Sonoma County

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.

Mother’s folic acid intake during pregnancy may decrease hypertension risk in children

Avocado – rich in folic acid.

A new article published in the American Journal of Hypertension finds that babies born to mothers with cardiometabolic risk factors were less likely to develop high blood pressure if their mothers had higher levels of folate during pregnancy.

Since the late 1980s, the prevalence of childhood elevated blood pressure has increased in the United States, in particular among African Americans. From a life course perspective, childhood high blood pressure can predict higher blood pressure values later in life, and people with higher blood pressure are at greater risk of developing cardiovascular, metabolic and kidney disease and stroke. Research has also shown that maternal cardiometabolic risk factors during pregnancy — including hypertensive disorders, diabetes, and obesity — are associated with higher offspring blood pressure.

Because controlling hypertension and cardiovascular disease in adults is difficult and expensive, identifying early-life factors for the prevention of high blood pressure may be an important and cost effective public health strategy.

There is growing evidence that maternal nutrition during pregnancy, through its impact on the fetal intrauterine environment, may influence offspring cardiometabolic health. Folate, which is involved in nucleic acid synthesis, gene expression, and cellular growth, is particularly important.

In young adults, higher folic acid intake has been associated with a lower incidence of hypertension later in life. Citrus juices and dark green vegetables are good sources of folic acid. However, the role of maternal folate levels, alone or in combination with maternal cardiometabolic risk factors on child blood pressure has not been examined in a prospective birth cohort.

In the current study, researchers analyzed the data from a prospective U.S. urban birth cohort, enriched by low-income racial and ethnic minorities at high risk for elevated BP, to examine whether maternal folic acid levels and cardiometabolic risk factors individually and jointly affect offspring blood pressure.

Researchers included 1290 mother-child pairs, 67.8% of which were Black and 19.2% of which were Hispanic, recruited at birth and followed prospectively up to age 9 years from 2003 to 2014 at the Boston Medical Center. Of the mothers, 38.2% had one or more cardiometabolic risk factors; 14.6% had hypertensive disorders, 11.1% had diabetes, and 25.1% had pre-pregnancy obesity. A total of 28.7% of children had elevated systolic blood pressure at age 3-9 years. Children with higher systolic blood pressure were more likely to have mothers with pre-pregnancy obesity, hypertensive disorders, and diabetes. Children with elevated systolic blood pressure were also more likely to have lower birth weight, lower gestational age, and higher BMI.

The study findings suggest that higher levels of maternal folic acid may help counteract the adverse associations of maternal cardiometabolic risk factors with child systolic blood pressure, although maternal folic acid levels alone were not associated with child systolic blood pressure. Among children born to mothers with any of the cardiometabolic risk factors, those whose mothers had folic acid levels above the median had 40% lower odds of elevated childhood systolic blood pressure. These associations did not differ appreciably in analyses restricted to African Americans, and they were not explained by gestational age, size at birth, child postnatal folate levels or breastfeeding.

“Our study adds further evidence on the early life origins of high blood pressure,” said Dr. Xiaobin Wang, the study’s senior corresponding author. “Our findings raise the possibility that early risk assessment and intervention before conception and during pregnancy may lead to new ways to prevent high blood pressure and its consequences across lifespan and generations.”


Story Source:

Materials provided by Oxford University Press USA. Note: Content may be edited for style and length.


Journal Reference:

  1. Hongjian Wang, Noel T. Mueller, Jianping Li, Ninglin Sun, Yong Huo, Fazheng Ren, Xiaobin Wang. Association of Maternal Plasma Folate and Cardiometabolic Risk Factors in Pregnancy with Elevated Blood Pressure of Offspring in Childhood. American Journal of Hypertension, 2017; DOI: 10.1093/ajh/hpx003

Cite This Page:

Oxford University Press USA. “High folic acid level in pregnancy may decrease high blood pressure in children.” ScienceDaily. ScienceDaily, 8 March 2017. <www.sciencedaily.com/releases/2017/03/170308081047.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.

How harnessing fat cells could help in battle against breast cancer

The research points to exercise — which has none of the harmful side-effects of many cancer drugs — as being a potentially beneficial therapy in some breast cancer patients


jogger-1435341New research led by York University Professor Michael Connor highlights how fat cells could help determine the most effective way to fight breast cancer; including using exercise to combat the disease.

Previously, adipose tissue (body fat) was thought of as a storage form of energy. However, fat cells are now understood to be active cells that produce more than 400 adipokines (hormones) which eventually end up in the blood and make their way around the body. Connor and his research team set out to determine whether the hormones found in body fat can account for the observed association between obesity and breast cancer.

“Our research has found that the characteristics of hormones produced by fat cells in obese people can promote breast cancer growth, whereas in lean people it prevents growth,” said Connor. “The characteristics of those hormones differ depending on whether the person is lean or obese and that determines whether the cancer grows or not.”

Using a rodent model, Connor and his team looked at whether the fat cells play a role in the link between obesity and breast cancer, and whether interventions targeted at obesity counteract any of the life-threatening effects of breast cancer.

The research published in the Journal of Applied Physiology points to exercise — which has none of the harmful side-effects of many cancer drugs — as being a potentially beneficial therapy in some breast cancer patients.

“Our study shows that voluntary and rigorous exercise can counteract, and even completely prevent the effects on cancer growth that are caused by obesity. We also show that even moderate exercise can lead to slowing of breast cancer growth and that the more exercise you do, the greater the benefit.” said Connor.

For nearly a half century, researchers have studied the links between obesity and breast cancer. This recent study has revealed specifically that adiponectin and leptin are possible reasons for poorer response to therapy and higher risk of death in obese persons than in others.


Story Source:

The above post is reprinted from materials provided by York University. Note: Materials may be edited for content and length.

Read this article on ScienceDaily …

Symptoms And Treatments of Menopause Explained

For women, the menopause typically starts between the ages of 45 and 55.

It can be extremely debilitating and can cause anything from hot flushes to depression to decreased sex drive – in fact one quarter of women over 40 say their sex life is non-existent thanks to menopause.

The symptoms can last between two and five years, which means it’s really important to seek out treatment if you’re finding the experience unbearable. To help you on your way, we spoke to Dr Helen Webberley from Oxford Online Pharmacy about what treatments are available. She also gave her verdict on whether hormone replacement therapy (HRT) is safe.

The end of a woman’s reproductive life is marked by a reduction in the function of the ovaries. When this finally stops, the menopause begins.

“Generally speaking, for a woman over the age of fifty, the menopause can be said to have taken place one year after the last period, or two years after the last period in the under fifties,” explains Dr Webberley.

Read the full story …

A Mother’s High-fat and Sugar Diet Now Thought to Affect Generations

Dr. Lela Emad of the Women’s OB/GYN Medical Group shares some insight into a recent study pertaining to maternal nutrition and how a mother’s poor diet may predispose children to obesity

A new study from Washington University School of Medicine in St. Louis points to the likelihood that a mother’s high-fat, high-sugar diet can impact not just immediate offspring with genetic abnormalities and chronic health conditions, but as many as three generations into the future.

According to results of this research, regardless of whether offspring of an overweight mother opt to consume healthy diets themselves – their lifetime heath will be affected with potentials for obesity-related conditions such as heart disease and diabetes. The unique factor in this study revealed that even before becoming pregnant, a woman’s lifelong obesity can cause health issues for future generations. Researchers say that this study should serve as a wake-up call for U.S. women of child-bearing age as more than two-thirds are currently overweight or obese.

“Findings such as these help to point out that eating a healthy diet every day as well as during pregnancy is one of the best things women can do for themselves and their baby,” says Dr. Lela Emad of Women’s OB/GYN Medical Group in Santa Rosa, California.

When Eating for Two is Too Much

The amount of weight a woman should gain during pregnancy depends on what her body mass index (BMI) was before becoming pregnant. As a general rule, pregnant women need to consume more protein and calcium, take appropriate vitamins and mineral supplements (folic acid and iron in particular), and consume more calories.

But eating better doesn’t necessarily mean over-eating. Women who start off at a healthy weight need to consume only about 340 extra calories a day during the second trimester and about 450 extra calories per day during the third trimester. Women who are underweight or overweight at the beginning of pregnancy require some adjustment to the average, depending on individual weight gain goals. Consulting with an OB/GYN healthcare provider is the best way to determine projections for healthy weight gain during pregnancy.

“Obviously, the food a mother consumes while pregnant is the baby’s main source of nutrition. And by making healthy lifelong food choices combined with an eye toward eating nutritiously during pregnancy a woman can have a positive impact on her baby’s health as well as potentially; her grandchildren’s children,” points out Dr. Emad.

Women who are overweight or obese before pregnancy are also expected to gain a certain amount of weight during pregnancy, but according to recent studies – women who are obese can safely gain less weight than the guidelines recommend. A healthcare provider will determine what’s best for each case and will also help manage weight throughout pregnancy.

Overweight Mothers Are at Risk

In addition to affecting the health of a baby, women who are overweight before pregnancy are also at an increased risk of developing various pregnancy complications, including gestational diabetes and high blood pressure.  According to the Centers for Disease Control and Prevention pregnant women who are obese are more susceptible to complications including preeclampsia, GDM, stillbirth and cesarean delivery. CDC research shows that obesity during pregnancy is associated with an increase in the need for healthcare services, and can result in longer hospital stays for delivery. But the good news is; overweight women who lose weight before pregnancy are much more likely to have healthier pregnancies.

