A new Cochrane Review concludes that all countries should consider establishing proper home birth services. They should also provide low-risk pregnant women with information enabling them to make an informed choice. The review has been prepared by senior researcher, statistician Ole Olsen, the Research Unit for General Practice, University of Copenhagen, and midwifery lecturer PhD Jette Aaroe Clausen.
In many countries it is believed that the safest option for all women is to give birth in hospital. However, observational studies of increasingly better quality and in different settings suggest that planned home birth in many places can be as safe as planned hospital birth and with less intervention and fewer complications.
“If home birth is going be an attractive and safe option for most pregnant women, it has to be an integrated part of the health care system,” Ole Olsen says and adds, “In several Danish regions the home birth service has been very well organised for several years. This is not the case everywhere in the world.”
The updated Cochrane Review concludes that there is no strong evidence from experimental studies (randomised trials) to favour either planned hospital birth or planned home birth for low-risk pregnant women. At least not as long as the planned home birth is assisted by an experienced midwife with collaborative medical back up in case transfer should be necessary.
Fewer interventions in home birth
Routines and easy access to medical interventions may increase the risk of unnecessary interventions in birth explaining why women who give birth at home have a higher likelihood for a spontaneous labour. There are 20-60 per cent fewer interventions, for example fewer cesarean sections, epidurals and augmentation among those women who plan a homebirth; and 10-30 per cent fewer complications, for example post partum bleeding and severe perineal tears.
“Patience is important if women want to avoid interference and give birth spontaneously,” says Jette Aaroe Clausen. “At home the temptation to make unnecessary interventions is reduced. The woman avoids for example routine electronic monitoring that may easily lead to further interventions in birth.”
Jette Aaroe Clausen adds that interventions in childbirth are common in many countries, but also that there is a growing concern internationally because interventions may lead to iatrogenic effects; iatrogenic effects meaning unintended consequences of the intervention. Routine electronic monitoring may for example lead to more women having artificial rupture of membranes which in turn can lead to more interventions.
Evidence and human rights
While the scientific evidence from observational studies has been growing, the European Court of Human Rights in Strasbourg in the case Ternovszky versus Hungary has handed down a judgment stating that “the right to respect for private life includes the right to choose the circumstances of birth”. This is quoted in the review.
Thus the conclusions of the review are based on human rights and ethics as well as on results from the best available scientific studies.###
Ref.: Olsen O, Clausen JA. Planned hospital birth versus planned home birth. The Cochrane Library, Issue 9, 2012.
The full review may be available here (depends on country): http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000352.pub2/abstract
[Check your local medical, academic, and public libraries for access to this article.
Many medical and academic libraries are open to the public. Ask a reference librarian for assistance]
- Cocharane Reviews
Cochrane Reviews are systematic reviews of primary research in human health care and health policy, and are internationally recognised as the highest standard in evidence-based health care. They investigate the effects of interventions for prevention, treatment and rehabilitation. They also assess the accuracy of a diagnostic test for a given condition in a specific patient group and setting. They are published online in The Cochrane Library.
- Birth is no reason to go to hospital (eurekalert.org)
- Birth is no reason to go to hospital, review says (medicalxpress.com)
- Balanced Birthing Options (betternature.wordpress.com)
- Home births: Midwives ‘risk not being objective enough’ (telegraph.co.uk)
- SOCIAL GOOD: One Mom’s Mission to Save Lives in Laos (worldmomsblog.com)
- Autumn’s Homebirth (thebirthinterviewproject.com)
- The Myth of a Safer Hospital Birth for Low-Risk Pregnancies (foodconsumer.org)
Increased levels of depression as a result of discrimination could contribute to low birth weight babies.
Given the well-documented relationship between low birth weight and the increased risk of health problems throughout one’s lifespan, it is vital to reduce any potential contributors to low birth weight. A new study by Valerie Earnshaw and her colleagues from Yale University sheds light on one possible causal factor. Their findings, published online in Springer’s journal, theAnnals of Behavioral Medicine, suggest that chronic, everyday instances of discrimination against pregnant, urban women of color may play a significant role in contributing to low birth weight babies.
