Monday, February 10, 2014

5 Safe Herbs for a more comfortable pregnancy and better birth.

Written by Dr. Avivia Romm While there is limited scientific research on the safe use of most herbs in pregnancy, there is good evidence of safety for several. Overall, most herbs that are traditionally used to support pregnancy are safe for use in moderation. There have been almost no reports of adverse outcomes in pregnant women, and when they have occurred, it has been from using herbs that are not considered safe in pregnancy, or from products that have been tainted with unsafe herbs or even pharmaceutical additives – which has mostly been a problem with imported products from China and India. http://avivaromm.com/5-safe-herbs-for-a-more-comfortable-pregnancy-and-better-birth

Sunday, July 7, 2013

Friday, March 15, 2013

Doulas Do It Better

Doulas Do It Better


Providing doulas to low-income mothers-to-be could save Medicaid millions.





(PHOTO: MICHAELJUNG/SHUTTERSTOCK)

March 15, 2013 • By Kevin Charles Redmon • No Comments and 12 Reactions Here’s a quick medical quiz: What’s the most common reason for hospitalization in the United States? Take a stab. Respiratory distress? Cardiac arrest?


Try childbirth. As researchers at the University of Minnesota’s School of Public Health observe, more than four million babies are born in American hospitals every year, and from maternal checkups to newborn care, moms-to-be rack up more charges than any other patients. In 2009, those costs totaled nearly $30 billion.


Maternal health care is a big burden on Medicaid, which pays the expenses of low-income patients and annually foots the bill for 45 percent of all births. What’s more, low-income moms have disproportionately high rates of complication and Caesarean section. According to the Minnesota researchers, Medicaid mothers are more likely to give birth prematurely, or to low-weight babies, than more affluent women.


Writing this month in the American Journal of Public Health, Katy Backes Kozhimannil and her colleagues propose a novel way to reduce birth complications and bring down maternal Medicaid costs at the same time: use doulas.

Unlike an obstetrician or delivery nurse, a doula—from the Ancient Greek term for “female servant”—possesses no formal medical training (which also differentiates her from a midwife). Instead, she’s on hand during labor to provide counsel and emotional support to mothers and their partners, not unlike a coach on the sidelines of a tennis match, or a guide leading a first-time climber up a mountain. In addition to serving as a mother’s advocate in the delivery room, doulas also provide pre- and post-partum advice on homebirth, nursing, and infant wellbeing. In an age of high-tech medicine and mommy blogs, a doula fills a rather more traditional cultural role: she’s a confidant, a mentor, a hand to hold in the worst of labor pains.


A 2011 Cochrane Review looked at 21 studies involving 15,000 pregnancies and found that women who were provided a doula’s “continuous support” during childbirth experienced shorter labors, fewer Caesarians, and were less likely to require the use of instruments—forceps, vacuums—or epidural drugs. “Continuous support during labour has clinically meaningful benefits for women and infants and no known harm,” the review concluded. “All women should have support throughout labour and birth.”
Unfortunately, all women don’t. “The women who stand to benefit the most from doula care have the least access to it—both financially and culturally,” Kozhimannil notes. “Most doulas are white middle-class women serving white middle-class women.” And because few private insurers cover a doula’s services, any woman who wants one in the delivery room is forced to pay for the care—often $400 to $800—out-of-pocket.
Kozhimannil wondered if state Medicaid programs might actually reap long-term cost savings by providing their poor patients with doulas, thus avoiding the astronomical hospital bills associated with premature labor, Caesarean section, and neonatal intensive care. (At the moment, just five states allow public funds to pay for labor coaches, according to the Kaiser Family Foundation.) If doulas really did decrease the risk of complicated pregnancies, it would make sense to invest in their services up front, in the same way that it’s cheaper for an insurer to pay for a customer’s gym membership now than to treat her diabetes later.

Everyday Miracles is a Minneapolis non-profit that provides Spanish- and Somali-speaking doulas to mothers on Medicaid—precisely the kind of women that Kozhimannil argues most need their support. The organization’s 22 doulas assisted more than 1,000 births between 2010 and 2012, so Kozhimannil compared their outcomes with 280,000 Medicaid-funded births, presumably few of which were doula-assisted. She found that, as was predicted, Everyday Miracle mothers had 30 percent fewer Caesarean sections than regular Medicaid mothers.

Kozhimannil then projected how much states might save were doulas able to lower C-section rate among all low-income moms as much as they had among Everyday Miracle moms. (According to the University of Minnesota, the average Medicaid payment is about $9,000 for a vaginal birth, but significantly higher—$13,600—for a Caesarean delivery.) Assuming Medicaid could negotiate a standard $200 fee for doula birth services, most states would save at least $2 million a year, and the average would cut costs by $7 million. Populous states stand to see an even bigger windfall: with fewer surgical births, California alone might recoup some $200 million in obstetrics costs.


