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.

Introducing Kirsten Eckert, CNM – Women’s OB/GYN Medical Group’s Newest Provider

DrKirsten Eckert is a certified nurse midwife (CNM) and Women’s Health Nurse Practitioner (WHNP).  She graduated in 2010 from UCLA with a BS in paleo biology and geology.  While at UCLA, she taught sex education with the Los Angeles Unified School District and decided to pursue her interests in women’s health care and education.

Kirsten then received her MSN from Yale University in 2014 with a specialty in midwifery.  She is excited to be back in her home state providing full scope midwifery care with this group of outstanding women and providers.  She is honored and blessed to be able to help women be active and empowered decision-makers during their pregnancies and confidently give birth.

In her free time, Kirsten enjoys hiking, rock climbing, and throwing pottery.

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 ….


The Oakland Press Health: A Christmas Birthday Story – Midwives and New Moms

obgyn 2.22Anna Trela has a daughter who will soon be 12 and while she and her husband always wanted a second child, after 10 years of trying they lost hope. In February, Trela nearly lost her life after being hit by two cars while crossing a street in Hamtramck. Her leg was crushed and other injuries left her speech and mobility impaired. But during her darkest hour, in the midst of surgeries and therapy sessions, she discovered she was pregnant.

Her second child, a boy, Alexander, is due Wednesday.

“A Christmas baby, come on. It couldn’t be better. I feel like the angels sent him from heaven to keep me sane,” said Trela, of Warren, who stopped taking painkillers when she learned she was pregnant despite excruciating pain. Read the full story on the Oakland Press website …

What to Expect with Routine Pregnancy Check-ups

Regularly scheduled pregnancy check-ups allow you and your physician to determine the best, personalized pregnancy care for your individual body and lifestyle, as well as to track both your health and the health of your baby. Like every woman’s individual body, every pregnancy is unique. Regularly scheduled pregnancy check-ups allow you and your physician to determine the best, personalized pregnancy care for your individual body and lifestyle, as well as to track both your health and the health of your baby. We understand that many women remain very active during their pregnancies and we are happy to work with you to schedule appointments with our physicians and midwives that will fit with your day.

Pregnancy Check-up Timeline

While no two pregnancies will ever be exactly the same, the following information will help prepare you for what to expect at your check-ups based on the stage of your pregnancy. Our physicians and certified nurse midwives will perform standard evaluations of you and your baby and check for abnormalities throughout your pregnancy, with heightened vigilance during stages of increased risk.

First Trimester: 0 to 12 Weeks

What to expect at your first visit:

  • A thorough physical exam and review of your medical history.
  • An ultrasound to confirm your due date (when to expect you will go into labor).
  • Blood work and standard cultures for Chlamydia and gonorrhea.
  • A pap smear, unless you’ve had one recently.
  • Arrangement to consult with a specialist (if certain risk factors are present).
  • A request to see your old medical records (if needed).

What to expect after your first visit (every three to four weeks during first trimester):

  • Documentation and tracking of your blood pressure and weight.
  • Testing your urine for protein and glucose.
  • Answers to some of your questions as your doctor will have more information about your baby.
  • An early ultrasound may be performed if there is suspected risk involved in your pregnancy

Second Trimester: 12 to 24 Weeks

Visits generally scheduled every three to four weeks:

  • An examination of fetal heart tones (your baby’s heartbeat)
  • Alpha-fetoprotein (AFP) screening between weeks 16 and 18. Your doctor will also determine fetal growth at this time. Your doctor will also refer you to prenatal classes at your hospital or through private instruction if you are not enrolled in them already.
  • The anatomy scan ultrasound is generally performed between 18 and 22 weeks of pregnancy, and the sex of the baby may be determined at this time.
  • If you require any surgery related to your pregnancy, your provider will most likely schedule it during this trimester.

Third Trimester: 24 Weeks to Delivery

Visits generally scheduled every two to three weeks:

  • A glucola screen for gestational diabetes at 26 weeks

Visits generally scheduled weekly from 36 weeks until delivery:

  • A group B strep vaginal culture (a test for Group B Strep bacteria) at 35-36 weeks. Your provider will also discuss signs of preterm labor and begin monitoring them if indicated.
  • At 36 weeks, your doctor will determine the fetal position (this is the time a baby usually locks into position). If the baby is suspected to be breech (head facing away from the vagina) in the third trimester, your provider may perform an ultrasound.
  • Your provider may perform an external cephalic version if your baby is breech, or recommend some home exercises that may help move the baby into a vertex (head-first) position.
  • Weekly cervical checks.
  • At 39 weeks your provider may offer birth induction.
  • 40 weeks marks a complete term. If you’ve not yet had your baby, expect more frequent visits with your provider. Your doctor may offer to induce labor if your cervix is ripe.
  • If labor has not occurred by 41-42 weeks, expect to be induced. Inducing labor at this point is necessary to minimize risks to yourself and the baby.

