Friday, January 29, 2010

Study Examines The Effectiveness Of A Test To Detect The Onset Of Preterm Birth

Found on the Medical News Today website
Originally published December 9, 2009

Less than 50% of women with threatened preterm labour actually deliver when they present at hospital. However, for many of these women, antenatal admissions are common and many are subjected to unnecessary interventions. New research to be presented at the 8th RCOG International Scientific Meeting reveals how a simple test helps to determine if women showing signs of preterm birth will in fact not deliver early.

Fetal fibronectin (fFN) is the protein which helps attach the fetal sac to the uterus. Previous research has shown that when fFN is found to be leaking at a certain stage of pregnancy, a spontaneous preterm birth is more likely. A diagnostic fFN test has been developed though it is not commonly used in all maternity units. Relatively cheap and easy to perform, the test is done at the same time as a vaginal examination, which is routine when a woman is admitted with abdominal pain in pregnancy. A negative result means fetal fibronectin is minimally present and the chance of the woman having an imminent preterm birth is low.

The researchers from University College London and University College Hospital London conducted a two-stage audit to assess the effectiveness of the fFN test and the impact of its introduction.

Over a two-month period, there were 95 hospital admissions that were at <37 weeks gestation. Out of 22 women (23%) who presented with threatened preterm labour, 17 (78%) did not deliver during their admission. 16 of these women received steroids (to improve the baby's lung function) or tocolytic drugs (to halt the contractions which bring on labour) and three women had an in-utero transfer to a hospital with neonatal cots available. The mean duration of hospital stay was 8.1 days.

After introducing the fFN test, in 94 of the tests carried out, the negative predictive value for delivery within two weeks was 98.6%. Of the 78 women in threatened preterm labour with negative fFN, only seven were admitted for management of abdominal pain.
Dr Anna David, consultant obstetrician at UCLH and the UCL Institute for Women's Health, who led the study said "Threatened preterm labour often causes much anxiety for pregnant women. Doctors are working hard to uncover the causes of preterm birth and to develop preventive treatments.

"In the meantime, the fetal fibronectin test has been found to be very accurate at predicting those women who will not imminently deliver. Women with a negative test can be reassured that they do not need inpatient care. They can therefore avoid leaving their families for observation in a hospital, though a few may need admission for pain relief. More importantly, unnecessary drug interventions can be prevented which could translate into significant cost savings to the NHS.

"Based on the results of our study, the use of fFN tests can also reduce unnecessary in-utero transfers, which at this time of neonatal unit cot shortages is a huge advantage."


The Royal College of Obstetricians and Gynaecologists 8th International Scientific Meeting is taking place in Abu Dhabi, the United Arab Emirates, from Monday 7 to Wednesday 9 December 2009. The meeting is held in collaboration with the Abu Dhabi Health Services Co. (SEHA) and sponsored by the Abu Dhabi Tourism Authority. For more information about the meeting, please click here.

About UCL Elizabeth Garrett Anderson Institute for Women's Health

The Institute is a joint venture between UCL (University College London) and University College London Hospitals NHS Foundation Trust (UCLH) and brings together individuals with expertise across the whole spectrum of women's health - from laboratory science to clinical skills to social and behavioural sciences - with the objective of making a major contribution to the health of women, both in the UK and internationally, by pioneering research, education programmes and clinical initiatives.

SourceRoyal College of Obstetricians and Gynaecologists

Thursday, January 28, 2010

Groundbreaking Study Demonstrates Benefits of Exclusively Human Milk-Based Diet for Very Low-Birth-Weight Preterm Infants in Neonatal Intensive Care

Found on Your-Story website
Origianlly published January 19, 2010

Study Finds Lower Rate of Necrotizing Enterocolitis Than a Diet of Bovine Milk-Based Products

MONROVIA, Calif.–(BUSINESS WIRE)– Prolacta Bioscience, the first and only company to offer human milk fortifier (HMF) made from 100% human breast milk for premature and critically ill infants, has announced the results of a groundbreaking study that will have long-term benefits for the nutritional care of very low-birth-weight preterm infants (less than 2 pounds, 12 ounces or 1250 grams) in the neonatal intensive care unit (NICU). The study was published in The Journal of Pediatrics December 28, 2009 online edition at

The landmark study, whose lead author was Sandra Sullivan M.D. with the department of pediatrics at the University of Florida, Gainesville, concludes that for very low-birth-weight preterm infants weighing less than 1250 grams, an exclusively human milk-based diet is associated with significantly lower rates of necrotizing enterocolitis (NEC) and surgical NEC, when compared to a very low-birth-weight preterm infant who received a diet that includes bovine milk-based products. NEC is a severe complication that often affects preterm infants, in which the intestinal tissue disintegrates. It is a serious disease with a mortality rate approaching 25%1. The results of the study are significant because, until recently, the standard of care and the only human milk fortifiers available were bovine-based. This posed challenges for the nutritional care of very low-birth-weight preterm infants in the NICU because of the occurrence of intolerance to feedings, possibly as a result of exposure to non-human protein in the bovine-based fortifier.

“The results of this study are astounding. No other intervention has shown such a beneficial effect for NEC,” said Dr. Sullivan. “Neonatologists now have a way to appropriately nourish very low-birth-weight preterm infants and maintain the benefits of an exclusive human-milk diet. The decision to use traditional bovine-based HMF for these babies should not be made lightly, and warrants reconsideration in all NICUs.”

The trial was comprised of three study groups of infants whose birth weights ranged between 500 and 1250 grams. Groups one and two began fortification at different times. These first two groups of infants received pasteurized donor human milk-based HMF, Prolact+ H2MFTM from Prolacta Bioscience. The third group received the standard feeding protocol of bovine milk-based HMF, and preterm formula if mother’s own milk was not available. The most significant difference among the three study groups was the incidence of NEC, which was approximately two-thirds lower in the two study groups using the human milk-based HMF, compared to the study group using bovine milk-based HMF.

Prolact+ H2MF is the first and only commercially available human milk fortifier made from 100% human breast milk. The current standard practice in the NICU uses bovine milk-based products for human milk fortification. A recent study has demonstrated that for very low-birth-weight preterm infants in the NICU, human breast milk decreases the incidence of diseases such as necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and sepsis2. NEC is a devastating disease of the gut and a leading cause of premature infant death3.

Prematurity has been escalating steadily over the past two decades, and one out of eight babies is born prematurely in the U.S.4 Of that category, about 10% of these births are very low-birth-weight preterm infants. Most babies who use Prolacta products are born weighing less than 1250 grams. These infants are considered very low birth weight, and are at substantial risk of serious health problems, lasting disabilities, and even death5. Prolacta’s products are formulated to meet specific criteria as prescribed by neonatologists. Therefore, Prolacta standardizes their products with precise calories, nutrients, and proteins to meet these criteria.

About Prolacta

Prolacta Bioscience, Inc. ( is a life science company dedicated to improving quality of life by Advancing the Science of Human MilkTM. Prolacta creates specialty formulations made exclusively from human milk for the nutritional needs of critically ill premature infants in Neonatal Intensive Care Units. It is the first and only company to provide a human milk fortifier made from 100% human milk, Prolact+ H2MFTM. They operate a pharmaceutical grade processing plant and have designed and patented processes that enable them to make their one-of-a-kind life saving products. Prolacta is committed to making a meaningful difference in the lives of the most vulnerable infants through world class research and innovative products.

1Medline Plus. (2009, May 15). U.S. National Library of Medicine and National Institutes of Health website: Accessed December 26, 2009.

2Meinzen-Derr J, Poindexter B, Wrage et al. Role of human milk in extremely low birth weight infants’ risk of necrotizing enterocolitis or death. Journal of Perinatology 2009 Jan;29(1):57-62.
3Spitzer A. Intensive Care of the Fetus and Neonate. 1996.

4March of Dimes. Accessed December 26, 2009.

5Laffan EE, McNamara PJ, Amaral et al. Review of interventional procedures in the very low birth-weight infant (<1.5 kg): complications, lessons learned and current practice. Pediatric Radiology. 2009 Aug;39(8):781-90.

Wednesday, January 27, 2010

No need for pregnant women to fast during labor

Found on the Reuters website
Written by Megan Brooks
Originally published on January 20, 2010

NEW YORK (Reuters Health) - There is no reason why pregnant women at low risk for complications during delivery should be denied fluids and food during labor, a new Cochrane research review concludes.


"Women should be free to eat and drink in labor, or not, as they wish," the authors of the review wrote in the Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research.

Dr. Jennifer Milosavljevic, a specialist in obstetrics and gynecology at Henry Ford Health System, Detroit, who was not involved in the Cochrane Review, agrees that pregnant women should be allowed to eat and/or drink during labor.

"In my experience," she told Reuters Health in an email, "most pregnant patients at Henry Ford are placed on a clear liquid diet during labor which includes water, apple juice, cranberry juice, broth, and jello. If a patient is brought in for a prolonged induction of labor, she will typically be permitted to eat a regular diet and order anything off the menu in between different induction modalities."

Milosavlievic has "not seen any adverse outcomes by allowing women the option of liquids and/or a regular diet in labor."

Standard hospital policy for many decades has been to allow only tiny sips of water or ice chips for pregnant women in labor if they were thirsty. Why? It was feared, and some studies in the 1940s showed, that if a woman needed to undergo general anesthesia for a cesarean delivery, she might inhale regurgitated liquids or food particles that could lead to pneumonia and other lung damage.

But anesthesia practices have changed and improved since the 1940s, with more use of regional anesthesia and safer general anesthesia.

And recently, attitudes on food and drink during labor have begun to relax. Last September, the American College of Obstetricians and Gynecologists (ACOG) released a "Committee Opinion" advising doctors that women with a normal, uncomplicated labor may drink modest amounts of clear liquids such as water, fruit juice without pulp, carbonated beverages, clear tea, black coffee, and sports drinks. They fell short of saying food was okay, however, advising that women should avoid fluids with solid particles, such as soup.

"As for the continued restriction on food, the reality is that eating is the last thing most women are going to want to do since nausea and vomiting during labor is quite common," Dr. William H. Barth, Jr., chair of ACOGs Committee on Obstetric Practice, noted in a written statement at the time.

But based on the evidence, Mandisa Singata of the East London Hospital Complex in East London, South Africa, an author on the new Cochrane Review, says "women should be able to make their own decisions about whether they want to eat or drink during labor, or not."
Singata and colleagues systematically reviewed five studies involving more than 3100 pregnant that looked at the evidence for restricting food and drink in women who were considered unlikely to need anesthesia. One study looked at complete restriction versus giving women the freedom to eat and drink at will; two studies looked at water only versus giving women specific fluids and foods and two studies looked at water only versus giving women carbohydrate drinks.
The evidence showed no benefits or harms of restricting foods and fluids during labor in women at low risk of needing anesthesia.

Singata and colleagues acknowledge that many women may not feel like eating or drinking during labor. However, research has shown that some women find the food and drink restriction unpleasant. Poor nutritional balance may be also associated with longer and more painful labors. Drinking clear liquids in limited quantities has been found to bring comfort to women in labor and does not increase labor complications.

The researchers emphasize that they did not find any studies that assessed the risks of eating and drinking for women with a higher risk of needing anesthesia and so further research is need before specific recommendations can be made for this group.

SOURCE: Cochrane Library, 2010.

Tuesday, January 26, 2010

Should Women Eat While Giving Birth?

Found on the Early Show website
Originally published January 10, 2010

(CBS) To eat or not to eat during labor?

New research may change the tradition of women having only ice chips while giving birth.

"Early Show contributor Dr. Holly Phillips of WCBS-TV in New York explained that women's consumption is limited to ice chips to try to avoid aspiration -- a condition that causes food in the stomach to move into the lungs when women need general anesthesia for a C-section.
However, she said, attitudes are changing; for example, general anesthesia is hardly ever used for a C-section.

Studies also support a new outlook on eating during labor.

Research just released by the Cochrane Systematic Review of five previous studies found that 3,000 women at low risk of needing a C-section who had something to eat or drink during labor were at no increased risk of complications.

"There were no increased inductions -- no increased rate of C-sections or any other complications," Phillips said. "I think a lot of women would welcome the opportunity to have something to eat or drink during labor, because I think it's called labor for a reason. It's hard work. You need fuel to get through the hard work."

But, as "Early Show" co-anchor Maggie Rodriguez stressed, that doesn't mean you should eat a ham sandwich or spaghetti and meatballs on the delivery table.

"Exactly. No burgers and fries in the labor room," Phillips replied. "We're talking about small amounts of foods. The American College of Gynecologists recently loosened their previous recommendations. They're allowing clear liquids."

Clear liquids may include sports drinks, water and fruit juice. In addition, some doctors allow some solid foods, such as toast, popsicles, applesauce and Jell-O.

Phillips said, "These are all things that can really be digested easily."

Monday, January 25, 2010

Pregnancy and Gestational Vitamin D Deficiency

As seen on the Vitamin D Council website

In the last 3 years, an increasing amount of research suggests that some of the damage done by Vitamin D deficiency is done in-utero, while the fetus is developing. Much of that damage may be permanent, that is, it can not be fully reversed by taking Vitamin D after birth. This research indicates Vitamin D deficiency during pregnancy endangers the mother's life and health, and is the origin for a host of future perils for the child, especially for the child's brain and immune system. Some of the damage done by maternal Vitamin D deficiency may not show up for 30 years. Let's start with the mother.

Incidence of Gestational Vitamin D Deficiency

Dr. Joyce Lee and her colleagues at the University of Michigan studied 40 pregnant women, the majority taking prenatal vitamins. Only two had blood levels >50 ng/mL and only three had levels >40 ng/mL. That is, 37 of 40 pregnant women had levels below 40 ng/mL, and the majority had levels below 20 ng/mL. More than 25% had levels below 10 ng/mL. Lee JM, Smith JR, Philipp BL, Chen TC, Mathieu J, Holick MF. Vitamin D deficiency in a healthy group of mothers and newborn infants. Clin Pediatr (Phila). 2007 Jan;46(1):42–4.

Dr. Lisa Bodnar, a prolific Vitamin D researcher, and her colleagues at the University of Pittsburg studied 400 pregnant Pennsylvania women; 63% had levels below 30 ng/mL and 44% of the black women in the study had levels below 15 ng/mL. Prenatal vitamins had little effect on the incidence of deficiency. Bodnar LM, Simhan HN, Powers RW, Frank MP, Cooperstein E, Roberts JM. High prevalence of vitamin D insufficiency in black and white pregnant women residing in the northern United States and their neonates. J Nutr. 2007 Feb;137(2):447–52.

Dr. Dijkstra and colleagues studied 70 pregnant women in the Netherlands, none had levels above 40 ng/mL and 50% had levels below 10 ng/mL. Again, prenatal vitamins appeared to have little effect on 25(OH)D levels, as you might expect since prenatal vitamins only contain 400 IU of Vitamin D. Dijkstra SH, van Beek A, Janssen JW, de Vleeschouwer LH, Huysman WA, van den Akker EL. High prevalence of vitamin D deficiency in newborns of high-risk mothers. Arch Dis Child Fetal Neonatal Ed. 2007 Apr 25.

Thus, more than 95% of pregnant women have 25(OH)D levels below 50 ng/mL, the level that may indicate chronic substrate starvation. That is, they are using up any Vitamin D they have very quickly and do not have enough to store for future use. Pretty scary.

Effects on the Mother

Caesarean section

The rate of Caesarean section in American women has increased from 5% in 1970 to 30% today. Dr. Anne Merewood and her colleagues at Boston University School of Medicine found women with levels below 15 ng/mL were four times more likely to have a Cesarean section than were women with higher levels. Among the few women with levels above 50 ng/mL, the Caesarean section rate was the same as it was in 1970, about 5%. Merewood A, Mehta SD, Chen TC, Bauchner H, Holick MF. Association between vitamin D deficiency and primary cesarean section. J Clin Endocrinol Metab. 2009 Mar;94(3):940–5.


Preeclampsia is a common obstetrical condition in which hypertension is combined with excess protein in the urine. It greatly increases the risk of the mother developing eclampsia and then dying from a stroke. Dr. Lisa Bodnar and her colleagues found women with 25(OH)D levels less than 15 ng/mL had a five-fold (5 fold) increase in the risk of preeclampsia. Bodnar LM, Catov JM, Simhan HN, Holick MF, Powers RW, Roberts JM. Maternal vitamin D deficiency increases the risk of preeclampsia. J Clin Endocrinol Metab. 2007 Sep;92(9):3517–22.

Gestational Diabetes

Diabetes during pregnancy affects about 5% of all pregnant women, is increasing in incidence, and may have deleterious effects on the fetus. Dr. Cuilin Zhang and colleagues at the NIH found women with low 25(OH)D levels were almost 3 times more likely to develop diabetes during pregnancy. Zhang C, Qiu C, Hu FB, David RM, van Dam RM, Bralley A, Williams MA. Maternal plasma 25-hydroxyvitamin D concentrations and the risk for gestational diabetes mellitus. PLoS ONE. 2008;3(11):e3753.

Bacterial Vaginitis

Dr. Lisa Bodnar and her colleagues found pregnant women with the lowest 25(OH)D level are almost twice as likely to get a bacterial vaginal infection during their pregnancy. Bodnar LM, Krohn MA, Simhan HN. Maternal Vitamin D Deficiency Is Associated with Bacterial Vaginosis in the First Trimester of Pregnancy. J Nutr. 2009 Apr 8.

Effects on the child

Seventeen experts—many of them world-class experts—recently recommended:

"Until we have better information on doses of vitamin D that will reliably provide adequate blood levels of 25(OH)D without toxicity, treatment of vitamin D deficiency in otherwise healthy children should be individualized according to the numerous factors that affect 25(OH)D levels, such as body weight, percent body fat, skin melanin, latitude, season of the year, and sun exposure. The doses of sunshine or oral vitamin D3 used in healthy children should be designed to maintain 25(OH)D levels above 50 ng/mL. As a rule, in the absence of significant sun exposure, we believe that most healthy children need about 1,000 IU of vitamin D3 daily per 11 kg (25 lb) of body weight to obtain levels greater than 50 ng/mL. Some will need more, and others less. In our opinion, children with chronic illnesses such as autism, diabetes, and/or frequent infections should be supplemented with higher doses of sunshine or vitamin D3, doses adequate to maintain their 25(OH)D levels in the mid-normal of the reference range (65 ng/mL) — and should be so supplemented year-round (p. 868)."

That's right. Healthy children need about 1,000 IU per 25 pounds of body weight and their 25(OH)D levels should be >50 ng/mL, year-round.

Eight years before the above recommendations, Professor John McGrath of the Queensland Centre for Mental Health Research theorized that maternal Vitamin D deficiency adversely "imprinted" the fetus, making infants more liable for a host of adult disorders. Research since that time has supported McGrath's theory. Consider, for a minute, what it must be like for John McGrath, to know that maternal Vitamin D deficiency is causing such widespread devastation, to know it could be so easily treated, but to also know he must wait the decades that will be required to deal with the problem. McGrath J. Does 'imprinting' with low prenatal vitamin D contribute to the risk of various adult disorders? Med Hypotheses. 2001 Mar;56(3):367–71.


Dr. Dennis Kinney and his colleagues at Harvard published a fascinating paper last month on the role of maternal Vitamin D deficiency in the development of schizophrenia, in support of Dr. McGrath's theory. As they point out, the role of inadequate Vitamin D during brain development appears to "overwhelm" other effects, explaining why schizophrenia has so many of the footprints of a maternal Vitamin D deficiency disorder, such as strong latitudinal variation, excess winter births, and skin color. Kinney DK, Teixeira P, Hsu D, Napoleon SC, Crowley DJ, Miller A, Hyman W, Huang E. Relation of schizophrenia prevalence to latitude, climate, fish consumption, infant mortality, and skin color: a role for prenatal vitamin d deficiency and infections? Schizophr Bull. 2009 May;35(3):582–95.


I will say not more, other than to point out that Scientific American ran a lengthy article last month on my autism theory but the editors insisted that the author not cite me, nor my paper, because I am "not a scientist." Gabrielle Glaser. What If Vitamin D Deficiency Is a Cause of Autism? 2009 April 24. Scientific American.

Mental Retardation

The only evidence that Vitamin D deficiency is a common cause of mental retardation is from researchers at the CDC who found mild mental retardation is twice as common among African Americans as whites, and that the politically correct explanation—socioeconomic factors—cannot explain it. If latitudinal studies of mild mental retardation exist, I am unable to locate them. Yeargin-Allsopp M, Drews CD, Decoufle P, Murphy CC. Mild mental retardation in black and white children in metropolitan Atlanta: a case-control study. Am J Public Health 1995;85(3):324–8. Drews CD, Yeargin-Allsopp M, Decoufle P, Murphy CC. Variation in the influence of selected sociodemographic risk factors for mental retardation. Am J Public Health 1995;85(3):329–34.

Of course, it is claimed you are a racist if you believe these studies. In fact, a number of writers have told me their editors will not allow writers to discuss these studies in their stories. I am glad these studies were conducted by researchers at the CDC. Although, I worry about their political longevity at the CDC after reporting such findings.

I will mention one other fact (at my peril) and that is the fact that a very smart man, President Barack Obama, was born in the late summer (August) and has a brain that developed in a womb covered in white skin, during the spring and summer, in the subtropics (Latitude 21 degrees North), during an age before sun-avoidance was the mantra (1961). Make what you want to of that fact. My point is that whites living at temperate latitudes may have a huge developmental advantage over blacks, an advantage that begins immediately after conception, an advantage that has nothing to do with innate genetic ability and everything to do with environment.

Newborn Lower Respiratory Tract Infection

Newborn babies are vulnerable to infections in their lungs and women with the lowest 25(OH)D level during pregnancy were much more likely to have their newborn in the ICU being treated for lower respiratory tract infections. Drs. Walker and Modlin at UCLA recently presented reasons why viral pneumonia is probably only one of many pediatric Vitamin D deficient infections. Karatekin G, Kaya A, Salihoğlu O, Balci H, Nuhoğlu A. Association of subclinical vitamin D deficiency in newborns with acute lower respiratory infection and their mothers. Eur J Clin Nutr. 2009 Apr;63(4):473–7. Walker VP, Modlin RL. The Vitamin D Connection to Pediatric Infections and Immune Function. Pediatr Res. 2009 Jan 28.
Birth weight

While conflicting results exist on the effects of maternal Vitamin D deficiency and birth weight, the majority of the studies find an effect. Furthermore, the studies are comparing women who have virtually no intake to women who have minuscule intakes. For example, women who ingested around 600 IU per day were more likely to have normal weight babies compared to women whose intake was less than 300 IU per day. One can only wonder what would happen if pregnant women had adequate intakes? Drs. Scholl and Chen, at the Department of Obstetrics at the University of Medicine and Dentistry of New Jersey, concluded pregnant women need 6,000 IU per day, not the 400 IU/day contained in prenatal vitamins. Scholl TO, Chen X. Vitamin D intake during pregnancy: association with maternal characteristics and infant birth weight. Early Hum Dev. 2009 Apr;85(4):231–4.


My old nemesis, cod liver oil, when given during pregnancy resulted in children who were three times less likely to develop juvenile diabetes before the age of 15. Of course, this was back when cod liver oil had meaningful amounts of Vitamin D (these Norwegian mothers were taking cod liver oil in the 1980s). Stene LC, Ulriksen J, Magnus P, Joner G. Use of cod liver oil during pregnancy associated with lower risk of Type I diabetes in the offspring. Diabetologia. 2000 Sep;43(9):1093–8.


Newborns frequently have seizures and those seizures are almost always due to low blood calcium. This problem is so common that many newborns are given a prophylactic injection of calcium. In 1978, researchers found such hypocalcemia can easily be prevented by giving Vitamin D. Sadly, standard treatment remains—not Vitamin D, but calcium and an analogue of activated Vitamin D. Such analogues do not correct Vitamin D deficiency. The fact that this was known in 1978 and has been routinely ignored by obstetricians since then should give you pause. Do not think science will solve the Vitamin D problem. Science simply points the way, activists must change the practice. Fleischman AR, Rosen JF, Nathenson G. 25-Hydroxycholecalciferol for early neonatal hypocalcemia. Occurrence in premature newborns. Am J Dis Child. 1978 Oct;132(10):973–7.

Heart Failure

Idiopathic infant heart failure is often fatal. Of course, idiopathic to whom? The uninformed cardiologists who do not recognize severe infantile Vitamin D deficiency? Luckily, for 16 infants, Dr. Maiya, Dr. Burch, and colleagues at the Great Ormand Street Hospital for Children are not among them. Maiya S, Sullivan I, Allgrove J, Yates R, Malone M, Brain C, Archer N, Mok Q, Daubeney P, Tulloh R, Burch M. Hypocalcaemia and vitamin D deficiency: an important, but preventable, cause of life-threatening infant heart failure. Heart. 2008 May;94(5):581–4.

Weak bones

Dr. Muhammad Javaid and colleagues at the University of Southampton found that children of Vitamin D deficient mothers were much more likely to have weak bones 9 years later. Dr. Adrian Sayers and Jonathan Tobias of the University of Bristol recently found the same thing when they looked at maternal sun-exposure. Javaid MK, Crozier SR, Harvey NC, Gale CR, Dennison EM, Boucher BJ, Arden NK, Godfrey KM, Cooper C; Princess Anne Hospital Study Group. Maternal vitamin D status during pregnancy and childhood bone mass at age 9 years: a longitudinal study. Lancet. 2006 Jan 7;367(9504):36–43. Sayers A, Tobias JH. Estimated maternal ultraviolet B exposure levels in pregnancy influence skeletal development of the child. J Clin Endocrinol Metab. 2009 Mar;94(3):765–71.

Brain Tumors

John McGrath's group discovered that children with astrocytomas and ependymomas (brain tumors you do not want your child to have) were more likely to be born in the winter. Ko P, Eyles D, Burne T, Mackay-Sim A, McGrath JJ. Season of birth and risk of brain tumors in adults. Neurology. 2005 Apr 12;64(7):1317.


Three studies have found that epileptic patients are much more likely to be born in the winter. Dr. Marco Procopio of the Priory Hospital Hove in Sussex has written all three. Procopio M, Marriott PK, Davies RJ. Seasonality of birth in epilepsy: a Southern Hemisphere study. Seizure. 2006 Jan;15(1):17–21.


Craniotabes is softening of the skull bones that occurs in 1/3 of "normal" newborns. Recent evidence indicates it is yet another sign and sequela of maternal vitamin D deficiency. Yorifuji J, Yorifuji T, Tachibana K, Nagai S, Kawai M, Momoi T, Nagasaka H, Hatayama H, Nakahata T. Craniotabes in normal newborns: the earliest sign of subclinical vitamin D deficiency. J Clin Endocrinol Metab. 2008 May;93(5):1784–8.


Dr. Robert Schroth from the University of Manitoba reported that mothers of children who developed cavities at an early age had significantly lower vitamin D levels during pregnancy than those whose children were cavity-free. Megan Rauscher. Prenatal vitamin D linked to kids' dental health. 2009. Reuters.


The extant data here is conflicting. Two studies have found higher Vitamin D intakes during pregnancy decrease the risk of asthma in later childhood and one has found the opposite. The best review of the issue is by Drs. Augusto Litonjua and Scott Weiss, at Harvard, who conclude that the current epidemic of asthma among our children is related to both gestational and ongoing childhood vitamin D deficiency. Litonjua AA, Weiss ST. Is vitamin D deficiency to blame for the asthma epidemic? J Allergy Clin Immunol. 2007 Nov;120(5):1031–5.

Furthermore, a very recent study by Dr. John Brehm and the same Harvard group found low Vitamin D levels in asthmatic children were associated with hospitalization, medication use, and disease severity. Brehm JM, Celedón JC, Soto-Quiros ME, Avila L, Hunninghake GM, Forno E, Laskey D, Sylvia JS, Hollis BW, Weiss ST, Litonjua AA. Serum vitamin D levels and markers of severity of childhood asthma in Costa Rica. Am J Respir Crit Care Med. 2009 May 1;179(9):765–71.

In case you are wondering, black children are four times more likely than white children to be hospitalized or die from asthma. Akinbami LJ, Schoendorf KC. Trends in childhood asthma: prevalence, health care utilization, and mortality. Pediatrics. 2002 Aug;110(2 Pt 1):315–22.

My experience, both at the hospital and via my readers, is that asthma improves—albeit sometimes slowly—when adequate doses of Vitamin D are taken. However, Vitamin D does not appear to be a cure, like it is in some other conditions. I suspect children with asthma have suffered both gestational and ongoing childhood Vitamin D deficiency that probably altered, perhaps permanently, their immune system.

The Vitamin D Council's Effort

We recently ran a ¼ page announcement in OB/GYN News and the American Journal of Obstetrics and Gynecology (AJOG). Unfortunately, the editor of AJOG censored our announcement after its first month, but we were able to get the full, three-month run in OB/GYN News. We also sent a very similar email to 18,000 obstetricians in the United States. The total cost to the Vitamin D Council for this campaign was about $12,000.00.

The announcement simply pointed out that the American Academy of Pediatrics (AAP) recently recommended that all pregnant women have a 25(OH)D blood test because Vitamin D is important for normal fetal development (p. 1145):

"Given the growing evidence that adequate maternal vitamin D status is essential during pregnancy, not only for maternal well-being but also for fetal development, health care professionals who provide obstetric care should consider assessing maternal vitamin D status by measuring the 25-OH-D concentrations of pregnant women. On an individual basis, a mother should be supplemented with adequate amounts of vitamin D3 to ensure that her 25-OH-D levels are in a sufficient range (>32 ng/mL). The knowledge that prenatal vitamins containing 400 IU of vitamin D3 have little effect on circulating maternal 25-OH-D concentrations, especially during the winter months, should be imparted to all health care professionals." Wagner CL, Greer FR; American Academy of Pediatrics Section on breastfeeding; American Academy of Pediatrics Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008 Nov;122(5):1142–52.

As the AAP recommendation came from an official medical body, to medical malpractice attorneys it represents evidence of a "standard of care" for future lawsuits. We also reminded obstetricians that the statute of limitations on malpractice suits does not toll (begin) until the injured party recognizes the injury. That is, the parents of a 5-year-old child diagnosed with autism five years in the future may bring suit against that obstetrician for how the child was treated during his time in the uterus, citing the 2008 AAP's recommendation as a standard of care. Obstetricians are already burdened with lawsuits, but they could decrease the number of suits significantly if they would just take the time to learn about Vitamin D.

Finally, we used our last $12,000 to produce and run a television announcement in the Washington, D.C. TV market, entitled Pregnancy and Vitamin D.

What can you do?

Most people want to do good—at least some good—in their lives. The endless pursuit of the God-almighty dollar, better clothes, better houses and better vacations than your neighbors eventually leaves a hole in your soul. Here is an opportunity to fill it.

If you don't feel that soul hole, try a meditation I learned at Esalen Institute in the 1980s and have practiced ever since. Lie on the floor and pretend you are dead in your grave. Feel the worms, smell the rot, sense the finality. Then, when you really feel dead, visualize your gravestone above. What does it say? "Here lies Robert; he had a big fancy house." "Here lies Vanessa; she wore beautiful clothes and had four face lifts." Here lies Michael; he made a billion dollars." Through this meditation, I realized I want my gravestone to say, "Here lies John, he did something good."

