Friday, January 08, 2010

Readmissions After Cesarean Higher Than Vaginal Delivery

Hospital readmissions for women in the postpartum period are often due to infections, and women have a higher risk of readmission after cesarean than vaginal deliveries, according to research published in the January issue of the American Journal of Obstetrics & Gynecology.

Michael A. Belfort, M.D., of the Hospital Corporation of America (HCA) in Nashville, Tenn., and colleagues analyzed 222,751 deliveries in 2007 in 114 HCA hospitals to evaluate reasons for readmission after delivery.

Of this group, the researchers found that 2,655 women (1.2 percent) were readmitted within six weeks. Readmission was more common after cesarean than vaginal delivery (1.8 versus 0.83 percent). Hypertension and uterine and wound infections were the most common reasons for readmission, though readmissions for cholecystitis, appendicitis, and pneumonia were also notable.

"Our data confirm that, although readmissions in the first six weeks after delivery are uncommon, cesarean delivery carries with it roughly twice the risk for readmission as does vaginal birth," the authors write. "Perhaps of most interest was our observation of a significantly higher rate of hospital readmission for cholecystitis, appendicitis, and pneumonia in the first few postpartum weeks than would be expected by chance. None of these conditions has ever before been linked causally to pregnancy or delivery."


Breastfeeding difficulties may be due to presence of high testosterone during pregnancy

According to a research conducted by the researchers at the Norwegian University of Science and Technology, mothers who find it difficult to breastfeed their child might have had high level of testosterone, a male hormone during their pregnancy. The study published in Acta Obstetricia and Gynacologica Scandinavica was conducted on 180 pregnant women.

High testosterone levels in women may be due to various reasons, which bring unwanted results to a woman's appearance and health. She may suffer from hair loss, acne, unexplained weight gain and irregular menstrual cycles. The most common hormonal imbalance disease is the polycystic ovary syndrome (PCOS). High testosterone level may also result after the placenta, the site of the hormone production, comes into action.

According to the researchers, testosterone may disrupt the development of the glandular tissue in the breast, which can affect the breastfeeding abilities of the pregnant woman. They found a direct relationship between low breastfeeding rates at three and six months and high level of testosterone in the new mothers more than factors like smoking, age and education.


Thursday, January 07, 2010

Inducing labor may lead to more C-sections

Dr. J. Christopher Glantz at the University of Rochester School of Medicine found that inducing labor introduces a risk of 1 to 2 cesareans per 25 inductions that might have been avoided by waiting for spontaneous labor to begin.

While this risk to individual women is not particularly large, Glantz told Reuters Health that 1 to 2 cesareans per 25 inductions can quickly add up to tens of thousands of unnecessary cesareans over the course of millions of inductions.

While the procedures have become more common, C-sections are major surgeries, and carry risk of infection, bleeding, blood clots, and injury to other organs, Glantz emphasizes in a report in the journal Obstetrics and Gynecology.

The researcher analyzed birth certificate data for some 38,000 women from 13 hospitals in the Finger Lakes region of New York State from January 2004 to March 2008. He excluded women with scheduled or previous cesarean deliveries, or who had come to the hospital with ruptured membranes.

While previous studies have already shown that induced labor increases the risk for cesarean, Glantz examined how that risk might shift given a redefined comparison group.

He examined C-section rates after induction using three comparison groups: a week-by-week comparison of women induced to labor compared with those delivering spontaneously; women induced at a chosen week compared with women who delivered spontaneously after that week; and women induced at a chosen week compared with women who delivered spontaneously on or after that week.

In a nutshell, the study found that all labor induced groups faced increased risk for C-section, except for those women delivering after 39 weeks.

Glantz advises that pregnant women and their doctors may be better off waiting for spontaneous labor. "Try to reserve interventions for situations where risk outweighs benefit," said Glantz, such as in cases of diabetes, high blood pressure, problems with the placenta, a baby that is not growing well, or a woman being 10 days past her due date.


Wednesday, January 06, 2010

Breast not always best, study shows

Women should forget what they have been told about the health benefits of breastfeeding, researchers have claimed.

A controversial new study has concluded that, contrary to the view of many experts, breast is not necessarily best for children in the first months of life.

Professor Sven Carlsen, who led the Norwegian team, declared: "Baby formula is as good as breast milk."

What really affects the health of a growing infant is the hormone balance in the womb before birth, according to the research.

This in turn influences a woman's ability to breast feed, resulting in a misleading association between breastfeeding and child health, it is claimed.

The only benefit from breastfeeding supported by genuine evidence is a "small IQ advantage", said the scientists. And even this was yet to be properly confirmed.

