Evaluating Novel and Relevant Information for Children's Health and Emotional Development
I’m an OB-GYN. I’m not sure every baby needs to be born in the hospital
Dr. Neel Shah
There is a good chance that your grandparents were born at home. I am going to go ahead and assume they turned out fine, or at least fine enough, since you were eventually born too and are now reading this.
But since the late 1960s, very few babies in Britain or the United States have been born outside of hospitals. As a result, you may find the new guidelines from Britain’s National Institutes for Health and Care Excellence just as surprising as I did. For many healthy women, the NICE guidelines authors believe, there may be significant benefits to going back to the way things were.
Shortly after the NICE guidelines were issued, the New England Journal of Medicine invited me to write a response. The idea that any pregnant patient might be safer giving birth outside the hospital seemed heretical, at least to an American obstetrician like me. Knowing that no study or guideline is foolproof, I began my task by looking for holes to form a rebuttal.
I soon realized that this rebuttal largely hinged on flaws in the American system, not the British one. While we take excellent care of sick patients, we do less well for healthy patients with routine pregnancies – largely in the form of turning to medical interventions more than strictly necessary.
As the guidelines suggest, some women in Britain with low-risk pregnancies may be better off staying out of the hospital. Why? Because the significant risks of over-intervention in hospitals, such as unnecessary C-sections, may be far more likely (and therefore more dangerous) for patients than the risks of under-intervention at home or in birth centers. But women in Britain have access to greater range of settings where they can give birth. For women in much of the United States, the choice is often the hospital or nothing.
Home Birth: Why This Doctor Would Still Choose One
Aviva Romm M.D.
Nearly 30 years ago I gave birth to my first baby at home, followed by three more children via three more home births in the ensuing decade. My four births were beautiful, meaningful, empowering events that supported my smooth transition into natural mothering. Admittedly, this was long before I was a physician.
In fact, I was a home birth midwife.
Having home births – and being a midwife – were congruent with how I lived: as close to nature in my lifestyle choices as possible. During labor I felt the most comfortable being in my home, walking on the golf course behind my house, squatting during contractions, and eating & drinking freely to maintain my energy and stamina. It was where I felt the safest and could take the path of least resistance to how I wanted to birth. I also knew I was making an educated decision based on extensive research into the history of birth in many cultures, and the evidence for obstetric practices at the time.
‘Miriam’: A Midwife Who Makes House Calls
Sara Trappler Spielman
At a recent screening of Miriam: Home Delivery—a new documentary from British director Juliet Jordan that explores midwifery in New York City—a group of Orthodox mothers, a group that I am a part of, showed up to the IFC Center in Manhattan proudly with our babies. The films follows the work of home birth midwife Miriam Schwarzchild, an unaffiliated Jew, with whom Jordan followed for three months in 2012, practically on call together. Miriam, who has helped with my own home births, has established a regular clientele for herself in New York City, where its a growing trend for women from diverse communities to give birth at home, including Orthodox Jews.
My Homebirth Experience
During my first pregnancy, my husband and I went to a birthing class sponsored by the hospital where I was planning on delivering. The first evening our teacher, a nurse with 20 years in labor and delivery, posed a question to us and the ten other couples in our class: “How many of you are planning on having a natural birth?”
I was the only one who raised my hand.
She tipped her head to the side and gave me a close-lipped smile, as if to say, Isn’t that sweet. “Just so you know, ninety percent of the patients who come through maternity at this hospital get an epidural. The other ten percent show up too late to get one. But you’re welcome to try it naturally.”
I was crushed.
Safety Of Home Birth (McMaster Study)
Midwives in Ontario, Canada, have been providing care for expectant mothers in both home and hospital settings. They have been integrated into the provincial health-care system since 1994.
A recent study by McMaster University researchers reveals that low-risk women giving birth with the assistance of midwives have positive outcomes regardless of where the delivery takes place.
The findings of the study are published in the print and online editions of the journal Birth. It concludes that home birth is as safe as hospital delivery.
Almost 6,700 planned home births in Ontario were assessed in the study. Results indicated that newborns and mothers were no more likely to suffer complications than their counterparts in a clinical setting.
Eileen Hutton, the lead investigator of the study and assistant dean of midwifery at McMaster University said: "Home birth has been huge debated over the last 40 to 50 years."
"As birth made its way into hospital without any clear evidence that it was a safer place to be, home birth has become more and more discouraged. I think for women who want to make that choice, it's important to have good information about those aspects of care."
