Science & Sensibility

A neat new blog from Lamaze International, Science & Sensibility, a "research blog about healthy pregnancy, birth & beyond". Looks wonderful already.

Thanks to Molly of Citizens for Midwifery for pointing it out.

The "Swine Flu" and Pregnant/Breastfeeding Women

The CDC yesterday issued some guidance for healthcare providers in treating pregnant and breastfeeding women who have or may have the swine influenza A (H1N1) virus. The CDC notes that the flu can be more severe in pregnant women, with a higher risk of complications for the baby, especially if the mom develops pneumonia.

On the subject of breastfeeding, the CDC's advice - which is applicable for pretty much any illness, not just the flu - is as follows:

Infants who are not breastfeeding are particularly vulnerable to infection and hospitalization for severe respiratory illness. Women who deliver should be encouraged to initiate breastfeeding early and feed frequently. Ideally, babies should receive most of their nutrition from breast milk. Eliminate unnecessary formula supplementation, so the infant can receive as much maternal antibodies as possible.

If a woman is ill, she should continue breastfeeding and increase feeding frequency. If maternal illness prevents safe feeding at the breast, but she can still pump, encourage her to do so. The risk for swine influenza transmission through breast milk is unknown. However, reports of viremia with seasonal influenza infection are rare.

It is important to note that by the time a woman shows symptoms of an illness, her baby has already been exposed, so she should never stop breastfeeding or be separated from the baby when sick. There are only a couple notable exceptions to this rule - tuberculosis and HIV come to mind. But for almost all diseases, a sick mother should breastfeed more, not less.

More "news" we already knew: Don't lie on your back when you are in labor

Remaining active and mobile during labor can shorten the first stage and results in less discomfort for moms:

Women who walk, sit, kneel or otherwise avoid lying in bed during early labor can shorten the first stage of labor by about an hour, according to a new Cochrane evidence review.

Women who labored out of bed during the early stages were also 17 percent less likely to seek pain relief through epidural analgesia, the review found.

This is not only for physiological reasons, such as widening the pelvis and optimizing fetal position, but "[o]ther research has found that feeling in control and able to make choices reduces pain and psychological distress in general." If fact, lying on your back during labor can be dangerous:

[l]ying flat on one's back during labor can put a great deal of pressure on the blood vessels in the abdomen. "There is widely accepted physiological evidence that the supine position may be harmful in late pregnancy and labor," [lead review author Annemarie] Lawrence said.

According to the reviewers, the supine position puts the entire weight of the pregnant uterus on the blood vessels that supply oxygen to both mother and child, which could potentially lead to problems with heart functioning in the mother and reduced oxygen to the baby. These outcomes could be serious in extreme cases. Lying on one's side has no link with such problems, however.

So why do so many women labor in bed?

[Teri] Stone-Godena[, director of midwifery at the Yale School of Nursing,] said that despite all the attention given to empowering women to have the type of birth experience they prefer, medical professionals still pressure women into lying in bed during labor, because it is more convenient this way for nurses and doctors - and makes fetal monitoring easier.

"I think this research is very vindicating of women being allowed to assume positions of comfort," she said. "Listening to their bodies is what they need to do. Most of time when we limit people's activity, it isn't for reasons that are soundly based on evidence."

She added, "This clearly shows that there are no advantages in staying in bed unless that's where you want to be."

Generally speaking, if a particular labor position causes you increased pain or discomfort, it's not a good one to be in - for you or the baby. Pain is your body's way of letting you know you need to change what you are doing.

Link to article.

Baby News - the Joy and the Sorrow

Hello everyone!

When I started this blog, it's purpose was two-fold; first, to be my pregnancy journal for my third pregnancy (now a very busy three-year-old). I posted pretty much every week during the second & third trimesters, and a couple times while in labor. Second, the blog was to be a place to post interesting and helpful links about pregnancy, childbirth, breastfeeding, and infant care. I do a lot of research & reading and I just needed to share it. Isn't that why anyone has a blog? To share their stuff with the world?

