Posted by Melissa Maimann on May 31, 2009 in
Birth,
Obstetrics For further information, contact Melissa Maimann at Essential Birth Consulting.
Link
The number of assisted reproduction cycles performed worldwide jumped 25.6% from 2000 to 2002, according to an international report.
… Between 219,000 and 246,000 babies were born through assisted reproductive technology (ART) in 2002 — an estimated 12% increase over the same two-year period …
Frozen embryo transfers increased 47% between 2000 and 2002, twice as fast as the increase in egg aspiration cycles.
… The researchers noted that these increases reflected growth in the number of countries and centers reporting, as well as true growth in assisted reproduction activity.
… Worldwide, the 601,243 initiated cycles resulted in a delivery rate of 22.4% per aspiration for conventional in vitro fertilization, 21.2% per intracytoplasmic sperm injection, and 15.3% per frozen embryo transfer.
Overall, frozen embryo transfers represented 21.7% of the aspirations, up from 14.4% in 2000.
There was substantial variation in overall assisted reproductive technology by nation, ranging from a low of two cycles per 1 million inhabitants in Ecuador to 3,688 per million in Israel.
Overall, the number of transferred embryos dropped, with particularly low numbers in Europe and Australia.
… The percentage of transfers with four or more embryos decreased from 15.4% to 13.7% in fresh cycles.
The proportion of single embryo, fresh transfers increased from 10.5% to 12.4%.
The proportions of twin pregnancies fell from 26.5% to 25.7%.
The proportion of triplet pregnancies decreased from 2.9% to 2.5%.
There was similar reduction in multiple pregnancies for frozen embryo transfers.
… In the report, multiple pregnancies were associated with a higher rate of premature birth … For example, 94.2% of triplets were born prematurely, compared to 13.5% for singletons. Likewise, the perinatal mortality rate was 71.2 per 1,000 babies among triplets, compared to 10.7 among singletons.
Dr. de Mouzon’s group also reported a notable increase in intracytoplasmic sperm injection, which accounted for 56.6% of fertilization procedures in 2002 compared with 47.6% in 2000. The rates were particularly high in Latin America (75.9%) and the Middle East (92.4%).
“Since there is no reason to believe that there is such an increase in male infertility, the reasons behind this trend are difficult to know, since [it] has not been demonstrated to improve results for non-male infertility treatment,” …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, Complicated pregnancy or birth, intervention, Obstetrics, Preconception care
Posted by Melissa Maimann on May 30, 2009 in
Birth For further information on nutrition and exercise in pregnancy, contact Melissa Maimann at Essential Birth Consulting.
Link
Obese women should gain only 11 to 20 pounds during pregnancy, according to updated guidelines from the Institute of Medicine.
The recommendation builds on the agency’s earlier guidelines that recommend a weight gain of 15 to 25 pounds for overweight women, 25 to 35 pounds for normal women, and 28 to 40 pounds for underweight women.
Researchers have included recommendations for obese women since body mass index (BMI) and gestational weight gain have increased among women across the country.
… The new ranges are more conservative, with the underweight BMI category starting at 18.5 instead of 19.8.
… This will result in better outcomes for both mom and baby, he said, since it is “remarkably clear that pre-pregnancy BMI is an independent predictor of many adverse outcomes.”
Interventions in diet and exercise — both before and during pregnancy — will be essential in assisting women in meeting the guidelines, especially those who are obese, he said.
“The idea is that it will require an effort by many people,” Dr. Catalano said. “It’s not just something that one healthcare provider during pregnancy can do. It includes a host of other people including a nutritionist, dietician, and even an exercise physiologist.”
… “Women don’t need to eat for two, but for 1.1,” he said.
… There is no continued support for lower-range weight gains in women under 20, as younger women and adolescents often need to gain more to improve birth outcomes.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Birth choices, Complicated pregnancy or birth, Preconception care
Posted by Melissa Maimann on May 29, 2009 in
Birth,
Obstetrics For further information, contact Melissa Maimann at Essential Birth Consulting.
