Early planned birth linked to increased risk of poor child development at school age: new research

Scimex: Planned births occur where a considered decision is made to deliver an infant, and in recent years there have been significant changes in clinical practice resulting in an increase in planned births before the ideal time of birth at 39-40 weeks’ gestation. This is mostly attributable to the increased use of elective caesarean section and induction of labour. The study of 153,000 Australian children published today in Pediatrics reports that overall, 9.6 per cent of children were developmentally high risk. In particular, infants born following planned birth before the optimal time of birth were more likely to have poor child development.

Reducing Risk of Lung Distress in Preterm Babies

Jefferson: Steroids for women at risk of preterm birth improve lung development and reduces risk of severe respiratory distress in babies. Currently, corticosteroids are recommended for women at high risk of preterm birth between 23 and 33 weeks of pregnancy, but not after. A new meta-analysis compiling evidence from six clinical trials confirms earlier work suggesting that at-risk babies may benefit from steroids after 34 weeks and suggests that babies born to mothers who had a scheduled cesarean section after 37 weeks may benefit as well. The study was published in The BMJ on October 12.

Health information causing new mums anxiety

Monash: Pregnancy and motherhood are both wonderful and worrisome times – could public health campaigns and social stereotypes be contributing to anxiety for mothers? Researchers from Monash University have identified links between perinatal anxiety and social and health messages that women are exposed to during the perinatal period, the period immediately before and after birth.

Umbilical cord ‘milking’ improves blood flow in preterm infants

A technique to increase the flow of blood from the umbilical cord into the infant’s circulatory system improves blood pressure and red blood cell levels in preterm infants delivered by cesarean section, according to a study funded by the National Institutes of Health.

The study, published online in Pediatrics, was conducted by researchers at the Neonatal Research Institute at Sharp Mary Birch Hospital for Women and Newborns in San Diego, and Loma Linda University, Loma Linda, California. It was supported by NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

The technique, known as cord milking, consists of encircling the cord with thumb and forefingers, gently squeezing, and slowly pushing the blood through the cord to the infant’s abdomen. For infants delivered by cesarean, cord milking appears to offer benefits over the standard practice of waiting 45 to 60 seconds before clamping and then cutting the umbilical cord. These benefits, which include greater blood flow to and from the heart, higher red blood cell level, and higher blood pressure, were seen only in the infants delivered by cesarean. Among a smaller number of vaginal births, the researchers found no difference in blood volume between infants undergoing cord milking and those undergoing delayed cord clamping.

“The study results are very encouraging,” said Tonse Raju, M.D., chief of NICHD’s Pregnancy and Perinatology Branch. “The findings need to be confirmed in a larger number of births, but at this point, it appears that umbilical cord milking may prove to be of great benefit to preterm infants delivered via cesarean.”

The study authors note that in 2012, the American College of Obstetricians and Gynecologists recommended External Web Site Policy a 30 to 60-second delay before clamping the umbilical cord in all preterm deliveries. The organization has not made a recommendation on when to clamp the umbilical cord in term births, and so physicians typically use their best judgement on the timing of cord clamping in term infants.

NIH: Delaying umbilical cord clamping by 30 to 60 seconds is thought to allow sufficient time for blood from the umbilical cord to fill the blood vessels in the infant’s lungs, Dr. Raju explained in an earlier podcast. Among preterm infants, the delay is believed to protect from intraventricular hemorrhage, or bleeding in the ventricles — the cavities inside the infant’s brain. The hemorrhage is thought to result from low blood pressure, brought on by having too little blood in the circulatory system. Bleeding in the brain may result in developmental delays, cerebral palsy, and in severe cases, death.

Delay clamping babies' umbilical cords for better health and development

TheConversation: One of the most common surgical procedures in the world today – one that every human alive has undergone – is the clamping and cutting of the umbilical cord at birth. There is no dispute that we need to clamp and cut the umbilical cord. But there remains controversy over how soon after birth this should occur. Early clamping of the cord began in the 1950s and 60s with the introduction of active management of the third stage (birth of the placenta) in order to lower the rate of haemorrhage after birth. This involves giving women an injection of Syntocinon (synthetic oxytocin) with the birth of the baby, clamping and cutting the cord and pulling the placenta out using controlled cord traction.

