Friday, April 30, 2010

Lance Armstrong To Be A Dad For The Fifth Time!

Cyclist Lance Armstrong is getting set to expand his brood yet again! The soon-to-be dad-of-five took to Twitter to share the news, writing, "Getting ?'s today about someone I'm following, a certain @Cincoarmstrong. What to say? Yet another blessing in our lives. I cannot wait!"

Yes, much like big brother Max, 10 months, baby Armstrong already has a Twitter account and this morning posted a couple of clues about his or her identity:

"I got 2 arms, 2 legs, a nickname, and i'm 2 inches long. See y'all in October."

"I'm now the size of a lemon, 3.5 inches long, and weigh 1.5 ounces. And oh yeah, I'm on Twitter."

Along with Max, Lance's son with his girlfriend Anna Hansen, the baby on the way will join older siblings Isabelle and Grace, 8 1/2, and Luke, 11, his kids from his previous marriage.

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Why Prenatal Care Matters during Your Pregnancy

It is important that pregnant women see a physician more often than just to confirm their pregnancies and to have their babies delivered. Quality prenatal care by an established OB/GYN or nurse practitioner throughout the entirety of the pregnancy is the best way to monitor a baby's growth and to identify any problems or complications early on, before they become a health threat to the future mother or her unborn child. During these prenatal visits, a mother-to-be is also educated on how to care for herself during a healthy pregnancy, and also how to manage unique circumstances-such as gestational diabetes-that can emerge during pregnancy. Statistics show that women who make regular visits to health care providers during their pregnancy have healthier babies, are less likely to give birth prematurely, and are less likely to have other serious pregnancy-related issues. A pregnant woman's OB/GYN will often refer her and her partner to helpful support groups or Lamaze classes. These health care practitioners also connect low-income pregnant women with referrals to much-needed government services, such as WIC.

During a normal, low-risk pregnancy, it is recommended that a woman make prenatal visits about once a month during her first 28 weeks; twice a month from week 28 to week 36; and up to once a week after week 36, according to helpful information compiled by the March of Dimes. Those with higher-risk pregnancies may need to make more frequent visits with their doctor.

Knowing the approximate due date is another reason prenatal visits are useful because this helps women determine how much time they will have to prepare for a new baby. Prenatal visits also provide an opportunity to receive an ultrasound to determine the sex of the baby after it has reached the appropriate point of development.

The education a woman receives about pregnancy and childbirth during prenatal visits is invaluable. Women will learn the important role prenatal vitamins play in the healthy development of the baby, how to manage their weight during pregnancy, and answer any tricky questions they may have about their pregnancy. Topics a pregnant woman may want to discuss with a health care practitioner during a prenatal visit might include: sexual activity during pregnancy, exercise during pregnancy, the risk factors associated with being pregnant as a teen or older adult, what changes to expect in your body during pregnancy, and how to manage discomfort during pregnancy.

This guest post is contributed by Jennifer Johnson, who writes on the topics of NP Schools. She welcomes your comments at her email Id: j.johnson19june@gmail.com.

New diapers causing chemical burns on babies?

Thousands of mothers say a new diaper is causing chemical burns on their babies.

The new Pampers Swaddlers and Cruisers diapers are made with something Pampers calls "Dry Max Technology," and Pampers says diapers made with it are the thinnest and driest on the market.

They've been out for about four weeks, but now many mothers are saying they cause severe diaper rashes, burns, blisters and even bleeding.

Parents are using the Pampers Facebook page to talk about what they say the diapers are doing to their babies.

There are so many complaints, a spokesperson for Pampers posted this note on the Facebook site to refute the claims:

Hi everyone, my name is Jodi Allen. I lead the Pampers business in North America. I know many of you have questions regarding our new Pampers with Dry Max and I want to take this opportunity to answer them.

First, if anyone is experiencing problems that you feel are not being well addressed, we have set up a special 800 number (1-877-256-3265) to field these inquiries. I plan to check and review calls into this number daily. I cannot promise that we'll be able to meet all your needs, but we are interested in hearing from you.

I wanted to take a moment to review what we have done so far. Before our March 2010 Dry Max launch, some parents received the new Dry Max diaper in our original packaging without an explanation as to why. This triggered many questions and concerns for good reason. Nothing is more important to me than your satisfaction and the health and well being of babies. I'm a mom myself and can understand your concerns. These were early shippings of the new product that occurred during the transition in our manufacturing process. And I am very sorry for the confusion that this caused.