Prof Carlsen's team reviewed data from more than 50 international studies looking at the relationship between breastfeeding and health. Most concluded that the more children were breastfed, the healthier they were.

On the surface this was correct, said Prof Carlsen, from the Norwegian University of Science and Technology in Trondheim. But he added: "Even if this is statistically true, it is not because of breastfeeding itself. There are very few studies that have examined the underlying controls on breastfeeding ability."

The largest study on breastfeeding was conducted in Belarus and involved more than 17,000 women and children who were monitored for six years. It "cut the legs out from underneath most of the assertions that breastfeeding has health benefits" said the scientists. For example, the study found no evidence that breastfeeding reduced the risk of asthma and allergies in children.

The research is published in the January edition of the journal Acta Obstestricia and Gynecologia Scandinavica.


Baby No.8 on the way for the mother of all surrogates

After giving birth to seven babies, Jill Hawkins was happy to call time on her career as a surrogate mother.

But then she found she missed being pregnant so much that she decided to do it all again.

The 45-year-old was implanted with two embryos from a professional couple in their early thirties.

And last night Miss Hawkins said she was 'absolutely ecstatic' after a home pregnancy test revealed at least one of the embryos has started to grow in her womb.

It will be the first time she has carried a child not from her own eggs.

She will find out later this month if she is expecting one baby or twins.

Miss Hawkins, who has no children of her own, will hand over the baby - or babies - to the couple while still in the maternity ward.

She insists that she has no desire to keep a baby, and that she is continuing to be a surrogate mother because she loves being pregnant.

All the previous children she has given away have been conceived using her own eggs and sperm from the father which was artificially inseminated.

Miss Hawkins, who will be paid around £12,000 in 'expenses' for her pregnancy, had spent 18 months trying for an eighth baby, but without success.

'My eggs have just packed up which is not unusual for a woman of my age,' she said.

'I was worried that because my eggs aren't as strong as they were that the rest of me might not be up to it either.

'But I've had scans and there's nothing wrong with my womb so being a host should not be a problem.

In a previous interview, she insisted she would not undergo IVF treatment to become a surrogate mother for the eight time.

But it seems that the temptation was too great and Miss Hawkins stepped in to help a 32-year-old mother-of-one who is unable to become pregnant again because of the powerful drugs she had to take after a lung transplant.

The woman and her husband had six embryos frozen before the transplant - two of which are now in Miss Hawkins' womb.

Miss Hawkins, from Brighton, said: 'It's a new experience this time because they are not my biological children. I feel different.

'I feel there's not so much pressure on me because it's not my genes. I'm just providing the womb for the baby to grow in.

She added: 'Being a host is more of a hassle because of all the fertility drugs you have to take.

'The side effects can make you feel weepy one moment and then bursting with rage the next.'

Miss Hawkins, a legal secretary, is the most prolific surrogate mother living in Britain.

Carole Horlock, from Stevenage in Hertfordshire, who has given birth to 12 surrogate babies, held the title before moving to France four years ago.


ADHD linked to obesity during pregnancy

Children are at double the risk of displaying symptoms of attention deficit hyperactivity disorder if their mother was overweight or obese when she became pregnant, according to European research.

It confirms for the first time in a large-scale study a suspected link between mothers' weight and children's mental health.

The study of nearly 2000 Swedish children identified a reduced ability to pay attention at school or preschool among those whose mothers had been overweight. This was even after taking into account the possible effects of mothers' mental health - which could influence the children's upbringing - and the children's own weight.

Children of obese mothers were also twice as likely to express negative emotions such as sadness and fear, and to have difficulty dealing with these appropriately, according to the research by Alina Rodriguez, a psychologist from the University of Uppsala. Her study followed the health of children from the first weeks of their mother's pregnancy through to age five.

Dr Rodriguez said a possible explanation was that excess weight might disrupt mothers' metabolism, making it harder for nutrients essential to brain development to reach the foetus.

Pregnancy puts huge stress on the metabolism, she said, and excessive weight gain might throw it out of balance - perhaps by raising mothers' levels of blood glucose, or of the hormone leptin.

Alternatively, the findings might result from inadequate vitamin D - which is linked to mental development and is known to be present in lower levels in overweight women - or from greater exposure to damaging chemicals, which accumulate in body fat.

Dr Rodriguez said her results, published in the Journal of Child Psychology and Psychiatry, could not prove whether maternal obesity caused the problems.


Tuesday, January 05, 2010

Ultrasounds during pregnancy soar

The number of ultrasounds administered to pregnant women has soared over the past decade, new research suggests.

A new study finds that the annual number of ultrasounds rose to 3,264 per 1,000 pregnancies in 2006 from 2,055 per 1,000 in 1996.

