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.
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.”
The researchers behind the new study, published Aug. 12 in Circulation, point out that that up to 10 percent of young adults today are born premature.
“We wanted to understand why this occurs so that we can identify the small group of patients born premature who may need advice from their health care provider about this cardiovascular risk,” said study author Paul Leeson, a professor of cardiology at the University of Oxford’s Cardiovascular Clinical Research Facility in the U.K., in a press release. “The changes we have found in the right ventricle are quite distinct and intriguing.”
The study was funded by the British Heart Foundation.
The human heart contains four chambers: the right and left atria — which receive and collect blood — and right and left ventricles, which pump blood from the heart into the circulatory system and rest of the body.
The ventricle on the right side of the heart, specifically, pumps blood from the heart to the lungs, according to the National Heart Lung and Blood Institute.
When breathing air in, a cycle kicks off in which oxygen is passed from the lungs through blood vessels and into the blood. Then, carbon dioxide (waste) is passed from the blood through the lungs where it’s removed when you breathe out. The left atrium is what receives this oxygen-rich blood from the lungs, which is then pumped out by the left ventricle into the main artery of the body, the aorta. Then it is delivered to the rest of the body.
The researchers followed a group of premature babies born in the 1980s until they were about 25. They were given standard heart tests checking for blood pressure and cholesterol, in addition to MRI machines to measure patients’ blood vessels and heart structures. They then created a computer model to determine how much blood is being pumped in their hearts.
“Their hearts appear to be slightly smaller, they had slightly thicker walls and had a slight reduction of the blood they are pumping,” Leeson told CBS News’ Alphonso Van Marsh of those born prematurely, when compared to those born at full term.
People with these types of changes in the right ventricle’s structure are more likely to have mild to moderate cases of high blood pressure (hypertension), and are at an increased risk for heart failure or cardiovascular-related death, according the researchers.
Women who received flu vaccines during the 2009 flu season, which was deemed a “pandemic” because of its severity, were more likely to have healthy pregnancies than those who didn’t get their flu shots, according to a new study published in the journal Clinical Infectious Diseases. More from The New York Times:
Typically flu vaccination rates among pregnant women have hovered between 13 to 18 percent nationally. But a push by health officials during the 2009 season drove vaccination rates for the H1N1 vaccine up to about 45 percent in the United States, where they have remained since.
Some expectant mothers have been reluctant to get a flu shot over concern about the health of the fetus, but the study showed that flu vaccination was not only safe but protective, said Dr. Saad Omer of the Rollins School of Public Health at Emory University, the senior author of the study.
Dr. Omer and his colleagues looked at the electronic medical records of 3,327 pregnant women between April 2009 and April 2010. The study, published in the journal Clinical Infectious Diseases, found that the infants born to vaccinated mothers had a 37 percent lower likelihood of being premature, and they also weighed more at birth than babies born to unvaccinated women.
The Food and Drug Administration has issued a warning against a common thickener used to help premature babies better consume and digest their food. The warning states that SimplyThick has a risk of causing necrotizing enterocolitis, or NEC, a life-threatening condition that damages intestinal tissue. More from The New York Times:
An F.D.A. investigation of 84 cases, published in The Journal of Pediatrics in 2012, found a “distinct illness pattern” in 22 instances that suggested a possible link between SimplyThick and NEC. Seven deaths were cited; 14 infants required surgery.
Last September, after more adverse events were reported, the F.D.A. warned that the thickener should not be given to any infants. But the fact that SimplyThick was widely used at all in neonatal intensive care units has spawned a spate of lawsuits and raised questions about regulatory oversight of food additives for infants.
SimplyThick is made from xanthan gum, a widely-used food additive on the F.D.A.’s list of substances “generally recognized as safe.” SimplyThick is classified as a food and the F.D.A. did not assess it for safety.
John Holahan, president of SimplyThick, which is based in St. Louis, acknowledged that the company marketed the product to speech language pathologists who in turn recommended it to infants. The patent touted its effectiveness in breast milk.
However, Mr. Holahan said, “There was no need to conduct studies, as the use of thickeners overall was already well established. In addition, the safety of xanthan gum was already well established.”
The number of premature births in the United States has dropped to 11.7 percent of all births, the lowest number in a decade, and the 5th consecutive year the number has fallen. This news from the March of Dimes in its annual Premature Birth Rate Report Card. Though the U.S. as a whole earned a “C” grade from the report card, four states–Vermont, Oregon, New Hampshire, and Maine–earned “A” grades for their excellent prenatal health education programs and other measures, including smoking cessation programs, that help reduce preterm birth rates.
The March of Dimes has set a goal of reducing the total number of premature births to 9.6 by the year 2020, as the organization’s president, Dr. Jennifer L. Howse, discusses in this video about the report card: