Vitamin D in Pregnancy

Vitamin D in Pregnancy

With a growing (and sometimes overwhelming) checklist for a healthy pregnancy, here’s an easy one: Vitamin D supplementation!

New research shows that taking Vitamin D supplements during pregnancy may help protect against asthma and other respiratory infections.

The study showed that women who had received Vitamin D supplementation during pregnancy gave birth to babies with a boosted immune response. This immunity may result in a decreased risk of asthma.

“But I live somewhere sunny… do I need vitamin D?”

Yup. According to Kathy Adams LM, CPM, a midwife at Babymoon Inn, nearly everyone – pregnant or not – could benefit from supplementation.

“No matter how much sun we get, most people are deficient in vitamin D,” she said. “Different people may need different supplementation amounts depending on sex, age, lifestyle, etc. Talk to your doctor or midwife about what vitamin D supplement may be most appropriate for you.”

Read more about the Vitamin D study here.

Nurses and Cesarean Rate

Nurses and Cesarean Rate

With one out every three babies currently being born surgically in the United States, health care providers, researchers, and consumers are all beginning to question what can be done to lower the Cesarean rate and consequently the associated risks for moms and babies.

We recently shared a study conducted by Dr. Neel Shah and Ariadne labs that uncovered the correlation between facility design and Cesarean rate, and now a new study now looks at how nurses impact this rate as well.

The Journal of Obstetric, Gynecological and Neonatal Nursing published a retrospective cohort study that included 3,031 births and 72 nurses. While the mean nurse Cesarean rate was 26%, nurse’s individual rates ranged from 8.3% to a whopping 48%.

With such a wide variation in Cesarean rates across nurses, the study concluded that “the nurse assigned to a patient may influence the likelihood of cesarean birth.” The authors further suggest that, “Data regarding this outcome could be used to design practice improvement initiatives to improve nurse performance.”

Find the original study.

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

Facility design and Cesarean rate

Facility design and Cesarean rate

More than 73% of women prioritized choosing their care provider over choosing the hospital in which they would give birth, according to research published earlier this year. Only 17% chose a hospital first and then sought out a care provider.

The research included more than 6,000 women who answered survey questions through the Ovia Pregnancy app.

In an article for Slate.com, Christina Cauterucci looked at the Ovia survey and also at a recent assessment of 12 childbirth facilities that examined the correlation between the design/layout of the facility and the Cesarean rate. The assessment included both freestanding birth centers and hospitals.

She writes:

“Neel Shah, a Boston OB/GYN who works at health-care research center Ariadne Labs, was one of the authors of the Ovia Pregnancy survey. He says U.S. hospital C-section rates range from around 7 to 70 percent, often with wide ranges in a single zip code. And though hospital choice can be a woman’s biggest risk factor in the care she receives, including her chances of needing a C-section, few women pick their delivery hospital first. ‘Nobody picks a restaurant based on who the waiter is,’ he told Slate, comparing restaurant service to hospital care. The service might be impeccable, but, if the restaurant has a higher-than-average record of food poisoning, not many customers would want to take that risk.”

The 50-page assessment, published by Ariadne Labs, found the following:

Cesarean rates were higher in facilities where delivery rooms were farther apart
Cesarean rates were higher in facilities where the call rooms for staff were farther away from the delivery rooms
Cesarean rates were higher in rooms that see more than 100 annual deliveries
The primary lowrisk Cesarean rate was lowest in the three freestanding birth centers included in the study

So what does this mean for you? It means that while your choice is provider is important, so is the location you choose to have your baby.