Since then, there have also been concerns posted here on our page about whether the Dry Max diaper may be causing or contributing to instances of diaper rash. Some parents have reported that their children experienced severe rashes.

The minute we hear about anything like that, we jump. We may not always handle every call correctly, and we've heard you on that. We're not perfect, but believe me, it is my job to be sure that we are paying close attention whenever issues like that are reported. We are working hard to respond in a comprehensive way to each and every call. As you know, Dry Max is one of the most tested diapers in our history developing Dry Max involved 20,000 babies and 300,000 diaper changes. Still, we didn't rely just on that background testing. When we started getting these calls, we gathered together our entire product safety, research, and consumer relations teams and began researching specific cases. In some instances, we requested that diapers be returned. We tested these products and examined again the materials that go into our diapers. (I just want to emphasize that the Dry Max diaper uses the same type of materials as the older Cruisers and Swaddlers.) We double-checked everything again to be sure there weren't unknown issues. Then we consulted with a team of respected outside pediatricians and dermatologists, who reviewed our safety data.

This comprehensive evaluation did not find any evidence whatsoever that Dry Max is behind the diaper rashes that some moms have reported. Diaper rashes, as you all know, can be a mystery. On average babies get them three to four times a year, and sometimes they are severe. Pampers has the responsibility to regulatory agencies, including the U.S. Consumer Product Safety Commission, to alert consumers to any such problems if they exist. More importantly, we also feel deep responsibility to you as parents ourselves. Believe me, if we found anything wrong, we would tell you. But that simply has not been the case. We even surveyed parents nationwide over the past few weeks, to gauge their opinions, and more than 70 percent said they preferred Dry Max to their current diaper because it is thin, flexible, and one step better for the environment than the product replaced.

I realize this information may contradict what you've experienced personally or seen reported by others. I just want to assure you that we cannot find any evidence that Dry Max is causing of diaper rash, or for that matter causing other safety issues that some parents say have happened to their children. I would only suggest that, in addition to contacting us, you consult your pediatrician, who also is welcome to call our special 800 number (1-877-256-3265) to review whatever they find.

On another note, I'd like to add that we do want to hear your comments regarding our products whether it's good or bad, however we have certain Facebook guidelines in place that do not allow advertising or promoting outside links or pages. Some comments have been previously deleted because they breached these guidelines. We hope you understand.

We'd like to continue to hear from you, so please post any questions you have. I'll do my very best to answer as many as I can...

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Mother-daughter pregnancy sickness link found

Pregnant women are three times more likely to suffer from severe morning sickness if their mothers did, say Norwegian researchers,

Around 2% of women suffer excessive nausea and vomiting in pregnancy - known as hyperemesis gravidarum - which can require hospital treatment.

But a study of 2.3 million births showed a threefold higher rate in those whose mothers had the condition.

Experts said the results could help women better understand their risk.

Hyperemesis is defined as excessive sickness which starts before the 22nd week of pregnancy and in its most serious form it can lead to dehydration and weight loss because women cannot keep food or water down.

It can be extremely debilitating, women can't work, can't look after their families and they need to be admitted to hospital.

It is the most common cause of admission to hospital in early pregnancy and can be a cause of low birth weight and premature birth.

The researchers said that previous studies have attributed the condition to "psychological causes".

They analyzed birth records, which included information on pregnancy complications, from 1967 to 2006.

It found the daughters of women who had the condition during their pregnancy had a 3% risk compared with 1% in those whose mothers did not have it.

But there was no increased risk to the female partners of sons whose mothers had suffered from the illness.

The researchers said although the results suggest a genetic link between mothers and daughters, it is also possible that there are lifestyle or environmental factors shared between mother and daughter that increase the risk.

Dr Catherine Nelson-Piercy, a consultant obstetric physician at Guy's and St Thomas' Foundation Trust in London, said that better understanding of the genetic risks of hyperemesis may help clinicians when counseling women about the risk of recurrence in future pregnancies.

She said many women were undertreated because of the legacy of thalidomide - a drug given for morning sickness in the 1960s which caused birth defects - despite the availability of safe drugs.

"It is safe to take anti-sickness drugs and it's better for the baby and the pregnancy to treat this condition than let the woman get very severely ill and risk complications."