Twice as many black women give birth to low birth weight babies than white or Latina women in the U.S. Reasons for this disparity are, as yet, unclear. But initial evidence suggests a link may exist between discrimination experienced while pregnant and the incidence of low birth weight. In addition, experiences of discrimination have also been linked to depression, which causes physiological changes that can have a negative effect on a pregnancy…
Levels of everyday discrimination reported were generally low. However, the impact of discrimination was the same in all the participants regardless of age, ethnicity or type of discrimination reported. Women reporting greater levels of discrimination were more prone to depressive symptoms, and ultimately went on to have babies with lower birth weights than those reporting lower levels of discrimination. This has implications for healthcare providers who work with pregnant teens and young women during the pre-natal period, while they have the opportunity to try and reduce the potential impacts discrimination on the pregnancy.
The authors conclude that “Given the associations between birth weight and health across the life span, it is critical to reduce discrimination directed at urban youth of color so that all children are able to begin life with greater promise for health. In doing so, we have the possibility to eliminate disparities not only in birth weight, but in health outcomes across the lifespan.”
- Study finds racism may harm pregnant women of color and cause low birth weight in newborns (thegrio.com)
- The effects of discrimination could last a lifetime (eurekalert.org)
- The effects of discrimination could last a lifetime (whitenewsnow.com)
- Increased risk of prematurity and low birth weight in babies born after 3 or more abortions (eurekalert.org)
- Health News: Maternity leave delay as dangerous to unborn baby as smoking (dailyrecord.co.uk)
Pregnant women who are highly exposed to common environmental chemicals — polyfluoroalkyl compounds (PFCs) — have babies that are smaller at birth and larger at 20 months of age, according to a study from Emory University’s Rollins School of Public Health published online in the August 30 edition ofEnvironmental Health Perspectives.
PFCs are used in the production of fluoropolymers and are found widely in protective coatings of packaging products, clothes, furniture and non-stick cookware. They are persistent compounds found abundantly in the environment and human exposure is common. PFCs have been detected in human sera, breast milk and cord blood…
The researchers found that even though girls with higher exposure were smaller than average (43rd percentile) at birth, they were heavier than average (58th percentile) by 20 months of age. The authors say this path may lead to obesity at older ages.
“Previous animal and human research suggests prenatal exposures to PFCs may have harmful effects on fetal and postnatal growth,” says lead researcher Michele Marcus, MPH, PhD, a professor of epidemiology in Emory’s Rollins School of Public Health and the assistant program director at Kaiser Permanente’s Center for Health Research.
“Our findings are consistent with these studies and emerging evidence that chemicals in our environment are contributing to obesity and diabetes and demonstrate that this trajectory is set very early in life for those exposed.”
According to Marcus, a recent study in Denmark found that women exposed to PFCs in the womb were more likely to be overweight at age 20. And experimental studies with mice have shown that exposure in the womb led to higher levels of insulin and heavier body weight in adulthood….
- Chemical exposure in the womb from household items may contribute to obesity (engineeringevil.com)
- Chemical exposure in the womb from household items may contribute to obesity (scienceblog.com)
- Chemical exposure in the womb from household items may contribute to obesity (eurekalert.org)
- Chemical exposure in the womb from household items may contribute to obesity (medicalxpress.com)
- Child obesity link to magnetic field exposure in the womb (nyrnaturalnews.com)
- Exposure To Magnetic Fields In The Womb Associated With Increased Risk Of Obesity In Childhood (medicalnewstoday.com)
- Exposure To Chemical In Drinking Water In The Womb And Early Childhood May Affect Vision (medicalnewstoday.com)
- Diesel Exhaust Exposure In The Womb A Possible Risk Factor For Obesity (medicalnewstoday.com)
- Exposure to environmental chemicals in the womb reprograms the rodent brain to disrupt reproduction (medicalxpress.com)
- Widely Used Pesticide Harms Boys’ Brains (eastbayexpress.com)
Go to http://prolife2011.wordpress.com/category/facts/ for larger image
From the Full Text Reports Web page
December 23, 2011Source: Guttmacher Institute
In the United States, nearly nine in 10 abortions occur in the first trimester, but, until now, little was known about the 10% of women who have abortions at 13 weeks’ gestation or later. According to “Who Has Second-Trimester Abortions in the United States?,” by Rachel K. Jones and Lawrence B. Finer of the Guttmacher Institute, certain groups of women are overrepresented among second-trimester abortion patients. These groups include women with lower educational levels, black women and women who have experienced multiple disruptive events in the last year, such as unemployment or separating from a partner.