Article
The New York Times on Sunday examined maternal mortality in Tanzania … the country has a maternal death rate of 578 per 100,000 births, though the World Health Organization puts the count at 950 maternal deaths per 100,000 births. Roughly 13,000 Tanzanian women die of pregnancy- or childbirth-related causes annually, giving it “neither the best nor the worst record in Africa,” the Times reports. Tanzania is one of the world’s poorest countries and faces shortages in several areas — including health workers, drugs, equipment and infrastructure — that contribute to maternal mortality.
The Times profiled obstetrical care at a rural hospital in Berega, Tanzania, that typifies efforts to reduce maternal mortality in Africa. Facing a shortage of doctors and nurses, the hospital has been training “assistant medical officers” to perform caesarean sections and other procedures. Meanwhile, the government also is attempting to train more assistants and midwives, build more clinics and nursing schools, offer housing to attract health workers to rural areas and provide places for pregnant women to stay closer to hospitals.
… many women who die in childbirth are young and healthy, and most maternal deaths are preventable with basic obstetrical care. The five leading causes of maternal death are bleeding, infection, high blood pressure, prolonged labor and complications resulting from abortions … In discussing maternal mortality, experts often refer to what are known as “the three delays”: a woman’s delay in going to the hospital, the time spent traveling there and the hospital’s delay in starting treatment upon the woman’s arrival. Although only around 15% of births have dangerous complications, the problems are almost impossible to predict, and seemingly normal labors can quickly progress into serious emergencies. Worldwide, more than 536,000 women die annually from pregnancy or childbirth, according to WHO …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Caesarean, Complicated pregnancy or birth, hospital birth, intervention, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on May 28, 2009 in
Birth,
Caesarean,
Obstetrics For further information, contact Melissa Maimann at Essential Birth Consulting.
Article
The increasing trend for Caesarean births may be linked to a rise in diabetes cases.
The increasing popularity of Caesarean births and having children later in life are contributing to a dramatic rise in cases of diabetes in young children.
The number of children under five with Type 1 diabetes is likely to double by 2020 and there are ’substantial’ increases among older children, say researchers.
Modern lifestyles are partly to blame, with children born to older mothers and by Caesarean section being at greater risk, while reduced exposure to germs is also a factor.
Doctors say all these factors reflect the fact that Type 1 diabetes and the development of a child’s immunity system are linked.
Increased height and weight among infants, and rapid growth during the first year of life are also contributory factors, says a report published on the The Lancet medical journal’s Online First website.
It looked at data from 17 European countries from 1989-2003 when there was an overall rise of almost 4 per cent a year in incidence of Type 1 diabetes, with the biggest rise of 5.4 per cent among 0 to four year olds.
… About 250,000 people in the UK have Type 1 diabetes, many of whom are children and young adults. Most need insulin injections daily to control the illness which, when poorly managed, can lead to long-term complications such as blindness, kidney failure and heart disease. There is no cure.
Dr Chris Patterson of Queen’s University … said the increasing number of cases over time was so rapid that it cannot be related to genetic factors alone.
‘Environmental factors are driving this,’ he said. ‘We know children born to older mothers, for example, are more at risk. There is a 20 per cent extra risk for babies born as a result of Caesarean section, while those putting on weight rapidly during the first year of life are also at increased risk. Breastfeeding reduces the risk.
‘In addition there are other environmental issues behind the rising trend, such as children being exposed to fewer germs.
‘Type 1 diabetes is very much involved in the development of the immune system – which, in the case of Type 1 diabetes, turns on the body and stops it producing insulin. But it is still a rare disease.’
Dr Iain Frame … said: ‘This evidence that children are developing Type 1 diabetes at an increasingly younger age is worrying.
‘Parents have the task of giving their children or babies insulin injections several times a day.’
He said their children would be at risk of short-term complications such as hypoglycaemic episodes – where the brain does not get enough energy through blood sugars – or diabetes ketoacidosis – where the blood can become dangerously acidic – both of which may require hospital treatment …
So, having a caesarean is a risk for children developing diabetes. I wonder if women are told this as part of the informed consent process that needs to occur before a caesarean is performed? I am also puzzled by the article’s title, “Birth Choices Linked to ….” because caesarean is rarely a birth “choice”. Most women prefer a natural birth. And they can achive it with the right support! The title of the article seems to shift blame for a child’s development of Type 1 diabetes onto the child’s mother. This displacement of blame is unnerving. Women only ever want the best for their children, and they make decisions based on their information they receive from their care providers.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Birth choices, Caesarean, Complicated pregnancy or birth, hospital birth, intervention, Obstetrics, Public and private hospitals
Posted by Melissa Maimann on May 27, 2009 in
Midwifery For further information on advocacy, contact Melissa Maimann at Essential Birth Consulting.
