- 6_2_12 Risk of Severe Postpartum Hemorrhage in Low-Risk Childbearing Women in New Zealand
Exploring the Effect of Place of Birth and Comparing Third Stage Management of Labor
SUMMARY — Primary postpartum hemorrhage is a leading cause of maternal mortality and morbidity internationally. Research comparing physiological (expectant) and active management of the third stage of labor favors active management, although studies to date have focused on childbirth within hospital settings, and the skill levels of birth attendants in facilitating physiological third stage of labor have been questioned. The aim of this study was to investigate the effect of place of birth on the risk of postpartum hemorrhage and the effect of mode of management of the third stage of labor on severe postpartum hemorrhage.
- 5_2012 What to Reject when You’re Expecting
SUMMARY — Ten procedures to think twice about during your pregnancy. Despite a health-care system that outspends those in the rest of the world, infants and mothers fare worse in the U.S. than in many other industrialized nations. The infant mortality rate in Canada is 25 percent lower than it is in the U.S.; the Japanese rate, more than 60 percent lower. According to the World Health Organization, America ranks behind 41 other countries in preventing mothers from dying during childbirth.
- 3_29-_2012 Homebirth Midwives and the Hospital Goliath: Evidence Builds for Disruptive Innovation
SUMMARY — ”Midwives have a central focus in our strategic plan. We are hoping Washington State can double out-of-facility births in the next two or three years.” – Jeff Thompson, M.D., MPH
- 9_23_2011 Your OBGYN’s Personal Beliefs Could Ruin Your Birth
SUMMARY — Not everyone who leans toward natural birth practices started there — many have had bad experiences in hospitals or have been close to women who have. Sometimes it’s women who read incredible amounts of literature on pregnancy long before peeing on the stick. It’s not just patchouli-wearing, long-haired, barefoot hippies. It’s law students, businesswomen, head of your PTA — anyone. Especially with homebirth on the rise, it’s safe to assume it’s no longer just a fringe group of “weirdos.”
- 9_16_2011 OB-GYN Guidelines Often Based on Opinion, Weak Data
SUMMARY — Solid evidence is often missing from the practice guidelines used by obstetrician-gynecologists across the U.S., a new study shows.
- 8_14_2011 Maternal IV Fluids Linked to Newborns’ Weight Loss
SUMMARY — A newborn baby’s weight loss is often used to determine how well a baby is breastfeeding, and concern about a baby which loses too much weight may result in supplementing breastfeeding with formula. However, many women receive IV fluids during labor, and new research published in BMC’s open access journal International Breastfeeding Journal shows that some of a newborn’s initial weight loss may be due to the infant regulating its hydration and not related to a lack of breast milk.
- 7_7_2010 Critique of a meta-analysis by Wax and colleagues
Critique of a meta-analysis by Wax and colleagues which has claimed that there is a three-times greater risk of neonatal death among babies without congenital anomalies planned to be born at home
SUMMARY — Along with other previous researchers, Wax and colleagues found no difference in the safety of planned home birth and planned hospital birth for women without known risk factors when comparing perinatal mortality rates, the usual measure of safety. They found a two-fold increase risk for all planned home birth babies in what they called neonatal mortality, rising to a three-fold risk for those without congenital anomalies. Is there really evidence that there is a three-times greater risk of neonatal death among ‘non-anomalous’ babies planned to be born at home, based on the Wax et al meta-analysis (2010)? In summary, NCT has found that this study has serious methodological limitations.
- 6_2010 Cruelty in Maternity Wards: Fifty Years Later
SUMMARY — Fifty years have passed since a scandal broke over inhumane treatment of laboring women in U.S. hospitals, yet ﬁrst-person and eyewitness reports document that medical care providers continue to subject childbearing women to verbal and physical abuse and even to what would constitute sexual assault in any other context. Women frequently are denied their right to make informed decisions about care and may be punished for attempting to assert their right to refusal. Mistreatment is not uncommon and persists because of factors inherent to hospital social culture. Concerted action on the part of all stakeholders will be required to bring about systemic reform.
