Overcoming Disparity:
Midwives collaborating for equality in Birth outcomes
July 16-18, 2010
]]>Index Number: AMR 51/007/2010
Date Published: 12 March 2010
Categories: USA
Women have a greater lifetime risk of dying in pregnancy-related causes in the USA than in 40 other countries. For women of colour the risks are especially high. Despite the huge sums of money spent on the health care system, women continue to face a range of obstacles in obtaining the services they need. This report shows the human cost of these systemic failures and highlights the steps that are urgently needed to move towards a health care system that respects, protects and fulfils the human right to health without discrimination.
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Most people think “bones” when they think of vitamin D, and while it’s true that it’s important for bone health, researchers are finding that it does much more than that. Studies are showing that vitamin D deficiencies during pregnancy are linked to a higher risk of developing preeclampsia, gestational diabetes and insulin resistance. Vitamin D is also extremely important for the brain development of the baby in utero, as well as the development of the baby’s immune system. Another study found that women with lower vitamin D rates were more likely to have a c-section, though the researchers did not have a strong explanation for this finding. Talk to your doctor or midwife about your prenatal nutrition and whether he or she recommends increasing your vitamin D.
Vitamin D helps our bodies absorb calcium, so it’s a major ingredient in building strong bones. As babies and kids grow, they need to get enough vitamin D and calcium to prevent rickets, a disease of soft, brittle bones. Some studies are showing that infants who are breastfed may need additional vitamin D supplementation; these studies indicate that maybe not enough vitamin D is passed on to baby through breastmilk even if the mom is taking extra vitamin D herself. Breastmilk is still the best food for your infant, but there may be a need for extra vitamin D. Talk to your doctor about the best options for your baby.
Studies:
Kovacs, C. “Vitamin D in pregnancy and lactation: maternal, fetal and neonatal outcomes from human and animal studies” 2008.
Lapillone, A. “Vitamin D deficiency during pregnancy may impair maternal and fetal outcomes” 2009.
Merewood, A. etal. “Association between vitamin D deficiency and primary cesarean section” 2009.
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Vaginal Birth After Cesarean: New Insights, Structured Abstract. March 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/vbacuptp.htm
Objectives: To synthesize the published literature on vaginal birth after cesarean (VBAC). Specifically, to review the trends and incidence of VBAC, maternal benefits and harms, infant benefits and harms, relevant factors influencing each, and the directions for future research.
Data Sources: Relevant studies were identified from multiple searches of MEDLINE®; DARE; the Cochrane databases (1966 to September 2009); and from recent systematic reviews, reference lists, reviews, editorials, Web sites, and experts.
Review Methods: Specific inclusion and exclusion criteria were developed to determine study eligibility. The target population includes healthy women of reproductive age, with a singleton gestation, in the U.S. with a prior cesarean who are eligible for a trial of labor (TOL) or elective repeat cesarean delivery (ERCD). All eligible studies were quality rated and data were extracted from good or fair quality studies, entered into tables, summarized descriptively and, when appropriate, pooled for analysis. The primary focus of the report was term pregnancies. However, due to a small number of studies on term pregnancies, general population studies including all gestational ages (GA) were included in appropriate areas.
Results: We identified 3,134 citations and reviewed 963 papers for inclusion, of which 203 papers met inclusion and were quality rated. Studies of maternal and infant outcomes reported data based upon actual rather than intended router of delivery. The range for TOL and VBAC rates was large (28-82 percent and 49-87 percent, respectively) with the highest rates being reported in studies outside of the U.S. Predictors of women having a TOL were having a prior vaginal delivery and settings of higher-level care (e.g., tertiary care centers).
TOL rates in U.S. studies declined in studies initiated after 1996 from 63 to 47 percent, but the VBAC rate remained unimproved. Hispanic and African American women were less likely than their white counterparts to have a vaginal delivery. Overall rates of maternal harms were low for both TOL and ERCD. While rare for both TOL and ERCD, maternal mortality was significantly increased for ERCD at 13.4 per 100,000 versus 3.8 per 100,000 for TOL. The rates of maternal hysterectomy, hemorrhage, and transfusions did not differ significantly between TOL and ERCD. The rate of uterine rupture for all women with prior cesarean is 3 per 1,000 and the risk was significantly increased with TOL (4.7/1,000 versus 0.3/1,000 ERCD). Six percent of uterine ruptures were associated with perinatal death. No models have been able to accurately predict women who are more likely to deliver by VBAC or to rupture.
Women with one prior cesarean delivery and previa had a statistically significant increased risk of adverse events compared with previa patients without a prior cesarean delivery; blood transfusion (15 versus 32.2 percent), hysterectomy (0.7 to 4 percent versus 10 percent), and composite maternal morbidity (15 versus 23-30 percent). Perinatal mortality was significantly increased for TOL at 1.3 per 1,000 versus 0.5 per 1,000 for ERCD. Insufficient data were found on nonmedical factors such as medical liability, economics, hospital staffing, structure and setting, which all appear to be important drivers for VBAC.
Conclusions: Each year 1.5 million childbearing women have cesarean deliveries, and this population continues to increase. This report adds stronger evidence that VBAC is a reasonable and safe choice for the majority of women with prior cesarean. Moreover, there is emerging evidence of serious harms relating to multiple cesareans. Relatively unexamined contextual factors such as medical liability, economics, hospital structure, and staffing may need to be addressed to prioritize VBAC services. There is still no evidence to inform patients, clinicians, or policymakers about the outcomes of intended route of delivery because the evidence is based largely on the actual route of delivery. This inception cohort is the equivalent of intention to treat for randomized controlled trials and this gap in information is critical. A list of future research considerations as prioritized by national experts is also highlighted in this report.
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Feeling a loss of control during and/or after birthing
Fear for your baby's safety or your own safety
Feeling unheard, uncared for, or pushed into making difficult decisions
Poor pain relief during labor
Distress and Intense Fear during and following your birth experience
Disappointment and deep sadness about your birth experience
Experience of an emergency delivery
Difficulty processing and accepting your birth experience
Separation from your baby at or following birth
Group Description:
An 8 week psycho-educational, therapeutic, support group for women seeking inner healing related to their experience of birth trauma. The Group offers a confidential, safe space to make peace with one's birth experience. Topics for discussion will include, but are not limited to; understanding trauma, normalizing the trauma response, healing birth trauma, and the power of innate wellness. Group participants will be offered an opportunity to share their birth stories with each other through verbal, written and artistic expression.
Dates:
Monday evenings from March 1st through April 19th
Location and Time:
1207 East Superior Street, Suite D, Duluth, MN 55802
6pm-7:30pm
Cost:
$122 ($10 is for art supplies)
Contact:
Karen Byrd M.A., LPC
218-464-8396 growcounseling@gmail.com
https://sites.google.com/site/growcounseling
THE REGISTRATION DEADLINE IS FEBRUARY 28TH. LIMITED SPACE IS AVAILABLE. THE FIRST 8 REGISTRANTS WILL BE ACCEPTED. PLEASE CONTACT ME BY PHONE OR EMAIL TO REGISTER FOR THIS GROUP.
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