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• Midwife-led units safest for straightforward births
• 25-hydroxyvitamin D3 status is associated with developing adaptive and innate immune responses in the first 6 months of life
• Nation’s OB/GYNs Take Aim at Preventing Cesareans
• Medicaid Breast Pump Policy
• Avoid fetal “keepsake” images

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25-hydroxyvitamin D3 status is associated with developing adaptive and innate immune responses in the first 6 months of life

This study suggests that improving Vitamin D3 intake in pregnancy or early infancy may reduce the development of allergies in high-risk infants.

Nation’s OB/GYNs Take Aim at Preventing Cesareans

New ACOG guideline recommend allowing women to labor longer to help avoid cesarean delivery. The Safe Prevention of the Primary Cesarean Delivery report discusses ways to decrease cesarean deliveries, including:

• Allowing prolonged latent (early) phase labor.
• Considering cervical dilation of 6 cm (instead of 4 cm) as the start of active phase labor.
• Allowing more time for labor to progress in the active phase.
• Allowing women to push for at least two hours if they have delivered before, three hours if it’s their first delivery, and even longer in some situations, for example, with an epidural.
• Using techniques to assist with vaginal delivery, which is the preferred method when possible. This may include the use of forceps, for example.

Medicaid Breast Pump Policy

Medicaid has released its Expanded Breast Pump Policy which took effect January 1. This policy allows physicians and non-physician practitioners to write an order for a breast pump for all breastfeeding mothers enrolled in a Medicaid Health Plan. Read the bulletin from the Michigan Department of Public Health.

Avoid fetal “keepsake” images

The FDA has called into question the commercial (non-medical) use of ultrasound imaging, noting that ultrasound can heat tissues slightly and, in some cases, produce very small bubbles or cavitation in exposed tissues. Because the long-term effects of tissue heating and cavitation are not known, consumers should be aware that prolonged or repeated exposure by nonmedical personnel may be risky. Read the article.

Cesarean Rates by Hospital in Michigan

Yikes! Twenty-seven (27) hospitals in Michigan report cesarean rates of over 35 percent. Seriously? Definitely a “buyer-beware” situation for all you expectant parents out there. Everyone understands that a cesarean can be a life-saving operation for mom or baby, but consider that in 1970, the U.S. cesarean rate was 5.5 percent and that the dramatic (and unconscionable) rise in use of this surgery cannot be justified by a corresponding improvement outcomes. Currently, the U.S. ranks 41st among industrialized countries for infant mortality. I constantly marvel at the notion that the best care provider for a low-risk pregnant woman is a OB/GYN surgical specialist. For a non-surgical birth, start by choosing a midwife! Follow up with childbirth classes and engaging the services of a doula. Read the report.

To close, let’s review some of the risks involved with cesarean birth. Moms face:

• 2x risk of maternal death
• increased risk of uterine infection, hemorrhage and blood clots
• 10–15% risk of infection in incision site
• increased in postpartum pain and disability

And for future pregnancies, there is an increased risk of:

• ectopic pregnancy, esp. after more than one cesarean
• problems with the placenta (such as placenta previa or placental abruption)
• repeat cesarean
• invasive scar tissues and adhesions

For babies, cesareans are associated with an increased risk of:

• Prematurity, esp. when scheduled
• 5x more likely to require assistance with breathing
• 5x more likely to be admitted to special care
• 1–2% of babies cut during surgery

It should be understood that, in this latter category of risks to the infant, some of these risks may involve the reason the cesarean was performed in the first place (e.g., baby was admitted to special care after a cesarean was done for fetal distress in labor). All in all, major abdominal surgery is not something to be taken lightly and there is no evidence to support its routine use.

Planned C-sections provide no advantage over planned vaginal birth of twins, study suggests

Findings suggest planned birthing of twins at 32-38 weeks by Cesarean section does not decrease perinatal or neonatal death compared to planned vaginal birth. The randomized study, “The Twin Birth Study: A multicenter RCT of planned cesarean section and planned vaginal birth for twin pregnancies,” should help women understand that a planned vaginal birth is as safe as a planned cesarean section as long as the first twin is situated head first. There’s no evidence that a cesarean section is better for the babies or you.

Judging progress in labor: 6 cm is the new 4cm

A threshold of 6 cm cervical dilation is more accurate than the conventional 4 cm to determine when a woman enters the active phase of labor, a reevaluation of the evidence suggests. “The historical evidence behind the commonly used assumption that 4-cm dilation signals the start of active labor contains methodological flaws, doesn’t match today’s population of pregnant women, and is contradicted by more recent studies supporting the 6-cm threshold,” according to Tekoa King, C.N.M, Ph.D. Switching to the 6-cm threshold may delay or reduce the use of epidural anesthesia and might lower the high rate of cesarean sections in the United States. Read the article.