One good thing you can do is simply tell every pregnant woman and women thinking of getting pregnant that she needs to take more Vitamin D, a lot more. Pregnant women need a minimum of 5,000 IU per day and even that dose will not achieve 25(OH)D levels of >50 ng/mL in all women. Why not buy a few bottles of 5,000 IU capsules and hand out the bottles to your pregnant friends? You can get 250 vitamin D capsules for 15 bucks. Or, forward this email to them. Show them our Pregnancy and Vitamin D public service announcement.

If you want to do more, why not get a copy of our Pregnancy and Vitamin D public service announcement by emailing our webmaster at (the ad is not copyrighted) and then pay to run it on a TV station in your hometown? You can easily add a caption at the bottom saying this public service announcement is being sponsored by your company, combining a good deed with good business.

Alas, no glory will be yours, at least in this life. No woman will ever thank you for the schizophrenic child she never had, for the trips to the emergency room with a breathless child that she never made, for the repetitive moaning of the autistic child she never endured. Although, she may wonder why her pregnancy was so easy and why her infant is so healthy, alert, active, and smart.

John Jacob Cannell MD
Executive Director

Friday, January 22, 2010

Study advises against non-medial cesareans but how accurate is the advice?

Pauline McDonagh Hull left a comment about the article I posted on Wednesday about Elective Cesarean Sections and a WHO study that suggests cesarean births are too risky. So, I figured I would post Pauline's article as a follow up. This article was posted on Pauline's blog on Tuesday, January 12th.

Study advises against non-medial cesareans but how accurate is the advice?

written by Pauline McDonagh Hull

I am utterly perplexed by the conclusions drawn in this latest report from the World Health Organization, 'Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08, Lumbiganon et al', but not in the least bit surprised.

It's bad enough that the presentation of data is skewed in order to make planned vaginal delivery appear safer than it actually is, but the authors have decided to single out "the increased risk of maternal mortality and severe morbidity" in cesarean deliveries with no medical indication as the "most important finding of the survey".

Pregnant women and ALL JOURNALISTS - I urge you to please read the study in full and make up your own mind about which delivery type is the most risky.

If you don't have time, here are some extracts from the study that you won't see in today's media reports:

*The authors write: "Our study has some limitations. First, we had information about mortality and morbidities only until discharge from hospital; some outcomes might therefore have been underestimated, especially for women delivering vaginally who are usually discharged earlier than women having caesarean section."

This is important because damage to the pelvic floor (both in the short- and long-term) leads to physical and psychological trauma, financial costs and hospital readmissions that this study completely ignores. It also ignores the huge cost of litigation that can follow vaginal delivery complications.

*"The calculated odds ratio might overestimate the risk of caesarean section. Although we had adjusted for many potential confounding factors, there might be some other factors that we did not have information about and could not adjust for."

An admission of underestimating vaginal delivery risks and overestimating cesarean delivery risks - and yet this is ignored in the conclusion, perhaps because it does not suit the authors' own birth ideology.

*"Second, data were abstracted from the patients' records. We were not able to confirm the absence of some of the risk factors if they had not been recorded.
This is an issue that has been written about by doctors in the past (and indeed critics of studies such as this) because there may well have been medical indications for some of the 'without indications' cesarean group, and these were simply missing from the patients’ records. This would adversely affect the results for this group; again, potentially causing an over-estimation of its risks.

*"Third, our survey included only hospitals with caesarean facilities having 1000 or more deliveries every year. The results therefore cannot be generalised to smaller facilities."

In the UK especially, some of the highest numbers of cesarean delivery on maternal request occur in small, private hospitals. It is also worth noting here that the quality of hospital care in countries like the UK, USA, Canada and Australia (e.g. infection control through prophylactic antibiotics) may be of a higher standard than some of the regions's hositals included in this study.

*The conclusions drawn about poorer outcomes with cesarean delivery with no medical indication are "analysed as a composite outcome (the maternal mortality and morbidity index)".

This is crucial - because depending on what researchers include in such an "index", this will affect comparative results. Here is what the WHO's index includes:

"We assessed the association of each maternal outcome of death, admission to ICU, blood transfusion, hysterectomy, and mortality and morbidity index (which was defined as the presence of at least one of: maternal mortality, admission to ICU, blood transfusion, hysterectomy, or internal iliac artery ligation); and perinatal outcomes of perinatal mortality, fetal deaths, neonatal mortality up to hospital discharge, stay in neonatal ICU for 7 days or longer, and perinatal mortality and morbidity index (defined as the presence of perinatal death or stay in neonatal ICU for 7 days or longer)"

Notice what is missing: for example, pelvic floor damage; urinary and fecal incontinence; postpartum sexual health; long-term injuries to babies such as Erb's Palsy; psychological outcomes; degree of birth satisfaction. All of these potential birth outcomes are relevant in a truly 'informed' birth risk-benefit analysis, and for many women, they may have a lower tolerance for these risks than the risks associated with planned surgery.

*Referring to planned cesareans without indications, the WHO writes: “The findings for the individual outcomes that make up the composite outcome suggest that the increased risk is mainly attributable to increased admission to ICU and blood transfusion. Although we acknowledge that both ICU admission and blood transfusion depend on the availability of those services and the potentially differing thresholds for giving blood and for admission of women to ICU or referral to higher levels of care, this outcome is nevertheless important.”

This is important because effectively, it is the high occurrence of just two risks within the WHO’s “composite” and self-appointed “index” that leads to this type of cesarean delivery ending up with such a high overall negative score by the end of the study. This has occurred in previous studies too – namely, the 2006 Deneux-Tharaux et al study.


Which delivery type do YOU think has the most risks?

FYI, the study’s data is separated into six birth categories:

- Spontaneous vaginal delivery (reference category)
- Operative vaginal delivery
- Antepartum (before labor) cesarean delivery with indications
- Antepartum (before labor) cesarean delivery without indications
- Intrapartum (during labor) cesarean delivery with indications
- Intrapartum (during labor) cesarean delivery without indications

“Risk of perinatal mortality was significantly increased compared with spontaneous vaginal delivery in infants born by operative vaginal delivery and intrapartum caesarean section with indications. Only infants delivered by antepartum caesarean section with indications had a significantly lower risk of fetal death than those born vaginally, whereas risk of fetal death did not differ significantly for other methods of delivery compared with spontaneous vaginal delivery. For neonatal mortality up to hospital discharge, infants born by operative vaginal delivery, antepartum caesarean section with indications, and intrapartum caesarean section with indications had significantly increased risk compared with spontaneous vaginal delivery. We recorded no cases of neonatal mortality up to hospital discharge for women delivering by caesarean section without indication, and the risk compared with spontaneous vaginal delivery could not be estimated.”

“Infants born by operative vaginal delivery and intrapartum and antepartum caesarean section with indications had significantly increased risk of stay for 7 days or longer in neonatal ICU compared with spontaneous vaginal delivery. Operative vaginal delivery and antepartum and intrapartum caesarean section with indications had significantly increased risk of perinatal mortality and morbidity index. For breech and other abnormal presentation, caesarean section with indication, either antepartum or intrapartum, significantly reduced risk of perinatal mortality but had significantly increased risk of stay in neonatal ICU for 7 days or longer.”

“For maternal mortality, only operative vaginal delivery had significantly increased risk compared with spontaneous vaginal deliveries. The risk for antepartum caesarean section without indication could not be estimated because there were no maternal deaths in this group. Operative vaginal delivery and all types of caesarean section had significantly increased risk of admission to ICU compared with spontaneous vaginal delivery. Operative vaginal delivery, antepartum caesarean section with indications, and intrapartum caesarean section with and without indication had significantly increased risks of blood transfusion compared with spontaneous vaginal delivery. The risk of hysterectomy was increased in mothers who delivered by operative vaginal delivery, antepartum caesarean section with indications, and intrapartum caesarean section with indications. We recorded no cases of hysterectomy in women who delivered by antepartum caesarean section without indications and intrapartum caesarean section without indications, so the risk could not be estimated. Operative vaginal delivery and all types of caesarean section were associated with significantly increased risk of maternal mortality and morbidity index compared with spontaneous vaginal delivery. Intrapartum caesarean section (both with and without indications) had higher risk of maternal mortality and morbidity than did antepartum caesarean section. Deliveries by all types of caesarean section had significantly increased risks of maternal mortality and morbidities except for perineal tears of third and fourth degree, for which as expected caesarean section had a protective effect compared with vaginal delivery (data not shown).”

