A study published in the January edition of the journal Pediatrics examines the effect of domperidone on the nutrient composition of breast milk. Domperidone is a drug that is often prescribed to improve breast milk volume, but there is a lack of evidence on its effects on milk composition. The study authors examined a group of mothers who had experienced lactation failure and who had delivered infants at less than 31 weeks gestation. Mothers were randomly assigned to receive domperidone or a placebo for 14 days. Protein, energy, fat, carbohydrate, sodium, calcium and phosphate levels were measured, in addition to serum prolactin levels and total milk volume. Domperidone did not substantially alter the nutrient composition of the breast milk, while it did increase the volume of milk in the mothers studied.
To access the study online, go to http://pediatrics.aappublications.org/cgi/content/abstract/125/1/e107
Showing posts with label study. Show all posts
Showing posts with label study. Show all posts
Tuesday, January 26, 2010
Wednesday, January 7, 2009
Best Practices in Maternity Care Not Widely Used in the United States
WASHINGTON (January 7, 2009)—Despite best evidence, health care providers continue to perform routine procedures during labor and birth that often are unnecessary and can have harmful results for mothers and babies. The Centers for Disease Control’s (CDC) most recent release of birth statistics reveals that the rate of cesarean surgery, for example, is on the rise to 31.1% of all births—50% greater than data from 1996. This information comes on the heels of The Milbank Report’s Evidence-Based Maternity Care, which confirms that beneficial, evidence-based maternity care practices are underused in the U.S. health care system.
Research indicates that routinely used procedures, such as continuous electronic fetal monitoring, labor induction for low-risk women and cesarean surgery, have not improved health outcomes for women and, in fact, can cause harm. In contrast, care practices that support a healthy labor and birth are unavailable to or underused with the majority of women in the United States.
Beneficial care practices outlined by Evidence-Based Maternity Care, a report produced by a collaboration of Childbirth Connection, the Reforming States Group and the Milbank Memorial Fund, could have a positive impact on the quality of maternity care if widely implemented throughout the United States. Suggested practices include to:
“Lamaze is alarmed by the current rate of cesarean surgery, and furthermore, by the overall poor adherence to the beneficial practices outlined above in much of the maternity care systems in the United States,” says Lamaze International President Pam Spry, PhD, CNM, FACNM, LCCE. “We are continuing to work to provide women and care providers with evidence-based information to improve the quality of care.”
Lamaze International has developed six care practice papers that are supported by research studies and represent “gold-standard” maternity care. When adopted, these care practices have a profound effect—instilling confidence in the mother, and facilitating a natural process that results in an active, healthy baby. Each one of the Lamaze care practices is cited in the Evidence-Based Maternity Care report as being underused in the U.S. maternity care system.
Debra Bingham, MS, RN, DrPH(c), Chair of the Lamaze International Institute for Normal Birth says, “As with any drug, we need to be sure that women and their babies receive the right dose of medical interventions. In the United States we are giving too high a dose of cesarean sections and other medical interventions which are causing harm to women and their babies. Yet there are many countries where life saving medical interventions are under dosed which can also cause harm. Every woman and her baby needs and deserves the right dose of medical interventions during childbirth.”
The research is clear, when medically necessary, interventions, such as cesarean surgery, can be lifesaving procedures for both mother and baby, and worth the risks involved. However, in recent years, the rate of cesarean surgeries cause more risks than benefits for mothers and babies. Cesarean surgery is a major abdominal surgery, and carries both short-term risks, such as blood loss, clotting, infection and severe pain, and poses future risks, such as infertility and complications during future pregnancies such as percreta and accreta, which can lead to excessive bleeding, bladder injury, a hysterectomy, and maternal death. Cesarean surgery also increases harm to babies including women giving birth prior to full brain development, breathing problems, surgical injury and difficulties with breastfeeding.
For more information on the Six Care Practices that Support Normal Birth, finding a health care provider and how to give birth with confidence, visit www.lamaze.org.
Research indicates that routinely used procedures, such as continuous electronic fetal monitoring, labor induction for low-risk women and cesarean surgery, have not improved health outcomes for women and, in fact, can cause harm. In contrast, care practices that support a healthy labor and birth are unavailable to or underused with the majority of women in the United States.
Beneficial care practices outlined by Evidence-Based Maternity Care, a report produced by a collaboration of Childbirth Connection, the Reforming States Group and the Milbank Memorial Fund, could have a positive impact on the quality of maternity care if widely implemented throughout the United States. Suggested practices include to:
- Let labor begin on its own.
