childbirth

The High Cost Of Low Breastfeeding Rates

A new cost analysis of the long-term impacts of breastfeeding found that lower-than-recommended breastfeeding rates among U.S. mothers “may cause as many as 5,000 cases of breast cancer, nearly 54,000 cases of hypertension, and almost 14,000 heart attacks each year.” The study, led by a researcher at Harvard Medical School and published today in the journal Obstetrics & Gynecology also found that the economic toll associated with such “sub-optimal” breastfeeding practices reaches into the billions annually.

breastfeeding

The study’s lead author, Melissa Bartick, M.D., an assistant professor of internal medicine at Harvard Medical School and an internist at Cambridge Health Alliance says via email that the bottom line of the analysis is this: “Women need to be supported to be able to breastfeed each child for at least a year — their health, and our economy depend on it.” She adds: “The CDC has found that 60% of women do not even reach their personal breastfeeding goals. Now we know this has a real cost, with thousands of women suffering needless disease and premature death.”

(Bartick also happens to be founder of the “Ban The Bags” campaign, a pro-breastfeeding advocacy group working to stop the common hospital practice of handing over free infant formula samples, or gift bags, to new moms after they give birth.)

Here’s more detail on the breastfeeding study from the Cambridge Health Alliance news release:

The analysis used sophisticated models to compare the effect of current breastfeeding rates in a simulated group of nearly two million U.S. women who turned 15 in 2002. The authors modeled this cohort of women across their lifetimes and estimated cumulative costs. They then compared these results to what would be expected if 90% of the women followed medical recommendations to breastfeed each child for one year. Currently, only about 25% of US children are still breastfeeding at one year of age. Continue reading →

FILED UNDER: Medicine/Science, Money, Personal Health, breastfeeding, childbirth, women's health

May 17, 2013 | 9:48 AM | Rachel Zimmerman

Is It ‘Unethical’ To Prescribe Bed Rest For Pregnant Women?

(cscott2006/flickr)

It seems so intuitively right. You’re facing the risk of delivering your baby early and the doctor prescribes bed rest. What could be more cozy and safe? Why wouldn’t you endure a little extra annoyance (you’re pregnant, after all) if it would help keep your tiny, oh-so-vulnerable fetus floating inside the fortress of your womb as long as possible? Even the words “bed” and “rest” feel so inherently soothing and therapeutic.

Think again.

Bed rest, a growing body of research suggests, may be bad for you. And for physicians to blithely prescribe it is, in a word, “unethical,” argue a trio of doctors from the University of North Carolina School of Medicine.

In a paper called “‘Therapeutic’ Bed Rest in Pregnancy: Unethical and Unsupported by Data” recently published in the journal Obstetrics and Gynecology, Dr. Christina A. McCall and her colleagues make a powerful case against the practice many perceive as cuddly and innocuous.

They cite the medical paradox in which bed rest remains widely used despite no evidence of benefits and, on the contrary, “known harms.” They further suggest that in its current form, strict bed rest should either be discontinued or else viewed as a “risky and unproven intervention” requiring rigorous testing through formal clinical trials.

“If we have anything to learn from the history of medicine it is that instincts and good intentions are a highly fallible compass without the check of scientific controls.”

In an email exchange, Dr. McCall clarifies that she is talking about strict bed rest here and adds:

“If a woman feels that increasing her daily rest lessens anxiety or improves symptoms (whatever they may be), then we are not suggesting this should be discontinued. We are merely suggesting that every woman receive INFORMED CONSENT regarding the literature on bed rest and the autonomy to make her own decision.”

Research suggests that the potential harms for women on bed rest (a broad term that can include everything from total inactivity to limits on strenuous endeavors like household chores, exercise and sex) can be significant. They range from potentially dangerous blood clots and bone demineralization to muscle and weight loss, financial harship due to restrictions on working and a range of psychological suffering, notably depression. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, bed rest, childbirth, obstetrics, pre-term labor, pregnancy

May 9, 2013 | 4:38 PM | Rachel Zimmerman

Report: Many Mothers Say They’re Pressured To Have Birth Interventions

(Listening To Mothers III/Childbirth Connection)

It’s Mother’s Day Sunday — a time for high-calorie brunches and pastel-colored bath products — but an even better time to do some listening.