In summary:
There are NO RECORDED NEONATAL OR MATERNAL DEATHS following cesarean deliveries without medical indications – yet this is absent from the study’s conclusion. Why?

There are NO RECORDED CASES OF HYSTERECTOMY following cesarean deliveries without medical indications - yet again, this is absent from the conclusion. Why?

Cesarean delivery PROTECTS AGAINST SEVERE PERINEAL TRAUMA – yet not only is this fact absent from the conclusion, the researchers decided not to omit the data from its public report entirely. Why?

The WHO uses “spontaneous vaginal delivery” as its comparative “reference” in this study. This in itself is nonsensical. The data is going to be used to advise pregnant women about different risks during the PLANNING stage of their births - not once the birth is over. The problem is, a spontaneous delivery can never be absolutely predicted or guaranteed. Even the healthiest woman with the healthiest pregnancy can suffer a physically and psychologically traumatic labor involving instrumental assistance and ultimately surgical delivery. Therefore, the WHO should have compared birth PLANS – i.e. compared all planned vaginal deliveries (and their ultimate mortality/morbidity outcomes) with all planned cesareans (with and without indications). That said, even with the current vaginal delivery bias, I think it’s clear from the extracts above that maternal request cesareans fair better in the study than the conclusion would have us believe.

The WHO insists that “Assisted vaginal delivery represents a high-risk situation, and combination of such deliveries with spontaneous vaginal deliveries as the reference group might not be appropriate.” Firstly, we know that operative vaginal delivery does NOT always represent a high-risk situation. But even if I accept that argument, other comparative studies frequently mix the data of planned cesareans with and without medical indications, and then compare them in a negative light with vaginal delivery outcomes (and these studies are cited in WHO reports). Perhaps a fairer approach in the WHO's study (or as an additional footnote) would be to compare ALL vaginal delivery outcomes (incl. operative and emergency cesareans) with ALL planned cesarean outcomes (incl. with and without indications groups)?


**Advocates of vaginal delivery should focus their efforts on improving best practice care for women choosing vaginal delivery, and reducing the number of unwanted cesarean deliveries. They should not concern themselves with women who want a cesarean delivery. Numerous medical studies demonstrate high levels of post-birth satisfaction in women who choose a cesarean delivery and I think it’s unethical to try to stop these women enjoying a birth plan that is their legitimate choice.
Millions of women throughout the world plan to have a spontaneous delivery but you only have to look at any birth trauma website to see that many of these plans result in unhappy, traumatic stories of physical and psychological damage. From what I can see (both in studies and in emails I receive from women), those of us that choose cesareans are a generally happy bunch in terms of our birth outcome, and with the clocks turned back, would make the exact same birth decision all over again.

**The WHO is not entirely reliable in terms of making recommendations on cesarean delivery. Back in 1985 it suggested that national rates of cesarean delivery should maintain an upper limit of 15%, and then finally (after much insistence from critics, including the CCA), in its 2009 handbook it admits that "no empirical evidence for an optimum percentage" exists, an "optimum rate is unknown," and world regions may choose to "set their own standards." You can read more about this here.

**There have been a large number of media reports on this study, and what concerns me most is that if perhaps even journalists don’t have time to read a study in full (and in fairness, many don’t), then it’s unlikely that readers of their newspapers will read the study in full either. Therefore, we are in danger of effectively ‘misinforming’ whole nations of women about the true risks of different birth types. Here are a few examples:

Rebecca Smith writes for The Telegraph:
Perform caesarean deliveries only where medical problem: researchers’… Hospitals should only perform caesarean sections if there is medical problem and not just because women simply choose the procedure because they are 'too posh to push', experts said.

Bella Battle writes for The Sun:
Cesareans a ‘risk’ to mums’… MUMS dubbed 'too posh to push' were given a stark health warning on caesareans today.

Emily Cook writes for The Mirror:
Don't have a caesarean unless it's essential, warms news study’…Mums to be should only give birth by caesarean when strictly necessary, insists a new study.

Some of the reports do provide criticism of the WHO’s study, but this tends to come further down in the page. The Telegraph for example notes that “experts in Britain said the study was conducted in Asia and so was not as relevant to practice in Britain. They said the findings had been 'over sensationalised'.” For example, Dr Virginia Beckett, spokesman for the Royal College of Obsestricians and Gynecologists, said: "These findings are actually quite reassuring for women opting for caesarean sections. They found that three in 1,500 women who had a c-section without medical indication before labour needed a blood transfusion and I would expect elective caeseareans to be even safer in Britain… "There are some very big conclusions drawn from some very small numbers.”

**This study is relatively small; an analysis of just 107,950 deliveries throughout nine countries - Cambodia, China, India, Japan, Nepal, Philippines, Sri Lanka, Thailand and Vietnam, and is receiving maximum media exposure in the UK, Australia and North America. Yet where are the vast swathes of media reports on studies like the ones I’ve cited in this blog in the past or in the various press releases I've written (highlighting very positive health outcomes with maternal request cesareans) - many of which are conducted in countries far closer to home than Asia?

I don’t necessarily blame the media here; after all, a powerful natural birth ideology PR machine ensures its message gets reported, but isn’t it time that more journalists looked afresh at the easy target of ‘too posh to push’ mothers and consider for just one second an alternative truth – that these women are in fact making educated and informed decisions about their babies and their bodies?

And while I’m on my soapbox, could the natural birth lobby get busy making suggestions about how we deal with the extremely challenging maternal landscape that obstetrics has to deal with in the developed world – namely, mothers giving birth at increasingly older ages and with heavier body weights, and babies being born larger and heavier too. It’s all too easy to seek a reduction in cesarean rates by trying to encroach on my right to plan the birth of my choice, but what are your plans to encourage a reduction in the number of unwanted cesareans? Do they include an uncomfortable discussion on issues such as earlier parenting or pre-pregnancy weight loss? Your responsibility lies more in counseling women about vaginal delivery risks – help them achieve the delivery of their choice and allow me, and other women like me, to enjoy our own personal choice.


The WHO reports that the “most important finding of the survey is the increased risk of maternal mortality and severe morbidity [analysed as a composite outcome using the maternal mortality and morbidity index] in women who undergo caesarean section with no medical indication.”

And it concludes that to “improve maternal and perinatal outcomes, caesarean section should be done only when there is a medical indication.”

Well, I find myself heading to bed now and still wondering, how on earth can WHO researchers conclude from the data results above that a planned cesarean delivery with no medical indication is any more risky than a planned vaginal delivery? And moreover, how can it claim that of all the data it accumulated in nine countries, that this particular finding was "the most important"?

What about the risks associated with operative vaginal delivery? What about the protective benefit of a planned cesarean with regards third and fourth degree perineal tears? What about the low number of deaths and absence of hysterectomy? What about the positive outcomes with cesarean breech deliveries? Do these areas of risk not warrant our attention?

The WHO’s goal – and that of all true birth autonomy advocates – should be POSITIVE BIRTH OUTCOMES FOR ALL WOMEN in all walks of life. Millions of women and babies continue to die in childbirth despite the WHO’s best efforts, so I would suggest that it focus more on INCREASING cesarean rates for these women and decreasing rates of UNWANTED cesareans for others, and focus less on reducing access for women that WANT cesarean surgery and don't want a trial of labor.

