This article caught my eye this morning as I was scrolling through the NPR health news feed and I wanted to share it with you all. In class, we have briefly discussed health outcomes of cesarean section births, but I am not sure if we have talked very much about elective cesarean section births. As someone who is passionate about natural childbirth, this issue really interests me. An article from ACOG explains that elective cesarean, or Cesarean delivery on maternal request, is prelabor cesarean delivery on maternal request in the absence of any maternal or fetal indications (ACOG, 2013). However, the aspect of elective cesarean sections that I am most interested in regards providers who either:

a) allow women to electively schedule cesarean section births despite the evidence that claims poorer outcomes for both mothers a babies (potential risks include a longer maternal hospital stay, an increased risk of respiratory problems for the infant, and greater complications in subsequent pregnancies, including uterine rupture, placental implantation problems, and the need for hysterectomy ACOG 2013)

or

b) do not facilitate adequate education to women about the benefits of vaginal delivery, especially if the case of women who may desire a VBAC if the option was provided

The NPR article discusses a recent report that claims approximately 9% of births covered by medicaid are elective cesarean sections. However, because of the potential negative outcomes of elective cesarean deliveries some states (2) are now refusing to pay for elected cesareans while others are finding other ways to discourage this practice.

What do you all think about providers allowing elective cesarean section births? What are some reasons you all think women, and providers, might prefer elective cesarean sections? And, how do you all think this might (or might not) be primarily an “American” problem?

http://www.npr.org/blogs/health/2014/12/08/369378083/despite-decline-elective-early-births-remain-a-medicaid-problem

http://www.childbirthconnection.org/article.asp?ck=10456

Cesarean delivery on maternal request. Committee Opinion No. 559. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013:121;904–7. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Cesarean-Delivery-on-Maternal-Request

Brenna’s presentation on HIV make me think of this article I read a while back about why women don’t take HIV medication, even when it is provided to them for free. The article talks about a study in South Africa where 5,000 women were given either HIV gel or a pill to prevent the transmission of HIV during intercourse. However, the study was interrupted when it was discovered that women were not taking the medication even though they claimed to take it every day. The article states, “more than 90 percent of the women claimed to be complying. But blood samples told a different story: Just 24 percent were using the gel, and only 30 percent were taking the pills.” The article then progresses to talk about the reasons why the women chose not to take the medication. I wanted to see what you all think about the article and if you all think that the reasons the women report not using the medication would be the same in different cultures?

http://www.npr.org/blogs/goatsandsoda/2014/11/13/363595295/yes-doctor-i-took-my-anti-hiv-meds-but-really-i-didnt

A nursing student in our cohort posted this article to our class Facebook page this week and I found it very interested and wanted to share with you all. The article begins by discussing the Healthy People 2020 goal to decrease the number of infant deaths to 6/1000 and tells how currently the US is at 6.1/1000. However, as we have discussed in class, the U.S. infant death rate is still relatively high compared to other developed countries such as Austria whose has a rate of 3.8, Finland who has a rate of 2.3, and Monaco who has a rate of 1.8 (the lowest in the world.) However, the article brings up an important concept that we have only briefly touched upon in class… how these data/stats are collected. The article states that there is often a discrepancy in the definition of a live birth and claims that the US rate may actually be lower (around 4.2). U.S. statistics include babies born before 24 weeks (even though chance of survival is very low for babies born before 23wks) while other countries may classify extremely low birth weight babies as a stillbirth/miscarriage; thus, if the ELBW babies die they are not included in the infant death rate.

While this in itself is interesting to think about, and can spark conversation about policies that perhaps need to be in place to insure more accurate data collection and parameters defining how we calculate infant death rate, the article goes even further to discuss an issue I find even more intriguing.

The article claims that the majority of infant deaths in the U.S. actually do not occur in the neonatal period (first 28 days) while the babies are still in the hospital, but over time after they are home. Furthermore, they examined how this is particularly true with babies born to women of lower socioeconomic status. While we have discussed how socioeconomic status contributes to birth outcomes across the globe, I found it interesting that the article claims that in comparing outcomes between the U.S., Austria, and Finland that children born to poor minority women in the U.S. “were more likely to die within the first year than children born to similar mothers in other countries.” So, I am wondering what you all think may play in to this. What makes infants (and women) of lower socioeconomic status in the U.S. more vulnerable than women of lower socioeconomic status in other developed nations?