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.

May; a Royally Busy Month for Midwives

Midwifery is celebrated this month, while Kate Middleton delivers second child with help of midwives – putting the spotlight on CNM’s. For all mothers, royal or otherwise – maximizing the birth experience, helping to ensure the health of newborns and their mothers is the Women’s OB/GYN Medical Group of Santa Rosa’s primary goal for pregnant patients.

Midwifery ServicesMay is the month that features a special day to celebrate a very important medical provider for women; the midwife (May 5). And with the birth of the latest royal (Princess Charlotte et al) happening just a few days earlier –overseen by no less that two midwives per Kate Middleton’s (the Duchess of Cambridge) request – the art of midwifery is in now the spotlight. “With so much world-wide attention on midwives this month, the Women’s OB/GYN Medical Group would like to pay special tribute to our own highly skilled midwife providers, Kirsten Eckert, CNM, Cecelia Rondou, CNM and Suzanne Saunders, CNM,” says Women’s OB/GYN Medical Group’s Dr. Lela Emad, obstetrician & gynecologist.

Midwives are Highly Trained Professionals

Midwives, like other healthcare providers for women, are making a difference in the lives of women in their communities – all over the world. Certified Nurse-Midwives (CNMs) are specially trained in providing healthcare to pregnant women, and can oversee the birth process from conception through labor and into delivery. According to the latest available statistics on the subject, women are opting to have a CNM serve as their primary healthcare providers during pregnancy at an increasing rate.

According to the American College of Nurse-Midwives since 1989 the percentage of midwife-attended births has been on the rise, and in the latest available report as of 2012, midwives attended almost eight percent of all hospital births, a six percent increase from 2005. The percentage of out-of-hospital births attended by CNMs also increased from 28.6 percent in 2005 to 30.4 percent as of 2012. Both the number and percentage of midwife-attended births in the United States slightly increased from 2011 to 2012 despite a decrease in total US births.

Compassionately Providing Birthing Services to Women

“The ability to successfully oversee an expectant mother from conception to delivery requires expert knowledge about the gestation period and birthing process as well as heightened empathy between providers and their patients,” explains Dr. Lela Emad. “Our CNMs work in close collaboration with OB/GYN doctors, and serve as the primary health resource for many pregnant women who prefer to involve a midwife in their pregnancies.” And according to the latest statistics, midwives practice wherever women give birth. In 2012, the majority of midwife-attended births in the U.S. occurred in hospitals (94.9 percent), while 2.6 percent occurred in freestanding birth centers, and the remaining 2.5 percent occurred in homes.

Women’s OB/GYN Medical Group’s highly skilled CNMs offer expertise, tender care and personalized 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,” said Dr. Emad. To ensure that patients have the best possible experience during their pregnancies, Women’s OB/GYN Medical Group CNMs are especially attentive to pregnant mothers’ personal philosophies on giving birth and general reproductive health.

What patients can expect from a Certified Nurse-Midwife at Women’s OB/GYN Medical Group during pregnancy:

• Routine Gynecological Check-ups with attentive care to physical and emotional health needs
• Hospital delivery of baby and special guidance during labor if desired
• Supportive consultations with patient and partner
• Constant communication with 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

Why the Women’s OBGYN Medical Group’s CNM’s are so special

The provider team of expert OB/GYN physicians, certified nurse midwives, family nurse practitioners, and medical assistants at the Women’s OB/GYN Medical Group provides unmatched care to patients in the region. Cecelia Rondou, CNM, Kirsten Eckert, CNM and Suzanne Saunders, CNM – all highly qualified professionals, make up the team of midwives in the medical group. “These experienced midwife professionals are vital to the overall quality of care we are able to offer to patients,” explains Dr. Emad.

The Women’s OB/GYN Medical Group CNM’s provide comprehensive midwife services including diagnostic women’s health screening tests, care throughout the child bearing cycle, management of common perinatal problems, education to promote and maintain health, specimen collection and interpretation of laboratory data, contraception counseling, and so much more. For more information call (707) 579-1102 or visit their website.