Mode of delivery and asthma -- is there a connection?

The results of this study in Finland suggests that caesarean section delivery may be associated with an increased prevalence of atopic asthma.

Kero J, Gissler M, Gronlund MM, Kero P, KoskinenP, Hemminki E, Isolauri E   Mode of delivery and asthma -- is there a connection?   Pediatr Res 2002 (Jul);   52 (1):   6-11

Forceps Up the Risk of Fecal Incontinence

Forceps-assisted childbirth significantly boosts a woman's risk of fecal incontinence, researchers report. Investigators pooled data on more than 7,800 mothers. Ten percent reported experiencing fecal incontinence during the year following childbirth. Those whose deliveries involved forceps and who experienced tears in the anal sphincter were at double the risk of fecal incontinence during the three months following delivery, compared with mothers whose deliveries did not involve forceps.

MacArthur C, Glazener CM, Wilson PD, Herbison GP, Gee H, Lang GD, Lancashire R   Obstetric practice and faecal incontinence three months after delivery   BJOG 2001 (Jul);   108 (7):   678-683

Episiotomy Increases Risk of Incontinence

According to new study conducted at Harvard Medical School, women who undergo episiotomy during childbirth are more likely to develop anal incontinence, compared with women who have "natural" childbirth - even if they withstand perineal tearing. The study enrolled 209 women who received a midline episiotomy, 206 women who endured spontaneous perineal tearing and 211 women who experienced neither event. All subjects had singleton deliveries.

At 6-month follow-up, investigators determined that episiotomies tripled the risk of fecal incontinence and doubled the risk of flatus incontinence. This finding was independent of maternal age, complicated labor, or instrument use during delivery (i.e., forceps).

The study's authors concluded that, "midline episiotomy is not effective in protecting the perineum and sphincters during childbirth and may impair anal continence."

Signorello LB, Harlow BL, Chekos AK, Repke JT   Midline episiotomy and anal incontinence: retrospective cohort study   Brit Med J 2000 (Jan 8);   320 (7227):   86-90

Breech Baby? You May Not Need A C-Section After All

Just because your baby decides he'd rather be born bottom-first doesn't necessarily mean you should get a cesarean section, says a study in the British Journal of Obstetrics and Gynecology. In fact, routine c-sections for women whose full-term babies are breech may raise the women's risk of complications such as urinary tract infections, endometriosis, hysterectomy, pulmonary embolism, and cardiorespiratory arrest. Researchers at University Hospital in Geneva examined 705 consecutive breech deliveries and found that women who delivered vaginally were not only healthier but also were out of the hospital sooner than those who'd scheduled c-sections. The study found there were significantly fewer maternal complications in the planned vaginal delivery group than in the elective caesarean section group. The researchers found that neither delivery method affects the babies' risk of complications, and went on to conclude "There is no firm evidence to recommend systematic elective caesarean section for breech presentation at term."

Irion O; Hirsbrunner Almagbaly P; Morabia A   Planned vaginal delivery versus elective caesarean section: a study of 705 singleton term breech presentations   Br J Obstet Gynaecol. 1998 (Jul);   105 (7):   710-717

Forceps, C-Section Linked With Head Injury

Babies delivered with the help of surgical intervention are at a greater risk of head injury than are babies born by natural childbirth, according to a paper in the New England Journal of Medicine.

As part of the study, researchers reviewed data on 583,340 babies born between 1992 and 1994. One-third of these babies were born with the help of surgical procedures such as vacuum extraction, cesarean section (performed during labor) or forceps. Babies born via operative techniques were up to 3.5 times more likely to suffer intracranial hemorrhage, compared with children who were delivered spontaneously. However, no additional risk was seen among children born via cesarean section performed with no labor, indicating that abnormal labor, rather than delivery method, may be the causative factor in many head injuries.

