childbirth

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 | By 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 | By 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 →

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

October 4, 2011 | 9:30 AM | By Rachel Zimmerman

Will The C-Section Rate Soon Hit 50 Percent?

A doctor wonders how to stop the relentless rise in C-sections

Pretty much everyone agrees that the number of cesarean deliveries in the U.S. is too high: the rate has soared from 6% in the 1960s to 32% today.

In a recent editorial in the medical journal Obstetrics and Gynecology, Deputy Editor Dr. John Queenan suggests that we have yet to reach the peak. “The rate is likely to exceed 50% very soon in the U.S.,” he writes. “How can we curtail this runaway increase in cesarean deliveries?”

What’s really troubling, says Queenan, Professor and Chair emeritus at Georgetown University’s Department of Obstetrics and Gynecology, is that almost one-third of C-sections are for women who are having their first child, and that sets up a vicious cycle of future surgeries since vaginal births after cesareans (VBACs) are decreasing — some hospitals won’t even do them. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, cesarean delivery, childbirth

August 22, 2011 | 2:28 PM | By Rachel Zimmerman

Insurance Quagmire For A New Mom: An Unpaid $4,000 Hospital Bill

Will some insurer please pay this baby's $4000 hospital bill?

This is one of those stories that makes you understand why insurers are not always the most popular guys in the room.

Last week, I got a note from Lisa, who works in a global technology company based in Andover. The subject line of her message was: “2 Insurance Policies, No One Will Pay.” Here’s her story:

When Lisa and her husband Mark got married a few years back, they each had their own separate insurance plans: she was covered by what she calls Blue Cross Blue Shield of New York (even though she lives and works in Massachusetts) and he had Tufts Health Plan. They were fine with what they had and never bothered to switch.

But when their first child was born in October, they quickly realized they’d better put the newborn on one or the other parent’s health insurance. Within 10 days after the little girl was born, they signed her on to her father’s Tufts plan. (Lisa was planning to join this new family plan as soon as the open enrollment period rolled around.)

Everything seemed to be going fine. Tufts covered the child’s pediatric appointments no problem, Lisa said. Then in early summer, the couple got a bill for $4,000 from the hospital. After numerous calls, this is what they found out: both insurance companies had refused to pay the bill.

Blue Cross wouldn’t pay for the baby’s care, but Lisa said Tufts told the couple that it is “standard practice” that a new baby is added to her mother’s insurance plan.

“Well if it is standard practice,” writes Lisa. “Why didn’t Tufts mention this when we added the baby to the policy? It is pretty obvious that her father (Mark) is the only other person on the policy.” Lisa says she and her husband have spent countless hours and between 20 and 30 phone calls trying to fix the problem. This on top of a new baby and a full-time job. “The thing that irks me the most,” writes Lisa. “is that if anything, we are OVER Insured with both of us paying the cost of 2 policies… and yet no one will cover this cost? If I had given birth with no insurance at all the state would probably pay for it and I would never even see a bill. Instead I am being penalized for a random internal insurance practice that I was never made aware of.” Continue reading →

FILED UNDER: Insurance, Medicine/Science, childbirth, cost

August 3, 2011 | 10:42 AM | By Rachel Zimmerman

CDC: Most U.S. Hospitals Do A Bad Job Supporting Breastfeeding

About 80% of hospitals give newborns formula though it's medically unnecessary, a report found

Most women want to breastfeed their newborns, studies show.

But when it comes to supporting breastfeeding — a pretty fabulous way to protect babies against all sorts of ills and to secure the connection between mothers and infants — hospitals are doing a fairly miserable job, according to a new report by the Centers For Disease Control and Prevention.

The CDC says:

Breastfeeding protects against childhood obesity, yet less than 4 percent of U.S. hospitals provide the full range of support mothers need to be able to breastfeed, according to the most recent Vital Signs report released Tuesday by the CDC.

“Hospitals play a vital role in supporting a mother to be able to breastfeed,” said CDC Director Thomas R. Frieden, M.D., M.P.H. “Those first few hours and days that a mom and her baby spend learning to breastfeed are critical. Hospitals need to better support breastfeeding, as this is one of the most important things a mother can do for her newborn. Breastfeeding helps babies grow up healthy and reduces health care costs.”

The report also notes these pretty dismal findings:

– Only 14 percent of hospitals have a written, model breastfeeding policy.

– (And this one is astounding to me, hence the bold) In nearly 80 percent of hospitals, healthy breastfeeding infants are given formula when it is not medically necessary, a practice that makes it much harder for mothers and babies to learn how to breastfeed and continue breastfeeding at home.

