On Our Radar

** The March of Dimes, in collaboration with the American College of Nurse-Midwives, American Academy of Pediatrics, American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, Association of Women’s Health, Obstetric and Neonatal Nurses, and the Centers for Disease Control and Prevention, is organizing a Prematurity Prevention Symposium scheduled to take place on January 19-20, 2012, at the Omni Shoreham Hotel in Washington, DC.

The Symposium will provide a forum to share and review lessons learned from various collaboratives, prematurity prevention efforts and intervention programs.  This Symposium will also launch the Prematurity Prevention Network where those interested in the health of women and infants can continue the discussions started at the Symposium, to share ideas and help each other address the important problem of prematurity.

For more information, and to register for the symposium, click here.

** New Research out of the Canadian Medical Association is re-examining the association between NSAID use in early pregnancy and risk of spontaneous abortion (SAB).  The odds ratios from this study (statistics that demonstrate the likelihood of exposure to a risky substance or event for “cases” versus “controls”) was quite high—suggesting a strong link between NSAID use and SAB.  One interesting postulation the study authors make is the potential linkage between use of NSAIDS to treat cramping, and subsequent miscarriage.

My addition to this postulation:  Many women will experience some mild to moderate implantation cramping when a newly fertilized egg finds its way to the uterine wall and subsequently burrows into the endometrium.  Perhaps the use of NSAIDS to treat this cramping can result in a miscarriage that might not have otherwise happened.  For women who are concertedly trying for pregnancy (recalling that only 50% of pregnancies are statistically planned)advice from a woman’s care provider to avoid NSAID use if possible, during the last two weeks of their cycle (ovulation, onward) may serve this population well.

** The San Francisco Gate recently reported on a new study out of the NYU School of Medicine which looked at risk for emotional and behavioral problems in children ages 5-17 when one or both of their parents exhibited depressive symptoms.  Much research up until now has appropriately focused on maternal depressive disorders, including postpartum depression and other related perinatal mood disorders, and their implication on children’s mental health wellness.  This significant study, including 22,000 study subjects, suggests that while their seems to be a greater down-stream effect when a mother exhibits (untreated) depressive symptoms, paternal depression is also a risk factor for childhood development of behavioral problems, as exemplified in this summary from the SF Gate article:

"The findings also indicate that the risks of child emotional or behavioral problems are much greater if mothers, rather than fathers, have such problems. Paternal mental health problems are independently associated with a 33 percent to 70 percent increased risk, depending on how assessed, whereas maternal mental health problems are associated with a 50 percent to 350 percent increased risk. Most striking, we believe, is the increase in child emotional or behavioral problems when both parents have such problems, with 25 percent of children living in such homes having behavioral or emotional problems.”

For the childbirth educator, this information that suggests the importance of recognizing mood disorders in mothers and fathers can be easily incorporated into discussions pertaining to postpartum topics when (hopefully!) perinatal mood disorders are covered.

** And lastly, huge congratulations go out to Dr. Michael Lu who was recently interviewed by S&S contributor, Walker Karraa.  Dr. Lu has been appointed the position of Associate Administrator of the Maternal & Child Health Bureau (MCHB).  The MCHB is an office within the Health Resources and Services Administration, which is a branch of the U.S. Department of Health and Human Services.  MCHB oversees the Block Grant Program of Title V of the Social Security Act, the Healthy Start Program, Universal Newborn Hearing Screening, Emergency Medical Services for Children,  Sickle Cell Services and Family to Family Information Centers.

In recent years there has been increasingly wide-spread concern over Maternal & Child Health being so focused on the child…that the mothers in the equation are receiving less attention than they deserve.  Perhaps then, with an OBGYN whose career has been dedicated to both maternal and child wellness, we will see some changes rolling out to equalize the distribution of research and programming efforts.