- Walk, move around, and change positions throughout labor.
- Bring a loved one, friend, or doula to support you
- Avoid interventions that are not medically necessary
- Choose the most comfortable position to give birth and follow your body’s urges to push
- Keep your baby with you – it's best for you, your baby and breastfeeding.
“Lamaze is alarmed by the current rate of cesarean surgery, and furthermore, by the overall poor adherence to the beneficial practices outlined above in much of the maternity care systems in the United States,” says Lamaze International President Pam Spry, PhD, CNM, FACNM, LCCE. “We are continuing to work to provide women and care providers with evidence-based information to improve the quality of care.”
Lamaze International has developed six care practice papers that are supported by research studies and represent “gold-standard” maternity care. When adopted, these care practices have a profound effect—instilling confidence in the mother, and facilitating a natural process that results in an active, healthy baby. Each one of the Lamaze care practices is cited in the Evidence-Based Maternity Care report as being underused in the U.S. maternity care system.
Debra Bingham, MS, RN, DrPH(c), Chair of the Lamaze International Institute for Normal Birth says, “As with any drug, we need to be sure that women and their babies receive the right dose of medical interventions. In the United States we are giving too high a dose of cesarean sections and other medical interventions which are causing harm to women and their babies. Yet there are many countries where life saving medical interventions are under dosed which can also cause harm. Every woman and her baby needs and deserves the right dose of medical interventions during childbirth.”
The research is clear, when medically necessary, interventions, such as cesarean surgery, can be lifesaving procedures for both mother and baby, and worth the risks involved. However, in recent years, the rate of cesarean surgeries cause more risks than benefits for mothers and babies. Cesarean surgery is a major abdominal surgery, and carries both short-term risks, such as blood loss, clotting, infection and severe pain, and poses future risks, such as infertility and complications during future pregnancies such as percreta and accreta, which can lead to excessive bleeding, bladder injury, a hysterectomy, and maternal death. Cesarean surgery also increases harm to babies including women giving birth prior to full brain development, breathing problems, surgical injury and difficulties with breastfeeding.
For more information on the Six Care Practices that Support Normal Birth, finding a health care provider and how to give birth with confidence, visit www.lamaze.org.
Thursday, June 5, 2008
"Big Baby" Diagnosis Increases Chance of C/S Without Improving Newborn Outcomes
Prenatal Diagnosis of Suspected Fetal Macrosomia Increases Risks of Cesarean Section and Maternal Morbidity without Improving Newborn Outcomes
Sadeh-Mestechkin, D., Walfisch, A., Shachar, R., Shoham-Vardi, I., Vardi, H., & Hallak, M. (2008). Suspected macrosomia? Better not tell. Archives of Gynecology and Obstetrics, doi: 10.1007/s00404-008-0566-y. [Abstract]
Summary: In this prospective observational trial, researchers followed 145 women thought to be carrying babies weighing more than 4000g (about 8lb, 13oz) to evaluate the reliability of sonographic and clinical estimates of fetal weight and to determine whether a diagnosis of "suspected macrosomia" affects pregnancy management or outcomes. To answer these questions, they first divided the "suspected macrosomia" into two subgroups depending on whether the babies in fact weighed more or less than 4000g. This resulted in a "false-positive" subgroup of 82 babies thought to be macrosomic but actually weighing less than 4000g and a "true-positive" group of 63 babies thought to be macrosomic and indeed weighing more than 4000g.
The researchers compared outcomes between these two groups, then compared the "true-positive" group to all other births of macrosomic infants to women admitted to the same hospital in the study period (i.e., women giving birth to infants weighing over 4000g but who did not have a prenatal diagnosis of suspected macrosomia).
The study confirms an existing body of literature that tells us that prenatal methods for detecting macrosomia are not reliable—only 44% of babies suspected to weigh over 4000g actually did. Clinical estimates (those performed by a care provider using palpation) were more reliable than ultrasound estimates, but were still off by more than 10% in one out of every six cases.
The 145 women with suspected macrosomia were assigned by the admitting doctor to elective cesarean surgery (16%) induction of labor (39%) or observation awaiting labor (46%). Thirty-five of the 56 women who underwent induction and 47 of the 66 women who were admitted in spontaneous labor gave birth vaginally, for an overall vaginal birth rate of 57% (including 2% who had instrumental vaginal births). The remaining women gave birth by cesarean surgery either before (21%) or during (22%) labor.