–Only one-third of hospitals practice rooming in, which helps mothers and babies learn to breastfeed by allowing frequent chances to breastfeed.

–In nearly 75 percent of hospitals, mothers and babies do not get the support they need when they leave the hospital, including a follow-up visit, a phone call from hospital staff and referrals to lactation consultants, WIC and other important support systems in their community

Let’s face it: it’s not easy becoming that groovy earth mother you’d always imagined, the one who blissfully nurses her newborn with grace. It takes practice and guidance to get all that latching on and positioning working properly. And if your hospital is pushing formula while you’re trying to figure it all out, it’s no wonder you might feel like giving up.

Continue reading →

FILED UNDER: Medicine/Science, Personal Health, breastfeeding, childbirth, hospitals

June 21, 2011 | 10:14 AM | By Rachel Zimmerman

Spicy Foods & Sex: When Pregnant Women Induce Their Own Labor

40 weeks and counting...

By Ananda Lowe
Guest Blogger

With about 4 million births per year in the United States, at any given moment there are thousands of pregnant women who have just gone past their estimated due date. As a professional labor coach (doula) and the mother of a nine-month-old, I interact with these women regularly. I like to think of them as belonging to a certain sisterhood, in limbo together between 40 and 41 weeks pregnant.

The experience can be lonely though, in spite of, or perhaps because of the bevy of family and friends calling to ask “have you had your baby yet?” as well as the seeming casualness with which many obstetricians propose setting a date to start labor with drugs – in the past two decades, the rate of medical inductions increased by 140 percent.

According to a study published this month in the medical journal Birth, fifty percent of mothers surveyed tried to start their own labors when they believed pregnancy was taking too long.

I did. And this was after saying for years that self-inducing was something I saw no need to do.

For the 201 women in the Birth study, the most popular attempted methods were walking, sexual intercourse, eating spicy food, and nipple stimulation.

Some of these techniques have scientific evidence to support them. For example, an earlier study found that “only 6.9% of sexually active study women remained undelivered at 41 weeks of gestation, compared with 29.8% of abstinent women.” Since the hormones of birth and arousal are the same, a range of sexual activities could hasten labor when pregnancy is full-term. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, childbirth, labor, pregnancy

May 23, 2011 | 2:02 PM | By Rachel Zimmerman

Why Home Births Are Becoming More Popular

Holland has a robust tradition of home births, according to Agence France-Press. Maarten Rammeloo (depicted above) was born at home in 2007, along with a third of Dutch infants.

In the birthing world, it was big news: After a 15-year decline, home births in the U.S. rose 20 percent between 2004-2008. Though the actual numbers remain tiny — out of about 4 million births, 28,357 happened at home in 2008 — the reversal of the long downward trend is notable. So are the demographics: much of the increase was driven by highly educated white women. A full 1 percent of them decided to forgo the hospital and give birth at home, according to the new report published Friday in the journal Birth: Issues in Perinatal Care.

Boston University School of Public Health Professor Eugene Declercq, an authority on childbirth trends and one of the study authors, says he was struck by some media portrayals of these home-birthers. “They made it seem like it was these crazed, crunchy granola women,” Declerq said. “Do they even still exist?”

A widely reprinted AP story, for instance, quotes the study’s lead author, Marian MacDorman of the CDC’s National Center for Health Statistics, saying: “I think there’s more of a natural birth subculture going on with white women.”

Declercq says this “natural” subculture-y characterization misses the point. The women who gave birth at home, researchers found, were mostly white, married and in excellent prenatal health. They were, in the language of labor and delivery, low-risk. Many had a post-graduate degree. And a lot of them had already given birth to one or more children, likely at a hospital. Declercq said that while this study was conducted by analyzing birth records, not through interviews, a previous study found that the top three reasons women gave for choosing home birth were:

1. Safety.
2. Avoidance of unnecessary medical interventions common in hospital births.
3. Previous negative hospital experience.

So, it’s fair to guess that at least some of the healthy, degree-wielding, not-so-crunchy women in the recent analysis chose home birth to avoid the “cascade of interventions” — including labor-inducing drugs and surgery — they’d endured previously at the hospital.

Tina Cassidy is the modern home-birther.