The proportion of pregnancies with at least four ultrasounds in the second or third trimesters grew to 18.7 per cent in 2006 from 6.4 per cent in 1996. Women who were deemed low-risk by their physicians received more ultrasounds than women categorized as high-risk.

Women fell into a high-risk category if the pregnancy endangered their life, required a genetics consultation or amniocentesis, or if they had a history of complications in a previous pregnancy. All other pregnancies were considered low-risk.

The study of 1,399,389 single deliveries was conducted between 1996 and 2006 by researchers at McMaster University in Hamilton, Toronto's Institute for Clinical Evaluative Sciences, and St. Michael's Hospital in Toronto. It is published in the Jan. 4 issue of the Canadian Medical Association Journal.

"Although guidelines generally recommend that two ultrasound examinations be performed in a pregnancy without complications — one in the first trimester for measurement of nuchal translucency to screen for aneuploidy (a chromosomal abnormality), and one in the second trimester to screen for fetal anomalies — it is conceivable that the proliferation of prenatal ultrasonography reflects changes in maternal risk over time," write the authors.

The authors speculate that many factors could be involved in the spike in ultrasounds. They attribute it to "defensive medicine," meaning doctors are erring on the side of caution, the desire of physicians to reduce patient anxiety, requests from mothers and even the "entertainment value of seeing one's fetus."

Over the course of the 10-year study period, the proportion of women aged 34-54 rose to 20.4 per cent of all pregnancies from 15.1 per cent in 1996. The number of high-risk pregnancies also grew to 19.3 per cent from 15.7 per cent.

The study's authors also point out that the cost of administering ultrasounds to women at low risk of pregnancy complications is high. At $64 per exam in Ontario, the cumulative total of ultrasound exams in the province since 1996 is $30 million.

It also questions the safety of multiple ultrasounds, noting that some studies have shown that frequent scans may cause the fetus's growth to be restricted, delayed speech and non-right-handedness. As well, the study points out that benign findings on ultrasounds can lead to invasive and potentially risky procedures that are not necessary, such as amniocentesis.


Yao Ming's wife is pregnant!

The wife of NBA center Yao Ming is expecting their first child, sending netizens into a frenzy of hope for a new generation to lead China's basketball team in the future.

"The news that Ye Li is pregnant is true. Yao Ming and his wife would like to thank all those who are showing concern," Yao's China-based spokesman Zhang Chi said in a statement to leading portal on Tuesday.

"Out of concern for Ye Li's state of mind and the need for a relaxed environment, it is not convenient to offer any further information concerning the baby," the spokesman said.

According to the Beijing News, the 29-year-old Houston Rocket -- out for the season as he recovers from a foot injury -- is expected to become a father in July. No decision has been made on where the baby will be born.

Both Yao and his wife -- once a centre on China's women's national basketball team -- are the offspring of professional athletes. They reportedly married at the request of sports officials in their hometown of Shanghai.

Ever since the 2.29-metre (seven-foot-six-inch) Yao married his 1.90-metre wife in 2007, speculation has run rampant as to when their first baby would be born, noted.

As both Yao and his wife were born in the 1980s and are only children, the couple will be allowed to give birth to two children under China's recently relaxed "one-child" family planning policy, the report said.

"We hope that Yao Ming and Ye Li will go further and raise more pillars of the next generation of Chinese basketball," it said.

Yao and his wife returned to China late last year to do promotional work for the 2010 Shanghai World Expo and to launch the season of the Shanghai Sharks, a professional Chinese basketball club that Yao recently purchased.

Congratulations to the extraordinary couple!


Nurse Program During Pregnancy Reduces Child's Criminality

Girls whose mothers were visited at home by nurses during pregnancy and the children's infancy appear less likely to enter the criminal justice system by age 19, according to a report in the January issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

John Eckenrode, Ph.D., of Cornell University, Ithaca, N.Y., and colleagues studied 310 19-year-olds whose mothers were enrolled in the Nurse-Family Partnership program in Elmira, N.Y., in which nurses visited homes to help women improve health-related behaviors during pregnancy, provide more competent care during infancy and improve their economic self-sufficiency through appropriate life choices. A total of 400 pregnant women enrolled in the study between 1978 and 1980; 85 percent of them were age 19 or younger, unmarried or from households with low socioeconomic status.

Of the 310 families followed up when the children were 19 years of age, 140 were in the control group, 79 received visits during pregnancy only and 91 received visits during pregnancy and infancy. Families in the program received an average of nine home visits by nurses during pregnancy and 23 from birth through the child's second birthday.

