birth center care is economical and in keeping with the fiscal goals of the Patient Protection and Affordable Care Act (aka “Obamacare”).

Some nuts and bolts of the NBCSII, FAQ-style:

What, exactly, is a “birth center”?

  • The American Association of Birth Centers defines a birth center as “a homelike facility existing within the health care system with a program of care designed in the wellness model of pregnancy and birth.” The key here is “within the health care system”—the integration between birth center and hospital is critical to the success of any birth center. When emergencies arise, a smooth transfer is vital to keeping mother and baby safe.

Who runs these birth centers?

  • The birth centers in the study were all midwifery-led. 80% were staffed by certified nurse midwives (CNMs), 14% by certified professional midwives (CPMs) or licensed midwives (LMs), and the remaining 6% by teams of CNMs,  CPMs, and LMs. (The different types of midwives in the U.S. can be a bit confusing for the layperson—the American College of Nurse-Midwives provides a handy comparison chart.)

What is a “low-risk” pregnancy? Who qualifies for a birth center birth?

  • Here are the AABC’s eligibility requirements for birth center birth: a single fetus in head-down position, with no medical or obstetrical risk factors that might interfere with normal vaginal birth or require interventions like continuous fetal monitoring or labor induction.
  • By those standards, approximately 85% of pregnancies are “low-risk.”

Why did 16% of the women who planned a birth center birth end up giving birth in hospitals anyway?

  • Of that 16%, about one-fourth were transferred to hospitals before being admitted to the birth center, due to medical issues. Of the rest, the majority were for non-emergency problems, such as prolonged labor. Only 0.9% of the birth center women required an emergency transfer during labor.

Is birth center birth really as safe as hospital birth?

  • Yes, according to the NBCSII’s findings. The rates of fetal death (4.7/10,000 women admitted to a birth center in labor) and neonatal death (4/10,000) in the study were comparable to those in other studies in the U.S. and elsewhere, including those of low-risk birth in hospitals. There were no maternal deaths.

Does birth center care really save money?

  • Yes. In this study alone, cost savings–mainly from fewer medical interventions (including cesareans)–were estimated at more than $30 million, and these 15,574 pregnancies represent less than 1% of all U.S. births. Given that expenses for hospital birth in 2008 exceeded $97 billion nationwide, the opportunity for savings in these health-care-dollar-scarce times is enormous.

A few quibbles:

  • The women in the study were mainly white (77.4%), well-educated (71.8% had at least some college education, and 51.8% were college graduates), and married (80.1%). They were also relatively slender (only 5.7% were overweight or obese, compared with more than 50% of all pregnant American women), mentally healthy (3.3% were being treated for depression or other psychiatric disease), and largely free of substance use (1.5% smokers, 0.5% users of other substances). Though the study’s findings on safety and cost-savings compare favorably with other studies of low-risk pregnancy outcomes, it isn’t clear that these findings can be extrapolated to the U.S. population as a whole.
  • Death rates are crude tools for measuring safety, particularly in low-risk pregnancies. I’d like to know more about morbidity–were the birth center babies more, less, or just as likely as hospital-born babies to suffer birth trauma, for example? I suspect they were less likely to have such complications, given the tendency of birth center staff to perform fewer interventions, but I can’t be certain from this study. Hopefully that will be addressed in a future review.
  • What about breastfeeding? Were the birth center mothers more likely to breast feed than those who gave birth in hospitals? Again, I suspect so, and hope that information on breastfeeding will appear in future reviews of NBCSII data.
  • The 79 birth centers that participated in the study represent only 32% of American birth centers. All 79 are AABC members and as such support the AABC’s Standards for Birth Centers. Other, non-member birth centers may or may not adhere to such standards, and their safety records may or may not be as good as those in this study. With new birth centers appearing at a remarkable pace (up 27% since 2010), ensuring high quality care in all birth center settings may be challenging.

Conclusion:

Withe the publication of this review, the well-entrenched belief that hospitals are the safest place to have a baby takes yet another beating. It’s increasingly clear that most women with low-risk pregnancies can safely give birth at midwifery-led birth centers. A personal/professional note: I’ve taken care of a number of families who’ve had their babies at the Women’s Health and Birth Center here in Santa Rosa, California, run by Rosanne Gephart, CNM. (Rosannne and I go way back). They speak glowingly of their experience at the Birth Center.

One caveat, though. Not all birth centers are alike, and it behooves expectant parents to check out things like staff credentials and birth center accreditation, and to ask pointed questions about how the center handles emergencies and hospital transfers, and how often these occur. Membership in the American Association of Birth Centers is a plus, too. Whether choosing an auto repair shop, a law firm, a pediatrician, or a birth center, it definitely pays to do your homework.

Photo credit: JER_0079

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Filed under Cesareans, Maternal-child health, Natural childbirth

Surgery-saving prenatal intervention or nefarious anti-lesbian plot? You decide.

First do no harm?

First do no harm?

If you’re in the mood for a science-wonky tale of hormones, gender roles, a possible anti-lesbian plot, and a ‘medical intervention-versus-human experimentation’ controversy,  skip on over to a post I wrote for Our Bodies Ourselves (OBOS) in December.

