Friday, January 16, 2009
Wednesday, December 24, 2008
Friday, December 19, 2008
Is internal podalic version a lost art?
Is internal podalic version a lost art? Optimum mode of delivery in transverse lie. Chauhan AR, Singhal TT, Raut VS - J Postgrad Med
Internal Podalic Version (IPV) is an ancient procedure and was extensively practised by Hippocrates, who recommended cephalic version for all presentations other than the head.[1] Aetius, Celsus and others at different times pointed out the fallacies of the Hippocratic teaching and the advantages of podalic version. Supported by Galen, IPV continued to be in favour till the sixteenth century. IPV had a revival that was initiated by Ambroise Pare (1510-90).[2] Pare was the first to describe clearly and to point out the possibilities and the advantages of podalic version. About a hundred years later, an alteration in the technique of the operation was suggested by Portal – the bringing down of one leg instead of both, as was the custom up till then.[2]
In modern obstetrics, caesarean section is the method of choice for the delivery of babies in transverse lie, and IPV is performed less frequently. While this is true in most cases, does IPV still have a role to play in modern obstetrics, or is it indeed a lost art?
There has been a drastic decrease in the number of IPVs performed on babies with transverse lie in the past decade. Hence, this study was carried to evaluate the changing trend in the mode of delivery of transverse lie, maternal and neonatal outcomes with respect to the mode of delivery and whether IPV has a role to play in the management of second twin.
Internal Podalic Version (IPV) is an ancient procedure and was extensively practised by Hippocrates, who recommended cephalic version for all presentations other than the head.[1] Aetius, Celsus and others at different times pointed out the fallacies of the Hippocratic teaching and the advantages of podalic version. Supported by Galen, IPV continued to be in favour till the sixteenth century. IPV had a revival that was initiated by Ambroise Pare (1510-90).[2] Pare was the first to describe clearly and to point out the possibilities and the advantages of podalic version. About a hundred years later, an alteration in the technique of the operation was suggested by Portal – the bringing down of one leg instead of both, as was the custom up till then.[2]
In modern obstetrics, caesarean section is the method of choice for the delivery of babies in transverse lie, and IPV is performed less frequently. While this is true in most cases, does IPV still have a role to play in modern obstetrics, or is it indeed a lost art?
There has been a drastic decrease in the number of IPVs performed on babies with transverse lie in the past decade. Hence, this study was carried to evaluate the changing trend in the mode of delivery of transverse lie, maternal and neonatal outcomes with respect to the mode of delivery and whether IPV has a role to play in the management of second twin.
Hand Presentation / Prolapsed Hand: UK Midwifery Archives
Hand Presentation / Prolapsed Hand: UK Midwifery Archives
A rare and potentially disastrous complication, managed successfully at a home birth.
"The waters broke and the arm dangled out. I didn't pull on the arm but tried to locate a cephalic pp (presenting part) without success. What to do? I went through the options and and decided to treat as a cord prolapse and got the woman to turn on all fours. This wasn't straightforward as she has a disability. Yet she did get there and then it flashed into my mind after a short prayer to locate the lower limb if possible and do an internal podalic version. This was done between contractions and then with legs and body dangling with the next push a gentle breech extraction was performed of a 2.3kgs baby boy."
A rare and potentially disastrous complication, managed successfully at a home birth.
"The waters broke and the arm dangled out. I didn't pull on the arm but tried to locate a cephalic pp (presenting part) without success. What to do? I went through the options and and decided to treat as a cord prolapse and got the woman to turn on all fours. This wasn't straightforward as she has a disability. Yet she did get there and then it flashed into my mind after a short prayer to locate the lower limb if possible and do an internal podalic version. This was done between contractions and then with legs and body dangling with the next push a gentle breech extraction was performed of a 2.3kgs baby boy."
Wednesday, December 10, 2008
Laboring to save home births | csmonitor.com
Laboring to save home births | csmonitor.com: "Midwife Diane Goslin’s farmhouse office bustles with activity this summer morning. Horse drawn buggies line the driveway, while pregnant women line the waiting room inside – their hair tucked into bonnets, their dark dresses covered by black aprons.
A mother expecting her 11th child arrives with her daughter, who is expecting her first. Women do mending as toddlers scoot around their ankles. Childhood friends reunite, chattering in Pennsylvania Dutch. Sisters shriek with laughter at the unexpected sight of their expectant aunt."...
The world of medicine, for Goslin, is no enemy. Raised in an extended family of doctors, and the mother of a physician as well, she became interested in home birth, she explains, when a hospital-acquired infection she sustained at the birth of her oldest child left her infertile.
In the Amish farmhouses of this rolling hill country, Goslin is considered family. For some women, she’s delivered a dozen babies. And, in Goslin’s own time of need, this community rallied to help – a departure for the reticent Amish who generally refuse to be photographed or be quoted by name. But on behalf of their midwife, they protested at the state capitol, staged benefits and teas, and filed an amicus brief.
An Amish mother expecting her sixth child recalls how Goslin strapped her birthing supplies on a toboggan and walked uphill to her farm when the road was impassible one winter. "I didn't even think to be worried. I figured she'd get here. She always does."
A mother expecting her 11th child arrives with her daughter, who is expecting her first. Women do mending as toddlers scoot around their ankles. Childhood friends reunite, chattering in Pennsylvania Dutch. Sisters shriek with laughter at the unexpected sight of their expectant aunt."...
The world of medicine, for Goslin, is no enemy. Raised in an extended family of doctors, and the mother of a physician as well, she became interested in home birth, she explains, when a hospital-acquired infection she sustained at the birth of her oldest child left her infertile.
Seven years later and about to begin medical school herself, Goslin learned that -- in spite of her diagnosis -- she was pregnant and decided against medical school."I wanted to raise my miracle baby myself," she says. She delivered with a midwife and, believing that such care shouldn't be solely a counter cultural option, began to apprentice with a midwife...
In the Amish farmhouses of this rolling hill country, Goslin is considered family. For some women, she’s delivered a dozen babies. And, in Goslin’s own time of need, this community rallied to help – a departure for the reticent Amish who generally refuse to be photographed or be quoted by name. But on behalf of their midwife, they protested at the state capitol, staged benefits and teas, and filed an amicus brief.
An Amish mother expecting her sixth child recalls how Goslin strapped her birthing supplies on a toboggan and walked uphill to her farm when the road was impassible one winter. "I didn't even think to be worried. I figured she'd get here. She always does."
Friday, November 07, 2008
Hospital sends wrong baby home
FOXNews.com - It's a Girl... No Wait, Hospital Sends Mom Home With Boy Instead - : "A woman who gave birth to a baby girl had the shock of her life when she went home from the hospital and changed the baby's diaper for the first time — and discovered nurses had given her a boy instead."
Tuesday, October 28, 2008
Monday, October 27, 2008
Patient undergoing C-section dies - The Boston Globe
Patient undergoing C-section dies - The Boston Globe:
"The mother died Friday, and the baby experienced complications but appears to be improving, Dr. Kenneth Sands, the hospital's senior vice president of healthcare quality, said in a brief statement.
The risk of death from a caesarean section is estimated at fewer than 1 in 2,500, according to information on the hospital's website.
That is significantly more than the roughly 1-in-10,000 risk of death during a vaginal birth.
CAREY GOLDBERG
� Copyright 2008 Globe Newspaper Company."
"The mother died Friday, and the baby experienced complications but appears to be improving, Dr. Kenneth Sands, the hospital's senior vice president of healthcare quality, said in a brief statement.
The risk of death from a caesarean section is estimated at fewer than 1 in 2,500, according to information on the hospital's website.
That is significantly more than the roughly 1-in-10,000 risk of death during a vaginal birth.
CAREY GOLDBERG
� Copyright 2008 Globe Newspaper Company."
Cesarean Section Quadruples The Risk Of Maternal Death
Cesarean section qudruples the risk o f maternal death
"CESAREAN SECTION QUADRUPLES THE RISK OF MATERNAL DEATH
FOR IMMEDIATE RELEASE October 1, 2003
Contact: Rae Davies, Executive Director Phone: (888) 282-CIMS Fax: (904) 285-2120 E-mail: info@motherfriendly.org
The Coalition for Improving Maternity Services views with alarm a recent study showing that U.S. women having cesarean sections are four times more likely to die compared with women having vaginal births.1 Investigators reported a maternal death rate of 36 per 100,000 cesarean operations versus 9 per 100,000 vaginal births. This is the difference attributable to the surgery itself, not any complications that might have led to the need for surgery. Based on calculations of what constitutes a reasonable cesarean rate versus the actual U.S. cesarean rate,* 135 women die every year as a result of having surgery they did not need.
