HEALTH: 11/14 Pregnancy / Obstetrics News From Medical News Today

Pregnancy / Obstetrics News From Medical News Today

Home Birth Not As Safe, Cost Effective Or Satisfying As Previously Reported

November 14, 2012 at 12:30 AM

Editor's Choice
Main Category: Pregnancy / Obstetrics
Also Included In: Women's Health / Gynecology
Article Date: 13 Nov 2012 - 11:00 PST

Having a home-birth- similar experience in the hospital proves to be more financially feasible, safer, and more satisfying than an actual at home birth, according to new research appearing in the American Journal of Obstetrics & Gynecology.

Advocates of planned home birth have stressed its advantages for patient safety, low costs, respect for women's choices, and patient satisfaction. This new study closely examines each of these suggestions in an effort to pinpoint proper responses for health professionals who are concerned with planned home birth.

In recent years, planned home birth has risen in popularity throughout Europe and the United States.

Lead author Frank A. Chervenak, MD, the Given Foundation Professor and chairman of the Department of Obstetrics and Gynecology at Weill Cornell Medical College, and obstetrician and gynecologist-in-chief and director of maternal-fetal medicine at New York-Presbyterian Hospital/Weill Cornell Medical Center, said:

"Positions taken about planned home birth, in our view, are not compatible with professional responsibility for patients....We call on obstetricians, other concerned physicians, midwives, and other obstetric providers, and their professional associations not to support planned home birth when there are safe and compassionate hospital-based alternatives and to advocate for a safe home-birth-like experience in the hospital."

The authors analyzed evidence of obstetric results and found that planned home birth does not meet safety standards for patients presently. During home birth, surprise complications can develop during labor and can lead to late emergency treatment. When travel is required from home to an obstetric unit, the perinatal mortality rate was documented to be over eight times greater than without this transport.

Patient satisfaction is often reported as one of the main advantages of home birth, however, the researchers of this study found this satisfaction was weakened by a high incidence of mandatory emergency transport as well as delayed emergency care.

Other factors that compromised patient satisfaction were pain levels of the patient, anxiety about losing the baby during transport, and unhappiness with caregivers. Physicians and their staff can produce a home-birth-like environment in the hospital which can guarantee patient satisfaction and appropriate healthcare personnel.

On the topic of cost effectiveness, the authors cite a study that reports an increase in costs for home births that is three times greater; expenses include obstetrician services, a midwife, and patient transport. Examination of costs must also take into account:

professional liability
transport system maintenance
hospital admission
lifetime expenses of supporting neurologically disabled children

Lastly, the authors analyzed the relationship between women's rights and home birth. Their findings suggest that medical professionals should not let the unlimited rights of pregnant women dictate the location of the birth. They believe this would be unethical.

After examination of these four different claims, the researchers were able to develop appropriate responses to obstetricians' questions in reference to their responsibility for planned home birth. These topics include:

root cause of planned home birth recrudescence
responding to patients who ask about or request home birth
receiving a patient on emergency transport from planned home birth
planned home birth clinical trials

Professional associations of obstetricians have a responsibility to encourage patient safety, and reevaluate their statements on planned home birth, shifting them to agree with professional responsibility.

Dr. Chervenak concludes:

"Advocacy of planned home birth is a compelling example of what happens when ideology replaces professionally disciplined clinical judgment and policy. We urge obstetricians, other concerned physicians, midwives and other obstetric providers, and their professional associations to eschew rights-based reductionism in the ethics of planned home birth and replace rights-based reductionism with an ethics based professional responsibility."

The argument over hospital birth versus at home birth will continue. These authors' findings oppose findings from a previous review this year, stating that home birth is actually a realistic and safe option with less interventions and complications than hospital birth.

Written by Kelly Fitzgerald
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Visitor Opinions (latest shown first)

Biased report on home births

posted by Tim on 13 Nov 2012 at 1:14 pm

Let me quote: Physicians and their staff can produce a home-birth-like environment in the hospital which can guarantee patient satisfaction and appropriate healthcare personnel.

No they cant, they can not and do not guarantee patient satisfaction.

Quote: medical professionals should not let the unlimited rights of pregnant women dictate the location of the birth

They try their best to deviate from patients who want a home birth. This is not their call, Drs are not God, nor are they responsible for a mothers choice.

This whole report seems to support the mail orientated view on childbirth. Its biased.

My last point - How many mothers are completely satisfied with hospital births - I know my wife wasn't. I also understand that the desire for mothers to have home births is to ensure such things as MEN dont get involved, that they wont be forced into uncomfortable positions (on back strapped up with a baby monitor) and importantly that they wont end up with a horrid infection, as we all know but pretend doesnt happen - hospital infections count for a lot of injury. With latest research stating MRSA can be airbourne why would anyone go to a hospital.

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Children Born To Stressed Moms Have a Higher Chance of Being Bullied

November 14, 2012 at 12:30 AM

Editor's Choice
Main Category: Pediatrics / Children's Health
Also Included In: Pregnancy / Obstetrics
Article Date: 13 Nov 2012 - 11:00 PST

Children are more likely to be bullied at school if their mothers were severely stressed during pregnancy.