When researchers compared outcomes of the "true-positives" with the "false-positives" within the "suspected macrosomia" group, there were no differences in maternal or infant complications.
When the researchers compared the true-positive macrosomic infants in the study group (those suspected to weigh and actually weighing >4000g) to the macrosomic infants in the comparison group (those not suspected to be macrosomic prior to birth), they found much higher rates of intervention and related morbidity in the study group. The cesarean surgery rate for macrosomic infants in the suspected macrosomia group was 57%, compared with only 17% for macrosomic infants in the comparison group (absolute difference 40%). Likewise, 25% of macrosomic infants in the study group were induced compared with 14% in the comparison group (absolute difference = 11%). There was no difference in shoulder dystocia between the two groups. However, maternal morbidity (including hemorrhage, wound infection, wound dehiscence, fever, and use of antibiotics) was significantly higher in study group, most likely because of the much higher rate of cesarean surgery in this group.
Significance for Normal Birth: The concern that a baby is growing "too big" is one of the most common reasons cited for induction of labor and also prompts decisions to perform cesarean surgery both before and during labor (Declercq, Sakala, Corry, & Applebaum, 2006). However, there is strong and consistent evidence that elective induction or cesarean surgery for "suspected macrosomia" does not improve outcomes and expert bodies including the American College of Obstetricians and Gynecologists oppose routinely interfering when a baby is suspected to be large (American College of Obstetricians & Gynecologists, 2004).
This study, summed up by its title, "Suspected macrosomia? Better not tell" provides damning evidence that shows clearly that the provider's belief that the baby is "too big" is itself a strong risk factor for injudicious intervention and poor health outcomes.
An initial suspicion that the baby is large may instill fear in the pregnant woman which may impede both her confidence in her body and her labor progress. Slow labor progress reinforces the suspicion that the baby is big and more aggressive management ensues. This management often hinders the woman's ability to move freely and assume the positions that may help her baby negotiate through her pelvis, further slowing progress and reinforcing the perceived need for surgical intervention. Based on this study and previous evidence, women should strongly consider refusing tests late in pregnancy intended to estimate fetal weight.
The estimate itself may be bad for her health because the care provider's expectation that the baby will be macrosomic appears to increase both unnecessary medical intervention and the morbidity that may accompany it.
References: American College of Obstetricians and Gynecologists. (2004). Ultrasonography in pregnancy. ACOG Practice Bulletin No. 58. Obstetrics and Gynecology, 104, 1449–58.
Declercq, E., Sakala, C., Corry, M. P., & Applebaum, S. (2006). Listening to mothers II: Report of the second national U.S. Survey of women's childbearing experiences. New York: Childbirth Connection.), 116-122.
Sadeh-Mestechkin, D., Walfisch, A., Shachar, R., Shoham-Vardi, I., Vardi, H., & Hallak, M. (2008). Suspected macrosomia? Better not tell. Archives of Gynecology and Obstetrics, doi: 10.1007/s00404-008-0566-y. [Abstract]
Summary: In this prospective observational trial, researchers followed 145 women thought to be carrying babies weighing more than 4000g (about 8lb, 13oz) to evaluate the reliability of sonographic and clinical estimates of fetal weight and to determine whether a diagnosis of "suspected macrosomia" affects pregnancy management or outcomes. To answer these questions, they first divided the "suspected macrosomia" into two subgroups depending on whether the babies in fact weighed more or less than 4000g. This resulted in a "false-positive" subgroup of 82 babies thought to be macrosomic but actually weighing less than 4000g and a "true-positive" group of 63 babies thought to be macrosomic and indeed weighing more than 4000g.
The researchers compared outcomes between these two groups, then compared the "true-positive" group to all other births of macrosomic infants to women admitted to the same hospital in the study period (i.e., women giving birth to infants weighing over 4000g but who did not have a prenatal diagnosis of suspected macrosomia).
The study confirms an existing body of literature that tells us that prenatal methods for detecting macrosomia are not reliable—only 44% of babies suspected to weigh over 4000g actually did. Clinical estimates (those performed by a care provider using palpation) were more reliable than ultrasound estimates, but were still off by more than 10% in one out of every six cases.
The 145 women with suspected macrosomia were assigned by the admitting doctor to elective cesarean surgery (16%) induction of labor (39%) or observation awaiting labor (46%). Thirty-five of the 56 women who underwent induction and 47 of the 66 women who were admitted in spontaneous labor gave birth vaginally, for an overall vaginal birth rate of 57% (including 2% who had instrumental vaginal births). The remaining women gave birth by cesarean surgery either before (21%) or during (22%) labor.
