[ozmidwifery] article FYI
New Findings Support Fetal Overnutrition Hypothesis Reuters Health Information 2007. © 2007 Reuters Ltd. NEW YORK (Reuters Health) Feb 28 - Findings from an epidemiologic study lend further support to the fetal overnutrition hypothesis: subjects overexposed to glucose, free fatty acids, and amino acids in utero are at increased risk for obesity later in life. According to this hypothesis, it is the mother's weight status that determines the degree of fetal overnutrition. Thus, the hypothesis helps explain why obesity is often passed from parent to offspring. In the present study, reported in the February 15th issue of the American Journal of Epidemiology, Dr. Debbie A. Lawlor and colleagues correlated the maternal body mass index (BMI) with offspring BMI in 3340 parent-offspring trios drawn from an Australian birth cohort. Maternal BMI was assessed at the first antenatal clinic visit and offspring BMI was determined at age 14. In addition, paternal BMI was calculated from the mother's report of the father's height and weight. The offspring's BMI was more closely linked to the mother's BMI than the father's, Dr. Lawlor, from the University of Bristol in the UK, and colleagues note. For a one-standard-deviation increase in maternal and paternal BMI, offspring BMI increased by 0.362 and 0.239 standard deviations. There is currently an epidemic of obesity in Western societies, the authors conclude. The potential importance of the suggestion, from our study, that greater maternal size during pregnancy, either through programming of neuroendocrine pathways or through epigenetic or other mechanisms, results in greater offspring BMI in later life means that this issue warrants further investigation. Am J Epidemiol 2007;165:418-424. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 _ Advertisement: Your Future Starts Here. Dream it? Then be it! Find it at www.seek.com.au http://a.ninemsn.com.au/b.aspx?URL=http%3A%2F%2Fninemsn%2Eseek%2Ecom%2Eau%2F%3Ftracking%3Dsk%3Ahet%3Ask%3Anine%3A0%3Ahot%3Atext_t=754951090_r=seek_m=EXT -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] RE:
Hi Belinda, My daughter had recurrent boils for approximately 2 years and we tried all the treatments you have mentioned: salt baths, vitamin supplements and antibiotics (even though I hate them and believe they are overused) etc ... etc ... I spoke with a naturopath and she said it tended to be a depressed immune system. So I decided to try to improve her diet as my daughter has always been a fussy eater. I started giving her a punnet of strawberries and a punnet of cherry tomatoes every week and she hasnt had a boil since!! It would seem that the extra vitamin C has boosted her immune system sufficiently. So ... its worth a try and tastes alot better than antibiotics without the side-effects!! All the best, Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: Belinda Pound [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Date: Tue, 13 Feb 2007 16:51:11 +1000 Just wondering if anyone has any ideas on treating boils. Started about 18/40 (second pregnancy..none with first). Glucose at 28/40 fine. Drs said it was due to pregnancy. Had several courses of oral ab's, two treatments of bactroban nasally. (partner and 2yo daughter also treated with nasal ab at this time). Bath in detol/phisohex. Baby now 11 weeks, breastfeeding, and I currently have four boils. All have been on the right hand side of body. Take pregnancy and breastfeeding vitamin daily. (have had 15-20 in past 6 months.and don't want yet another dose of ab's) Any suggestions on experience/treatment greatly appreciated. Thanks Belinda _ Advertisement: Fresh jobs daily. Stop waiting for the newspaper. Search Now! www.seek.com.au http://a.ninemsn.com.au/b.aspx?URL=http%3A%2F%2Fninemsn%2Eseek%2Ecom%2Eau_t=757263760_r=Hotmail_EndText_Dec06_m=EXT -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI re insecticide pregnancy
This information can be found by going to http://emotional.healthcentersonline.com Insecticide affects infancy development HealthCentersOnline Dec 18 (HealthCentersOnline) - Women who are exposed to the insecticide chlorpyrifos during pregnancy are at increased risk of having babies with significantly poorer mental and motor development as well as behavioral problems during early childhood, according to a new study. The study was conducted by researchers from the Columbia Center for Children's Environmental Health at Columbia University's Mailman School of Public Health and the Centers for Disease Control and Prevention (CDC). Chlorpyrifos is an insecticide used for large-scale crops throughout the world, although it was banned for household pest control use in the United States in 2001. Previous research has shown that chlorpyrifos exposure in utero can affect birth weight and length. This study established a link between exposure to chlorpyrifos during pregnancy and developmental problems in the offspring of women who are exposed. This research is part of an ongoing study examining the effects of exposure of pregnant women and babies to indoor and outdoor air pollutants, pesticides and allergens. For this study, the research teams assessed the growth and development of about 250 infants from New York City who were born between 1998 and 2002. By their third birthdays, those children with the highest levels of chlorpyrifos at birth showed significantly lower levels of mental development and motors skills than children with lower exposure levels to the insecticide. The children with the most exposure also were more likely to show early signs of behavior and attention problems. These findings indicate that prenatal exposure to the insecticide chlorpyrifos not only increases the likelihood of developmental delays, but may have long-term consequences for social adjustment and academic achievement. Relatively speaking, the insecticide effects reported here are comparable to what has been seen with exposure to other neurotoxicants such as lead and tobacco smoke, Dr, Virginia Rauh, lead author and investigator of the study, said in a recent press release. The research appears in this month's issue of the journal Pediatrics. Copyright 2000-2006 HealthCentersOnline, Inc. Publish Date: December 18, 2006 Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 _ Advertisement: Meet Sexy Singles Today @ Lavalife - Click here http://a.ninemsn.com.au/b.aspx?URL=http%3A%2F%2Flavalife9%2Eninemsn%2Ecom%2Eau%2Fclickthru%2Fclickthru%2Eact%3Fid%3Dninemsn%26context%3Dan99%26locale%3Den%5FAU%26a%3D23769_t=754951090_r=endtext_lavalife_dec_meet_m=EXT -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI - epidurals hinder breastfeeding
Getting an epidural may hinder breastfeeding Moms who opt for popular narcotic during labor have more trouble nursing NEW YORK - Some women who get epidural anesthesia during childbirth may have difficulty with breastfeeding in the short- and long-term, a new study suggests. Specifically, researchers found, women who received an epidural with the narcotic fentanyl seemed to have more problems with breastfeeding than women who went without an epidural. They reported more difficulty with breastfeeding in the first week of their babies lives, and they were twice as likely to have given up breastfeeding by the time the baby was 6 months old. Though its not clear that the epidurals were the reason, there is evidence from other research that fentanyl can hinder infants ability to suckle, Dr. Siranda Torvaldsen, the studys lead author, told Reuters Health. Theres no evidence, however, that other drugs used in epidurals interfere with breastfeeding, according to Torvaldsen, a researcher at the University of Sydney in Australia. No need to feel guilty Moreover, the findings, which are published in the International Breastfeeding Journal, do not mean women should feel guilty about wanting an epidural. I think the most important message for pregnant women is to get good advice and help with breastfeeding, Torvaldsen said. Lactation consultants, she noted, can help women learn how to best support breastfeeding and overcome any difficulties they may encounter. For many women, the benefits of epidural analgesia will outweigh the risks and it is important that women feel supported whatever decision they make, Torvaldsen said. Of the 1,260 women in the current study, one-third had an epidural during labor. All of the epidurals included fentanyl and an anesthetic called bupivacaine. Overall, the study found, women who received an epidural were more likely than other mothers to be partially, rather than exclusively, breastfeeding in the week after the birth. They were also twice as likely to report breastfeeding difficulties in the first week and to give up breastfeeding before the baby was 6 months old. In general, experts recommend that babies be fed only breast milk for the first 6 months, and then continue breastfeeding after solid foods are introduced, for at least the first year of life. Although its not certain that epidural drugs directly cause problems with breastfeeding, Torvaldsen said its important that women be aware of the possibility, so they can make informed decisions about analgesia, and seek advice on successful breastfeeding if they need it. Copyright 2006 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content is expressly prohibited without the prior written consent of Reuters. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 _ Advertisement: Fresh jobs daily. Stop waiting for the newspaper. Search Now! www.seek.com.au http://a.ninemsn.com.au/b.aspx?URL=http%3A%2F%2Fninemsn%2Eseek%2Ecom%2Eau_t=757263760_r=Hotmail_EndText_Dec06_m=EXT -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI - smoking in pregnancy
Parents' cigarette smoke harms kids for years Effects of exposure during pregnancy can last up to age 12, study finds NEW YORK - A new international study of more than 20,000 children confirms that exposure to cigarette smoke before and after birth impairs their lung function, and that parental smoking remains a serious public health issue. The effects of smoking during pregnancy last up to age 12, while exposure to cigarette smoking after birth further worsens lung function, Dr. Manfred A. Neuberger of the Medical University in Vienna, one of the studys authors, told Reuters Health. It is difficult to tell, Neuberger noted, whether the impairment of lung function resulting from prenatal and early life exposure is permanent, given that many individuals with parents and siblings who smoke will have started smoking themselves by their teen years. The researchers analyzed results from a subset of children who had participated in the Pollution and the Young Study, including a total of 22,712 children from eight countries. The findings appear in the American Journal of Respiratory and Critical Care Medicine. Children whose mothers smoked during pregnancy were 31 percent to 40 percent more likely to have poor lung function than children born to non-smokers, the researchers found. Early-life exposure independently increased risk of poor lung function to a lesser degree, by 24 percent to 27 percent. Sixty percent of the children in the study had been exposed to cigarette smoke before birth or in early life, the researchers found. Considering the high number of exposed children, this indicates that both environmental tobacco smoke exposure and smoking during pregnancy remain a severe public health problem, Neuberger and his team conclude. The findings are a stark reminder that legal efforts to reduce exposure to cigarette smoke in workplaces arent protecting the group of people at greatest risk from passive smoking, young children, Drs. Mark D. Eisner of the University of California, San Francisco and Francesco Forastiere of the Rome E Health Authority in Italy write in an editorial accompanying the study. Children are primarily exposed to tobacco smoke in the home, where legal restrictions do not apply, they note. Copyright 2006 Reuters Limited. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 _ Advertisement: House hunt online now! http://a.ninemsn.com.au/b.aspx?URL=http%3A%2F%2Fninemsn%2Erealestate%2Ecom%2Eau%2Fcgi%2Dbin%2Frsearch%3Fa%3Dbhp%26t%3Dres%26cu%3DMSN_t=758874163_r=HM_EndText_Nov06_m=EXT -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI - another example of technology that promises more than it delivers
). The rates of cesarean delivery associated with a non-reassuring fetal heart rate were also similar, occurring in 7.1% of cases in the open data group and 7.9% of cases in the blinded data group (P=0.30). Rates of dystocia (i.e., abnormal or difficult delivery) too were similar, occurring in 18.6% of openly-monitored fetuses and 19.2% of fetuses monitored under cover (P=0.59). When they considered the 2,160 women whose fetus had a non-reassuring heart rate before randomization, they found that the results were similar, with no significant differences between unmasked and masked labor. There were no significant differences in maternal or infant complications or in the condition of the infants at birth. As with previous studies, application of the monitoring device was generally successful, was not associated with a high incidence of adverse effects, and was successful in obtaining the desired data about fetal oxygen saturation approximately 74% of the time the device was in place, the investigators wrote. Unfortunately, knowledge of this additional fetal physiological information did not change the rates of cesarean or operative vaginal delivery in either the general study population of 5,341 women or the subgroup of 2,168 women with non-reassuring fetal heart-rate patterns. In his editorial, Dr. Greene noted that the findings of no apparent benefit from an added technology provide an opportunity for regulators. Should the FDA's charge be minimalist and framed very narrowly, to approve a device that reliably does what it claims -- in this case, accurately record fetal oxygen saturation -- while not injuring people in the process? he wrote. Or should the FDA's charge be more expansive, to approve a new device only after it demonstrates some medical value added to the current standard of care? Primary source: New England Journal of Medicine Source reference: Bloom SL et al. Fetal Pulse Oximetry and Cesarean Delivery. N Engl J Med 2006;355:2195-202 Additional source: New England Journal of Medicine Source reference: Greene MF. Obstetricians Still Await a Deus ex Machine. N Engl J Med 2006;355:2247-2248 Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 _ Win a $40K private Lear Jet experience with Flight Sim X! http://ninemsn.com.au/share/redir/adTrack.asp?mode=clickclientID=730referral=hotmailtaglineURL=http://games.ninemsn.com.au -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI - fetus in fetu
Chilean boy born with fetus in his stomach Condition occurs in 1 in 500,000 live births SANTIAGO, Chile - A boy has been born in Chile with a fetus in his stomach in what doctors said was a rare case of fetus in fetu in which one twin becomes trapped inside another during pregnancy and continues to grow inside it. Doctors carried out a scan on the boy's mother shortly before she gave birth on Nov. 15 in the southern city of Temuco and noticed the 4-inch-long fetus inside the boy's abdomen. It had limbs and a partially developed spinal cord but no head and stood no chance of survival, doctors said. After the birth, doctors operated and removed the fetus from the boy's stomach. The boy, who has not been named, was recovering at Temuco's Hernan Henriquez hospital. It's very rare, said Maria Angelica Belmar, head of the hospital's neonatal wing, speaking of fetus in fetu cases. It occurs in only one in every 500,000 live births, she told Reuters, adding that the number of cases recorded worldwide was fewer than 90. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 _ Advertisement: House hunt online now! http://a.ninemsn.com.au/b.aspx?URL=http%3A%2F%2Fninemsn%2Erealestate%2Ecom%2Eau%2Fcgi%2Dbin%2Frsearch%3Fa%3Dbhp%26t%3Dres%26cu%3DMSN_t=758874163_r=HM_EndText_Nov06_m=EXT -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI - rare birth defect
Doctors save baby born with heart outside chest Surgeons in Florida use Gore-Tex to repair rare birth defect MIAMI - Using a piece of Gore-Tex fabric to make their repairs, doctors performed corrective surgery on a baby born with his heart outside his chest, and said Wednesday that the youngster should be able to lead a close-to-normal life. Naseem Hasni underwent surgery to put his heart inside his chest hours after being delivered by Caesarean section Oct. 31 at Holtz Childrens Hospital. He remained in critical but stable condition Wednesday. Hes not going to be able to play certain kinds of sports where a blow to the sternum to you and me wouldnt be a problem, but in him it would be. So I think some competitive sports are going to be out, said Dr. Eliot Rosenkranz, a cardiothoracic surgeon, but hes going to be able to participate in other sorts of activities. He added: Certainly the goal is as normal a childhood as he can achieve. Before the surgery, Naseems heart looked like a peeled plum sitting atop his pink chest, with the aorta diving back underneath the skin. Nevertheless, the heart was beating away normally. During the six-hour operation, surgeons first wrapped Naseems heart in Gore-Tex, then a layer of his own skin, to substitute for his missing pericardium, the sac that encloses the heart. The heart was then slowly eased inside his chest. Rare congenital defect The baby was born with an extremely rare congenital defect, ectopia cordis, in which the heart grows outside the body and the chest wall and sternum fail to develop. The defect was spotted in an ultrasound exam in late September after the mother, Michelle Hasni, 33, began feeling unusual movement from the baby. He was having hiccups, but it was constantly and it was every day. Naseem was delivered at 36 weeks, a few days early. Surgeons made a larger incision than normal to ensure that the heart would not be squeezed or touch any part of the womb. Other than the heart defect, Naseem had developed normally: He was 21 inches long and weighed 9 pounds, 2 ounces at birth. In a few weeks, Naseem will be fitted with a protective piece of plastic to wear over his chest. When he is about 6 months old, surgeons will graft pieces of his own ribs across his chest to create a sternum, or breastbone. While doctors had not initially been sure that Naseem would survive until Thanksgiving, he could be home with his family as early as Christmas, Rosenkranz said. Ectopia cordis occurs 5.5 to 7.9 times per 1 million live births, and the survival rate after surgery is less than 50 percent, the boys doctors said. © 2006 The Associated Press. All rights reserved. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 _ Advertisement: Looking for the latest range of toys available? Go to www.tradingpost.com.au http://a.ninemsn.com.au/b.aspx?URL=http%3A%2F%2Fwww%2Etradingpost%2Ecom%2Eau%2Fbrowse%2FHousehold%2FFamily%2FToys%2DGames%2Floc%5FlocRZSQregtAVSCdistRZSQAVSCstateRZSQ9AVSCregRZSQ%5Fns%5FTrue%5Foff%5F0%5Fsqt%5F1%5Fsrchtype%5Fbrwse%5Fstpg%5F3%5F%3Freferrer%3Dplace2_t=758874129_r=emailtagline_nov_m=EXT -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: FW: [ozmidwifery] getting synto etc
Hi All, I did a little research recently concerning Misoprostil and discovered that the WHO has also been researching Misiprostil for the prevention of PPH. Like many of you have already mentiioned it is not recomended for use in obstetrics although it is widely used and it is easier to store as it doesnt require refridgeration and easier to administer as it is oral or PR not IMI. However the recent WHO Expert Commitee on the Selection and Use of Essential Medicines found that Syntocicnon is actually more effective than Misoprostil and due to a lack of evidence they decided not to include it in The Interagency List of Essential Medicines for Reproductive Health 2006. Both these documents are worth reading. So I have decided that I will continue to use Syntocinon 10 IU/mL, if required, for the management / prevention of PPH when I attend a homebirth. Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: LJG [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: FW: [ozmidwifery] getting synto etc Date: Wed, 15 Nov 2006 19:09:57 +1000 We have it in our cupboard and regularly use it for pph (used pr) and it works well for this, I imagine this it what you would be having it on hand for Philippa? Because it's a tablet it doesn't need refrigeration. Most of our Tops are now done with it too. It is dispensed by our pharmacyalthough kept in the dd cupboard and counted in the same manner. If obs in the public system are using it freely then I can't see why a GP would object...or maybe a hospital doctor would write it up for you? - I am hoping to get a script for Misoprostal (sp) for my homebirth. Any ideas. Should I just ask a GP? What are they liable for if they do prescribe it. Cheers Philippa Scott Birth Buddies - Doula Assisting women and their families in the preparation towards childbirth and labour. President of Friends of the Birth Centre Townsville - -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. _ Advertisement: House hunt online now! http://a.ninemsn.com.au/b.aspx?URL=http%3A%2F%2Fninemsn%2Erealestate%2Ecom%2Eau%2Fcgi%2Dbin%2Frsearch%3Fa%3Dbhp%26t%3Dres%26cu%3DMSN_t=758874163_r=HM_EndText_Nov06_m=EXT -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Delaying synto with active 3rd stage
Sue, You really need to decide whether your patient wishes for an active or a physiological third stage. It can be dangerous to try and do a half-half sort of third stage. If you plan a physiological third stage then you need to: 1. Dont clamp or cut the cord until it stops pulsating. 2. Put the baby to the breast as soon as possible, this will stimulate oxytocin release which works better than 10units Syntocinon ever does! 3. Allow the placenta time to separate without pulling on the cord. 4. If the woman is upright gravity will help, sitting on the toilet usually works well. 5. Wait until the woman feels some afterbirth pains, then suggest she gives a little push 6. Always observe for excessive bleeding but dont confuse that initial gush which indicates the placenta is separating with excesive blood loss. 7. Be patient, have faith in the normal process! All the best, Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: Sue Cookson [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Delaying synto with active 3rd stage Date: Tue, 14 Nov 2006 11:00:25 +1100 Hi, I'm interested if there is any research on delaying synto for say up to 5 minutes in 'active 3rd stage'. Have been doing actively managed third stage throughout my clinical placements as a student (nearly finished!!) with some practitioners cutting the cord immediately, and most at about 10 - 20 seconds. I've just prepared a powerpoint presentation on delayed cord clamping but know I will get into a discussion around the seeming conflict between active 3rd stage and delaying the clamping. Obviously if you don't want the effects of synto's action - strong uterine contraction with excess blood being pumped into bub, then you need to delay the entire process of actively managed 3rd stage until the cord is clamped. Does anyone practice delaying the synto injection for those first few minutes? Any evidence of harm in doing this? Thanks, Sue -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. _ Advertisement: Fresh jobs daily. Stop waiting for the newspaper. Search now! www.seek.com.au http://a.ninemsn.com.au/b.aspx?URL=http%3A%2F%2Fninemsn%2Eseek%2Ecom%2Eau_t=757263760_r=Hotmail_EndText_Nov06_m=EXT -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Delaying synto with active 3rd stage
I should add that a physiological third stage is the natural progression from a normal labour. However if the woman has had a labour influenced by IOL, augmentation and directed pushing in second stage then she is more at risk of a PPH because her uterus has been unnaturally pushed to labour harder. In this instance active management of third stage may be more appropriate. You need to consider the overall situation, not merely the issue of when do we clamp the cord?. Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: leanne wynne [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] Delaying synto with active 3rd stage Date: Tue, 14 Nov 2006 11:27:11 +1100 Sue, You really need to decide whether your patient wishes for an active or a physiological third stage. It can be dangerous to try and do a half-half sort of third stage. If you plan a physiological third stage then you need to: 1. Dont clamp or cut the cord until it stops pulsating. 2. Put the baby to the breast as soon as possible, this will stimulate oxytocin release which works better than 10units Syntocinon ever does! 3. Allow the placenta time to separate without pulling on the cord. 4. If the woman is upright gravity will help, sitting on the toilet usually works well. 5. Wait until the woman feels some afterbirth pains, then suggest she gives a little push 6. Always observe for excessive bleeding but dont confuse that initial gush which indicates the placenta is separating with excesive blood loss. 7. Be patient, have faith in the normal process! All the best, Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: Sue Cookson [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Delaying synto with active 3rd stage Date: Tue, 14 Nov 2006 11:00:25 +1100 Hi, I'm interested if there is any research on delaying synto for say up to 5 minutes in 'active 3rd stage'. Have been doing actively managed third stage throughout my clinical placements as a student (nearly finished!!) with some practitioners cutting the cord immediately, and most at about 10 - 20 seconds. I've just prepared a powerpoint presentation on delayed cord clamping but know I will get into a discussion around the seeming conflict between active 3rd stage and delaying the clamping. Obviously if you don't want the effects of synto's action - strong uterine contraction with excess blood being pumped into bub, then you need to delay the entire process of actively managed 3rd stage until the cord is clamped. Does anyone practice delaying the synto injection for those first few minutes? Any evidence of harm in doing this? Thanks, Sue -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. _ Advertisement: Fresh jobs daily. Stop waiting for the newspaper. Search now! www.seek.com.au http://a.ninemsn.com.au/b.aspx?URL=http%3A%2F%2Fninemsn%2Eseek%2Ecom%2Eau_t=757263760_r=Hotmail_EndText_Nov06_m=EXT -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. _ Advertisement: Fresh jobs daily. Stop waiting for the newspaper. Search now! www.seek.com.au http://a.ninemsn.com.au/b.aspx?URL=http%3A%2F%2Fninemsn%2Eseek%2Ecom%2Eau_t=757263760_r=Hotmail_EndText_Nov06_m=EXT -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Iron woes - longish