Home Births Not Linked to Increased Risk of Complications
Over 100 years ago, nearly all births in the US happened outside of a hospital, but by 1940, only 44% of births occurred this way, with the rate falling to just 1% by 1969. Now, a new study shows support for home births, suggesting they pose no increased risk of harm to the baby, compared with planned hospital births.
The study, published in CMAJ, was led by Dr. Eileen Hutton, from McMaster University in Ontario, Canada.
According to the Centers for Disease Control and Prevention (CDC), the percentage of out-of-hospital births in the US increased from 1.26% in 2011 to 1.36% in 2012.
Although this rate is still quite low, out-of-hospital births have been on the rise lately. If the increasing trend continues, the CDC note that it "has the potential to affect patterns of facility usage, clinical training and resource allocation, as well as health care costs."
Home Birth: Is It Safe?
Team Mama Natural
Home birth has been embraced by many natural mamas and is increasing in popularity… again!
Home birth was the norm until the early part of the 20th century when women started going to the hospital to give birth. So home birth is the traditional way of birthing a baby but, is it safe?
Studies are piling up that show home birth is very safe for low risk women. In fact, British regulators are urging women to consider home birth because home birth can be safer than a hospital birth for many women. But how?
Top Foods to Eat When You're Pregnant
There is rarely a more nutritionally demanding time during a woman's life than pregnancy (and later breastfeeding), when your intake of nutrients from foods and supplements are needed not only to keep your body running, but also to nourish and support your rapidly growing baby.
Proper nutrition is crucial at all stages of fetal development (and even before conception), and if mom doesn't eat right, her growing baby won't either. For a succinct and easy-to-follow overview of the types of foods and nutrients that will support a healthy pregnancy, read my optimized nutrition plan.
Ideally, by the time you enter pregnancy, you will already be in the Intermediate or Advanced stage, but even the Beginner stage is far better that the typical American diet.
As you'll see, it is focused on minimizing processed foods while increasing your intake of vegetables, healthy fats, and high-quality sources of protein, all of which are ideal for nurturing a growing fetus.
If you're wondering about specific foods, see below for some of the top superfoods to eat when you're pregnant.
7 Strategies to Reverse Infertility
Mark Hyman, MD
“My husband and I are suffering from infertility,” my patient tells me. “Does this have to do with things like lifestyle, or is it just bad luck? Is there anything we can do to reverse this situation?”
I’m sad to say today one in seven couples suffer from infertility, which researchers define as the diminished ability or the inability to conceive and have offspring, or more specifically, failure to conceive after a year of regular intercourse without contraception.
The questions becomes, why have infertility rates increased?
While there are no easy answers here, I don’t believe it’s coincidence that infertility has increased just like diabetes and obesity has. That’s because excess sugar and subsequent belly fat drive hormonal imbalances and create infertility.
In women, these imbalances manifest as polycystic ovarian syndrome (PCOS), which is really a nutritional and metabolic problem that adversely affects insulin and other hormones.
Natural Family Planning - Know Your Body!
What is Natural Family Planning?
Natural family planning (also know as The Billing's Ovulation Method) is a method used to determine when a woman is fertile. During the menstrual cycle, numerous changes occur in a woman's body. By learning to identify your natural signals of fertility, you can use this method to become pregnant or avoid pregnancy and to safeguard your reproductive health.
Why Would I Want to Practice Natural Family Planning?
This method enables a woman to safeguard her reproductive health while allowing effective management of fertility. This scientific method of fertility management is completely natural, and as a result, there are none of the harmful side effects commonly associated with many contraceptives.
Pregnancy-Friendly Protection? The Truth About Whooping Cough Vaccine
Dr. Kelly Brogan
So, you’re trying to grow a plant. You take it inside, in a little pot. You feed it fertilizer, put it under lights, and when it starts to wilt, you prop it up with all sorts of sticks and tape, and when one fails, you add more. Eventually it dies. All it wanted was sun, fresh air, clean water, and the magic of natural soil. I think of this pathetic image when I reflect up the absurdity of our vaccination program. If it were only absurd, and not deadly, my reflections would be just that. Instead, I am here to speak to pregnant women about how to arm themselves with knowledge, to warn them so there are no regrets.