This first-ever comprehensive profile of second-trimester abortion patients in the United States relies on data from a nationally representative sample of more than 9,400 women obtaining abortions in 2008. The authors first compared first-trimester abortion patients with those obtaining abortions at 13 weeks or later to see if there were differences in characteristics between the groups; next, among second-trimester abortion patients, they compared early second-trimester abortion patients (13–15 weeks’ gestation) with those having abortions at 16 weeks or later.
Certain groups of women were more likely than others to obtain abortions at 13 weeks or later. For example, teens were more likely than older women to obtain an abortion in the second trimester—accounting for 14% of abortions among teens, compared with 9% among women aged 30 and older. Similarly, the proportion of abortions that occurred in the second trimester was 13% among black women, compared with 9% among non-Hispanic whites; 13% among women who had not graduated from high school, compared with 6% among college graduates; 14% among those using health insurance to pay for the procedure, compared with 8% among those who paid out of pocket; and 15% among those who had experienced three or more disruptive events in the past year, compared with 9% among women experiencing no disruptive events.+ Full Report (PDF)
- Report: Younger, Less Educated Women More Likely To Undergo Second Trimester Abortions (thinkprogress.org)
- Study Reveals Who Gets Late-term Abortions (maboulette.wordpress.com)
- Study Reveals Who Gets Late-Term Abortions (livescience.com)
Infant Mortality and Pregnancy LossThe Maternal and Child Health Library at Georgetown University released a new edition of the knowledge path, Infant Mortality and Pregnancy Loss. The knowledge path directs readers to resources that analyze data, report on research aimed at identifying causes and promising intervention strategies, and describe risk-reduction efforts as well as bereavement-support programs. Separate sections present resources about factors that contribute to infant mortality and pregnancy loss: birth defects, injuries, low birthweight and prematurity, preconception and pregnancy, and safe sleep environments. The knowledge path was created for health professionals, policymakers, researchers, and families. View the path online at http://www.mchlibrary.info/KnowledgePaths/kp_infmort.html. A resource brief for families accompanies the knowledge path and is available at http://www.mchlibrary.info/families/frb_infmort.html.
Research suggests exposure to electromagnetic fields before and after birth might play role
MONDAY, Dec. 6 (HealthDay News) — Children exposed to cell phones in the womb and after birth had a higher risk of behavior problems by their seventh birthday, possibly related to the electromagnetic fields emitted by the devices, a new study of nearly 29,000 children suggests.
The findings replicate those of a 2008 study of 13,000 children conducted by the same U.S. researchers. And while the earlier study did not factor in some potentially important variables that could have affected its results, this new one included them, said lead author Leeka Kheifets, an epidemiologist at the School of Public Health at the University of California at Los Angeles.
“These new results back the previous research and reduce the likelihood that this could be a chance finding,” said Kheifets. She stressed that the findings suggest, but do not prove, a connection between cell phone exposure and later behavior problems in kids.
The study was published online Dec. 6 in the Journal of Epidemiology and Community Health.
Farm Environment, Cats Help Kids Avoid Skin Disease & Related Article (Growing Up on Farm Strengthens Immune System)
- Growing Up On A Farm Directly Affects Regulation Of The Immune System (medicalnewstoday.com)
- Growing up on a farm directly affects regulation of the immune system (eurekalert.org)
Excerpt from a October 6, 2010Reuters Health Information item
NEW YORK (Reuters Health) – New research confirms that women plagued by morning sickness in early pregnancy are less likely to miscarry.
But women who don’t experience nausea and vomiting during their first trimester shouldn’t be alarmed, Dr. Ronna L. Chan of The University of North Carolina at Chapel Hill, one of the study’s authors, told Reuters Health.
because of the nature of the study, the authors could not prove that there was any cause-effect relationship between morning sickness and a healthier pregnancy, just that the two were linked.
A number of theories have been put forth to explain why morning sickness might signal a healthier pregnancy, Chan said. “Some postulate nausea and vomiting during pregnancy is a mechanism to help improve the quality of a pregnant woman’s diet or a way to reduce or eliminate potentially harmful substances from the mother in order to protect the fetus,” she explained.
While these ideas are “plausible,” the researcher said, she thinks the symptoms reflect a pregnant woman’s sensitivity to the sharp rise in certain hormones key for sustaining pregnancy that occurs during the first trimester.
Note from the editor…
About 15 years ago I took several ecology classes. One instructor agreed with one of the hypotheses above, that morning sickness is a product of natural selection in keeping potentially harmful substances away from the fetus. He gave us several more examples (they elude me now!) of treating conditions that are in reality beneficial. I think some fevers were another example.