Midwifery

Women’s health volunteerism: Delivering care around the globe, where it’s needed most

NCMA’s Suzi Saunders, CNM, on providing care to women in countries where access is challenging, like Haiti and the Philippines

NCMA’s Suzi Saunders, CNM, on providing care to women in countries where access is challenging, like Haiti and the Philippines

Photo by Suzanne Saunders, CNM

I have been a certified nurse midwife for 21 years. Having worked with NCMA Women’s OB/GYN Center for nearly 18 of those years, I’m very happy to continue my work both in Sonoma County and in sometimes faraway locales where adequate care is scarce.

I truly love women’s health. And let me tell you, there is nothing like holding a brand new baby in your hands!

I have long had an interest in providing care to women in countries where access is challenging. In addition to my master’s in nursing at Emory University, I also completed a master’s in public health, with a focus on international health concerns. My public health program emphasized the need for sustainable programs that had a lasting effect rather than “Band-Aid”-type efforts. Most programs rely heavily on donated supplies, and on volunteer labor to sustain them over time. I knew I wanted to make an impact, but wasn’t sure how to get started.

My first adventure became a family adventure

On the advice of a local colleague, I looked into two programs that had lengthy histories in their host countries, and had made significant impacts on local maternal health. The one I chose in 2011 was with Mercy in Action. It is located in Olongapo, Philippines, which was a nice coincidence, as my brother lived a few hours from there! I wanted my kids to be a part of my efforts. Although they were too young at the time to participate directly, by traveling there with me they could understand why it was important to me. In addition, I wanted them to realize how different life can be outside the U.S. By choosing this project, I could start my adventures as a volunteer, as well as get the kids involved.

I participated in a two-week intensive training on providing care in a low-resource environment, in addition to hiking to remote areas to provide needed prenatal and post-partum care to rural Filipina women. It was an amazing learning experience! My kids stayed with family, and while they were not with me, I did my work. They still had a lengthy trip in a developing nation. They were 5 and 10 at the time, and have never forgotten it.

On the ground in Haiti

Two years later, I went to Hinche, Haiti, with a group called Midwives for Haiti. It is a non-governmental organization (NGO) based in rural Haiti for the last 25 years. A midwife colleague had been there, and highly recommended the work they were doing.

After some vigorous fundraising, two labor nurses and I flew into the unknown. Haiti is the most dangerous country in the Western Hemisphere to have a baby, due to factors such as:

  • difficult access for rural women,
  • very few providers per thousand population,
  • a preference for home delivery due to costs, and
  • a high rate of risk factors such as preeclampsia and malnutrition.

In the U.S., midwives are often in a position of protecting normal pregnant women from having a disturbed or interventive birth. In Haiti, many, many births are high risk, and many more women need intervention than actually get it.

Midwives for Haiti has three main directives:

  1. To teach as many Haitians as possible the profession of midwifery. The more providers there are in the country, the more women have access to care.
  2. To support the mobile midwife service. These are a group of 5–6 midwives that go to a rural village every day, for a total of about 25 communities a month. This is typically the only way the women in those villages will ever get prenatal care.
  3. To train the “matwons,” which are traditional or “granny” midwives, working in remote areas but typically without much medical knowledge. The mobile midwives work closely with the matwons, to encourage them to give the best care they can, and to refer high risk women back to them.
Suzanne Saunders, CNM, Haiti, newborn baby and mother

Suzanne Saunders (L) loves her volunteer work.

The conditions in Haiti cannot be more different than here, and can be quite shocking if you have not traveled to truly desperate, developing nations. I saw and experienced things you might only see once, or never, in an entire career in the U.S. We had a patient die of pre-eclamptic complications the second day of our trip, which would have been fairly easily treated and dealt with here. It’s crushing to know that every woman you treat knows a friend or family member (often several) who has died of childbirth complications. The ambivalence toward newborn babies that might not even survive their first six months is heartbreaking.