As I have declared, I take pregnancy interventions, epigenetic exposures, and maternal health very, very seriously. After my fellowship-level training in psychiatric treatment of these women, I understand, all too well, how flawed and nearly impossible to achieve, safety data is for pharmaceutical products in pregnancy. Passive reporting systems and industry-maintained registries don’t cut it. I’d like to take you on a brief tour of one particular product that your OB may recommend, coerce, or bully you into, and then your child’s pediatrician will take the torch and do the same for your tiny baby: the diptheria, tetanus, pertussis vaccine, also known as DTaP.
The Hidden Risk of Epidurals
Sarah J. Buckley
The first recorded use of an epidural was in 1885, when New York neurologist J. Leonard Corning injected cocaine into the back of a patient suffering from “spinal weakness and seminal incontinence.”1 More than a century later, epidurals have become the most popular method of analgesia, or pain relief, in US birth rooms. In 2002, almost two-thirds of laboring women, including 59 percent of women who had a vaginal birth, reported that they were administered an epidural.2 In Canada in 2001-2002, around half of women who birthed vaginally used an epidural,3 and in the UK in 2003-2004, 21 percent of women had an epidural before or during delivery.4
Epidurals involve the injection of a local anesthetic drug (derived from cocaine) into the epidural space”hthe space around (epi) the tough coverings (dura) that protect the spinal cord. A conventional epidural will numb or block both the sensory and motor nerves as they exit from the spinal cord, giving very effective pain relief for labor but making the recipient unable to move the lower part of her body. In the last five to ten years, epidurals have been developed with lower concentrations of local anesthetic drugs, and with combinations of local anesthetics and opiate painkillers (drugs similar to morphine and meperidine) to reduce the motor block. They produce a so-called walking epidural. Spinal analgesia has also been increasingly used in labor to reduce the motor block. Spinals involve drugs injected right through the dura and into the spinal (intrathecal) space, and they produce only short-term analgesia. To prolong the pain-relieving effect for labor, epidurals are now being coadministered with spinals, as a combined spinal epidural (CSE).
Midwife-Led Continuity Models Versus Other Models of Care For Childbearing Women
Sandall J, Soltani H, Gates S, Shennan A, Devane D
Midwife-led continuity models versus other models of care for childbearing women.
In many parts of the world, midwives are the main providers of care for childbearing women. Elsewhere, it may be obstetricians or family physicians that have the main responsibility for care; or the responsibility may be shared. The philosophy behind midwife-led continuity models is normality, continuity of care and being cared for by a known, trusted midwife during labour. The emphasis is on the natural ability of women to experience birth with minimum intervention. Midwife-led continuity of care can be provided through a team of midwives who share the caseload, often called ’team’ midwifery. Another model is ’caseload midwifery’, which aims to ensure that the woman receives all her care from one midwife or her or his practice partner. Midwife-led continuity of care is provided in a multi-disciplinary network of consultation and referral with other care providers. This contrasts with medical-led models of care where an obstetrician or family physician is primarily responsible for care. In shared-care models, responsibility is shared between different healthcare professionals.
In this review we included models of care where midwives provided care throughout the pregnancy, and during labour and after birth. We identified 13 studies involving 16,242 women both at low and increased risk of complications. Midwife-led continuity of care was associated with several benefits for mothers and babies, and had no identified adverse effects compared with models of medical-led care and shared care. The main benefits were a reduction in the use of epidurals, with fewer episiotomies or instrumental births. Women’s chances of being cared for in labour by a midwife she had got to know, and having a spontaneous vaginal birth were also increased. There was no difference in the number of caesarean births. Women who received midwife-led continuity of care were less likely to experience preterm birth, or lose their baby before 24 weeks’ gestation, although there were no differences in the risk of losing the baby after 24 weeks, or overall. All trials included licensed midwives, and none included lay or traditional midwives. No trial included models of care that offered out of hospital birth.
The review concludes that most women should be offered midwife-led continuity models of care, although caution should be exercised in applying this advice to women with substantial medical or obstetric complications.
NICE Recommends Home Births for Some Mums
Home births have dominated the UK media today, following the publication of guidance by the National Institute for Health and Care Excellence (NICE) on the care of healthy women and their babies during childbirth. The main talking point was the recommendation that women thought to have a low risk of pregnancy complications would be better served by giving birth at home or at a midwife-led unit, rather than at hospital.
NICE has reviewed the evidence for the vast majority of pregnant women in England and Wales who have healthy, uncomplicated pregnancies. The rate of interventions, such as the use of forceps or a caesarean section, in these low-risk women are generally slightly lower in the home or midwife-led units, compared with hospital-based maternity wards.