The finding came from a team at the University of Warwick, led by Professor Dieter Wolke, Professor of Developmental Psychology at University of Warwick and Warwick Medical School, and was published in the Journal of Child Psychology and Psychiatry.

Prior research has indicated that stress in pregnancy can cause behavioral abnormalities in the child. One report from a team at Harvard Medical School found that prenatal stress may cause the baby to have an increased sensitivity to allergen exposure as well as a heightened chance of developing asthma. However, until now, the effect of the stress on a child's vulnerability to bullying was unknown.

For the purpose of this study, the team examined 8,829 kids from the Avon Longitudinal Study of Parents and Children (ALSPAC), a long-term study consisting of over 14,000 moms who enrolled during pregnancy in 1991 and 1992 and have had their child's health and development recorded since.

In pregnancy and the postnatal period, maternal anxiety, family adversity, and depression were evaluated. When the kids were in preschool, parenting, temperament, and partner conflict were assessed. Between the ages of 7 and 10, peer victimization was evaluated by asking questions to the child, teacher, and parent.

The experts discovered that a developing baby can be impacted by the stress and mental health issues that his/her mom has while she is pregnant. They also found that these factors directly increase the chance of the child becoming a victim of bullying later on.

This research was the first to observe the effect a mom's stress in pregnancy has on a child's susceptibility to being bullied, Wolke said.

There are a great amount of neurohormones that are let into the blood stream when a person becomes stressed. However, when a pregnant women becomes stressed, this can alter the stress response system of the growing baby.

Wolke explained:

"Changes in the stress response system can affect behavior and how children react emotionally to stress such as being picked on by a bully. Children who more easily show a stress reaction such as crying, running away, anxiety are then selected by bullies to home in to."

The main prenatal stress factors, according to the scientists, were serious family issues, such as:

financial difficulty
maternal mental health
alcohol/drug abuse

Professor Wolke concluded:

"The whole thing becomes a vicious cycle, a child with an altered stress response system is more likely to be bullied, which affects their stress response even further and increases the likelihood of them developing mental health problems in later life."

Written by Sarah Glynn
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Flu In Pregnancy Raises Autism Risk

November 13, 2012 at 2:30 PM

Editor's Choice
Academic Journal
Main Category: Autism
Also Included In: Pregnancy / Obstetrics; Flu / Cold / SARS
Article Date: 13 Nov 2012 - 1:00 PST

Pregnant women who catch flu or have a fever that lasts over one week have a higher risk of giving birth to a baby with an ASD (autism spectrum disorder), researchers from the University of Aarhus, Denmark, reported in the journal Pediatrics (published on November, 12th, 2012).

The authors gathered and analyzed data on a population-based cohort of 96,736 children, all of them were born in Denmark from 1997 to 2003.

Their mothers were asked what illnesses, especially infections and fevers they had during their pregnancies and the early days after giving birth. They were also asked about any antibiotic use during those periods.

The following maternal infections were not linked to autism risk in their offspring:

Respiratory infections
Urinary tract infections
Genital infections
Colds
Sinus infections

The following infections or conditions during pregnancy were linked a higher autism risk in their baby:

Influenza (flu) - pregnant mothers who caught the flu had twice the risk of giving birth to a baby who eventually was diagnosed with an autism spectrum disorder before the age of three years

Fever - pregnant mothers who said they had a fever that lasted for at least one week had three times the risk of giving birth to a baby who eventually was diagnosed with an ASD before the age of 3

Antibiotic usage - pregnant mothers who took antibiotics had a slightly higher risk of having a baby with an ASD

The authors emphasized that their findings need to be backed up with a more thoroughly controlled study. Theirs had certain methodologic limitations, they added.

Lead researcher, Hjordis Osk Atladottir, MD, PhD, said that women who catch the flu or have a fever during pregnancy should not be alarmed by these findings. Approximately 98% of those who did catch flu or had a lasting fever gave birth to children with no ASD.

Recent research finding more links to autism risk

Older fathers - older father's have a higher risk of having children with some kind of ASD than younger fathers. Researchers explained in the journal Nature that an older father has a higher chance of passing on new mutations to his offspring than older mothers.

Specific gene mutations - scientists from the Seattle Children's Research Institute discovered new gene mutations which were associated with the development of autism, epilepsy, hydrocephalus and cancer. They were mutations in the following genes - AKT3, PIK3R2 and PIK3CA. Their study was published in Nature Genetics (July 2012 issue).

Immune system irregularities - researchers from Caltech (California Institute of Technology) reported in PNAS (Proceedings of the National Academy of Sciences) (July 2012 issue) that specific changes in an overactive immune system can contribute to autism-like behaviors in mice. They added that in some cases, this activation may be related to how a fetus develops while in the womb.

Parents with bipolar disorder or schizophrenia - a child whose parents or sibling have been diagnosed with bipolar disorder or schizophrenia has a higher risk of being diagnosed with an autism spectrum disorder, scientists from The University of North Carolina reported in Archives of General Psychiatry (July 2012 issue).

Written by Christian Nordqvist
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'Flu In Pregnancy Raises Autism Risk'

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