Friday, October 4th, 2013
A large new study of twin births in the U.S. has concluded that most are safe without requiring mothers to have Cesarean sections. More on the study from NBC News:
Studies increasingly are challenging long-held beliefs about Caesareans, such as that women who had one need to deliver future babies the same way.
Now doctors are looking hard at C-sections for twin births, which are on the rise because of infertility treatments. Twins have more risk for birth complications and some studies suggest C-sections lower that risk, but this had not been put to a rigorous test.
Dr. Jon Barrett of Sunnybrook Health Sciences Center in Toronto, led a study in 25 countries of 2,800 women pregnant with twins. All of the first of the twins to be delivered were in good position for birth (most doctors still recommend a C-section if the first twin is in feet-first or breech position).
Half of the moms were scheduled to have C-sections and the rest, vaginal births. About 40 percent of the latter group wound up having C-sections, and 10 percent of those scheduled to have Caesareans ended up giving birth vaginally.
About 2 percent of newborns died or had a serious problem, but the manner of birth made no difference. Nor did it affect the rate of complications in moms.
The Canadian Institutes of Health Research paid for the study. Results are in Thursday’s New England Journal of Medicine.
Image: Twin babies, via Shutterstock
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Tuesday, September 24th, 2013
Over the past 15 years, the cost of delivering a baby vaginally in a hospital has more than doubled, and the cost of Cesarean sections–which have also increased in frequency–have skyrocketed by 70 percent during that period. More from NBC.com:
Over the last 15 years, the cost of vaginal deliveries has practically doubled in the United States, shooting up from $4,918 to $9,294, while the cost of C-sections has increased 70 percent from an average of $8,268 to $14,055, according to Truven Health Analytics.
By contrast, the average cost for an uncomplicated vaginal delivery last year in Switzerland was $4,039 and the average cost in France was $3,541, according to the International Federation of Health Plans (IFHP). That’s nearly half to a third of what it cost in the U.S.
In fact, the United States is the most expensive place in the world to give birth, according to the IFHP. The reason, experts say, has to do with the way hospitals calculate our bills.
“Every time you walk into the hospital, they look at everything that happens to you and say, ‘Can I bill for that?’” explained Gerard Anderson, director of the Johns Hopkins Center for Hospital Finance and Management.
“So, if you get an aspirin, they’re going to bill for that. If you get seen by a specialist, they’re going to bill for that.”
Even when families do have insurance, their portion of the bill can be staggering.
Image: Pregnant woman in the hospital, via Shutterstock
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Thursday, July 18th, 2013
A regular regimen of exercise–two or three periods of moderately intense activity weekly during the second and third trimesters of pregnancy–could help protect women from delivering high birth weight babies, as well as lowering the likelihood they will require a Cesarean section, according to new research published in the British Journal of Sports Medicine. More from ScienceDaily.com:
The researchers contacted a total of 780 Spanish pregnant women attending two primary health care centres in Leganés (Madrid). Finally, 510 gave their consent to participate in the study. They all recognized they were sedentary — that is, that they exercised for less than 20 minutes on fewer than 3 days a week.
The intervention group followed a training program that consisted of 55 minute sessions of aerobic, muscle strength and flexibility exercises on three days a week from weeks 10-12 to weeks 38-39 of pregnancy, while the control group received standard recommendations and care.
The results showed the training sessions did not reduce the appearance of gestational diabetes mellitus but did diminish the incidence of two major associated risks: macrosomia [high birth weight babies] (down by 58%) and caesarean delivery (which fell by 34%).
These findings “reinforce the need to encourage more supervised exercise interventions during pregnancy to combat the negative effects of gestational diabetes mellitus,” says Jonatan Ruiz, researcher in the University of Granada Department of Physical and Sports Education and corresponding author of the study.