A Boston journalist, Tina had a C-section in 2004 that she believes was unnecessary. She subsequently investigated alternative methods, the history of birthing trends and how other cultures and government handled childbirth. (All this research ended up in her book, Birth: The Surprising History of How We Are Born. Her next book is about Jackie Onassis, who, according to Tina, had four C-sections.) In 2008, determined to avoid another intervention-laden, surgical delivery in the hospital, Tina gave birth to her second son at home, in the bathtub. Continue reading →

FILED UNDER: Medicine/Science, Personal Health, childbirth

April 14, 2011 | 4:27 PM | By Rachel Zimmerman

A Snapshot Of Massachusetts Midwifery Care: 6 Surprising Facts

The number of midwives attending births in the state nearly tripled from 1990-2008

The UMass Boston’s Center for Women in Politics and Public Policy today released the first comprehensive study of midwives in Massachusetts: who they serve, who they are and the challenges they face. Here are a few facts from the report — which includes responses from 290 certified nurse midwifes — that may surprise you:

1. Midwife-Assisted Births On The Rise

In Massachusetts, the number of nurse-midwife-attended vaginal births nearly tripled between 1990 and 2008 (from 7.9% to 21.6%) and there has also been a recent uptick in the rate of home births.

2. Beyond Childbearing Women

While midwives are more commonly known for the care they provide to childbearing women, midwives serve women in all stages of life. A substantial number of Certified Nurse Midwives (CNMs) care for young women (under 20 years of age), recent immigrants, and women whose first language is not English. About one-third (33%) of CNMs indicated that at least 31% of their patients are Hispanic or Latina. The majority of CNMs noted that a significant proportion of their service reimbursement comes through government-assisted health care.

Also, the age range of patients that CNM’s care for is vast, the report notes: from 8 years old up to 100.

3. Providing Primary Care

According to the report, 38.5% of those surveyed said that primary care constitutes some portion of their practice.

4. Docs Still Supervising Midwives

Massachusetts is one of the few remaining states (there are five others) that require certified nurse midwives to work under a physician’s supervision in a hospital setting. That’s a result of legislation enacted in 1977; a bill now pending would do away with that requirement.

5. What They Earn

The majority of CNMs (71.5%) work full-time and 28.5% work part-time. Full-time CNMs earn a median of $92,000 and part-time CNMs earn a median of $65,500.

6. Midwives Age Too

Nearly half of all midwives in Massachusetts have been practicing for over 10 years and many for more than two decades, the report says. Over 30% of CNMs indicated possible retirement by 2020. With an average age of 53, it is likely that CPMs/DEMs will soon also face a workforce shortage. A midwifery workforce shortage would pose challenges in meeting women’s reproductive and maternal health needs, particularly for the vulnerable populations served by CNMs.

The overall goal of the report is to “bring attention to the midwifery workforce, which we think is largely invisible in the system, but is profoundly important,” said Christa Kelleher, the study’s co-principal investigator, and research director at the Center for Women in Politics & Public Policy at the University of Massachusetts Boston. “Nurse midwives are becoming the lead maternity caregivers for many women in the Commonwealth and primary care givers for certain women, particularly those in underserved communities.”

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

February 14, 2011 | 9:48 AM | By Rachel Zimmerman

AP: Laughing Gas For Labor Pain Coming To Dartmouth

Back in September, we reported a small but growing interest in the U.S. in using laughing gas, or nitrous oxide, to ease labor pain during childbirth.

Now, an AP dispatch says that Dartmouth-Hitchcok Medical Center will begin offering nitrous oxide as an alternative pain-killer for laboring women.

At Dartmouth-Hitchcock, where officials plan to order two machines, nurse midwife Suzanne Serat estimated that 10-20 percent of her patients might try nitrous oxide.

“We have a number of people who don’t want to feel the pain of labor, and nitrous oxide would not be a good option for them. They really need an epidural, and that’s perfect for them,” she said. “Then we have a number of people who are going to wait and see what happens, and when they’re in labor, decide they’d like something and then the only option for them is an epidural but they don’t need something that strong. So they would choose to use something in the middle, but we just don’t have anything in the middle.”

The hospital hopes to begin offering nitrous oxide for labor by summer. In the meantime, the federal Agency for Healthcare Research and Quality is reviewing the effectiveness and safety of nitrous oxide compared to other pain relief methods.

As we mentioned in our earlier post, nitrous oxide (which is basically the same thing you get at the dentist’s office) doesn’t have the super-pain-relieving magic of an epidural. But, it’s been found to be safe and effective: and it definitely take the edge off, according to women who have used it, to the point that some laboring moms may never end up needing an injection of anesthesia in their spine.

[Nitrous] offers something closer to an elixir of dulled pain tempered by nonchalance, says William Camann, chief of obstetric anesthesia at the Brigham & Women’s Hospital and the co-author of the book “Easy Labor.” “The pain may still exist for some women but the gas may create a feeling of, ‘Painful contraction? Who cares?’”

Right now, nitrous oxide is used by about 50% of laboring women the United Kingdom; 60% in Finland and widely across Canada, according to a published review. But it’s available only in two U.S. hospitals.

Apparently, that may be changing.