… The policy of Open Disclosure mandates that clinicians explain, take action, express regret and apologise for unexpected outcomes. In an effort to acknowledge patients’ concerns following adverse events and their preference for open communication, Open Disclosure policy is being mandated at national and international levels.
I wonder if this extends to birth-related outcomes, especially when unnecessary interventions take place. You know, inductions for “big” 3Kg babies, caesareans for “failure to progress”, limited options for VBAC (well, I really mean no option – repeat caesarean or repeat caesarean).
New legislation which may come through will mandate all health professionals to report colleagues whose practices are deemed to be unsafe. Currently, we ought to report unsafe practices; this new legislation will make it mandatory.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Public and private hospitals, women's rights
Posted by Melissa Maimann on May 26, 2009 in
Birth,
Home birth,
Midwifery,
Normal Birth For further information on home birth or water birth, contact Melissa Maimann at Essential Birth Consulting.
Article
WA maternity hospitals should allow water births as part of a more flexible approach to cater for women disgruntled with mainstream services, a report into the safety of WA home births has found.
An independent review by Sydney obstetrician Michael Nicholl and professor of midwifery Caroline Homer has found that home births in general are not riskier than hospital births, but calls for tighter scrutiny to make childbirth safer, particularly for high risk babies.
The report was commissioned by the WA Health Department after a series of apparent deaths among home births. It found that while 18 babies with planned home births died in the review period of 2000-2007, none was reported in 2006 and 2007.
… It calls for an urgent review of the State’s home birth policy developed in 2001 and warns that home births are more likely to become unsafe if they are marginalised and out of the mainstream services.
The review found some women were opting for home births because they had limited choices in traditional maternity units, including access to water births, which were often discouraged by hospitals, and women wanting to have a normal delivery after a previous caesarean.
“It seems apparent that the maternity systems are, for some women, too medicalised and restrictive, and do not meet their needs,” the report found.
Professor Homer said when home births were well supported they were a safe option for some but not all women. “Our report does not support that home births in general are unsafe but we need to have the right mechanisms in place,” she said. “We need continued education and more checks and balances.
“What many women really want is continuity of care and services close to their home. They don’t necessarily want a home birth but they want all the things that they perceive home birth women get.” …
It’ll be great if waterbirths can be given the go-ahead in WA, as currently there are no hospitals in WA that support water births. But … having a waterbirth policy does not mean that women will be able to birth in the water. Restrictive policies around fetal monitoring often mean that women are not “allowed” to labour and birth in water. When you remove women who are:
over 42 weeks
under 37 weeks
VBAC
prolonged ruptured membranes
being augmented or induced with syntocinon
having twins
baby ? too small
gestational diabetes
hypertension
any bleeding in pregnancy
long labour
meconium in the waters
having an epidural
had pethidine or morphine
and anything else you can think of, you will see that very few women are actually able to labour and birth in the water. Some hospitals in Sydney offer waterbirths, but only if you don’t fall into one of the above categories, and only if a midwife is on duty who is comfortable with waterbirth. If water birth is important to you, the best way to facilitate this is to book a private midwife for a home birth.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Birth choices, continuity of care, Home birth, hospital birth, intervention, midwife, Midwifery, Midwifery services, Normal Birth, Obstetrics, Public and private hospitals, women's rights
Posted by Melissa Maimann on May 26, 2009 in
Birth For further information about nutrition in pregnancy, contact Melissa Maimann at Essential Birth Consulting.
Article
There is more medical evidence that pregnant women should steer clear of advice to “eat for two.”
Alison Stuebe, M.D. … reviewed data for more than 1,300 women and found that those who consumed extra calories … were more likely to gain more than is recommended during pregnancy that’s 35 pounds or more for a woman with a normal body mass index, or BMI.
Stuebe found that eating an extra 500 calories a day increased the odds of gaining too much by 10 percent. “That’s the number of calories in a muffin or a bagel with cream cheese at Dunkin Donuts,” Stuebe says. “It doesn’t take much for the calories to add up.”
