On Our Radar
News, new research and interesting tidbits…
Saving Pregnant Women One Device at a Time
Of course the blogosphere lit up last week with the release of yet another study about a piece of technology pegged to “save” women from the dangers of childbirth. This new device, a compilation of MRI screening and computer software entitled, Predibirth, was designed Dr. Olivier Ami and colleagues at the Antoine Béclères Hospital at Université Paris Sud, France. The promise of being able to detect whether or not a fetus will successfully navigate the confines of his mother’s pelvis during labor and delivery come from a study including 24 pregnant women upon whom Predibirth’s technology was employed. Interestingly, of those 24 women, a little over half—13—ultimately underwent a cesarean delivery.
The creation of such a device, I think, is based on the age-old anthropological understanding we have of pelvic tight quarters. In short, when humans began walking upright some eons ago, our pelvic structures had to change to maintain our balance—thus creating a tighter space through which the large-headed fetus must pass during the birth process. If you want an in-depth read about this process, go here.
That being said, I’m not sure how well the Predibirth takes into account factors such as hormonal fluctuations that influence pelvic diameters during the labor process and labor and birth positions which work to expand (or reduce) the pelvic inlet and outlet. The other elephant in the room for this topic is the questionable effect of the magnetic fields and radiofrequencies associated with this type of imaging upon the fetus—for which very little research data is available.
Web-based Buzz on Labor Inductions
With the Lamaze International webinar on labor induction happening next week ( December 12), you may find interest in referring your patients and clients to the related discussion on Henci Goer’s, Ask Henci forum, in which induction for a woman aged 40 or above is addressed.
Forceps = Safe(?)
Reuter’s recently covered a new study released in the American College of Obstetricians and Gynecologists’ Green Journal, suggesting that forceps-assisted delivery is safer for the neonate, when looking at long term neurological outcomes, compared to vacuum extraction or cesarean delivery. Data was pulled from over 1 million births that occurred in New York City between 1995 – 2003, with 122,507 vaginal surgical births ultimately analyzed. Interestingly, births included in the study went down to 34 weeks gestation for nulliparous women delivering singleton babies between 500-5,000g, and excluded breech births, birth weights greater than 5,000g and cases of placenta previa. Significant outcomes were considered to be: neonatal subdural hemorrhage, intraventricular hemorrhage, seizures, scalp laceration or cephalohematoma, fracture, facial nerve palsy, brachial plexus injury, or 5-minute Apgar score of less than 7.
A remark I read from a seasoned obstetrician and Director of Maternal Fetal Medicine in a Canadian facility suggested that these outcomes may be congruent with the limited use of forceps by (older and more experienced) clinicians who were once heavily trained in their use. As forceps skills seem to have fallen out of the repertoire of many newer OBs (perhaps a “young” obstetrician will write in and correct any inaccuracy in this statement, if it exists) forceps usage in this study may have occurred in particularly adept hands while vacuum extraction and cesarean delivery were distributed more evenly.
Regardless, the findings of this large study are interesting—if not a bit chilling. Last time I spoke with a woman who endured a forceps delivery, her description was a ghastly one, in exchange for a 4th degree perineal tear and a healthy baby. What are your thoughts??? (HINT: this is an invitation for YOU, the reader, to weigh in on this.)
Down into the Water, Baby.
University of Minnesota and Twin Cities hospitals have been adding water birth to their compendium of birthing options with Amplatz Children’s Hospital being the latest to get on board.
Childbirth Connection has recently launched a new video on their Transforming Maternity Care Site, encouraging all of us to join in the process of ensuring childbearing women are cared for using best practices and the most up-to-date evidence.
What’s on YOUR radar?
Feel free to share (respectfully) what you’ve been reading with interest lately.
Posted by: Kimmelin Hull, PA, LCCE, FACCE