Hi Kristin, A Hb of 12.9 is perfectly normal, even for a non-pregnant women ... so stop worrying. In fact the current research suggests that the best perinatal outcomes occur with a Hb between 95 -110g/L. The fainting spell was more likely caused by low blood pressure which is also normal in pregnancy and women should merely avoid standing for long periods which causes a further drop in blood pressure. The tiredness is also a normal part of pregnancy and just your body just trying to tell you to nurture yourself a little. I recall when I did my midwifery training that Maggie Miles had a whole chapter on the normal discomforts of pregnancy and amongst these are tiredness, breathlessness, fainting, pressure pains, etc etc ... The secret is to listen to your body, trust your body, rest when you need to and stop worrying and stop looking for problems. All the best, Leanne Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: Kristin Beckedahl [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Iron woes - longish Date: Tue, 31 Oct 2006 16:05:15 +0800 Hi all, I have just received this query from a woman - any ideas of how to help her with this greatly appreciated! 28/40 bloods Hb 12.9, Ferritin 7 - That's the lowest it has ever been as far as I'm aware. Dr wasn't too worried about it as he felt my body had probably aclimatised to the low iron stores. However I am concerned about this and am wanting to get my levels up as quickly as possible. The problem is is that I have not been able to tolerate any form of oral iron. The Iron Plus were too constipating, so I became even more conscious (if that was possible) of getting as much iron from my diet as possible. However, I was becoming more and more lethargic etc and so I tried taking Clements Iron (liquid) that was recommended to me. However this had the opposite effect (diarrhoea) and my stools were very black, which made me doubt if I was absorbing any iron at all. As well as the black stools, I was becoming increasingly symptomatic of iron deficiency and anaemia. My bloods last week showed my Hb 11.0 Ferritin 7 (However a fingerprick sample for my Hb 2 days earlier was 10.0 g/dL) I became quite dizzy when standing, my BP dropped to 90 / 44, very short of breath, exhausted, oedema in my ankles etc. I saw a locum GP and he wanted to see what my blood results were before suggesting any treatment. I relayed all of this to my Midwives down south who consulted a Homeopath who felt that maybe I was toxic to iron and that is why my body wouldn't tolerate any supplements. (When I look back I have been on Iron on and off since I was pregnant with my little boy ~ 2.5 years ago). I was advised to stop taking any Fe supplements and do a 3 day detox on Pulsatilla 6c three times a day. I have just completed this and surprisingly, I have started to feel better, less dizzy, BP now normal 100 / 70, still SOB and tired though as could be expected. My GP is back now and he wants me to have iron injections over the next 2 weeks to see if that will restore my levels. What do you think??? Thousands of jobs, millions of opportunities at seek.com.au -- This mailing list is sponsored by ACE Graphics. Visit to subscribe or unsubscribe. _ Thousands of jobs, millions of opportunities at seek.com.au http://a.ninemsn.com.au/b.aspx?URL=http%3A%2F%2Fninemsn%2Eseek%2Ecom%2Eau_t=757263760_r=Hotmail_EndText_Oct06_m=EXT -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
. As the researchers suggest, non-fatal amniotic fluid embolism might have been overdiagnosed in their study. Moreover, fatal cases of the disorder are less likely to be misdiagnosed. Thus, he added, the association between amniotic fluid embolism and a given risk factor is most reliable when a death is recorded. The odds ratio for induced labor as a risk factor is higher for deaths alone than for total cases of the disorder, which lends support to the argument for this association. Primary source: The Lancet Source reference: Kramer MS et al. Amniotic-fluid embolism and medical induction of labor: a retrospective, population-based cohort study. The Lancet 2006; 368: 1444-48 Additional source: The Lancet Source reference: Moore J. Amniotic fluid embolism: on the trail of an elusive diagnosis. The Lancet 2006; 368: 1399-1401. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 _ See The Killers in the UK. Download mobile stuff to win! http://ninemsn.com.au/share/redir/adTrack.asp?mode=clickclientID=723referral=hotmailtaglineURL=http://ninemsn.blueskyfrog.com/index.cfm?dir=promospage=killers -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] article FYI
Hi Angela, I am actually quite familiar with Ellen G White and her prolific writings... If you want some more research into antenatal influences, both physical and emotional then check-out Michel Odent's research on his Primal Health web-site and his numersous books ... it will be a little more up-to-date and evidence based than Ellen White!! All the best, Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: Angela Rayner [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] article FYI Date: Thu, 5 Oct 2006 10:07:39 +1000 Hi Leanne Thanks for your posting. These research findings sit very well with me. I'm not sure if you have heard of the author Ellen White, but she has written much on many subjects, and as a midwife I have been very interested in her comments on prenatal influences. She says that where possible mothers should try to have a pleasant disposition when pregnant as their temperament affects the personality of their unborn child. This makes a lot of sense from a 'scientific' point of view, but there was no research to date that I was aware of, and I was curious to know how this could be tested. I have been deliberating on plans to do research in the near future, and this has inspired me somewhat. Thank you. Kind regards, Angela -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of leanne wynne Sent: Thursday, 5 October 2006 9:07 AM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] article FYI Stress During Pregnancy Linked to Smaller Babies WEDNESDAY, Sept. 27 (HealthDay News) -- Stressed-out pregnant women may carry smaller-than-average babies, a new study finds. In findings published in the September-October issue of Psychosomatic Medicine, researchers from the University of Miami School of Medicine studied 98 women who were 16 to 29 weeks pregnant. The women completed questionnaires that measured their levels of distress from daily hassles, depression and anxiety. The women also underwent ultrasounds to measure their fetuses, and they provided urine samples to measure levels of stress-linked hormones such as cortisol and norepinephrine. The researchers found that the fetuses of the mothers with higher rates of depression, anxiety and stress weighed less and were smaller than average. In addition, cortisol levels were linked to the weight of the fetus, indicating that cortisol may be a potential mechanism for transmitting a mother's stress to her unborn baby. One of the things this research highlights is that if you are pregnant and under extreme amounts of stress or feeling depressed, you should talk with your doctor about ways of treating these conditions during pregnancy, study author Miguel A. Diego said in a prepared statement. -- Krisha McCoy SOURCE: Health Behavior News Service, news release, Sept. 22, 2006 Copyright (c) 2006 ScoutNews LLC. All rights reserved. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Stress During Pregnancy Linked to Smaller Babies WEDNESDAY, Sept. 27 (HealthDay News) -- Stressed-out pregnant women may carry smaller-than-average babies, a new study finds. In findings published in the September-October issue of Psychosomatic Medicine, researchers from the University of Miami School of Medicine studied 98 women who were 16 to 29 weeks pregnant. The women completed questionnaires that measured their levels of distress from daily hassles, depression and anxiety. The women also underwent ultrasounds to measure their fetuses, and they provided urine samples to measure levels of stress-linked hormones such as cortisol and norepinephrine. The researchers found that the fetuses of the mothers with higher rates of depression, anxiety and stress weighed less and were smaller than average. In addition, cortisol levels were linked to the weight of the fetus, indicating that cortisol may be a potential mechanism for transmitting a mother's stress to her unborn baby. One of the things this research highlights is that if you are pregnant and under extreme amounts of stress or feeling depressed, you should talk with your doctor about ways of treating these conditions during pregnancy, study author Miguel A. Diego said in a prepared statement. -- Krisha McCoy SOURCE: Health Behavior News Service, news release, Sept. 22, 2006 Copyright © 2006 ScoutNews LLC. All rights reserved. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] MSNBC.com Article: More infant deaths with elective C-sections
More infant deaths with elective C-sections A new study has found a higher risk of infant deaths among infants born by Caesarean section to mothers who have no medical need for the procedure. http://www.msnbc.msn.com/id/14838765/from/ET/
RE: [ozmidwifery] Henci Goer's Article on GD
Henci is absolutely correct - Gestational Diabetes is a big firfy!! Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: Kelly @ BellyBelly [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Henci Goer's Article on GD Date: Fri, 4 Aug 2006 16:40:25 +1000 What are everyone's thoughts on Henci Goer's GD article? It's caused a bit of a stir in my GD forum: http://www.bellybelly.com.au/forums/showthread.php?p=382564 but I don't feel that I know enough about it to comment. Best Regards, Kelly Zantey Creator, http://www.bellybelly.com.au/ BellyBelly.com.au Gentle Solutions From Conception to Parenthood http://www.bellybelly.com.au/birth-support http://www.bellybelly.com.au/birth-support BellyBelly Birth Support - http://www.bellybelly.com.au/birth-support -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Hi All, There is alot of contradictory research on this topic at the moment but this confirms what most midwives believe. Leanne. Coitus at Term May Be Linked to Earlier Onset of Labor News Author: Laurie Barclay, MD July 21, 2006 -- Coitus at term is associated with an earlier onset of labor and reduced need for induction at 41 weeks' gestation, according to the results of a prospective, longitudinal study reported in the July issue of Obstetrics Gynecology. The effect of coitus on preterm labor is uncertain, write Peng Chiong Tan, MRCOG, from the University of Malaya in Kuala Lumpur, Malaysia, and colleagues. A decreased risk of preterm birth has been reported to be associated with having intercourse in later pregnancy and also with having orgasms. On the contrary, increased risk of preterm births is also linked to having preterm intercourse. Of 344 healthy women with uncomplicated pregnancies and established gestational age who were approached regarding study participation, 241 were recruited to keep a diary of coital activity from 36 weeks of gestation until birth and to answer a short questionnaire. Of these, 200 women provided complete coital diaries for analysis. End points included coitus, postdate pregnancy (defined as pregnancy beyond the estimated date of confinement), gestational length of at least 41 weeks, labor induction at 41 weeks of gestation, and mode of delivery. The likelihood of reported sexual intercourse at term was affected by a woman's perception of coital safety, her ethnicity, and her partner's age. After multivariable logistic regression analysis controlling for these and other potential confounders, reported coitus at term remained independently associated with reductions in postdate pregnancy (adjusted odds ratio [AOR], 0.28; 95% confidence interval [CI], 0.13 - 0.58; P = .001), gestational length of at least 41 weeks (AOR, 0.10; 95% CI, 0.04 - 0.28; P .001), and requirement for labor induction at 41 weeks of gestation (AOR, 0.08; 95% CI, 0.03 - 0.26; P .001). At 39 weeks of gestation, the number of couples needed to have intercourse to avoid 1 woman having to undergo labor induction at 41 weeks of gestation was 5 (95% CI, 3.3 - 10.3). Coitus at term did not significantly affect operative delivery (adjusted P = .15). Reported sexual intercourse at term was associated with earlier onset of labor and reduced requirement for labor induction at 41 weeks, the authors write. This finding has important clinical implications because labor induction at 41 weeks of gestation is a common practice. The authors recommend that these findings be confirmed by intervention studies. Any intervention based on such a complex issue as sexual intercourse is likely to be challenging to implement effectively, and the widespread safety concern of women would have to be allayed before the suggested intervention could be widely adopted, the authors conclude. Obstet Gynecol. 2006;108:134-140. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Perinat Epidemiol 2001;15:232-40. Hannah ME, Hannah WJ, Hodnett ED, Chalmers B, Kung R, Willan A, et al. Outcomes at 3 months after planned cesarean vs planned vaginal delivery for breech presentation at term: The International Randomized Term Breech Trial. JAMA 2002;287: 1822-31. Gjerdingen DK, Chaloner KM. The relationship of women's postpartum mental health to employment, childbirth, and social support. J Fam Pract 1994;38:465-72. Forman DN, Videbech P, Hedegaard M, Salvig JD, Secher NJ. Postpartum depression: Identification of women at risk. Br J Obstet Gynaecol 2000;107:1210 -7. Beck CT. A meta-analysis of predictors of postpartum depression. Nurs Res 1996;45:297-303. Lydon-Rochelle M, Holt VL, Martin DP, Easterling TR. Association between method of delivery and maternal rehospitalization. JAMA 2000;283:2411-6. Hofmeyr GJ, Hannah ME. Planned caesarean section for term breech delivery. In Cochrane Library, Issue 1. Oxford, England: Update Software, 2001. Robinson JN, Norwitz ER, Cohen AP, McElrath TF, Liebermen ES. Episiotomy, operative vaginal delivery, and significant perineal trauma in nulliparous women. Am J Obstet Gynecol 1999;181:1180-4. Johanson RB, Heycock E, Carter J, Sultan AH, Walklate K, Jones PW. Maternal and child health after assisted vaginal delivery: Five-year follow up of a randomized controlled study comparing forceps and ventouse. Br J Obstet Gynaecol 1999;106: 544-9. Sultan AH, Stanton SL. Preserving the pelvic floor and perineum during childbirthElective caesarean section? Br J Obstet Gynaecol 1996;103:731-4. Miller J, Thornton E, Gittens C. Influences of mode of birth and personality. Br J Midwifery 2002;10:692-7. McQueen A, Mander R. Tiredness and fatigue in the postnatal period. J Adv Nurs 2003;42:463-9. Albers L, Williams D. Lessons for US postpartum care. Lancet 2002;359:370 -1. MacArthur C, Winter HR, Bick DE, Knowles H, Lilford R, Henderson C, et al. Effects of redesigned community postnatal care on womens' health 4 months after birth: A cluster randomised controlled trial. Lancet 2002;359:378-85. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] FW: Contemporary OB/GYN Newsline, August 2006
Hi All, I have forwarded this entire email because it wouldn't allow me to copy and paste just the article on VBAC. I hope you can access it ... Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: Contemporary OB/GYN Newsline [EMAIL PROTECTED] To: [EMAIL PROTECTED] Subject: Contemporary OB/GYN Newsline, August 2006 Date: Tue, 01 Aug 2006 10:07:49 -0400 Please do not reply to this message. If you wish to unsubscribe from this mailing list, or if you wish to contact us, please read the message at the bottom of this email. This email is written in HTML and links to an Adobe Acrobat PDF. If you are unable to read it, please go to http://www.contemporaryobgyn.net/obgyn/article/articleDetail.jsp?id=361613 to view the page in your browser. To read Adobe Acrobat files, you will need to download and install the FREE Adobe Acrobat Reader, available from AdobeSystems Incorporated at http://www.adobe.com/products/acrobat/readstep2.html. New support for VBAC after multiple C/S Which repair for anal sphincter injury? Legal Briefs Update on hysteroscopic tubal sterilization Uterine smooth muscle tumors Should patients undergoing low-risk C/S get prophylactic antibiotics? HPV testing better than conventional Pap So say the results of the first randomized, controlled comparison of conventional cytology and combined HPV testing and liquid-based cytology. The study, done on women aged 35 to 60, also suggests that 2 pg/mL may be a better cutoff for HPV testing than 1 pg/mL. New research on condoms and HPV Watch, medicate, or evacuate for first-trimester miscarriage? Infant death after shoulder dystocia A 39-year-old Illinois woman pregnant with her seventh child was admitted to the hospital at 38 weeks' gestation in 1997 for induction of labor due to increased fetal weight. The admitting obstetrician was her physician's partner and was on-call for the group that evening. Hospital staff informed him of the patient's admission. Did inappropriate ROM lead to prolapsed cord? Pre-existing brain damage defense Need CME credits? Look no further than Contemporary OB/GYN. One article in every monthly issue is accredited. Read the article and complete the post-test and evaluation to get your free credit. Look for the CME button on our Web sitehttp://www.contemporaryobgyn.netfor more information on the program and a link to an archive of CME-accredited articles from Contemporary OB/GYN. You have received this e-mail because you indicated an interest in receiving healthcare information from us. You are subscribed to cog_enews as [EMAIL PROTECTED] To unsubscribe from this monthly newsletter, please send a blank email to [EMAIL PROTECTED] If you have any questions, or if you wish to contact us, please send an email to [EMAIL PROTECTED] or call 1-877-922-2022. Contemporary OB/GYN Five Paragon Drive Montvale, NJ 07645 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Vaginal Birth After Cesarean in California: Before and After a Change in Guidelines John Zweifler, MD, MPH; Alvaro Garza, MD, MPH; Susan Hughes, MS; Matthew A Stanich, MPH; Anne Hierholzer; Monica Lau Ann Fam Med. 2006;4(3):228-234. ©2006 Annals of Family Medicine, Inc. Posted 07/07/2006 Abstract Purpose: In 1999 the American College of Obstetricians and Gynecologists (ACOG) adopted more-restrictive guidelines for vaginal birth after cesarean delivery (VBAC). This study assesses trends in VBAC in California and compares neonatal and maternal mortality rates among women attempting VBAC delivery or undergoing repeat cesarean delivery before and after this guideline revision. Methods: The 1996 through 2002 California Birth Statistical Master Files were used to identify 386,232 California residents who previously gave birth by cesarean delivery and had a singleton birth planned in a California hospital. Results: Attempted VBAC deliveries decreased significantly from 24% before to 13.5% after guideline revision (P .001). Neonatal mortality rates per 1,000 live births for attempted VBAC deliveries were not different from repeat cesarean delivery rates among neonates weighing #8805;1,500 g in either the study periods 1996 to 1999 or 2000 to 2002. Neonatal mortality rates for attempted VBAC deliveries were higher for repeat cesarean deliveries among neonates weighing 1,500 g in the same periods (attempted VBAC: 19961999, 253.2; 95% Poisson confidence interval [CI], 197.7308.6; 20002002, 336.8; CI, 254.3419.4; repeat cesarean delivery: 19961999, 59.1; CI, 48.369.9; 20002002, 60.5, CI, 48.472.5). Maternal death rates per 100,000 live births for attempted VBAC deliveries were similar for both periods (19961999, 2.0; CI, 0.111.0; 20002002, 8.5; CI, 1.030.6). Conclusions: Neonatal and maternal mortality rates did not improve despite increasing rates of repeat cesarean delivery during the years after the ACOG 1999 VBAC guideline revision. Women with infants weighing #8805;1,500 g encountered similar neonatal and maternal mortality rates with VBAC or repeat cesarean delivery. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Vaginal Delivery Can Be Safe After Multiple Cesareans By David Douglas NEW YORK (Reuters Health) Jul 11 - In women attempting vaginal birth after multiple previous cesarean deliveries, the risk of uterine rupture is no greater than in women who have had only one previous cesarean delivery, researchers report in the July issue of Obstetrics and Gynecology. The author of an accompanying editorial, Dr. Vern L. Katz, from the Center for Genetics and Maternal-Fetal Medicine in Eugene, Oregon, told Reuters Health that this is exactly the type of evaluation we need to help advise women on the relative safety and relative risks of both repeat cesarean delivery and trials of labor after cesarean. Each woman's situation is specific and advice should be individualized for those specifics. In the study, Dr. Mark B. Landon of Ohio State University College of Medicine and Public Health, Columbus, and colleagues prospectively examined data for women attempting vaginal birth after a single or multiple cesareans. Uterine rupture occurred in 9 of 975 women who had had multiple prior cesareans (0.9%) and in 115 of 16,915 women with a single previous cesarean (0.7%), a nonsignificant difference. However, the rates of hysterectomy were significantly increased in the multiple cesarean group (0.6% versus 0.2%), as were transfusion rates (3.2% versus 1.6%). Similarly, a composite of maternal morbidity, including endometritis and operative injury, was significantly increased in women who had had multiple cesareans. Despite this increased risk of complications, the absolute risk is small, the researchers conclude, and vaginal birth after multiple cesarean deliveries should remain an option. Dr. Katz added that there is a shifting paradigm of cesarean, not as an adverse outcome -- a complication -- but as one tool towards achieving the goal of a healthy mother and baby. Thus, he concluded, the studies that we need, like Mark Landon's, help provide guidelines in the best use of the tool. Obstet Gynecol 2006;108:2-3,12-20. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Maternal Complications Increase With Multiple Cesarean Delivery By Will Boggs, MD NEW YORK (Reuters Health) Jul 12 - The risk of major maternal complications increases significantly with multiple cesarean deliveries, according to researchers based in Israel. We believe that a decrease in multiple cesareans is especially important for women who desire many children, Dr. Victoria Nisenblat from Bnai-Zion Medical Center, Haifa, told Reuters Health. This is possible by doing the best we can to reduce the number of first cesareans and perhaps even more important, increasing the percentage of vaginal births after cesareans in such populations. Dr. Nisenblat and colleagues evaluated the maternal complications associated with three or more repeat cesarean deliveries compared with those associated with a second planned repeat cesarean delivery by examining medical records of women who underwent repeat cesarean deliveries at their hospital. The 277 women in the multiple-cesarean group were significantly more likely to have excessive blood loss, difficult delivery of the neonate, and dense adhesions than were the 491 women in the second-cesarean group. These differences persisted after adjustment for maternal age, parity, and gestational age, the authors report in the July issue of Obstetrics Gynecology. The proportion of women having any major complication was significantly higher in the multiple-cesarean group (8.7%) than in the second-cesarean group (4.3%), the researchers note, though minor and major postoperative complications were not significantly different between the two groups. When, after the first cesarean, the route of delivery is discussed with the patient, the doctor should take into consideration the family planning of this specific woman, Dr. Nisenblat said. In the case of additional pregnancies planned, the a vaginal birth after cesarean trial should be proposed. We are completing a longitudinal study comparing the outcome and complications in the second and third delivery post-cesarean, of women who on their first-post cesarean delivery underwent a trial of labor compared with women who underwent an elective cesarean delivery, Dr. Nisenblat added. Obstet Gynecol 2006;108:21-26. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Circumcision Could Cut HIV Infection Male Circumcision Would Prevent Millions of AIDS Deaths in Africa By Daniel DeNoon WebMD Medical News Reviewed By Louise Chang, MD on Tuesday, July 11, 2006 July 11, 2006 -- Male circumcision , if widely adopted in Africa, would prevent 3 million deaths over 20 years. It would work as well as a moderately effective AIDS vaccine. The prediction comes from an international team of researchers including Brian G. Williams, PhD, of the World Health Organization. They report their findings in the July issue of the public-access, online journal PLoS Medicine. Male circumcision could avert 2 million new HIV infections and 300,000 deaths over the next 10 years in sub-Saharan Africa, Williams and colleagues write. In the 10 years after that, it could avert a further 3.7 million new infections and 2.7 million deaths. About a fourth of the impact would be in South Africa, which is particularly hard-hit by the AIDS pandemic. These estimates are based on a 2005 clinical trial that found male circumcision reduces female-to-male spread of HIV -- the AIDS virus -- by 60%. This would be the same effect as an AIDS vaccine that was 37% effective in protecting both men and women against HIV infection. Preventing HIV infection of men would slow HIV spread to women. But Williams and colleagues note that women need protection of their own -- a safe, HIV-killing agent that could be applied directly to the vagina prior to sex. And while it's important to find ways to cut the spread of HIV, it's even more important to get effective treatments to people already infected with the virus that causes AIDS. The need to keep HIV-positive people alive through the provision of [AIDS drugs] remains the most immediate priority, Williams and colleagues write. SOURCE: Williams, B.G. PLoS Medicine, July 2006; vol: 3 pp e262. © 2006 WebMD Inc. All rights reserved Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Low iron and inability to breastfeed?
