Archive for the ‘Studies and Statistics’ Category

Weekend Links

Saturday, September 18th, 2010

Last night, I joined the #doulaparty on Twitter – whew! Talk about a birth junkie high! Anyway, I came across some great links this week I’d like to share with you. If you’re one of my facebook friends, you have probably already seen these. Pass them on to your own friends who don’t have facebook accounts! If you haven’t already, please join me on facebook to see the articles I post, to ask questions, or start some discussion groups on all issues birthy.

Linkage

Thursday, December 17th, 2009

This week, I attended my first meeting with the Pikes Peak Regional Doula Association, and will be an official member after next month’s business meeting. I also just signed on with the local Birth Network chapter, and will have a listing in their 2010 resource guide for Colorado Springs.

I am really excited about joining PPRDA! I’ve met several of the doulas, and hope to join the mentoring program, so I can learn from all of the wise women who belong to this organization. I’m also incredibly thrilled about the opportunities for Continuing Education Units (CEU’s), since I’ll need to obtain at least 15 in the next three years to maintain my labor doula certification.

The reality of all of this is finally hitting me. Pretty soon, I hope to be attending at least two births a month, and teaching independent childbirth courses. I especially can’t wait for the opportunity to teach at the local pregnancy center. After all, this is one of the top three reasons I have for becoming a doula in the first place.

In the meantime, I have an over-abundant number of links I want to share with you, but I decided to limit it to five tonight.

Interesting…

Saturday, August 8th, 2009

0407-sci-INFANTSTATS

More About Midwifery: Hoping to Educate

Thursday, January 8th, 2009

For those of you who responded to my earlier Midwives Deliver post, I wanted to back up some of what I said there.

However, I want to make it very clear upfront, that I don’t post this stuff because I think using a midwife or having natural birth is the only right way to have a baby. I believe firmly in a woman’s choices for childbirth – but I also believe firmly that women have given control of their choices (unintentionally) to caregivers, and too often settle for the status quo, when there’s so much more out there for them.

I believe that most women simply don’t know all their options, and my aim is purely to educate and show “the other side.”

I believe that women need to take responsibility for their choices, and that means knowing EVERYTHING you can before you decide what is best for YOU. This, of course, mostly applies to women with low-risk, healthy pregnancies. Outstanding medical circumstances really limit your options, but I still believe that you need to educate yourself about different options for your situation – if there are any. 🙂

I hope that dispels the myth that all natural childbirth and midwifery advocates are self-righteous, holier-than-thou brow beaters (although some are – just like some Dr’s are).

I truly and sincerely hope that the information I post is beneficial, interesting, and helpful to you – not preachy. Although, some of the articles I will post will have a clear bias. It’s impossible to avoid on either side.

Just take everything here with a grain of salt, and look it up yourself. Don’t take my word for anything either. If you have questions, ask. You can’t offend me.

Anyway, here are a few more links from what I believe to be reliable sources:

Infant Mortality: US Ranks 29th

“Evidence-based maternity care uses the best available research on the safety and effectiveness of specific practices to help guide maternity care decisions and to facilitate optimal outcomes in mothers and newborns. Although the field of pregnancy and childbirth pioneered evidence-based practice, resulting in a wealth of clear guidance for evidence-based maternity care, there remains a widespread and continuing underuse of beneficial practices, overuse of harmful or ineffective practices, and uncertainty about effects of inadequately assessed practices.”
-Introductory paragraph from: Evidence-Based Maternity Care: What it is and what it can achieve

CDC Releases New Infant Mortality Data

I got all of the preceding information from Change.org, a reputable activism website. Here is the short article from that site: Legalize and Endorse Certified Professional Midwifery Nationwide

Only 1% of women in this country birth out of hospital. That’s fine with me. I just hope to be a part of bringing evidence-based maternity care into the hospital environment. But never by bringing my own agenda to the birth of a client. My desire, again, is to educate my clients, one at a time, so that they are empowered to make the right decisions for themselves, and come out of their birth experience (no matter what it is) satisfied and at peace with their choices – and with full support from their entire birth team.

I hope this helped you. 🙂

Why Do Hospitals Stop Offering Midwifery Services?

Friday, October 24th, 2008

“Research published [in 2007] concluded that hospitals’ articulated reasons for closing or placing limits on their related midwifery services are not necessarily what is motivating such moves.

Looking at two cases in which hospital-affiliated midwifery services had good outcomes, the researcher in this report conducted 52 detailed interviews with midwives, nurses, administrators, childbirth educators, policymakers and physicians and reviewed archived data such as e-mail, policy statements and memos.