Watching what Midwives for Haiti can do on a shoestring budget is a bright light in all of this! They train 20–30 midwives a year, who then go and serve their own communities for years and years. They send midwives out into the villages to give women much-needed prenatal care. And support the home-based Matwons in their quest to provide home birth. All of this has made a significant impact on maternal and infant mortality in their corner of Haiti. I am very satisfied that their program meets many criteria of sustainability in the NGO realm, and have seen with my own eyes the impact they are having.

Going back to Haiti

I went back to Haiti two years later and it was just as powerful. The supplies and medicines we brought were eagerly distributed as needed. Our work felt important, in a way that is hard to describe. It is incredibly hard work, under ridiculous conditions (think, rare running water—in the hospital!, think 90+ degrees with nary a fan, think riding in a rattle-trap jeep over washboard roads for two hours to reach the mobile clinic, think mosquitos that are trying to kill you!). But fulfilling in a way that first world health care isn’t.

I am hoping to go again in December after a bit of fundraising. If you are able to contribute, please visit our GoFundMe campaign. We will be so grateful.

Every dollar goes to teaching students, purchasing meds and supplies to bring along, and to the very small staff that keeps it all running. Believe me, they make every dollar work double time! Certain supplies are highly desirable, as are certain medications.

Most needs are simple, like

  • sutures,
  • Tylenol/ibuprofen,
  • cloth diapers,
  • blood pressure cuffs, and
  • other basics.

A basic kit of equipment is put together for each midwife student, to make sure they are prepared for their training and first months of work afterwards.

If any of you have donations of medical supplies, and/or funds to purchase said supplies, they are very warmly and happily accepted.

Suzi Saunders, CNM
NCMA Women’s OB/GYN Center

Focus on health risks for new mothers for Preeclampsia Awareness Month

May is Preeclampsia Awareness Month and NCMA Women’s OB/GYN Center joins with the Preeclampsia Foundation to help raise awareness. This year the foundation’s efforts are on postpartum preeclampsia as 97 percent of maternal deaths related to preeclampsia and other hypertensive disorders of pregnancy occur within just six weeks of delivery, a time when most new mothers might think the danger has passed.

A woman can develop preeclampsia after her baby is born, regardless of whether she experienced high blood pressure during her pregnancy. With such alarming statistics related to postpartum preeclampsia, it very important that a new mother remain vigilant and continue to monitor her heart health and blood pressure even after delivery.

Understanding preeclampsia

Postpartum preeclampsia is a serious condition related to high blood pressure. Women who have just delivered a baby are most at risk, although it has no effect on the baby. There is no known cause for preeclampsia to manifest in pregnant women. In many cases, women diagnosed with preeclampsia see symptoms abate following delivery, but the Preeclampsia Foundation emphasizes that ‘delivery is not a cure’. In some cases, symptoms begin during pregnancy, but some patients may not be symptomatic until after the baby is born. Postpartum preeclampsia most commonly occurs within the first seven days after delivery although new mothers remain at risk for up to six weeks following delivery.

Know the warning signs

Early diagnosis and being vigilant to symptoms followed by quick response is imperative to saving lives. Symptoms include (and can be complicated by lack of sleep, postpartum depression and/or simple lack of awareness about the signs):

  • nausea
  • swelling in hands/feet
  • severe headache
  • seeing spots or other vision changes
  • shortness of breath

When a patient thinks they are experiencing warning signs of postpartum preeclampsia, the first thing to do is go to the Emergency Department, request to be seen by an OB, and report that they have recently given birth. The first seven days after delivery is when women who experience preeclampsia are at highest risk. Effectively controlling high blood pressure is key to avoiding very serious health risks that include; seizures, stroke, organ damage and sometimes death.

About NCMA Women’s OBGYN Center

Our provider team of expert OB/GYN physicians, certified nurse midwives, family nurse practitioners, and medical assistants provides unmatched care to patients in our region. As women proudly serving women, we understand the needs and expectations of our patients. For more information, visit our website or call 707-579-1102.

Study reveals no increase in risks for women who eat and drink during labor

At most US maternity units, women in labor are put on nil per os (NPO) status -- they're not allowed to eat or drink anything, except ice chips. But new nursing research questions that policy, showing no increase in risks for women who are allowed to eat and drink during labor.