Thursday, January 21, 2010

9 Reasons Why You Should Choose Independent Birth Education

By Kelly Winder
BellyBelly Creator, Mum & Birth Attendant

So you’re pregnant, want the very best birth for you and your baby and want to get your hands on as much information as possible! So, here’s 9 great reasons why independent childbirth education is going to help give you the best chance possible at the most positive experience. So, why should you choose independent childbirth education? Because…

1. Independent Educators Are Specialists In What They Do

When you choose an independent educator, they are trained specifically in birth education. Some are also skilled in other areas including midwifery, birth attendants (doulas), natural therapists and more. Birth education is a major component of an independent educator’s work, compared to a hospital which may or may not have specialised educators. Many hospitals rotate midwives and/or physiotherapists into the job of running birth education classes, so you never know who you’ll get, what their philosophies and attitudes towards birth are and let’s face it – they may not even like presenting birth education. It may be a part of their job they are required to do. Either way, educators as passionate about education.

Independent educators know the right way to encourage both yourself and your partner to feel comfortable and engaged. You don’t want a presenter to start a session with something like this (said in a smug fashion), “You all probably want a natural birth right now, but around 40% of you are going to end up with caesareans anyway.” This is what one of my clients told me happened in their classes. Nice positive way to start the session! Sure it might be true (some of our hospitals have caesarean rates even higher than this) but negativity is catching and it’s all in how you present it. The class apparently went downhill from there so my clients walked out soon after. They went on to have one on one independent education and loved it.

Even if you’ve had a bad experience before, great birth education is so important, so don’t give up – find something better! Don’t settle for maccas when you can have a lamb roast with all the trimmings! There’s lots more you can learn from independent education that you’ve not heard in hospital based classes.

2. Information is Not Hospital Policy Biased

Hospitals all have varying maternity policies (and know that policy is not law, so you don’t have to legally do anything they tell you) so whoever makes the decisions can influence what you hear and what you can and can’t do.

Policies can be/are based on reducing potential legislation, making birth progress to their own time preferences so there are beds available, making things easier or ‘safe’ for staff – even if it’s not in the mother’s best interest. Yes that sounds strange, but in a leading Melbourne private hospital, I have seen midwives refuse to let women birth on the floor (on a mat/squatting etc) because of occupational health and safety apparently (the midwife also said she didn’t want to stand on her head to ‘deliver’ her baby). She then went on to repeatedly tell the mother to lie on her back and get off her hands and knees to make it easier. Luckily dad firmly said no.

If you’ve had hospital education (or believe what you see on t.v.!), you might think that’s just how you’re supposed to do it – “Ahhhh, I need to get on the bed and lie down my back!” which in labour becomes, “Gees it’s really painful in this position and I don’t know if I can cope anymore.” I had my two children in a private hospital and thinking about this bed issue later I found it curious that I had unconsciously gravitated towards the bed when I arrived. I guess it happened because the bed is in the centre of an empty room and I felt clueless and unsure of what to do, with no tools or decent knowledge under my belt. Lucky I know better since my births.

Most hospitals like you to be compliant and on the bed most of the time, when it’s the last place you want to be for a good labour. However, if you’ve had independent education, you would know that pushing while on your back is not only more painful, but much less effective – in fact it’s THE least productive position to push in. Why? Because your uterus which normally contracts away (or upwards if you’re lying down) from your body, which means it will be working against gravity if you are lying down. Women in labour naturally want to lean forward – something your pelvis does when it contracts, so it makes sense to work with it. Your pelvis is also least open when on your back, whereas squatting gives you up to 30% more pelvic space. Thats something pretty neat I learnt after I had given birth – but not what you’ll hear in hospital classes. And if you end up in a private hospital like the one I mentioned, you might not even be able to do that, further reason why they do not have their hospital built with the premise of helping you have the best/easiest birth possible.

Remember a hospital is a business and has business issues to consider firstly and foremostly. They don’t open with the premise to give women the best experience possible, but to have a functioning maternity unit and to succeed as a business.

3. You’ll See Birth DVDs Designed To Inspire Not Frighten

Believe it or not, there is actually a birth DVD that’s been in circulation for years in some hospitals where the labouring woman is yelling, ‘Get me a gun so I can shoot myself.’ This and many other DVDs have result in couples walking out of their classes feeling like they cannot cope with a vaginal birth, serving to further convince them that they actually do need drugs for the birth – just like all their friends have told them. There are many factors that result in how a woman copes in labour and this is a big blow from the start. The DVD I saw when I was having my daughter was a mother in a hospital bed, screaming in pain, who then asked for an epidural and then she was really happy. What sort of message do you think this sends out to a first time, nervous expectant mother and father?

The DVDs some hospitals show are definitely not productive nor appropriate, whereas DVD’s you see in independent classes are very inspiring, uplifting and show you the potential of your own body.

4. You’ll Gain Many More Tools For Natural Pain Relief

Both yourself and your partner will have more confidence on how to cope with the tougher parts to labour if you are given more options and tools for natural pain relief. That one thing that ends up being your lifesaver, helping you get through without pain relief, may be so simple. If you happen to be in a class which skims this part of the education or omits it altogether in preference of pharmaceutical pain relief, then thats the path you are most likely to take – because you don’t know any other options and you just cannot think about it and what you want in labour (apart from wanting to get the baby out – NOW!). You are also being given an important insight into the philosophy of the hospital when they teach pain relief in the form of drugs. I remember one client telling me that her hospital (a large Melbourne private hospital) had birth classes which was very detailed about pain relief – there was lots of information about epidurals and other drugs. I ended up asking a midwife during her labour why this was so, her reply, ‘Well most women walk in here wanting epidurals, so we just teach them what they want to know about.’ Too bad for the woman that would like to labour without one.

5. You Will Find Out ALL Your Options

Again, independent birth educators do not operate based on policy, but what is possible for you – what options and rights you have as a labouring couple. There will be no ‘we do this’ or ‘we do that’ only, ‘you could choose to do this’ or ‘you could choose to do that’ – with the pros and cons both ways. It is a much more balanced view of what’s possible, with the view that your body is extremely capable – and not just what everyone else is like.6. You Do Pay For What You Get
Birth educators educate for a living, their livelihood depends on presenting great classes which couples enjoy. Great word of mouth feedback comes from their clients who leave the classes feeling great about birth – informed, empowered and educated.

So it’s in their best interest to make sure the class is worth it to you, since it’s their own business and not someone else’s. Some hospitals offer their classes for free, some don’t – either way your money is best invested in independent education. I was shocked at how much I wasn’t told in a hospital class, after attending independent classes during my training as a birth attendant. I even felt angry for some time – the care factor is so much more evident during independent classes. The educators genuinely want you to have a great experience and have great philosophies about birth.

7. You Know Who You Are Getting

Independent birth educators often operate individually or in a small team, so you will know who you are getting. You will be able to find out what their testimonials and feedback are like before you go, so you know you are getting a great service. They are also happy to take your calls and questions before and after the classes and trying to locate them isn’t as difficult as in a big establishment!

8. Helps Partners Get More Involved

Because more time is spent on tools you can use, and the classes are more in depth in general, fathers-to-be learn much more and feel more comfortable getting involved – which is good for dads-to-be and good for mum-to-be. It’s so important that a partner learns and understands what’s going on during labour, as a support person who panics or is unsettled in labour will have the same effect on the mum – she needs someone solid as a rock to get her through. Pain relief is often used by mothers to help escape that horrible feeling of not being supported, or when she feels frightened or anxious.

If a partner only knows that if there is pain, the only way he can help is to offer pain relief, then thats likely where the birth will go. Men tend to be ‘fixers’, they like to fix, and there is nothing wrong with that, but this puts them very much outside their comfort zone in birth, where there is nothing he can do to take it all away. Labour is not a time for saving or fixing, but encouraging and reassuring!

9. It Will Help Better Form Your Birth Preferences (aka Plan)

If you are more aware of your options and choices, then you will be able to have a more indepth discussion with your partner and your support people about the choices in your birth plan. You will have more control over what you want, rather than feeling you have to ‘leave it to the experts.’ You don’t need to be an expert to have a great, empowered birth, but you do need to inform yourself and your support people and make choices based on what you have learnt. And the best, unbiased place to learn about your REAL options and gain more knowledge and tools for your birth is through independent childbirth education.

Where Can I Find An Independent Educator?

