Some Birth Research Headlines

Courtesy of the Lamaze Institute for Normal Birth Research Summaries:

Prenatal Diagnosis of Suspected Fetal Macrosomia Increases Risks of Cesarean Section and Maternal Morbidity without Improving Newborn Outcomes

Sadeh-Mestechkin, D., Walfisch, A., Shachar, R., Shoham-Vardi, I., Vardi, H., & Hallak, M. (2008). Suspected macrosomia? Better not tell. Archives of Gynecology and Obstetrics, doi: 10.1007/s00404-008-0566-y.

"An initial suspicion that the baby is large may instill fear in the pregnant woman which may impede both her confidence in her body and her labor progress. Slow labor progress reinforces the suspicion that the baby is big and more aggressive management ensues. This management often hinders the woman's ability to move freely and assume the positions that may help her baby negotiate through her pelvis, further slowing progress and reinforcing the perceived need for surgical intervention. Based on this study and previous evidence, women should strongly consider refusing tests late in pregnancy intended to estimate fetal weight.

"The estimate itself may be bad for her health because the care provider's expectation that the baby will be macrosomic appears to increase both unnecessary medical intervention and the morbidity that may accompany it" (exerpt from the Lamaze Research Summary).

Women Having Spontaneous Vaginal Birth Without Episiotomy Least Likely to Experience Postpartum Pain

Declercq, E., Cunningham, D. K., Johnson, C., & Sakala, C. (2008). Mothers' reports of postpartum pain associated with vaginal and cesarean deliveries: Results of a national survey. Birth, 35(1), 16-24.

"One argument made for elective cesarean surgery is that it avoids the pain of labor. Its proponents also allege that surgery occurring before labor offers advantages over intrapartum surgery. This study, however, finds that women having cesarean surgery are more likely to experience pain that interferes with routine activities and to experience long-term pain than women birthing vaginally and that timing of the surgery makes no difference.

"Women considering elective surgery to avoid labor pain should be advised that while labor pain can be controlled, cesarean surgery substantially increases their risk of experiencing many months of pain postpartum or pain that affects their quality of life. Instrumental vaginal delivery likewise increases the probability of experiencing perineal pain in both the short and long term compared with spontaneous vaginal birth" (exerpt from the Lamaze Research Summary).

Prenatal Yoga May Result in Less Labor Pain, Shorter Labor

Chuntharapat, S., Petpichetchian, W., & Hatthakit, U. (2008). Yoga during pregnancy: Effects on maternal comfort, labor pain and birth outcomes. Complementary Therapies in Clinical Practice, 14(2), 105-115.

"This study provides evidence that regular yoga practice in the last 10-12 weeks of pregnancy improves maternal comfort in labor and may facilitate labor progress. The researchers offer several theories for these effects. First, yoga involves synchronization of breathing awareness and muscle relaxation which decrease tension and the perception of pain. Second, yoga movements, breathing, and chanting may increase circulating endorphins and serotonin, "raising the threshold of mind-body relationship to pain" (p. 112). Third, practicing yoga postures over time alters pain pathways through the parasympathetic nervous system, decreasing one's need to actively respond to unpleasant physical sensations.

"Prenatal strategies that help women prepare emotionally and physically for labor may help reduce pain and suffering and optimize wellbeing in childbirth by providing coping skills and increasing self-confidence and a sense of mastery. More research is needed to confirm the findings of this study. However, yoga's many health benefits and the lack of evidence that yoga is harmful in pregnancy or birth provide justification for encouraging interested women to incorporate yoga into their preparations for childbirth" (exerpt from the Lamaze Research Summary).

No wonder the mermaids do it...