Posted by: Kimmelin Hull, PA, LCCE, FACCE


On Our Radar

December 8, 2011 07:00 AM by Melinda Delisle
I am responding to the invitation to comment on the use of forceps. I have heard some experiences that support the study authors' conclusion that forceps, when used judiciously in experienced hands, is safer than vacuum extraction. Some years ago, I had a student couple who had a very long second stage, and was getting extremely tired. In addition, baby had not progressed for some time. This couple was lucky to have an OB skilled in forceps, and she offered them the option of doing a high forceps to move the baby down, then removed them and had mom push the baby out on her own for a normal birth. This was all accomplished with only some bruising on baby, and a few small tears on mom. We have all heard horrow stories about forceps deliveries. I could also say that for just about every other possible birth intervention and non-intervention. Yes, I have heard descriptions of traumatizing unmedicated births, as well. How a birth, or an intervention at a birth, turns out seems to have a lot to do with preparation and control (in this case, of both the parents and the practitioner). My understanding has always been that forceps in the hands of an experienced user carries less risk than vacuum extraction. Perhaps it is because it is harder to sense exactly what is going on with the vacuum? Of course, it is entirely possible that the difference in safety noticed between forceps and vacuum is entirely due to the skill of the practitioner. I once observed a very careful vacuum extraction that seemed to just "give a little help" without much negative effect on baby. Perhaps if vacuum extraction were practiced with as much patience and skill as the forceps births, the differences would not be so pronounced.

On Our Radar

December 8, 2011 07:00 AM by Ann Cowlin
What concerns me about the Predibirth is the static nature of the evaluation it provides. In contrast, one of the most impressive demonstrations I remember from my early days in the birthing field was a lecture during which the speaker showed us 2 red rubber rain boots at the beginning. One was hers and the other belonged to her 8 year old daughter. Initially, she had no problem fitting her foot into her own boot, but her daughter's boot was clearly too small for her foot. But, by the end of the hour, she had slowly and gently worked her entire foot into the smaller boot. The foot - like the pelvis and the fetal skull - is made up of a number of bones connected by elastic tissue. These bones can be realigned when this connective tissue is warmed up.

On Our Radar

December 10, 2011 07:00 AM by JudyC
About the Predibirth: what can one say that has not been said about the CTG. Technology with no evidence base which will cause more CS and cost the country and consumers more dollars. Bound to be heaps of side effects for mum and baby from the MRI. About the forceps, the study should have been with low risk women/babies at term. It doesn't account for operator experience as mentioned, nor does it account for the reasons for caesarians such as fetal distress. I am sure there is more but haven't read it yet. And, as already mentioned it doesn't mention the trauma to the mother.

On Our Radar

December 11, 2011 07:00 AM by Kimmelin Hull, PA, LCCE
The following is a comment submitted anonymously from one of our readers. I thank her, whole-heartedly, for sharing this story: "My forceps delivery was excruciating. I was unmedicated and screaming for the OB to stop. Looking back, I had only been in labor for a few hours, and it was progressing well, but it was 3:00 on a Sunday night, and the OB was eager to go home and sleep. I ended up with deep tears and stitches all the way to my rectum, crying every time I had a bowel movement. I felt deeply violated, and that affected my relationship both to my husband (for not protecting me), and my baby that I associated with such misery. I never was able to have orgasm in the same way because my vaginal wall was scarred. Now, years later, I have deep hip and thigh pain on the side of the cut that I attribute to the serious cutting and tearing I went through."

On Our Radar

December 12, 2011 07:00 AM by Walker Karraa, MFA, MA, CD(DONA)
My appreciation to the reader's courage to reach out and share. I would like to offer that these deeply intrusive physical interventions and the subsequent distress caused by them merits looking at posttraumatic stress disorder secondary to childbirth that unfortunately was not recognized, nor treated. A therapist or care provider trained in PTSD in her area might be of tremendous value. Also, the website www.solaceformothers.org has an online support group and resources that might be beneficial. My heart broke when I read this, however it is an un-recognized diagnosis so often.

On Our Radar

December 13, 2011 07:00 AM by Emalee Danforth, CNM
There was a great article in the New Yorker by Atul Gawande a couple years ago about the increasing use of cesarean section being due in part to the easy reproduction of the skill. Teaching and performing cesarean surgery is quite similar from one delivery to the next, whereas the use of vacuums and particulary forceps is a truly advanced skill with greater potential variation in outcome. Many doctors, midwives and birthing women, especially in an age when birthing one or two children is the norm, will opt for the more predictable intervention when the birth is difficult. I for one would like to see forceps re-employed in delivery as a way to increase the opportunity for vaginal birth for some women. Using forceps rather than C/S for second stage arrest or true maternal exhaustion can make a primip into a multip, rather than a primip into a future repeat C/S. I think this would be especially useful for women who think they may have more than two children. The primary problem with this is that most training institutions no longer teach forceps, or even those OBs who might initially be trained in residency end up working at hospitals to do not encourage the maintenance of those skills. I hope that there will be a reverse in this trend, though so far I hear little word of it even with the growing awareness that the continually climbing C/S rate is not benefiting anyone.

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