This summer I became pregnant with Baby #4. If you were paying attention, you would have noticed that in July I noted that I would be taking a break from blogging, and did not post again until October 15th, National Pregnancy and Infant Loss Remembrance Day. In mid-August, at 11 weeks, I began bleeding heavily and a sonogram revealed an embryo that had stopped growing about three weeks prior and had no heartbeat. Needless to say, we were sad and also a bit surprised, since I had already produced three children without incident. The actual miscarriage process went as smoothly as could be expected and so we were blessed in that. Baby #4's due date was March 7, just a month ago.

In November we discovered that we were expecting Baby #5. We were neither "trying" nor not trying, but rather were monitoring closely (BTW, if you are a woman of childbearing age and haven't yet read Toni Weschler's Taking Charge of Your Fertility, do so now, and thank me later. I'd also like to give a shout out to fertilityfriend.com). We kept the pregnancy a secret for 11 weeks, through Christmas and the New Year, a feat made possible due only to the fact that this was my first non-HG pregnancy (still plenty of nausea & vomiting, though). So far so good! I've passed the 20-week mark, which means there is zero chance of miscarriage (only because after 20 weeks, a fetal death is considered a stillbirth); and in another couple weeks I will have passed the viability point. Not milestones I had ever felt the need to mark with my previous pregnancies. I do not feel that I am particularly anxious or fearful with this pregnancy, only more cautious with my hopes and feelings.

So what's the plan for The Baby Blawg? I will start up regular updates, probably every couple weeks and then weekly towards the end. And expect more regular posting on birth stuff and, hopefully, a lot of book reviews. Please join me!

Shopping for Breast Pumps

Shopping for a breast pump? The US Food & Drug Administration has a whole website devoted to choosing a pump. This might be a good place to start, but the FDA does not make any recommendations as to specific brands. For even more information, check out Kellymom's list of
milk expression tips & pump information.

Are tocolytics safe & effective?

A new study questions the safety of drugs used for pre-term labor, saying some are linked to complications and not always effective:

In an accompanying editorial, the researchers said their study is a reminder that the decision to use tocolysis shouldn't be taken lightly.

"After 30 years of research, we still do not know whether tocolysis benefits the fetus, so the choice of which drug to use remains a secondary question. The real dilemma is whether or not we should treat at all," they wrote. The long-held belief that "keeping the baby inside longer must be a good thing" needs to be reevaluated, they said.

Early Caesareans Pose Risks to Newborns

Research is catching up to what we knew all along: babies born by elective c-section prior to 39 weeks are at a significantly higher risk of medical problems. Even just a week can mean a huge difference for a baby's health. Complications of being born too early include respiratory distress, infections, and hypoglycemia. This is in addition to the normal risk of being born by c-section, as the New York Times article points out,

Doctors noted that even when babies born by Caesarean are delivered at the same week of pregnancy as babies delivered vaginally, they are at higher risk of respiratory difficulties because the process of labor and delivery primes the fetal lungs for breathing air.

Although the increasing prematurity rate in the US is often blamed on women with little to no prenatal care and poor nutrition, a large chunk of the problem is inductions or c-sections scheduled too early - perhaps in combination with incorrect due dates. Read between the lines of this quotation:

But Dr. Alan Fleischman, medical director of the March of Dimes, said the findings should reinforce the message that "every week counts" in a pregnancy. The women who were more likely to deliver early were white women with private health insurance, and the medical centers were all top-notch hospitals, he noted.

"These are not preterm babies, and these are pregnancies that should have good outcomes," he said.

Keep in mind that the research deals with "elective" cesareans, meaning there was no medical indication for the surgery. The National Partnership for Women and Families' article on the same study reports:

John Thorp, professor of obstetrics and gynecology at the University of North Carolina-Chapel Hill, said that there are differences between infants delivered at 37 weeks vaginally and those delivered via elective c-section. He said, "We would not worry about a 37-and-a-half week baby born vaginally with the onset of labor" because in that situation, "there is some signal from a baby to his mother that says 'I'm ready'"

More discussion and links are available at the Citizens for Midwifery blog. And check out a related press release from Lamaze International, Best Practices in Maternity Care Not Widely Used in the United States.

And as for my opinion, God (or Mother Nature, if you prefer) knew what He was doing. If a 37 or 38 week baby was ready to be born, he would have been born already. Anytime you force a baby to come early, whether through drugs or surgery, you have got to expect a baby that is not completely ready to face life "on the outside".