Strollerderby : preterm birth

They [Didn't] Say: Not Even a Drop of Alcohol

Miriam Axel-Lute — Mon, 16 Mar 2009 14:30:00 GMT

Oh the pull of the easy, dramatic headline.

Lauredhel, over at Hoyden About Town, has two interesting, detailed posts up recently about the, shall we say, divergance between what a scientific study and a set set of agency guidelines, respectively, actually say, and what's been been reported about them. It's all Aussie, but I know the same things happen here (and presumably booze and pregnancy aren't that different down under, physically).

In the first, she takes apart a study that finds an increased risk of pre-term birth for binge drinkers (shocking, I know) and, with very slim margins of confidence, women who drink heavily in the first trimester and then stop (but not, interesting, those who keep going. It would be interesting to come up with a mechanism for why that would be). It does not find an increased risk for light drinking. Also, much of its data appears to be pretty tentative.

But the coverage of it says the report states that "abstinence is still the safest option" (It might be. I did. But the report says no such thing) and also gets the data about the trimesters wrong. Laurdehel takes both the original study and the coverage apart in minute detail.

In the second, quite similarly, she notes some health guidelines that, based on no new evidence, reverse their previous stance that a light amount of drinking is OK while breastfeeding and start suggesting abstinence, though retaining a level-headed description of what would constitute a cautious approach to alcohol and lactation. The coverage (1) implied that there was some new evidence that it's more dangerous than previously believed and (2) never even mentioned the existence of the more nuanced guidelines.

It's easy to pick on journalists, sometimes too easy, but it's also necessary sometimes, because they have all the same cultural biases and habits (like infantilizing women and being alarmist about pregnancy) as everyone else.

Photo by timomcd.

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New Risks Associated With Elective Deliveries

Hannah Tennant-Moore — Fri, 26 Dec 2008 16:00:00 GMT

With induced labors up a whopping 125 percent since 1989, it’s clear that many preterm labors are not medically necessary. And this is particularly true around the holidays, when many parents schedule deliveries in time for a tax deduction or to fit in with a crazy travel schedule.

It’s understandable why parents have traditionally believed it safe to schedule a delivery anytime after the 34th week, since until recently obstetricians believed that everything except for the baby’s size was fully developed by then. But new research shows that those last weeks are more important than previously believed.

According to the Wall Street Journal, a study in the American Journal of Obstetrics and Gynecology found that “for each week a baby stayed in the womb between 32 and 39 weeks, there is a 23% decrease in problems such as respiratory distress, jaundice, seizures, temperature instability and brain hemorrhages.” Furthermore, it’s now clear that pinpointing the exact age of a fetus is very difficult; a fetus believed to be in the 34th week may only be in the 32nd.

Doctors must do their part to make sure parents know of the risks of an unnecessary preterm birth. The medical director of labor and delivery at Massachusetts General Hospital admits that it’s simply easier and less time-consuming to “cave” to parents’ request for an elective delivery than to inform them of the benefits of waiting for a full term birth. And according to the March for Dimes, some obstetricians fudge the requirements to qualify parents for a "medically necessary" preterm birth.

But with increasing research like the above study, some hospitals are now wisely requiring parents to sign a consent form before scheduling a delivery before the 39th week. F. Sessions Cole, the director of newborn medicine at St. Louis Children's Hospital, urges parents to trust their babies. "The idea is that somehow, if you're in complete control of the delivery, then only good things will happen," Cole said. "But that's categorically wrong. The baby and the uterus know best."

Photo: mothering.com

Why Insure Pre-Term Elective C-Sections?

Pre-Term Elective C-Sections Are Dangerous: So Why Insure Them?

Miriam Axel-Lute — Fri, 19 Dec 2008 15:00:00 GMT

Michael McGuire is CEO of UnitedHealth, a health-insurance provider in New Jersey. In an op-ed in the Trenton Times recently he talked intelligently about the health dangers of elective pre-term c-sections.

The evidence keeps mounting—prematurity, even by a few weeks, means higher rates of breathing problems, cerebral palsy, NICU stays, etc. When the baby's not ready to come out, it's not ready, folks.