Do kids born by C-section have a higher risk of chronic disease? A new study looks at the evidence

TheConversation: In many parts of the world, rates of cesarean delivery are too high, and growing. In the UK, for instance, about one-quarter of babies are born by cesarean. In the US, the rate is one-third, and in Brazil, it is one-half. The World Health Organization recommends that no more than 15% of deliveries be by cesarean. The reasons behind these variations and growing numbers are complex, and beyond my scope here. Whatever the reason, more and more babies are entering the world surgically. We need to understand the potential consequences.

Does your birthday affect your disease risk?

NHS: "Scientists Find Surprising Link Between Birth Month And Disease Risk," the Huffington Post reports. Using data mining techniques on 1.7 million electronic medical records, US researchers found an association between birth month and certain chronic diseases, as well as less serious conditions such as insect bites. Fifty-five diseases were found to be associated with birth month – 19 were previously reported in the literature, 20 were for conditions with close relationships to those previously reported, and 16 were new associations. The newly found associations were a mixed bag, ranging from various cardiovascular diseases (such as high blood pressure and heart failure) and prostate cancer, to incidents such as bruising and insect bites.

Are hospitals the safest place for healthy women to have babies? An obstetrician thinks twice

TheConversation: There is a good chance that your grandparents were born at home. I am going to go ahead and assume they turned out fine, or at least fine enough, since you were eventually born too and are now reading this. But since the late 1960s, very few babies in the United Kingdom or the United States have been born outside of hospitals. As a result, you may find the new guidelines from the UK’s National Institutes for Health and Care Excellence (NICE) just as surprising as I did. For many healthy women, the NICE guidelines authors believe, there may be significant benefits to going back to the way things were.

Dramatic increase in Caesarean sections

WHO: For most women, giving birth is a pleasurable and exciting experience and, with great care and support, it is a safe procedure. However, improved technology and increased knowledge about childbirth have also brought a dramatic increase in the number of Caesarean sections (C/S). Medical interventions such as C/S, fetal monitoring and ultrasound are increasingly being used unnecessarily in some countries and women are pressurized into giving birth in a hospital when a home birth may be the best option.

Waiting to clamp cord benefits child development

Scimex: Waiting a few minutes before clamping a newborn's umbilical cord could benefit them later down the track, suggests a new Swedish study. Researchers found that 4-year-olds whose umbilical cord were not clamped until 3 minutes after they were born are more likely to have improved scores in fine-motor and social skills than children whose cords were clamped immediately after birth. This link was seen to be stronger in boys than girls, but the researchers did not see any links between cord clamping time and overall IQ or behaviour.

Popular media influences choice of childbirth

Monash: Women’s magazines influence whether women decide to have a more natural childbirth or not, with most of the messages biased towards promoting the benefits of medicalised birth. Researchers from Monash University have studied how popular media influences women’s choices for childbirth. The study, published in Women & Health, specifically aimed to assess the effect of communicating the benefits of more natural birth (e.g. no medical intervention such as epidurals or caesarean section).

Why isn’t the UK a safer place to give birth?

TheConversation: It has been a week of contrasts. The world’s press has been focused on the safe birth of one tiny princess at the same time as hundreds of babies are being born into an earthquake-devastated Nepal. It is tempting to consider that neither of these two extremes have much real impact on the lives of the majority of families in the UK. But it is against this backdrop that Save the Children’s 16th State of the World’s Mothers report was published. It extensively analyses a range of indicators of women’s and children’s health to rank the experience of being a mother in 179 countries.

Inducing Labor at Full Term Not Associated with Higher Caesarean-section Rates

Jefferson: As cesarean section rates continue to climb in the United States, researchers are looking to understand the factors that might contribute. There has been debate in the field about whether non-medically required induction of labor leads to a greater likelihood of C-section, with some studies showing an association and others demonstrating that inductions at full term can actually protect both the mothers and babies. In order to tease apart the evidence, a new analysis pooled the results from five randomized controlled trials including 844 women, and found no link between induction and rates of C section in uncomplicated pregnancies of singleton babies at full term. The results were published online April 13th in the American Journal of Obstetrics & Gynecology.

Women’s magazines could play a role in promoting natural births

TheConversation: Reading just one magazine article promoting childbirth without medical intervention makes women want a more natural birth. This is the finding of research recently published in the peer-reviewed journal Women and Health. Our research suggests the media could play a role in reducing rates of unnecessary medical intervention in childbirth.
Such intervention is associated with preventable maternal and infant ill health, and it places an extra burden on the health-care system.
Epidural, for instance, is associated with increased risk of the mother having very low blood pressure and fever, as well as the use of forceps and vacuum extraction. And caesarean section in low-risk births is associated with increased risk of babies needing intensive care.