Friday, May 29, 2009

Natural Childbirth Classes Offer No Special Benefit Part 2

If you teach childbirth education classes OR are a doula, be prepared for a flood of questions about the new Swedish study discussing childbirth education. The British Journal of OB/GYN has published the full text version of the study and the study makes some sweeping statements.

However, I will try to dissect it all down for you - first and foremost, READ the entire study. And be prepared to work with the facts about the study and the value of childbirth education. Be sure also to listen to the 5 minute interview between the co-author of the study and Belinda Phipps of the UK National Childbirth Trust.

1) The sampling is small, only 1087 women over 1.5 years and in one geographical location. This calls into question the statistical significance where broad statements are made.

2) The educators were all midwives. However, there is no mention of these midwives being childbirth educators, having taught childbirth education before, or being trained or certified by any childbirth education organization. Those who have been trained and certified as childbirth educators are well versed in the methods of adult learning/education, can provide memory hooks to aid in informational retention AND the passion to present objectively all of the information an expectant mother and her partner would need to make sound decisions based on the information.

2a) What was the belief system of the educators? Do they believe what they are teaching? Did anyone monitor voice inflections and body language?

3) Flow Chart #2 provides some significant questions about the model of education given to the "natural childbirth" classes. Omitted from the "natural classes" was the Risk/Benefit model of teaching where interventions, complications or birth plans with exploration of expectations could be discussed.

4) Also missing from the "natural classes" were the films. What films were shown? What was the tone of the films?

To me, if a study is to make broad statements that could impact a woman's birth experience, the EXACT same classes should have been taught to the expectant participants sans only the psychoprophylactic information. As a Lamaze certified childbirth educator for over 30 years, I would energetically challenge the validity of this study based on the 4 comments above.

It is important to note that this study should not be embraced immediately without further study and much tighter/more accurate models of education.

As an aside, Doulas have enjoyed nearly 25 years and over a dozen studies are still are not fully embraced.

Natural Childbirth Classes Offer No Special Benefit

A research team at the Karolinska Institute in Sweden studied data collected from 1,087 first-time mothers. Malin Bergström, a clinical psychologist who co-authored the study, said: "Our conclusion is that natural childbirth preparation with psychoprophylaxis does not reduce the need for epidural analgesia or improve the birth experience, when compared with the standard form of antenatal education."

While I am trying to get a copy of this study, I am curious about several issues: exactly what type of classes were these? How long did the classes last and was there time to practice the techniques? Who taught the classes ~ were they taught by certified childbirth educators?

These and many more questions need to be addressed, I believe, before sweeping statements like these can be made....

Tuesday, May 26, 2009

Health Canada Urges Caution

Health Canada is advising expectant mothers and breastfeeding women not to take the vitamin-mineral supplements Maxum Matragen or Maxum Multi-Vite by Seroyal International Inc.

Health Canada has not received any adverse reaction reports associated with Maxum Matragen and/or Maxum Multi-Vite. Pregnant or breastfeeding women who may be taking Maxum Matragen or Maxum Multi-Vite are advised to consult their health care professional prior to continuing use of these products.

Friday, May 15, 2009

Childbirth Class Trends/Cesareans Increase Problems

According to one report, "the National Center for Health Statistics estimates more than 4,317,119 babies were born in U.S. during 2007, about one percent more than in 2006. The biggest increase in birth rate (2 percent) was among women 30 to 34 years. The smallest (less than one percent) was among women 20 to 24. Among teens 15-19, the birth rate rose about one percent. Cesarean deliveries continue to rise in the U.S., accounting for 31.8 percent of all births. The rate of preterm births/low birth weight declined slightly between 2006 and 2007."

The amazing rise in cesareans is NOT according to birth researcher Eugene Declercq of Univ. of Boston, due to cesarean delivery on maternal request or CDMR. It is, statistically speaking, due to the physicians' fear of litigation.