At most US maternity units, women in labor are put on nil per os (NPO) status — they’re not allowed to eat or drink anything, except ice chips. But new nursing research questions that policy, showing no increase in risks for women who are allowed to eat and drink during labor. The study appears in the March issue of the American Journal of Nursing, published by Wolters Kluwer.

“The findings of this study support relaxing the restrictions on oral intake in cases of uncomplicated labor,” write Anne Shea-Lewis, BSN, RN, of St. Charles Hospital, Port Jefferson, N.Y., and colleagues. Adding to the findings of previous reports, these results suggest that allowing laboring women to eat and drink “ad lib” doesn’t adversely affect maternal and neonatal outcomes.

No Increase in Complications with ‘Ad lib’ Oral Intake During Labor

The researchers analyzed the medical records of nearly 2,800 women in labor admitted to one hospital from 2008 through 2012. At the study hospital, one practice group of nurses and doctors had a policy of allowing laboring women to eat and drink ad lib (ad libitum, or “as they please”). Another four practice groups kept all patients NPO (nil per os, or “nothing by mouth”).

Recommendations to restrict oral intake during labor reflect concerns over the risk of vomiting and aspiration (inhalation) in case general anesthesia and surgery are needed. However, with advances in epidural and spinal anesthesia, the use of general anesthesia during labor has become rare (and, if needed, much safer than before).

The study compared maternal and child outcomes in about 1,600 women who were kept NPO (except for ice chips) with 1,200 who were allowed to eat and drink ad lib during labor. The two groups were “sufficiently equivalent” for comparison. The women’s average age was 31 years. Before delivery, a “preexisting medical condition” complicating pregnancy was identified in 14 percent of the NPO group compared with 20 percent of the ad lib group.

Even though the women in the NPO group started out with fewer medical problems, they had a significantly higher incidence of complications during labor and birth, compared with the ad lib group. The women in the NPO group were also significantly more likely to give birth via unplanned cesarean section.

Other outcomes — including requiring a higher level of care after delivery and the newborns’ condition as measured by Apgar score — were not significantly different between groups. Analysis using a technique called propensity score matching, comparing groups of women with similar risk factors, yielded similar results.

The findings add to those of previous studies suggesting that restrictions on eating and drinking during labor could be safely relaxed in uncomplicated cases. “Yet in keeping with current guidelines, most obstetricians and anesthesiologists in the United States continue to recommend restrictions on oral intake for laboring women,” Anne Shea-Lewis and colleagues write.

“Our findings support permitting women who are at low risk for an operative birth to self-regulate their intake of both solid food and liquids during labor,” the researchers add. They note some limitations of their study, especially the fact that the women weren’t randomly assigned to NPO or ad lib groups.

The authors hope their study will lead to reconsideration of current recommendations to keep women NPO during the “often long and grueling” process of labor and delivery. “Restricting oral intake to a laboring woman who is hungry or thirsty may intensify her stress,” Anne Shea-Lewis and colleagues conclude. “Conversely, allowing her to eat and drink ad lib during labor can contribute to both her comfort and her sense of autonomy.”

Story Source:

Read this article on Science Daily: Wolters Kluwer Health. “Ice chips only? Study questions restrictions on oral intake for women in labor.” ScienceDaily. ScienceDaily, 23 February 2018. www.sciencedaily.com/releases/2018/02/180223151852.htm.


The Women’s OB/GYN Medical Group strives to better the lives of all women with a holistic approach to women’s health. Call for an appointment today: (707) 579-1102. Visit our website: www.womensobgynmed.com

Mothers over 40 more at risk of preterm birth

Maternal age over 40 is associated with an increased risk of preterm birth Mothers aged 30-34 years old may have the lowest risk of preterm birth
Pregnant mothers aged 40 and over may have an increased risk for preterm birth, regardless of confounding factors, according to a new study.
Pregnant mothers aged 40 and over may have an increased risk for preterm birth, regardless of confounding factors, according to a study published January 31, 2018 in the open-access journal PLOS ONE by Florent Fuchs from CHU Sainte Justine, Canada and colleagues.

