What determines risk factors in pregnancy?  New research

What determines risk factors in pregnancy? New research

If you’ve seen a Babymoon Inn staff member lately, you’ve probably noticed a shirt that reads, “Evidence-based care with a hug. #birthcenters.” As an accredited birth center, we have a long history of providing holistic and personalized care, but also care that is driven by evidence and what research has shown to lead to the best outcomes for parents and babies.

What that research has demonstrated again and again is that for healthy, low-risk people, accredited birth centers tended by midwives are the safest place to have a baby.

But what makes someone low-risk? New research has identified factors to help determine a person’s risk status and help guide them to the choice of birth location that is appropriate for them.

Jeanette McCullough, IBCLC and co-founder of BirthSwell, interviewed one of the researchers, Melissa Cheyney, PhD, CPM , about the results of the study and its implication on maternity care and policy-making.

Cheyney acknowledged that “there is actually very little agreement on what constitutes ‘low-risk” and that the majority of research on risk factors has been limited to a hospital setting, whereas this new study includes nearly 50,000 people seeking planned birth center or home birth.

The study looked at eight risk factors:

  • primiparity (having your first baby)
  • history of a prior cesarean (with or without a history of also having a vaginal birth)
  • multiple pregnancy
  • breech presentation
  • gestational diabetes
  • preeclampsia
  • post-term pregnancy (greater than 42 weeks
  • advanced maternal age
  • elevated body mass index.

The study compared the risk factors with the following outcomes:

  • likelihood of transfer
  • cesarean section
  • any genital tract trauma
  • any postpartum hospitalization for a maternal indication in the first 6 weeks
  • low 5-minute Apgar score (<7)
  • very low 5-minute Apgar (<4)
  • any neonatal hospitalization in the first 6 weeks
  • any NICU admission in the first 6 weeks
  • combined fetal and neonatal death

The outcomes of Cheyney’s research showed that:

“Older than average mothers (35 years and older), women with an elevated BMI (30 and over) and women who labored after a cesarean who had also had a vaginal birth all had very little additional risk relative to our comparison group… Women who are older, heavier, or who have had a previous C-section and a vaginal birth who have no other complications actually do quite well in the community setting, and we are hopeful that state regulations will be modified to reflect these findings where needed.”

The research also gives insight into the risks of VBAC (vaginal birth after Cesarean) in an out-of-hospital setting.

“Women who labored after a cesarean who had also had at least one vaginal birth had excellent outcomes in the community setting. In fact, their risk was lower than what we found for women having their first baby.  However, we also found that clients laboring after a cesarean who have not had a vaginal birth were at higher risk than anticipated. Their outcomes grouped among the highest risk of the subgroups we analyzed, which included breech and preeclampsia. Women laboring after a cesarean without a previous vaginal birth had a risk of fetal or neonatal death that was ten times higher than the low risk comparison group of healthy multiparous women with no risk factors. Their rate of fetal and neonatal death was 10 out of 1000 compared to a less than one out of 1000 among multiparous women with no risk factors.”

Cheyney continues:

“To complicate matters, among women laboring after a cesarean with no prior vaginal birth, the repeat cesarean rate was just over 22%, which is less than our overall national cesarean rate of 32%. This means that 78% of women in this higher risk group had a vaginal birth! Pregnant people with this risk factor who are considering a community birth are forced to navigate a complex balance of risks and benefits associated with laboring after a cesarean in a community setting.”

Navigating through the research to understand the benefits and risks of any birth setting can be a challenge. Have questions? Ask us.

Read the rest of McCullough and Cheyney’s interview

‘I’m going to stop you there’ and other conversational comebacks to protect your pregnant soul – blog at The Spinoff

‘I’m going to stop you there’ and other conversational comebacks to protect your pregnant soul – blog at The Spinoff

At some point during pregnancy, it’s inevitable that you will receive advice you didn’t ask for, a horror story you wish you could unhear, or a reminder that things aren’t going to get any easier once your baby arrives. I spoke with a pregnant woman who recently tried to buy a beverage at a local farmer’s market and was refused service because the vendor felt that strongly that she shouldn’t be drinking caffeine, and he let her know allllllllll about it.

So what do you do when the unwelcome advice starts rolling in? Columnist Thalia Kehoe Rowden shared some advice in a recent blog at The Spinoff.

“When the advice that flies towards you is not welcome, for whatever reason, here are some things you can say:

  • ‘That’s something to think about [+ change the subject].’
  • ‘We’re still figuring that stuff out [+ subject change].’
  • ‘Thanks.’
  • ‘Good tip! Now tell me, what was your favourite thing about being pregnant?’
  • ‘Hmm.’
  • ‘Actually, I’m feeling a bit overwhelmed with advice at the moment, let’s talk about something else.’

This is important: you don’t need to engage with every person who wants to influence your parenting, either to take their advice on board or to tell them that you’re not going to. You can just say ‘Hmm,’ and move on, if you want.”

Pregnant people are also often subject to scary stories about birth or parenting. Kehoe Rowden offers some quick and easy responses when a conversation is going in this direction:

  • “Does this story have a happy ending? Because I’m finding I don’t want to hear sad stories at the moment.”

  • “I’m going to stop you there. I’m trying to focus on positive birth stories.”

  • “Please only tell me encouraging things at the moment.”

  • “I need your support to reassure me. Tell me what went really well.”

If someone in your life feels the need to issue the “just wait” warning when you issue a complaint regarding pregnancy, Kehow Rowden has suggested responses for this situation as well:

  • “So you’re saying that insomnia in pregnancy might be bad, but it’s only going to be worse when the baby arrives? That’s actually not very helpful to hear.”

  • “Yes, I’m sure each stage will have its own challenges. My challenge at the moment is [repeat what’s on your mind now].”

  • “Yes, I know there will be challenges. Please let me enjoy this stage while I can!”

Did you receive unsolicited advice or hear unwelcome stories or comments during your pregnancy? How did you respond?