Vital Health Information
For Pregnant Moms

First Time Mothers Do Better Without
C-Sections, Forceps or Vacuum Extraction

Of the nearly 4 million deliveries in the United States in 1996, 22 percent were by cesarean, 14 percent were vaginal deliveries assisted by forceps or vacuum extraction and 64 percent were spontaneous vaginal deliveries.

A new study reveals that first-time mothers who had cesarean or assisted vaginal deliveries had significantly lower general health and functioning seven weeks postpartum than women who had unassisted vaginal delivery. In fact, women with assisted vaginal deliveries (by forcepts or vacuum extraction) reported substantially worse sexual, bowel, and urinary functioning than women with spontaneous vaginal deliveries. This information should help doctors advise women about what to expect in the postpartum recovery period, given their delivery method, conclude the researchers from the University of Washington in Seattle.

In a study that was supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00034), the researchers analyzed data from a survey of maternity care at 10 hospitals in Washington State of women giving birth for the first time to a single infant in 1991. Compared with women who had c-sections, more women with unassisted vaginal delivery said they had no limitation when performing vigorous activities, such as running, lifting heavy objects, and participating in strenuous sports (65 vs. 45 percent); had no difficulty doing normal household tasks (50 vs. 34 percent); had excellent general health (32 vs. 20 percent); and had no limitations in social activities in the past month (56 vs. 45 percent).

Significantly more women with assisted vaginal delivery said they had not resumed sexual activity compared with women who had an unassisted vaginal delivery (40 vs. 29 percent) and suffered from bowel or urinary tract problems that interfered with their daily activities (50 vs. 40 percent). The mechanical trauma accompanying assisted vaginal delivery may have contributed to these women's problems following childbirth, note the researchers. They suggest that doctors should selectively substitute vacuum extraction for forceps, restrict use of episiotomy, and use more effective suture techniques and other methods to minimize the mechanical trauma of assisted vaginal delivery to improve the postpartum functioning of these women.

See "Delivery method and self-reported postpartum general health status among primiparous women," by Mona T. Lydon-Rochelle, Ph.D., M.P.H., Victoria L. Holt, Ph.D., M.P.H., and Diane P. Martin, Ph.D., M.A., in the July 2001 Paediatric and Perinatal Epidemiology 15, pp. 232-240.

Pregnant Women Must Avoid
Eating Certain Types of Fish

They should not eat shark, swordfish, king mackerel or tilefish because they may contain enough mercury to damage the fetus's nervous system, the U.S. Food and Drug Administration announced. The agency warned that young children, nursing mothers and women who may become pregnant should also avoid those fish. Consumer groups wanted fresh tuna, used in sushi or served as tuna steak, added to the warning list as well.

A National Academy of Sciences report estimate that up to 60,000 children a year were born who had been exposed during pregnancy to levels of mercury that could interfere with development of the brain and nervous system.

Baths During Labor Reduce Pain,
Don't Cause Infection

By Saralie Faivelson
©1998 Medical Tribune News Service

Women in labor who want to take whirlpool baths for pain relief can do so without worrying about increasing their risk of infection, according to California researchers. In a study of 207 women, those who used the baths were no more likely to develop infections during labor than were women who did not use the baths, reported Dr. Sarah J. Kilpatrick, director of obstetrics at the University of California, San Francisco, Medical Center.

"Traditionally, obstetricians think you shouldn't take baths during active labor because it might increase the risk of infection,'' Kilpatrick explained. But an increasing number of women, especially those who use midwives or have read the work of European childbirth expert Dr. Michel Odent, bathe during labor for pain relief, according to Gwendolyn Spears, chief nurse-midwife of the King/Drew Medical Center in Los Angeles. Kilpatrick and her colleagues studied 110 patients who had developed chorioamnionitis or endometritis, 97 women without the infections and each group's use of whirlpool baths to see if infection and bathing were linked. Chorioamnionitis is an infection of the membranes that surround the baby that can occur when bacteria enter the vagina. Endometritis is an infection of the lining of the uterus that may strike after long labors or those in which forceps were used. Risk factors for the infections include the number of vaginal exams a woman undergoes during labor and the number of hours of labor.

About 36 percent of the women who developed infections and 38 percent of the women who did not had used whirlpool baths during labor, Kilpatrick reported in a recent issue of the American Journal of Obstetrics and Gynecology. "Whether patients took water baths or not did not increase the infection rate," she said. Each labor and delivery room at the University of California at San Francisco has a private bathroom with a whirlpool bathtub. Kilpatrick pointed out that the tubs are scrubbed carefully after the patient has left the labor room.

"This study, together with European studies, gives us good news about a trend that is going on in this country," said Dr. William Dillon, associate chair of obstetrics and gynecology at the State University of New York at Buffalo. "Whirlpool baths during labor are a good adjunct for pain relief. The swirling of the water is very relaxing." Dillon noted that disease-causing organisms found in the water supply do not cause chorioamnionitis. Another potential source of infection would be bacteria left in the tub by the previous patient. "Cleaning out the whirlpool bath following use is an absolute necessity," Dillon said. "That cuts down on any chance of transmission of bacteria from one woman to another."

"A study conducted in Los Angeles came to the same conclusion as the new San Francisco study, according to Spears. "There was no correlation between water baths and chorioamnionitis," she said. "The baths are great for pain reduction, they take the place of medication during labor," she added. The patients ask for it."
- - - American Journal of Obstetrics and Gynecology
(1998;178:1215-1221)

Infection Linked to Prematurity

Low grade infections, even toot decay, have a tendency to cause premature births reports Dr. Peter Nathanielsz of the Laboratory for Pregnancy and Newborn Research at Cornell University's College of Veterinary Medicine. Therefore, it is very wise to visit a dentist before becoming pregnant if possible, or as soon as you know you are pregnant, to treat your teeth. Also treat and resolve any other infections as early as possible.

Video Violence

"Two Chicago doctors, Leonard Eton and Rowell Huesmann, followed the viewing habits of children for 22 years. They found that watching violence on television is the single best predictor of violent or aggresive behavior later in life, ahead of such commonly accepted factors as parents' behavior, poverty and race."
Marin Independent Journal article, 11/24/93. Full story at
http://www.alternativemedicine.com/whatshot/whatshot.shtml

Infants Delivered by Certified Nurse Midwives
have Lower Mortality Rates

National Center for Health Statistics Press Office
May 19, 1998

The first study known to examine the infant mortality risks for all babies delivered by certified nurse midwives in the United States shows excellent birth outcomes for these midwife-attended deliveries. The new study from the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), published in the May, 1998 issue of the "Journal of Epidemiology and Community Health," examined all single, vaginal births in the United States in 1991 delivered at 35 to 43 weeks of gestation by either physicians or certified nurse midwives.

After controlling for a wide variety of social and medical risk factors, the risk of experiencing an infant death was 19 percent lower for births attended by certified nurse midwives than for births attended by physicians. The risk of neonatal mortality (an infant death occurring in the first 28 days of life) was 33 percent lower, and the risk of delivering a low birthweight infant was 31 percent lower. Mean birthweight was 37 grams heavier for the certified nurse midwife attended than for the physician attended births. Low birthweight is a major predictor of infant mortality, subsequent disease, or developmental disabilities.

Certified nurse midwives attended a greater proportion of women who are at higher risk for poor birth outcome: African Americans, American Indians, teenagers, unmarried women, and those with less than a high school education. Physicians attended a slightly higher proportion of births with medical complications. However, birth outcomes for certified nurse midwives were better even after sociodemographic and medical risk factors were controlled for statistical analyses.

The differences in birth outcomes between certified nurse midwife and physician attended births may be explained in part by differences in prenatal, labor, and delivery care practices. Other studies have shown that certified nurse midwives generally spend more time with patients during prenatal visits and put more emphasis on patient counseling and education, and providing emotional support. Most certified nurse midwives are with their patients on a one-on-one basis during the entire labor and delivery process providing patient care and emotional support, in contrast with physician1s care, which is more often episodic.

The proportion of births attended by certified nurse midwives in the United States is growing. In 1995, 6 percent of all U.S. births were delivered by certified nurse midwives, compared to 3 percent in 1989.

"Midwifery care, social and medical risk factors and birth outcomes in the USA," by Marian F. MacDorman and Gopal K. Singh is based on information from the death certificate for each infant under 1 year of age who died in 1991.

Birth and death records are maintained by State vital statistics offices and reported to NCHS/CDC through the National Vital Statistics System. Some experts, however, warn that the research may be misleading.

"Midwives should always have better delivery outcomes because they are mandated by rules and regulations to turn over to an obstetrician any mother who develops a medical complication during pregnancy or delivery," said Dr. Ruth Lawrence, professor of pediatrics and obstetrics and gynecology at the University of Rochester. "Therefore, this research is slightly misleading. It is true, however, that midwives do an excellent job when they work with low-income and adolescent mothers and provide them with good support. In these instances, midwives can indeed have very excellent delivery outcomes."