Where it is best for the birth: the hospital or at home?

Where it is best for the birth: the hospital or at home? - In the second half of the 20th century, the birth of the hospital had become the norm in most Western countries. 

Hospital birth monitors and interventions, many of which saved the lives of mothers and babies. At the same time, births have become more and more - and some would say unnecessarily - medicalized.

Many might also argue that the pendulum has swung too far procedure. For example, from 1970 to 2010, the caesarean section rate US It doubled - but (if both are low) risk of a baby dying during delivery was unchanged, and the risk of dying mother little Rose. In an apparent effort to avoid unnecessary intervention, and find an alternative for the room environment, it is not surprising that some women have turned again to home birth.

Home birth safe?

We do not have better data to answer this question. The ideal way to respond would be a randomized controlled trial. But the random part (the place of delivery would essentially be decided by the draw) would be unacceptable to most women.

So instead, women and their doctors have had to rely on after analyzing the reality of large sets of administrative data (such as information recorded on birth certificates). 

There are some problems with this type of analysis.

There may be differences between women who give birth at home and those who delivered at the hospital are not counted in the time to draw conclusions. For example, a woman may choose to give birth at home because she does not have access to care, and can therefore be more likely to suffer complications. 

On the other hand, maybe the women who choose home birth focuses on a lifestyle designed to prevent problems and health interventions in general (healthy diet, not smoking, etc.). 

So when evaluating the results of the home birth, it is possible that the results are due to factors on the woman herself both as a place where you have your baby. 

One of the things that make mockery of these hard data is that until recently, there was no way to distinguish between planned home births and planned home deliveries. planned home births may include factors that make home birth are riskier than it may actually be (eg, birth due to unexpected emergencies or in women who have not had access to regular prenatal care ). 

On the other hand, counting the deliveries from the house, but can not be completed as "hospital births" could hide the risk of delivery at home complicated.Women and those who care about their health and have been an urgent need for better data and analysis.

A single set of data gives an idea

A recent article in the New England Journal of Medicine describes a study in which the Oregon researchers have managed to overcome some of these data problems. Oregon birth certificate register if an expected mother to give birth at home or in hospital.

The researchers also had access to information about the health of the mother (such as diabetes or high blood pressure), which puts them at higher risk for problems during labor and delivery. For the study, the researchers excluded planned home births and that included what appeared to be healthy singleton deliveries (no twins or more). 

In its analysis, the risk of dying of a baby was small in any context, but the group is providing 1.8 per 1,000 for planned hospital births compared to 3.9 per 1000 births for unplanned outside the hospital.

Provided outside the hospital at birth was also associated with lower Apgar scores and a greater likelihood that the baby has a crisis or need a respirator, and a mother who had need a blood transfusion. 

However, planning for home delivery has also been associated with lower rates of admission need a baby to an intensive care unit and a lower rate of obstetric interventions, including the use of drugs or other ways to start (induce) or strengthen (increase) labor or vaginal forceps or vacuum delivery, cesarean delivery, and severe lacerations of the vagina.

What this means for women and their doctors? 

These results are consistent with other studies of sense to me, since many obstetricians. Sometimes an emergency occurs and you have the tools, medicines and facilities to respond quickly can make a difference. But have all these things on how the hand can also be used in cases where doing nothing would have been just as well. 

It is important to recognize that although the risk of problems for the babies was "superior" in the home birth group are not "high" in both groups. The difference was considered in absolute terms of the order of 0.5 to 2 infant deaths per 1,000 births. 

This risk is similar to other options supported in obstetric care, as a trial of labor after a cesarean past. The group home birth had lower rates of caesarean section and other complications that can affect the health of the mother. 

The risks to be considered for each option are very different, but this data can help women make decisions based on what they value most.

 

Finally, about 15% of women planning home birth requires a transfer to the hospital. Note that currently, there are no national standards of the United States to integrate home birth in a continuum of care.  

There are no agreed criteria to help identify good candidates for home birth, and there are rules to ensure adequate training for assisted home births. We need these systems and criteria to the US You should consider matching the recent call in Britain to encourage and support home birth. 

By: Jeffrey Ecker, MD.

 

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Why your baby may need wheezing TLC, not drugs

Why your baby may need wheezing TLC, not drugs - When a baby is sick with fever, coughing and wheezing, it is natural to think that they need is a drug - as an antibiotic, or one of the drugs used to treat wheezing in children with asthma (like albuterol). It is only if a condition called bronchiolitis is the culprit, the best treatment is no treatment. 

Bronchiolitis is a bad cold (caused by several viruses) that is installed in the lungs. When he does, leading to fever, heavy congestion, coughing and wheezing or noisy breathing. It is incredibly common.

In fact, five babies under 12 months ending in the doctor's office for bronchiolitis - and 2% to 3% until the end of hospitalization. It can be very serious, especially when it is caused by a particular virus called respiratory syncytial virus (RSV).

So here in the US It is rarely fatal, in other countries with less medical resources, thousands of babies die each year of bronchiolitis.