So, just in time, here’s a new report that does just that. “Listening to Mothers III,” produced by the nonprofit Childbirth Connection, is an in-depth look at women’s pregnancy and birth experiences that covers a huge range of topics, from pregnancy weight gain, breast-feeding and postpartum depression to use of pain medication during birth and paying for maternity care.

The report, the third of its kind, is based on online surveys of 2,400 women who gave birth to a single baby from July of 2011 through June of 2012 in a U.S. hospital. There’s a lot to digest here, but for anyone interested in birth, it’s worth spending time wading through the material.

(popularpatty/flickr)

Here, as highlighted by authors of the report, are some of the more salient findings:

–A quarter of women surveyed experienced three or more of five major medical procedures such as labor induction, drugs to speed labor, and cesarean section, while only one in eight women had none of these interventions.

–Unnecessary interventions — such as inducing labor for convenience or routine repeat cesareans — exposed women and their babies to avoidable risk.

–Most of the women could not correctly identify risks of labor induction or cesarean section, revealing problems with prenatal education.

–One in four who had these procedures reported experiencing pressure from a care provider to do so.

–Mothers expressed a high degree of trust in maternity care providers, with nearly half rating them as “completely trustworthy.”

Maureen Corry, Executive Director of New York-based Childbirth Connection, said in an interview that a perfect storm of forces — including pressure on women and complete trust in their provider — could lead to unwanted outcomes.

“The pressure to have an induction or c-section, a lack of awareness about the risks of those interventions and an unqualified trust in their health care providers is a potent combination that could result in women and their babies being exposed to unnecessary risk and receiving care that isn’t based upon the evidence,” Corry said. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, childbirth, mother's health, pregnancy, women's health

January 8, 2013 | 9:48 AM | Rachel Zimmerman

What’s A ‘Natural Cesarean’ And How Natural Is It?

That was my reaction when I read a recent post by my friend Ananda Lowe who writes a blog, thedoulaguide, about childbirth issues of all sorts. (Disclosure: she is also my co-author on a book we wrote on how to have a fulfilling and fully-informed birth experience.)

Ananda explains that a new “natural cesarean technique” is being developed here in Boston at Brigham and Women’s Hospital:

While talking with my friend Dr. William Camann, director of obstetric anesthesiology at Brigham and Women’s hospital in Boston, I was surprised and excited to learn that he recently helped the hospital adopt components of what is being called “the natural cesarean” technique. Bill is co-author of the book “Easy Labor: Every Woman’s Guide to Choosing Less Pain and More Joy During Childbirth,” and the Brigham is Boston’s largest maternity hospital, so its adoption of these methods is good news. In the past, some mothers reported feeling “a disconnection from their cesarean baby because they did not actually see or feel the baby born,” according to the International Cesarean Awareness Network (ICAN). The natural cesarean technique offers parents the option of viewing the emergence of the baby if they wish. (For years, ICAN has been a pioneer in proposing guidelines for family-centered cesareans, as well as advocating for other reforms related to the use of cesarean sections—I encourage everyone to support their work!)

I spoke with Camann today and he said the preferred term for the new technique is “family-centered Cesarean,” or “gentle Cesarean.” The concept has been evolving for several years, he said, with some elements of it — like early skin-to-skin contact between mom and baby in the operating room — becoming more standard. The newest element — a clear surgical drape that allows the mom to actually see the birth — just started a few months ago. “To my knowledge, the Brigham is the only hospital doing that,” Camann says. “It was my idea; the patients love it.”

A “natural” or “family-centered” Cesarean section. (Photo courtesy Dr. Bill Camann)

But a bird’s eye view of a surgical birth isn’t for everyone, he added, and some new moms don’t want to see anything. “You pick up cues from the patients and other providers,” Camann says. “It’s very much a judgement call.”