Ignorance and arrogance are a bad combination!! ...in fact concentrations of 95-115 g/L with a normal mean corpuscular volume (84-99fL) should be regarded as optimal for fetal growth and well-being and are associated with the lowest risk of preterm labour. Steer PJ 2000 American Journal of Clinical Nutrition, Vol 71, No 5, May There is evidence to suggest that most doctors are too quick to promote iron supplementation in pregnancy. Leanne Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: Kelly @ BellyBelly [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Low iron and inability to breastfeed? Date: Mon, 19 Jun 2006 13:34:03 +1000 Yeah my jaw dropped too. any advice for this mum?: I was wondering if anyone else has been told they would have trouble b/f as their iron levels are too low? I'm due any day now and have never leaked or had any signs that I will be able to produce milk... The midwife at the BC told me that as my iron levels were below 100 I would have trouble b/f... this has upset me greatly as I really want to be able to do this.. I was wondering if she could be wrong, or if anyone else has had a similar experience and what happened? Best Regards, Kelly Zantey Creator, http://www.bellybelly.com.au/ BellyBelly.com.au Gentle Solutions From Conception to Parenthood http://www.bellybelly.com.au/birth-support http://www.bellybelly.com.au/birth-support BellyBelly Birth Support - http://www.bellybelly.com.au/birth-support -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Repeat C-Sections Raise Risk of Maternal Morbidity Reuters Health Information 2006. © 2006 Reuters Ltd. NEW YORK (Reuters Health) May 31 - As the number of repeat c-sections increases, so does the risk of bowel injury, ICU admission, and other maternal complications, according to a report in the June issue of Obstetrics and Gynecology. In light of this finding, the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery, lead author Dr. Robert M. Silver, from the University of Utah School of Medicine in Salt Lake City, and colleagues note. The findings are based on analysis of data for 30,132 women who underwent c-section without labor in 19 academic centers from 1999 to 2002. There were 6,201 first (primary), 15,808 second, 6,324 third, 1,452 fourth, 258 fifth, and 89 sixth or more cesarean deliveries, the investigators report. The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, ileus, postoperative ventilatory use, ICU admission, and blood transfusion of at least 4 units were directly related to the number of cesarean deliveries. In addition, both the operative time and hospital stay rose as the number of c-sections increased. The rate of placenta accreta ranged from 0.24% in first-time c-section patients to 6.74% in women with six or more c-sections. In women with previa, the rates were much higher, ranging from 3% in first-time c-section patients to 67% in women with at least five c-sections. The hysterectomy rate was lowest in second-time c-section patients and highest in those with at least six c-sections, ranging from 0.42% to 8.99%. Women planning large families should consider the risks of repeat cesarean deliveries when contemplating elective cesarean delivery or attempted vaginal birth after cesarean delivery, the authors conclude. Obstet Gynecol 2006. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
VBAC Declines but Outcomes Do Not Improve By Judith Groch, MedPage Today Staff Writer Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine. May 30, 2006 Review FRESNO, Calif., May 30 ¡ª Neonatal and maternal mortality rates did not improve despite an increase in repeat cesarean deliveries, apparently engendered by revised guidelines from the American College of Obstetricians and Gynecologists, researchers here reported. In 1999, responding to safety and medicolegal considerations, the ACOG adopted more restrictive guidelines for vaginal birth after cesarean delivery (VBAC). As a result, attempted VBAC rates declined from 24% to 13.5% in 2002 (P .001), according to a report in the May/June Annals of Family Medicine. The revised guidelines stated that because uterine rupture may be catastrophic, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care. The VBAC decline, however, seems to have continued a trend that began in 1997 and mirrored national trends, perhaps reflecting unease among obstetrician and foreshadowing the 1999 revisions, wrote John Zweifler, M.D., and colleagues at the University of California San Francisco. Using the California Birth Statistical Master files from 1996 through 2002, the researchers identified 386,232 California residents who had previously had a cesarean delivery and had a singleton birth planned in a California hospital. The findings were: Neonatal mortality rates per 1,000 live births for attempted VBAC deliveries were no different than repeat cesarean delivery rates among neonates weighing ¡Ý 1,500 g in study period, 1996 to 1999 or 2000 to 2002. Findings for the two procedures among infants of very low birth weight differed. Neonatal mortality rates for attempted VBAC deliveries were higher than those for repeat cesarean deliveries among neonates weighing 1,500 g in the same periods (attempted VBAC: 1996-1999, 253.2, 95% CI 197.7-308.6; 2000-2002, 336.8, CI, 254.3-419.4; repeat cesarean delivery: 1996-1999, 59.1, CI, 48.3-69.9; 2000-2002, 60.5, CI, 48.4-72.5). Among all births, multiple logistic regression analysis showed the strongest predictor of neonatal death to be very low birth weight. Maternal death rates per 100,000 live births for attempted VBAC deliveries were similar for both periods (1996-1999, 2.0; CI, 0.1-11.0; 2000-2002, 8.5; CI, 1.0-30.6). Overall, recorded pregnancy complications were higher in women who attempted VBAC than in the cesarean groups in both pre- and post- revision periods, the researchers said. The rate of attempted VBAC was positively associated with educational level. Among the study's limitations, the researchers pointed out that a much larger sample would be needed to have the power to detect differences in maternal mortality. The proportion of older women and black women who attempted VBAC delivery did not decrease after the 1999 revision to the same extent that it did for younger women or those from other racial and ethnic groups, a finding consistent with national trends, the researchers said. The analysis of birth certificate information did not permit the researchers to assess important neonatal or maternal comorbidities. Other coding problems and possible misclassifications may also have occurred, they said. Finally, the researchers wrote, it may be difficult to generalize these findings to populations outside California, because California births may occur in settings more or less ethnically diverse or rural compared with other states. The successful VBAC rate for California women was 8.0% compared with the national rate of 12.6%, the researchers pointed out. During the past decade the pendulum in the U.S. has swung dramatically away from VBAC delivery toward repeat cesarean section, and the 1999 ACOG revision may have accelerated this trend, Dr. Zweifler said. Nevertheless, he added, in 2002 California births constituted 13.1% of U.S. deliveries. We recommend that a balanced presentation of risks and the encouraging outcomes found in this analysis be included in discussions with pregnant women who have had a previous cesarean section, Dr. Zweifler's team advised. An evidence-based approach to VBAC delivery, he said, may lead to further refinements in these guidelines. Primary source: Annals of Family Medicine Source reference: John Zweifler, et al Vaginal Birth After Cesarean in California: Before and After a Change in Guidelines, Annals of Family Medicine 2006;4:228-234. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: Re: [ozmidwifery] Fw: E-News 8:11 - Postdates Pregnancies (May 24, 2006)
I for one am sick and tired of all the artificial machines, gadgets and procedures that are dreamed-up as some magical method to improve on normal birth. The birthing process is designed to work perfectly most of the the time so lets keep our interferring hands off until there is a medical indication!! Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: Ken Ward [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: RE: Re: [ozmidwifery] Fw: E-News 8:11 - Postdates Pregnancies (May 24, 2006) Date: Tue, 30 May 2006 18:12:00 +1000 I was thinking the same today, Abby. The list seems to have changed. It wasn't all that long ago we would have been discussing how not to give hepb, but just last week the topic was when to give it. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of [EMAIL PROTECTED] Sent: Monday, 29 May 2006 5:59 PM To: ozmidwifery@acegraphics.com.au Subject: Re: Re: [ozmidwifery] Fw: E-News 8:11 - Postdates Pregnancies (May 24, 2006) Hi, I do find this totally horrifying, but not any more so than most the stuff OBs and midwives use on a regular basis already in hospitals. In recent times it seems that not many on the Ozmid list raise their voices in response to the ways, techniques and instruments used in the abuse of women and their rights in childbirth. Sort of speaks of the whole birthing scene in this country, midwives in hospitals too scared to speak out against things that fellow care providers are doing to birthing women. To be perfectly honest about this new contraption, it seems way less of an atroscity than cutting a womans yoni open while she lays on a back with a bunch of people standing by! Love Abby ~ who, can't believe the horrible things she reads and hears of the way women are treated in our hospitals while trying to birth their baby's!! Alesa Koziol [EMAIL PROTECTED] wrote: Hi Andrea point taken -I was mindful of the copyright requests however..I am sending this to the list again. Originally posted on Friday with no feedback. Are there no others in the oz community horrified by the idea of this devise? Do we not have enough technology invading normal birth already? A timely reminder perhaps in light of the current thread on CTG is that they too were introduced widely with little research to validate their wide spread value yet have been grasped by the legal community as an all seeing tool - a tool which now governs a lot of 'normal' or 'routine' clinical practice. My thoughts Alesa Alesa Koziol Clinical Midwifery Educator Melbourne - Original Message - From: Andrea Robertson [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, May 26, 2006 4:35 PM Subject: Re: [ozmidwifery] Fw: E-News 8:11 - Postdates Pregnancies (May 24, 2006) Hi Alesa, Perhaps next time, just cut and paste the relevant section - I find these loo...ong bulletins impossible to wade through! However, I know Debby well and I've done workshops at her hospital. They have the only birth centre in Israel and are a terrific bunch of strong women and midwifery advocates. I am glad she has raised this issue. The thought of this technology is truly awful and I am sure that women will not want to use it if they are fully informed. Reminds me of a gadget that was tested at one of the UK's biggest midwifery hospitals a few years ago: it was a huge belt that was wrapped around the woman's tummy at the start of second stage and then inflated to push the baby down if the woman couldn't push due to having an epidural. You can imagine how the midwives felt about having to be part of the trials. As far as I know, this particular gadget didn't make it to the manufacturing stage, so perhaps this one that Debby speaks of won't either. Who dreams up these ideas? Dare I say it - men, probably! Regards, Andrea MIDWIFERY TODAY E-NEWS A publication of Midwifery Today, Inc. Volume 8, Issue 11, May 24, 2006 Postdates Pregnancies ~~ A high tech company called Barnev (www.barnev.co.il/) is currently manufacturing a product called a computerized labor monitoring system. This product works by placing two clips with electrodes on a laboring woman's cervix and a scalp electrode on the fetus and using ultrasound waves to measure cervical dilation and height (descent) of the fetal head. I am aware of this product because of clinical trials were held at the hospital with which I am affiliated. In spite of the midwives' opposition to using this mechanical device on women, we were not able to totally block its use (although some changes were made in the informed consent, and many women did not agree to participate due to midwives' explaining to them what was involved). The trials were moved
RE: [ozmidwifery] Re:
Hi All, If a baby is truly vitamin K deficient such as may happen if a baby has been on IV fluids only because it was sick then the best way to give Konakion is IMI as it is absorbed more quickly. The fact is most baby's dont need it! Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: Kelly @ BellyBelly [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] Re: Date: Fri, 26 May 2006 17:30:37 +1000 Just a side question if that's okay - what are your opinions on oral vitamin K versus injection? Best Regards, Kelly Zantey Creator, BellyBelly.com.au Gentle Solutions From Conception to Parenthood BellyBelly Birth Support - http://www.bellybelly.com.au/birth-support -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Andrea Quanchi Sent: Friday, 26 May 2006 3:24 PM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Re: The place I work we give it when we do the NST. It was a midwife decision not an evidence based one. Like giving it with the vit K it is easier to do it at a predictable time so that it doesn't get overlooked. The midwives wanted not to do it at birth as they were wanting to do as little as possible to interupt Mum and baby, As we need to have a signed consent form to give it and the mothers have often not filled this is prior to birth it was very interupting to get all thisDone on the birth day and we find it not an issue later when everyone has had time to sit down read the literature and discuss it. Of course then we do have a number of mums who decline to have it which is their right and is not an issue at all. Andrea Q On 25/05/2006, at 8:10 PM, Amanda W wrote: Hi all, I have just started working at a new health facility that tends to give hep B injections on day 2 or 3. I have come from a facility that gives hep B at birth when vitamin k is given. Can anyone shed some light as to why the might do it this way. Any articles. They seem to not know why they do it. I just want to change practice so that can be done at the same time as the vitamin k. Thanks. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Hi All, The full article was 8 pages long so I've just copied the abstract - but its worth reading ... although it only confirms what we already know...! You will find it at: www.medscape.com/viewarticle/530788_print Factors Associated With the Rise in Primary Cesarean Births in the United States, 1991-2002 Eugene Declercq, PhD; Fay Menacker, DrPH; Marian MacDorman, PhD Am J Public Health. 2006;96(5):867-872. ©2006 American Public Health Association Posted 05/08/2006 Abstract Objectives: We examined factors contributing to shifts in primary cesarean rates in the United States between 1991 and 2002. Methods: US national birth certificate data were used to assess changes in primary cesarean rates stratified according to maternal age, parity, and race/ethnicity. Trends in the occurrence of medical risk factors or complications of labor or delivery listed on birth certificates and the corresponding primary cesarean rates for such conditions were examined. Results: More than half (53%) of the recent increase in overall cesarean rates resulted from rising primary cesarean rates. There was a steady decrease in the primary cesarean rate from 1991 to 1996, followed by a rapid increase from 1996 to 2002. In 2002, more than one fourth of first-time mothers delivered their infants via cesarean. Changing primary cesarean rates were not related to general shifts in mothers medical risk profiles. However, rates for virtually every condition listed on birth certificates shifted in the same pattern as with the overall rates. Conclusions: Our results showed that shifts in primary cesarean rates during the study period were not related to shifts in maternal risk profiles. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Second-Hand Smoke Traces Detected in Babies' Urine By Michael Smith, MedPage Today Staff Writer Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine. May 12, 2006 MINNEAPOLIS, May 12 Nearly half the infants in a small study exposed to second-hand smoke from their parents' cigarettes showed signs of a potent carcinogen in their urine, according to investigators here. The take home message is, 'Don't smoke around your kids,' said Stephen Hecht, Ph.D., of the University of Minnesota. Dr. Hecht said the study, published in the May issue of Cancer Epidemiology, Biomarkers Prevention, is the first to show that many infants living with at least one smoking parent have been exposed to the tobacco-specific carcinogen 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone, or NNK. NNK is known to cause cancer in rats and is believed to play a significant role as a cause of lung cancer in smokers and in nonsmokers exposed to second-hand smoke. Dr. Hecht and colleagues enrolled 144 mothers with babies ages three months to a year. Pairs were eligible if the mother was older than 18, not currently breast feeding, was herself a daily or occasional smoker, and if the infant recently had been exposed to tobacco smoke either in the home or in a car. The researchers tested mainly for metabolites of NNK (compounds dubbed total NNAL) but also for nicotine, cotinine, and their respective glucuronides. NNAL is an accepted biomarker for uptake of NNK, Dr. Hecht said. You don't find NNAL in urine except in people who are exposed to tobacco smoke, whether they are adults, children, or infants. All told, the study showed that: Total NNAL was detectable in 67 of the 144 infants (46.5%), and the mean level of total NNAL in the 144 infants was 0.083 picomoles per milliliter. 134 infants (93.1%), had detectable cotinine and 141 (97.9%), had detectable nicotine. The mean levels of total cotinine and total nicotine were 0.133 and 0.069 nanomoles per milliliter, respectively. The presence of NNAL in the urine of these infants can be explained only by their exposure to the tobacco-specific carcinogen NNK, the researchers concluded. The most likely vector was second-hand smoke, although some could also be absorbed from surfaces, such as rugs and furniture. In fact, Dr. Hecht said, the level of NNAL detected in the urine of these infants was higher than in most other field studies of environmental tobacco smoke in children and adults. As might be expected, the more direct exposure the infant had to tobacco, the more likely he or she was to have NNK metabolites in the urine, the researchers found. Among the 77 infants with no detectable total NNAL, the children were exposed to smoke from an average of 27 cigarettes a week, while among those with detectable NNAL, the average was 76. The difference was statistically significant at P0.0001. But that shouldn't be a consolation to light-smoking parents, Dr. Hecht said: With more sensitive analytical equipment, the NNAL from urine of babies in lower-frequency cigarette smoking households would most likely be detectable. The authors noted that a broad range of potentially effective interventions to decrease exposure exists. These include: Efforts to encourage women to quit before or during pregnancy and to avoid postpartum relapse. Encouraging smoking cessation among household members. Establishing no-smoking policies for the home and car. They pointed out that evidence that nicotine is present in dust and surfaces of houses in which smoking takes places indicates that the complete elimination of smoking in homes is preferable to an emphasis on not smoking in the presence of children. They added that regulatory and economic policies (e.g., increasing the excise tax on cigarettes) are important approaches to decreasing the overall prevalence of smoking and therefore decreasing environmental tobacco smoke exposure of children. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
C-Section Rates: Obesity to Blame? Patient Requests May Not Be Major Factor in Growing Number of C-Sections By Charlene Laino WebMD Medical News Reviewed By Louise Chang, MD0 on Tuesday, May 09, 2006 May 9, 2006 (Washington) -- Contrary to what many believe, patient requests are probably not the main driving force behind the increasing rates of cesarean births in the U.S., doctors say. Rather, obesity is probably to blame for much of the rise, says Frederic Frigoletto Jr., MD, professor of obstetrics and gynecology at Harvard Medical School in Boston. The doctors acknowledge that some pregnant women ask their doctors for C-sections because of the increased convenience of choosing the time of delivery and because of a desire for less painful childbirth. A National Institutes of Health task force found some increase in patients' requests. But it certainly didn't account for the sharp increase in cesarean deliveries, says Mary D'Alton, MD, chairwoman of obstetrics and gynecology at Columbia University Medical Center in New York. Frigoletto says his research suggests that the increase in cesarean deliveries coincides with the epidemic of obesity in this country. Obese women are at risk for pregnancy-related complications, including hypertension , gestational diabetes, and blood clots, all of which may lead to a recommendation for cesarean delivery, he says. The experts discussed the rising C-section rates at a news conference at the annual meeting of the American College of Obstetricians and Gynecologists (ACOG). C-Sections at All-Time High By 2004, the number of C-sections had reached an all-time high, accounting for 29% of all births -- or 1 million babies -- according to the latest data from the National Center for Health Statistics. That's in contrast to a 5% rate after World War II, a number that remained relatively stable until it skyrocketed to 15% in the 1970s. C-sections continued to gain popularity until the early 1990s, by which time 22% of babies were delivered by cesarean. Then reports that women who had undergone a first cesarean delivery might not need a cesarean the next time around led the rate to fall back to below 20%. But this was soon proven false with studies in the mid-1990s indicating that attempts for a vaginal delivery after a cesarean was dangerous for the mother, says Stanley Zinberg, MD, deputy executive vice president of ACOG. And so the number rose again. While ACOG has no formal position on maternal-requested C-sections, D'Alton says that elective procedures should not be performed before 39 weeks of gestation unless there is a medical reason to do so. D'Alton also stresses that women should not have more than three or four cesarean births. Repeated C-sections increase the risk of dangerous placental abnormalities in later pregnancies, she explains. More first-time cesareans are now increasing the rate of repeat surgeries later, each of which carries progressively higher risks to both mother and newborn. Doctors are seeing more severe life-threatening complications in which the placenta fails to detach from the uterus because it sticks to scars from previous cesareans in women who have had previous cesarean deliveries, she says. According to Zinberg, younger women are at less risk of C-section-associated complications. SOURCES: American College of Obstetricians and Gynecologists annual meeting, Washington D.C., May 6-10, 2006. Frederic Frigoletto Jr., MD, professor of obstetrics and gynecology, Harvard Medical School, Boston. Mary D'Alton, MD, chairman of obstetrics and gynecology, Columbia University Medical Center, New York. Stanley Zinberg, MD, deputy executive vice president, ACOG. News release, ACOG. © 2006 WebMD Inc. All rights reserved Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Hi All, It is worth noting that you are much more likely to die in a car accident than to die of pregnancy related problems!! ... I get so tired of fear-based emotional manipulation so this may be a statistic worth remembering...? Leanne. Putting reproductive risks in perspective Issue 10: 8 May 2006 Source: Contraception 2006; 73: 437-9 A new editorial has highlighted the importance of putting reproductive health risks into the correct perspective in discussions with women about contraception. The US authors, from Princeton Universitys Office of Population Research and from the Washington-based Association of Reproductive Health Professionals, say this is necessary in order to counter the often dramatic and sensationalized headlines about womens health in the media. In their editorial for the latest issue of the journal Contraception, the authors write: As sensationalized news reporting becomes more common, and thoughtful analysis becomes more difficult to find, given its perceived lack of appeal to media observers, healthcare practitioners must intensify efforts fully and repeatedly to inform patients of their true risks of death from various contraceptive methods. They say that alarmist, misleading, inaccurate or incomplete media coverage of health risks is a source of confusion to women. In the editorial, the authors provide a brief summary of the mortality risks associated with pregnancy, combined oral contraceptives, the contraceptive patch, and abortion. This summary includes a detailed table of published mortality risks associated with everyday activities. For example, the authors cite data suggesting that the overall risk of death from pregnancy and delivery is about 1 in 8,700. They point out that this risk is lower than the annual risk of death from a vehicle accident (1 in 5,000), but is much higher than the annual risk of death from use of combined oral contraceptives for most women (mortality risks ranging from 1 in 33,300 to 1 in 1,667,000 depending on age and smoking status) except those aged 35-44 years who also smoke (a mortality risk of 1 in 5,200). The authors conclude that women are far more likely to die from pregnancy-related complications, from vehicle accidents, or from a fall (annual mortality risk 1 in 20,000), than they are from using hormonal contraception, for example. They add: Those who claim that hormonal contraception and abortion are unsafe base this assertion on ideology, not evidence-based science. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Calif. law would ban Cruise ultrasound copycats Bill restricting home setups like stars moves on to state Senate SACRAMENTO, Calif. - The California Assembly has voted to restrict the use of ultrasound machines for personal use, approving a bill that would allow them to be sold only to licensed professionals. Democratic Assemblyman Ted Lieu introduced the bill after Mission: Impossible III star Tom Cruise bought an ultrasound machine to see images of his unborn child. The actors fiancee, Katie Holmes, gave birth to the couples daughter, Suri, last month in Los Angeles. Doctors and technologists typically receive years of training to perform ultrasound exams, which help obstetricians check a babys health. Cruise was criticized by doctors who said improperly using the devices can harm a fetus. Lieu said his bill was intended to prohibit copycats from using the devices at home. An ultrasound machine listed on the online auction site eBay was selling for $5,500 Wednesday. What we dont want is someone who unintentionally damages the fetus, Lieu said Thursday on the Assembly floor. If someone sees Tom Cruise buy one, they think this is the thing to do, added Lieu. Theres really no medical reason for an untrained person to use this machine. The actors publicist, Paul Bloch, did not return phone messages seeking comment. Cruise has been promoting his new film, which opens in theaters Friday. Ban on unlicensed use The chamber voted 55-7 to pass the bill and send it to the Senate. The bill prohibits a manufacturer or person from selling, leasing or distributing an ultrasound machine to any person other than a licensed practitioner. Some Republican lawmakers questioned whether the bill would prohibit the use of ultrasound devices by private companies that provide keepsake photos for parents-to-be. Lieu said it would not, as long as the person operating the machine was licensed under a certain section of the states Business and Professions Code. Laboratory tests have shown that certain diagnostic levels can affect human tissue, according to the Food and Drug Administration. The agency has determined that keepsake fetal videos and personal snapshots are an unapproved use of a medical device. The machine is also used by doctors on a high-frequency setting to get a better image of an adults kidneys, pelvis, uterus and other internal organs. There are many settings you would only use on adults and not on a fetus, said Dr. Miyuki Murphy, director of ultrasound at Radiological Associates of Sacramento. Obviously, somebody enamored with their own child would want to use it all the time, said Murphy, identified by the California Medical Association as an expert on the topic. You might push that button because the pictures are prettier. Critics of the bill said lawmakers should leave such decisions to health professionals. We dont have the expertise to dispense medical advice, said Assembly woman Audra Strickland, the mother of a 6-month-old daughter. © 2006 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 Breast-Feeding Duration Linked to Alcoholism in Adulthood Reuters Health Information 2006. © 2006 Reuters Ltd. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world. NEW YORK (Reuters Health) Apr 21 - Early weaning, along with a number of factors, appears to predispose adults to alcohol abuse and hospitalization for an alcohol-related diagnosis, according to data from the Copenhagen Perinatal Cohort. Previous research demonstrated a link between short duration of breast-feeding and alcoholism in men, Dr. Holger J. Sorenson and colleagues at Copenhagen University and the US examined this relationship in a larger cohort that included women and took into account other environmental and familial factors. The Copenhagen Perinatal Cohort includes 3245 men and 3317 women born between 1959 and 1961. Thirty-four percent of offspring had been breast-fed for no more than 1 month, according to the report in the American Journal of Psychiatry for April. After follow-up through 1999, the researchers found that 98 men (4%) and 40 women (1.2%) were hospitalized with an alcohol-related diagnosis. Of the 138 cases, 2.8% were weaned by 1 month and 1.7% were breast-fed for longer periods (odds ratio 1.65). The investigators report that significant predictors in the multivariate model were male gender, maternal prenatal smoking, unwanted pregnancy (at the time of conception), maternal psychiatric hospitalization for alcohol abuse, maternal psychiatric hospitalization with other diagnoses, and low parental social status when the child was 1 year old. After controlling for all covariates, there was still an increased likelihood of alcohol abuse associated with early weaning (odds ratio 1.47). Dr. Sorenson's group proposes several factors that could explain the relationship between early weaning and alcohol abuse, such as decreased physical and psychological contact between the mother and the infant. The researchers add that low intelligence and attention deficit hyperactivity disorder are associated with short duration of breast-feeding, and may increase the risk of alcoholism. They also note that breast milk contains long-chain polyunsaturated fatty acids and that a decrease could affect brain development. Am J Psychiatry 2006;163:704-709. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