For example, the correlation between the design of Babymoon Inn birth center and its Cesarean rate matches the correlation found in the Ariadne Assessment. This freestanding birth center features the following:

Two birthing suites eight feet apart
A midwife in the building during the entire labor and birth, no farther away than the next room
Birthing rooms that see around 90 births a year
A Cesarean rate around 56%, similar to the national birth center Cesarean rate

To make an informed choice about your birthing location, consumers must tour potential birth locations early and ask questions and seek out information that may not otherwise be offered. According to the Slate article:

“Shah recommends that pregnant women and their partners look at the whole ward and the process of delivery care, not just the delivery room, when touring birthing centers. Where will they check in, sit for triage, and recover? Where are the nurses and doctors hanging out—is it near the labor and delivery area or further removed? Prospective patients could also benefit from looking at publicly reported hospital data, like C-section rates and rates of hospital-acquired infections, on internet databases such as the one run by the Leapfrog Group before choosing a facility.”

How early in pregnancy did you tour your birth location? What questions did you ask to help make your decision?

Dr. Sarah Buckley:  Epidurals – Risks and Benefits

Dr. Sarah Buckley: Epidurals – Risks and Benefits

In Babymoon’s 5-week Lamaze series, we discuss at length the six “Healthy Birth Practices” that have been linked to better outcomes for moms and babies. One of these healthy birth practices is to avoid unnecessary interventions.

But how does one determine when an intervention is necessary or unnecessary? We recommend using your BRAIN – examining the Benefits, Risks, and Alternatives to an intervention, and then asking yourself what your Intuition says and what happens if we do Nothing (right Now).

In the first of series of her blogs on her web site, Sarah Buckley begins to examine the benefits and risks of an epidural and shares some of the research surrounding this common intervention. Buckley, a physician who also authored Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices, says:

“Obviously, the main benefit of an epidural is the very effective pain relief that most women experience. Because of this effective analgesia, epidurals also reduce stress, and stress hormones, in labour. This can be beneficial when women are experiencing very high levels of stress and pain, which can slow labour progress.”

To understand some of the risks or side effects of an epidural, we first must understand oxytocin. As we discuss in our Lamaze series, the hormone oxytocin – also known as the “love hormone” – is a key player in the process of labor and birth.

Childbirth Connection explains:

“Receptor cells that allow your body to respond to oxytocin increase gradually in pregnancy and then increase a lot during labor. Oxytocin stimulates powerful contractions that help to thin and open (dilate) the cervix, move the baby down and out of the birth canal, push out the placenta, and limit bleeding at the site of the placenta.”

Buckley explains that within the oxytocin “positive feedback cycle” (as illustrated in the diagram), uterine sensations lead to oxytocin release which contributes to stronger contractions, more sensations, and more oxytocin. The cycle continues and helps baby to be born quickly and easily. Oxytocin also activates reward and pleasure centers in the brain.

When epidural analgesia is introduced into the equation during labor, there are no longer sensations to trigger oxytocin release, and therefore levels will decline.

Buckely will explore the consequences of a lack of oxytocin in Part 2 of her series, coming soon.

Read all of Part 1

Babies In These Countries Cry More, Study Finds

Babies In These Countries Cry More, Study Finds

Anyone who has experienced parenting a baby with colic will tell you how challenging it is. And they will all likely be able to offer some advice, some comfort techniques, or at the least a shoulder to cry on. But it turns out you’ll find more of these parents in countries like Italy, the U.K., and Canada, as a new study reports that babies in these countries cry more than babies elsewhere.

The study, originally published in The Journal of Pediatrics and reported by Julia Zorthian of Time, found that:

“In the U.K. 28% of babies 1 to 2 weeks old had colic, for example, while the average prevalence for that age was only 17.4%. And 34.1% of babies in Canada had colic at 3 to 4 weeks, while the average percentage was 18.4%. On the other hand, the study found 6.7% of babies in Denmark at 5 to 6 weeks had colic, much lower than the average 25.1% for that age.”

Along with Denmark, the study found that babies in Japan and Germany cried the least. Wondering why the large discrepancy between countries? Unfortunately, we don’t know yet.

“The study did not determine a reason for the variation in crying time by country, but the scientists said there should be more research into potential cultural and genetic influences.”

What are your thoughts? Why are some countries reporting such high rates of colic in their babies?