Image: Pregnant woman exercising, via Shutterstock
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Friday, June 28th, 2013
The number of American women who deliver their babies via Cesarean section has stopped climbing, according to a national study by the Centers for Disease Control and Prevention, but it is still quite high, with one in three babies being born by C-section. More from ABC News:
Roughly one in three American singletons is born by C-section, according to the study — up 60 percent from the most recent low in 1996. But the rate of C-section deliveries has steadied since 2009, a trend experts say is ”good news” for American moms and babies.
“It’s good news because there’s some inherent risks in C-section deliveries compared to vaginal births,” said study author Michelle Osterman, a health statistician at the U.S. Centers for Disease Control and Prevention. “It’s a very invasive abdominal surgery, and with that comes risks to both mom baby as well as higher cost.”
But there are ups and downs buried in the apparent plateau. While the rate of C-sections performed at 37 or 38 weeks has fallen 4 percent since 2009, the rate of full-term C-sections performed after 39 weeks has increased 3 percent, the study found.
Osterman said the swings could stem from new guidelines issued by the American College of Obstetricians and Gynecologists, which state that vaginal delivery is “appropriate and should be recommended” in the absence of maternal or fetal complications, and that C-section delivery on maternal request “should not be performed before a gestational age of 39 weeks.”
In another example of canceled out ups and downs, C-section rates decreased by 7 percent among women younger than 25 but rose by at least 3 percent for women 25 and older. The rates also varied by location, with some states, such as New York, Oklahoma and Oregon, seeing decreases in 38-week C-section rates since 2009, and others, such as Maryland, Michigan and California, seeing increases in 39-week C-section rates.
Image: C-section equipment, via Shutterstock
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Friday, March 8th, 2013
A Florida woman found herself in the unusual position earlier this week of receiving an email from her obstetrician in which the doctor threatened to send police to her home if she refused to come to the hospital for an immediate cesarean section to deliver her fifth child. Lisa Epsteen had delivered her four previous children by cesarean, but had enlisted the help of Dr. Jerry Yankowitz, chairman of the University of South Florida’s department of obstetrics and gynecology, to attempt the high-risk process of vaginal-birth-after-cesarean (VBAC).
Epsteen was ultimately able to schedule her surgery for March 8, as she wanted, days after she received the email from Yankowitz stating, according to the Tampa Bay Times:
“I am deeply concerned that you are contributing to a very high probability that your fetus will die or your child will incur brain damage if born alive. At this time, you must come in for delivery,” Yankowitz wrote.
“I would hate to move to the most extreme option, which is having law enforcement pick you up at your home and bring you in, but you are leaving the providers of USF/TGH no choice,” he continued.
After contacting advocacy groups, Epsteen was able to delay the surgery and avoid police action. The Times reports:
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Yankowitz was frank with Epsteen about the risks she faced after four caesareans, she said. They met multiple times during her pregnancy, and he stayed in touch by email.
In their last meeting on Friday, she said he urged her to think about his recommendation that she have a caesarean. Epsteen had developed gestational diabetes, another risk factor, plus the baby was not in a good position for a vaginal delivery.
When an ultrasound Tuesday showed the fetus in possible distress, other USF physicians sent her directly to Tampa General and wanted to deliver right then.
But she questioned their alarm. Besides, she couldn’t leave her 2-year-old son with strangers. She was driving the family’s only car, so her husband, a team leader at a call center, couldn’t get to her.
“In Dr. Yankowitz’s defense, and all of the other physicians there, I don’t think they are trying to cover themselves. I think they really do have the best interests of my child and myself at heart,” she added. “On the other hand, this is not the way to go about protecting my baby or me.”
Yankowitz was named the USF chair of obstetrics and gynecology in late 2010. He is one of the few doctors in the nation who is doubly certified in genetics and maternal fetal medicine, according to the USF website. His areas of expertise include ultrasound diagnostics.
After the lawyer got involved, Yankowitz sent a subsequent email saying he wouldn’t send law enforcement to Epsteen’s home. “I personally recognize and respect your right to make the medical treatment decisions for both you and your unborn child. . . . In that regard, please understand my frustration as I truly believe you and your child are in jeopardy.”