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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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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Miscarriage: Keep breaking the silence

Miscarriage: Keep breaking the silence - I am encouraged to see public discourse about miscarriage of pain. Recently, Mark Zuckerberg, CEO of Facebook, was posted in his Facebook page with pregnancy loss, he and his companion suffered. 

Beyonce and Jay-Z wrote a song about her first miscarriage. Nicole Kidman, Mariah Carey, Celine Dion, Courteney Cox and Brooke Shields have all publicly shared their experiences of miscarriage. But too often, I always find women and their partners who suffer in silence and alone.
 
Recently, researchers from the Albert Einstein School of Medicine in New York polled more than 1,000 adults in the United States to determine what the public knows the causes of miscarriage and emotional effects. Their findings were published earlier this year in an article entitled "A national survey on public perception of miscarriage."

Fifteen percent of respondents said they (or a partner) had suffered a miscarriage. More than half of respondents believe that errors are rare, even though studies show that nearly one in four pregnancies end in miscarriage. Over three quarters of respondents believe a miscarriage as a result of stress, and more than a quarter also believes that the main causes were made lifestyle during pregnancy.  

But in fact, most miscarriages are the result of chromosomal abnormalities in the developing fetus, structural abnormalities of the uterus, or endocrine or autoimmune disorders in the mother.

For me, the most striking part of the survey was that many of those who had suffered a miscarriage said they felt they had done something wrong, and he was lonely and embarrassed. However, when his friends know their own involuntary abortions themselves, they feel less alone. They also felt less isolated when celebrities reveal their miscarriages.

So it's great that so many public figures spoke about their own recent involuntary abortions, the study results show that we have yet to achieve the discussion of miscarriage closet. This is the advice I always give my patients who have suffered a miscarriage:

       *  Nothing that has caused the error, and nothing you could have done would have prevented.
       *  Even if it had been completely still in bed, they were totally relaxed and ate only healthy food, although she had a miscarriage.

       *  You will be surprised how many of your close friends and family members have experienced a miscarriage. Share this experience with them. 
By: Hope Ricciotti, MD 
 

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Experts say that no amount of alcohol is safe during pregnancy

Let's face it: pregnancy is difficult. Yes, it is ultimately a wonderful thing to bring a baby into the world. But the process does not always feel so wonderful; accompanied by nausea, fatigue, stomach fat and uncomfortable varicose veins are not the things that are asked pregnant women to stop smoking. As the sushi; Swordfish; eggnog; Some soft cheeses; this extra cup of coffee; for smokers, cigarettes; and alcohol.

For some women, it is difficult to stop drinking completely. It can be tempting, especially on special occasions or in restaurants where everyone is drinking, to have a teensy-tiny glass of wine. After all, how much damage can a glass of wine?

But here's the problem: we do not know the answer to that. This means that to be safe, pregnant women should not drink alcohol at all. This is the conclusion of a clinical report just published by the American Academy of Pediatrics.

This is what we know: the alcohol is dangerous to the developing fetus. It can cause problems with the baby's growth. It can affect the kidneys, heart, muscles, eyes and ears. But what is more worrying is that it can affect the brain in a variety of ways - causing smaller and actually physically different, for a learning pattern and behavior.

The most serious form of damage is called fetal alcohol syndrome, or FAS. Babies born with this condition are smaller than other babies have distinctive facial features (small eyes, a thin upper lip, flat to the skin between the nose and the mouth instead of the usual chants), and effects on the brain. Occasional consumption at a party is unlikely to cause FAS; often occur when mothers drink at least a moderate amount of alcohol during pregnancy.

But what researchers have been finding is that there may be softer, more subtle effects of small amounts of alcohol. A study of 31,000 pregnancies found a risk for developmental problems when women had one alcoholic drink per day. And because some of the learning and behavior problems will not become clear until years after his birth, it is likely that even small amounts of alcohol have an effect. In fact, some experts believe the Disorder Fetal Alcohol Spectrum (a broad term that encompasses all the possible negative effects of fetal alcohol syndrome) affects up to 5% of all children.

About half of all women of childbearing age drink alcohol drink from sporadic to heavy drinking. Some of the damage caused by alcohol passes before women realize they are pregnant. Although most women cut or stop once they know they expect, over 7.6% of alcohol consumption continued - and 1.4% report binge drinking.

There is no time during pregnancy when it is "safe" to drink either. Yes, most organs are formed in the first quarter. But the baby grows and changes, and the brain develops during pregnancy. Alcohol can still hurt.

So do not risk it. Give your baby the best chance for the best life possible. If you are pregnant or could become pregnant, choose sparkling water instead. Nine months can seem like an eternity, but it is not.

If you do not think you can stop drinking for nine months, talk to your doctor. We can help you.
By: Claire McCarthy, MD
 

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Number of babies born in the withdrawal of drugs is on the rise

Each year, an alarming number of babies born in the United States spend their first days to withdraw from drugs, prescription painkillers often with their mothers took during pregnancy. This problem, called neonatal abstinence (NAS) syndrome, has quadrupled since 2004, according to a report published online today in the New England Journal of Medicine. 

NAS occurs in many babies whose mothers have taken a type of medicine called an opioid during pregnancy. (Two opioids are used OxyContin and Vicodin.) These drugs pass easily from the bloodstream of the mother to child. They can be addictive and are often abused. Indeed, the NAS is a baby opioid withdrawal.

Babies with NAS are more rigid and more irritable than normal babies. They do not eat well, and therefore do not gain weight as well. Some seizures. With medication and time, infants with NAS improve, but they need to spend time in hospital. In short, they get a difficult start in life that can reconfigure and can have long effects.

For the new study, researchers at several medical centers in the United States analyzed the records of nearly 700,000 infants treated at 299 neonatal intensive care units across the country between 2004 and 2013. During this period, the number of 'children treated for NAS It has nearly quadrupled, from 7 cases per 1,000 children admitted to neonatal intensive care units of 27 cases by 1000. 

Day neonatal intensive care needed to treat infants with NAS increased sevenfold. The report was published yesterday, coinciding with the presentation of the results at the annual meeting of the Pediatric Academic Societies in San Diego.

In the study, the main cause of the ENA was taking methadone mothers during pregnancy, which represents almost a third of cases. Methadone is a medication used to treat drug addiction, particularly addiction to heroin. The second most common reason for NAS mothers taking opioid analgesics.

Options for pain safer   

The number of prescriptions of opioid analgesics has skyrocketed in recent years, as the number of people dependent on opiates. Some opioid prescriptions are written for pregnant women. A study published online in the journal Pediatrics found that 28% of pregnant women with Medicaid in Tennessee has received at least one prescription for an opioid analgesic during pregnancy.

With so many security options for pain management, women who are pregnant should use opioids only if these drugs are absolutely necessary. Doctors can often recommend other effective pain control that are safer for baby options.

Because opiates are so addictive, many people become dependent on them. Pregnant women are no different - some are addicted before they get pregnant, others become addicted during pregnancy. In any case, the child's health is at stake. 

With opiate addiction on the rise, it is likely that the number of infants with NAS will continue to rise, too. It is often difficult for someone in the grip of addiction to a healthy change. That is why it is important for partners, family and friends of pregnant women are aware of this problem. Sometimes it is best to speak, to support and make a difference. Studies like this that draw attention to the most vulnerable, and totally innocent younger victims opioids may also help galvanize fight opiate addiction once and for all.

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