Midwives

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.

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 for Pregnancy

For any woman who is trying to have a baby or just thinking about it, it is never too early to start getting ready for pregnancy. Preconception health and health care focuses on things women can do before and between pregnancies to increase the chances of having a healthy baby.

For some women, getting their body ready for pregnancy takes a few months. For other women, it might take longer. Whether this is your first, second, or sixth baby, the following are important steps to help you get ready for the healthiest pregnancy possible.

Read the full story here …

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 …

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.

Northern California Medical Associates (NCMA) Proudly Welcomes Women’s OB/GYN Medical Group

In keeping with its goal of providing Northern California with a comprehensive network of state-of-the-art health services from leading specialists in a full-spectrum of medical fields, Northern California Medical Associates (NCMA) is proud to welcome Women’s OB/GYN Medical Group to its ever-growing practice.

For nearly 25 years, Women’s OB/GYN Medical Group has offered a full range of premier obstetrics and gynecology services to women of all ages in the North Bay region. The practice’s care team is made up of compassionate, expert doctors, midwives, nurses, and medical assistants that strives to meet all patients’ OB/GYN health care needs in a comfortable environment close to home. Services offered at Women’s OB/GYN include general gynecological health screenings, state-of-the-art diagnostics, contraception management, comprehensive pregnancy and postpartum care, minimally invasive laparoscopic surgery, uro-gynecological procedures, incontinence care, menopause care, laser hair removal and skin care.

Women’s OB/GYN Medical Group’s four elite physicians include Lela Emad, MD, Susan Logan, MD, Amita Kachru, MD, and Shazah Khawaja, MD. The doctors at this practice share in the whole-body care philosophy, meaning that they always strive to find the underlying causes of a woman’s health problems rather than simply treating the symptoms. The team of health professionals at Women’s OB/GYN is committed to both alleviating short-term ailments and maximizing long-term health.

Women’s OB/GYN Medical Group, located at 500 Doyle Park Drive, Ste. 103 in Santa Rosa, is an affiliate of Sutter Medical Center of Santa Rosa and Santa Rosa Memorial Hospital (SRMH). The partnership with NCMA strengthens Women’s OB/GYN’s network of experienced healthcare providers, directly benefitting patient access to healthcare specialists in the area. The practice is currently accepting new patients. For more information visit us at womensobgynmed.com. To start care with a knowledgeable OB/GYN physician who will always treat you with compassion and expertise, call 707-579-1102 to schedule an appointment today.