McGuire makes the impressive assertion that when he explained this carefully to a "pilot group" of physicians and hospitals and they stopped scheduling c-sections before 39 weeks, there was a 46 percent drop in NICU stays. Those are results to write home about. As he writes, "That's almost half the number of newborns with potential health problems, almost half the number of distraught parents, al most half the number of potential tragedies. The cost savings to these hospitals, the parents and the health-care system is enormous."

He notes carefully, as do I, that sometimes a pre-term c-section is medically necessary for health of mother and/or baby. Obviously, that is not what I'm talking about. But I would include c-sections that are planned for medical reasons,* but where there is no medical reason not to carry the baby to term. I think those are far, far more common than the over-hyped "too posh to push" phenomenon.

So here's what I want to know: If it's documented to be such a health risk, why don't McGuire and his colleagues just stop paying for c-sections that are unnecessarily scheduled at an unsafe time?

Insurers already go out of their way to not cover things they claim are optional (including some that are emphatically not), not to mention dangerous. Usually I question their judgment, but the evidence is pretty compelling on this one.

I'm all for educating docs, but it seems to me the insurers could stop this practice cold with their purse strings.

Photo by César Rincón.

*(Of course, many of those "medical reasons," like a previous c-sections or breech presentations, don't actually require a c-section, but that's a separate post.)

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They Say: Even Late Preemies at Higher Risk

Kate Tuttle — Mon, 15 Dec 2008 18:02:00 GMT

While it's long been known that premature babies face a much higher incidence of cerebral palsy and other medical problems, most of the infants thought to be at risk were those born before 34 weeks -- the tiny babies, notably premature, whose entire bodies can fit into the palm of their father's hands. But new research suggests that even bigger, healthier-seeming babies, when born before term, are much more likely to fall victim to the health problems of prematurity. And at a time when more and more women are giving birth early due to inductions or scheduled C-sections, that risk needs to be better communicated, according to the doctors who authored the study.

The study, which examined the circumstances of more than 140,000 babies born at 30 weeks or later, concluded that babies born from 34 to 36 weeks' gestation, although often appearing as big and healthy as full-term newborns, were three times more likely to have cerebral palsy than babies born at 37 weeks, and up to 25% more likely to face mental retardation and other developmental delays. Because the babies in the study have not yet entered elementary school, the authors point out, it's too early to know whether other learning-based problems will be detected.

While overall rates of prematurity are fairly steady, the number of babies born from 34-36 weeks is growing, and currently represents one in 11 births in the US. The study did not look into the reasons for the late preterm births, and some surely were medically indicated (pre-eclampsia, for instance, pretty much demands that a baby be born early, to save both lives).According to the study's authors, however, some of those "late preterm" births were due to early inductions or C-sections that were not medically necessary (remember that the next time a Hollywood starlet says she's due "sometime in the fall" and has a six-pounder).

Pre-term Elective C-Sections Are Dangerous: So Why Insure Them?

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Baby Nearly Starves to Death, Diluted Formula to Blame
Grandmother’s Right? Or Totally Obnoxious?
Health Scam: Crisis Pregnancy Centers
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Pre-eclampsia Linked With Herpes

Madeline Holler — Sun, 24 Feb 2008 21:09:00 GMT

In today's continuing coverage of STDs, this next report should raise plenty of eyebrows from now on whenever a new mom discusses preterm birth or high blood pressure during her pregnancy.

Researchers in Australia have linked exposure to viral infection -- especially the herpes type -- to both.

From Science Daily:

The research discovered the presence of viral nucleic acid in heel-prick blood samples from 1326 newborn babies, taken over a 10-year period. More than 400 of these babies were diagnosed with cerebral palsy.

High-blood pressure during pregnancy has been an enduring mystery for medical researchers, so these findings are exciting.

Now, of course all herpes viruses aren't of the STD variety. Chicken pox and shingles are also brought on by herpes. Which brings up plenty of questions besides, like the chicken pox vaccine or women who had chicken pox.

But finding a connection is good news in any case. Pre-eclampsia is a difficult and serious condition. Again, Science Daily:

Pregnancy hypertension (high blood pressure) occurs in up to 10% of first pregnancies throughout the developed world, such as in the UK, the United States and Australia. When untreated, it can lead to uncontrolled epileptic fits of eclampsia with loss of baby and mother. It is a common cause of maternal death in Third World countries.