NACE are the National Association of Childbirth Educators, and can help you locate a member in your area. Some educators BellyBelly recommends in Melbourne (but are not limited to) include:

* About Birth
* Birthing Wisdom (Rhea Dempsey) workshops
* Birth by Di Diddle
* Wonderful Birth by Lina Clerke

For the Men

A great book I recommend to all men is Men At Birth by David Vernon. It’s a great book written by Australian men, for men. There is also The Birth Partner by Penny Simkin.

Important to Note
While there are some brilliant birth educators out there, it’s really important that every birthing couple realises that it’s not birth classes alone that will get them across the line. Yes, they are a great start and will likely have you thinking about lots of things you hadn’t already thought about, but all your choices as a whole will shape your birth, not just education. The carer you choose, the hospital (or not!) you birth in, your support people and the philosophy of all of those things and the books you read can impact on what sort of birth you end up having.

For example, if you really want a natural birth and have chosen an Obstetrician and private hospital – then you have chosen the statistically worst option for avoiding interventions including pain relief, caesarean sections, assisted delivery – there are plenty of pieces that make up a puzzle. Check out our article, Natural Birth – Giving Yourself The Best Chance for more information.

Kelly Winder is a birth attendant (aka doula) the creator of BellyBelly and mum to two beautiful children.

Wednesday, January 20, 2010

Elective cesarean sections are too risky, WHO study says

By Katherine Harmon

Despite medical advances and increasing access to improved obstetric care across the globe, surgical childbirths are still more risky for both mother and baby, according to an ongoing international survey by the World Health Organization (WHO).

A new report from the survey, which was published online today in the medical journal The Lancet, found that in Asia—in both developed and developing nations—cesarean section births only reduced risks of major complications for mother and child if they were medically recommended. Elected surgical deliveries, on the other hand, put both at greater risk.

"Cesarean section should be done only when there is a medical indication to improve the outcome for the mother or the baby," the authors of the report concluded. Common reasons for a recommendation for cesarean delivery included a previous cesarean section, cephalopelvic disproportion (when the baby's head cannot fit through the mother's pelvic opening) and fetal distress.

In the nine countries studied (Cambodia, China, India, Japan, Nepal, the Philippines, Sri Lanka, Thailand and Vietnam), more than a quarter of the 107,950 births analyzed (27.3 percent) were C-sections, and in China, which had the highest rate of operations, nearly half (46.2 percent) of the births in the survey were cesarean. With these surgeries comes increased risk of maternal death, infant death, admission into an intensive care unit, blood transfusion, hysterectomy or internal iliac artery ligation (to control bleeding in the pelvis) compared to spontaneous vaginal delivery, according to the report.

But these risks have not necessarily been absorbed into popular, or even medical culture. The rates of cesarean section procedures are on the rise in many countries across the globe, the authors report, and in some countries they "have reached epidemic proportions." Among the nations studied, China had the highest rate of cesarean sections that were performed without medical indication—11.7 percent; the overall rate for the facilities studied had a rate of 1.9 percent.

Most cesarean sections (15.8 percent of births) were begun during labor, as opposed to before it starts. But these later procedures—both elected (0.5 percent) and medically required (15.3 percent)—also carry the most risks for adverse outcomes, the authors found.

In a commentary accompanying the report, Yap-Seng Chong of the National University of Medicine in Singapore and Kenneth Y C Kwek of the KK Women's and Children's Hospital also in Singapore call the results "surprising and chilling." The findings, they say "should help us to prioritize our strategies to reduce unnecessary interventions in childbirth," they wrote. "There is little wrong with medical interventions when indicated, but for those who are still inclined to consider caesarean delivery a harmless option, they need to take a cold hard look at the evidence against unnecessary cesarean section."

The investigators were able to analyze some 96 percent of the births reported in the 122 hospitals that participated in the survey over two to three months between 2007 and 2008. Facilities were located in the capital city of each country and two randomly chosen regions. To qualify for the survey, hospitals had to be delivering at least 1,000 babies a year and performing cesarean surgeries, so as the authors noted, "the results therefore cannot be generalized to smaller facilities" or to the countries overall.

Despite the increased risks associated with cesarean deliveries, no mothers or babies in the study died after an elected cesarean before hospital release. The most dangerous form of childbirth proved to be vaginal operative delivery, which includes using forceps or a vacuum to assist in delivery and is more rare, occurring in just 3.2 percent of the births analyzed.

The findings confirm a previous WHO report published in 2006 in The Lancet, analyzing the rates and safety of various childbirth approaches in Latin America, where the investigators found that "increasing rates of cesarean section do not necessarily lead to improved outcomes and could be associated with harm." Taking the two reports together, the authors concluded, lends "strong multiregional support for the recommendation of avoiding unnecessary cesarean sections."

Surgical childbirth also requires more resources than a natural vaginal delivery, the authors note. Especially in countries where money, medical practitioners or proper equipment is more limited, unnecessary cesarean sections can drain resources away from those cases in which it can improve the chances of a healthy mother and baby.

Image of cesarean surgery team at work courtesy of Wikimedia Commons/Bobjgaliando

Tuesday, January 19, 2010

Pre-Pregnancy - Stress

The Clearblue Easy website says that stress is your enemy when trying to conceive. As you all know, I've been dealing with this for the past 12 months. And since a conversation I had with my husband last night, I think it is settling in how I need to be. You're right, Dad. I always gotta learn things the hard way, the long's my way. In retrospect I always think why did I waste all that time being so worried and stressed? I could be pregnant by now! Nonetheless, I must have had to go through all that to get to where I am now. Each let-down every month has shaped this experience.

Last entry I was telling you about my HSG test in October which proved to be all clear. Starting cycle 12, I went on 50 mg of Clomid for cycle days 5-9. I was sure I'd get pregnant. Just knowing I had Clomid on my side helped my mental outlook. I even had 2 dreams back-to-back of reading a positive pregnancy test! I took my fertility drugs, I went in for the ultrasound to count follicles. I had 8. Three on the right ovary, and 5 on the left. The ultrasound tech said, "Are you prepared for twins? It could happen." I said, "Yes!" After all this I'd carry three if it meant I'd have a healthy child in 9 months. I went in for a progesterone blood draw 8 days after the (what I thought to be positive) LH surge. Goods news; 54.4. (whatever that means). The nurse said, "Take a pregnancy test in a week and let us know!" I was soooo excited. SO excited. I thought this is good! Progesterone is strong which means I can physically carry a baby. Then....last Sunday night, the Crimson Tide rolled in. Curses! Yes, I can't deny I was sad but where else is there to go but up, right? I cried to my husband last night that he just doesn't get it. He has no idea how I feel. Then I apologized this morning for being so over-dramatic. :)

On to Cycle 13...this Thursday brings Round 2 of Clomid, 100mg for cycle days 5 through 9. No monitoring this month because we are going out of town for Christmas but I am still to use the ovulation predictor kits. I coughed up the 50 bucks for 20 digital tests. Reading the lines on those things were adding more stress. Let the computer take care of it. I don't know if 100mg means more eggs to be released...we'll see!

I am going to Ohio to visit my family in a week. I am really looking forward to the mental break. Right in the middle of that first round of Clomid, I lost my job which probably didn't help my stress levels. I got some great advice from a friend, "Breathe, visualize, and the universe will take care of it." Brings me back to the dirt, rocks, and gravel my feet should have been on this entire time. I've started doing that and it's helping.

I'll leave here and let you know what happens next month. It is my promise to myself, and to you, that I will remain positive no matter how many more months it takes to have DJ Baby Z. Baby Z, you come when you're ready. Mommy and Daddy will wait as long as you need.

Monday, January 18, 2010

BINSI was on the The 10! Show - NBC Philadelphia

Getting The Whole Family Ready for New Baby

Shannon Choe, from Premier Baby Concierge, has some great new products to prepare everybody in the family for a new addition to the family. She has everything from a new iPhone application to a book preparing Dads for the delivery room.

"Labor is like an athletic event" Shannon Choe. So be ready to be active, change positions and wearing your BINSI Birth Skirt and Birth Top!

View more news videos at: