 There has been a lot of media coverage and panic over the Zika virus. Kaiser Permanente even called their pregnant mamas in California and played a prerecorded message about the Zika virus, A lot of the information was from the media and not really helpful. Where do you turn when there is so much panic about this seemingly new virus? Are you parents, friends, or family calling you and freaking out? Have you cancelled any and all trips?
I have some good news. The Zika virus has been around for 70 years and has never thought to be a public health risk. Most people who contract the Zika virus have no symptoms, or think they have a mild case of the flu. Over the decades it has infected tens of thousands of people without any cases of microcephaly (babies born with abnormally small heads and corresponding learning and developmental problems) being reported. Rebekah Wheeler, RN, CNM, MPH puts together a great article on the Zika Virus combining all the science and facts that we know this far. In it, she explains why there is a sudden link between Zika and microcephaly. "There was a Zika outbreak in Brazil in 2015, with between 500,000 and 1,500,000 Brazilians getting the virus (FRAMEWORK, S. R. 2016). At the same time, local health officials in northern Brazil noticed that there was a sharp increase in rates of microcephaly. Brazil usually sees about 150 cases of microcephaly each year, but in 2015 that number was above 3,000, a massive increase (FRAMEWORK, S. R. 2016). Researchers began to suspect, due to the fact that the Zika outbreak happened at the same time as the increase in microcephaly cases, that perhaps contracting Zika during pregnancy might be the cause of microcephaly in the fetus. What they don’t know, and may never know, is how many of the babies with microcephaly were exposed to Zika in utero. This may never be possible to measure, as Zika does not stay in the bloodstream for more than about 12 weeks (FRAMEWORK, S. R. 2016). Regarding the suspected link between Zika infection and microcephaly, it is very important to know that this is a suspected link, not a proven one. In fact, experts from the World Health Organization are being very careful to say that the link between Zika virus and microcephaly is a suspected one, but has not been confirmed in any scientific study. Microcephaly has historically been known to have multiple non-Zika causes, including Down Syndrome and other genetic disorders, exposure to toxic chemicals, smoking in pregnancy, maternal malnutrition and some severe maternal infections. Further cause for caution in assuming a causative link comes from Colombia, where they have had more than 3,000 cases of Zika but no increase in microcephaly rates." We do not know that Zika causes microcephaly. There have not been conclusive studies or evidence found that actually prove that Zika causes microcephaly. Studies are being done by the CDC. Scientists are working to discover the link, if any, between the two. As of right now, pregnant women and women trying to get pregnant should be careful, but there is no need to stay inside and cancel all travel plans. Reasonable Steps to Avoid Zika (from Rebekah Wheeler, RN, CNM, MPH)
Rebecca Wheeler goes on to say in Part 2 that she does not think it likely that the Zika Virus and microcephaly will be found to be linked. She says "there are factors about Zika that make it unlikely to be a frequent risk, and that also point to a very small likelihood of it causing microcephaly in most cases:
I hope this has helped to put your mind at ease. While pregnant women have to be careful about and avoid so many things, I do not think the Zika Virus should not be at the top of the list, especially for women in the US. To read the full articles by Rebekah Wheeler, RN, CNM, MPH, visit Science & Sensibility - Part 1 and Part 2.
