Thursday, August 22nd, 2013
A new research review finds that women who receive consistent care from midwives during pregnancy have better outcomes than those who see family doctors or obstetricians. This review, conducted by the Cochrane Library, found that moms who saw midwives were less likely to need medical interventions or to give birth prematurely.
More from The Huffington Post:
The reviewers looked at 13 trials of more than 16,000 women who saw a small team of midwives throughout their pregnancy, or one primary midwife. Eight of the trials included women who were at low-risk for complications during pregnancy and birth, while five included higher-risk women. All of the midwives were licensed in their respective countries, and none of the trials looked at home births.
On the whole, women who saw midwives throughout their pregnancy were less likely to have an epidural painkiller, an episiotomy (an incision made from the vagina to anus during delivery), or a delivery using instruments, such as a vacuum or forceps. There were no differences in Cesarean birth rates.
Women who received continuous care from midwives also were less likely to have a baby before 37 weeks of gestation, or to lose their babies before 24 weeks.
Notably, higher-risk women who saw a midwife as their point-person did not have worse outcomes than low-risk women — a discovery the researchers interpreted with cautious optimism.
“This is an important finding, because it means that midwives have something to offer women who are not low-risk, when they are coordinating care with a primary care physician or an OBGYN,” argued review author Jane Sandall, with the division of women’s health at Kings College, London.
For now, the researchers can only guess why continuous midwife care seems to confer important benefits.
“Having someone who is there for you, who you know is going to be there at your birth is important to women,” said Sandall. “Because women know their midwives, and they’re often easier to get in touch with them, the midwives are picking up any problems sooner and helping women get the right specialist input as early as possible.”
Image: Newborn baby and mom, via Shutterstock
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Wednesday, August 14th, 2013
The growing body of research about the causes of autism continues to point toward pregnancy and delivery as moments when the brain changes associated with the disorder can occur. Earlier this week, a study was published in the Journal of the American Medical Association, reporting that inducing labor may raise the risk of autism because babies likely to develop autism may fail to send out the biochemical signals to initiate labor. USA Today has more on a second study, which associates an elevated autism risk with an untreated thyroid condition in pregnant women:
One study, published Tuesday in Annals of Neurology, finds a four-fold increase in autism among women who had very low levels of a key thyroid hormone, called thyroxine. Researchers found the link in a study of more than 4,000 Dutch mothers and children. Doctors took blood samples from women around the 13th week of pregnancy, then followed up six years later, asking women to fill out a standard psychological checklist about the child’s behavior and emotional traits.
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Tuesday, August 13th, 2013
Women who give birth after having labor induced may be slightly more likely to have children who are later diagnosed with an autism spectrum disorder (ASD), according to a new study published in the journal JAMA Pediatrics. More from USA Today:
The increased autism risk likely stems from an underlying problem with the pregnancy, rather than any of the methods used to jump-start labor, says lead author Simon Gregory of the Duke Institute of Molecular Physiology.
It’s possible that “infants destined to develop autism are less likely to send out the correct biochemical signals for normal progression of labor,” says Tara Wenger, a pediatric genetics fellow at the Children’s Hospital of Philadelphia, who wasn’t involved in the new study, published in JAMA Pediatrics.
Pregnancy complications increase the risk of many developmental disorders, says Michael Rosanoff, associate director for public health research and scientific review at Autism Speaks, an advocacy group.
And a growing number of studies now link autism to a variety of things that can compromise the health of a pregnancy, says Rosanoff, who wasn’t involved in the study, funded by the Environmental Protection Agency. Researchers are increasingly looking at prenatal risk factors for autism, because this period plays a key role in brain development. Science has ruled out vaccines as a cause of autism, he says.
But studies have found that children are at higher risk for autism if they are born early or very small; if they are in medical distress during delivery; if they have older mothers or fathers; or if they are born less than a year after an older sibling. Autism risk also goes up if a mother has diabetes or high blood pressure; is obese; is exposed to significant air pollution during pregnancy; had low levels of folic acid; takes medications such as an anti-seizure drug called valproic acid; or makes antibodies toxic to the fetal brain.
Gregory notes that his findings are still preliminary and that women shouldn’t resist a doctor’s recommendation about jump-starting labor out of fear of autism.
Image: Woman in labor, via Shutterstock
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Thursday, July 11th, 2013
Leaving a newborn baby’s umbilical cord intact for at least a minute after birth may improve blood quality, specifically iron levels, in infants, and does not pose a health risk to mothers, according to a new study published in The Cochrane Database of Systematic Reviews. More from The New York Times:
[The study] found that delaying clamping for at least a minute after birth, which allows more time for blood to move from the placenta, significantly improves iron stores and hemoglobin levels in newborns and does not increase the risks to mothers.
Doctors usually clamp the umbilical cord in two locations, near the infant’s navel and then farther along the cord, then cut it between the clamps. The timing of the procedure has been controversial for years, and the new analysis adds to a substantial body of evidence suggesting that clamping often occurs too quickly after delivery.
The new paper, published on Wednesday in The Cochrane Database of Systematic Reviews, may change minds, though perhaps not immediately. “I suspect we’ll have more and more delayed cord clamping,” said Dr. Jeffrey Ecker, the chair of committee on obstetrics practice for the American College of Obstetricians and Gynecologists.
Newborns with later clamping had higher hemoglobin levels 24 to 48 hours postpartum and were less likely to be iron-deficient three to six months after birth, compared with term babies who had early cord clamping, the analysis found. Birth weight also was significantly higher on average in the late clamping group, in part because babies received more blood from their mothers.
Delayed clamping did not increase the risk of severe postpartum hemorrhage, blood loss or reduced hemoglobin levels in mothers, the analysis found.
“It’s a persuasive finding,” said Dr. Ecker. “It’s tough not to think that delayed cord clamping, including better iron stores and more hemoglobin, is a good thing.”
Image: Newborn baby, 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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