- 3_14_2010 Sunday News Round-Up, NIH VBAC+ Edition
SUMMARY — First up, some posts on the NIH VBAC Consensus Conference: CNM at Midwife Connection: A Midwife’s Take on the NIH VBAC Consensus Conference. Science & Sensibility: Do women need to know the uterine rupture rate to make informed choices about VBAC? – asking whether the oft-mentioned uterine rupture risk is the main issue. Momotics: around-up of coverage there and links to coverage by others. The Unnecesarean: NIH VBAC Consensus Development Conference: Gift Horse or Trojan Horse?, By Courtroom Mama on the refusal question. PinkyRN is not sure she wants anything to change: Vbacs, sea glass and peacefullness — “I do not think Vbacs are going to become assessable to women. I don’t agree with it but I understand the mechanisms…Not sure I personally want to go back and take those risks anymore. Not sure I want to worry not only about my patients health but the legal risk and the insurance burden that I will incur.”
- 3_12_2010 Deadly Delivery-The Maternal Health Care Crisis in the USA
SUMMARY — The report analyzes the barriers to health care that result in our country’s troubling maternal mortality and morbidity statistics. Among other issues, the report examines discrimination; financial, bureaucratic and language barriers to accessing care; information about maternal care options; participation in care decisions; staffing and quality questions; and accountability and oversight. This report is based on research carried out during 2008 and 2009 by Amnesty International USA (AIUSA). Amnesty International conducted over 100 in-depth interviews and 17 focus groups with women, their families, activists, advocates, public health experts, support workers, service providers and health workers in central Wisconsin; Memphis, Tennessee; Boston, Massachusetts; Washington, DC; Baltimore, Maryland; and New York City; as well as people from across the USA involved in maternal health care. The names and other personal details of some of those who spoke to Amnesty International have been withheld in order to respect their requests for privacy.
- 3_12_2010 Transforming Maternity Care — A Blueprint for Action
SUMMARY — The healthcare reform discussion now includes the problem of increasingly expensive maternity care in the United States, and troubling outcomes for women and newborns. Childbirth and birth-related conditions are the most common reasons for hospital care, accounting for one-fourth of hospital discharges in 2007. In that year, cesarean delivery was the most common operative procedure in the country, comprising 31.8% of births. Meanwhile, the incidence of vaginal birth after cesarean (VBAC) has declined to 9.7% (from 35.3% in 1997).[1,2] In the past 2 decades, rates of preterm birth have increased to 12.7%, and low birth weight to 8.2%. In 2006, charges for “mother’s pregnancy and delivery” and “newborn infants” were $86 billion — far exceeding charges for any other hospital condition.
- 2_25_2010 Science and Sensibility: Choice of Birth Place in the United States
Saraswathi Vedam, CNM, MSN, SciD(hc); Patricia A. Janssen, RN, BSN, MPH, PhD; Ronnie Lichtman, CNM, PhD
SUMMARY — Rates of planned home birth in the United States have remained at less than 1% for several decades, but current public discourse suggests that women are increasingly interested in this option. International investigators have defined “planned home birth” as the care of selected pregnant women by qualified practitioners within a system that provides for hospitalization when necessary. Safety of birth in any setting is of utmost priority and has been the focus of home-birth research and current professional and public debate. Many women and their families are aware that, in national and international settings, home births conducted in environments of multidisciplinary communication and integration of resources are associated with similar perinatal outcomes and fewer obstetric interventions compared with hospital births.
- 2_4_2010 Do We Need To Revisit VBAC Guidelines For Women With Three Or More Prior Caesareans?
SUMMARY — New research to be published in BJOG: An International Journal of Obstetrics and Gynaecology has found that women with three or more prior caesareans who attempt vaginal birth have similar rates of success and risk for maternal morbidity as those with one prior caesarean, and similar overall morbidity (adding vaginal births and emergency caesareans together) as those delivered by elective repeat caesarean.
- 2_4_2010 Do We Need To Revisit VBAC Guidelines For Women With Three Or More Prior Caesareans?