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A great article by Cristen Pascucci: “If you’re reading this, it’s because I care about you, and I want you to rock your birth. I believe you deserve the best. If “rocking your birth” sounds like something other people do, and you just want to “get through it” with a healthy baby--girl, raise your expectations…” -Read the rest of the article here! A very encouraging article by Ashlee Gad: “You just had a baby. I know your jeans don’t fit. It sucks. I know you tried on 17 pairs at Nordstrom Rack last week and almost cried in the dressing room. I know you went to Gap after that and tried on 14 other pairs and almost cried in thatdressing room. I know the only thing you bought that day was a pair of sweatpants and a loose white T-shirt. It’s OK.You just had a baby…” –Read the rest of the article here! A tear-jerker article by Jessica Dimas: “You won’t remember the way I stood in the bathroom late that night in labor with you, fearfully and excitedly gazing up at the moon, knowing I was going to bring you into the world soon and whispering to you, “We can do this.” You won’t remember the way you looked at me right after you were born, or the way I pulled you up next to my heart and marveled “Hi, baby” in your ear…” -Read the rest of the article here! A honest and touching look at being needed by Megan Morton: “I have to stop dreaming of “one day” when things will be easier. Because the truth is, it may get easier, but it will never be better than today. Today, when I am covered in toddler snot and spit-up. Today, when I savor those chubby little arms around my neck. Today is perfect. “One day” I will get pedicures and showers alone. “One day” I will get myself back. But, today I give myself away, and I am tired and dirty and loved SO much, and I gotta go. Somebody needs me…” -Read the rest of the article here! An article on the “warnings” of pregnancy and having a child by Jenny Studenroth Gerson: “They should’ve warned me that becoming a mommy would absolutely change every single thing, but that I would never want to go back and visit the “old” me, not even for a second. They should’ve warned me that my life was about to become so rich and beautiful and fulfilling, that I’d look back on what it was before and think, “Poor me. I didn’t know her yet…” -Read the rest of the article here!  “To understand the vagina properly is to realize that it is not only coextensive with the female brain, but is also, essentially, part of the female soul.” This is a powerful read. I see the complete truth in this article during labor and births, and even during pregnancy. I think one of the most powerful quotes of the whole article is by Wolf – “The way in which any given culture treats the vagina — whether with respect or disrespect, caringly or disparagingly — is a metaphor for how women in general in that place and time are treated.” I think everyone should read this article and really think and ponder what she is saying. Women are complex creatures, and so are our bodies, When you negatively affect one area – you negatively impact others. There is a lot more cause and effect than we think, or admit. Click to read the article –> The Science of Stress, Orgasm and Creativity: How the Brain and the Vagina Conspire in Consciousness So, how do you treat the vagina? How do you see it? Do you have slang-terms you use when you refer to the vagina? How are you respecting women? How will this impact your labor and birth?  The American Congress of Obstetrics and Gynecologists recently released a committee opinion on the safety of water births. (Read it here) This opinion was met with some concern from the American Association of Birth Centers (AABC) who say “the document has the potential to introduce inappropriate fear about the safety of water birth for families, providers, facility administrators, insurers, and others who want to make informed decisions regarding immersion in water for labor and birth.” The AABC have collected and analyzed 3998 water births and the outcomes over the period of January 1, 2007 through December 31, 2010 and have found the following:
As with all aspects of pregnancy, labor and birth, make sure you:
 Cesarean delivery is over-used. The lowest cesarean rate in the United States is 23%, the highest is 40%! In Oregon the cesarean rate is 29.4% (from ACOG article). The new statement by ACOG and SMFM will hopefully change those numbers. The American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine issued a joint Obstetrics Care Consensus statement: Safe Prevention of the Primary Cesarean Delivery. This is a big game changer for the medical field of labor and delivery. It discusses the rate of cesarean in the United States, the causes and the outcomes of the over use of cesarean and suggests steps to take to change the cesarean environment. The study states “the alarming and sustained increase in the cesarean rate in the United States has not improved either maternal or neonatal outcomes. In fact, data suggest that there is increased maternal mortality and morbidity associated with cesarean delivery.” The authors provide a new set of guidelines that offer ways to lower the cesarean rate and make labor and birth more safe for the mother and baby. The guidelines also offer a more hands off approach to the management of labor which would allow moms to labor longer, doctors would be forced to be more patient towards the natural (and sometimes slow) progression of normal labor. They suggest a respect for and understanding of women’s ability to give birth. This impacts hospitals as well, as they will have to plan for longer stays for women in labor and delivery. A safe and healthy mother and child are the end result; cesareans are not the only (and shouldn’t be the first choice) for that result. The hope and the goal is for women to have confidence in their ability to give birth and for all those involved (doctors, nurses, staff, friends, family, etc) to also respect a women’s body and ability to progress through labor on her own, in her own time and through her own means. Some of the new guidelines are:
The American Academy of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine are to be applauded for their careful research and willingness to make recommendations for labor management based on best evidence. They have provide direction for health care providers and women. This is a most welcome change. Read the full ACOG article here Read the full overview of the ACOG article from Science & Sensibility here Preeclampsia is pregnancy syndrome that is diagnosed when both hypertension and proteinuria (protein in the urine) are apparent It can happen in any pregnancy, though it is more common in women pregnant with their first child. There are risk factors that increase a woman’s chance of getting preeclampsia, but it can happen to anyone.
Preeclampsia can come about suddenly or remain mild for weeks at a time before accumulating into something more intense. It mainly affects the placenta, although other organs like the liver, brain and platelets can be impacted by the syndrome. Preeclampsia causes a placenta to weaken and causes the delivery of vital blood and nutrients to the placenta and baby to decrease or weaken. The signs of preeclampsia include:
To learn more, please visit Science & Sensibility: Preeclampsia: Research Roundup and Information for Professionals and Consumers*. Resources:
 1 in every 9 children born in the US is born premature.
As you sing live music or play live music to babies, especially premature babies their heart rates slow down, their breathing becomes steady and their oxygen saturation increases. It also helps improve suckling, it aids in sleeping and promotes quiet alertness. By relieving stress the babies and their bodies have more time to focus on development. Singing and playing music helps lower the stress levels of the parents too. Music therapy is something everyone can do! (or ask a friend to share their musical gifts :)) To read the full article from LA Times, click here. Written by Pam Belluck on April 15, 2013. To read the background research, click here. Done by the Louis Armstrong Center for Music & Medicine; NICU; Department of Biostatistics, Beth Israel Medical Center, New York. Of course, the idea is not to reject all interventions. The course of childbirth is not something that anyone can completely control. In some situations, inducing labor or doing a C-section is the safest option. And complications are the exception, not the norm. But when they’re not medically necessary, the interventions listed below are associated with poorer outcomes for moms, babies, or both. 1. An elective early deliveryBecause nearly all babies born a few weeks early survive and eventually thrive, many doctors have traditionally not seen the harm in moving up a delivery date to fit a schedule. “Although we knew 39 weeks or later was the optimal time for delivery, until recently there wasn’t good evidence showing that a lot of maturation took place after 37 weeks,” says Ashton of the March of Dimes, who terms research from the last five years “eye opening.” Late preterm babies “may look like full-term babies,” she says, “but they are different in important ways.” It turns out that carrying an infant to term has health benefits for both moms and babies. Research shows that babies born at 39 weeks or later have lower rates of breathing problems and are less likely to need neonatal intensive care. Full-term babies may also be less likely to be affected by cerebral palsy or jaundice, have fewer feeding problems, and have a higher rate of survival in their first year. Some research even suggests that full-term infants benefit from cognitive and learning advantages that continue through adolescence. Perhaps because late preterm infants have more problems, mothers are more likely to suffer from postpartum depression. In addition, the procedures required to intentionally deliver a baby early—either an induced labor or a C-section—also carry a higher risk of complications than a full-term vaginal delivery. “There is just much more chance of things going wrong if you interrupt the normal course of pregnancy,” says Catherine Spong, M.D., chief of the pregnancy and perinatology branch at the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Despite all that evidence, the latest statistics from the March of Dimes reveal only modest declines in the number of planned early deliveries in the last few years, suggesting that many doctors and families are still choosing to schedule an early delivery. For all those reasons, several professional medical organizations are now urging physicians and women to avoid planned early deliveries when possible. For example, when panels of experts at ACOG and AAFP were asked to identify five tests or procedures that they think are overdone, number one on the list was an elective early delivery. Of course, some babies arrive sooner than expected and complications during pregnancy, such as skyrocketing blood pressure in the mother, can make early delivery the safest option. But hastening the conclusion of an otherwise healthy pregnancy—even by a couple of days—is never a good idea. The rate of early deliveries varies widely among hospitals, as demonstrated in the table below of all six hospitals in Utah that report that data to the Leapfrog Group. It shows the percentage of early deliveries in each hospital that were done without medical reason. See the rates of planned early deliveries for the hospitals in your state on the Leapfrog website.  The rate of scheduled early deliveries varies widely in six Utah hospitals. 2. Inducing labor without a medical reason The second procedure to question according to ACOG’s and AAFP’s Choosing Wisely lists is inducing labor without a strong medical reason, even if a woman has reached the 39-week point in her pregnancy that is considered full term. The percentage of births resulting from artificially induced labor more than doubled from 1990 to 2008. “In many ways the system has become centered on convenience rather than evidence-based care,” says Carol Sakala, Ph.D., director of programs at Childbirth Connection. She points out that it’s no coincidence that more babies are born on Tuesdays than any other day of the week. “The births are scheduled so that parents and providers can all be home by the weekend.” But whether artificially induced or spontaneous, labor is labor, right? “Absolutely not,” says Debra Bingham Dr.PH., R.N., vice president of the Association of Women’s Health, Obstetric and Neonatal Nurses. She points out that women who go into labor naturally can usually spend the early portion at home, moving around as they feel most comfortable. An induced labor takes place in a hospital, where a woman will be hooked up to at least one intravenous line and an electronic fetal monitor. In addition, most hospitals don’t allow eating or drinking once induction begins. It’s no coincidence that more babies are born on Tuesdays. The births are scheduled so the parents and providers can all be home by the weekend.“An induced labor may also occur prior to a woman’s body or baby being ready,” Bingham says. “This means labor may take longer and that the woman is two to three times more likely to give birth surgically.” Induced labor frequently leads to further interventions—including epidurals for pain relief, deliveries with the use of forceps or vacuums, and C-sections— that carry risks of their own. For example, a 2011 study found that women who had labor induced without a recognized indication were 67 percent more likely to have a C-section, and their babies were 64 percent more likely to wind up in a neonatal intensive care unit, compared with women allowed to go into labor on their own. Induction is justified when there’s a medical reason, such as when a woman’s membranes rupture, or her “water breaks,” and labor doesn’t start, or when she’s a week or more past her due date. 3. A C-section with a low-risk first birthNearly one out of every three American babies now enters the world through a surgical birth. And while C-sections are generally quite safe, “the safest method for both mom and baby is an uncomplicated vaginal birth,” Spong says. The best way to reduce the number of Csections overall is to decrease the number of them among low-risk women who are delivering their first child. That’s because having an initial C-section “sets the stage for a woman’s entire reproductive life,” says Main. “In this country, if your first birth is a C-section, there’s a 95 percent chance all subsequent births will be as well,” he says. A C-section is major surgery. So it’s no surprise that as rates for the procedure go down, so do the numbers for several complications, especially infection or pain at the site of the incision. Rare but potentially life-threatening complications include severe bleeding, blood clots, and bowel obstruction. A C-section can also complicate future pregnancies, increasing the risk of problems with the placenta, ectopic pregnancies (those that occur outside the uterus), or a rupture of the uterine scar. And the risks increase with each additional cesarean birth. Babies born by C-section can be accidentally injured or cut during the procedure and are more likely to have breathing problems. They are also less likely to breastfeed, perhaps because of the challenges of starting in a post-surgical setting. In some situations, such as when the mother is bleeding heavily or the baby’s oxygen supply is compromised, surgical delivery is absolutely necessary. But women can maximize their chances of avoiding an unnecessary cesarean by finding a caregiver and birthing environment that supports vaginal birth. When choosing a practitioner and hospital or birthing center, ask about C-section rates, particularly rates for low-risk women having their first child. The target rate for that population should be around 15 percent, according to ACOG. Although it can be difficult to find a hospital with a C-section rate that low, you might be able find one that meets the more modest goal of about 24 percent, which was set by the government’s Healthy People 2020 initiative.  About a third of the babies born in the U.S. are now delivered by C-section. 4. An automatic second C-sectionJust because your first baby was delivered by C-section doesn’t mean your second has to be, too. In fact, most women who have had a C-section with a “low-transverse incision” on the uterus are good candidates for a vaginal birth after cesarean (VBAC), according to ACOG. (Note that a “bikini scar” on the skin does not indicate the type of uterine scar.) About three quarters of such women who attempt a VBAC are able to deliver vaginally. Yet the percentage of VBACs has declined sharply since the mid-1990s, particularly after ACOG said in 1999 that they should be considered only if hospitals had staff “immediately available” to do emergency C-sections if necessary. And some obstetricians don’t do VBACs because they lack hospital support or training, or because their malpractice insurance won’t provide coverage. So women seeking a VBAC delivery might have trouble finding a supportive practitioner and hospital. “It’s tragic, really,” Main says. “In many parts of