If it can be so serious, why the latest guidelines say doctors should not use antibiotics, albuterol, or other treatments? Because it does not help - and can have side effects that are not good for babies. 

Not that we can do nothing to help children with bronchiolitis. We just have to help in different ways.Some babies have a higher risk of getting really sick with bronchiolitis. Including premature babies, babies with lung disease or heart disease, and those who have problems with their immune systems are included.

For babies, it is recommended that they receive a monthly injection, called Synagis during the winter (around September-March) to help prevent RSV. If your baby falls into one of these categories and is under a year, you should definitely talk to your doctor about this treatment. 

For other babies, what we recommend is that families and caregivers use non-medical ways to help them feel more comfortable and breathe better. They understand:

       * plenty of fluids - dehydration can make things worse congestion
       * a humidifier to loosen congestion
       * a pear to clear the baby's nose (nasal saline drops, available in all pharmacies, can help you get the most out of the nose)
 
       * acetaminophen or ibuprofen for fever.

You should always consult your doctor if you think your baby has bronchiolitis and your doctor may want to see the baby to ensure that nothing is done that needs treatment. You should also call your doctor if, after being diagnosed with bronchiolitis, your baby grows

       * high fever (over 102 degrees F), or a new bout of fever after being sick for a few days
       * shortness of breath that is not relieved humidifier or bulb syringe (signs include shortness of breath or rapid breathing, sucking around the coast)

       * a pale or blue skin
       * sleepiness and irritability which is much worse than normal
       * refusal to take fluids, or not wetting diapers every 6 hours.

It is more likely that they are not going to happen, and that your baby is well. As with medicine and parenthood that most babies with bronchiolitis need a lot of TLC - and a little patience.
By: Claire McCharthy, MD. 

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Caesarean section rates: Consider this when deciding where to take your baby

Caesarean section rates: Consider this when deciding where to take your baby - There have been criticisms that the caesarean rate is very high because the highest rates are not translated into improved maternal and child health for many years. 

Many moms feel strongly to have a natural vaginal birth and want to do everything possible to avoid a C-section. But for some, a cesarean section may seem a good choice for a variety of reasons. And for others, a cesarean section may be essential to protect the health - or life - mom and baby. 

In some parts of the world where caesarean sections are not readily available, complications of vaginal delivery often lead to serious consequences, including loss of life for the mother and baby. However, the rapid access to caesarean sections has its own problems.

Especially, cesarean section is a safe procedure. But it has higher risks than vaginal delivery, including the rate is three times higher infection, bleeding and organ damage. It also has a longer recovery period.

So how many cesareans are is a number deserve attention.

Find the optimal cesarean rate 

Consequently, there is a sweet spot - a certain "type" of caesarean sections necessary to prevent the terrible suffering and consequences that can occur when a baby can not move or the birth canal, or when there is an emergency requiring immediate delivery. 

Recently, a study by researchers at Harvard Medical School and the School of Medicine at Stanford University found that the ideal rate of cesarean section appears to be about 19% of all births. This number is higher than previous guidelines have recommended, but lower than the rate in most US hospitals - which can be as high as 70%. 

How do researchers get this number? Caesarean rates of 194 countries analyzed and compared with the rates of maternal and infant mortality. Their analysis suggests that babies and mothers is not better wear when caesarean section rates are above 19%. The Caesarean section rate below 19% were associated with more complications related to childbirth and the poorest results.

This research also suggests that some of the reasons often cited for the high rate of caesarean sections - the moms who are older or obese, or who have had multiple births earlier, with the fear of being sued doctors - can not be only one small part of the bigger picture. In particular, these examples do not account for why some doctors and hospitals are simply more (or less) cesarean than others. 

Dr. Neel Shah is one of the co-authors of the study and an obstetrician in my department at Harvard-affiliated Beth Israel Deaconess Medical Center. Dr. Shah has discovered some previously unknown that help explain the variation in the factors cesarean rates.

For example, his research suggests that time pressure in some hospitals may lead to more caesarean sections compared, vaginal delivery may take a long time and staff resources. Provide the clinical team with access to better information and technology can help to make better decisions based on the volume of patients, staff and global resources to support safe care.

What this means for parents

If you are a healthy woman and have a low risk pregnancy, the hospital plans to use can determine the likelihood that you're going to have a caesarean section more than any other factor. So find out the caesarean section rate in the hospital where she will give birth. Talk to your doctor about this also. If you are early in your pregnancy, you can opt to choose your doctor on the basis that he or she exercises.

Finally, it is important to remember that there are times when a cesarean is the only sure way to give birth. When this happens, the woman may feel a sense of loss of the birth experience she had hoped for. But do your homework about the quality of care can help ensure that your delivery has been determined for the right reasons.
By: Hope Ricciotti, MD.

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Yoga during pregnancy: Many things are safer than we thought

Yoga during pregnancy: Many things are safer than we thought - Prenatal Yoga is usually mild, with certain modified poses or avoided depending on the stage of pregnancy. 

But a new study recently published in the journal Obstetrics & Gynecology, offers encouraging results of many yoga postures can be safe, even during the late stages of pregnancy.