Seashells. Who'd have thought? I just finished reading Amanda Dumenigo's article at Mothering.com ("Seashells"). Apparently women have been placing seashells on their breasts for thousands of years. They are used to treat all types of sores, infections, cracking, and bleeding. For Amanda Dumenigo, they were a life-saver as she struggled to get a proper latch and establish breastfeeding with her infant. Her story hit close to home for me. I, too, struggled with these same breastfeeding trials. I used all sorts of man-made objects to try to make things work. Eventually, I was breastfeeding without any trouble at all. But I wish I had known about seashells back then. It sounds a little strange, but at the same time so right and natural. I'm always amazed when I see how God and nature have given us everything we need.

Solace for Mothers

I just became aware of a website devoted to helping women recover from traumatic birth experiences--Solace for Mothers. I often wonder whether the incidence of postpartum depression is so high in the U.S. partly because the incidence of negative birth experiences is also very high. A positive birth experience is surely a strong springboard into motherhood. Solace for Mothers explains:

For many women, childbirth is an empowering, expansive experience. And for some, childbirth brings dashed dreams, grief, and the unshakable sense that your body and your mind are damaged. Some women feel betrayed by their care providers and the place in which they birthed. Sometimes fate itself interferes when the baby comes too soon, bearing health problems or even, tragically, when the baby does not survive. Even when birth is “normal,” some women are stunned to discover that bonding with their babies grows over a period of time rather than unfolding all at once. . . .

Solace for Mothers provides healing after traumatic childbirth through support. Support—in the form of a free telephone call with a trained peer counselor, in-person facilitated meetings to listen to and share birth-related stories in a safe and confidential setting, as well as referrals to community resources—is available by calling one number: 1-877-SOLACE4 (1-877-765-2334). We are also in the process of launching an online community for women dealing with these issues. (source)

The creators of our new discussion board would like you to know that you are not alone. Other women have felt traumatized, deeply disappointed, or even violated by their birth experiences. Birth trauma is very real. We are here to offer you an online meeting place to share and connect with other women who have had similar experiences, and a place for you to begin your healing journey. (source)

I'm so grateful for groups like Solace for Mothers who recognize the way birth experiences can profoundly affect women for good or bad. I never lose hope that as more and more people become aware of the problems with maternity care and demand change, more and more women will come away from their births being affected profoundly for good.

Two Tidbits Courtesy of Midwifery Today

I subscribe to Midwifery Today's weekly E-News, and found a couple of things in today's email worth mentioning.

Induction and Meconium Aspiration Syndrome

Part of this issue of E-News contained an excerpt from a Midwifery Today article entitled, "The Problem Is Induction, Not Meconium," by Gail Hart. Meconium is the fetus's thick, dark-colored first bowel movement, and, when found in the amniotic fluid, it is a sign of fetal distress. Meconium itself is not generally a problem unless it gets into the fetus's lungs--meconium aspiration syndrome (MAS). It is generally accepted that meconium is more common the longer the pregnancy goes, but that may be simply because those pregnancies are most likely to be induced. Gail Hart shares the findings of a study indicating that the factor most strongly associated with MAS was induction, not being postdates. This makes sense when you remember that drug-induced contractions can be abnormally intense and long, restricting oxygen supply to the fetus. It follows that fetuses being born by induction would experience more distress. Just one more strike against pitocin/induction in my book, as if I needed any more. Check out the actual excerpt from Gail Hart's article here.

Infant Formula and DHA/ARA

The other tidbit I wanted to share was especially disturbing. I have for the past few years been a big proponent of everyone making sure they get their omega-3 fatty acids, especially DHA, but this issue of E-News shared the dark side of the omega-3 craze as it applies to infant formula.

Based on a report presented by the Cornucopia Institute (a corporate watch-dog group), the DHA/ARA added to many infant formulas is created from fermented algae and fungus and is structurally different than the DHA/ARA found in breast milk. The FDA isn't even convinced of the safety of these algal and fungal DHA/ARA additives! Apparently some infants fed DHA/ARA formula have even suffered from severe diarrhea, vomiting, dehydration, and seizures until being switched to a non-DHA/ARA-supplemented formula. Some infants even suffered death. Despite the FDA's reservations, these additives were somehow still approved for infant/human consumption.