Patrick O'Brien, spokesman for the Royal College of Obstetrics and Gynaecology, said the study added to growing evidence that many conditions in pregnancy, such as diabetes or high blood pressure, were linked to a "genetic predisposition".

Source

Less sunlight in first trimester of pregnancy linked to MS

Region of birth and lower levels of exposure to ultraviolet radiation during the first trimester of pregnancy were both independently associated with an increased risk of multiple sclerosis (MS) in adult life, shows research published in the BMJ.

The study was conducted across five states and one territory in Australia, among people born between 1920 and 1950 who were still alive at the time of the 1981 population census. A prevalence survey of MS had also been carried out in 1981.

There were 1524 patients with multiple sclerosis born in Australia 1920-50 from a total population of 2 468 779. Researchers analyzed their data by sex, month and year of birth and region of birth.

As expected, MS was more than twice as common among women as among men.

Overall, people born in November-December (first trimester in the Australian winter) had a third higher risk of subsequently developing MS than those born in May-June (first trimester in the summer).

When researchers analyzed their data by region of birth, they found that people born in regions with the lowest average levels of ambient ultraviolet radiation had a more than four times greater risk of subsequently developing MS than those born in the sunniest regions.

The association with month of birth was accounted for by the month- and region-specific ambient ultraviolet radiation during the first trimester – the effect of month of birth did not persist after adjustment for first trimester ultraviolet radiation.

The authors discuss the implications for prenatal care, and conclude: “Vitamin D supplementation for the prevention of multiple sclerosis might also need to be considered during in utero development.”

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Thursday, April 29, 2010

Mark McGrath and Fiancée Welcome Twins

Thursday morning Mark McGrath's fiancée, Carin Kingsland, gave birth to twins - a boy and a girl - in Los Angeles.

Son Lydon Edward weighed in at 5 lbs., 7 oz. upon his arrival at 9:54 a.m., daughter Hartley Grace came one minute later, weighing 4 lbs., 8 oz., McGrath's rep told PEOPLE exclusively.

"We are so lucky," McGrath told PEOPLE. "I don’t think you can prepare for the love we are feeling."

After 16 years of on-and-off dating, the Sugar Ray frontman, 42, and Kingsland, 37, an aesthetician, became engaged last New Year’s Eve and confirmed in April that they were expecting twins thanks to IVF.

"These two kids will be the luckiest kids in the world in terms of their mom, that’s for sure," says McGrath, who will host Fox’s Don’t Forget the Lyrics! this fall and tour with Sugar Ray in the summer. "They’ll get a lot of love. "

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Sex of baby drives response to pregnancy stress

University of Adelaide research is showing that the sex of the baby determines the way it responds to stressors during pregnancy and its ability to survive pregnancy complications.

Male and female babies during pregnancy show different growth and development patterns following stressors during pregnancy such as disease, cigarette use or psychological stress.

The research is being carried out by the Robinson Institute's Pregnancy and Development Group, based at the Lyell McEwin Hospital and led by Associate Professor Vicki Clifton.

"What we have found is that male and female babies will respond to a stress during pregnancy by adjusting their growth patterns differently," said Associate Professor Clifton.

"The male, when mum is stressed, pretends it's not happening and keeps growing, so he can be as big as he possibly can be. The female, in response to mum's stress, will reduce her growth rate a little bit; not too much so she becomes growth restricted, but just dropping a bit below average.

"When there is another complication in the pregnancy - either a different stress or the same one again - the female will continue to grow on that same pathway and do okay but the male baby doesn't do so well and is at greater risk of pre-term delivery, stopping growing or dying in the uterus."

Associate Professor Clifton said this sex-specific growth response had been observed in pregnancies complicated by asthma, preeclampsia and cigarette use but was also likely to occur in other stressful events during pregnancy such as psychological stress.

She said this sex-specific growth pattern was a result of changes in placental function caused by the stress hormone cortisol.

In female babies, increased cortisol produces changes to the placental function which lead to the reduction in growth, but the increased cortisol levels in a mother carrying a male baby doesn't produce the same changes in placental function.

Associate Professor Clifton said this research could lead to sex-specific therapies in pre-term pregnancies and premature newborns. It was also important in helping obstetricians more accurately interpret growth and development of the fetus in at-risk pregnancies.

"We are looking at what events during pregnancy cause changes in how the baby grows, what's behind this and ways in which we can improve the outcomes for pregnant women and their babies," she said.

