Men and Pregnancy

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.

Why Some Women Are More Likely To Have Twins Than Others

Twins tend to run in families, and now researchers have identified two genes that make women more likely to conceive nonidentical twins. Both genes are related to the production and processing of the hormone that helps oocytes (egg cells) mature.

“There’s an enormous interest in twins, and in why some women have twins while others don’t,” study co-author Dorret Boomsma, a biological psychologist at Vrije Universiteit Amsterdam, said in a statement. “The question is very simple, and our research shows for the first time that we can identify genetic variants that contribute to this likelihood.”

Odds of twins

There are two ways that a woman may conceive twins. In one case, her ovaries release two eggs at the time of ovulation, and both are fertilized and become embryos; this results in fraternal, or nonidentical, twins. In contrast, identical twins are conceived when one embryo splits into two early in its development. Read the full story ….

 

Planning Ahead Helps to Ensure a Healthy Pregnancy and a Healthy Baby

The Women’s OBGYN Medical Group of Santa Rosa provides parents with the information and guidance needed to prepare as an individual and as a family, particularly important during the preconception process.

166426584

 

Any woman who is considering pregnancy in her future naturally wants to have the healthiest pregnancy possible – and healthiest baby possible. One way to help ensure a positive outcome is by planning for it ahead of time. Results of the Healthy Moms Study underscores the importance for women (particularly important for those with weight issues prior to pregnancy) to participate in a preconception planning process. In this way it is much more likely that they will be able to limit their weight gain during pregnancy and are then less likely to have large babies, which can complicate delivery and increase the baby’s risk of becoming obese later in life.

What is Preconception Healthcare

Preconception healthcare is medical care typically provided to a woman by the doctor or other health professionals and is designed to increase the chances of having a positive pregnancy experience and a healthy baby. When most people hear the term preconception healthcare, they think about women but when it comes to planning for a pregnancy, it’s important for men, too.

Preconception healthcare is uniquely designed for every individual, depending on personal needs and circumstances. When women and their families are planning for a baby, the Women’s OBGYN Medical Group encourages parents to begin making healthy lifestyle changes up to one full year prior to trying to get pregnant. This process improves the chances of becoming pregnant and prepares a woman’s body to provide the best environment for her infant. Based on a person’s health, the doctor or healthcare provider may suggest a course of treatment or follow-up care.

The goal of preconception care is to discover lifestyle and health factors that might affect pregnancy. Identifying these factors before becoming pregnant will make it possible for parents to take steps to increase the chances of a healthy pregnancy and a healthy baby. During a preconception care visit, the healthcare provider will typically focus on diet, lifestyle, medical and family history, previous pregnancies and currently prescribed medications. Topics to be discussed may include:

• Alcohol, tobacco, and caffeine use
• Recreational drug use
• Birth control
Diet and exercise
• Environmental concerns (including any toxic substances at work or at home that may impact fertility and overall health)
Family histories and genetics
• Health issues & concerns (diabetes, high blood pressure, depression, obesity, etc.)
• Possible testing for Hepatitis B and C & Sexually transmitted diseases (STDs)
• Medications, Vitamins and Supplements

Taking steps to prepare mentally and emotionally for pregnancy and parenthood is also a very important part of the preconception process. It is important to discuss expectations and concerns with your partner, family and close friends. Making appropriate financial adjustments for both expected and unforeseen costs associated with childrearing are also important considerations to take as is preparing for childcare with employers for after the baby is born.

Supplements vs. Food

Eating a nutrient rich and calorie conscious diet prior to and during pregnancy can help prevent excessive weight gain and cut the potential risk of obstetric complications. Since one of the most important changes to consider before pregnancy is to the diet, adding supplements or including nutrient rich foods will help to build a healthy physical environment for both mother and baby. Foods that contain sources of folic acid (vitamin B9) are important nutritional elements to incorporate into both the preconception and pregnancy diet. Folic acid helps to prevent some birth defects – particularly those affecting the brain and spinal cord. Folic acid is best taken before pregnancy and in the very early stages of pregnancy. It is found naturally in foods such as;

• leafy, green vegetables (spinach, collard greens, romaine lettuce)
• fortified breakfast cereals
• beans, peas and lentils
• citrus fruits
• asparagus
• broccoli

Since it is often difficult to get enough essential vitamins including folic acid from food alone, taking a multivitamin is a good way to add nutrients to the diet. Iron is also an important component to take during pregnancy as iron deficiency can be a problem for some women. It is essential for supplying oxygen rich blood to the developing baby. Although the bulk of nutrients should ideally come from eating fresh healthy foods, it is generally recommended that women start taking a prenatal vitamin supplement before pregnancy. Prenatal vitamin supplements are specifically formulated to contain all the recommended daily vitamins and minerals needed before and during pregnancy.

Men and Pregnancy

Whether you are a man or a woman considering pregnancy, preconception healthcare is about providing yourself and your loved ones with a healthy future. Preconception healthcare for men mainly focuses on overall health and lifestyle choices – to get and stay as healthy as possible. It is also about helping and supporting others as they get healthy, too.

Fertility is one aspect of preconception planning that men might want to take into consideration. There are common lifestyle factors that can cause a man’s sperm count to become low and affect the quality of semen and create low sperm count – all of which can make it difficult to get pregnant.

Some habits that can affect sperm count include;

• alcohol consumption
• tobacco use
• steroids
• illegal or recreational drugs
• certain prescription drugs and over-the-counter medicines
• sauna, hot tub, or whirlpool use over 102° F
• an unhealthy diet

About Women’s OBGYN Medical Group

Planning ahead and taking steps to ensure optimal pre-pregnancy health is a great way to create a healthy family. Whether you are a man or a woman, taking the time to plan a pregnancy and taking steps to improve your health now will help to ensure a better quality of life for both you and your family. The Women’s OBGYN Medical Group provides an experienced team of physicians, nurse midwives and nurse practitioners who are able to deliver comprehensive, compassionate preconception, pregnancy and post-partum care to patients and their families in a comfortable environment close to home. For more information call (707) 579-1102.

Resources:

Centers for Disease Control and Prevention. Recommendations to improve preconception health and health care—United States. MMWR Recommendations and Reports. 2006;55(RR-06):1–23.

1) Kimberly K. Vesco, Njeri Karanja, Janet C. King, Matthew W. Gillman, Michael C. Leo, Nancy Perrin, Cindy T. McEvoy, Cara L. Eckhardt, K. Sabina Smith, Victor J. Stevens. Efficacy of a group-based dietary intervention for limiting gestational weight gain among obese women: A randomized trial. Obesity, 2014; 22 (9): 1989 DOI: 10.1002/oby.20831