New article up from the New York Times detailing the latest research in the benefits of breastfeeding.
Researchers at the University of California, Davis are studying the individual components of breastmilk to determine their specific functions. They have found that the sugars in human milk contain a specific microbe that helps line the intestinal walls of an infant and help ward off disease.
This particular strain of bacterium, a subspecies of Bifidobacterium longum, protects infants from others strains of bacteria that would make an infant ill. Humans do not naturally process the sugars, which make up about 21% of breastmilk, but the bacteria is specially designed to do just that.
They have also found that harmful bacteria will bind to the sugars in breastmilk and will then be flushed out of the baby's system as waste.
“Everything in milk costs the mother — she is literally dissolving her own tissues to make it,” said Dr. Bruce German, “Finding that [milk] selectively stimulates the growth of specific bacteria, which are in turn protective of the infant, let us see the genius of the strategy — mothers are recruiting another life-form to baby-sit their baby.”
The research also suggests what breastfeeding advocates have been striving toward for decades, that mother's milk could be extremely beneficial to premature babies. They also suggest it may be good for the elderly.
Dr. David Mills noted that each component of breastmilk may hold biological significance, updating the previous notion that some elements just pass through with no effect. His quote finishes the article: “So for God’s sake, please breast-feed.”
Tuesday, August 3, 2010
Lessons from a Reservation Hospital
I found an article on this amazing hospital from this past March on the Pushed Birth blog. The Tuba City hospital is small and impoverished, yet it has significantly better birth outcomes than the majority of maternity wards in the U.S. It's cesarean rate is 13.7%, less than half that of the national average and in line with the WHO recommended rate. It also has offered women the option of having a VBAC for decades and with excellent outcomes.
"Tuba City ...with about 500 births a year, could probably teach the rest of the country a few things about obstetrical care. But matching its success would require sweeping, fundamental changes in medical practice, like allowing midwives to handle more deliveries and removing the profit motive for performing surgery," the Times writes.
Doctors and midwives have salaried pay, stripping the incentive to cram more patients in and perform more unnecessary and costly procedures. The hospital receives its insurance coverage from the federal government and as such is more likely to opt for less expensive, and less invasive techniques. At least in terms of birth, those simple and inexpensive methods--massage, words of encouragement, staying at the woman's side for the entirety of labor, encouraging a woman to move, having a tub available in birthing rooms--return significantly better outcomes for the majority of women.
Read the full Times article here.
"Tuba City ...with about 500 births a year, could probably teach the rest of the country a few things about obstetrical care. But matching its success would require sweeping, fundamental changes in medical practice, like allowing midwives to handle more deliveries and removing the profit motive for performing surgery," the Times writes.
Doctors and midwives have salaried pay, stripping the incentive to cram more patients in and perform more unnecessary and costly procedures. The hospital receives its insurance coverage from the federal government and as such is more likely to opt for less expensive, and less invasive techniques. At least in terms of birth, those simple and inexpensive methods--massage, words of encouragement, staying at the woman's side for the entirety of labor, encouraging a woman to move, having a tub available in birthing rooms--return significantly better outcomes for the majority of women.
"Birth is a joyous affair here, and the entire family — from children to great-grandparents — often go to the delivery room... Linda Higgins, the head of midwifery at Tuba City, said: 'All of a sudden Mom is surrounded by women, and they’re all helping her and touching her.'
As a result, many young women have already seen children born by the time they become pregnant, and birth seems natural to them, not frightening."
We can learn a lot from this small hospital, both in practice and in the perception of birth in our society. With the change in ACOG statements about the safety of VBACs, the recognition that our cesarean rate has shown no signs of decreasing to the detriment of mothers and babies, and the recent push for legislative reform covering more birthing options, there is hope the methods of the Tuba City hospital are echoed in hospitals across the country.Read the full Times article here.
Monday, August 2, 2010
Victory for midwives: The Midwifery Modernization Act passed
WAY TO GO NEW YORK!
The Midwifery Modernization Act passed unanimously in the New York State Congress and received Gov. Patterson's signature.
The bill was quickly pushed through the New York State Assembly following the recent near demise of midwifery and homebirth in New York City. The previous piece of legislation concerning midwifery required certified midwives to have the written practice agreements (WPA) with an obstetrician in order to practice in the state. In New York City, the only OBs willing to enter into this agreement were to be found at St. Vincent's Hospital, which shut its doors this past March.
The Midwifery Modernization Act removes the need for a WPA, allowing midwives to practice independently as primary care providers. It recognizes them as the qualified care providers they are and not just as second rate specialists for a fringe movement.
Under the new law, midwives may continue to refer women to obstetricians, gynecologist, or physicians when necessary, but this is on a as-needed basis--just the same as your regular physician refers you to any other specialist. This is the standard of care in countries where midwifery care is the norm for pregnancy and birth related matters and has a record of being a safe and cost-effective means of care. In fact, under this model, countries such as The Netherlands, Sweden, and Norway have better maternal and fetal outcomes than the United States where only 1% of births are attended by midwives.