In one of the cases, the hospital had claimed that too many of the women served were high-risk, so midwifery was not safe. In the other case, an increase in malpractice insurance was given as the reason for closure. No documentation backed up either of these claims; and the interviews and data analysis showed that the midwifery practice in fact represented competition for the hospital, doctors or both. In other words, the hospitals and doctors got less business if women had access to midwives, yet the public messages related to safety and liability.

The author of the study also pointed out that the US medical education system pays subsidies for medical residents, creating a disincentive to using midwives. Finally, she noted that since most state laws require that midwives be overseen by doctors, they are dependent on their competition, putting them at a disadvantage.

This small study reflects the reality that health care, as we know it in the US, is not necessarily about providing the best care for citizens, but about protecting the interests of the system. The logic of cost-saving and efficiency is also lost in this system.”

— Social Science & Medicine 65(3): 610–21

I read this today in my Midwifery Today E-News. I was not really surprised, but still, it’s kind of disgusting to me.

I think I’d definately like to see more research done into this topic. And of course, I think this is a generality that applies to the overall system, and is not going to apply to every hospital everywhere in the country. However, I think it underlines the need for real information to get into the hands of the women who make the choices about where to give birth…hence my decision to become a doula.

Small Pitocin Study

Friday, August 1st, 2008

**UPDATED** in response to Susan’s comment. You’re right, this small study was conducted for a doctorate thesis, I believe. It in no way encompasses the size and scope of an “official” medical study. It was posted on my doula boards, and I found it interesting, and wanted to share it with my readers. I did find a link to her actual study online – along with a downloadable PDF copy.

I’m sorry I couldn’t provide more for you. However, as I said, I don’t treat this study as something authoritative. Just interesting, and I think it merits some follow-up that is authoritative and farther-reaching than this student could provide.

Here is the link for you: SUMMARY OF FINDINGS OF THE STUDY. I hope this helps – even if it just lets you know the official source. 🙂

Thank you for your question!

The Relationship between Artificial Oxytocin (Pitocin) Use at Birth for Labor Induction or Augmentation and the Psychosocial Functioning of Three-year-olds

SUMMARY OF FINDINGS OF THE STUDY
Claire L. Winstone, Ph.D.

The focus of my dissertation research study was, as you can see by the above title, an exploration of whether there is any relationship between the use of Pitocin (artificial oxytocin) to start or speed up labor, and the way children born with its use function individually and in their relationships when they are three years old. I was interested in Pitocin use because what I read suggested that around two-thirds of inductions are now for non-medical reasons, but there wasn’t a lot of research to tell us whether there were any specific consequences to the child of this use.

Before starting this research I first interviewed six therapists who work with babies, children, and adults to resolve issues arising from challenging prenatal or birth experiences. All the therapists had worked with clients who had been born with the use of Pitocin. The therapists told me what they had observed and learned about their clients and the role they thought Pitocin played in their functioning. I performed a content analysis on the interview transcripts, and about two years later, had a long list of “items” that eventually became the raw material for a survey to be conducted with mothers of three-year-old children. I sent this list to the six therapists with a voting form, and they helped me select which items best represented the various areas of functioning about which I planned to ask the mothers.

Eventually, this list became the survey you were invited to complete. Ultimately, I had 498 completed surveys that could be analyzed to see if Pitocin use appeared to be related to a difference in how three-year-olds functioned. The following is a summary of the findings that were statistically significant.

1. Receiving Pitocin resulted in more negative recollections of labor and delivery, suggesting that mothers who received it had a more challenging experience than those who didn’t. However, there was a similar finding for the use of epidural anesthesia and for pain medication, both of which tend either to precede or follow the use of Pitocin.

2. Mothers who received Pitocin spent less time with their babies in the first hour after delivery, and were less likely to feed their babies exclusively at the breast in the first six months. In other words, babies who were born without Pitocin were more likely to be fed exclusively at the breast in the first six months than those born with Pitocin

3. Two factors distinguished children born with Pitocin from those born without Pitocin.

The first was called “Assertiveness” , which describes a socially appropriate way that babies and children communicate their need for help and comfort when they are feeling uncomfortable or unsafe. Typically, crying, using facial expressions and physical gestures, and later, verbalizing their thoughts and feelings, elicits helpful responses from parents, who try to identify and meet the need the baby or child is expressing. However, babies born with Pitocin, whose mothers reported having had a more challenging time during labor and delivery, appear to have a higher need to be assertive because they seem to experience more discomfort, but are apparently less effective in asserting their needs and getting them met when they feel unsafe or uncomfortable.