Moreover, the difference in mortality rates between cesarean section and vaginal birth is almost certainly larger than it appears. Investigators only considered deaths occurring up to 1 year after delivery. Some surgically-related deaths—scar tissue causing a twisted bowel, for example—may occur after the 1-year cut-off.
In a press release entitled “Weighing the Pros and Cons of Cesarean Delivery,” the American College of Obstetricians and Gynecologists offered the theory that cesarean section benefits mothers by protecting against pelvic floor prolapse as a counterbalance to the fact that it was associated with an increased maternal death rate.2 The research, however, does not support this theory. While some studies do report a short-term benefit with cesarean section for a few women,3 none find long-term differences in symptoms resulting from pelvic floor weakness or injury to maternal tissues.3-7 Other studies report considerable percentages of women with urinary or bowel problems in the early weeks and months after cesarean surgery.8-9
The finding that cesarean section offers no long-term advantages holds true even without taking into account that many features of standard obstetric management cause or contribute to weakness or damage, and the use of these features could be greatly reduced or eliminated. These include episiotomy, fundal pressure (pushing down on the woman’s belly to expel the baby), vacuum extraction, forceps delivery, and how and in what positions women are directed to push.10 Indeed, the ACOG press release acknowledges that vaginal instrumental delivery produces the worst results. Epidural analgesia also contributes indirectly by increasing the need for vaginal instrumental delivery and episiotomy.11-12 Had women birthing vaginally received optimal care, the incidence of pelvic floor laxity and genital injury would likely have been much smaller.
CIMS contends that reducing the use of injurious practices would do far more to improve maternal health and well-being than substituting major abdominal surgery. Increased risk of maternal death is but one of the many hazards of cesarean section. (See CIMS fact sheet, The Risks of Cesarean Delivery to Mother and Baby.)
*The 2002 cesarean rate was 26%. This means that about one million of the 4 million U.S. women giving birth every year have cesarean sections.13 The World Health Organization recommends no more than a 10% to 15% cesarean rate.14 If the U.S. cesarean rate were halved, 500,000 fewer women annually would have had cesarean sections. The death rate among them would have been 9 per 100,000 (45 women) rather than 36 per 100,000 (180 women) – a difference of 135 lives. {the present cesarean rate in the US is 33.1%}"
"CESAREAN SECTION QUADRUPLES THE RISK OF MATERNAL DEATH
FOR IMMEDIATE RELEASE October 1, 2003
Contact: Rae Davies, Executive Director Phone: (888) 282-CIMS Fax: (904) 285-2120 E-mail: info@motherfriendly.org
The Coalition for Improving Maternity Services views with alarm a recent study showing that U.S. women having cesarean sections are four times more likely to die compared with women having vaginal births.1 Investigators reported a maternal death rate of 36 per 100,000 cesarean operations versus 9 per 100,000 vaginal births. This is the difference attributable to the surgery itself, not any complications that might have led to the need for surgery. Based on calculations of what constitutes a reasonable cesarean rate versus the actual U.S. cesarean rate,* 135 women die every year as a result of having surgery they did not need.
Moreover, the difference in mortality rates between cesarean section and vaginal birth is almost certainly larger than it appears. Investigators only considered deaths occurring up to 1 year after delivery. Some surgically-related deaths—scar tissue causing a twisted bowel, for example—may occur after the 1-year cut-off.
In a press release entitled “Weighing the Pros and Cons of Cesarean Delivery,” the American College of Obstetricians and Gynecologists offered the theory that cesarean section benefits mothers by protecting against pelvic floor prolapse as a counterbalance to the fact that it was associated with an increased maternal death rate.2 The research, however, does not support this theory. While some studies do report a short-term benefit with cesarean section for a few women,3 none find long-term differences in symptoms resulting from pelvic floor weakness or injury to maternal tissues.3-7 Other studies report considerable percentages of women with urinary or bowel problems in the early weeks and months after cesarean surgery.8-9
The finding that cesarean section offers no long-term advantages holds true even without taking into account that many features of standard obstetric management cause or contribute to weakness or damage, and the use of these features could be greatly reduced or eliminated. These include episiotomy, fundal pressure (pushing down on the woman’s belly to expel the baby), vacuum extraction, forceps delivery, and how and in what positions women are directed to push.10 Indeed, the ACOG press release acknowledges that vaginal instrumental delivery produces the worst results. Epidural analgesia also contributes indirectly by increasing the need for vaginal instrumental delivery and episiotomy.11-12 Had women birthing vaginally received optimal care, the incidence of pelvic floor laxity and genital injury would likely have been much smaller.