This is also a victory for mothers in New York who now have more options in deciding where and with whom to give birth, an option that should be available to all women without political barriers.
The Midwifery Modernization Act passed unanimously in the New York State Congress and received Gov. Patterson's signature.
The bill was quickly pushed through the New York State Assembly following the recent near demise of midwifery and homebirth in New York City. The previous piece of legislation concerning midwifery required certified midwives to have the written practice agreements (WPA) with an obstetrician in order to practice in the state. In New York City, the only OBs willing to enter into this agreement were to be found at St. Vincent's Hospital, which shut its doors this past March.
The Midwifery Modernization Act removes the need for a WPA, allowing midwives to practice independently as primary care providers. It recognizes them as the qualified care providers they are and not just as second rate specialists for a fringe movement.
Under the new law, midwives may continue to refer women to obstetricians, gynecologist, or physicians when necessary, but this is on a as-needed basis--just the same as your regular physician refers you to any other specialist. This is the standard of care in countries where midwifery care is the norm for pregnancy and birth related matters and has a record of being a safe and cost-effective means of care. In fact, under this model, countries such as The Netherlands, Sweden, and Norway have better maternal and fetal outcomes than the United States where only 1% of births are attended by midwives.
This is also a victory for mothers in New York who now have more options in deciding where and with whom to give birth, an option that should be available to all women without political barriers.
New Examiner Article Up: Top 5 reasons NOT to induce
The following are some common occurrences associated with labors that are medically induced--through drugs such as Pitocin, Cytotec (or Misoprostol), and/or the artificial rupturing of the membranes (AROM)--as well as a number of common misconceptions. They do not happen 100% of the time, and there may be several medical indicators which suggest induction is the best option for the health of mother and baby. However, the rates of inductions in the U.S. have skyrocketed while our infant mortality rates not improved and maternal mortality rates have actually increased.
This article is not meant to scare any woman out of having an induction, or to judge anyone for having chosen to have one. Instead, this article is meant to be informative, and to urge women to educate themselves on the benefits and risks of non-medically indicated inductions in addition to other options and alternatives in childbirth. If your primary care provider is urging you to induce, make sure to ask him or her what indicators for needing an induction are present and what your options are. Make sure to inform yourself the risks and benefits of induction from more than one reliable source before making a decision. The following may be a useful place to start...
Read the rest of the article here.
This article is not meant to scare any woman out of having an induction, or to judge anyone for having chosen to have one. Instead, this article is meant to be informative, and to urge women to educate themselves on the benefits and risks of non-medically indicated inductions in addition to other options and alternatives in childbirth. If your primary care provider is urging you to induce, make sure to ask him or her what indicators for needing an induction are present and what your options are. Make sure to inform yourself the risks and benefits of induction from more than one reliable source before making a decision. The following may be a useful place to start...
Read the rest of the article here.
Friday, July 30, 2010
Congresswoman Lucille Roybal-Allard (CA-34) Introduces Maternity Care Reform Legislation
I'm going to eventually do a lot of research on this bill and keep my eyes and ears out for any new news on it being passed, but for now I just wanted to pass along the info on this new proposed piece of legislation from Lucille Roybal-Allard (D-CA).
The MOMS (Maximizing Optimal Maternity Services) for the 21st Century bill will seek to address the dismal maternal and infant mortality and morbidity rate in the U.S. in an effort to improve overall maternal and infant care. Seeing as the U.S. is ranked 33rd in the world for maternal and infant health, despite outspending every other country in birth-related health care costs, this bill could not be any more prudent or urgent.
Take a moment to read over the summary of the bill from Congresswoman Roybal-Allard's site and write her, or the Congressional representatives in your area, to show your support for this bill!
I'll post a template letter in the next few days so check back for that!
The MOMS (Maximizing Optimal Maternity Services) for the 21st Century bill will seek to address the dismal maternal and infant mortality and morbidity rate in the U.S. in an effort to improve overall maternal and infant care. Seeing as the U.S. is ranked 33rd in the world for maternal and infant health, despite outspending every other country in birth-related health care costs, this bill could not be any more prudent or urgent.
Take a moment to read over the summary of the bill from Congresswoman Roybal-Allard's site and write her, or the Congressional representatives in your area, to show your support for this bill!
I'll post a template letter in the next few days so check back for that!
New Online Pregnancy Video Library from Childbirth Connection!
Wonderful news, expectant mamas! The always wonderful website Childbirthconnection.org has recently been updated to include a pregnancy and childbirth video library.
As a doula and birth advocate, I can tell you that although birthing videos are incredibly valuable learning tools, it is often difficult to find some of the best of them, and even when you do, they often come with a high price tag. So welcome the free, online video library!
Some of the options on the site are full length, others provide edited versions of the full length movies you can opt to purchase. A few others, such as The Business of Being Born, allow you to rent the movie on your computer for 24 hours for a small fee. Each video also directs you to the movie's official web page, making it easy to find even more articles, books, and videos on pregnancy and childbirth.
