December 1, 2008
Research Update
Debby presented sessions entitled "Research Update for Childbirth Educators" at both the 2008 Lamaze International and ICEA conferences. Here are some highlights from her presentations:
Bariatric Obstetrics
The CDC now estimates that one in five women who give birth in the USA is obese. A review of the literature from 2000 to 2006 on the subject of obesity and its effects on pregnancy reveals that obese women are significantly at increased risk for complications during pregnancy, labor and birth, and the postpartum period. In addition, their babies are also at increased risk for neonatal morbidity and mortality. (*PubMed #18611299)
The current weight gain recommendations for pregnancy were issued by The Institute of Medicine in 1990 when preventing low birthweight babies was a greater concern than maternal obesity. If a woman enters pregnancy obese, what is the recommended weight gain for her? A study of over 120,000 obese women who gave birth in Missouri between 1990 and 2000 looked at maternal and neonatal outcomes by obesity class and total gestational weight gain. (PubMed #17906005) The recommended weight gain in order to minimize the risks for preeclampsia, cesarean delivery, and large for gestational age babies, yet not increase the risk for small for gestational age babies is as follows:
BMI greater than 30 (obese): Gain 10-25 pounds
BMI greater than 35 (severely obese): Gain 0 to 9 pounds
BMI greater than 40 (morbidly obese): Lose 0 to 9 pounds
Postpartum Experiences
Childbirth Connection, in partnership with Lamaze International, released their New Mothers Speak Out report in August. This survey of how well American women are coping in the first 18 months after birth had several surprising and concerning results. Sixty-three percent of the women surveyed had a score on the short version of the Postpartum Depression Screening Scale that indicated they were likely to be suffering from some degree of depression. Eighteen percent appeared to be suffering some symptoms of Post -Traumatic Stress Disorder (PTSD) and 9% appeared to meet all formal criteria for PTSD.
Not surprisingly, women who had cesarean deliveries reported more pain and difficulty in caring for their babies than women who delivered vaginally. The report also highlighted hospital practices which negatively impact breastfeeding. Download the executive summary and/or full report at no charge at the Childbirth Connection.
Cesarean Rates
A World Health Organization (WHO) report published in 2007 confirms WHO's earlier recommendation that no area of the world should have a cesarean rate higher than 15%. (PubMed
#17302638) In this analysis of cesarean rates and maternal and neonatal mortality around the world, researchers found that in countries in which cesarean rates are under 15%, higher cesarean rates were correlated with lower maternal mortality. In countries in which cesarean rates are over 15%, higher cesarean rates are predominantly correlated with high maternal mortality. Neonatal mortality followed a similar pattern. (PubMed #17302638)
There is controversy in this country about whether or not the increase in the cesarean delivery rate is due to an increase in older women having babies as well as more high-risk women having babies. In an analysis of cesarean birth trends in the United States published by the CDC, researchers concluded that “the increase in the primary cesarean rate seems primarily the result of changes in obstetric practice and not to changes in the medical risk profile of births or increases in maternal request.” (PubMed #18456070)
With the rise in cesarean deliveries, there are increasing reports of rare complications associated with cesarean delivery such as stroke (PubMed #18279835); cesarean scar ectopic pregnancy (PubMed #18393379); and amniotic fluid embolism. (PubMed #18295171)
Fascinating research from Italy shows that the intestinal flora of babies born vaginally is much more diverse than the flora of babies born by cesarean. (PubMed #18716189) Because there is strong evidence that the flora play an important role for the postnatal development of the immune system, this finding may explain why babies born by cesarean are at higher risk for developing auto-immune disorders such as asthma (PubMed #18571547) and childbhood-onset type I diabetes. (Pubmed #18292986)
*To access the abstracts for the research articles mentioned, go to PubMed and type just the PubMed number into the space “Search PubMed for...”