Maternal age at pregnancy has been increasing worldwide and so has the risk for preterm birth. However, the association between maternal age and preterm birth remains a topic of ongoing research.

Fuchs and colleagues sought to investigate the impact of maternal age on preterm birth in a large cohort. The researchers analyzed the previously-collected data from the QUARISMA randomized controlled trial, which had taken place in 32 hospitals in Quebec, Canada, from 2008 to 2011.

The researchers identified five different age groups among the 165,282 pregnancies included in the study, and compared them based on maternal characteristics, gestational and obstetric complications, and risk factors for prematurity. Some of the known risk factors identified more commonly in older mothers (40 and over) included placental praevia, gestational diabetes, medical history, use of assisted reproduction technologies and occurrence of an invasive procedure. On the other hand, nulliparity, past drug use and smoking were more prevalent in younger mothers (30 and under).

Even after adjusting for confounding factors, the researchers found that advanced maternal age (40 or over) was associated with preterm birth. Meanwhile, a maternal age of 30-34 years was associated with the lowest risk of prematurity.


Read this article on Science Daily:  “Maternal age over 40 is associated with an increased risk of preterm birth: Mothers aged 30-34 years old may have the lowest risk of preterm birth.” ScienceDaily. ScienceDaily, 31 January 2018. www.sciencedaily.com/releases/2018/01/180131160346.htm.


About Women’s OB/GYN Medical Group

The Women’s OB/GYN Medical Group strives to better the lives of all women with a holistic approach to women’s health. Call for an appointment today: (707) 579-1102. Visit our website: www.womensobgynmed.com

Fewer Cesarean Deliveries Associated with Midwife-Attended Hospital Births

Women who gave birth at hospitals with a larger percentage of midwife-attended births were less likely to have two specific medical interventions, cesarean delivery and episiotomy, a new, hospital-level analysis. These findings raise the possibility that greater access to midwifery care, which is low in the United States, might enhance perinatal care and lower costs for low-risk women.

In a new, hospital-level analysis by health policy researcher Laura Attanasio at the University of Massachusetts Amherst and Katy Kozhimannnil at the University of Minnesota School of Public Health, they report that women who gave birth at hospitals that had a larger percentage of midwife-attended births were less likely to have two specific medical interventions, cesarean delivery and episiotomy.

Attanasio, an assistant professor of health policy and management at UMass Amherst’s School of Public Health and Health Sciences, explains that a growing body of research at the individual level has shown that compared to women cared for by physicians, women considered at low-risk for complications in childbirth who receive care from midwives have good outcomes that include lower use of interventions such as cesarean delivery.

The researchers analyzed hospital-level data reported in New York State over one year. Details appear in the current Journal of Midwifery & Women’s Health. Their study analyzes the experiences of individual women; an accompanying policy brief looks at hospital rates of medical interventions at the time of childbirth.

The authors say their findings raise the possibility that greater access to midwifery care, which is low in the United States, might enhance perinatal care and lower costs for low-risk women. In 2014, the year of the study, Attanasio and Kozhimannil point out that midwives attended just 9 percent of U.S. births, compared to more than 66 percent in other western countries such as Australia, France and the U.K.

They add, “More midwife-attended births may be correlated with fewer obstetric procedures, which could lower costs without lowering the quality of care. This raises the possibility of improving value in maternity care through greater access to midwifery care for childbearing women in the United States.”

The researchers used the Healthcare Cost and Utilization Project State Inpatient Database data for New York and New York State Department of Health data on the percentage of midwife-attended births at hospitals in the state in 2014 to estimate the association between the hospital-level percentage of midwife-attended births and four outcomes among low-risk women: induced labor, cesarean delivery, episiotomy and severe obstetric morbidity — that is, unintended outcomes of labor or delivery that have significant negative effects on the mother’s health.

Of the 126 hospitals included, the researchers say, about 25 percent of the hospitals had no midwives present. About 50 percent had some midwives present, but they attended less than 15 percent of births, while at 7 percent of the hospitals, midwives attended over 40 percent of births. They controlled for such variables as mother’s age, insurance type, and diagnosis of diabetes and hypertension.