then, pain is a conscious, learned response, Dr. Derbyshire said. The limited neural system of fetuses cannot support such cognitive, affective, and evaluative experiences; and the limited opportunity for this content to have been introduced also means that it is not possible for a fetus to experience pain, he wrote. He acknowledged that his thesis is provocative and has both clinical and public policy implications. For example, with the growing frequency of in utero surgeries and other intervention to correct fetal developmental defects, clinicians might be inclined to give anesthesia to the fetus in the belief that it can mitigate pain. However, the greater immaturity of fetuses and their different hormonal and physical environment indicate that clinical trials should be carried out with fetal patients to show improved outcomes, Dr. Derbyshire wrote. Currently no defined evidence-based fetal anesthesia or analgesia protocol exists for these procedures. And from a political viewpoint, he noted that the case against fetal pain, as documented here, indicates that a mandate to provide pain relief before abortion is not supported by what is known about the neurodevelopment of systems that support pain. Proposals to directly inject fetuses with fentanyl or to provide pain relief through increased administration of fentanyl or diazepam to pregnant women, which increase risks to the women and costs to the health provider, undermine the interests of the women and are unnecessary for fetuses, who have not yet reached a developmental stage that would support the conscious experience of pain, Dr. Derbyshire wrote. Primary source: BMJ Source reference: Derbyshire SWG. Can fetuses feel pain? BMJ 2006;332:909-12 Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
New Guidelines Call for Restricted Use of Episiotomies Reuters Health Information 2006. © 2006 Reuters Ltd. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world. NEW YORK (Reuters Health) Mar 31 - Episiotomies should not be performed on a routine basis, but there are situations where the procedure is indicated, according to new practice guidelines by The American College of Obstetricians and Gynecologists (ACOG). Episiotomy has become one of the most commonly performed obstetrical procedures: roughly a third of women with a vaginal birth in 2000 had an episiotomy. The purported benefits include a reduced risk of perineal trauma and incontinence for the mother and a shortened second stage of labor for the fetus. However, data actually supporting these outcomes is lacking. In reviewing the literature on episiotomies, Dr. John T. Repke and colleagues, from ACOG, found that the procedure generally did not make labor, delivery, and recovery easier for the mother. Moreover, episiotomy is associated with important and, probably underestimated, risks, such as extension into a third- or fourth-degree tear, anal sphincter dysfunction, and dyspareunia. Still, the guidelines, which appear in the April issue of Obstetrics Gynecology, note there are situations where episiotomy may be appropriate, such as to prevent a severe maternal laceration or to expedite a difficult delivery. Based on good and consistent scientific evidence (level A), the guidelines: --Recommend restricted, rather than routine, use of episiotomy. --Note a lower risk of anal sphincter injury with mediolateral episiotomy versus median episiotomy. Based on limited or inconsistent scientific evidence (level B), the guidelines: --Suggest that mediolateral episiotomy may be preferably to the median approach in selected cases. --Emphasize that routine episiotomy does not prevent incontinence related to pelvic floor damage. In the case of episiotomy, as with all medical and surgical therapies, we need to continually evaluate what we do and make appropriate changes based on the best and most current evidence available, Dr. Repke said in a statement. We should avoid the pitfall of letting anything in medicine become 'routine' and therefore, outside the realm of review and critical analysis. Obstet Gynecol 2006;107:957-960. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Epidural Anesthesia With Low-Dose Oxytocin May Increase Cesareans Reuters Health Information 2006. © 2006 Reuters Ltd. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world. NEW YORK (Reuters Health) Apr 04 - Epidural anesthesia during labor, plus low-dose oxytocin treatment, which is usually used in most large North American obstetric units, may increase the likelihood of cesarean section, according to Canadian researchers. Most of the research has focused on the use of high-dose oxytocin, not on the low-dose protocol. The bottom line, lead investigator Dr. Andrew J. Kotaska told Reuters Health, is that epidural analgesia gives great pain relief but...it has undesired effects as well. Researchers, he added, noticed over a decade ago that aggressive detection of dystocia and treatment with high-dose oxytocin are required to offset the slowing effect of epidurals on labor, but the message has not gotten out to practicing clinicians or the public. Dr. Kotaska and colleagues at the University of British Columbia, Vancouver examined data from eight randomized trials involving more than 3500 women. These trials compared opioid and epidural anesthesia. Seven of the trials used a high-dose oxytocin protocol and none showed an increase in cesarean section in those given epidural anesthesia, the researchers report in the March issue of the American Journal of Obstetrics and Gynecology. However, the remaining trial included only 93 women and employed low-dose oxytocin, demonstrated a significant increase in cesarean section in the epidural group. The rate in the opioid group was 2% versus 25% in the epidural group. Because of the large difference in cesarean section rate, the trial was stopped. These data are limited, but most large North American obstetric units use low-dose oxytocin continued Dr. Kotaska, and women and their physicians across North America are choosing epidural analgesia in low-dose oxytocin settings thinking that they will not increase the likelihood of C-section. Our study, he concluded, highlights that the evidence they are basing this assumption on is not valid in most contemporary North American practice settings. Women should certainly have access to epidural analgesia, but also access to accurate information about its undesired effects. Am J Obstet Gynecol 2006;194:809-814. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] My Sunrise Email
Hi Mike and others, You are right about this sort of rigid, controlled child-rearing practices rearing it's head every so often, but it's not Christian in it's foundation anymore than David Koresh and Waco Texas was Christian in it's foundation. This sort of individual (eg Gary Ezzo) is psuedo-christian and merely twists Scripture to manipulate susceptible, vulnerable, sleep-deprived parents into following their instructions. Christianity teaches love and caring in all relationships not the rejection and failure to meet a baby's need for touch and affection that controlled-crying conveys to children!! I'll get off my soap-box now... Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: Mike Lindsay Kennedy [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] My Sunrise Email Date: Wed, 5 Apr 2006 23:35:09 +1000 This isn't new. If rears its head regularly (often in christian circles). The resul;ts of this type of teaching boarder on abuse. rgds mike On 4/4/06, Kelly @ BellyBelly [EMAIL PROTECTED] wrote: I'm pretty sure this one doesn't have children either. But at least she's more professional and composed than some other sleep experts I know. She's open to criticism and wont offer to sue as a first step LOL Best Regards, Kelly Zantey Creator, BellyBelly.com.au Gentle Solutions From Conception to Parenthood BellyBelly Birth Support - http://www.bellybelly.com.au/birth-support -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Jo Watson Sent: Tuesday, 4 April 2006 1:03 PM To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] My Sunrise Email Yet again we have another 'expert' telling us firstly that our babies *should* be sleeping through the night, and secondly that there is only one way to make them do this. Children's sleep cycles are so different to adults, that 'sleeping through the night' for them means a 5 hour stretch, not the 11 or so hours mentioned this morning. We are told we 'need' to force strict routines on our babies eating, playing and sleeping. Does this work for anyone? I get hungry at all different times of the day, and denying my body what it needs at the time is not healthy. Our babies tell us what they need, so we practice a child-led 'routine'. It is not a schedule dictated by times, but waiting for him to tell me when he's hungry/tired/ready to play, etc. I don't expect him to sleep all night - I certainly don't! What about getting a different breed of expert on to talk to parents about the realities of baby sleep. Most babies' sleep problems are, I'm sure, due to parents high expectations... then comes the guilt for 'giving in' and allowing your baby to sleep next to you *gasp* so that you can actually get some sleep yourself. There is nothing wrong with helping your baby to sleep in gentle ways, not forcing them to learn that no one will come to them if they cry in the night. For your next baby sleep expert, I nominate Pinky McKay. :) Thanks, Jo Watson (Mother and Midwife) -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- My photos online @ http://community.webshots.com/user/mike1962nz My Group online @ http://groups.yahoo.com/group/PSP_for_Photographers New Photo site@ Mike - http://mikelinz.dotphoto.com Lindsay - Http://likeminz.dotphoto.com Life is a sexually transmitted condition with 100% mortality and birth is as safe as it gets. Unknown -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
of perineal protection used. Table 1. Maternal Age, Duration of the Expulsive Period, Weight of the Newborn in Hands Off and Hands On Groups Labor Outcomes Hands Off (n = 35) Hands On (n = 35) P* Maternal age (y) Mean (SD) (2.7) 20.1 (3.3) .05 Median 18 19 Duration of expulsive period (min) Mean (SD) 17.4 (12.0) 21.3 (15.5) .25 Median 15 17 Birth weight (g) Mean (SD) 2996.7 (334.6) 3017.7 (416.0) .82 Median 2970 3020 *Student t test. Table 2. Perineal Outcomes in Relation to Hands Off Versus Hands On Management of Perineum Prior to Birth Perineal Outcome Total (n = 70) n (%) Hands off (n = 35) n (%) Hands on (n = 35) n (%) P Perineal laceration 57 (81.4) 29 (82.8) 28 (80) .76* Degree of laceration First degree 47 (82.5) 24 (82.7) 23 (82.2) 1.0 Second degree 10 (17.5) 5 (17.3) 5 (17.8) Location of laceration Anterior region of the perineum 21 (36.9) 10 (34.5) 11 (39.3) .76* Posterior region of the perineum 19 (33.3) 11 (37.9) 8 (28.6) Anterior and posterior region of the perineum 17 (29.8) 8 (27.6) 9 (32.1) *#967;2 test. Fisher exact test. References Klein MC, Janssen PA, MacWilliam L, Kaczorowski J, Johnson B. Determinants of vaginal-perineal integrity and pelvic floor functioning in childbirth. Am J Obstet Gynecol 1997;176:40310. Organização Mundial da Saúde-OMS. Assistência ao parto normal: Um guia prático. Brasília (DF): OPAS/USAID 1996 [OMS/SRF/MSM/96.24]. Eason E, Labrecque M, Wells G, Feldman P. Preventing perineal trauma during childbirth: A systematic review. Obstet Gynecol 2000;95:464 71. Mayerhofer K, Bodner-Adler B, Bodner K, Rabl M, Kaider A, Wagenbichler P, et al. Traditional care of the perineum during birth. J Reprod Med 2002;47:477 82. McCandlish R, Bowler U, van Asten H, Berridge G, Winter C, Sames L, et al. A randomised controlled trial of care the perineal during second stage of normal labor. Br J Obstet Gynaecol 1998;105:126272. Murphy PA, Feinland JB. Perineal outcomes in a home birth setting. Birth 1998;25:226 34. Silva SF, Caroci AS, Riesco MLG, Basile ALO. Ocorrência de episiotomia e rotura perineal no Centro de Parto Normal do Hospital Geral de Itapecerica da Serra-SP. In Anais da Conferência Internacional sobre Humanização do Parto e Nascimento, 2000 Nov. 24, Fortaleza. Fortaleza: Japan International Cooperation Agency, 2000:32. Cunningham FG, MacDonald PC, Gant NF, Leveno KJ, Gilstrap LC, Hankins GDV, et al. Williams obstetrician, 20nd edition. Rio de Janeiro: Guanabara Koogan, 2000:28198. Ministério da Saúde-MS (BR). Secretaria de Políticas de Saúde. Área Técnica de Saúde da Mulher. Parto, aborto e puerpério: Assistência humanizada a mulher. Brasília (DF): Ministério da Saúde-MS (BR), 2001. Schneck CA. Intervenções obstétricas no Centro de Parto Normal do Hospital Geral de Itapecerica da Serra-SECONCI-OSS: Estudo descritivo [dissertation]. Sao Paulo (SP): Escola de Enfermagem, University of Sao Paulo, 2004. Bomfim-Hyppólito S. Influence of the position of the mother at delivery over some maternal and neonatal outcomes. Int J Gynecol Obstet 1998;63(Suppl 1):S6773. Davim RMB, Caldas RM, Tavares FMC, Viana SMAA, Aquino GML. Parto normal sem episiotomia: Ocorrência de lacerações perineais. In Anais da Conferência Internacional sobre Humanização do Parto e Nascimento, 2000 Nov. 24, Fortaleza. Fortaleza: Japan International Cooperation Agency, 2000:89. Costa ASC, Silva SF, Basile ALO, Riesco MLG. Trauma perineal em primíparas: Resultados do Hospital Geral de Itapecerica da Serra-SECONCI-OSS. Itapecerica da Serra, 2002. In Anais do: 3º Congresso Brasileiro de Enfermagem Obstétrica e Neonatal, 2002 July 1619. Salvador: Abenfo-BA, 2002. Albers LL, Sedler KD, Bedrick EJ, Teaf D, Peralta P. Midwifery care measures in the second stage of labor and reduction of genital tract trauma at birth: A randomized trial. J Midwifery Womens Health 2005;50:36572. Lydon-Rochelle MT, Albers L, Teaf D. Perineal outcomes and nurse-midwifery management. J Nurse Midwifery 1995;40: 138. Albers LL, Anderson D, Cragin L, Daniels SM, Hunter C, Sedler KD, et al. Factors related to perineal trauma in childbirth. J Nurse-Midwifery 1996;41:269 76. Basile ALO. Estudo randomizado controlado entre as posições de parto: Litotômica e lateral esquerda [dissertation]. Sao Paulo (SP): Escola Paulista de Medicina, Federal University of Sao Paulo, 2001. Shorten A, Donsante J, Shorten B. Birth position, accoucheur, and perineal outcomes: Informing women about choices for vaginal birth. Birth 2002;29:18 27. Eason E, Feldman P. Much ado about a little cut: Is episiotomy worthwhile? Obstet Gynecol 2000;95:6168. McCandlish R. Perineal trauma: Prevention and treatment. J Midwifery Womens Health 2001;46:396401. Acknowledgements The authors thank Dr. Jan Nick from Loma Linda University School of Nursing, the General Hospital of Itapecerica da Serra, and all the participants of the study. Leanne Wynne Midwife in charge of Women's
[ozmidwifery] article FYI
Increasing Angle of Episiotomy Reduces Third-Degree Tear Risk Reuters Health Information 2006. © 2006 Reuters Ltd. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world. NEW YORK (Reuters Health) Mar 16 - The larger the angle of episiotomy, the lower the risk of anal sphincter injury, a new study shows. Injury to the anal sphincter due to a third-degree perineal tear during vaginal delivery is the leading cause of fecal incontinence in healthy women, Dr. Colm O'Herlihy of University College Dublin and colleagues note. While the risk of third-degree tear is lower with mediolateral episiotomy compared with midline episiotomy, they add, it remains unclear what effect the angle of incision has on injury risk. To investigate, the researchers looked at 100 primiparous women, all of whom had right mediolateral episiotomy. Fifty-four of the women sustained third-degree tears, while the rest did not and served as the control group. All were evaluated three months after delivery. The mean episiotomy angle in the cases was 30 degrees, compared with 38 degrees for controls. Nearly 10% of women with an angle of episiotomy below 25 degrees had third-degree tears, compared with 0.05% of women with an episiotomy angle above 45 degrees. With every 6.3-degree increase in angle size, the relative risk of third-degree tear was reduced by 50%. Women with third-degree tears were not significantly more likely to report problems with fecal incontinence, the researchers note. Nonetheless, a range of continence scores was seen in both groups, indicating that continence compromise can occur postnatally, regardless of mode of delivery or presence or absence of anal sphincter injury, they add. Therefore, it remains important to question and advise women on this problem in the postnatal period. They conclude: If right mediolateral episiotomy is indicated, the angle of this should be as large as possible in order to reduce the incidence, and thus the potential sequelae, of obstetric anal sphincter injury. BJOG 2006;113:190-194. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Studies Short on Soy Formula Risks Experts See Little Health Danger With Formula By Todd Zwillich WebMD Medical News Reviewed By Louise Chang, MD on Friday, March 17, 2006 March 17, 2006 -- There is not enough scientific data to determine whether or not soy formula consumed by millions of infants poses a health risk, a government panel concluded Friday. Experts say they have little concern that an estrogen-like substance in soy -- known as genistein -- poses a developmental risk to infants who consume it or whose parents consumed it in soy-based foods. Still, very few studies have looked at the long-term health effects of soy formula, which is used to feed an estimated 25% of all U.S. infants, the panel says. Soy has raised concerns not only because of its exploding consumption by U.S. infants and adults but also because studies have shown that genistein can interfere with hormonal function in rats and their offspring. A variety of toxic effects, including stunted growth, sexual organ abnormalities, and decreased fertilization, have all been observed in laboratory animals. All of the effects appear to be caused by genistein's ability to mimic the effects of natural estrogen. Some researchers also suspect soy of playing a role in reduced breast cancer rates in Japan, where soy consumption is very high. The committee says it had negligible concern that usual intakes of genistein cause adverse health effects in newborns and infants who consume soy formula, though one expert -- Ruth Etze, MD -- dissented from the conclusion. Etzel, a pediatrician at the Alaska Native Medical Center in Anchorage, could not be reached for comment. Human infants consume much lower genistein doses than laboratory animals, and most of the chemical is not absorbed into the human bloodstream, says Karl Rozman, PhD, a University of Kansas toxicologist who led NIH panel. But at the same time, few studies have looked at soy's effects in a controlled way, he explains. More Study Needed That means there are studies there, but they are not allowing us to come to a firm conclusion one way or another. But it also means that we do not see a problem, says Rozman. One study pegged infant formula feeding as a risk factor for premature breast development in girls. Experts called for better research to determine if that and other potential health effects are real. Another case-control study to examine premature breast development in females following exposure to soy infant formula is needed, the committee concludes. Panelist Jatinder Mhatia, MD, says soy formula has not shown a blip on the radar screen in terms of ill health consequences, despite use by an estimated 40 million total infants. But Mhatia also says parents are up to 10 times more likely to give their infants soy formula in the U.S. than in Britain. Some countries, including Israel, have restricted formula use to prescription-only status for infants who cannot consume milk. But American doctors are quick to recommend formula for fussy infants, which parents are heavily encouraged by advertising to use, he says. Only in our country are we using [soy] in a free-for-all, Mhatia, a pediatrician at the Medical College of Georgia, tells WebMD. Soy has a specific indication, and we tend to use and abuse in America. Why should you use soy unless there's an indication? he says. SOURCES: NTP-CERHR Expert Panel Report on the Reproductive and Developmental Toxicity of Genistein, Center for the Evaluation of Risks to Human Reproduction, National Institutes of Health, March 17, 2006. Karl Rozman, MD, University of Kansas. Jitander Mhatia, MD, department of pediatrics, Medical College of Georgia, Augusta. © 2006 WebMD Inc. All rights reserved Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Pregnancy and dysmenorrhea Issue 06: 13 Mar 2006 Source: International Journal of Gynecology Obstetrics 2006; 92: 221-7 Researchers have shed new light on the impact of pregnancy on the severity of primary dysmenorrhea. Specialists from centers in Taipei and Kin-Man, in Taiwan, conducted an 8-year prospective, observational study to evaluate the effect of gestation time and mode of delivery on the severity of dysmenorrhea. The subjects were primigravida women who presented to an obstetric clinic for their first prenatal check-up reporting a history of cramping pelvic pain during menstruation that had required pain-relief drugs or had resulted in absenteeism from school or work. Women completed a questionnaire, including a visual analogue scale to determine the severity of menstrual pain, at baseline and 6 months postpartum (and again 12 months postpartum if menstruation had not resumed by 6 months postpartum). Evaluations were repeated if a woman went on to have a second or third delivery in the study period. Four subgroups studied Writing in the latest issue of the International Journal of Gynecology Obstetrics, the researchers present their findings based on data from 3,694 women. They compared outcomes in four study subgroups based on length of gestation and method of delivery: Spontaneous delivery (full-term). Cesarean delivery (full-term). Preterm spontaneous delivery. Preterm cesarean delivery. In the first three of these groups, but not in the preterm cesarean group, visual analogue scale results indicated statistically significant improvements in dysmenorrhea after first delivery. The greatest improvement after first delivery was seen in the spontaneous delivery group, with an average reduction of 51 points in the 100-point visual analogue scale, from just under 70 at baseline to just under 20 at 6 months postpartum. (On the scale, a score of 1 to 50 is considered to be mild pain, 51 to 80 is moderate pain, and 81 to 100 is severe pain.) For second deliveries, only women in the spontaneous delivery subgroup showed significant improvement in dysmenorrhea. In none of the four groups did dysmenorrhea improve after a third delivery. Comparing mode of delivery for first deliveries, women having a spontaneous delivery (full-term or pre-term) showed significantly more improvement in dysmenorrhea than women having a cesarean delivery (full-term or pre-term). Comparing length of gestation for first deliveries, women delivering at term (spontaneous or cesarean) showed significantly more improvement in dysmenorrhea than women delivering pre-term (spontaneous or cesarean). The researchers say the results of the study provide objective evidence to validate the old concept that severity of dysmenorrhea can be relieved by childbirth. After a detailed discussion of other findings, and of possible explanations, they conclude with a practical message: This study conveys an important message that if a dysmenorrheic woman does not get relief after childbirth, she should see a gynecologist to check the possibility of pelvic pathology. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI - to support what we already
Birthing study backs kneeling position Women have less pain than when they sit for delivery MSNBC.COM SPECIAL REPORT Updated: 6:33 p.m. ET March 7, 2006 First-time pregnant women who give birth in a kneeling position experience less pain than those who deliver in a seated position, researchers in Sweden report. However, the duration of the active phase of labor (the time spent pushing) is similar with the two approaches, according to the study, published in BJOG: An International Journal of Obstetrics and Gynecology. Several studies have already reported the advantages of an upright delivery position compared to one lying down, such as less pain and more efficient contractions. However, this is the first time researchers compared the two most common upright delivery positions kneeling and sitting. Lead by I. Ragnar, from the University of Malardalen in Vasteras, the team followed 271 healthy first-time mothers, whom they randomly divided into two groups: one that prepared for labor in a kneeling position, the other for a seated position. After delivery the women filled out a questionnaire describing their experiences. The results revealed no major differences between the two groups in the duration of labor. The pushing phase lasted 48.5 minutes for women who kneeled and 41.0 minutes for women who sat. On the other hand, the two groups reported significantly different labor experiences. Women in a seated position reported a higher level of pain, less comfort giving birth and more frequent feelings of vulnerability and exposure than women in the kneeling position, the authors write. The researchers also found no difference in the frequency of sphincter ruptures between the two groups. However, women in the kneeling position reported significantly less pain after delivery than those in the sitting position. This might be explained by the kneeling position being more flexible when it comes to moving the lower back, diverting some of the pressure toward the lower spine, the authors suggest. In addition, the researchers detected no adverse effects on the fetus for either delivery position. Copyright 2006 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content is expressly prohibited without the prior written consent of Reuters. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Source: http://www.medicinenet.com Health Tip: Avoid Needless Ultrasounds of Fetus (HealthDay News) -- The U.S. Food and Drug Administration has warned against taking a picture of a developing fetus merely as a keepsake. These images can show facial features, hair and even the developing baby's sex. But the FDA says while ultrasounds are generally safe, they can affect developing tissues and may cause a rise in fetal temperature. Also, prenatal images being marketed for non-medical reasons are often done by less-experienced personnel and may expose a fetus to a longer period of imaging than one performed by a medical technician. The FDA recommends that women limit ultrasounds to those done for medical reasons only. -- Deborah DiSesa Hirsch Copyright © 2006 ScoutNews LLC. All rights reserved. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Blue patches on neonate
