Peaceful Parenting shares a study about the effectiveness of the Rotavirus vaccine versus exclusive breastfeeding at preventing diarrhea cases.
Which one do you think ‘wins’? Does considering this affect your decision to breastfeed or vaccinate?
Are you planning or deciding whether to have a VBAC or supporting someone who is? Check out A Woman’s Guide to VBAC.
Thanks to Midwifery Today E-News for Sharing this research tidbit:
Pregnant women in the US are much more likely to undergo repeated prenatal ultrasound exams now than they were 10 years ago, according to research recently published in the journal Medical Care.
In a study conducted by Northwestern University’s Department of Preventive Medicine, researchers looked at the average number of prenatal ultrasounds per pregnancy and percent of prenatal visits that included an ultrasound exam as recorded by hospitals on the National Hospital Ambulatory Medical Care Survey forms filled out between 1995 and 2000 and again in 2005 and 2006.
Results showed that, for low- and high-risk pregnant women, the average number of ultrasounds per pregnancy increased from 1.3 to 2.1 and from 2.2 to 4.2, respectively.
“In an adjusted analysis, the odds of a woman receiving an ultrasound in 2005–2006 were twice those of a visit in 1995–1997,” researchers noted, adding that women deemed “high-risk” were almost twice as likely as those in the “low-risk” group to receive an ultrasound during a prenatal visit.
— Siddique, Juned, et al., 2009. Med Care 47 (11) 1129–35.
For those who think we don’t need a strong focus on improving infant mortality rates here in the U.S.:
“Discussions of the U.S. infant mortality rate are often countered with criticism that the U.S. records data differently than other countries, reporting very premature babies as live births. While this is true for five of the 19 European countries whose data was analyzed, 14 of the 19 European countries require that all live births at any birth weight or gestational age be reported.”
» CDC Releases New Report Comparing U.S. and European Infant Mortality Rates.
And, if this ignites a fire within you to talk about it, please join us for BirthChat on November 16th at 6:00 p.m. We meet at the Tap Room @ Catalyst, 3501 S. Shields St. in Fort Collins. We’ll show the film Reducing Infant Mortality and discuss it afterward. Invite your neighbor, your doctor, your senator, your brother, your doula, your teacher, etc. We want everyone to understand that this is a big issue with affordable, credible, common sense solutions.
I’ve been thinking so much about BOLD that I haven’t been posting as much as I’d like about other areas of birth culture. Check out this page from the Big Push for Midwives and their release on ACOG research!
Preliminary research shows that use of condoms and antiretroviral therapy has more impact on HIV infection rates.
This Swedish study points to some very interesting possible effects of cesarean section on the infant. Is this the kind of information that will someday help the cesarean-happy folks understand the harm that comes along with using major abdominal surgery as a routine procedure.
An article on a recently released government study finds a correlation between babies of poor mothers and incidences of birth injury. Baby boys were also found to have increased risks. Intriguing!
OSU Study Reveals Conflict between Doctors, Midwives over Homebirth
CORVALLIS, Ore. Two Oregon State University researchers have uncovered a pattern of distrust—and sometimes outright antagonism—among physicians at hospitals and midwives who are transporting their homebirth clients to the hospital because of complications.
Oregon State University assistant professor Melissa Cheyney and doctoral student Courtney Everson said their work revealed an ongoing conflict between physicians and midwives, similar to that found in other studies of the dynamics between the two groups across the country.
The pair recently examined birth records in Oregon’s Jackson County from 1998 through 2003, a period when that county saw higher-than-expected rates of prematurity and low birth weight in some populations. The researchers wanted to assess whether those rates were linked to midwife-attended homebirths.
The findings revealed that assisted homebirths did not appear to be contributing to the lower-than-average health outcomes and, in fact, that the homebirths documented all had successful outcomes. But even more importantly to Cheyney, discussions with doctors and midwives uncovered a deep mistrust between the two groups of birthing providers, with doctors expressing the firm belief that only hospital births are safe, while midwives felt marginalized, mocked and put on the defensive when in contact with physicians.
“We’ve been getting insight into their world view, and it’s been quite illuminating,” Cheyney said.
Cheyney, who is a practicing midwife in addition to being an assistant professor of medical anthropology and reproductive biology, said she was surprised that physicians, when presented with scientifically conducted research that indicates homebirths do not increase infant mortality rates, still refuse to believe that births outside of the hospital are safe.
“Medicine is a social construct, and it’s heavily politicized,” she said.
She is working with Lane County obstetrician Dr. Paul Qualtere-Burcher to draft guidelines that would help midwives and their clients decide when they need to seek medical help, based in large part on Cheyney’s research, and another that would ask physicians to recognize midwives as legitimate caregivers.
Qualtere-Burcher said creating an open channel of communication isn’t easy.
“I do get some pushback from physician friends who say that I’m too open and too supportive,” he said. “My answer, to quote (President) Obama, is that dialogue is always a good idea.”
Qualtere-Burcher said he believes that if midwives felt more comfortable contacting physicians with medical questions or concerns, there would be a greater chance that women would get medical help when they needed it.
“Treat (midwives) with respect, as colleagues, and they’ll not be afraid to call,” he said.
While Qualtere-Burcher believes it would be wonderful, but Utopian, for all midwives to agree to seek medical assistance under the guidelines they’re proposing, and for all physicians to learn to deal more collegially with midwives, he hopes that if a small group on each side agrees to the plan, it will provide more evidence that a stronger relationship between physicians and midwives will lead to better outcomes for mothers and infants.
Last year the American Medical Association passed Resolution 205, which states: “the safest setting for labor, delivery and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex” The resolution was passed in direct response to media attention on home births, the AMA stated.
What is interesting, Cheyney points out, is that 99 percent of American births occur in the hospital, but the United States has one of the highest infant mortality rates of any developed country, with 6.3 deaths per 1,000 babies born. Meanwhile, the Netherlands, where a third of deliveries occur in the home with the assistance of midwives, has a lower rate of 4.73 deaths per 1,000.
One of the biggest problems Cheyney sees is that physicians only come into contact with midwives when something has gone wrong with the homebirth, and the patient has been transported to the hospital for care. There are a number of reasons why this interaction often is tension-filled and unpleasant for both sides, she says.
First is the assumption that homebirth must be dangerous, because the patient they’re seeing has had to be transported to the hospital. Secondly, the physician is now taking on the risk of caring for a patient who is unknown to them, and who has a medical chart provided by a midwife which may not include the kind of information the physician is used to receiving.
And because the midwife is often feeling defensive and upset, Cheyney said, the contact between her and the physician can often be tense and unproductive. Meanwhile, the patient, whose intention was not to have a hospital birth, is already feeling upset at the change in birth plan, and is now watching her care provider come into conflict with the stranger who is about to deliver her baby.
“It’s an extremely tension-fraught encounter,” Cheyney said, “and something needs to be done to address it.” As homebirths increase in popularity, she added, these encounters are bound to increase and a plan needs to be in place so that doctors and midwives know what protocol to follow.
“We’re having a meeting in early May to propose a draft for a model of collaborative care that might be the first of its kind,” in the United States, Cheyney said.
Cheyney is also pushing to get hospitals and the state records division to better track homebirths. The department of vital records had no way to indicate whether a birth occurred at home until 2008, and without being able to pull data, Cheyney said it’s hard to explore the nature of home birth in Oregon.
She’s also working on education programs for midwives in rural areas, including a cultural competency piece as demographics in Oregon continue to change.
From Midwifery Today E-News 11:13. You can subscribe here.