Key findings were:

  • Women who gave birth at hospitals with more midwife-attended births had lower odds of delivering by cesarean and lower odds of episiotomy.
  • Hospital-level percentage of midwife-attended births was not associated with changes in labor induction or severe obstetric morbidity.

Attanasio says, “This study is contributing to a body of research which shows that good outcomes for women at low risk in childbirth go hand-in-hand with lower use of medical procedures. And, there is increasing attention now to overuse of cesarean and other procedures that are not resulting in better outcomes for mom and baby.”

Kozhimannil adds that the findings imply that a greater midwifery presence may have important clinical benefits. “From a policy perspective, this study should encourage legislators and regulators to consider efforts to safely expand access to midwifery care for low-risk pregnancies,” she notes.

Several states are considering expanding midwives’ scope of practice as New York State did in 2010 for certified nurse midwives, Attanasio says. “I hope that this work contributes to the evidence related to promoting the quality and value in maternity care that midwives can bring. A number of studies have shown that expanding their scope of practice and giving midwives more autonomy can increase women’s access to midwifery care.”


Story Source:

Materials provided by University of Massachusetts at Amherst. Note: Content may be edited for style and length.


Journal Reference:

  1. Laura Attanasio, Katy B. Kozhimannil. Relationship Between Hospital-Level Percentage of Midwife-Attended Births and Obstetric Procedure Utilization. Journal of Midwifery & Women’s Health, 2017; DOI: 10.1111/jmwh.12702

Read this article on ScienceDaily: University of Massachusetts at Amherst. “Midwifery care at hospitals is associated with fewer medical interventions.” ScienceDaily. ScienceDaily, 16 November 2017. www.sciencedaily.com/releases/2017/11/171116132736.htm.

Women’s OB/GYN Medical Group Celebrates an Ironwoman Among the Ranks

It isn’t every day that someone on our staff competes in the Ironman World Championships. Cecelia  Rondou, CNM, of the Women’s OB/GYN (far right in above photo), competed in this grueling triathlon in Kailua-Kona, Hawaii on October 14.

Cecelia began running, swimming and biking seriously many years ago and along the way, inspired her colleagues to join her. Dr. Lela Emad and Suzanne Saunders, CNM frequently train with Cecelia. Others on the OB/GYN staff provide volunteer support in a variety of ways.

Cecelia, who trains year-round with a professional coach, has qualified and competed in these championships for the past 15 years. She has the distinction of being the only athlete in her age group to fully complete the course each time. Here is an excerpt from an article titled “Kona-Bound From St. George” on the Ironman website:

Cecilia Rondou, 62, went to St. George with the goal of qualifying for Kona, but with the ever-constant wind, she redirected her focus to making each time cut-off. Late into the run, her crew told her she was the only one left in her age group on the course. A quick bit of math and she knew it would be close but doable. With nine-minutes to spare (16:51:13) Cecilia was the oldest female finisher of the day.

The hardest part of competing in events such as this, is finding time to train when you have such a busy schedule, but the satisfaction of challenging and improving yourself pays off in the results. Let’s congratulate Cecelia who lives the Ironman mantra every day: Anything is Possible!

OB/GYN Midwives provide expertise and guidance during the childbearing years

Midwifery Services with Certified Nurse Midwives (CNMs)

Suzanne Saunders, CNM, Elisabeth Niess MSN, CNM, Cecelia Rondou, CNM, Kirsten Eckert CNM, WHNP

Suzanne Saunders, CNM, Elisabeth Niess MSN, CNM, Cecelia Rondou, CNM, Kirsten Eckert CNM, WHNP

Certified Nurse-Midwives (CNMs) are specially trained in providing healthcare to pregnant women from conception through labor and delivery. Many women opt to have a CNM serve as their primary healthcare providers during pregnancy. Maximizing the birth experience and the health of newborns and their mothers is our practice’s primary goal for pregnant patients. Achieving this goal requires expert knowledge about the gestation period and birthing process, as well as heightened empathy between providers and their patients.