The subject? Prenatal treatment of congenital adrenal hyperplasia (CAH), a rare inherited defect in hormone production that leads to an overproduction of male hormones in utero. CAH can cause deformity of the developing female genitalia (male genital development is unaffected), and can also lead to more “masculinized” behavior in affected girls and women. Though most are heterosexual, women with CAH are more likely to be lesbian or bisexual than the general population.

The prenatal treatment of CAH, in which mothers take very high doses of a steroid medication their entire pregnancies, is primarily intended to prevent genital deformity in girls. But some critics suspect a hidden agenda–the prevention of masculinized behavior and, by extension, lesbianism.

Other critics point out that very few affected girls really need the very aggressive genital surgery performed in the past, and that very high doses of prenatal steroids appear to increase the risk of serious consequences for treated children, including poor growth, learning disabilities, and even mental retardation. Such alarming reports have led many researchers in the United States and Europe to call for an end to the practice.

Still, Dr. Maria New, a pediatric endocrinologist in New York–by far the most prominent advocate of prenatal treatment–has declared the practice to be effective and “safe for mother and child.” Problem is, she and her colleagues haven’t been very diligent in following the babies they’ve treated over the last three decades, so the real risks of the prenatal steroid therapy aren’t yet completely known.

There’s much more detail in the post, and if you’re not feeling science-y enough to tackle that one, fear not. I’ll be back with lighter fare soon!

PS: Even if you’re not feeling science-y today, head to OBOS and donate money to that very worthy organization! Start racking up those 2013 tax deductions!

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Photo credit: Jason Pratt

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Filed under Development, Newborns, Science, Sex & Sexuality

More on cesareans and obesity

Cesareans? Really?

Does cesarean birth put a baby at increased risk for obesity in the future? Seems a little far-fetched at first glance, but Dr. Susanna Huh and her Harvard colleagues just published a study that makes the link a bit more “near-fetched.” (The study itself is available here.)

Huh’s team found that children born by cesarean section were twice as likely to be obese at 3 years of age than were those born vaginally. This relationship held up even when factors like the mother’s weight, ethnicity, age and how many babies she’d already had  were taken into account. Interestingly, it didn’t make a difference whether the cesarean was performed before or after labor started.

The study wasn’t designed to look at the reasons for the increased risk in obesity, but the Harvard team suggested several possibilities:

The first is the alteration of the gut microbiota–the sum total of all the bacteria found in the human bowel–caused by a cesarean birth. (More detail on that here and here.) This alteration can lead to low-level inflammation in the bowel which is associated with obesity.

The second possibility is that cesarean birth is just a stand-in for something else that’s happening at the same time. In this case, Huh and colleagues wonder about all the antibiotics given to women who are having cesareans. Antibiotics are known to alter the gut microbiota, but research results are mixed as to whether this is a lasting effect.

Finally, it’s possible (though unlikely) that all of this has nothing to do with the gut microbiota. There are hormones and other factors related to inflammation that surge in a mother’s bloodstream (and her baby’s) during labor, and these, obviously, are missing if a mother undergoes a cesarean before she starts labor. The lack of maternal stress response during labor could adversely impact the development of the newborn immune system, leading to the inflammation associated with obesity.

My best guess: it’s a big moosh of all of the above, plus other factors no one has even dreamed of yet. In the meantime, the issue of increased obesity risk is one more thing physicians and pregnant women should consider before deciding on how a baby is to be born.

It’s a complicated matter, this business of hatching healthy humans…

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Nicotine: A colic risk factor?

Headed for colic?

A study from Denmark shows a link between nicotine exposure during pregnancy, particularly nicotine replacement therapy, and colic. (Popular nicotine replacement therapies, or NRTs, include products like Nicorette gum, patches, etc.)

Babies born to smokers were 1.3 times more likely to be colicky; those born to women using NRT were 1.6 times as likely. Interestingly, women who both smoked and used NRT were no more likely to have colicky babies than women who only smoked.

The reasons for the higher rate of colic from nicotine exposure, and especially the even higher rates for mothers using NRTs, aren’t known. Possibilities (just me guessing here) include a neonatal withdrawal syndrome along the lines with what’s seen with other drugs, or negative effects on the fetal brain from maternal life stresses that may predispose a pregnant woman to smoke in the first place.

The researchers didn’t look at the total amount of nicotine the fetus was exposed to. It’s possible that women trying to quit smoking during pregnancy actually increased their nicotine intake when they switched to an NRT. Pregnancy can be stressful enough by itself–trying to kick an addiction can add to that stress, and perhaps lead to increased nicotine use via NRTs.

Given all the risks of maternal smoking–including SIDS–a few weeks of colic seems a small price to pay for kicking the nicotine habit. But maternity care and pediatric providers (and family members and friends) should be prepared to support a new mother through a rocky period with her fussy baby–a stressful time that may increase the risk of her taking up smoking again.

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Filed under Environment/Toxins, Maternal-child health, Smoking