When researchers compared outcomes of the "true-positives" with the "false-positives" within the "suspected macrosomia" group, there were no differences in maternal or infant complications.
When the researchers compared the true-positive macrosomic infants in the study group (those suspected to weigh and actually weighing >4000g) to the macrosomic infants in the comparison group (those not suspected to be macrosomic prior to birth), they found much higher rates of intervention and related morbidity in the study group. The cesarean surgery rate for macrosomic infants in the suspected macrosomia group was 57%, compared with only 17% for macrosomic infants in the comparison group (absolute difference 40%). Likewise, 25% of macrosomic infants in the study group were induced compared with 14% in the comparison group (absolute difference = 11%). There was no difference in shoulder dystocia between the two groups. However, maternal morbidity (including hemorrhage, wound infection, wound dehiscence, fever, and use of antibiotics) was significantly higher in study group, most likely because of the much higher rate of cesarean surgery in this group.
Significance for Normal Birth: The concern that a baby is growing "too big" is one of the most common reasons cited for induction of labor and also prompts decisions to perform cesarean surgery both before and during labor (Declercq, Sakala, Corry, & Applebaum, 2006). However, there is strong and consistent evidence that elective induction or cesarean surgery for "suspected macrosomia" does not improve outcomes and expert bodies including the American College of Obstetricians and Gynecologists oppose routinely interfering when a baby is suspected to be large (American College of Obstetricians & Gynecologists, 2004).
This study, summed up by its title, "Suspected macrosomia? Better not tell" provides damning evidence that shows clearly that the provider's belief that the baby is "too big" is itself a strong risk factor for injudicious intervention and poor health outcomes.
An initial suspicion that the baby is large may instill fear in the pregnant woman which may impede both her confidence in her body and her labor progress. Slow labor progress reinforces the suspicion that the baby is big and more aggressive management ensues. This management often hinders the woman's ability to move freely and assume the positions that may help her baby negotiate through her pelvis, further slowing progress and reinforcing the perceived need for surgical intervention. Based on this study and previous evidence, women should strongly consider refusing tests late in pregnancy intended to estimate fetal weight.
The estimate itself may be bad for her health because the care provider's expectation that the baby will be macrosomic appears to increase both unnecessary medical intervention and the morbidity that may accompany it.
References: American College of Obstetricians and Gynecologists. (2004). Ultrasonography in pregnancy. ACOG Practice Bulletin No. 58. Obstetrics and Gynecology, 104, 1449–58.
Declercq, E., Sakala, C., Corry, M. P., & Applebaum, S. (2006). Listening to mothers II: Report of the second national U.S. Survey of women's childbearing experiences. New York: Childbirth Connection.), 116-122.
Tuesday, May 6, 2008
Breastfeeding "Helps to Boost IQ"
WASHINGTON (Reuters) - A new study provides some of the best evidence to date that breast-feeding can make children smarter, an international team of researchers said on Monday.
Children whose mothers breast-fed them longer and did not mix in baby formula scored higher on intelligence tests, the researchers in Canada and Belarus reported.
About half the 14,000 babies were randomly assigned to a group in which prolonged and exclusive breast-feeding by the mother was encouraged at Belarussian hospitals and clinics. The mothers of the other babies received no special encouragement. Those in the breast-feeding encouragement group were, on average, breast-fed longer than the others and were less likely to have been given formula in a bottle.
At 3 months, 73 percent of the babies in the breast-feeding encouragement group were breast-fed, compared to 60 percent of the other group. At 6 months, it was 50 percent versus 36 percent. In addition, the group given encouragement was far more likely to give their children only breast milk. The rate was seven times higher, for example, at 3 months.
The children were monitored for about 6 1/2 years. The children in the group where breast-feeding was encouraged scored about 5 percent higher in IQ tests and did better academically, the researchers found. Previous studies had indicated brain development and intelligence benefits for breast-fed children. But researchers have sought to determine whether it was the breast-feeding that did it, or that mothers who prefer to breast-feed their babies may differ from those who do not. The design of the study -- randomly assigning babies to two groups regardless of the mothers' characteristics -- was intended to eliminate the confusion.