Gaining too much weight is linked with complications at birth, such as pre-eclampsia or requiring a C-section, as well as higher odds that both mom and child will be obese later in life.
… Several eating habits reduced moms’ risk of gaining too much. Women with vegetarian diets in early pregnancy were half as likely to gain an unhealthy amount of weight, and those who exercised vigorously for a half hour a day reduced their risk by 20 percent. The researchers also found that consuming more monounsaturated fat, found in olive oil and nuts, was linked with a lower risk of excessive weight gain.
… It might be obvious that a healthy diet and exercise reduce the odds of gaining too much weight during pregnancy, but more and more women are doing just that. Part of the problem is that providers don’t counsel moms on weight gain, Stuebe says. Other studies have shown that moms who get advice from their doctor or midwife are more likely to gain in a healthy range.
… Eating fried foods “was a huge predictor of excessive weight gain,” …
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Babies, birth, Complicated pregnancy or birth
Posted by Melissa Maimann on May 25, 2009 in
Birth,
Home birth,
Midwifery,
Normal Birth For further information about homebirth, midwifery, or anything relating to pregnancy and birth, contact Melissa Maimann at Essential Birth Consulting.
It’s interesting that whenever some pro-homebirth data is published, the medical community find something wrong with it. The Netherlands study was very large. Its results are consistent with other research that has also concluded that low-risk, midwife-attended home birth is safe.
Even more interesting is that this abstract details the comments of a mere six members of a multidisciplinary group. What would the medical community say if a group of six midwives published comments about a medical journal article that included a sample of over half a million women?
ABSTRACT
Objective:
To critically appraise a recent study on the safety of home birth (… BJOG 2008;115:554) and assess its contribution to the debate about risks and benefits of planned home birth for women at low risk of complications.
Design:
Critical appraisal of a published paper.
Setting:
England and Wales.
Population or Sample:
Home births from 1994–2003 and all women giving birth in the same time period.
Methods:
Six members of a multidisciplinary group appraised the paper independently. Comments were collated and synthesised.
Main outcome measures:
Assessment of: overall methodology; assumptions used in estimating figures; methods used for calculations; conclusions drawn from the results and reliability and consistency of data.
Results:
Although there were some positive aspects to the study, there were weaknesses in design and an inaccurate estimate of risk. Our evidence suggests that the conclusions drawn did not reflect the results and the methodological weaknesses found in the study rendered both the results and conclusions invalid.
Conclusions:
On the basis of our critical appraisal, the study does not contribute to the existing evidence about the safety of home birth to inform decision-making or provision of care. The limitations could have been identified by the peer review process and the problems were compounded by an inaccurate press release. Great care needs to be taken by journals to ensure the accuracy of information before dissemination to the scientific community, clinicians and the public. These data should not have been used to inform national guidelines.
“Great care needs to be taken by journals to ensure the accuracy of information before dissemination to the scientific community, clinicians and the public.” – aka “doctors should be in charge of what the public get to read”. Anyone else come to that conclusion?
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: birth, Birth choices, continuity of care, Home birth, hospital birth, midwife, Midwifery, Midwifery, Midwifery services, Normal Birth, women's rights
Posted by Melissa Maimann on May 24, 2009 in
Birth For further information, contact Melissa Maimann at Essential Birth Consulting.
Article
Despite [warnings] that alcohol can affect unborn children, pregnant women haven’t changed their drinking habits much over the past two decades, the CDC said.
The average annual percentage of pregnant women who drank remained relatively stable at about 12% for any alcohol use and 2% for binge drinking …
… The U.S. Surgeon General has consistently advised women against drinking alcohol during pregnancy. National prevalence of fetal alcohol syndrome is about 0.5 to 2.0 cases per 1,000 births, but the other fetal alcohol spectrum disorders occur about three times as often …
… Women with the highest rates of drinking during pregnancy were older, college graduates, employed, and unmarried.
Between 2001 and 2005, 17.7% of pregnant women ages 35 to 44 reported having at least one drink in the past 30 days, compared with 8.6% of women ages 18 to 24.