Formulas supplemented with DHA/ARA are marketed as being "more like breastmilk," suggesting to consumers that they are somehow healthier than other formulas. In fact, scientific studies are inconclusive regarding the benefits of these DHA/ARA additives. Martek Biosciences Corporation, a manufacturer of these additives even acknowledges: "Even if [DHA/ARA] has no benefit, we think it would be widely incorporated into formulas, as a marketing tool and to allow companies to promote their formula as 'closest to human milk'"(source). Here's what the Cornucopia Institute concludes about the motives of infant formula manufacturers: "Given the safety concerns and doubts within the scientific community, it is clear that the infant formula manufacturers’ claims are marketing tools designed to sell more formula, and sell it at a higher price"(source). So what it really comes down to is money. Are we really surprised? Of course not. They're corporations and it's their job to make money. Adding DHA/ARA sells more formula, regardless of the fact that it's very different from the DHA/ARA in breastmilk and may actually be dangerous.

Unfortunately, parents are too busy or too trusting to ask any questions about it. I know for a fact that, if I had needed to feed my infants formula, I would have gone with the DHA/ARA version because I would have believed it was better. Get this... just yesterday I bought some Yoplait drinkable yogurt. Which kind did I pick? The one that said "with DHA" on it, of course! I looked at the label this morning, and, sure enough, it has "omega-3 DHA algal oil"--the very stuff implicated the Cornucopia Institute's report! Marketers certainly aren't stupid. They know omega-3 DHA is all the rage. I'm especially prone to buy into the notion that anything with DHA is better, regardless of where that DHA came from. Oops.

Included in the Cornucopia Institute's report is the following disturbing tidbit (evidence that infant formula marketers have done their job very well): "According to the National Alliance for Breastfeeding Advocacy, mothers have contacted health care providers asking the following: 'I want the breast milk formula,' or 'I want the formula with breast milk in it,' and asking questions such as 'whose breast milk is in the formula?'"(source). Oh my.

While I do find all of this disturbing, I also recognize and accept that infant formula is a life-saver for infants who are unable to breastfeed. And, given this fact, I do believe that formula manufacturers should do everything they can to create a product as close as possible to breastmilk. Unfortunately, in the end, it's just a sort of lost cause because breastmilk is something technology, no matter how advanced, cannot duplicate. While formula saves some lives, it will never be ideal. I'll end with this quotation from the International Baby Feeding Action Network:

"While researchers fiddle with the balance of fatty acids in infant formula, and deal with the additional uncertainties of the complex cascade of interactions that each adjustment provokes within the omega families, breast milk will always be the simple, perfectly balanced source of each essential nutrient."(source)

For more info, see...
Midwifery Today, Volume 10, Issue 11
"Replacing Mother — Imitating Human Breast Milk in the Laboratory"
"C-sections, breastfeeding, and bugs for your baby," by Jeff Leach

New Citizens for Midwifery/Coalition for Improving Maternity Services Fact Sheet

I just got this email from Susan Hodges:

Dear Friends,

CfM created a well-received poster for the Coalition for Improving Maternity Care (CIMS) conference in February titled “What Does Good Maternity Care Look Like?”, and we have made a hand-out version. The colorful flier (which also looks good in black and white) includes the Midwives Model of Care, CIMS’ Ten Steps of Mother Friendly Care, and Lamaze’s “Six Care Practices that Support Normal Birth”, side by side, with their urls, with the caption “Supporting evidence-based care, and promoting healthy mothers and babies!”

We have now posted this flier at: http://www.cfmidwifery.org/pdf/ThreeModelsofCare.pdf

Please feel free to print it out and use it for classes, conferences, whatever. It gives a powerful message of “you don’t have to take my word” for what constitutes good maternity care!

Sincerely,
Susan Hodges