'MOTHERS WHO BREAST-FEED ... ARE DIFFERENT'
"Mothers who breast-feed or those who breast-feed longer or most exclusively are different from the mothers who don't," Dr. Michael Kramer of McGill University in Montreal and the Montreal Children's Hospital said in a telephone interview. "They tend to be smarter. They tend to be more invested in their babies. They tend to interact with them more closely. They may be the kind of mothers who read to their kids more, who spend more time with their kids, who play with them more," added Kramer, who led the study published in the journal Archives of General Psychiatry.
The researchers measured the differences between the two groups using IQ tests administered by the children's pediatricians and by ratings by their teachers of their school performance in reading, writing, math and other subjects. Both sets of scores were significantly higher in the children from the breast-feeding promotion group.
The study was launched in the mid-1990s. Kramer said the initial idea was to do it in the United States and Canada, but many hospitals in those countries by that time had begun strongly encouraging breast-feeding as a matter of routine. The situation was different in Belarus at the time, he said, with less routine encouragement for the practice.
Kramer said how breast-feeding may make children more intelligent is unclear. "It could even be that because breast-feeding takes longer, the mother is interacting more with the baby, talking with the baby, soothing the baby," he said. "It could be an emotional thing. It could be a physical thing. Or it could be a hormone or something else in the milk that's absorbed by the baby."
Previous studies have shown babies whose mothers breast-fed them enjoy many health advantages over formula-fed babies. These include fewer ear, stomach or intestinal infections, digestive problems, skin diseases and allergies, and less risk of developing high blood pressure, diabetes and obesity. The American Academy of Pediatrics recommends that women who do not have health problems exclusively breast-feed their infants for at least the first six months, with it continuing at least through the first year as other foods are introduced.
Children whose mothers breast-fed them longer and did not mix in baby formula scored higher on intelligence tests, the researchers in Canada and Belarus reported.
About half the 14,000 babies were randomly assigned to a group in which prolonged and exclusive breast-feeding by the mother was encouraged at Belarussian hospitals and clinics. The mothers of the other babies received no special encouragement. Those in the breast-feeding encouragement group were, on average, breast-fed longer than the others and were less likely to have been given formula in a bottle.
At 3 months, 73 percent of the babies in the breast-feeding encouragement group were breast-fed, compared to 60 percent of the other group. At 6 months, it was 50 percent versus 36 percent. In addition, the group given encouragement was far more likely to give their children only breast milk. The rate was seven times higher, for example, at 3 months.
The children were monitored for about 6 1/2 years. The children in the group where breast-feeding was encouraged scored about 5 percent higher in IQ tests and did better academically, the researchers found. Previous studies had indicated brain development and intelligence benefits for breast-fed children. But researchers have sought to determine whether it was the breast-feeding that did it, or that mothers who prefer to breast-feed their babies may differ from those who do not. The design of the study -- randomly assigning babies to two groups regardless of the mothers' characteristics -- was intended to eliminate the confusion.
'MOTHERS WHO BREAST-FEED ... ARE DIFFERENT'
"Mothers who breast-feed or those who breast-feed longer or most exclusively are different from the mothers who don't," Dr. Michael Kramer of McGill University in Montreal and the Montreal Children's Hospital said in a telephone interview. "They tend to be smarter. They tend to be more invested in their babies. They tend to interact with them more closely. They may be the kind of mothers who read to their kids more, who spend more time with their kids, who play with them more," added Kramer, who led the study published in the journal Archives of General Psychiatry.
The researchers measured the differences between the two groups using IQ tests administered by the children's pediatricians and by ratings by their teachers of their school performance in reading, writing, math and other subjects. Both sets of scores were significantly higher in the children from the breast-feeding promotion group.
The study was launched in the mid-1990s. Kramer said the initial idea was to do it in the United States and Canada, but many hospitals in those countries by that time had begun strongly encouraging breast-feeding as a matter of routine. The situation was different in Belarus at the time, he said, with less routine encouragement for the practice.
Kramer said how breast-feeding may make children more intelligent is unclear. "It could even be that because breast-feeding takes longer, the mother is interacting more with the baby, talking with the baby, soothing the baby," he said. "It could be an emotional thing. It could be a physical thing. Or it could be a hormone or something else in the milk that's absorbed by the baby."
Previous studies have shown babies whose mothers breast-fed them enjoy many health advantages over formula-fed babies. These include fewer ear, stomach or intestinal infections, digestive problems, skin diseases and allergies, and less risk of developing high blood pressure, diabetes and obesity. The American Academy of Pediatrics recommends that women who do not have health problems exclusively breast-feed their infants for at least the first six months, with it continuing at least through the first year as other foods are introduced.
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