Sounds like Mongolian spots to me. You tend to see them more often on babies with dark or olive skin and they eventually fade but it can take a few years. They look like bruises and are usually situated over the lower back or buttocks. Leanne. htmldivPFONT face=Verdana, Geneva, Arial, Sans-serif size=2Leanne Wynne BRMidwife in charge of Women's Business BRMildura Aboriginal Health Servicenbsp; Mob 0418 371862/FONT/P PFONT face=Verdana size=2/FONTnbsp;/P P align=leftnbsp;/P/div/html From: Julie Garratt [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Blue patches on neonate Date: Tue, 24 Jan 2006 00:38:18 +1030 Hi all, I was wondering if anyone can tell me why a newborn baby, only minutes old can sometimes have blue patches on its torso. I've seen it only once before and it was fairly transient, lasting an hour or so. The baby I caught today was alert and active after a totally drug free birth but had funny blue patches in a quiet symmetrical pattern on its body ( over kidneys ect,) . It was also rather acrocyanosed. Has anyone else seen this? I imagine it has something to do with transition from neonatal circulation but would really appreciate it if someone can explain the physiology of what is happening or even what its called so I can look it up. Looking forward to your wisdom, Julie:) -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI - more reasons to avoid c/s
be drawn from these results. Finally, another recent prospective randomized trial evaluated the use of general vs epidural anesthesia in the setting of placenta previa. Neonatal Apgar scores did not differ between the groups; however, the general anesthesia group had lower maternal postoperative hematocrits and more blood transfusions, suggesting a maternal benefit with the use of regional anesthesia in the setting of placenta previa.[7] Varying data exist regarding the effect of anesthetic options on neonatal Apgar scores and umbilical artery parameters, and the significance of small differences in these numbers is unclear. Each situation must be evaluated individually; however, in most cases maternal risk is greater with general anesthesia. There is some suggestion that neonatal Apgar scores are lower and resuscitation rates are higher in the setting of general anesthesia use, although the long-term clinical significance of this observation is unclear. Posted 01/10/2006 References Ong BY, Cohen MM, Palahniuk RJ. Anesthesia for cesarean section -- effects on neonates. Anesth Analg. 1989;68:270-275. Abstract Dyer RA, Els I, Farbas J, Torr GJ, Schoeman LK, James MF. Prospective, randomized trial comparing general with spinal anesthesia for cesarean delivery in preeclamptic patients with a nonreassuring fetal heart trace. Anesthesiology. 2003;99:561-569. Abstract Kavak ZN, Basgul A, Ceyhan N. Short-term outcome of newborn infants: spinal versus general anesthesia for elective cesarean section. A prospective randomized study. Eur J Obstet Gynecol. 2001;100:50-54. Sener EB, Guldogus F, Karakaya D, Baris S, Kocamanoglu S, Tur A. Comparison of neonatal effects of epidural and general anesthesia for cesarean section. Gynecol Obstet Invest. 2003;55:41-45. Abstract Gordon A, Mckechnie EJ, Jeffrey H. Pediatric presence at cesarean section: Justified or not? Am J Obstet Gynecol. 2005;193:599-605. Abstract Rolbin SH, Cohen MM, Levinton CM, Kelly EN, Farine D. The premature infant: anesthesia for cesarean delivery. Anesth Analg. 1994;78:912-917. Abstract Hong JY, Jee HJ, Yoon S, Kim M. Comparison of general and epidural anesthesia in elective cesarean section for placenta previa totalis: maternal hemodynamics, blood loss and neonatal outcome. Int J Obstet Anesth. 2003;12:12-16. Abstract Peter S. Bernstein, MD, MPH, has disclosed no relevant financial relationships. Dena Goffman, MD, has disclosed no relevant financial relationships. Medscape Ob/Gyn Women's Health. 2006;11(1) ©2006 Medscape Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
, Chan B, Helfand M. Safety of vaginal birth after cesarean: a systematic review. Obstet Gynecol. 2004;103:420-429. Landon MB, Hauth JC, Leveno KJ, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004;351:2581-2589. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Hi All, Here is more evidence that cerebral palsy is not caused by a difficult birth but by a viral infection earlier in the pregnancy. Fetal Exposure to Neurotropic Viruses Linked to Cerebral Palsy Reuters Health Information 2006. © 2006 Reuters Ltd. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world. NEW YORK (Reuters Health) Jan 05 - The presence of nucleic acids from neurotropic viruses in the blood of newborns is associated with cerebral palsy and preterm birth, Australian investigators report. Intrauterine exposure to viruses is postulated to be an important factor in the development of cerebral palsy, mediated either by direct infection or fetal inflammatory response, Dr. Catherine S. Gibson, at the University of Adelaide, and her associates in the South Australian Cerebral Palsy Research Group note. Subjects of their study, reported this week in BMJ Online First, included all children with cerebral palsy born between 1986 and 1999 in South Australia to white mothers and 883 randomly selected control infants. Blood samples taken at birth from the infants were tested for herpes simplex virus (HSV)-1, HSV-2, varicella zoster virus, Epstein-Barr virus, cytomegalovirus, human herpes viruses (HHV)-6, HHV-7, and HHV-8, and members of the Enterovirus family. In the control group, CMV was the most prevalent virus (26.7%). Some of those infected with CMV were also positive for herpes group B (3.1%) and herpes group A viruses (1.1%). Dr. Gibson's group observed that CMV was significantly more prevalent in the 247 control infants born before 37 weeks' gestation than in the term infants (odds ratio 1.57, p 0.01). The same trend was observed for the presence of any herpes virus (odds ratio 1.43). They also found a significant association between any viral exposure and cerebral palsy at all gestational ages compared with control subjects (odds ratio 1.30). The relationship was most marked for detection of herpes group B (odds ratio 1.68). Based on these findings, the authors suggest that exposure late in gestation may not result in preterm birth, instead having direct effects on the brain, whereas exposure early in gestation may result in preterm birth but increase the risk of neuropathology associated with prematurity. The high prevalence of exposure to viral infection in the control infants suggests that cofactors may be required before brain damage occurs, they add, such as genetic susceptibility to infection or disruption of the placental or blood-brain barrier. BMJ Online First 2006. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Vitamin D Levels During Pregnancy Affect Childhood Bone Mass Reuters Health Information 2006. © 2006 Reuters Ltd. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world. NEW YORK (Reuters Health) Jan 05 - Offspring of mothers with low serum vitamin D levels have reduced bone mineral content during childhood, potentially increasing their risk of osteoporosis in later life, British investigators report. Vitamin D is required for skeletal growth during infancy and childhood, the investigators note. Recent findings that the risk of osteoporosis in later life is affected by adverse intrauterine environmental conditions raises the concern that low levels of vitamin D during pregnancy may have a deleterious effect. Dr. Cyrus Cooper, from the University of Southampton, and his colleagues measured levels of 25(OH)-vitamin D in serum samples obtained from women during late pregnancy. Their offspring underwent dual energy X-ray absorptiometry at age 9. Included in the study, reported in the January 7th issue of The Lancet, were 160 mother-child pairs with complete data. Mothers deficient in vitamin D ( 11 g/L) had offspring whose whole-body bone mineral content at 9 years of age was significantly lower than in those born to women with levels 20 g/L (mean 1.04 kg versus 1.16 kg, p = 0.002). Maternal vitamin D status during late pregnancy was also significantly associated with lumbar-spine bone mineral content and areal bone mineral density. In contrast, birth weight, birth length, placental weight, abdominal and head circumference, and childhood height and lean mass were not associated with maternal vitamin D status. Children born during the summer -- whose mothers were exposed to more sunshine -- and children whose mothers took vitamin D supplements had significantly higher bone mineral content. Milk intake and physical activity were not significant determinants of bone mineral content. Dr. Cooper's group postulates that maternal vitamin D insufficiency during pregnancy leads to an impairment of placental calcium transport, perhaps mediated by parathyroid-hormone-related peptide and thereby reduces the trajectory of intrauterine and subsequent childhood bone-mineral accrual. They add: Vitamin D supplementation of such mothers, especially when the last trimester of pregnancy occurs during the winter months, could lead to an enhanced peak bone-mineral accrual and a reduced risk of fragility fracture in offspring during later life. Lancet 2006;367:36-43. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Smoking During Pregnancy Raises Risk for Finger, Toe Deformities WEDNESDAY, Jan. 11 (HealthDay News) -- Smoking during pregnancy greatly increases the risk of having a baby with finger or toe deformities, according to a study covering more than 6.8 million births in the United States during 2001 and 2002. The study identified 5,171 children with either extra, webbed or missing fingers and toes born to mothers who smoked during pregnancy. The mothers did not report other health risk factors such as heart disease, diabetes or high blood pressure. Women who smoked one to 10 cigarettes a day during pregnancy had a 29 percent increased risk of having a baby with finger or toe deformities, the study found. Smoking 11 to 20 cigarettes a day raised the risk by 38 percent, while smoking 21 or more cigarettes a day raised the risk by 78 percent. The study appears in the January issue of the journal Plastic and Reconstructive Surgery. The results of this study were interesting. We suspected that smoking was a cause of digital anomalies but didn't expect the results to be so dramatic, study author Dr. Benjamin Chang, of the University of Pennsylvania, said in a prepared statement. Smoking is so addictive that pregnant women often can't stop the habit, no matter what the consequences. Our hope is this study will show expectant mothers another danger of lighting up, Chang said. In the United States, webbed fingers or toes occur in one of every 2,000 to 2,500 live births and excess fingers or toes occur in one in every 600 live births, the researchers said. Chang said these kinds of abnormalities are the most common kinds of problems he treats. Parents would ask why this happened to their child, but I didn't have an answer. This study shows that even minimal smoking during pregnancy can significantly increase the risk of having a child with various toe and finger defects, he said. -- Robert Preidt SOURCE: American Society of Plastic Surgeons, news release, Jan. 5, 2005 Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Smoking During Pregnancy Raises Risk for Finger, Toe Deformities WEDNESDAY, Jan. 11 (HealthDay News) -- Smoking during pregnancy greatly increases the risk of having a baby with finger or toe deformities, according to a study covering more than 6.8 million births in the United States during 2001 and 2002. The study identified 5,171 children with either extra, webbed or missing fingers and toes born to mothers who smoked during pregnancy. The mothers did not report other health risk factors such as heart disease, diabetes or high blood pressure. Women who smoked one to 10 cigarettes a day during pregnancy had a 29 percent increased risk of having a baby with finger or toe deformities, the study found. Smoking 11 to 20 cigarettes a day raised the risk by 38 percent, while smoking 21 or more cigarettes a day raised the risk by 78 percent. The study appears in the January issue of the journal Plastic and Reconstructive Surgery. The results of this study were interesting. We suspected that smoking was a cause of digital anomalies but didn't expect the results to be so dramatic, study author Dr. Benjamin Chang, of the University of Pennsylvania, said in a prepared statement. Smoking is so addictive that pregnant women often can't stop the habit, no matter what the consequences. Our hope is this study will show expectant mothers another danger of lighting up, Chang said. In the United States, webbed fingers or toes occur in one of every 2,000 to 2,500 live births and excess fingers or toes occur in one in every 600 live births, the researchers said. Chang said these kinds of abnormalities are the most common kinds of problems he treats. Parents would ask why this happened to their child, but I didn't have an answer. This study shows that even minimal smoking during pregnancy can significantly increase the risk of having a child with various toe and finger defects, he said. -- Robert Preidt SOURCE: American Society of Plastic Surgeons, news release, Jan. 5, 2005 Copyright © 2006 ScoutNews LLC. All rights reserved. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Tearing after using Epi-No?
Hi All, I absolutely agree with Justine and Brenda. Artificial tools like the 'Epi-No' merely serve to instill fear of birthing and undermine women's belief in the ability of their own bodies to birth naturally and well. I have the same opinion of perineal massage - it just focuses the womens thoughts on the possibility, even likelihood that she will tear. Women need to focus on the positive beauty of birth not obsess over whether they will tear or not. The fact is that even if she does tear a little it will heal quickly. Just my opinion... Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: brendamanning [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Tearing after using Epi-No? Date: Tue, 10 Jan 2006 23:43:38 +1100 Kelly, Well, the bad news is that labour will be much more intense that what she's experienced with the epi-no! The good news is that the vagina is very vascular in a healthy woman heals quickly. A lot of blood can result from a quite minor laceration it'll almost certainly be healed by her birth time. It probably won't affect her ability to birth without tearing. I'm with Justine..those gadgets are money-making toys dangerous to boot ! With kind regards Brenda Manning www.themidwife.com.au - Original Message - From: Kelly @ BellyBelly To: ozmidwifery@acegraphics.com.au Sent: Tuesday, January 10, 2006 7:51 PM Subject: [ozmidwifery] Tearing after using Epi-No? Wondering if anyone has any suggestions for a woman I am supporting due in two weeks who emailed me with this: I had a slight incident this morning... Was using an epi-no birth trainer (for the second time) in an effort to reduce the risk of tearing or needing an episiotomy, and although it didn't hurt when it was inside me, when i pushed it out according to the instructions, i thought that it hurt like i was tearing apart, and boy, i hope labour isn't this bad But i was right, cos i went the the toilet straight away and there was blood all over the tissues and toilet seat etc... Called my obs, who said not to worry, i've probably just torn a bit of my vagina, and it can happen during birth etc... Anyway, only bleeding a little bit now, but as i'm due VERY soon, i'm a little worried it wont heal in time and i'll tear really badly now... Does anyone know how long will it take for this to heal so i don't have to worry??? Best Regards, Kelly Zantey Creator, BellyBelly.com.au Gentle Solutions For Conception, Pregnancy, Birth Parenthood BellyBelly Birth Support image001.gif -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Vaginal Birth Not Linked to Urinary Incontinence NEW YORK (Reuters Health) Nov 30 - Compared with their nulliparous sisters, women who have given birth vaginally are not at increased risk for urinary incontinence, according to a report in the December issue of Obstetrics and Gynecology. Rather, familial factors seem to play an important role in determining risk. Previous reports looking at the association between vaginal birth and incontinence have been plagued by various methodologic issues, such as the use of unvalidated self-report survey instruments and making no distinction between the various types of urinary incontinence or disease severity. In the present study, Dr. Gunhilde M. Buchsbaum, from the University of Rochester Medical Center in New York, and colleagues used a comprehensive questionnaire to assess pelvic floor disorders in 143 pairs of nulliparous/parous postmenopausal sisters. Clinical evaluation of urinary incontinence and genital prolapse was conducted in 101 of the pairs. The rate of urinary incontinence among the parous women was 49.7%, not significantly higher than the 47.6% rate seen among the nulliparous women, the authors state. Moreover, the type of incontinence and disease severity did not differ significantly between the groups. The same urinary status seen in one sister was often present in the other, suggesting that there is an underlying familial disposition toward urinary incontinence. A genetic predisposition for urinary incontinence needs to be explored further because finding a genetic link to this condition would have great implications for the direction of basic research, treatment approaches, risk management, and potential prophylactic interventions, the authors state. Obstet Gynecol 2005;106:1253-1258. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] commonsense article - for a change!
and they say something like Will Megan and her baby survive? Well find out right after this commercial! They create a lot of anxiety because they give women the impression that were all high-risk and the truth is that the vast majority of us are incredibly low-risk, says Grauer. Those TV programs, some pregnancy books and magazines, as well as Web sites and blogs offering opinions disguised as fact seem to play on the pervasive societal fear that already exists, Grauer says. After I spoke with a pregnant woman who told me she threw one pregnancy book across the room in disgust because it was filled with worst-case scenarios and instructions to walk on eggshells (not literally, of course; Im sure that would present some kind of risk of transdermal food poisoning), I started researching a book of my own. I learned that despite the risky tests, the possible perils of filling your car with gas or eating canned tuna, the recklessness of drinking a caffeinated beverage or taking an aspirin, the odds were overwhelmingly in a pregnant womans favor that around 40 weeks or so from conception, one way or another and mostly regardless of what she had or hadnt done, the average pregnant woman would deliver a baby and that baby would be just swell. I also discovered that once you saw the fetal heartbeat via an early ultrasound when you were around six weeks pregnant, your chances of miscarrying drop to just 2 percent. And that the majority of women, without killing themselves with exercise or crash dieting, are back to their pre-pregnancy weight (or at least within a few pounds of it) by the time their children celebrate their first birthdays. But, truly, as much as it hurts for a writer to admit this, you dont need a lot of books to calm your anxiety about pregnancy. Women who have newly passed over to the mommy side actually tell it best. I recently spoke with one such woman who had lots of fears during her pregnancy everything from weight gain, testing, whether shed get varicose veins, you name it. Now that shes a mom, this is what she told me: Most of what I worried about during pregnancy was stuff I dreamed up but never even happened or if it did it wasnt even a big deal. Now that I have my daughter, I think, what was I so worried about!? Look at her. Shes a miracle just like all the other kids at the park or mall or Gymboree class. Amen, Sister. Or rather: Amen, Mother. Victoria Clayton is a freelance writer based in California and co-author of Fearless Pregnancy: Wisdom and Reassurance from a Doctor, a Midwife and a Mom, published by Fair Winds Press Tips for a less anxious pregnancy Select a medical team you agree with. Some women only feel comfortable with an ob-gyn while some prefer a nurse-midwife. Others hire doulas as a sort of personal assistant in the pregnancy and birthing process. Research your options (including birth options). Most importantly, make sure you feel that you can ask questions of your medical practitioner and get them answered satisfactorily. Get an early ultrasound and, subsequently, whatever testing will make you feel calmer. An ultrasound around six weeks is the most accurate way to date a pregnancy plus it allows you to see the babys heartbeat, which is reassuring. Later, a number of tests will be available. None of them even the invasive ones such as CVS or amniocentesis carry much risk, but knowing the results may be a way to gain further peace of mind. Eat, drink and be yourself (for the most part). Five small meals a day keep blood sugar stable and eating a variety of foods helps ensure you and the baby get a full complement of nutrients. But don't obsess over what you eat or drink. The average womans diet, while probably not nutritionally perfect, provides far and away enough nutrients for a healthy baby especially if youre supplementing with a prenatal vitamin. And while it's advisable to avoid caffeine and alcohol, don't panic if you have an occasional cup of coffee or a Pepsi. Overall, just be you. Whatever you do when youre not pregnant save for drugs, alcohol and risky sports you can do when youre pregnant unless otherwise advised by your practitioner. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] systematic review
of Obstetrics and Gynaecology, University of Adelaide, 1st Floor, Queen Victoria Building, Women's and Children's Hospital, 72 King William Road, North Adelaide, S. Australia 5006, Australia. E- mail:[EMAIL PROTECTED] Copyright: University of York, 2005. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Breast-Feeding May Lower Mom's Risk of Diabetes By Serena Gordon HealthDay Reporter TUESDAY, Nov. 22 (HealthDay News) -- Breast-feeding your baby can cut your risk of developing type 2 diabetes, new research shows. We found that breast-feeding is really good for mothers. Each year she breast-feeds cuts the risk of type 2 diabetes by 15 percent, said study author, Dr. Alison Stuebe, a clinical fellow in maternal fetal medicine at Brigham and Women's Hospital, and an instructor at Harvard Medical School in Boston. Breast-feeding offers a host of health benefits for babies. Along with providing optimal nutrition, breast milk also provides compounds that boost babies' immune system and help protect against bacteria, viruses and parasites, according to the U.S. Food and Drug Administration. In addition, breast-fed children have lower rates of childhood illnesses and tend to be leaner than their formula-fed counterparts. And research has shown mothers benefit as well: Breast-feeding helps a mother's body return to normal faster after pregnancy, according to the FDA. Some studies have suggested that women who breast-feed for long periods of time may have lower rates of breast and ovarian cancer. But, no long-term studies had examined the effect of breast-feeding on maternal risk of diabetes, Stuebe said. Stuebe and her colleagues suspected breast-feeding might affect type 2 diabetes risk because it substantially changes a mother's metabolic requirements, and research has shown that breast-feeding improves insulin sensitivity and glucose tolerance. The researchers used data from the Nurses' Health Study and the Nurses' Health Study II, which together included more than 150,000 women who had given birth during the study period. More than 6,000 of these women were diagnosed with type 2 diabetes. After controlling for body mass index (BMI) -- because a high BMI is a known risk factor for type 2 diabetes -- the researchers found that long-term breast-feeding reduced a woman's risk of developing diabetes. The risk was decreased by 15 percent for each year of breast-feeding for women in the Nurses' Health Study, and by 14 percent for each year for those in the Nurses' Health Study II, according to the findings, which are published in the Nov. 23/30 issue of the Journal of the American Medical Association. Stuebe said the researchers weren't able to determine how breast-feeding might offer some protection against diabetes, only that breast-feeding was associated with a drop in the rate of type 2 diabetes. However, she said, the researchers suspect that breast-feeding may help keep blood sugar in balance, or homeostasis. Breast-feeding mothers burn almost 500 additional calories daily, according to the study. That's equivalent to running about four to five miles a day, Stuebe noted. If done for a year, it's not surprising that it might have an effect on how the body takes care of insulin and glucose, she said. Dr. Loren Wissner Greene, an endocrinologist at New York University Medical Center in New York City, said the explanation for why women who breast-feed for long periods may have lower rates of diabetes could be a simple one: The small weight changes from lactation can make a significant impact on diabetes risk. In fact, Wissner Greene said, the best advice for anyone to avoid type 2 diabetes is to maintain a healthy weight, and lose weight if you're carrying excess weight. Another potential explanation could be that women who breast-feed for a long time are more health-conscious than other women, and may have a healthier diet, may exercise more and do other health-promoting activities that could reduce their diabetes risk. Stuebe said the researchers tried to take lifestyle factors into account and still saw an association between breast-feeding and reduced diabetes risk. The bottom line, said Stuebe: We're talking about an intervention that doesn't cost anything, has no side effects and has other potential benefits. SOURCES: Alison Stuebe, M.D., clinical fellow in maternal fetal medicine, Brigham and Women's Hospital, and instructor, Harvard Medical School, Boston, Mass.; Loren Wissner Greene, M.D., endocrinologist, New York University Medical Center, and clinical associate professor of medicine, New York University School of Medicine, New York City; Nov. 23/30, 2005, Journal of the American Medical Association Copyright © 2005 ScoutNews LLC. All rights reserved. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI - oxytocin
. SOURCES: Seth D. Pollak, Ph.D, department of psychology, University of Wisconsin, Madison; Bruce Perry, M.D., Ph.D., senior fellow, Child Trauma Academy, Houston; Nov. 21-25, 2005, Proceedings of the National Academy of Sciences Copyright © 2005 ScoutNews LLC. All rights reserved. Oxytocin is indeed the hormone of love as Michel Odent calls it! This article would also support the argument against the 'crap' that people like Gary Ezzo teach!! Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] article FYI