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Wednesday, April 28, 2010

Breast-Feeding During Pregnancy: A Painful, Controversial Choice

I had a positive pregnancy test when my first daughter was just 9 months old, and I immediately called my ob-gyn to share the news.

"Stop breast-feeding," she told me, and dutifully, I weaned my daughter that night.

A week later, when I miscarried what turned out to have been a chemical pregnancy, I had two things to mourn: the baby I'd expected, and the nursing relationship I'd ended with my daughter.

I wondered, even if the pregnancy had continued, was it necessary to wean her? Why would my doctor have said that?

What I’ve learned since that day has changed my mind entirely about nursing during pregnancy. In fact, if I am lucky enough to get pregnant while breast-feeding, I’d want to continue the nursing relationship, even extending into a “tandem nursing” situation after the baby is born.

In all my years of playing with my young children in parks, I have never once seen an obviously pregnant woman breast-feeding. Why not?

Many times, apparently, it’s very painful.

According to Wendy Haldeman, one of the founders of the Los Angeles–based The Pump Station, it can hurt to breast-feed during the first trimester. “The nipple soreness is just something the mother has to endure,” she tells me. “Some can; others find it is just too painful to continue.”

Local mothers who attempted nursing while pregnant agreed with Haldeman. “By the time I was about 2 months pregnant, nursing became excruciatingly painful,” Amanda, a local mom, tells me. “I almost cried every time I went to nurse, it hurt so bad. I ended up weaning my son at that point.”

Milk supply can also diminish. “My experience is that if the first baby is over a year, the milk supply is not as much of a concern,” Haldeman says. “Infants under 9 months of age frequently need to be supplemented with formula because the mother simply can’t produce enough milk.”

Basically, your body begins producing a different quantity and quality of milk sometime in the second trimester. This is spelled out in Breastfeeding for Dummies by Sharon Perkins, RN, and Carol Vannais, RN:

“Somewhere between four and eight months of pregnancy, your milk does start changing from mature milk back to colostrum, the first type of milk that you gave your baby. The colostrum usually tastes a little different than mature milk, so you may find your baby not as interested in this new menu item and starting the process of weaning.”

But if I could bear the pain and my baby could bear the “new menu item,” is it a good idea from a medical perspective?

“In most circumstances, breast-feeding can be continued during an uncomplicated pregnancy,” says Pamela Berens, MD, an associate professor of obstetrics, gynecology, and reproductive sciences at the University of Texas Health Science Center, at Houston, who researches lactation and breast milk.

However, she explains that if your health-care provider has instructed you not to have intercourse, then you may not want to reconsider breast-feeding.

Apparently, both orgasm and breast-feeding trigger a release of oxytocin, which some women may want to avoid, as it can cause uterine contractions. “The increased oxytocin could be problematic in the patient that is experiencing preterm labor,” Dr. Berens says.

Dr. Berens advises that women with a history of preterm labor, placenta previa, or a “classical” C-section uterine incision consider weaning. However, these reasons occur later in pregnancy, so the mother wouldn’t need to wean abruptly in her first trimester.

Also, Dr. Berens recommends weaning for women with severe hypertension (high blood pressure), severe vascular or renal disease, or a prior “growth restricted” infant (a cautionary recommendation based on what Dr. Berens describes as a “small body of research that suggests that the weight of the infant born to the mother that breast-fed during her pregnancy may be very slightly reduced”).

Though no research has found any increased risk of miscarriage in women who continue breast-feeding during pregnancy, women might want to consider weaning if they are experiencing bleeding during early pregnancy, says Dr. Berens.

But be sure to confirm the pregnancy is viable. “If the pregnancy has already miscarried or is ‘non-viable’ (meaning no fetus has formed or the fetus has no heartbeat), then there is no benefit to weaning,” Dr. Berens says.

If only I’d heard that sound advice four years ago! Armed with this knowledge, I know that for any future pregnancies, I’ll hold on to my nursing relationship with much more confidence.

Source

Tuesday, April 27, 2010

Matt Damon's Wife Is Pregnant Again

Matt Damon and his wife Luciana are expecting another baby, his rep confirms to UsMagazine.com.

His rep tells Us, "Everyone is excited."

Damon, 39, and Luciana, 34, are parents to Isabella, 3, and Gia, 21 months. Luciana has a daughter, Alexia, 11, from a previous marriage.