It is worth seeking out videos that celebrate the event of birth and seek to educate families of their options in childbirth and this new site makes it so easy. The videos featured on the site offer more than worthy alternatives to the TLC-run horror stories that take up a five-hour block of morning television.
As a doula and birth advocate, I can tell you that although birthing videos are incredibly valuable learning tools, it is often difficult to find some of the best of them, and even when you do, they often come with a high price tag. So welcome the free, online video library!
Some of the options on the site are full length, others provide edited versions of the full length movies you can opt to purchase. A few others, such as The Business of Being Born, allow you to rent the movie on your computer for 24 hours for a small fee. Each video also directs you to the movie's official web page, making it easy to find even more articles, books, and videos on pregnancy and childbirth.
It is worth seeking out videos that celebrate the event of birth and seek to educate families of their options in childbirth and this new site makes it so easy. The videos featured on the site offer more than worthy alternatives to the TLC-run horror stories that take up a five-hour block of morning television.
Monday, July 26, 2010
ACOG Changes VBAC Statement
Following the recent NIH conference on VBAC (Vaginal Birth After Cesarean) this past March, The American College of Obstetrics and Gynecology (ACOG) recently altered their statement on the safety of VBACs to make them more accessible for the majority of women who have previously had a cesarean birth.
ACOG's previous statement, issued in 1999, stated that hospitals have an anesthesiologist who could be "immediately" available to perform a repeat cesarean section on women attempting VBACs if necessary--a situation which even the largest hospitals in the country could rarely accommodate. ACOG's previous statement, issued after an NIH conference in 1980, suggested only that the necessary staff for an emergency cesarean be made "readily" available, helping to keep the U.S. cesarean rate at a relatively low percentage.
The change in wording in the official statement was prompted by a handful of articles published in medical journals in the late '90s regarding the incidence of uterine rupture in attempted VBACs. Though these articles relied on limited data, ACOG soon shifted it's stance on VBACs, thus being a major contributing factor in the incredible increase in the national cesarean rate over the past decade.
In recent years, several more studies have suggested that attempting vaginal birth after prior cesarean is most often the safest option for women, backing the original data that prompted the ACOG statement prior to the 1999 change. These studies show that the chances of uterine rupture in labor due to a cesarean scar are below 1%, only increasing above 1% in cases where labor was induced or augmented. It is safe to say that ACOG is finally coming around to meet the evidence-based standards proven not only in the past several years, but in what was originally found throughout the 1970's and 80's.
This change should offer women more options in care providers and place of birth when attempting VBACs, though it may take several years to see this becoming a national trend. It is still to be seen whether or not this changes any stances on VBAC attempts in home deliveries, or for women who would wish to deliver at a birthing center, but this may open those options to women, allowing these practices to come out from the underground networks they are currently forced to transverse due to limited access.
Allowing more women to have vaginal deliveries should also cause a shift in the amount spent on births in the U.S. each year, and hopefully will send the national cesarean rate on a downward slope, edging closer, at least, to the World Health Organization's (WHO) recommended 15% (the U.S. currently has a 32% cesarean rate).
ACOG's previous statement, issued in 1999, stated that hospitals have an anesthesiologist who could be "immediately" available to perform a repeat cesarean section on women attempting VBACs if necessary--a situation which even the largest hospitals in the country could rarely accommodate. ACOG's previous statement, issued after an NIH conference in 1980, suggested only that the necessary staff for an emergency cesarean be made "readily" available, helping to keep the U.S. cesarean rate at a relatively low percentage.
The change in wording in the official statement was prompted by a handful of articles published in medical journals in the late '90s regarding the incidence of uterine rupture in attempted VBACs. Though these articles relied on limited data, ACOG soon shifted it's stance on VBACs, thus being a major contributing factor in the incredible increase in the national cesarean rate over the past decade.
In recent years, several more studies have suggested that attempting vaginal birth after prior cesarean is most often the safest option for women, backing the original data that prompted the ACOG statement prior to the 1999 change. These studies show that the chances of uterine rupture in labor due to a cesarean scar are below 1%, only increasing above 1% in cases where labor was induced or augmented. It is safe to say that ACOG is finally coming around to meet the evidence-based standards proven not only in the past several years, but in what was originally found throughout the 1970's and 80's.
This change should offer women more options in care providers and place of birth when attempting VBACs, though it may take several years to see this becoming a national trend. It is still to be seen whether or not this changes any stances on VBAC attempts in home deliveries, or for women who would wish to deliver at a birthing center, but this may open those options to women, allowing these practices to come out from the underground networks they are currently forced to transverse due to limited access.
Allowing more women to have vaginal deliveries should also cause a shift in the amount spent on births in the U.S. each year, and hopefully will send the national cesarean rate on a downward slope, edging closer, at least, to the World Health Organization's (WHO) recommended 15% (the U.S. currently has a 32% cesarean rate).
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