Thanks Joanne, It's nice to know that they are appreciated. All the best, Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: Joanne Steve Fisher [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] article FYI Date: Sat, 26 Nov 2005 12:53:00 +1000 Hi Leanne, I want to thank you for posting all your interesting articles FYI. I often print them off and take them to work. Please keep them coming. Cheers, Joanne -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Heavy Coffee Drinking in Pregnancy Tied to Increased Risk of Fetal Death By Anne Harding NEW YORK (Reuters Health) Nov 15 - Fetal death is twice as likely among women who drink eight or more cups of coffee daily during pregnancy compared to women who avoid coffee while pregnant, Danish researchers report. Adjusting for other risk factors weakened the association somewhat, but heavy coffee drinkers remained at 59% greater risk of fetal death, Dr. Bodil Hammer Bech of the University of Aarhus and colleagues report. Women who drank four to seven cups daily had a 33% increased risk of fetal death. Due to our findings and previous studies we think it is reasonable to apply the precaution principle and advise pregnant women to abstain from drinking more than 3 cups of coffee per day, Dr. Bech told Reuters Health. Denmark currently has an official policy warning women to restrict their coffee intake to three cups or less daily. While a number of studies have linked coffee drinking to adverse pregnancy outcomes, and there are plausible physiological mechanisms by which caffeine might harm a fetus, the risks of coffee drinking in pregnancy have been questioned, Dr. Bech and colleagues note in the November 15 issue of the American Journal of Epidemiology. To investigate, they surveyed 88,482 women enrolled in the Danish National Birth Cohort, among whom there were 1,102 fetal deaths. The women were interviewed about coffee intake and potentially confounding factors, such as alcohol consumption and smoking, at approximately 16 weeks' gestation. Among the women, 55.4% reported drinking no coffee during pregnancy, while 31.4% drank one-half to three cups daily. Thirteen percent of the women drank more than three cups of coffee daily, while 3.4% drank eight or more cups a day. After adjustment, the researchers found, women who drank one-half to three cups a day had a 3% increased risk of fetal death; those who consumed four to seven cups had a 33% increased risk; and those who drank eight or more cups had a 59% greater risk of fetal death. The association was strongest for fetal deaths after 20 weeks gestation. The researchers found no link between tea or cola consumption and fetal death, suggesting that caffeine may not be the exposure of interest. Coffee contains a number of chemical compounds, Dr. Bech noted. Further studies should try to disentangle a caffeine effect from a non-caffeine effect. Am J Epidemiol 2005;162:983-990. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Duration of Lactation and Incidence of Type 2 Diabetes Alison M. Stuebe, MD; Janet W. Rich-Edwards, ScD; Walter C. Willett, MD, DrPH; JoAnn E. Manson, MD, DrPH; Karin B. Michels, ScD, PhD JAMA. 2005;294:2601-2610. Context Lactation is associated with improved glucose and insulin homeostasis, independent of weight change. Objective To evaluate the association between lactation history and incidence of type 2 diabetes. Design, Setting, and Participants Prospective observational cohort study of 83 585 parous women in the Nurses Health Study (NHS) and retrospective observational cohort study of 73 418 parous women in the Nurses Health Study II (NHS II). Main Outcome Measure Incident cases of type 2 diabetes mellitus. Results In the NHS, 5145 cases of type 2 diabetes were diagnosed during 1 239 709 person-years of follow-up between 1986 and 2002, and in the NHS II, 1132 cases were diagnosed during 778 876 person-years of follow-up between 1989 and 2001. Among parous women, increasing duration of lactation was associated with a reduced risk of type 2 diabetes. For each additional year of lactation, women with a birth in the prior 15 years had a decrease in the risk of diabetes of 15% (95% confidence interval, 1%-27%) among NHS participants and of 14% (95% confidence interval, 7%-21%) among NHS II participants, controlling for current body mass index and other relevant risk factors for type 2 diabetes. Conclusions Longer duration of breastfeeding was associated with reduced incidence of type 2 diabetes in 2 large US cohorts of women. Lactation may reduce risk of type 2 diabetes in young and middle-aged women by improving glucose homeostasis. Author Affiliations: Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Womens Hospital (Dr Stuebe), Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care (Dr Rich-Edwards), Departments of Nutrition (Dr Willett), and Epidemiology (Drs Rich-Edwards, Willett, Manson, and Michels), Harvard School of Public Health, Channing Laboratory (Drs Rich-Edwards, Willett, Manson, and Michels) and Division of Preventive Medicine (Dr Manson), Department of Medicine, and Obstetrics and Gynecology Epidemiology Center, Department of Obstetrics, Gynecology, and Reproductive Biology (Dr Michels), Brigham and Womens Hospital and Harvard Medical School, Boston, Mass. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Depriving babies of cuddles does long-term harm By Kate Ravilious in London November 23, 2005 Failing to give babies cuddles and affection subtly changes how their brains develop, and in later life can leave them anxious and poor at forming relationships. Love and affection from parents and carers are vital to developing the brain pathways involved in dealing with stress and forming social bonds, according to a study published yesterday. Seth Pollak, a psychologist at the University of Wisconsin, led a research team that compared the progress of children raised by their biological parents with children who had come from crowded orphanages in Russia and Romania and had been adopted by parents in the US. When these [orphanage] children were babies there were so few adults around that there was rarely one available to respond to their needs, Dr Pollak said. The children studied had an average age of 4½ years, and the orphans had been settled with their foster parents for two years and 10 months on average. Eighteen of the 39 children studied were from orphanages. They were observed at home playing interactive games and sitting on their mother's lap. Before and after this physical contact, the children provided a urine sample to measure levels of two hormones: vasopressin, thought to help us recognise familiar individuals and live in social groups; and oxytocin, the release of which makes us feel secure and protected. It was discovered that the children from orphanages had lower underlying levels of vasopressin and, unlike children raised by their biological parents, their levels of oxytocin did not rise with cuddling. The study appeared in the journal Proceedings of the National Academy of Sciences yesterday. It is remarkable that the children's deficiencies in these affection hormones could still be detected now, after they had spent three years in loving adoptive homes, said Terrie Moffitt, a developmental psychiatrist at King's College London. An unanswered question is whether or not the hormonal deficiencies will result in any behavioural difficulties for the children in the long term. The researchers suspect that if deprived of close adult contact soon after birth, children will never fully develop the brain pathways. It used to be thought that the brain came all wired up, but now it seems that social experiences after birth are vital for opening up the pathways and strengthening the connections in the brain for these hormones, Dr Pollak said. The research team plans a follow-up study with the same children to see if this is the case. He also speculates that giving children plenty of cuddles at birth leads to an addiction to close relationships in late life. The area of the brain that acts as the receptor for oxytocin is also the reward centre associated with drug addictions. It is possible that close relationships function like an addiction, making us go and seek them out in later life, he said. The Guardian Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Another blow for VBAC
Hi All, The full article is available at: www.mja.com.au/public/issues/183_10_211105/tay10392_fm.html The important point is in their conclusion - Caesarean section in a first pregnancy confers additional risks on the second pregnancy, primarily associated with labour. These should be considered at the time caesarean section in the first pregnancy is being considered, particularly for elective caesarean section for non-medical reasons. This study just confirms what we already know - that unneccessary elective C/S's should be avoided! Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: Andrea Robertson [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Another blow for VBAC Date: Mon, 21 Nov 2005 07:19:30 +1100 This is in today's Sydney Morning Herald. No doubt this report will trigger furious debate (as it should) but let's try an get the focus on the first caesarean, not the possible risks with VBAC. These figures for first caesareans are shocking - higher that the USA! http://www.smh.com.au/news/health/caesareans-lift-risks-in-later-births--study/2005/11/20/1132421548464.html Andrea - Andrea Robertson Birth International * ACE Graphics * Associates in Childbirth Education e-mail: [EMAIL PROTECTED] web: www.birthinternational.com -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
., associate professor, public health, and director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; Nov. 15, 2005, CDC report Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Diet influences preterm delivery? Issue 23: 14 Nov 2005 Source: American Journal of Obstetrics Gynecology 2005; 193: 1292-301 Adopting a cholesterol-lowering diet could reduce the risk of preterm delivery in low-risk pregnancies, according to the findings of a new study. Specialists from centers in Oslo, Norway, randomly assigned 290 women aged 21-38 years to, from 17-20 weeks gestation onwards, either continue their usual diet or to adopt a diet with a high intake of fish, low-fat meats and dairy products, oils, whole grains, fruits, vegetables, and legumes. The women in the dietary intervention group met with a dietician at the start of the study and at weeks 24, 30, and 36 of their pregnancy. The diet (described in detail in the published paper) included limiting the intake of cholesterol to 150 mg/day, reducing saturated fat to 8% of total energy intake, and aiming at a weight gain of 8-14 kg from pre-pregnancy levels. All of the women in the study were non-smoking, white, with singleton pregnancies, and had no previous pregnancy-related complications. About two-thirds were nulliparous. Lipids lowered Writing in the latest issue of the American Journal of Obstetrics Gynecology, the researchers report that maternal levels of total cholesterol and low-density lipoprotein were significantly lower in the intervention group than in the control group. There were no differences between the two groups in levels of cord and neonatal lipids. Overall, one of the 141 women in the dietary intervention group had a preterm delivery (defined as a live delivery before 37 completed weeks of gestation), compared with 11 of the 149 women in the control group. This was a statistically significant difference. There were no differences between the groups in the incidence of other pregnancy complications. The researchers write: In conclusion, a diet that was reduced in saturated fat and cholesterol, and enriched in a number of micronutrients, modified maternal cholesterol levels, but not cord and neonatal lipids. It was associated with a lower incidence of preterm delivery in low-risk pregnancies and had no adverse effects. They say the findings warrant replicating the study in a larger population of pregnant women, involving both low-risk and high-risk pregnancies: The marked observed effect of this diet on the reduction of preterm delivery in low-risk pregnancies should encourage future larger studies to clarify the role of such a diet in the prevention of preterm birth. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] another article FYI
Obstetrics and gynecology in ancient Egypt Issue 23: 14 Nov 2005 Source: European Journal of Obstetrics Gynecology and Reproductive Biology 2005; 123: 3-8 Researchers have identified a large number of similarities between modern practices and concepts relating to reproductive medicine, and those recorded in documents from ancient Egypt. In a new paper, specialists from the Hadassah Hebrew University Hospital in Jerusalem, Israel, write: Ancient Egyptian medicine exercised obstetric practices and reproductive concepts based on some extremely accurate observations. They examined a series of relevant papyri written in Egypt in Pharonic times, including the Kahun papyrus, a gynecological text dated to about 1800 BC. Their paper discusses in detail many apparent overlaps between ancient and modern practices, including: Diagnosing pregnancy The researchers note that one method of diagnosing pregnancy in ancient Egypt was to count the number of times the woman vomits when placed on a mash [mixture] of beer and date. The aversion of strong aromatic odors, nausea with or without vomiting, is also specified today as a presumptive evidence of pregnancy, they write. Another method used in ancient Egypt was to place an onion bulb deep in the vagina overnight. Being able to detect the onions characteristic smell on the womans breath the next morning was a sign that the woman was pregnant. The researchers suggest that absorption of the onions sulfuric compounds into the womans blood via engorged submucosal blood vessels could result in onion breath. Delivery Egyptian writings and wall paintings suggest that delivery was performed in the squatting position, with the woman supporting her arms on her knees, and sitting on two bricks. A 2004 Cochrane analysis of positions during the second stage of labor showed that squatting has advantages over supine or lithotomy positions in terms of a reduced duration of the second stage, a reduction in assisted deliveries and episiotomies, and a reduced reporting of severe pain in the second stage. It was, however, also associated with an increase in second-degree perineal tears and increased blood loss. Assessment of newborns In ancient Egypt, the newborns cry and muscle tone were both used as indicators of health. One papyrus states that if the newborn said ny, it would live, and if it said mebi, it would die. It was also thought that if the child moaned or turned its head downwards, it would die. Cry and muscle tone are two of the five parameters used to determine the Apgar score in newborns today, the researchers write. Complications of delivery There are suggestions from certain writings that perineal tears were sutured after delivery, with one papyrus referring to the bringing together of the vagina. Contraception The researchers say ancient papyri include several recipes for intra-vaginal contraceptives, with ingredients including acacia gum, sour milk, and acacia spikes. Compounds derived from the acacia tree/shrub have been found in modern-day research to be spermicidal, with a sperm-immobilizing effect in vitro. It has been suggested that such active ingredients may have been indirectly identified when herders of domesticated animals noticed that animals that grazed on certain plants failed to reproduce. Erectile dysfunction Ancient Egyptian remedies for erectile dysfunction included active components such as carob, juniper, hyoscyamus, pine, and watermelon, say the researchers. They note that carob, for example, has a high content of histidine, a major component of histamine. Recently, they write, it has been shown that histamine-deficient mice have a low reproduction rate due to decreased male mating behavior. The full paper is published in the latest issue of the European Journal of Obstetrics Gynecology and Reproductive Biology. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] emergency skills
Yes! I have been to Maggie Banks Midwifery Intensive and it was truly inspiring and had a midwifery perspective whereas the ALSO course is very obstetric in nature. It is worth every cent!! Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: McAlpine, Joan (AHS) [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: 'ozmidwifery@acegraphics.com.au' ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] emergency skills Date: Mon, 14 Nov 2005 15:40:02 +1100 Hi everyone, I was just wanting to know if anyone had been to Midwifery Skills for Emergencies run by Birth International with Maggie Banks as the facilitator. It's just that it is quite expensive ($1095) , which is dearer than the ALSO course. Thanks, Joan THIS E-MAIL IS CONFIDENTIAL. If you have received this e-mail in error, please notify us by return e-mail and delete the document. If you are not the intended recipient you are hereby notified that any disclosure, copying, distribution or taking any action in reliance on the contents of this information is strictly prohibited and may be unlawful. Eastern Health is not liable for the proper and complete transmission of the information contained in this communication or for any delay in its receipt. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Family First
Dear Justine, I am meeting with senator Steve Fielding at 3pm this afternoon so I hope you get this and are able to get that previous briefing to me by then. If not then I will just use the briefings drafted by the ACMI for Julia Gillard. Thanks, Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: Justine Caines [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: OzMid List ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Family First Date: Thu, 10 Nov 2005 16:17:38 +1100 Dear Leanne On our last Canberra roadshow we briefed Sen Fielding (In September) so this is really a good opportunity to show him that what we (Maternity Coalition) have said is backed up by others in the community. From our experience with Julia Gillard it is good for those who belong to MC to identify this and show their support. For those non-members, please JOIN, support our work, because together we can get there! Leanne good work organising this and will send the briefing through to you so you know what we said. In solidarity Justine -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] Family First
Thanks Justine, I need all the ammunition I can lay hands on. Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: Justine Caines [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: OzMid List ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Family First Date: Thu, 10 Nov 2005 16:17:38 +1100 Dear Leanne On our last Canberra roadshow we briefed Sen Fielding (In September) so this is really a good opportunity to show him that what we (Maternity Coalition) have said is backed up by others in the community. From our experience with Julia Gillard it is good for those who belong to MC to identify this and show their support. For those non-members, please JOIN, support our work, because together we can get there! Leanne good work organising this and will send the briefing through to you so you know what we said. In solidarity Justine -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] Family First
Hi All, Next Tuesday 15th November Steve Fielding, senator and leader of the Family First Party will be in Mildura. He has requested to meet with me and discuss Indigenous women's issues and related midwifery issues. He is also speaking at a meeting at the Settlers Club on Tuesday evening. It would be great if we could get as many midwives there as possible to impress on him that half the voting public are women who have babies, who need midwives, who need Medicare Provider numbers and PI insurance. I have already forwarded to him the briefings which the ACMI drafted for Julia Gillard. I will also give him the motion which Aiden Ridgeway tabled in the Senate earlier in the year. If anybody has any other documents they feel are pertinent and succinct please feel free to forward them to me. Thanks Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Strep B screening
Hi Nicola, You just need to ask to have another low vaginal swab at around 36 weeks gestation. It is possible that you will be negative this time. Yes you could request that the doctor put the IV cannula somewhere less uncomfortable. Also remember that you do have the option of refusing the antibiotics if you wish. Years ago all the midwives did, if Mum was GBS positive, was monitor the baby's temperature and then treat the baby symtomatically if necessary. All the best, Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: Nicola Morley [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] Strep B screening Date: Tue, 8 Nov 2005 15:17:25 +1100 Can I ask a personal question on this one? Last birth (January 2003, Gosford Hospital Community Midwives) I was given intravenous antibiotics automatically because I had been StrpB positive in the previous pregnancy. I wasn't retested. I am pregnant again - will I be automatically assumed to have Strep B again? will I be tested again? Is it even possible to be clear now even if I have been Strep B positive in the past or am I hoping in vain to avoid the treatment? It only bothers me because I like to spend a LOT of labour on my hands and knees and I found the drip in my hand very uncomfortable. If it is inevitable to have them again, what is the best plan of action? To stay home as long as possible? To ask for the drip in my forearm instead of the back of my hand? Any other suggestions. I will of course talk about it with the midwives when I book in next week, but just wondering in the meantime, seeing the topic has come up here! Nicola Morley Trainee Doula -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Jenny Cameron Sent: Tuesday, November 08, 2005 12:23 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Strep B screening Current recommendations in Vic are to offer screening at 35-37 weeks per the CDC evidence. It does appear to be the best available evidence, far better than the risk-based approach of administering IV ABS to a select group of women considered to be 'at-risk'. Women are unlikely to change their status within a month, therefore with screening only those women who test GBS +ve will be offered IV ABs intrapartum to prevent early onset (within the first week of life) GBS pneumonia in the neonate. Also surface swabbing and collection of gastric asp on neonates is a waste of time, the baby will be sick with GBS well before the results of any swabs are available. Many years ago I saw a baby become ill subsequently die of GBS pneumonia. The baby was term perfectly welll at birth, within an hour of birth started having apnoeic attacks and four hours later was shocked gravely ill. The Vic guidelines are currently under review but you can check the site below: http://www.3centres.com.au/ Jenny Jennifer Cameron FRCNA FACM President NT branch ACMI PO Box 1465 Howard Springs NT 0835 08 8983 1926 0419 528 717 - Original Message - From: diane mailto:[EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, November 07, 2005 8:17 PM Subject: Re: [ozmidwifery] Strep B screening With respect Jenny, Im not sure that too many of the recommendations out of the good old U.S of A could be described as 'best practice'. Here is the NSW directive, it does however, also refer to the CDC guidelines http://www.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_240.pdf At our unit we do not routinely swab, we take the risk factor approach,but if it appears in MSU or on a swab done for other reasons we then require our women to birth at Gosford where there are paediatricians they can transfer back after 24-48 hrs Cheers Di - Original Message - From: Jenny mailto:[EMAIL PROTECTED] Cameron To: ozmidwifery@acegraphics.com.au Sent: Sunday, November 06, 2005 4:52 PM Subject: Re: [ozmidwifery] Strep B screening Curent best practice is to offer screening for GBS at 35-37 weeks. See site below: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/groupbstrep_g.htm Jenny Jennifer Cameron FRCNA FACM President NT branch ACMI PO Box 1465 Howard Springs NT 0835 08 8983 1926 0419 528 717 - Original Message - From: Mary mailto:[EMAIL PROTECTED] Murphy To: ozmidwifery@acegraphics.com.au Sent: Friday, November 04, 2005 6:47 PM Subject: [ozmidwifery] Strep B screening I have been told by a pregnant woman that she was reluctant to have a strep B test at 35-37 weeks. She was informed by a doctor in the A/N clinic of our public tertiary hospital, that if she went into labour with an unknown status and attended the delivery suite , her baby would have to be given IMI antibiotics until the baby's screening swabs came back 48hrs later. She felt that to protect the baby, she had to consent to A/N screening. Those who recognize the description of this hospital
[ozmidwifery] midwife / nurse practitioner
Hi All, I may be able to clarify a little the issue of midwives who choose to pursue credentialling as a nurse practitioner. I agree that a midwife is a midwife is a midwife! However, there are already many degrees of experience and areas of specialty (clinical specialist, clinical consultant, lactation consultant, associate charge midwife, level 1, level 2, grade 3, grade 4, hospital-based midwife, homebirth midwife, independent midwife etc...) within midwifery so the fear of another level is a problem is a bit irrelevant. Australia is currently behind the internationally accepted standard for midwifery ie Australian midwives are unable to prescribe, order diagnostic pathology and ultrasound or refer as we do not have Medicare Provider numbers and prescribing is not part of our authorisation as registered midwives. This needs to change and there are poitical moves afoot (however slow...) to change Medicare accordingly. In the mean time the only avenue available to midwives who wish to be more autonomous and be able to implement these extensions to practice is to become credentailled as a nurse practitioner. In NSW the title 'midwife practitioner' is legislated but in Victoria the titles 'midwife' and 'nurse practitioner' cannot legally be combined so a midwife becomes labelled as a nurse practitioner in midwifery. Personally I dont like that title and I will choose to continue calling myself a midwife. Hope that helps a little. Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: B G [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] The Advertiser today... Date: Mon, 31 Oct 2005 11:20:33 +1000 Sorry Tania, I must have this reply to my email. I have concerns with the thinning or another layer of midwifery with Midwife Practitioner. To me a midwife is a midwife and a midwife. OK we can all develop other competencies but basically we should be able to care for birth women and their families as per ACMI definition of a midwife. This practitioner notion concerns me as it is a spin off from nursing. A shortage of medical staff results in nurses plugging up the gap such as ordering tests, medications and pathology etc. Surely we could have these added to our core education as modules. Here in Qld there is this push that only those that have Masters can be practitioners. I know graduate midwives coming out of Uni's are beginning midwives. Contrast that with midwives with experience who now will never be be to be called a Practitioner. Cairns has been accepted by Qld Health for a trial of Midwife Practitioner primarily for remote areas such as Palm Island. It is felt being a remote location they would be better serviced by a midwife ... (I don't know the rest as I say a midwife is a midwife ). Best to contact them direct for more information. I was at the ANF Conference in Darwin last week. Victorian midwives I can understand your frustration of ANF Victoria. Cows, cows and cows behave better. Their views on midwives are so entrenched. Basically there is an enhanced acknowledgement and understanding of midwifery and midwives that I did not see last time in Hobart. The first and only midwives problem was encountered with the second motion- A2. Inclusion of midwife and midwifery in the policies of the ANF | ANF New South Wales Branch That the 2005 ANF Biennial National Delegates Conference requests the inclusion of the word 'midwife' or 'midwifery' in the body of all appropriate ANF policies, guidelines, and position statements, instead of it being just a footnote. Moved: Seconded: Background Information Currently, all ANF policies carry the following stem statement which appears directly below the title of the policy: Where the term 'nurse' is used it includes all licensed classifications including, but not limited to: registered nurse, midwife, enrolled nurse, nurse practitioner. It is evident that the needs to conciliation work to be done between the ANF branches in Victoria and ACT with the ACMI branches. Their reasoning for voting against this resolution was unreasonable and obviously there is great discomfort with midwives in general in those two states. NSW Branch state secretary Brett Holmes gave a powerful address about the need for midwives and nurses to be working together and supporting each other as there is a lot to be learnt from the midwives and they (midwives) do not have the industrial strength to do it alone. He quoted what had happened in NZ with the NZNO having to get an agreement from the NZ Midwives organisation before the government would sign off the new agreement. He said in NZ they found it unwieldy and difficult to be negotiating from two fronts. He did not want the midwives to go out and form their own union. ANF is to be considered inclusive and if we do not include midwives it would be to our (ANF
[ozmidwifery] article FYI