… While it’s not well understood why drinking habits differ across certain aspects of social status, the researchers had a few possible explanations. It could be that older women may be more alcohol dependent and have more difficulty abstaining from alcohol while pregnant, they speculated.
Also, they said, more-educated women and employed women might have more discretionary money to spend on alcohol.
… healthcare providers should routinely ask women of childbearing age about their alcohol use and inform them of the risks of drinking during pregnancy.
Alcohol use levels before pregnancy are a strong predictor of alcohol use during pregnancy … Many women who use alcohol continue to do so during the early weeks of gestation because they don’t realize they’re pregnant, as about half of all births are unplanned.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: Preconception care
Posted by Melissa Maimann on May 23, 2009 in
Birth,
Caesarean,
Midwifery,
Normal Birth,
Obstetrics,
VBAC For further information about VBAC and birth options, contact Melissa Maimann at Essential Birth Consulting.
Article
[Elective repeat caesarean] doubles odds for intensive care compared to vaginal birth newborns, researchers say.
Babies delivered by elective, repeat cesarean section delivery are nearly twice as likely to be admitted to the neonatal intensive care unit (NICU) than those born vaginally after the mother has previously had a c-section [VBAC], a new study finds.
These c-section babies are also more likely to have breathing problems requiring supplemental oxygen, the researchers say.
“In addition, the cost of the birth for both mother and infant was more expensive in the elective repeat c-section group compared to the vaginal birth after c-section (VBAC) group,” …
… Nationwide, the c-section delivery rate keeps rising. According to the study authors, by 2006, 31.1 percent of deliveries in the United States were done this way.
Australia’s caesarean rate was 31% in 2006, and our national VBAC rate was 16.5%. In NSW hospital VBAC rates can be as low as 2%.
Furthermore, women who have delivered once by c-section have a greater than 90 percent chance of undergoing another, the authors noted. But experts continue to debate whether these women should try labor and vaginal delivery, or automatically undergo another c-section, as there are risks are associated with each method.
… Kamath and her colleagues turned to records from the perinatal database at the University of Colorado Denver. Those records ran from late 2005 through mid-2008 and focused on babies born to 343 women who had planned a repeat, elective c-section and another 329 who planned to try vaginal birth after having previously had a baby via c-section.
The researchers looked at the differences between groups in newborn admissions to the neonatal ICU and the need for oxygen for breathing problems, as well as cost differences.
Kamath’s team further divided the women into four groups. Of the 343 repeat c-sections, 104 went into labor before the c-section and 239 did not. Of the 329 women who attempted vaginal delivery, 85 failed … and went on to have a c-section.
Kamath’s team found that 9.3 percent of the c-section babies were admitted to the NICU, but just 4.9 percent of the vaginally delivered babies were. And while 41.5 percent of the c-section babies required oxygen in the delivery room, 23.2 percent of the vaginally delivered babies did. After NICU admission, 5.8 percent of the c-section babies needed the oxygen compared to 2.4 percent of the vaginally delivered babies.
The median hospital stay was three days for babies who were delivered vaginally and four days for the other three groups …
“The failed VBAC babies required the most resuscitation and had the most expensive total birth experience,” Kamath concluded. But, overall, the VBAC group did better than the c-section group …
Women who opt for a repeat c-section should first understand these risks and differences before they make their decision, Kamath said.
The study results suggest another important take-home point … “The decision to have your first c-section is very important,” he said. “There should be a clear medical indication [because] your first may dictate subsequent [delivery methods].”
Women also need to know that vaginal delivery is possible for many women who have already undergone a c-section, Fleischman said. Some hospitals do not allow vaginal delivery after a prior c-section, however, so he suggested that any woman who is planning on one find out early on what her hospital’s policy is.
If you are planning a hospital VBAC, employ the services of a private midwife to advocate for you and provide support and advice. Australia’s hospital VBAC success rate is very low, however homebirth (private) midwives have a high VBAC success rate – some as high as 90%. By taking a private midwife with you to hospital, you can benefit from the high success rate while also being in your chosen birth environment.
Melissa Maimann, Essential Birth Consulting 0400 418 448
Tags: birth, Birth choices, Caesarean, continuity of care, hospital birth, intervention, midwife, Midwifery, Midwifery, Midwifery services, Normal Birth, Obstetrics, Public and private hospitals, VBAC, women's rights