Here, Camann offers more details on the technique:

A growing movement is attempting to make the cesarean delivery a more natural, or family-centered, event.

Modifications of the standard technique include:
· Early skin-to-skin contact in the operating room (with either mom or dad)
· A slow delivery (with intent to mimic the “vaginal squeeze”) Continue reading →

FILED UNDER: Medicine/Science, Personal Health, Brigham & Women's Hospital, cesarean delivery, childbirth

July 10, 2012 | 9:42 AM | Rachel Zimmerman

Fierce Views Of Anti-Home-Birth Activist Questioned In Slate

The home-birth debate rages on. (Chris and Jenni/flickr)

Every time I (or pretty much any other journalist) writes about homebirth, it’s a good bet that a scathing comment about its dangers will be posted by a former ob-gyn who hasn’t practiced medicine in years. Her name is Amy Tuteur, or Dr. Amy, as she’s often called.

At long last (according to some folks), a darker side of Dr. Amy has been unveiled in an excellent piece by Jennifer Block in Slate called “How To Scare Women: Did a Daily Beast story on the dangers of home birth rely too heavily on the views of one activist?”

That activist is, of course, Tuteur, who is extensively quoted in Michelle Goldberg’s Daily Beast story about scary homebirths. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, Politics, childbirth, homebirth, women's health

June 19, 2012 | 8:00 AM | Rachel Zimmerman

Some View ‘Gruesome And Sad’ Case As Victory For Women In Childbirth

(cassy1723/flickr)

Allissa Pugh, of Milford, is an unlikely poster child for the rights of pregnant and laboring women.

But in a ruling last week, the state’s Supreme Judicial Court effectively said that the actions of women who refuse medical treatment during childbirth shouldn’t be criminalized. And that unanimous decision, some say, put Pugh at the center of a battle over whether mothers should be allowed to make their own decisions about how to progress through pregnancy and give birth.

Here’s Pugh’s story:

In the fall of 2006, Pugh was 28 and working at an animal hospital when she discovered she was pregnant, according to court records. She told no one. In January, after feeling abdominal pain, she left work, went home and sat on the toilet, thinking she might be having a miscarriage. When her water broke, Pugh realized she was in labor, the court records say. At that point, she reached inside herself, felt a foot, pushed approximately 10 times and then “pulled on the baby’s feet, legs, and body to hasten the delivery.”

Things got worse from there, the records show:

After approximately five minutes of this combined effort, the baby fully emerged from the defendant’s body.
The baby was blue. The defendant stated that she tried scooping out the baby’s mouth and made repeated attempts at rescue breaths, but the baby’s color never changed and the baby never appeared to cry or move. Despite her efforts, the defendant could not resuscitate the baby. She disposed of the baby’s body in the trash. During the delivery and immediately thereafter, she did not call for help or seek emergency medical assistance. On discovery of the mangled body several days later, a police investigation led officers to the defendant.

In 2009, a Superior Court judge found Pugh guilty of involuntary manslaughter Continue reading →

FILED UNDER: Medicine/Science, Personal Health, childbirth, women's health

May 24, 2012 | 10:53 AM | Rachel Zimmerman

NYT: The Battle Over Home Births

http://www.youtube.com/watch?v=siLbqthiTWo

Before Ricki Lake gave birth in her bathtub and before “Orgasmic Birth” was a top movie pic among the doula set, there was Ina May Gaskin, the earth-mother-high-priestess-venerated-goddess of natural childbirth.

This weekend, The New York Times discovers what proponents of home birth have known for decades: Ms. Gaskin, a self-taught midwife who launched her communal birthing center, The Farm in Summertown, Tennessee, with her husband Stephen in the 1970s, has helped deliver thousands of healthy babies without any medical help.