Here is the link to the article:

Romm, C. (2014, October 1). Why American Babies Die. Retrieved November 18, 2014, from http://www.theatlantic.com/health/archive/2014/10/why-american-babies-die/381008/

Hi everyone! I felt a bit rushed at the end of my presentation yesterday, but I wanted to talk a little bit more about Kangaroo Care because I think it provides a great alternative to expensive care for premature infants. For example, I’ve been reading a lot about the use of Kangaroo Care in Malawi. Malawi has approximately 15,000 neonatal deaths a year and 60-90% of those deaths are attributed to LBW babies who are mostly preterm. I’ve attached a video and some resources in hopes that it might be interesting to you all since we have seen through reading Monique and the Mango Rains how important (yet lacking) good maternal care is in Malawi.

Here is the link for the video:

http://www.healthynewbornnetwork.org/multimedia/video/kangaroo-mother-care-living-proof-malawi

And here are a couple (short) articles that you all might find interesting:

http://www.unicef.org/malawi/reallives_13345.html

http://www.who.int/pmnch/events/2007/20071113_malawi_kangaroo.pdf

I’m also wondering how you all think that various disciplines (nursing, public health, politics, etc.) can contribute to promoting programs such as Kangaroo Care.

There are  advantages and disadvantages of giving birth at home, in a birth center, and in a hospital. It can be argued that a hospital provides a safe environment because expert medical help is available should unexpected interventions be needed during the birth process and there are a variety of pain relief options (Nice, 2007). However, women who give birth in a hospital are also more likely to receive some form of medical intervention and many may not be able to relax as well or have as much autonomy because they are in an unfamiliar environment (Wickham, 1999).

Contrasting hospital birth is the idea of giving birth at home. A home birth can be empowering because it allows a woman to labor in the comfort of her own, familiar environment. This may allow a woman to be more relaxed, mobile, and comfortable to do as she pleases throughout labor (Wickham, 1999).  Women are also less likely to have unnecessary interventions if giving birth at home (Oleson, Clausen, 2013). However, there is also the concern that if an emergency arises that there will be a delay in care because the woman must transfer to a hospital.

Lastly, birth centers seem to provide a middle ground between the two extremes of giving birth in a hospital or at home. Birth centers can provide a safe and home-like place for women to give birth and received prenatal and postnatal care, but usually have more resources and may provide quicker transfer to a hospital should an emergency arise (White, 2014).

In the summary of the Chapter 11 case study, “Providing a Safe Space for Birth in Warkworth, New Zealand” the author writes, “…there is no one thing that promotes a positive birth experience for women and their families, but rather an interconnected weaving of many things. Commitment is the common ingredient” (White, 2014).  I believe this is an incredibly profound statement that ultimately sums up what our class agreed upon after our discussion on birth location. All of the previously mentioned advantages and disadvantages of different birth locations only skim the surface of the issues revolving around birth and birth location; as birth is such a unique experience for every woman. This is why I believe that our goal should not be to decide which birth location is best, as this will clearly vary, but to commit to perfecting each of these options so that they are safe and accessible to all women.

Sources:

Nice. 2007. Intrapartum Care – care of healthy women and their babies during childbirth. National Institute of Health and Clinical Excellence. Clinical Guideline 55. London: NICE. www.nice.org.uk

Olsen O, Clausen JA. Planned hospital birth versus planned home birth. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD000352. DOI: 10.1002/14651858.CD000352.pub2.

Symthe, L., Payne, D., Wilson, S., Wynyard S. (2014). Providing a safe space for birth in Warkworth, New Zealand. In White R. (Ed.), Global Case Studies in Maternal and Child Health (pp. 187-208). Seattle: Ascend Learning Company.

WIckham, S. (1999). Homebirth: What are the issues? Retrieved 2014, from Midwifery Today: www.midwiferytoday.com/articles/homebirthissues.asp