Towner D, Castro MA, Eby-Wilkens E, Gilbert WM   Effect of mode of delivery in nulliparous women on neonatal intracranial injury   N Engl J Med 1999 (Dec 2);   341 (23):   1709-1714

Low Birth Weight ups Asthma Risk

Low birth weight boosts an individual's risk of asthma, say researchers in the journal Thorax.

A total of 8,960 people were enrolled in the British Cohort study in 1970. Periodically, the participants completed questionnaires recording height, weight and symptoms of asthma experienced during the previous 12 months. The study found that low birth weight increased a subject's odds of having asthma at age 26.

Shaheen SO, Sterne JAC, Montgomery SM, Azima H   Birth weight, body mass index and asthma in young adults   Thorax 1999 (May);   54 (5):   396-402

C-Section Tied to Risk of Allergies

Researchers recently unearthed another reason for parents to choose natural childbirth over elective Caesarean section (C-section): allergy prevention. It seems that C-section delivery may predispose an infant to atopic disease, according to a paper presented at the annual meeting of the American Academy of Allergy, Asthma and Immunology in Orlando, Florida.

Investigators in Finland analyzed umbilical cord blood from 16 infants delivered via elective C-section and 12 infants delivered vaginally. The study found that cord blood from babies delivered via C-section contained one-third the number of IgA antibodies, compared with controls. In addition, cord blood from infants delivered via C-section had less interleukin 6 and 12. Experts speculate that stress from C-section delivery initiates biochemical changes that make infants more susceptible to allergy. However, the study's authors stress that more research is necessary before a clear link may be established. Specifically, they note that studies involving older children are needed.

Sütas Y   The role of mode of delivery in atopy: elective caesarean sec­tion delivery impairs the capacity to generate IgA and IL 12   American Academy of Allergy, Asthma and Immunology, 55th Annual Meeting March 15,1999

Birthing Naturally at Home

"If left alone in labor, the body of a woman produces most easily the baby that is not interfered with... If left alone, just courage and patience are required."
- Grantly Dick-Read, Childbirth without Fear: The Principles and Practice of Natural Childbirth

There are Two Philosophies on Birth , however most women are not exposed to both.

Obstacles in choosing a natural birth

It seems that as much as we see the awareness of natural birthing expanding we also see a continued increase in the c-section rate. It's time to look at what is impeding the movement of natural birth in our modern societies.

"Obstetricians should be heroes" by Jock Doubleday

The Assault on Normal Birth by Henci Goer, published in the current issue of Midwifery Today offers further referenced insight.

Is home birthing really safe?

Outcomes of planned home births in Washington State : is one study where the myth is perpetuated. Please refer a review of this study and how the myth gets perpetuated by junk science.

Search the literature to help dismantle the myth that home births are not safe.

Reassurance for the natural process

Women who listen to their inner promptings . Stories of women who went with the process. Download the article and help reconnect your patients to their innate possibilities.

Offer mothers the information to make informed choices about birth. Three excellent resourses for natural birthing at home.

There's no place like home *** The Home Birth Choice *** Home Birth Website ***

Patient education for options is timely

Finally, a recent rise in obstetric malpractice insurances are closing down obstetric wards around the country.

"...In all, more than 1,300 health care institutions have already been affected, according to a survey by the American Hospital Association. The survey, released in June, found that 20 percent of the association's 5,000 member hospitals and other health care organizations had cut back on services and 6 percent had eliminated some units. Many of those units are obstetric wards, where medical mistakes have historically led to expensive jury awards and settlements."

"Rise in Insurance Forces Hospitals to Shutter Wards." NY Times online.

Epidurals May Affect Newborns

A recent study published in April's issue of The Journal of the American Academy of Pediatrics states that epidurals can cause fevers in mothers during childbirth which in turn causes doctors to test newborns for blood and tissue infections and treat the newborns with antibiotics. Newborns who are born to mothers with epidurals are 4 times more likely to receive antibiotics because doctors are concerned about the possibility of newborn infection. This is in spite of the fact that babies of women who receive epidurals were not more likely to have infections than those born of mothers without epidurals.