As the expensive surgery's popularity rises (according to the LA Times), so have premature births, maternal deaths and neonatal intensive care admissions. Serious medical intervention has diminishing returns, a doctor notes. Because the average uncomplicated cesarean runs about $4,500, nearly twice as much as a comparable vaginal birth, cesareans account for a disproportionate amount (45%) of delivery costs. Among privately insured patients, uncomplicated cesareans run about $13,000.

"Cesarean birth ends up being a profit center in hospitals, so there's not a lot of incentive to reduce them," said Dr. Elliot Main, chief of obstetrics for Sutter Health, a Northern California hospital chain.

Really? Not a lot of incentive? How about the embarrassing fact that the US is still 27th or 28th in the world when it comes to infant morbidity/mortality and maternal morbidity/mortality? So the almighty dollar is more important than a mother or baby's life.

I don't think I have to say any more...............

Tuesday, May 12, 2009

Poll on Natural Childbirth & An Important New Book!

I don't usually pay attention to polls. However ~

A recent online poll of expectant mothers showed that 34% became interested in natural childbirth methods because "it is how we are supposed to give birth". Over 16% said their interest in natural childbirth was because the recovery was faster. And 11% stated it was perceived as a safer method.

Natural childbirth IS catching on, even in Hollywood. Celebs who choose natural childbirth rarely make the news but the who's who list of natural childbirth advocates is growing. The most noteworthy spokesperson of natural childbirth lately is Ricki Lake (with Abby Epstein), in part due to her film "The Business of Being Born" and her new book "Your Best Birth: Know all of your options, discover the natural choices and take back the birth experience". She joins the ranks of famous moms such as Laila Ali (CBS Early Show), Melissa Joan Hart, Minnie Driver and Maria Bello (The Mummy: Tomb of the Dragon Emperor) who all experienced natural birth.

Lake and Epstein point out that while 99% percent of births in the U.S. take place in hospitals and one-third are cesareans, the vast majority of births are not high risk and may not require medical intervention. But the fear of pain combined with unnecessary hospital protocols cause many couples to narrow or relinquish their options. The authors discuss the pros and cons of such interventions as episiotomies, epidurals and electronic monitors, and encourage women to carefully question their practitioners and hospital personnel.

This may very well be one of the most important books of our time!

Wednesday, May 06, 2009

Breastmilk in NICU's

The National Association of Neonatal Nurses has a position paper “The Use of Human Milk and Breastfeeding in the Neonatal Intensive Care Unit.” The link in below.

Saturday, May 02, 2009

FDA: Hydroxycut.......Cytotec

According to a CNN report on May 1, 2009:

The FDA said it has received 23 reports of serious liver injuries linked to Hydroxycut products, which are also used as energy enhancers and as fat burners.
The reports include the 2007 death of a 19-year-old man living in the Southwest, which was reported to the FDA in March. Other serious liver problems reported included liver damage that resulted in a transplant in 2002, liver failure, jaundice, seizures and cardiovascular problems. The FDA is warning consumers to immediately stop using 14 Hydroxycut products manufactured by Iovate Health Sciences Inc. of Oakville, Ontario, and distributed by Iovate Health Sciences USA Inc. of Blasdell, New York.

In the July/August 2001 issue of Mothering Magazine, Ina May Gaskin wrote:

My review of 30 misoprostol [Cytotec] induction studies and reports representing 3,415 births was far less reassuring. I found 14 baby deaths, 25 uterine ruptures, 2 maternal deaths, and 2 life-threatening hemorrhages.4-14 Significantly, several of these complications occurred in women given a single 25 mcg dose-the smallest dose possible.15 According to one researcher, the author of several studies, "Some patients appear to be quite sensitive to misoprostol, demonstrating prolonged contraction responses after a dose of the agent, sometimes in excess of 20 hours after the drug."16

While this may not be the first occurence of such a disparity of truth, I feel betrayed as a medical professional, woman, mother, and US citizen. However, I have renewed energy to educate both the medical and expectant parent population about this disparity.