Women’s OB/GYN Medical Group’s experienced CNMs offer expertise and tender care guidance to women during their childbearing years. Our CNMs understand that delivery preferences are extremely important and personal to expecting mothers, and that they can also be difficult for some women to determine. To ensure that our patients have the best possible experience during their pregnancies, our CNMs are especially attentive to pregnant mothers’ personal philosophies on giving birth and general reproductive health.

Our CNMs work in close collaboration with OB/GYN doctors, and serve as the primary health resource for pregnant women whom prefer to involve a midwife in their pregnancies. What to expect from your Certified Nurse-Midwife at Women’s OB/GYN Medical Group during your pregnancy:

  • Routine Gynecological Check-ups with attentive care to your physical and emotional health needs
  • Hospital delivery of your baby and special guidance during labor if desired
  • Supportive consultations with you and your partner
  • Constant communication with our OB/GYN physicians
  • Family planning and expert advice on the contraceptive use
  • Obstetrical Care
  • Educational discussions about breastfeeding, infant care, and what to expect during the postpartum period

The Women’s OB/GYN Medical Group strives to better the lives of all women with a holistic approach to women’s health. Call for an appointment today: (707) 579-1102. Visit our website: www.womensobgynmed.com

Breastfeeding after a C-section may help manage pain

Breastfeeding after a cesarean section (C-section) may help manage pain, with mothers who breastfed their babies for at least 2 months after the operation three times less likely to experience persistent pain compared to those who breastfed for less than 2 months, according to new research being presented at this year’s Euroanaesthesia Congress in Geneva (3-5 June).

C-sections account for around a quarter of all births in the UK, USA, and Canada. Chronic pain (lasting for more than 3 months) after C-section affects around 1 in 5 mothers. It is widely accepted that breast milk is the most important and appropriate nutrition in early life, and WHO, the UK Department of Health, and US Department of Health and Human Services all recommend exclusive breastfeeding up to 6 months of age. But until now, little has been known about the effect of breastfeeding on a mother’s experience of chronic pain after C-section.

The study, by Dr Carmen Alicia Vargas Berenjeno and colleagues from the Hospital Universitario Nuestra Señora de Valme in Sevilla, Spain, included 185 mothers who underwent a C-section at the hospital between January 2015 and December 2016. Mothers were interviewed about breastfeeding patterns and the level of chronic pain at the surgical site in the first 24 and 72 hours after C-section, and again 4 months later. The researchers also looked at the effect of other variables on chronic pain including surgical technique, pain in the first 24-72 hours, maternal education and occupation, and anxiety during breastfeeding.

Almost all (87%) of the mothers in the study breastfed their babies, with over half (58%) reporting breastfeeding for two months or longer. Findings showed that around 1 in 4 (23%) of the mothers who breastfed for two months or less still experienced chronic pain in the surgical site 4 months post-op compared to just 8% of those who breastfed for 2 months or longer. These differences were notable even after adjusting for the mother’s age. Further analysis showed that mothers with a university education were much less likely to experience persistent pain compared to those who were less well educated. The researchers also found that over half (54%) of mothers who breastfed reported suffering from anxiety.

The authors conclude: “These preliminary results suggest that breastfeeding for more than 2 months protects against chronic post-cesarean pain, with a three-fold increase in the risk of chronic pain if breastfeeding is only maintained for 2 months or less. Our study provides another good reason to encourage women to breastfeed. It’s possible that anxiety during breastfeeding could influence the likelihood of pain at the surgical site 4 months after the operation.”

The authors are currently analyzing additional data from women interviewed between November 2016 to January 2017, which, when combined with data from all the other women, shows that anxiety is associated with chronic post Cesarean pain in a statistically significant way.


Story Source:

Materials provided by ESA (European Society of Anaesthesiology). Note: Content may be edited for style and length.


Read this article on Science Daily: (European Society of Anaesthesiology). “Breastfeeding may protect against chronic pain after Caesarean section.” ScienceDaily. ScienceDaily, 4 June 2017. www.sciencedaily.com/releases/2017/06/170604115807.htm

Good outcomes for older women who give birth at home or in a birth center

Women with some characteristics commonly thought to increase pregnancy risks — being over age 35; being overweight; and in some cases, having a vaginal birth after a cesarean section — tend to have good outcomes when they give birth at home or in a birth center, a new assessment has found.