The second factor was called “Need to Control Environment” and this summarizes what seems to be a higher level of discomfort or insecurity, particularly in response to “outside-in” influences (e.g., reacting to food with digestive problems or being picky eaters; problems coping with other people’s timing and structure, refusing help from others) and increased or exaggerated efforts to control their environment, resulting in behaviors that may be more challenging to their mothers/family. There appears to be some continuity of effects between infancy and age three: for example, children who were described as picky eaters, or as having digestive problems at three, were likely to have been colicky, fussy babies. Interestingly, the hormone oxytocin is very involved in the digestive process: it plays a role in the production of digestive enzymes and as we enjoy our meal, in a positive feedback loop, we produce more oxytocin.

It may be that a process described as “hormonal imprinting”, identified in a considerable number of animal studies since the 1970s, is the mechanism that accounts for these differences between children exposed to Pitocin and those who were not. Using Pitocin to initiate labor may “flood” the available oxytocin receptors in mother and baby, apparently affecting children’s internal comfort levels and how they interact with others, although how this takes place in the babies has not yet been studied. Since both mother and baby receive Pitocin during labor and delivery, it is as yet unclear to what degree each contributes to challenges in their mutual relationship.

Claire L. Winstone, Ph.D.
Santa Barbara Graduate Institute
July 2008

Doula support reduces cesarean and epidural rates.

Saturday, June 7th, 2008

Source: Birth 2008; 35: 92-7

Examining the perinatal effects of doula support for nulliparousmiddle-income women accompanied by a male partner during labor and delivery.

MedWire News: The continued presence of a doula during labor significantly reduces cesarean delivery rates and the need for epidural analgesia in middle- and upper-class US women accompanied by their male partner or another family member, researchers report.

They suggest that maybe fathers should not be expected to fulfill the role of primary labor companion. Susan McGrath and John Kennell from Case Western Reserve University, Cleveland, Ohio, USA, investigated the potential benefit during labor of an experienced doula to provide both emotional and instrumental support.

A total of 420 women were randomly assigned to either have a doula present throughout labor in addition to their male partner or no such additional support. Women who had the support of a doula had a significantly lower cesarean delivery rate than the control group, at 13.4 percent versus 25.0 percent.They were also less likely to need epidural analgesia, at 64.7 percent versus 76.0 percent, respectively.

Among women with induced labor, just 12.5 percent of women with a doula had a cesarean delivery, compared with 58.8 percent of those without a doula.

All women and their male partners who received the support of a doula rated their experience as positive. “Continuous labor support by a doula is a risk-free obstetric technique that could benefit all laboring women and should be made available in all maternity units,” the researchers conclude.

Posted: 03 June 2008(c) 2008 Current Medicine Group Ltd, a part of Springer Science+BusinessMedia

Possible biological explanation for C-section-linked allergies and asthma found.

Friday, May 23rd, 2008

“Scientists believe they may have identified a biological explanation for the link between cesarean-section delivery and risk of allergy and asthma in childhood. They will present their findings at the American Thoracic Society’s 2008 International Conference in Toronto on Tuesday, May 20.

‘This finding is exciting because it suggests that the mode of delivery may be an important factor influencing immune system development in the neonate,’ said Dr. Ly, who postulated that the stress and process of labor itself or exposure to specific microbes through the birth canal in vaginal as compared to c-section delivery may influence neonatal immune responses.” (emphasis mine)
~Full Article at Physorg.com

Gee whillikers…are they really telling us what we’ve suspected to be the truth all along? That c-sections have many many risks, and that they should be reserved for those times they are medically indicated? That vaginal birth is the safest way to birth – for mom & baby both – the vast majority of the time?

Think of it this way: Vaginal birth is not a lofty goal to be achieved. Rather, pretty much every other birth method is inferior to vaginal birth in its ability to prepare the newborn for life outside the womb. Vaginal birth is safe. It is normal. Billions of women have done it for thousands of years. It is not impossible, or abnormally difficult.

Please remember that I attach no morality to whatever method a woman chooses to birth. And I firmly believe that women should be able to choose how and where to birth. However, too many women make choices without being truly fully informed. And it can lead to so many serious complications – mentally, physically, and emotionally.

I also believe that women have been misled for too long, and it’s about time that they take responsibility for their decisions, become proactive, and learn all they can about birth & their choices regarding it.

Breastfeeding Brain?

Wednesday, May 7th, 2008

Breast-fed babies found smarter.

I have a theory about this. I think that there is an invisible tube leading from your brain to your breast. And in that tube flows all of a mother’s best brain cells – straight into her infant’s mouth.

If that doesn’t explain “mom-brain” (and I know you know what I’m talking about), I don’t know what does!