CIMS contends that reducing the use of injurious practices would do far more to improve maternal health and well-being than substituting major abdominal surgery. Increased risk of maternal death is but one of the many hazards of cesarean section. (See CIMS fact sheet, The Risks of Cesarean Delivery to Mother and Baby.)
*The 2002 cesarean rate was 26%. This means that about one million of the 4 million U.S. women giving birth every year have cesarean sections.13 The World Health Organization recommends no more than a 10% to 15% cesarean rate.14 If the U.S. cesarean rate were halved, 500,000 fewer women annually would have had cesarean sections. The death rate among them would have been 9 per 100,000 (45 women) rather than 36 per 100,000 (180 women) – a difference of 135 lives. {the present cesarean rate in the US is 33.1%}"
Thursday, October 23, 2008
Brewer Diet Registry USA
Registry II: "A List of Pro-Brewer Doulas, Midwives, Physicians, and Teachers"
Wednesday, July 09, 2008
Tuesday, July 08, 2008
Thursday, July 03, 2008
Birthing Options - Traditional Midwifery Care
Birthing Options - Traditional Midwifery Care: "They told me babies
should not be held;
It would spoil them
and make them cry.
I wished to do what is
best for them.
And the years went
swiftly by.
Now empty are
my yearning arms:
No more that
thrill sublime.
If I had my babies
back again,
I'd hold them all the time."
should not be held;
It would spoil them
and make them cry.
I wished to do what is
best for them.
And the years went
swiftly by.
Now empty are
my yearning arms:
No more that
thrill sublime.
If I had my babies
back again,
I'd hold them all the time."
Wednesday, April 02, 2008
Monday, March 31, 2008
Maybe Pregnant mammas CAN eat Canned Fish!
Powerful New Salvo In The Fish Wars: "This important study, set for publication next week in the American Journal of Epidemiology, is just the latest sign that activist groups like Oceana, the Environmental Working Group, and the Sea Turtle Restoration Project are dead wrong about the supposed health threat from trace levels of mercury in fish.
The research team, led by Harvard’s Dr. Emily Oken, wrote:
The research team, led by Harvard’s Dr. Emily Oken, wrote:
“The 28 mothers (8 percent) who reported eating canned tuna at least twice weekly had children with higher scores … compared with the 130 mothers (38 percent) who reported never eating tuna fish” while pregnant."“We next examined maternal fish intake and mercury levels simultaneously … Children whose mothers consumed more than two weekly fish servings and whose mercury levels were in the top decile also had somewhat higher scores, whereas children of mothers who consumed up to two weekly servings of fish and had mercury levels in the top decile had somewhat lower scores.” [emphasis added]
Translation: Among mothers with the highest mercury levels, those who ate the most fish (more than two servings per week) had children who performed above average on cognitive tests. High-mercury moms who ate less fish were the ones whose kids appear to be at a disadvantage. The key appears to be tuna. The most maligned fish in the sea, it turns out, is actually a comparatively low-mercury choice. We found as much in our 2006 fish-testing reports (see page 7 here, and page 10 here).
“Science doesn’t lie. Pregnant women who frequently eat canned tuna are having brainier children than those who don’t. Green groups have been demonizing tuna for years. Now it looks like they’ve been causing the very harm they sought to prevent.”
Birth Trauma Myths
Joyous Birth - The Australian Homebirth Network:
MYTH 4: Just concentrate on your healthy baby, and get over it, can also be: You’ll forget all about it as soon as you see your baby.
FACT: If you are raped, being given a present at the end of it doesn’t wipe out the rape. It may give you very ambivalent feelings about the gift but it doesn’t somehow cure you of the trauma and to suggest that women are so facile and stupid is offensive indeed. What this usually means is that the person speaking is uncomfortable with the pain they see visible in the woman and wish she would stop making them feel that way.
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