However, women with some other risk factors, a breech baby and some other cases of vaginal birth after cesarean or VBAC, may face an increased risk of poor outcomes for themselves or their babies, researchers at Oregon State University have found. The study is believed to be the first to examine these risks and the outcomes. About 2 percent of all births in the U.S., and about 4 percent in Oregon, occur at home or in a birth center, rather than in a hospital setting. Generally, women who are considered “low-risk” are good candidates for home or birth center births, also referred to as community births, if they are attended by a midwife or other trained provider and timely access to a hospital is available.

However, there is little agreement among health providers on what should be considered low- or high-risk, and some women choose to have a community birth despite potential risks, said Marit Bovbjerg, a clinical assistant professor of epidemiology at Oregon State University and lead author of the study.

Medical ethics and the tenets of maternal autonomy dictate that women be allowed to decide where and how they wish to give birth. That’s why it’s important to have as much information as possible about potential risks, said Bovbjerg, who works in the College of Public Health and Human Sciences at OSU.

There are also risks associated with hospital births, such as increased interventions, which means there aren’t always clear answers when it comes to determining the best and safest place to give birth, said Melissa Cheyney, a medical anthropologist and associate professor in OSU’s College of Liberal Arts.

The goal of the research was to better understand the outcomes for women and babies with some of the most common pregnancy risk factors, to see how those risk factors affected outcomes.

“There’s a middle or gray area, in terms of risk, where the risk associated with community birth is only slightly elevated relative to a completely low-risk sample,” Cheyney said. “We’re trying to get more information about births that fall in that middle zone so that clinicians and pregnant women can have the best evidence available when deciding where to give birth.”

The findings were published recently in the journal Birth. Other co-authors are Jennifer Brown of University of California, Davis; and Kim J. Cox and Lawrence Leeman of the University of New Mexico. Using birth outcome data collected by the Midwives Alliance of North America Statistics Project, commonly referred to as MANA Stats, the researchers analyzed more than 47,000 midwife-attended community births.

They looked specifically at the independent contributions to birth outcomes of 10 common risk factors: primiparity, or giving birth for the first time; advanced maternal age, or mother over age 35; obesity; gestational diabetes; preeclampsia; post-term pregnancy, or more than 42 weeks gestation; twins; breech presentation; history of both cesarean and vaginal birth; and history of only cesarean birth.

The last two groups are both considered VBACs and hospital policies and state regulations for midwifery practice usually make no distinction between the two types. However, the researchers found a clear distinction between the two groups in terms of community birth outcomes.

Women who delivered vaginally after a previous cesarean and also had a history of previous vaginal birth had better outcomes even than those women giving birth for the first time. On the other hand, women who had never given birth to a child vaginally had an increased risk of poor outcomes in community birth settings.

“That finding suggests that current policies that universally discourage VBAC should be revisited, as the evidence does not support them,” Bovbjerg said. “Women who in the past have successfully delivered vaginally seem to do just fine the next time around, even if they have also had a previous C-section. That’s really important because some medical groups totally oppose VBACs, even in hospital settings, and many hospitals don’t offer the option of a VBAC at all.”

Researchers also found that women whose babies were in breech position had the highest rate of adverse outcome when giving birth at home or in a birth center.

There was only a slight increase in poor outcomes for women over age 35, or women who were overweight or obese, compared to those without those risk factors. In some categories, there were not enough births in the data set to properly evaluate a risk’s impact, such as with gestational diabetes and preeclampsia.

“As is appropriate, women who face high complication risks such as preeclampsia tend to plan for and choose a hospital birth, rather than a community birth,” Bovbjerg said. “But even for these women, it’s important to remember that they can choose a community birth if their faith, culture or other considerations dictate that is the best choice for them.”

The researchers emphasized that the new information about risks and outcomes can serve as an important tool in decision-making for families making very personal choices about where to give birth. “These findings help us to put information and evidence, rather than fear, at the center of discussions around informed, shared decision-making between expectant families and their health care providers,” Cheyney said.