Gaskin’s statistics are eye-popping: out of approximately 3,000 total births, The Farm’s C-section rate is about 2 percent, The Times reports (compared to a more than 30% rate in the U.S.) and epidural anesthesia has been used only once. “Failure to progress,” a frequent diagnosis for long-laboring moms in American hospitals (and often the trigger for a cascade of medical interventions, including C-sections) are virtually non-existent at The Farm. This less-medicalized approach is, once again, gaining momentum and Gaskin’s ideals are increasingly going mainstream.

Samantha Shapiro writes:

Unmedicated home birth is being chosen by a growing minority of women. Between 2004 and 2009, giving birth at home increased 29 percent. Most of this rise is among white women. Recent pregnancy documentaries like “Pregnant in America,” “Orgasmic Birth” and “The Business of Being Born” — all of which feature Gaskin — present hospital birth as profoundly disempowering to women.

Continue reading →

FILED UNDER: Personal Health, c-section, childbirth, home birth

May 10, 2012 | 7:22 PM | Rachel Zimmerman

The Pessary For Prematurity: An OB’s New Look At An Old Technique

Dr. Adam Wolfberg, a specialist in high-risk obstetrics, knows more than most about the highly technical world of maternal-fetal medicine and the extreme interventions often required to save infants born prematurely. About half a million babies — 1 in every 8 — are born pre-term in the U.S. and much of Wolfberg’s work focuses on how to prevent and manage such births.

Lately, though, he’s been thinking about a particularly low-tech, centuries-old device that is getting new attention as a method to prevent premature delivery: the pessary, described by researchers as “a tiny inverted cereal bowl with a hole cut in the center” more typically used hold up sagging pelvic organs. Writing in the Huffington Post, Wolfberg details the latest, promising research:

In this excellent study, published in the prestigious British journal The Lancet, obstetricians at five Spanish hospitals randomized 385 women with a short cervix to use of pessary or nothing. Pessaries are centuries-old devices that women place in their vagina to support their uterus and pelvic organs and prevent symptoms of pressure when these organs “fall” (prolapse) typically later in life. A handful of small studies using pessaries to prevent preterm delivery (the idea is that the pessary supports the cervix or lower uterus) have been published over the past 50 years, but none has had the size or scientific rigor to convince the obstetric community.

The cervical pessary (The Lancet)

In their study, the Spanish group used the Dr. Arabin pessary, named after the German scientist who developed it… The Dr. Arabin pessary is approved for sale in Europe but not in the U.S…”

Continue reading →

FILED UNDER: Medicine/Science, Personal Health, childbirth, obstetrics, prematurity

March 8, 2012 | 10:41 AM | Rachel Zimmerman

Politico: From Death Panels to Birth Panels, Bachmann Weighs In

Michelle Bachman speaking (markn3tel/flickr)

Didn’t Michelle Bachmann exit the GOP race for president already?

No matter, here she is, reports Politico, not so subtly suggesting that the Obama administration’s birth control coverage policy for women might lead inexorably to a government-mandated childbirth policy. Wow.

The Minnesota congresswoman said the Obama administration’s contraception coverage mandate could be a slippery slope to a point where a “health dictator” decrees that women could only have one or two children. Continue reading →

FILED UNDER: Insurance, Medicine/Science, Personal Health, Politics, childbirth, contraception, Michelle Bachmann, policy

October 7, 2011 | 4:52 PM | Rachel Zimmerman

11 Ways To Lower The C-Section Rate (Your Suggestions Included)

Everyone’s been through it. But for some reason, the topic of childbirth seems to get people awfully riled up.

Readers responded passionately to a story we posted earlier this week about the rate of cesarean deliveries in the U.S. creeping up to 50 percent. The comments section included some intense back-and-forth on how to fix things.

So here are 11 suggestions for lowering the c-section rate. The first six come from John Queenan, an emeritus professor at Georgetown University’s department of obstetrics and gynecology and author of a recent editorial on the topic in the medical journal Obstetrics and Gynecology. The last batch are from readers.

1. Get a commitment from hospital obstetric departments to work on lowering the C-section rate and also cut down on the number of drug-based labor inductions. (See this related post on pregnant women inducing their own labor.) Continue reading →