In the end, of course, it’s about more than money. For low-income expectant mothers and their infants, the stakes are so much higher. But if economic logic is what’s required to compel state governments to act, well, that’s good medicine of a different sort.

Prenatal folic acid supplementation shows protective effect against autism


Friday, March 15, 2013.
     The February 13, 2013 issue of the Journal of the American Medical Association reported the findings of researchers at the Norwegian Institute of Public Health of a protective benefit for supplementing with folic acid early in pregnancy against the risk of giving birth to a child with autism. The vitamin is routinely recommended to women who are pregnant or trying to conceive, to help prevent neural tube defects in their offspring.


The study included 85,176 children who were born between 2002 and 2008 who were followed through March, 2012. Mothers were recruited at 18 weeks of gestation and queried concerning their intake of vitamins, minerals and other supplements. Over the follow-up period, 114 children were diagnosed with autistic disorder, 56 with Asperger syndrome, and 100 with pervasive developmental disorder—not otherwise specified, all of which fall under the umbrella of autism spectrum disorder.
Mothers who consumed folic acid supplements during the period from four weeks prior to conception to their eighth week of pregnancy had a 40 percent lower risk of giving birth to a child diagnosed with autistic disorder in comparison with mothers who did not use the supplements. No association with Asperger syndrome or pervasive developmental disorder was noted, and no association was found for folic acid use during mid-pregnancy. "It appears that the crucial time interval is from four weeks before conception to eight weeks into pregnancy," stated lead researcher Pål Surén, MD, who is a doctoral fellow at the Norwegian Institute of Public Health.

"The findings show that a measure already used here in Norway, one which is simple, inexpensive and without any known side effects among pregnant women, can prevent autism," he remarked. "Previous studies we have carried out have shown that folic acid may have a similar effect on other developmental disorders as well."

"It will be a tremendous breakthrough if it turns out that folic acid also prevents other developmental disorders."

While over 70 percent of the mothers in the study reported supplementing with folic acid during their ninth through twelfth week of pregnancy, just one third were using the supplements before they conceived—a period during which an adequate supply of folic acid is important for the prevention of birth defects.
"We know that there is a genetic component to the body's ability to use folate, so it is possible that some mothers are more prone to folic acid deficiency than others," Dr Surén added.

Thursday, March 14, 2013

What the research says about waterbirth


What the research says about waterbirth
taken from the web site Baby Center

Is it safe to labour and give birth in water?As long as you are healthy and your pregnancy is straightforward it is safe for you to labour in water. There's little difference in the health of babies born to healthy mums who laboured in water compared to babies born to healthy mums who laboured in air (Cluett and Burns 2009).
There is also some evidence that labouring in water is helpful for mums who have had a previous caesarean (Garland 2006). This is provided their doctors are happy for them to use water. The use of water for pain relief is also recommended for women who have been induced. But provision may depend on the reason for induction (NCCWCH 2008).
Evidence for or against the safety for giving birth or delivering the placenta in water is harder to find. Births in water have similar rates of babies needing special care as those for air births (Cluett and Burns 2009). They also have similar Apgar scores and other indicators of the wellbeing of the baby (Cluett and Burns 2009).
Find out more about the safety of water birth.

What effect does water have on the length of labour?Length of labour appears to be similar whether mums-to-be labour in water or not. A 2009 Cochrane Review found no real difference in length of labour between mums who laboured in water and those who laboured in air (Cluett and Burns 2009).

What effect does water have on easing pain in labour?Labouring in water can help you cope with the pain of labour. The 2009 Cochrane Review found that being in water during labour reduced perceptions of labour pain. It also reduced the need for some pain-relieving drugs (Cluett and Burns 2009).
Mums-to-be were much less likely to need an epidural or spinal if they used a pool, tub or bath during the first stage of labour (Cluett and Burns 2009).
No difference in the use of pethidine-type pain-relieving drugs was found between mums-to-be using a birth pool and mums-to-be labouring in air (Cluett and Burns 2009).

What should the temperature of the water be?The National Institute for Health and Clinical Excellence (NICE) recommends that for labouring, the temperature of the water should not be above 37.5 degrees C (NCCWCH 2007: 96).
However, there is little evidence on which the NICE temperature guidance is based. There have been no studies comparing the effects of different water temperatures on the wellbeing of mums and babies (Cluett and Burns 2009).
If you are using a birth pool, your midwife will check both the temperature of the water and your temperature. This is to make sure that you are comfortable and not becoming feverish (NCCWCH 2007). She will also monitor your baby's heart rate at regular intervals, using a waterproof Sonicaid monitor.