Safety testing of various yoga poses 

For the study, researchers asked 25 women between 35 and 38 weeks of pregnancy to participate in a yoga session. Women with previous yoga experience is included as well as those new to the practice. All the women were generally healthy and free from problems related to pregnancy or other health problems like high blood pressure or gestational diabetes.

The yoga session consists of 26 stations, some of which (such as posture of happy baby corpse pose) that are often avoided during pregnancy. Various poses including balancing poses such as Half Moon, Warrior III, and the tree is modified using blocks, chairs, or wall.

During the session, the researchers were monitoring blood pressure of every woman, heart rate, temperature, oxygen levels, and uterine contractions and fetal heart rate - a measure of the welfare of a child . All the vital signs of the mother and baby were normal during the poses and after the session. There were no knockdowns, injuries or safety issues. 

The researchers also followed up with each participant by email 24 hours after the session. All women reported feeling safe during yoga postures. None had any problems later with contractions, vaginal bleeding, or reduces the movement of the baby.

All the women, except three that describe muscle pain, only expressed positive experiences with yoga session. The researchers concluded that 26 different yoga postures - including those that were previously avoided - were safe for the mother-to-be and their babies. 

Here is a list of the 26 positions of the study. The poses marked with an asterisk (*) was believed to be cons-indicated during pregnancy. 

This study suggests that yoga can be safe in late pregnancy and the scientific evidence increasingly that yoga is a useful and safe tool for reducing stress, anxiety and depression during pregnancy adds.

More than half of all women experience anxiety at some point during pregnancy, and about 13% of pregnant women suffer from clinical depression. Yoga has been shown to relieve stress and anxiety during pregnancy and reduce the levels of cortisol, the stress hormone.

Several studies yoga during pregnancy is also found effective in reducing depression, especially when started early in pregnancy and can be combined with standard treatment of depression. Yoga can also reduce pain and discomfort, as well as improve the quality of life in general during pregnancy. 

Prenatal Yoga is particularly effective as part of an integrated approach that includes breathing exercises, meditation and deep relaxation.

Getting the most out of yoga during pregnancy

Mothers-to-be should focus more on the stability and strength rather than endurance and flexibility. Use changes, carriers, or wall installation for each well supported. Pregnancy hormones loosen the muscles and ligaments, increasing the risk of injury if you push too far in terms of flexibility. 

This is true even in the first quarter. Another hormone called relaxin, which is at its highest level in the first quarter and relaxes the muscles, tendons and ligaments, also culminates in the first quarter. This laxity means you can accidentally over-stretch joints and muscles.

Finally, some forms of yoga done in extreme heat, such as Bikram yoga, where the room can be up to 105 degrees Fahrenheit, are not recommended during pregnancy. 

Currently, there are no studies that can tell us whether the heated yoga is safe for pregnant women. But we know hot yoga tends to raise body temperature, which can pose significant risks to mother and baby. Heat relaxes ligaments and also increases the risk of overheating and dehydration.

Yoga offers many benefits during pregnancy. But if you are pregnant and want to try yoga, not talking to your doctor.
By: Marlynn Wei,MD, JD    

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Many infants and young children using mobile devices every day

Many infants and young children using mobile devices every day - This is probably no surprise to anyone who has paid attention to the world around them, but a study just published in the journal Pediatrics indicates that 44% of children under 1 using mobile devices every day. At the age of 2, which passes 77%.

At 4 years, half of the children in the study had their own TV - and three-quarters had their own mobile device. And it was not rich nor children; the study was conducted in low-income urban practice in Philadelphia.

When the researchers asked parents about the different situations in which they let their children use the devices, this is what they said:

   *  70% allow children to use for tasks they could do  
   *  65% use them to keep the child calm in a public place  
   *  58% have used them during the races  
   *  29% of them used to put their children to sleep
 
Now, as a parent, I see quite how to have a smartphone can make all the difference when you are unexpectedly trapped in a boring place with a child who must be calm and quiet. And it is quite possible that some of these children are doing on their devices educational activities that help them learn, or using Skype or Face Time with a friend or relative.

But again, this is worrying. Dr. Dimitri Christakis like, a pediatrician at the University of Washington to study the effect of media on young children, he said in a recent New York Times, "Children need more rounds of applications." We've all been in situations where people interact with their phones and not the other. Radesky Dr. Jenny did a study where we observed families in fast-food restaurants and an alarming number of parents was found to pay . more attention to your phone for your child's interaction with adults is essential for brain development of children -. and build strong relationships Interaction with devices simply can not replace. 

When my children were young, so we went wherever they might need to be calm and patient, who was always ready - with books, small toys, pencils and paper, and some games to play (I Spy, Guess what I am I thought, etc.) do not see too many parents who do. What I see is that parents give their children a tablet or smartphone.

Only time will tell what effect this will have on the children; we will need years to understand if and how it affects their brains and their relationships. While we wait, we must try to do what we know works well for both. So, parents - with the smartphone, pack of crayons. And keep in mind, before turning on the iPad, put your child on your lap and play I Spy.  
By: Claire McCarthy, MD 

 

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