Damon -- who quietly wed Luciana at NYC City Hall in December 2005 -- has credited his kids with keeping him grounded in Hollywood.

“It's pretty easy to kind of lose your way... having kids is really helpful," he told Parade magazine. "They kind of disabuse you of the notion of your greatness pretty quickly. There's a routine that you get into with kids that precludes you from going back to your single days. I'm probably more boring than I used to be. I go to bed earlier and I get up earlier."

He said he hopes his daughters take after their mother. "My wife is a very wise and a very thoughtful person. Hopefully, they'll inherit that," Damon said.

Added the actor (who supports charities including One, which fights AIDS and poverty in third world countries): "From me, I hope they'll inherit a sense of social justice and a desire to continue some of those programs that I'm involved with. Maybe not those exact ones, but hopefully, something to further social justice."

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Babies Suck: A Look at Pacifiers

Type "pacifiers" into Google and it immediately asks a common parenting question. "Pacifiers: Are they good for your baby?"

I thought no. Isaiah thought yes. And if he could type, he'd put that "yes" in italics and all caps.

From the moment my son was born, the one and only thing he asked of the world is that it give him something to suck. Isaiah sucked -- poorly -- on his thumbs and fingers and -- expertly -- on dirty laundry, stuffed sheep, our necks, other people's noses. If we had put lumber in his bassinet, he would have sucked it down to driftwood.

Like all newborns, he was a body led around by a mouth. "Sucking is a predominant activity during the first 6 months of life," as the infancy scientist Tiffany Field has written, "just as walking is the predominant milestone at 1 year." It starts early: Ultrasounds frequently capture fetuses sucking on their extremities; babies are born tattooed with sucking blisters.

Sucking was what Isaiah was born to do. So why did I feel wracked about giving him a pacifier? He wasn't wracked about taking it; he thought multicolored silicone was delightfully soothing. And it wasn't just me who felt uncertain about it. Even Google's algorithms knew we didn't know what to make of pacifiers.

Strangely, our contemporary anxieties about pacifiers likely have less to do with the actual objects -- recent research suggests they're helpful, not harmful -- than with their twisted modern history. We've inherited over a century of medical hysteria about infant sucking. No wonder pacifiers get us all worked up.

Psychologists immediately drew a parallel between sucking, with its world-obliterating intensity, and drug addiction; indeed, many concluded that all addiction was sublimated sucking. In 1925, the American psychologist James Mursell went so far as to argue that "the drive behind the smoking habit cannot be due to the specific effects of tobacco as a drug, for these are negligible in any case." The ultimate effects of alcohol and tobacco, he concluded, are "largely fictitious." Sucking was the true menace.

It's a fear that sounds at once far away and close by: Too much sucking is bad. For some reason. Really. Trust us.

Paradoxically, though, the bulk of contemporary research into pacifiers is not about their dangers. It's about their benefits. Premature infants who are given pacifiers mature faster and leave the hospital sooner: Non-nutritive sucking is now a standard part of preterm care. Pacifiers are highly effective pain relievers, dramatically reducing crying during painful procedures like circumcision. They -- somewhat mysteriously -- reduce the risk of SIDS: The American Academy of Pediatrics, in a highly controversial decision, now recommends pacifier use at night and during naps. The pacifier entry in a recent book on infant development includes this unconditional assessment: "Pacifiers provide comfort, promote physiological tranquility, and help in growth and development."

It's a confusing verdict: It seems unequivocal. Things can't be that simple, can they? And according to many doctors and lactation consultants, they aren't. This entry only tells half the story: The real problem with pacifiers is that they impede breast-feeding -- the flimsy, fake nipple confuses the infant and disturbs the natural rhythms of nursing. Weaning soon follows.

In fact, UNICEF/WHO's influential Baby-Friendly Hospital Initiative requires that hospitals "[g]ive no pacifiers or artificial nipples to breastfeeding infants." It makes intuitive sense that pacifiers would disturb breast-feeding. But evidence for it is underwhelming. The best studies on the question conclude that pacifiers, at least if given 15 days after birth, have no effect on the duration or success of breast-feeding. Nipple confusion, for that matter, may simply be a myth. A recent review of the literature concludes that "[p]acifier use should no longer be actively discouraged and may be especially beneficial in the first six months of life."