When is the best time to get into a pool during labour?The 2009 Cochrane Review looked at women who needed to have their labours speeded up, because their labours had slowed down. They found no difference in the use of ways to speed up labour between those who had laboured in water and those who had not (Cluett and Burns 2009).
Only one study in the review investigated whether getting into a birth pool earlier on in labour (before cervical dilation of at least five centimetres) made a difference. Women who got in early were more likely to have an epidural and to need their labour speeded up, when compared to women who got in later in labour (Cluett and Burns 2009).


This one study had some flaws, though. It wasn't clear what proportion of the women in the early group were in latent or active phases of first stage of labour. Women in latent phase may have been expected to progress more slowly.
The current NICE guideline concluded that there wasn't enough evidence on timing of use of water in labour (NCCWCH 2007). So it should be up to you as to when you want to get in (or out) of a birth pool in labour.

Will I be less likely to need an assisted birth or a caesarean?Not necessarily. The 2009 Cochrane Review looked at the type of birth mums had after they laboured in water or in air for the first stage of labour. It showed no real difference in rates of assisted birth or caesarean birth between the two groups (Cluett and Burns 2009).
Two trials in the review studied the use of water in the second stage (the pushing stage and birth). One found no difference (Cluett and Burns 2009).

The other found a reduced risk of assisted birth for mums who had used water during labour than for those who had not (Cluett and Burns 2009).


A UK study published in 2012 reported that the place of birth had an impact on birth intervention rates, particularly for mums-to-be having their first baby (Burns et al 2012).

Mums-to-be were more likely to have a straightforward vaginal birth when using a birth pool in a community midwife-led unit, compared to an alongside midwife-led unit or a labour ward. Fewer first-time mums also required transfer to hospital in the community setting compared to the alongside units.

What are my chances of tearing if I labour in water?Your chances of tearing are the same whether you give birth in water or in air. The 2009 Cochrane Review found no difference in the likelihood of tearing (Cluett and Burns 2009). Episiotomy rates were also similar.



One study has since suggested that although the rate of tears is similar between water and air births, the incidence of third degree tears may be increased in water births (Cortes et al 2011). In this study the pushing stage tended to be quicker in the water birth group, which could have been a factor.
Another possible factor is the limited extent to which the midwife is physically able to protect the mum-to-be's perineum during water birth (Cortes et al 2011). ReferencesAnderson T. 2004. Time to throw the waterbirth thermometers away. MIDIRS Midwifery Digest 14(3):370–4

Burns et al. 2012. Characteristics, Interventions, and Outcomes of Women Who Used a Birthing Pool: A Prospective Observational Study. Birth 39(3):192-202
Cluett ER, Burns E. 2009. Immersion in water in labour and birth. Cochrane Database of Systematic Reviews (2): CD000111. onlinelibrary.wiley.com [pdf file, accessed January 2013]
Cortes E, Basra R, Kelleher CJ. 2011. Waterbirth and pelvic floor injury: a retrospective study and postal survey using ICIQ modular long form questionnaires. Eur J Obstet Gynecol Reprod Biol 155(1): 27-30
Garland D. 2002. Collaborative waterbirth audit - supporting practice with audit. MIDIRS Midwifery Digest 12(4):508-11
Garland D. 2006. Is waterbirth a "safe and realistic" option for women following a previous caesarean section? Completion of a three-year data study. MIDIRS Midwifery Digest 16(2):217-20
Geissbuehler V, Eberhard J, Lebrecht A. 2002. Waterbirth: water temperature and bathing time – mother knows best! J Paediatr Med 30:371–8
NCCWCH. 2007. Intrapartum care: care of healthy women and their babies during childbirth. National Collaborating Centre for Women's and Children's Health, Clinical guideline. London: RCOG Press. www.nice.org.uk [pdf file, accessed January 2013]
NCCWCH. 2008. Induction of labour. National Collaborating Centre for Women's and Children's Health, Clinical guideline. London: RCOG Press. www.nice.org.uk [pdf file, accessed January 2013]
RCOG/RCM. 2006. Immersion in water during labour and birth. Royal College of Obstetricians and Gynaecologists/Royal College of Midwives, Joint statement 1. www.rcog.org.uk [Accessed January 2013]

http://www.babycentre.co.uk/a542005/what-the-research-says-about-waterbirth#ixzz2NZ4Ca8jQ

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