the country, the option has all but disappeared.” In response, ACOG recently relaxed its guidelines. For example, it makes clear that while it’s preferable for staff to be at the ready, hospitals can make do with a clear plan for dealing with uterine ruptures and assembling an emergency team quickly. Experts we spoke with say it’s too early to tell if the move will lead to a change in clinical practice. Although some women turn to home births as an alternative, our experts say that isn’t a good idea in this situation. “The risk of uterine rupture is low,” Main says, “but if it happens, it can be catastrophic.” Instead, if you had a C-section, find out whether your obstetrician and hospital are willing to try a VBAC. Let them know that you understand that your baby will be monitored continuously during labor, and ask what the hospital would do if an emergency C-section became necessary. Vaginal births after a C-section have declined sharply since the late 1990s.  5. Ultrasounds after 24 weeksUnless there is a specific condition your provider is tracking, you don’t need an ultrasound after 24 weeks. Although some practitioners use ultrasounds after this point to estimate fetal size or due date, it’s not a good idea because the margin of error increases significantly as the pregnancy progresses. And the procedure doesn’t provide any additional information leading to better outcomes for either mother or baby, according to a 2009 review of eight trials involving 27,024 women. In fact, the practice was linked to a slightly higher C-section rate.  6. Continuous electronic fetal monitoringContinuous monitoring, during which you’re hooked up to monitor to record your baby’s heartbeat throughout labor, restricts your movement and increases the chance of a cesarean and delivery with forceps. In addition, it doesn’t reduce the risk of cerebral palsy or death for the baby, research suggests. The alternative is to monitor the baby at regular intervals using an electronic fetal monitor, a handheld ultrasound device, or a special stethoscope. Continuous electronic monitoring is recommended if you’re given oxytocin to strengthen labor, you’ve had an epidural, or you’re attempting a VBAC.
7. Early epiduralsAn epidural places anesthesia directly into the spinal canal, so that you remain awake but don’t feel pain below the administration point. But the longer an epidural is in place, the more medication accumulates and the less likely you will be able to feel to push. Epidurals can also slow labor. By delaying administration and using effective labor support strategies, you might be able to get past a tough spot and progress to the point you no longer feel it’s needed. If you do have an epidural, ask the anesthesiologist about a lighter block. “Ideally, a woman should still be able to move her legs and lift her buttocks,” Main says. 8. Routinely rupturing the amniotic membranesDoctors sometimes rupture the amniotic membranes or “break the waters,” supposedly to strengthen contractions and shorten labor. But the practice doesn’t have that affect and may increase the risk of C-sections, according to a 2009 review of 15 trials involving 5,583 women. In addition, artificially rupturing amniotic membranes can cause rare but serious complications, including problems with the umbilical cord or the baby’s heart rate. 9. Routine episiotomiesPractitioners sometimes make a surgical cut just before delivery to enlarge the opening of the vagina. That can be necessary in the case of a delivery that requires help from forceps or a vacuum, or if the baby is descending too quickly for the tissues to stretch. But in other cases, routine episiotomies don’t help and are associated with several significant problems, including more damage to the perineal area and a longer healing period, according to a 2009 review involving more than 5,000 women. Allowing healthy infants and moms to stay together right after delivery promotes bonding and breast-feeding. 10. Sending your newborn to the nurseryIf your baby has a problem that needs special monitoring, then sending him or her to a nursery or even an intensive care unit is essential. But in other cases, allowing healthy infants and mothers to stay together promotes bonding and breast-feeding. Moms get just as much sleep, research shows, and they learn to respond to the feeding cues of their babies. Allowing mothers and babies to stay together is one of the criteria hospitals must meet to be certified as “baby friendly” by the Baby-Friendly Hospital Initiative, a program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF). From Consumer Reports, read entire article here Other Resources: For information on CA delivery statistics, visit The Leapfrog Group here Article by March of Dimes and Other Organizations: Elimination of Non-medically Indicated (Elective) Deliveries Before 39 Weeks Gestational Age - A California Toolkit to Transform Maternity Care Article on Sutter Hospitals who implemented the CA Toolkit to Transform Maternity Care –“More Babies Born Full-Term” VBAC information for hospitals all over US from ICAN website - What hospitals allow and what hospitals don’t allow VBAC clients The Birth Survey – lists resources by State |