But there's real reluctance to acknowledge evidence in favor of pacifiers. The current edition of "Breastfeeding and Human Lactation," the standard reference for lactation consultants, says, flatly, "Pacifiers undermine exclusive breastfeeding for the first six months." Negative studies are cited; positive studies are ignored.

Isaiah sucked on pacifiers compulsively for a few months. But after they began ruining his sleep -- he'd wake up when they fell out -- we broke him. And after a day, he hardly noticed. He didn't need to suck so much anymore. He'd changed. And we'd survived.

If pacifiers are benign, or even beneficial, it is hard not to feel that what permeates the contemporary pacifier debate is a fundamental distrust of parents: the fear that pacifiers will allow parents to detach themselves from their children -- to substitute a cold, industrial object for warm skin and sweet whispering and a steady heartbeat. But I'd like to think that while Isaiah used a pacifier, we had more of ourselves to give him: Screaming exhausts parental love; it doesn't strengthen it.

Of course, the current research on pacifiers might turn out to be flawed. Or maybe too many parents will rely too much on pacifiers. Or who knows. But until any of that happens, it'd be nice for parents -- at least for parents like myself, people who are instinctively, mysteriously allergic to the idea of pacifiers -- to be told that their decision might not much matter. For too long, how babies suck has mattered way too much.

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USDA Cracks Down on Synthetic Fatty Acids in Organic Milk

The Obama administration, continuing its crackdown on the $25 billion organic food industry, is moving to eliminate two synthetic additives widely found in organic baby formula and organic milk.

Most U.S. manufacturers of conventional and organic baby formula have supplemented their products with the fatty acids DHA and ARA for several years in order to make them more closely mimic breast milk. Some studies suggest the omega 3-fatty acid DHA and the omega-6 fatty acid ARA promote cognition and eyesight in babies.

The U.S. Department of Agriculture, which isn't challenging the safety of the additives, is responding to complaints from activists that the Bush administration ignored proper procedures when it decided to include synthetic versions of the fatty acids on a list of nonorganic ingredients that are nonetheless allowed into products that carry the USDA's organic seal.

Kathleen Merrigan, an organics expert and second-most powerful person in the Agriculture Department, said in an interview Monday that organic regulators in 2006 misinterpreted the federal guidelines and erred by not seeking public comment on the 2006 move.

The USDA plans to issue a draft guidance later this year that would give food makers a grace period to reformulate their lines. The public will have 60 days to comment, after which the USDA will issue a final decision.

"We don't want an industry that acted in good faith to be harmed," said Dr. Merrigan, who is the USDA's deputy secretary. "On the other hand, we have a rule to uphold," she added.

The largest supplier of these ingredients is Martek Biosciences Corp., Columbia, Md., which extracts DHA and ARA from microorganisms using the chemical hexane, a solvent long used to make cooking oils. Martek's process sparked a food fad about eight years ago by giving manufacturers an alternative to using fish-oil-derived fatty acids.

Martek spokeswoman Cassie France-Kelly said Monday the company's synthetic fatty acids are used in organic products offered by Abbott Laboratories' Similac infant formula brand, the Earth's Best brand owned by Hain Celestial Group, and Dean Foods' Horizon milk brand.

Ms. France-Kelly said banning synthetic fatty acids from organic products wouldn't have a material impact on the financial results of Martek, which gets most of its business from conventional brands. But she warned that such a move would make it difficult for organic brands to offer the essential fatty acids.

Dr. Merrigan is leading a push by the USDA to both promote and more closely supervise the organic industry. Among other things, the USDA is making plans to spot-check products for residues of banned materials.

Source

Monday, April 26, 2010

Fetal Heart Rate Monitor Leads to Unecessary C-Sections

My patient needed to be delivered. She had just developed eclampsia, a potentially fatal disease that afflicts women in the second half of pregnancy. She had suffered a seizure and dangerously high blood pressure, and was at risk for far worse, including a stroke. No one knows why this condition arises, but delivery sure clears it up in a hurry.

So we gave medication to start labor, and the nurses placed a fetal heart monitor.

Worn like a belt, but higher on the abdomen, the ultrasound monitor would play a crucial role in the hours to come. It prints a read-out strip of the baby's heart rate, and the pattern would guide us in determining whether the delivery would be natural or through cesarean section.

As I suspected, the baby's heart-rate strip showed worrisome changes soon after labor began, and I knew it would get worse as labor progressed. We would fight through the night to have a natural delivery. But ultimately that single heart-rate test, which is surprisingly unreliable, would be a key factor in whether my patient would get a C-section or not.