For women having their second or subsequent baby, a birth in either the home or a midwife-led unit are equally safe options. However, for low-risk first-time mothers, the midwife-led unit may be the best choice.
No woman will be “forced” to give birth at home or a midwife-led unit. NICE advises that all low-risk women should be free to choose their birth setting, and be supported in this choice.
American College of Nurse-Midwives
It is the position of the American College of Nurse-Midwives (ACNM) that:
All women who have experienced cesarean birth have the right to safe and accessible options when giving birth in subsequent pregnancies.
Women who have had a prior cesarean birth have the right to evidence-based information to guide their decision-making when considering a trial of labor after cesarean (TOLAC) versus an elective repeat cesarean birth.
Informed consent regarding TOLAC or elective repeat cesarean includes an evidence- based presentation of the benefits and potential harms for both the mother and infant of both options.
Women should have access to qualified maternity care providers who can offer the opportunity for a TOLAC regardless of geographic location, socio-economic status or type of medical care coverage.
Certified nurse-midwives (CNMs) and certified midwives (CMs) are qualified to provide education, informed consent and risk assessment regarding a woman’s decision to have a TOLAC.
CNMs and CMs are qualified to provide antepartum and intrapartum care for women who are candidates for a TOLAC including establishing appropriate arrangements for medical consultation and emergency care if necessary.
Professional liability carriers and hospital administrators should not prohibit maternity care providers or facilities with maternity services from providing care to women who are candidates for a TOLAC.
Continued research should be conducted to identify the necessary resources that should be available in sites where services are provided for women who desire a TOLAC, including VBAC success rates and maternal and newborn health outcomes.
Call the Midwife
Jamie Santa Cruz
When Kelly LeGendre found out in 2012 that she was pregnant with her first child, the Arizona resident, then 34, knew she needed to seek prenatal care. Unlike most American mothers, however, LeGendre didn’t seek out an obstetrician. Instead, she opted for a midwife.
For LeGendre, the decision was a no-brainer: “I wanted minimally invasive prenatal care and a completely natural childbirth experience,” she explains. She’d known several women who had positive birth experiences with midwives; meanwhile, some mothers who had gone the traditional physician route told her they had been urged to accept interventions that LeGendre didn’t want, like genetic testing, early induction of labor, or IV antibiotics during labor.
LeGendre is part of a small but growing minority of American mothers opting for midwives over obstetricians: In 1989, the first year for which data is available, midwives were the lead care providers at just 3 percent of births in the U.S. In 2013, the most recent year for which statistics are available, that number was close to 9 percent.
Consider this: If you’ve had a child within the last decade, you might still be suffering some consequences—lethargy, memory disturbances, and poor energy levels, among other symptoms. And according to Dr. Oscar Serrallach, a family practitioner in rural Australia, it’s not just because being a parent is hard—physically, the process of growing a baby exacts a significant toll. The placenta passes nearly 7 grams of fat a day to the growing baby at the end of the pregnancy term, while also tapping into the mom’s “iron, zinc, Vitamin B12, Vitamin B9, iodine, and selenium stores—along with omega 3 fats like DHA and specific amino acids from proteins.” On average, a mom’s brain shrinks 5% in the prenatal period, as it supports the growth of the baby (much of the brain is fat) and is re-engineered for parenthood. He has spent the majority of his career witnessing this syndrome, which he calls Postnatal Depletion, first-hand, watching as women fail—hormonally, nutritionally, and emotionally—to get back on their feet after the baby comes. Dr. Serrallach first became tuned in to it when he encountered a patient named Susan, a mother of five children, who was so emaciated and depleted that she “was visibly running on empty.”
How Safe Are Home Births For Mothers?
Recent studies in the New England Journal of Medicine and the Canadian Medical Association Journal have examined the safety of home births. That they came to different conclusions isn't as interesting as the fact that so much attention is being devoted to a phenomenon that accounts for less than 1% of U.S. births. So, why should we care?
Because the rising interest in home births tells us a lot about the experiences of mothers in the 3.9 million hospital births every year.
While the rate of home births has increased by 70% since 2004, the decision to seek a home birth in the United States still involves some daunting challenges. Oversight of midwives who attend planned home births (M.D.s attend less than 1% of planned home births) is done at the state level and involves a bewildering patchwork of laws and regulations that can make it difficult to find, let alone determine the qualifications of, a home birth provider.