According to Dr. Emad, when women are thinking about having a baby it is best to begin making healthy lifestyle changes at least one full year prior to trying to get pregnant. This process improves the chances of becoming pregnant sooner and prepares a woman’s body to provide the best environment for her infant – nutrition, exercise and a healthy weight are all key factors in planning ahead. “Eating nutritiously is a good choice for any woman to make, but particularly important for a woman who is considering having a baby – one that can potentially impact the health of her family for generations to come,” says Dr. Emad.

About Women’s OBGYN Medical Group

The 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, call (707) 579-1102 or visit our website.

Learn more about our providers – Susan Logan M.D.

Susan Logan, MD

Dr. Susan C. Logan is a respected, caring OB/GYN certified by the American Board of Obstetricians and Gynecologists. Dr. Logan attended University of California, Berkeley for her undergraduate degree in Biochemistry, graduating in 1985. Dr. Logan went on to medical school the same year at University of Southern California, School of Medicine, obtaining her Medical Doctorate in 1989. She then completed her internship and residency at the Obstetrics and Gynecology Women’s Hospital in Los Angeles through the University of Southern California. In the final year of her residency, Dr. Logan was honored with the USC Best Resident Teacher Award in OB/GYN.

Dr. Logan has been a part of Women’s OB/GYN Medical Group since 1993, and has played an integral role in building the practice with Dr. Emad. At Santa Rosa Memorial Hospital, a close affiliate of Women’s OB/GYN, Dr. Logan serves as the OB/GYN Department Chair, the Antepartum Testing Medical Director, as well as the Medical Director of the Sweet Success Program. Dr. Logan’s deeply involved professional activity in the community demonstrates her resolute commitment to improving the overall healthcare available for Sonoma County women.

When Dr. Logan gets a break from all of her hard work, she enjoys spending her time traveling, kayaking, hiking, and taking photos. To schedule an appointment with Dr. Logan, please call our office: (707)-579-1102.

Women with demanding jobs at high risk for major health issues

Work weeks that averaged 60 hours or more over three decades appear to triple the risk of diabetes, cancer, heart trouble and arthritis for women, according to new research from The Ohio State University.
Credit: © shefkate / Fotolia

New research from The Ohio State University indicates that women whose work weeks averaged 60 hours or more over three decades appear to triple the risk of diabetes, cancer, heart trouble and arthritis for women.

The risk begins to climb when women put in more than 40 hours and takes a decidedly bad turn above 50 hours, researchers found.

“Women — especially women who have to juggle multiple roles — feel the effects of intensive work experiences and that can set the table for a variety of illnesses and disability,” said Allard Dembe, professor of health services management and policy and lead author of the study, published online this week in the Journal of Occupational and Environmental Medicine.

Read the full story here …

Health Conditions Can Lead to Low Libido in Women

sleeping-woman-1432242A woman’s sex drive can often wax and wane over the years due to many complex components. Sexual satisfaction is an important part of a woman’s overall health and well-being.

When problems arise, it is vital to discover what is causing her to have her libido bottom out. There are four areas that play a role in affecting a woman’s desire for sex — physical, hormonal, psychological and relationship issues.

Physical reasons

• Medications such as antidepressants and anti-seizure meds can squelch sex drive.

• Being fatigued or exhausted due to caring for children or aging parents will make her less likely to look forward to sex.

• Surgery or a prolonged illness can affect how she feels about her body and sexual functioning.

• Medical conditions such as arthritis, diabetes, high blood pressure, heart disease or neurological diseases can all put a damper on desire for sex.

• Any type of sexual problems such as pain during intercourse or not being able to achieve an orgasm can drive sex drive into the ground.

Hormonal changes

• Pregnancy and breastfeeding have huge hormonal changes associated with them which can affect sex drive. Add to that, the fatigue, body changes, and becoming a new mom with tremendous responsibility can often put sex at the bottom of her to-do list.

If any of these areas is a source of the problem, a woman should seek out professional help by making an appointment with her primary care doctor or gynecologist. Either one are trained to discuss these issues of intimacy allowing a woman to candidly talk about her sexual concerns. It is better to approach this topic sooner than later before it begins negatively affecting your relationship with your partner.

Read the full story here …

Migraines may increase risk of stroke, heart disease

Women who suffer from migraine headaches may have a slightly increased risk of heart disease or stroke, a new study suggests.

“Migraine should be considered a marker for increased risk of cardiovascular disease, at least in women,” said lead researcher Dr. Tobias Kurth, director of the Institute of Public Health at Charite-Universitatsmedizin in Berlin, Germany.

But, Kurth cautioned that this study can’t prove that migraines cause heart attack or stroke, only that they may make these events more likely. Read the full story here …