Unnecessary episiotomies Issue 22: 31 Oct 2005 Source: International Journal of Gynecology Obstetrics 2005; 91: 157-9 Researchers have questioned the continuing widespread use of routine episiotomy, after finding high rates at some centres in countries in South America, Asia, and Africa. Systematic reviews of published trials, including a Cochrane review, have suggested that episiotomies should not be performed routinely, because of the associated maternal morbidity. Some specialists have said that no more than 10 percent of nulliparous women delivering vaginally should need one, according to the researchers writing in the latest issue of the International Journal of Gynecology Obstetrics. But their study suggests that episiotomy rates are far higher than this at some hospitals. The researchers, from Uruguay and the USA, analyzed data on episiotomy rates for nulliparous and multiparous women at hospitals in Argentina, Brazil, Bolivia, Chile, the Democratic Republic of Congo, Ecuador, India, Tibet, Uruguay, Venezuela, and Zambia. The hospitals studied (from 1 to 13 per country) were part of the US National Institute of Child Health and Human Developments Global Network for Womens and Childrens Health Research. Rates above 90 percent Reporting their findings, the researchers say that episiotomy rates among nulliparous women were higher than 90 percent in all countries except Zambia (6.9 percent). Episiotomy rates for all vaginal births were higher than 20 percent in all countries except Zambia, and were as high as 80 percent in Brazil. The exception, Zambia, was unusual in having a lower rate for nulliparous women than for all vaginal births. The researchers, however, caution that the data for Zambia were obtained from only one hospital. They also advise against generalizing the findings beyond the centres studied. However, they say the data illustrate the widespread use of routine episiotomy in contradiction to the evidence questioning its efficacy. Unnecessary episiotomies, the researchers write, increase the risk of morbidity as indicated by the Cochrane review, including posterior perineal trauma, the need for suturing the perineal wound, and healing complications at 7 days. They conclude: Strategies should be developed to decrease episiotomy rates at a global level. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Iodine: the clever mineral October 25, 2005 When we think of iodine, we think of that fluorescent yellow liquid that was painted viciously on our cuts and grazes as kids. But according to recent studies, this mineral has a far more important role in our health, particularly for pregnant women and their developing babies brains. Iodine is essential for a healthy thyroid which produces the thyroid hormone or brain juice for developing babies and children. A prolonged lack of iodine in your diet may lead to a condition known as Iodine Deficiency Disorder or IDD. This deficiency is the single most important cause of preventable intellectual deficit in the world. Preventable intellectual deficit refers to conditions such as goitre, cretinism and mental retardation. It is important to ensure adequate iodine intake during pregnancy, as this is the time when the brain does the most developing. Iodine deficiency, particularly in children, may lead to lower intelligence levels and learning disorders. It has also been noted that an iodine deficiency can mean development problems for the baby and may even lead to miscarriage. The recommended daily intake for pregnant women is 120 150 micrograms with a maximum of 1.1 milligrams per day. Sydney endocrinologist, Professor Creswell Eastman coordinated a study which measured iodine levels in eight-to-ten year old children. The results were expected to trigger the mandatory addition of iodine to salt. This move has already been agreed to, in principle, by state health ministers. Its going to be years before mandatory fortification takes place, and in the meantime it would be intolerable, almost criminal, to let [pregnant] women be at risk of iodine deficiency, Professor Eastman said. Where to find rich sources of iodine: Seafood fish, mussels. Vegetables in particular, beets, celery, lettuce, mushrooms. Fruits grapes, oranges in particular So, if youre lucky enough to be pregnant, reach for a salad sandwich instead of that second helping of cake and your baby will thank you for it when theyre graduating with their masters degree. REFERENCES First National Iodine Study Western Sydney Area Health Services Media Release 20.09.03 Hetzel BS. Iodine deficiency disorders and their eradication. Lancet 1983; 2: 1226-1229. First National Iodine Study Western Sydney Area Health Services Media Release 20.09.03 Iodine - http://www.birth.com.au/class.asp?class=6510page=15 Rouse Rada Extra Iodine Recommended in Pregnancy Medical Observer September 2005 : Rich Sources of Nutrients - http://www.gmhc.org/health/nutrition/factsheets/nutrients.html Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Lactation after ART
Hi All, I think Nicole has put her finger on the most important issue - anxiety! Oxytocin cannot kick-in while adrenaline is charging through the system. If this woman has also had a C/S then she is really behind the 'eight ball'. Anxious women are more likely to have C/S, induction, drugs, interventions ... etc. This anxiety can also have been caused by months of unsuccessful attempts of ovarian hyperstimulation and IVF etc. Doctors have a habit of dumping fear on women in the misguided belief that they must advise women of all possible adverse outcomes or in an even more misguided attempt to cover their own backsides and avoid litigation! ... or even more self-serving attempt to protect their golf day! Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: Nicole Carver [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] Lactation after ART Date: Mon, 24 Oct 2005 19:56:07 +1000 Another observation about women who have had ART, they are often anxious. It is difficult for an anxious woman to sit and finish a breast feed properly, or even sometimes recognise feeding cues. I wouldn't completely discount a hormonal link, although the hormones play a larger part in early lactation, from memory I think after three to four months lactation is mostly under autocrine control ie local feedback mechanisms in the breast (This might benefit from a bit more investigation though). Cheers, Nicole. -Original Message- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] Behalf Of Barbara Glare Chris Bright Sent: Monday, October 24, 2005 7:45 PM To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] Lactation after ART Hi, I think the answer is.possibly. I tend to agree with Nicole that it's more likely to be birthing interventionist birthing practices which get breastfeeding off to a poor start, followed up by scheduled breastfeeding which makes brestfeeding successfully a near impossibility. After all, women can breastfeed past menopause, without ovaries, breastfeed adopted children without ever having given birth. I wouldn't assume that because a women has to be assisted to get pregnant she won't be able to breastfeed. I recently helped a woman who had given birth to twins @ 34 weeks. They were concieved via IVF and the mother had PCOS. Most of the staff had written her off. And when I first saw her she was so disheartened because of the small drips of milk she was getting, the babies were being comped and she had to go home 3/4 of an hr from the hospital and leave her babies. 8 weeks later she was fully breastfeeding and babies putting on 200 and 300 g per week each. Barb IBCLC - Original Message - From: Michelle Windsor To: ozmidwifery@acegraphics.com.au Sent: Monday, October 24, 2005 7:05 PM Subject: Re: [ozmidwifery] Lactation after ART Hi Jenny, This is something that I noticed as well when working in a private hospital in Hobart. The general consensus by the midwives there was that if a woman needed help to become pregnant then perhaps there was an underlying cause which would then interfere with lactation. The midwives there said they had noticed this quite often. Cheers Michelle Jenny Cameron [EMAIL PROTECTED] wrote: Hi all Does anyone have information on the effect on human lactation of assisted reproductive technology? I am noticing a lot of poor lactation among women who have had a baby by ART. A lot of women seem to be on Domperidone these days at the best of times?? Anyone else experiencing these phenomena? It does make sense that if the woman's hormonal milieau is such that reproduction needs hormonal assistance then lactation is likely to also??? Cheers Jenny Jennifer Cameron FRCNA FACM President NT branch ACMI PO Box 1465 Howard Springs NT 0835 08 8983 1926 0419 528 717 Do you Yahoo!? The New Yahoo! Movies: Check out the Latest Trailers, Premiere Photos and full Actor Database. ATT00013.gif -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
of Pediatrics National Conference and Exhibition. Harvey Karp, MD, associate professor of pediatrics, University of California at Los Angeles Medical School. Karen Miller, MD, associate professor of pediatrics, Tufts University, Boston. WebMD Feature: Quieting Colic.Quieting Colic. © 2005 WebMD Inc. All rights reserved Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] article FYI
Hi Sadie, Sorry, I just copied it as it was written on the web-site ... I guess you could get a librarian to find the journal for you . Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 From: Sadie [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] article FYI Date: Sat, 8 Oct 2005 17:58:51 +1000 Hi Leanne, Do you have the names' of the authors who wrote this article? Thanks, Sadie - Original Message - From: leanne wynne [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Friday, October 07, 2005 9:42 AM Subject: [ozmidwifery] article FYI Building an antenatal care consensus Issue 20: 3 Oct 2005 Source: European Journal of Obstetrics Gynecology and Reproductive Biology 2005; 122: 22-32 1-3 A new study has identified the extent to which guidelines on the antenatal care of normal pregnancy are consistent between different European countries. Researchers at the European Institute of Health and Medical Sciences, in Guildford, UK, set out to evaluate and compare the content of national guidelines for routine antenatal care in the 25 countries that make up the European Union (EU). Antenatal care was defined as baseline clinical care of all pregnancies of a healthy woman with an uncomplicated singleton pregnancy. The researchers conducted a literature review and identified 37 routine tests. They then sent a questionnaire to government health departments and national ob/gyn organizations, asking them to specify which of the 37 tests were recommended in official antenatal care guidelines. Of the 25 member countries, 20 reported having such national guidelines. Overall, these guidelines recommended 47 different tests (10 more than identified in the literature review). Of these, 23 tests were recommended for routine care by more than 50 percent of the countries, and applied to more than 50 percent of the total population. This 50 percent/50 percent criterion was considered by the researchers to be suitable for clarifying which tests should be included in a proposed common minimum guideline for EU member countries. The final 23? Writing in the European Journal of Obstetrics Gynecology and Reproductive Biology, the researchers say the 23 tests included three that were recommended in all 20 countries with national guidelines. These three universal tests were blood group, blood pressure and Rhesus factor determination. The 23 tests also included 12 that were recommended by more than 75 percent of the countries (but not 100 percent). These included maternal weight, urinalysis/bacteria, hemoglobin, urinalysis/protein, fetal position, fundal height, and hepatitis B. Four of the 23 tests were considered not to be sufficiently supported by published literature. These were vaginal examination to predict a premature ripening of the cervix, auscultation of the fetal heart rate, an oral glucose tolerance test for gestational diabetes, and urinalyses for glucose. The researchers say these tests require further investigation. Concluding, they write that the suggested minimum guideline can only be seen as the beginning of a process which might culminate in a consensus conference at which national representatives of the relevant institutions as well as individual health professionals can find a consensus, which can be finally accepted by all member states. In a brief commentary in the same issue of the journal, its editor says the study will perform a valuable function in showing obstetricians how their practice compares with that elsewhere, and it provides an important basis for reflection and discussio Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Building an antenatal care consensus Issue 20: 3 Oct 2005 Source: European Journal of Obstetrics Gynecology and Reproductive Biology 2005; 122: 22-32 1-3 A new study has identified the extent to which guidelines on the antenatal care of normal pregnancy are consistent between different European countries. Researchers at the European Institute of Health and Medical Sciences, in Guildford, UK, set out to evaluate and compare the content of national guidelines for routine antenatal care in the 25 countries that make up the European Union (EU). Antenatal care was defined as baseline clinical care of all pregnancies of a healthy woman with an uncomplicated singleton pregnancy. The researchers conducted a literature review and identified 37 routine tests. They then sent a questionnaire to government health departments and national ob/gyn organizations, asking them to specify which of the 37 tests were recommended in official antenatal care guidelines. Of the 25 member countries, 20 reported having such national guidelines. Overall, these guidelines recommended 47 different tests (10 more than identified in the literature review). Of these, 23 tests were recommended for routine care by more than 50 percent of the countries, and applied to more than 50 percent of the total population. This 50 percent/50 percent criterion was considered by the researchers to be suitable for clarifying which tests should be included in a proposed common minimum guideline for EU member countries. The final 23? Writing in the European Journal of Obstetrics Gynecology and Reproductive Biology, the researchers say the 23 tests included three that were recommended in all 20 countries with national guidelines. These three universal tests were blood group, blood pressure and Rhesus factor determination. The 23 tests also included 12 that were recommended by more than 75 percent of the countries (but not 100 percent). These included maternal weight, urinalysis/bacteria, hemoglobin, urinalysis/protein, fetal position, fundal height, and hepatitis B. Four of the 23 tests were considered not to be sufficiently supported by published literature. These were vaginal examination to predict a premature ripening of the cervix, auscultation of the fetal heart rate, an oral glucose tolerance test for gestational diabetes, and urinalyses for glucose. The researchers say these tests require further investigation. Concluding, they write that the suggested minimum guideline can only be seen as the beginning of a process which might culminate in a consensus conference at which national representatives of the relevant institutions as well as individual health professionals can find a consensus, which can be finally accepted by all member states. In a brief commentary in the same issue of the journal, its editor says the study will perform a valuable function in showing obstetricians how their practice compares with that elsewhere, and it provides an important basis for reflection and discussio Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Increased Risk of Cow Milk Allergy After Cesarean Delivery Reuters Health Information 2005. © 2005 Reuters Ltd. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world. By Will Boggs, MD NEW YORK (Reuters Health) Sept 13 - Children delivered by cesarean section face twice the risk of cow milk allergy or intolerance than other children, according to a report in the September issue of Allergy. If the findings are confirmed and the underlying mechanism is shown to be tied to an altered intestinal microbial flora, this would open up very exciting future possibilities of treatment of allergic diseases, Dr. Merete Eggesboe from Norwegian Institute of Public Health, Oslo, told Reuters Health. Dr. Eggesboe and associates, who previously reported a similar association between cesarean section and egg, fish, and nut allergy, investigated possible links between cesarean delivery and cow milk allergy/intolerance in 2656 participants in the Oslo Birth Cohort. Although there was no association between mode of delivery and parentally perceived reactions to milk, the authors report, cow milk allergy/intolerance was twice as common among children delivered by cesarean section compared to children delivered vaginally. None of the children previously diagnosed with milk allergy/intolerance but deemed tolerant by age 2.5 years had been delivered by cesarean section, the researchers note, suggesting a negative association between becoming tolerant and cesarean section. The results of the present study cannot be explained by differences between predisposed and not predisposed children and thus provides support for early intestinal colonization playing a role in the etiology of food allergy, the investigators conclude. We have started a study on the intestinal microflora in children, relating it to mode of delivery and development of allergic diseases, Dr. Eggesboe said. The aim is to study whether any of the observed differences in intestinal microflora tied to mode of delivery, is also associated with subsequent development of allergic disease. Allergy 2005;60:1172-1173. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] interesting article FYI
Fat Content of Breast Milk Increases with Time By Amanda Gardner HealthDay Reporter TUESDAY, Sept. 6 (HealthDay News) -- The longer a mother breast-feeds, the higher the fat and energy content of her breast milk . However, experts are not sure what this finding, which appears in the September issue of Pediatrics, signifies. This is the first study to analyze the fat and energy content of breast milk of mothers who breast-feed for longer than a year, said study co-author Dr. Ronit Lubetzky, who is with the department of pediatrics at Dana Children's Hospital at Tel Aviv Sourasky Medical Center in Israel. There are more and more women who choose to breast-feed for longer time periods, and not many studies about the nutritional value of their milk during this prolonged lactation. This is a nicely done study which looked at a question that really needed to be answered, added Dr. Ruth Lawrence, a professor of pediatrics at the University of Rochester School of Medicine and a member of the executive committee of the American Academy of Pediatrics' section on breast-feeding. I think many people's general impression is if you continue to breast-feed beyond a year, probably the nutrient value drops, and this is quite different information and very important. No one is sure how long mothers should breast-feed, although the American Academy of Pediatrics recommends that breast-feeding continue for at least 12 months, and thereafter for as long as mutually desired. A reduction in cardiovascular risks in adulthood is one oft-cited benefit of this practice. Others, however, have said it might have the opposite effect. To determine the fat and energy content of human breast milk at longer periods, Lubetzky and colleagues sampled the breast milk of 34 mothers who had been breast-feeding for 12 to 39 months, and compared that with the milk of 27 mothers who had been breast-feeding for only two to six months. They found a startling difference: the fat content in the mothers who had breast-fed for longer periods of time was 17.5 percent, versus only 5 percent in the short-term group. The researchers said that, while it was possible that something other than duration might be affecting the findings, they still felt this was the most likely explanation for the difference. It's not clear what the effects of this higher energy and fat content are on a child's health. We showed that the milk of mothers who breast-fed more than a year had a very high fat content, Lubetzky said. That contradicts the claim that breast-feeding at this stage has no nutritional contribution. On the other hand, the long-term effect of such a high-fat intake has not been studied. The constituents of fat and human milk are very different than what we provide in formula today. One of the most important constituents of human milk is cholesterol. Formula does not, Lawrence said. There are many people who think that probably one of the problems with cholesterol today occurs because infants have not had any cholesterol in the first few months of life; perhaps the body doesn't learn to deal with it. There are studies that show that young adults have much lower cholesterol levels if they were breast-fed than if they were bottle-fed. Still, Lawrence added, this is an area that needs to be researched further. Lubetzky agreed. Further studies should analyze this milk fat qualitatively, and try to sort out the influence of prolonged breast-feeding on cardiovascular issues, she said. Another study in the same issue of the journal found, not surprisingly, that American hospitals designated as Baby Friendly by the World Health Organization (WHO) and the United Nations Children's Fund had higher breast-feeding rates than other hospitals. These hospitals follow WHO's Ten Steps to Successful Breast-feeding. At Baby Friendly institutions, the rate of women beginning breast-feeding was 83.8 percent, versus 69.5 percent nationally. The initiation rate at hospitals with a higher proportion of black patients was only 70.7 percent. The overall rate of women who breast-fed exclusively during their hospital stay was 78.4 percent at Baby Friendly hospitals compared with a national mean of 46.3 percent. More information The American Academy of Pediatrics has a policy statement on breast-feeding. SOURCES: Ronit Lubetzky, M.D., department of pediatrics, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Ruth Lawrence, M.D., professor, pediatrics, University of Rochester School of Medicine, Rochester, N.Y., and member, executive committee, section on breast-feeding, American Academy of Pediatrics; September 2005 Pediatrics Copyright © 2005 ScoutNews, LLC. All rights reserved. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au
[ozmidwifery] article FYI
Delivery by Cesarean Section Linked to Fewer Subsequent Pregnancies NEW YORK (Reuters Health) Aug 31 - Women who have a delivery by cesarean section are significantly less likely to go on to have another pregnancy compared to those who have an initial delivery by spontaneous vaginal birth, according to researchers. Dr. Jill Mollison, of the University of Aberdeen, UK, and colleagues studied women who had delivered their first singleton child in Aberdeen Medical Hospital between 1980 and 1997. The team obtained data on the index and next pregnancy from the Aberdeen Maternity Neonatal Databank, and compared subsequent pregnancy across three modes of delivery groups. Data from 25,371 women were included in the analysis, which is published in the August issue of the British Journal of Obstetrics and Gynecology. A subsequent pregnancy was significantly less likely among women who had an initial delivery by cesarean section (66.9%) compared with instrumental vaginal delivery (71.6%) and spontaneous vaginal delivery (73.9%). Women who delivered by cesarean section were less likely to have a subsequent pregnancy than those who delivered vaginally (hazard ratio [HR] = 0.91). This finding confirmed those from a previous study on an earlier cohort of the same population. All of the women were followed for a minimum of 5 years. Women who delivered by cesarean section had the greatest median time to next pregnancy (36.3 months) compared to instrumental vaginal delivery (31.8 months) and spontaneous vaginal delivery (30.4 months). In contrast to the earlier study, the likelihood of a subsequent pregnancy following instrumental vaginal delivery was similar to spontaneous vaginal delivery (HR = 1.0). These data do not allow us to suggest that fertility is compromised following cesarean section (i.e. involuntary factors) or whether the difference in subsequent pregnancy is due to voluntary factors, Dr. Mollison's team notes. It has been suggested that fertility may be compromised due to pelvic pathology following surgery such as tubal damage. The authors explain that the experience of cesarean section and the circumstances surrounding it may be enough to lead to avoidance of further pregnancies. Thus, reduced fertility following CS could be an extension of pre-existing fertility problems, pathological, social or psychological, they write. Br J Obstet Gynecol 2005;112:1061-1065. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] NSW news
I tend to agree with you Sally! I would be interested to read the ACMI's ratiionale behind credentialling for midwives. I too believe that a qualified midwife should be fully capable and responsible to care for normal pregnancy and birth. I guess it comes back to old arguement: A midwife is a midwife or alternately: When is a midwife not a midwife? Leanne. From: Sally Westbury [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: RE: [ozmidwifery] NSW news Date: Fri, 2 Sep 2005 08:04:50 +0800 Sheesh.. The old credentialing crap. Midwives do not need to be credentialed to provide care for low risk women. That is what we are trained to do. Credentialing should be for things that are outside the scope of normal midwifery care. Things like epidurals, interpreting electronic fetal monitoring, induction of labour etc. This drives me crazy Sally Westbury Homebirth Midwife Learn from mothers and babies; every one of them has a unique story to tell. Look for wisdom in the humblest places - that's usually where you'll find it. - Lois Wilson -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] interesting article
This is an interesting article from ObGynWorld.com Breast-feeding: a win-win game And finally, a study of new mums in Canada has demonstrated that, further to being the best source of nutrition for their child, breast-feeding benefits mothers themselves by alleviating their levels of stress. The work showed that 25 breast-feeding mothers responded less strongly to stressful situations, as assessed by cortisol levels in their saliva, than 25 mothers who bottle-fed their infants. The researchers think this effect will free up more energy for the new mothers to dedicate to their child. Our study may also have implications for women prone to postpartum depression, said lead author Claire-Dominique Walker (Douglas Hospital Research Centre). Postpartum stress is a risk factor for postpartum depression. If we can better understand how the breast-feeding moms reduce their stress... we may be able to better treat the moms prone to postpartum depression. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] interesting article
This is an interesting article from ObGynWorld.com Breast-feeding: a win-win game And finally, a study of new mums in Canada has demonstrated that, further to being the best source of nutrition for their child, breast-feeding benefits mothers themselves by alleviating their levels of stress. The work showed that 25 breast-feeding mothers responded less strongly to stressful situations, as assessed by cortisol levels in their saliva, than 25 mothers who bottle-fed their infants. The researchers think this effect will free up more energy for the new mothers to dedicate to their child. Our study may also have implications for women prone to postpartum depression, said lead author Claire-Dominique Walker (Douglas Hospital Research Centre). Postpartum stress is a risk factor for postpartum depression. If we can better understand how the breast-feeding moms reduce their stress... we may be able to better treat the moms prone to postpartum depression. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] guidelines re placenta praevia