Compared with the 73 in the comparison group, the 44 girls whose families were visited during pregnancy and infancy were less likely to have been arrested by age 19 (10 percent vs. 30 percent) or convicted (4 percent vs. 20 percent), and had fewer lifetime arrests (an average of 0.1 vs. 0.54) and convictions (0.04 percent vs. 0.37 percent). When the analysis was restricted to girls whose mothers were high-risk (unmarried or low-income), those who were visited by nurses had fewer children (11 percent vs. 30 percent) and were less likely to use Medicaid (18 percent vs. 45 percent) than those who were not visited.

For boys, the likelihood of an arrest increased significantly in both the intervention and control groups after age 12, with no difference in arrests between groups through age 19.

"In the current debate over health care reform, the question of the cost vs. benefit of investing in prevention has become a hot topic," writes J. David Hawkins, Ph.D., of the University of Washington, Seattle, in an accompanying editorial.

"The Nurse-Family Partnership Program costs about $7,000 per child. Benefit-cost analyses for the already published effects of the program have found that it produces total benefits of about $41,000 per child of low-income, unmarried, nurse-visited mothers and about $9,000 per child of lower-risk nurse-visited mothers, a positive benefit-cost ratio in both cases."


Monday, January 04, 2010

Four amazing childbirth stories from 2009

-Southwest Airlines is often recognized as kid-friendly, and last year the airline proved that they're even equipped to deliver a baby. In December, a woman gave birth on a flight en route to Salt Lake City. When the woman went into labor, the pilot diverted the flight to Denver but this baby wanted to make a grand entrance at 30,0000 feet and was born in the back of the plane with the help of a doctor and two nurses who happened to be onboard.

-Think childbirth in an airplane sounds exciting? How about delivering in a helicopter? Natasha Watahomigie lives in the remote Supai Village at the bottom of the Grand Canyon where the only way out on land is by horseback. In December she went into labor several days early and a chopper came to the rescue. Her baby popped out on the short flight to a hospital. Natasha isn't the only member of her family to be born in a helicopter. Her sister delivered in a helicopter on Christmas day over 11 years ago.

-A playwright unexpectedly starred in his own drama when he helped his wife deliver their baby girl in the back seat of a Manhattan taxi last fall, according to the NY Post. Addison Proctor, and his wife, Sally Schuiling, were in a cab speeding from their Upper West Side apartment to NYU Medical Center when the baby's head popped out. "I scooped her up and put her on my chest, and she was breathing right away," Schuiling told the Post.

-Milwaukee mom Annmarie Schulte already went through three cesarean sections, and she was determined to have her fourth child naturally, according to the Milwaukee Wisconsin Journal Sentinal. Some doctors told her it shouldn't be done. Vaginal births after two c-sections are considered risky because they can cause uterine rupture. But Schulte found two midwives who agreed to work with her and a hospital where she could deliver. Only Schulte never made it to the hospital. She and her husband were caught in rush-hour traffic after her contractions started and they got in the car. In the front passenger seat of a 1998 Toyota Corolla, Schulte delivered her baby herself--can you get more natural than that? Schulte named her baby Cecilia Freeway Schulte.

Do you have an unusual birth story?


Finally, an Excuse for Pregnant Women to Eat Bacon and Eggs

If you're pregnant and looking for an excuse to eat bacon and eggs, now you've got one: a new research study published in the January 2010 print issue of the FASEB Journal by a team of University of North Carolina researchers shows that choline plays a critical role in helping fetal brains develop regions associated with memory. Choline is found in meats, including pork, as well as chicken eggs.

"Our study in mice indicates that the diet of a pregnant mother, especially choline in that diet, can change the epigenetic switches that control brain development in the fetus," said Steven Zeisel, the senior scientist involved in the work and a senior member of the FASEB Journal's editorial board. "Understanding more about how diet modifies our genes could be very important for assuring optimal development."

Zeisel and colleagues made this discovery by feeding two groups of pregnant mice different diets during the window of time when a fetus develops its hippocampus, that part of the brain responsible for memory. The first group received no choline while the other received choline (1.1g/Kg). The group that received no choline had changes in epigenetic marks on the proteins (histones) that wrap genes in cells responsible for the creation of new brain cells (neural progenitor cells). Then, by isolating these cells from the developing brains and growing them in cell culture, the scientists determined the expression of genes for two proteins that regulate neuronal cell creation and maturation. These two proteins (G9a and Calb1) were changed in the brains of fetuses whose mothers were fed low choline diets.

The Agricultural Research Service says that "experts suggest that an adequate choline intake is 425 milligrams a day for women and 550 milligrams a day for men. Top sources of choline include meat, nuts, and eggs."