American College of Obstetricians and Gynecologists
SUMMARY — New research to be published in BJOG: An International Journal of Obstetrics and Gynaecology has found that women with three or more prior caesareans who attempt vaginal birth have similar rates of success and risk for maternal morbidity as those with one prior caesarean, and similar overall morbidity (adding vaginal births and emergency caesareans together) as those delivered by elective repeat caesarean. Planned vaginal birth after caesarean (VBAC) refers to any woman who has experienced a prior caesarean birth who intends to try for a vaginal birth rather than to deliver by elective repeat caesarean. Although relatively low complication rates, including uterine rupture, have been demonstrated among women with two prior low-transverse caesareans who attempt vaginal birth, there are very limited data available on outcomes among women with more than two prior caesareans. Neither the American College of Obstetricians and Gynaecologists (ACOG) nor the Royal College of Obstetricians and Gynaecologists (RCOG) currently recommend planned VBAC attempt in women with three or more prior caesarean deliveries.
- 8_2009 Abuse in Hospital-Based Birth Settings?
SUMMARY — Are laboring and birthing women treated abusively in the hospital? Although seldom recognized as abuse or violence against women, bullying and medical treatments under false pretenses, even in a hospital, constitute abuse and a basic human rights issue that needs attention. Naming the problem is a first step. The power of medical authority, the lack of accountability in the hospital hierarchical system, policies and protocols, and expectations of compliancy all make an environment ripe for abuse and present obstacles for both women and staff to recognize or stop abuse. Learning to recognize abuse and take effective action, and understanding the legal requirements for “informed consent” can help, but ending abuse will require systemic change.
- 4_21_2009 Mommy, What Did You Do in the Industrial Revolution?
Meditations on the rising cesarean rate
SUMMARY — As the cesarean rate rises in the United States, it is sometimes hailed as a move toward increased safety or increased autonomy. But the industrialization of birth may have consequences which actually decrease women’s autonomy and strip choices away.
- 4_15_009 Netherlands Study on Low Risk Planned Home and Hospital Births
SUMMARY — This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.
- 1_31_2009 Born in the USA: Exceptionalism in Maternity Care Organisation Among High-Income Countries
SUMMARY — The kind and quality of maternity care available to certain groups of US women (and not others) is influenced by historical developments, the portrayal of childbirth in the mass media, the way in which both the health care system and the accompanying health insurance system is organised, the risk of litigation experienced by obstetricians, and by inter-professional conflict rather than collaboration.
- 1_30_2009 Sonogram Able to Predict Uterine Rupture Risk for Women Attempting VBAC
SUMMARY — Repeat cesarean deliveries are an obvious concern. “There is a growing concern about the increase in cesarean births because there is a body of evidence showing that they are associated with higher rates of maternal and infant complications,” said lead author Emmanuel Bujold, MD, Department of Obstetrics & Gynecology, Universite Laval, Laval, Quebec. “There are far fewer complications to the mother and infants as a result of a vaginal birth, so it is important to determine when a patient with a history of prior cesarean section can have a vaginal birth safely.”
- 2009 Births Financed by Medicaid as a Percent of Total Births, 2009
SUMMARY — Births financed by Medicaid as a percent of total births in 2009.
- 2009 Medicaid Coverage of Delivery Care, 2009
SUMMARY — Medicaid coverage of delivery care in 2009 shown on a map.
- 11_2008 Labor Before a Primary Cesarean Delivery: Reduced Risk of Uterine Rupture in a Subsequent Trial of Labor for Vaginal Birth After Cesarean
SUMMARY — Labor before the primary cesarean delivery can decrease the risk of uterine rupture in a subsequent trial of labor. A history of primary cesarean delivery preceded by spontaneous labor is favorable for VBAC.
- 4_20_05 Outcomes of Planned Home Births with Certified Professional Midwives: Large Prospective Study in North America
SUMMARY — 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 countries. Views are particularly polarised in the United States, with interventions and costs of hospital births escalating and midwives involved with home births being denied the ability to be lead professionals in hospital, with admitting and discharge privileges. Although several Canadian medical societies and the American Public Health Association have adopted policies promoting or acknowledging the viability of home births, the American College of Obstetricians and Gynecologists continues to oppose it.