Advice for patients about placenta previa Issue 14: 11 Jul 2005 Source: RCOG draft guidance patient guidance for comment (www.rcog.org.uk) The UKs Royal College of Obstetricians and Gynaecologists (RCOG) is inviting comment on new draft information for patients about placenta previa. The draft report, Placenta praevia: information for you, is available on the RCOGs website and is based on the colleges guidance for healthcare professionals (see the article Updated placenta previa advice, from the ORGYN Online Magazine issue dated 10 January 2005). The advice for patients is divided into 10 brief sections, answering questions that include What could placenta praevia mean for my baby and me?, What extra antenatal care can I expect if I have placenta praevia?, and What will happen at the birth?. Some of the key points of the draft patient guidance are as follows: Placenta praevia can be very serious, as there is a risk of serious bleeding, and may threaten the health and life of the mother and baby. Maternal deaths from placenta praevia are fortunately very rare in the UK. About three women die each year as a result of placenta praevia. If you have a major degree of placenta praevia you will need a caesarean section. A hysterectomy is sometimes necessary to save a womans life, the advice adds. The 6-page report also advises women with the condition to avoid having sex, and to eat a healthy diet to reduce the risk of anemia. To view the draft report, and the advice for specialists (the report Placenta praevia and placenta praevia accreta: diagnosis and management), visit the RCOGs website at www.rcog.org.uk. The deadline for submitting comments on the patient advice is 29 July 2005. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Cesarean 'affects odds of future pregnancy' Source: BJOG: an International Journal of Obstetrics and Gynaecology 2005; 112: 1061-5 Investigating the influence of primary mode of delivery on the likelihood of subsequent pregnancy. A 17-year study has shown that women who undergo cesarean delivery are less likely than other mothers to have another pregnancy. The research, which involved over 25,000 women whose babies were delivered between 1980 and 1997, has not, however, revealed whether this observation is due to an actual decline in fertility, or is a result of choice, points out Jill Mollison, from the University of Aberdeen in the UK, who led the study. Analyzing data for women who gave birth at the Aberdeen Maternity Hospital, the authors report that 66.9 percent of women who had a cesarean delivery became pregnant again, compared with 73.9 percent of those who had a spontaneous birth, and 71.6 percent of those who had an instrumental vaginal delivery. In addition, the average length of time until the next pregnancy was extended for women with a prior cesarean birth, and the risk of ectopic pregnancy was increased. In view of the findings, Peter Bowen-Simpkins, from the Royal College of Obstetricians and Gynaecologists, said: Those involved in the delivery of obstetric care should be aware of the association and consider its implications when making a decision to perform a cesarean section. Posted: 3 August 2005 Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Behavioral problems may derive from maternal smoking Source: British Journal of Psychiatry 2005; 187: 155-60 Investigating whether the observed link between maternal smoking and antisocial behavior in offspring is mediated by attention-deficit hyperactivity disorder. Smoking during pregnancy significantly raises the risk of antisocial behavior in the child, independently of its influence on attention-deficit hyperactivity disorder (ADHD), UK research suggests. While the association between delinquency and maternal prenatal smoking has long been recognized, whether antisocial behavior is linked to smoking during pregnancy independently, or as a result of ADHD, has remained unknown, explains the team, led by Dr Tanya Button from the Institute of Psychiatry in London. To address this issue, they studied questionnaires evaluating antisocial behaviors and symptoms of ADHD completed by the parents of 723 identical and 1173 non-identical pairs of twins, who took part in the Cardiff Study of All Wales and North West England Twins. In all, 29.1 percent of the mothers reported smoking during pregnancy. Such smoking was found to affect children's scores for both antisocial behavior and ADHD, with average scores increasing with the number of cigarettes smoked per day. When fitting bivariate models to the data, the team found the best fit with a model in which maternal smoking had a specific, independent influence on each phenotype. Offering possible explanations for the findings, Dr Button suggested that the nicotine absorbed during smoking might impair fetal brain development, leading to neurological impairment, or that the effects of smoking could be mediated by a reduction in the level of oxygen reaching the fetus. Posted: 2 August 2005 Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Fentanyl During Labor May Impede Establishment of Breastfeeding NEW YORK (Reuters Health) Jul 21 - Women who receive fentanyl analgesia during labor may be less likely to breastfeed their infants, according to UK investigators. Based on their findings, they propose that women who receive neuraxial lipophilic opioids during labor receive support to successfully establish breastfeeding in the hospital. Currently, there is no evidence that neuraxial opioids do not impact on infant feeding, and some suggestions that they do, Dr. Sue Jordan from the University of Wales in Swansea and colleagues note in their report a report in the July issue of BJOG: an International Journal of Obstetrics and Gynecology. To look into the matter, the team retrospectively analyzed a random sample of 425 healthy women who delivered a healthy term infant, their first, in 2000. At discharge from the hospital, 45% of the women were exclusively bottle-feeding their infants and no woman began breast feeding after going home. In analyses accounting for well-established determinants of infant feeding, intrapartum fentanyl, particularly at higher doses, appeared to impede the establishment of breastfeeding, the investigators report. This is the first report of a dose-response relationship between intrapartum neuraxial opioid analgesia and infant feedings, they write. Dr. Jordan and colleagues caution, however, that any impact of intrapartum analgesia on infant feeding is unlikely to be uniform across the population studied. In the current study, where women intended to bottle feed, intrapartum fentanyl made no difference, they report, and delivery by cesarean section was a more powerful determinant of infant feeding than the type of analgesia. On the other hand, where other factors favoured breastfeeding, intrapartum fentanyl appeared to thwart the mothers' intentions, the team notes. For example, for a woman planning to breastfeed and delivering vaginally, administration of fentanyl increased the probability of bottle-feeding by 63%, from 3.7% to 6.1%. The authors note that up to 50% of parturient women are given neuraxial opioids, and suggest that using only local anesthetics could increase breastfeeding rates. BJOG 2005;112:927-934. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Intrapartum antibiotics predispose to nursing-linked yeast infection Source: Obstetrics Gynecology 2005; 106: 19-22 Estimating whether the receipt of intrapartum antibiotics increases the risk of neonatal thrush or maternal breast infections in nursing mother-infant pairs. Use of intrapartum antibiotics appears to raise the risk of thrush and breast candidiasis in nursing infant-mother pairs, researchers warn. In addition to the well-recognized role of antibiotics in the development of vaginal candidiasis, there is some evidence to suggest that such treatment during the postpartum period influences nipple candidiasis, notes Mara Dinsmoor, from the Medical College of Virginia Hospital in Richmond, USA, and her team. To investigate whether intrapartum antibiotic therapy influences the risk of neonatal thrush and maternal breast infections, they analyzed follow-up data for 435 mother-infant pairs who nursed for 1 month or longer. Among these new-mothers, 173 (39.8 percent) received intrapartum antibiotics, mostly for group A streptococci prophylaxis. Within 1 month of delivery, thrush or breast candidiasis were detected in 46 (10.6 percent) mother-infant pairs. Both the breast and oral infection were more common in individuals exposed to antibiotics postpartum, with odds ratios of 2.1 and 1.87, respectively; however, only the former relationship reached statistical significance. Dinsmoor and co-authors say their findings, if confirmed in larger studies, warrant further investigation into methods to reduce the risk of postnatal yeast infections. Posted: 13 July 2005 Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] article FYI
Postnatal depression 'unpreventable' In other news, the results of a literature review have cast doubt on the value of psychosocial and psychological interventions for the prevention of postpartum depression. In her analysis of 15 trials, involving a total of 7697 women, Cindy-Lee Dennis, from the University of Toronto in Canada, found no overall statistically significant effect of all the types of interventions studied, including psychosocial activities, such as antenatal or postnatal classes, and psychological interventions, such as interpersonal psychotherapy, on rates of postnatal depression. Despite this negative result, they did observe a potential reduction in the condition in certain groups of patients, including those considered already at risk. The most promising intervention is the provision of intensive, professionally based postpartum support, they add. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] calling Tanya Fleming
Tanya, I seem to have misread your e-mail address that you gave me yesterday at the Midwifery Intensive - could you please send it me me again. Thanks, Leanne. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Homebirth of twins
Sue, You should write-up this birth as a case study and submit it to a midwifery or medical journal. Congratulations on a great birth! Leanne. From: Sue Cookson [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Homebirth of twins Date: Wed, 06 Jul 2005 08:48:54 +1000 Hi everyone, I thought to let you know about a lovely homebirth of twins on Monday 4th July. Two little boys, 6lb7oz and 5lb 12oz, born 10.5 hours apart. SRM 3.30 am and birth of baby #1 at 6.49am. Then a few hours where ctxs were fairly regular but not so strong unless baby#1 was breastfeeding. You could see the second baby positioning itself and the uterus working hard to pull down into shape for baby#2. I'd clamped the cord of baby#1 after 10 mins in case of bleedthrough, and clamped the other end as well so that the placenta retained its size until after baby#2 was born. After about 4 hours I asked to check baby #2 position. It was too hard to palpate so I did a VE and found head there, not well applied, but there. Cervix was 9 ish cms. So we waited, fetal heart always good and strong. Set up the pool and mother relaxed for an hour or so with ctxs beginning to pick up again. She decided to hop out and at 5.05 pm baby#2 emerged in his caul. She birthed the placenta unaided 35 minutes later. Blood loss 300ml. (Her Hb and ferritin levels were both low). It was a huge leap of faith, but there was nothing happening to raise any alarm bells. Both babies are really gorgeous, feeding well and very happy. I am once again humbled by the strength of women Sue -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[no subject]
Home superior to hospital birth Source: British Medical Journal 2005; 330: 1416-22 The largest prospective study of planned home births to date evaluates the safety of such births supported by direct entry midwives. Among low-risk women, home births assisted by certified midwives achieve similar rates of intrapartum and neonatal mortality as hospital births, with lower rates of medical intervention, reveal Canadian researchers. Despite a wealth of evidence supporting planned home birth as a safe option for women with low risk pregnancies, the setting remains controversial in most high resource settings, note Kenneth Johnson (Public Health Agency of Canada) and Betty-Anne Daviss (International Federation of Gynecology and Obstetrics, Ottawa). To examine its safety further, the team compared perinatal outcomes for all planned home births (n = 5418) supported by the North American Registry of Midwives in 2000, with those previously reported for low-risk hospital births in the USA. Overall, 12.1 percent of women were transferred to hospital for delivery. The incidence of neonatal mortality among those who remained at home was similar to that documented for low-risk hospital births, with no maternal deaths. Medical intervention, however, was substantially less common among home, versus hospital, births, with epidural, episiotomy, forceps, vacuum extraction, and cesarean section rates of 4.7 percent, 2.1 percent, 1.9 percent, 0.6 percent, and 3.7 percent, respectively. Our study of certified professional midwives suggests that they achieve good outcomes among low-risk women without routine use of expensive hospital interventions, conclude Johnson and Daviss. Posted: 23 June 2005 Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] FYI
Hi All, I thought the comment at the end of this article about caregiver bias very relevant. Leanne. Short stature independently predicts cesareans Issue 13: 27 Jun 2005 Source: European Journal of Obstetrics Gynecology and Reproductive Biology 2005; 120: 175-8 Maternal short stature is an independent risk factor for cesarean section, according to new findings. The researchers report a significantly higher rate of cesareans among women less than 155 cm in height compared with taller women, even after controlling for labor dystocia. Specialists from the Soroka University Medical Center in Beer-Sheva, Israel, analyzed the records of all 159,210 deliveries that occurred at the center between 1988 and 2002. In 5,822 of these deliveries (3.65 percent), the mother was of short stature, defined as being less than 155 cm in height. These women were almost twice as likely to have a cesarean section compared with taller women (21.3 percent versus 11.9 percent, respectively). Women of short stature also had significantly higher rates of previous delivery by cesarean, intrauterine growth restriction, premature rupture of membranes, failed induction, labor dystocia, malpresentations, and cephalopelvic disproportion. However, the researchers found no significant differences in perinatal complications such as low birth weight, meconium-stained amniotic fluid, perinatal mortality, and low 5-minute Apgar scores. Significant and independent Importantly, the association between short stature and cesareans persisted even after controlling for other potentially confounding factors, including dystocia. Writing in the European Journal of Obstetrics Gynecology and Reproductive Biology, the researchers report that short stature is an independent risk factor for cesarean section, with an odds ratio of 1.7. They say the higher rate of deliveries by cesarean among short women can be partially attributed to caregiver bias. Whenever the attending obstetrician realizes that the patients stature is short, even mild deviations from the normal labor curves lead to cesarean section. They suggest that the findings should prompt obstetricians to reconsider their attitudes towards cesarean deliveries in mothers 155 cm, and call for an objective evaluation of the benefits and risks of performing cesareans in such women. The researchers say further prospective studies investigating indications for cesareans need to be conducted in order to help inform decisions. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] FYI
AMA Says Ultrasound In-Utero Portraits Are Bad Idea Reuters Health Information 2005. © 2005 Reuters Ltd. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world. By M. Mary Conroy CHICAGO (Reuters Health) Jun 21 - Keepsake ultrasound portraits of fetuses are not medically appropriate and should be discouraged, the American Medical Association's House of Delegates stated at its annual meeting here this week. Recent advances in ultrasound technology, including 3-D image capacity, have made the pre-birth portraits popular, which prompted the Missouri delegation to the House of Delegates to ask the AMA to go public about the risks of the practice. The Missouri doctors said the ultrasound portraits are often done by unqualified technicians in whose hands ultrasound, which is generally a safe procedure, may have unanticipated risks. The new AMA policy directs the organization to adopt current Food and Drug Administration policy on the use of non-diagnostic fetal ultrasound. The FDA policy states that keepsake fetal videos are an unapproved use of a medical device. In approving the policy, the House of Delegates also directed AMA leaders to lobby the FDA to enforce its prohibition of unapproved, non-medical uses of the technology. During a reference committee hearing testimony was overwhelmingly in support of this resolution calling for the responsible use of diagnostic ultrasound during pregnancy, said Dr. Daniel van Heeckeren, who chaired the reference committee. Dr. Van Heeckeren, a thoracic surgeon at University Hospitals, Cleveland, Ohio, added that fetal ultrasonography is considered safe when properly used. And although there is no evidence to suggest that exposing a fetus to unnecessary ultrasound is harmful, strong support was voiced endorsing its use only where there is a clear medical benefit to the patients. He also noted that use of diagnostic ultrasound for keepsake purposes puts the clinician at risk of potential legal liability since this imaging is often performed without parents receiving the standard counseling that normally precedes ultrasound examinations. Dr. Marilyn Laughead, of Scottsdale, Arizona, and a delegate form the American Institute of Ultrasound in Medicine, said, Although there is no confirmed biological effect of ultrasound known today, there may be some effect identified in the future. For that reason ultrasound should be used only for medically indicated purposes. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Short women
Absolutely Felicity!! Thats why I drew your attention to the comment by the researchers that caregiver bias can result in minor deviations from normal being perceived as an indication for intervention and thus increasing the incidence of C/S. Leanne. From: cummins [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Short women Date: Mon, 4 Jul 2005 13:26:08 +1000 Leanne In my experience, women of short stature (of which I am one!) very commonly have babies in the OA position. I have concluded (my own opinion, without research or evidence) that this is because there is simply no room for a baby to be OP. Us women of short stature, do not labour or birth any differently to other women, and due to position could even exceed the expected 'normal labour curves'. Felicity (152cm) - Original Message - From: leanne wynne [EMAIL PROTECTED] To: ozmidwifery@acegraphics.com.au Sent: Monday, July 04, 2005 11:49 AM Subject: [ozmidwifery] FYI Hi All, I thought the comment at the end of this article about caregiver bias very relevant. Leanne. Short stature independently predicts cesareans Issue 13: 27 Jun 2005 Source: European Journal of Obstetrics Gynecology and Reproductive Biology 2005; 120: 175-8 Maternal short stature is an independent risk factor for cesarean section, according to new findings. The researchers report a significantly higher rate of cesareans among women less than 155 cm in height compared with taller women, even after controlling for labor dystocia. Specialists from the Soroka University Medical Center in Beer-Sheva, Israel, analyzed the records of all 159,210 deliveries that occurred at the center between 1988 and 2002. In 5,822 of these deliveries (3.65 percent), the mother was of short stature, defined as being less than 155 cm in height. These women were almost twice as likely to have a cesarean section compared with taller women (21.3 percent versus 11.9 percent, respectively). Women of short stature also had significantly higher rates of previous delivery by cesarean, intrauterine growth restriction, premature rupture of membranes, failed induction, labor dystocia, malpresentations, and cephalopelvic disproportion. However, the researchers found no significant differences in perinatal complications such as low birth weight, meconium-stained amniotic fluid, perinatal mortality, and low 5-minute Apgar scores. Significant and independent Importantly, the association between short stature and cesareans persisted even after controlling for other potentially confounding factors, including dystocia. Writing in the European Journal of Obstetrics Gynecology and Reproductive Biology, the researchers report that short stature is an independent risk factor for cesarean section, with an odds ratio of 1.7. They say the higher rate of deliveries by cesarean among short women can be partially attributed to caregiver bias. Whenever the attending obstetrician realizes that the patient's stature is short, even mild deviations from the 'normal' labor curves lead to cesarean section. They suggest that the findings should prompt obstetricians to reconsider their attitudes towards cesarean deliveries in mothers 155 cm, and call for an objective evaluation of the benefits and risks of performing cesareans in such women. The researchers say further prospective studies investigating indications for cesareans need to be conducted in order to help inform decisions. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
RE: [ozmidwifery] Antenatal Urine Analysis
Hi Justine, The 3 Centres Consensus Guidelines, which is the evidence based guidelines that Victorian doctors and midwives are supposed to be basing their antenatal care on, state that routine urinalysis is not necessary. If, however, there is some other indication such as elevated BP or urinary symptoms then a urinalysis is appropriate. Protein (albumin) in the urine may indicate renal problems or pre-eclampsia, glucose could indicate diabetes but not always, nitrites would indicate a urinary tract infection. You can download the guidelines from the 3 Centres web-site. Hope that helps a little. Leanne. From: Justine Caines [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: OzMid List ozmidwifery@acegraphics.com.au Subject: [ozmidwifery] Antenatal Urine Analysis Date: Mon, 20 Jun 2005 12:56:49 +1000 Dear Wise Ones I am about to spar with a local GP and was looking for some wee on the stick¹ evidence. I somehow remember there was an article that came across the list on routine antenatal urine analysis. Any one know what I am talking about? JC Justine Caines National President Maternity Coalition Inc PO Box 105 MERRIWA NSW 2329 Ph: (02) 65482248 Fax: (02)65482902 Mob: 0408 210273 E-Mail: [EMAIL PROTECTED] www.maternitycoalition.org.au Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] interesting article
FYI Elective Repeat C-Section May Negatively Affect Neonatal Outcomes NEW YORK (Reuters Health) Jun 09 - Compared with intending to deliver vaginally, undergoing a scheduled repeat cesarean delivery apparently raises the risk that the newborn will be admitted to an advanced care nursery, according to a brief report. The researchers say women should be alerted to the possible negative effects. The study, in the May issue of the American Journal of Obstetrics and Gynecology, is the first to directly compare the neonatal outcomes of elective c-section with those of a trial of labor in uncomplicated pregnancies, note Dr. Nicholas Fogelson and colleagues, from the Medical University of South Carolina in Charleston. In a retrospective cohort analysis, the investigators assessed the neonatal outcomes of 3134 mothers intending to deliver vaginally and 117 mothers who underwent elective repeat cesarean section. In the overall analysis, the risk ratio for admission to an advanced care nursery was 3.58 for infants in the elective c-section group compared to those from the intended vaginal group (p 0.001). Transient tachypnea was also more common in the elective cesarean group (p = 0.0009). When the analysis was confined to mothers who underwent unscheduled c-section after a trial of labor, the advanced care nursery finding was no longer statistically significant. Also, infants born to such mothers were more likely to have lower APGAR scores than those in the elective c-section group. The decision to undergo elective cesarean delivery appears to have a negative impact on immediate neonatal outcomes, the authors state. They advise that for women considering a scheduled cesarean delivery, physicians should counsel patients about potential neonatal issues in addition to concern for maternal well-being. Am J Obstet Gynecol 2005;192:1433-1436. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
Re: [ozmidwifery] RE Twins
spontaneous. No cesarean deliveries were performed. The Apgar assessment scores of the newborns, at both 1 and 5 minutes after birth, were identical at the two units. The proportions of second twins transferred to the neonatal intensive care unit were also similar at both units, at 18-19 percent. Equivalent outcomes After reviewing these and many other indicators of health, the researchers conclude: The neonatal results were similar in both groups, even though both the rate of obstetric maneuvers and the interbirth interval differed significantly. The two methods therefore appear to be equivalent when judged by the second twin's neonatal indicators. They call for further research to verify whether an active approach helps to avoid or reduce the risk of cesarean delivery. The researchers finish by making an important observation about a risk associated with the expectant approach that could not be quantified in the study: This risk is the unfamiliarity or loss of clinical experience with the obstetric maneuvers involved in version by intra-uterine manipulations and total extraction, and thus to be unequipped to perform them on the day they are indispensable. They therefore suggest that tertiary maternity units promote the active approach to second-twin delivery, to ensure adequate training of interns, residents and student midwives. From: Lindsay Yvette [EMAIL PROTECTED] Reply-To: ozmidwifery@acegraphics.com.au To: ozmidwifery@acegraphics.com.au Subject: Re: [ozmidwifery] RE Twins Date: Thu, 2 Jun 2005 10:54:38 +1000 Thanks for your reply Lieve. What state are you in? I'm certainly not keen to let them induce if I get to 38 weeks. They say there is no way of telling the condition of the placenta, and that there's evidence or studies to show significant increase in worse outcomes after 38 weeks or something like that, but I don't know yet what studies/evidence they're relying on re this. I will be asking for details as soon as they let me see someone. I see with the second one you described there was 1/2 hour between babies for monochorionic diamniotic twins. I'm not convinced about the 10 minute thing either, and they'll have to give me details of what evidence they're relying on if they want me to consider this seriously as well. I'm starting to think I should place the onus more on them to prove to me why I should adhere to their recommendations rather than the other way around. If they can let me see the info myself I can consider it, but I don't think I should just take their word for it. I met another pregnant mum yesterday, same type of twins as me and in a public hospital in Melbourne too. She's having the same issues as me. She doesn't want an epidural and has been told she has to have one. She waits up to 2 hours for a rushed 10 minute appointment with an Ob, then doesn't get to ask any questions. We'll be staying in touch; she's due a few weeks before me. Yvette (pg with monochorionic diamniotic twins due 5th Sept). Hello Yvette, I just want to tell you my excperience. I accompagned two twin births this year in the hospital. We have there very good supporting obs, that are very confident with breech and twin births. Lieve -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
[ozmidwifery] interesting article
Abortions Tied to Subsequent Preterm Delivery Reuters Health Information 2005. © 2005 Reuters Ltd. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world. By David Douglas NEW YORK (Reuters Health) Apr 27 - Having previously had an induced abortion is associated with the birth of very preterm (22 to 33 weeks of gestation) singletons, French researchers report in the April issue of the British Journal of Obstetrics and Gynaecology. Dr. Caroline Moreau of Hopital de Bicetre, Le Kremlin Bicetre and colleagues note that there had been much debate on the effect of induced abortions on subsequent pregnancies. However, studies have failed to reach clear conclusions. To investigate further, the researchers examined data on 1943 very preterm singletons, 276 moderately preterm singletons and 618 unmatched full-term controls. Women with a history of induced abortion were at a higher risk (odds ratio, 1.5) of very preterm delivery than those without such a history. Furthermore, the risk of deliveries at less than 28 weeks was even higher in this group (odds ratio, 1.7). No association was found between induced abortion and very preterm delivery due to hypertension. However, a history of induced abortion was associated with an increased risk of premature rupture of the membranes, antepartum hemorrhage not associated with hypertension and idiopathic spontaneous preterm labor. Thus the investigators conclude that induced abortion increases the risk of preterm births, particularly extremely preterm deliveries. The findings suggest the need for further research in particular to assess the differences in the level of risk according to the technique used for abortion, Dr. Moreau told Reuters Health. As medical abortion is supposed to reduce mechanical injuries, she said, it would be important to know if it also reduces the risk of subsequent preterm delivery, compared with surgical abortion. Br J Obstet Gynaecol 2005;112:430-437. Leanne Wynne Midwife in charge of Women's Business Mildura Aboriginal Health Service Mob 0418 371862 -- This mailing list is sponsored by ACE Graphics. Visit http://www.acegraphics.com.au to subscribe or unsubscribe.