Researchers next plan to examine how the healthcare culture and standards of care in different locations within the U.S. affect outcomes of home and birthing center deliveries.


Story Source:

Materials provided by Oregon State University. Note: Content may be edited for style and length.


Journal Reference:

  1. Marit L. Bovbjerg, Melissa Cheyney, Jennifer Brown, Kim J. Cox, Lawrence Leeman. Perspectives on risk: Assessment of risk profiles and outcomes among women planning community birth in the United States. Birth, 2017; DOI: 10.1111/birt.12288

Read this article on Science Daily: www.sciencedaily.com/releases/2017/04/170413154439.htm.

Researchers find Vitamin B3 beneficial for pregnant women to treat preeclampsia, prevent strokes

Vitamin B3 nicotinamide may help treat pregnant women who suffer from preeclampsia by preventing strokes and in some cases, even stimulating the growth of their fetus, research indicates.

Scientists in Japan and the US have found that vitamin B3 nicotinamide may help treat pregnant women who suffer from preeclampsia by preventing strokes and in some cases, even stimulating the growth of their fetus.

Up to 8% of pregnant women suffer from preeclampsia, a deadly disease characterized by high blood pressure, blood vessel damage, high levels of protein in the urine and fluid retention that causes swelling in the legs and feet. In some cases, preeclampsia is also believed to restrict a fetus’ growth.

Blood pressure-lowering drugs do not improve blood vessel damage. In fact, they reduce blood supply to the babies, which could lead to fetal death.

Until now, the only treatment for preeclampsia-affected pregnant women has been delivery of the baby. Now, researchers at Tohoku University, in collaboration with US scientists, have found that nicotinamide — also referred to as Vitamin B3 — relieves preeclampsia in mouse models. Moreover, they have also discovered that nicotinamide can even improve fetal growth in mothers with preeclampsia.

“We had previously shown that endothelin, a strong vessel narrowing hormone, worsens preeclampsia. But inhibiting the hormone is harmful to the babies,” says Associate Professor Nobuyuki Takahashi of Tohoku University’s Graduate School of Pharmaceutical Sciences, who co-led the study.

“In contrast, nicotinamide is generally safe to mothers and babies, corrects the blood vessel narrowing effect of endothelin, and reduces stress to the babies. Accordingly, we evaluated the effects of nicotinamide using two mouse models of preeclampsia caused by different mechanisms.”

The researchers concluded that nicotinamide is the first safe drug that lowers blood pressure, reduces urine protein and alleviates blood vessel damage in preeclampsia-affected mice. The researchers went on to show that in many cases, nicotinamide also prevents miscarriage, prolongs pregnancy period and improves the growth of the babies in mice with preeclampsia.

“Nicotinamide merits evaluation for preventing and treating preeclampsia in humans,” says Oliver Smithies, a Weatherspoon Eminent Distinguished Professor at the University of North Carolina at Chapel Hill. Smithies is a Nobel Laureate in Physiology or Medicine, and co-leader of this study.

The research team hopes that if the treatment works in humans, nicotinamide could help treat preeclampsia and prevent fetal growth restriction associated with the disease in pregnant women.

Journal Reference:

  1. Feng Li, Tomofumi Fushima, Gen Oyanagi, H. W. Davin Townley-Tilson, Emiko Sato, Hironobu Nakada, Yuji Oe, John R. Hagaman, Jennifer Wilder, Manyu Li, Akiyo Sekimoto, Daisuke Saigusa, Hiroshi Sato, Sadayoshi Ito, J. Charles Jennette, Nobuyo Maeda, S. Ananth Karumanchi, Oliver Smithies, Nobuyuki Takahashi. Nicotinamide benefits both mothers and pups in two contrasting mouse models of preeclampsia. Proceedings of the National Academy of Sciences, 2016; 113 (47): 13450 DOI: 10.1073/pnas.1614947113

Read this article on Science daily:  “Potential treatment for pregnant women who suffer from preeclampsia found in a vitamin.” ScienceDaily. ScienceDaily, 19 December 2016. <www.sciencedaily.com/releases/2016/12/161219100556.htm>.