Nearly all American mothers are monitored during labor, and bad fetal heart strips are an important cause of high cesarean section rates. A recent report detailed the dizzying increases: Almost one in three babies was delivered by cesarean in 2007, the most recent year for which data are available. That rate has grown by more than 50 percent in a decade.

I have performed hundreds of cesarean sections during residency, and many were the result of bad heart-rate strips.

A jagged pattern indicating increases in the heart rate reassures us that the baby's brain is awake and alert, and that labor could continue. But a flat line or decreases in the heart rate after contractions make us think the baby is not getting enough oxygen and pushes us to do a C-section - delivering the baby through incisions in the abdominal wall and the uterus.

For the worst readings, we believed every second counted and rushed the surgery: If the baby wasn't delivered one minute from the first incision into the skin, we had moved too slowly.

The complication we feared most was hypoxia, the baby not getting enough oxygen during labor. Going too long without adequate oxygen could result in a serious permanent injury, such as cerebral palsy, or even death.

No test is perfect. But almost every time we whisked a mother back to the operating room, and I cut through skin, fat, fascia, and finally the muscle of the uterus, expecting a blue, floppy baby, the child I delivered emerged pink, healthy, and a little bit angry.

Were we saving lives and averting disaster? Or were we performing unnecessary surgery?

Fetal heart-rate monitoring is a screening test. Good tests get several things right; they are cheap, detect a possible problem when there is still time to act, and minimize unnecessary follow-up tests.

But fetal heart monitoring is an appallingly poor test. The test misses the majority of babies with cerebral palsy, the condition researchers hoped it would prevent. It causes increased rates of a painful and invasive surgery: cesarean section. Even worse, almost all women undergo continuous heart monitoring during labor, not just those at highest risk.

The odds of my patient's baby suffering from dangerous lack of oxygen were slim. A study in the New England Journal of Medicine found that only 1 of 500 babies with a bad strip had cerebral palsy. Moreover, it remained unclear if the condition had developed before labor, in which case cesarean couldn't prevent it.

A 2006 analysis by the British Cochrane Collaboration, evaluating all available research, found that fetal heart monitoring failed to reduce perinatal mortality - the risk of a baby's dying late in pregnancy, during birth, or shortly after birth - and increased cesarean section rates and forceps deliveries, compared with listening to a baby's heart rate intermittently.

As a medical student, I loved watching emergency cesarean sections. The baby's heart rate went down, doors swung open, residents rushed the patient down to the OR, and a frantic minute or two of surgery later, a screaming baby was out. The excitement pushed me to choose a career in obstetrics. I never questioned the need for the surgery.

Now, cesarean sections for bad tracings are one of the least satisfying parts of my job.

Steven Clark and Gary Hankins, two prominent obstetricians, voiced my frustration. "A test leading to an unnecessary major abdominal operation in more than 99.5 percent of cases should be regarded by the medical community as absurd at best," they wrote in the American Journal of Obstetrics and Gynecology. "Electronic fetal heart rate monitoring has probably done more harm than good."

Why do doctors cling to continuous fetal heart monitoring? An obstetrician will most likely point to the fear of being sued, but the complete answer is more complex. Our medical culture prizes technology and tests, even if they don't work and can cause harm.

"It's our bias that anything that can be quantified is an improvement," said H. Gilbert Welch, a professor at Dartmouth Medical School whose research focuses on harm caused by screening and over-diagnosis.

"I think we get in trouble when we start promising things to . . . well [patients]," Welch said in an interview. "It is not that hard to make them worse."

For three or four hours that night, I struggled with my patient's bad fetal heart strip. I wanted her to avoid a cesarean section. She had type 1 diabetes, and I expected her sugars to swing wildly after surgery, and her recovery to be slow.

To improve the strip, the nurses and I tried giving her oxygen, changing her position in the bed, even rubbing the baby's head through the cervix to wake it up.

Finally, at 3 a.m., I felt compelled to recommend cesarean. The strip continued to look bad, and my patient's labor progressed slowly.

We went to the operating room, and delivered the baby by cesarean. My patient's child greeted the world pink and well-oxygenated.

The test was wrong again.

Alex Friedman is a fellow in maternal-fetal medicine at the Hospital of the University of Pennsylvania.

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