July/Aug. 2011 - Why Babies Need 39 Weeks: The Case Against Induced Labor
There are certainly sound reasons for your doctor to suggest inducing labor. But a recently published study by a large group of hospitals in Utah provides some of the most up-to-date information on the complications than can arise from inducing labor.
“Utah has the highest birthrate in the nation, so it may not be surprising that close to 30,000 babies are delivered every year at Intermountain Healthcare, a Salt Lake City-based system of nonprofit hospitals and clinics,” writes Janie Wilson, M.S., R.N.of Intermountain Hospitals. Here’s her recent article ‘Designing Best Practices through Data Mining’ that explains what her hospital system found about induced labor. Her article was about the hospital’s practice of collecting data about medical procedures, but her research focused on a particular trend they discovered – induced labor.
“Since the 1970s, Intermountain has pioneered the use of EMRs to improve patient care.
Intermountain’s record system gives clinicians a complete medical history for individual patients, but it also serves as a giant research tool. For more than 30 years, these records – including medical details about every birth – have been compiled in a database, much like large, clinical data warehouse.
The database collects medical information from certain data fields in order to track trends and best practice care models across Intermountain’s entire patient population. This means that unlike some other EMR systems that are focused only on individual records, Intermountain’s clinical database allows statisticians to statistically evaluate treatment methods such as the benefits of various interventions or the efficacy of different medications. Using a rigorous statistical analysis of millions of patient records, statisticians can identify trends and make evidence-based decisions about best practices that can improve quality, saving lives and money across the system.
As an outgrowth of the clinical database, Intermountain was one of the first health care organizations to implement continuous quality improvement techniques to manage care.
These techniques – used for many years in other industry sectors like manufacturing and education – consist of thinking about complex organizations as systems with processes that can be continually improved using objective data.
Analyzing statistics from the database, Intermountain has developed best care models or protocols that continually improve medical outcomes in several clinical programs including cardiovascular, oncology, surgical services, primary care, intensive medicine, pediatric specialties, preventive medicine, and behavioral health along with programs for women and newborns.
Specifically, the data showed that of babies delivered at 37 weeks gestational age, 8.85 percent were admitted to the neonatal intensive care unit. The number dropped to 4.51 percent of babies delivered at 38 weeks and then bottomed out to 3.34 percent at 39 weeks. The percentage of NICU admissions climbs slowly for babies born at 40 weeks gestational age and beyond.
So according to Intermountain’s statistics, hitting the magic 39-week mark seemed to significantly cut the chances of a baby being sent to the NICU. But that wasn’t all the research found. Babies also were more likely to struggle with respiratory distress syndrome if physicians electively induced labor before 39 weeks.
The data showed that if delivery occurs at 37 weeks, 1.92 percent of babies were affected. At 38 weeks the percentage drops to .68 percent and bottoms out at .42 percent at 39 weeks, before slightly climbing again at 40 weeks. The need for newborns to be on a ventilator was also significantly reduced if delivery occurred at 39 weeks gestational age.
Armed with statistical information from their own hospitals and using standards from the American College of Obstetrics and Gynecologists, Intermountain instituted a new guideline to limit labor inductions before 39 weeks unless a consulting physician agreed that an earlier induction was medically necessary.
Many physicians said that in their experience, inducing labor at 38 or even 37 weeks did not result in memorable problems for moms or babies. They also said that that early inductions were being driven by patient demand.
But when the Intermountain team showed Utah physicians the composite data indicating that when birth occurred at 37 weeks the risks to babies were up to three times higher than waiting two more weeks, the number of elective inductions dropped. Early adopters helped to encourage their medical colleagues to follow the 39-week guideline. Today there is strong support for the best practice protocol throughout all of Intermountain’s labor and delivery units.
In 1999, approximately 28 percent of all inductions at Intermountain’s hospitals occurred before 39 weeks. Today, that percentage is only 3.4 percent. And with the significant drop in early elective inductions, Intermountain has also seen a 90-minute drop in the average length of labor in electively induced patients, with fewer emergency cesarean sections and other medical complications associated with deliveries. The guidelines benefit new babies and their moms. And as icing on the cake, the protocol also saved patients approximately $2 million since the program began.
Read 0 Comments... >>
April 2011 - Are Ultrasound ‘Snapshots’ of Your Baby a Good Idea?
For many expectant parents, ultrasounds offer a window into the world of their growing unborn baby. Unlike most standard prenatal tests that involve nothing more than a urine cup or a needle, ultrasounds allow a sneak preview of what's to come and what's going on inside — if the heart is beating normally or if the baby registry should contain pink or blue items.
But it's important to remember that ultrasounds are medical procedures that should be done on a healthcare provider's order. Yet this test that was once used solely by medical professionals is now being utilized by businesses in strip malls and shopping centers to sell keepsake prenatal portraits and videos.
Using technology that allows parents to see high-resolution three- and four-dimensional (moving) images of their babies in the womb, these facilities may employ poorly trained — or even untrained — technicians who aren't given a health provider's order to authorize the procedure and aren't supervised by a physician.
The U.S. Food and Drug Administration and the American Institute of Ultrasound in Medicine warn parents-to-be that these nonmedical ultrasounds are unapproved, inappropriate and possibly even risky.
A special jelly is applied to the skin on the expectant mother's abdomen, and a wand-like instrument (called a transducer) is positioned over it. Sound waves are generated and reflected back to the transducer as electric impulses, which produce an image of the baby on a computer screen.
Images seen on most two-dimensional ultrasounds are difficult for the untrained eye to understand. What might look like a hand to an expectant parent might actually be a foot — which is why the images must be interpreted by a properly trained technician. A doctor will then view the report and make his or her own interpretations.
When used correctly — at low power levels and for short periods of time by trained professionals (such as sonographers, radiologists and obstetricians) — ultrasounds are a standard procedure used to:
Usually performed between 18 and 20 weeks, an ultrasound can be done sooner or later and sometimes more than once.
The FDA is also concerned that these nonmedical ultrasounds can be misinterpreted as medical examinations and so prevent women from seeking standard prenatal care.
It might be tempting to get your baby's first portrait before the little bundle of joy is even born, but talk to your OB, nurse-midwife or family doctor if you're expecting and have questions about ultrasounds. If you've already had a nonmedical ultrasound, be sure to follow up with your healthcare provider.
Read 0 Comments... >>
FEB. 2011 - Banking Your Newborn’s Cord Blood
On the day you deliver your baby, you'll probably be overcome with visions of your future with your child — first smiles and steps, birthday parties and sports events, and holidays and life milestones. Your little one ever becoming seriously ill will probably be the last thing on your mind.
But some parents do consider the possibility that a serious illness might someday affect their child — and they make a choice on the day their baby is born that might affect the future health of that child or even their other children. They're deciding to bank their newborn's cord blood.
So, what is cord-blood banking, and is it right for you?
What are blood-forming stem cells? These are primitive (early) cells found primarily in the bone marrow that are capable of developing into the three types of mature blood cells present in our blood — red blood cells, white blood cells, and platelets. Cord-blood stem cells may also have the potential to give rise to other cell types in the body.
Some serious illnesses (such as certain childhood cancers, blood diseases, and immune system disorders) require radiation and chemotherapy treatments to kill diseased cells in the body. Unfortunately, these treatments also kill many "good" cells along with the bad, including healthy stem cells that live in the bone marrow.
Depending on the type of disease and treatment needed, some kids need a bone marrow transplant (from a donor whose marrow cells closely match their own). Blood-forming stem cells from the donor are transplanted into the child who is ill, and those cells go on to manufacture new, healthy blood cells and enhance the child's blood-producing and immune system capability.
After a vaginal delivery, the umbilical cord is clamped on both sides and cut. In most cases, an experienced obstetrician or nurse collects the cord blood before the placenta is delivered. One side of the umbilical cord is unclamped, and a small tube is passed into the umbilical vein to collect the blood. After blood has been collected from the cord, needles are placed on the side of the surface of the placenta that was connected to the fetus to collect more blood and cells from the large blood vessels that fed the fetus.
During cesarean births, cord-blood collection is more complicated because the obstetrician's primary focus in the operating room is tending to the surgical concerns of the mother. After the baby has been safely delivered and the mother's uterus has been sutured, the cord blood can be collected. However, less cord blood is usually collected when delivery is by C-section. The amount collected is critical because the more blood collected, the more stem cells collected. If using the stem cells ever becomes necessary, having more to implant increases the chances of engraftment (successful transplantation).
After cord-blood collection has taken place, the blood is placed into bags or syringes and is usually taken by courier to the cord-blood bank. Once there, the sample is given an identifying number. Then the stem cells are separated from the rest of the blood and are stored cryogenically (frozen in liquid nitrogen) in a collection facility, also known as a cord-blood bank. Then, if needed, blood-forming stem cells can be thawed and used in either autologous procedures (when someone receives his or her own umbilical cord blood in a transplant) or allogeneic procedures (when a person receives umbilical cord blood donated from someone else — a sibling, close relative or anonymous donor).
How long can blood-forming stem cells last when properly stored? Theoretically, stem cells should last forever, but cord-blood research only began in the 1970s, so the maximum time for storage and potential usage are still being determined. Blood-forming stem cells that have been stored for more than a decade have been used successfully in transplants.
If you'd like to donate your child's umbilical cord blood, contact your local chapter of the American Red Cross or a local university hospital, or check the National Marrow Donor Program's list of registered cord-blood facilities that accept donations. You'll need to give proper written consent before you donate your child's umbilical cord blood, but there's no cost and the process is confidential.
Read 0 Comments... >>
NOV. 2010 - Healthy Eating for Moms-to-Be
Did you know more women conceive during the cooler nine months of the year than at any other time? According to the Centers for Disease Control and Prevention, the baby boom that occurs from July to September explains this timing. For all moms who are pregnant, or thinking about getting pregnant, it's important to have a healthy diet of nutrient-rich foods. By following clear advice from health experts, moms-to-be can ensure their health and boost their baby's growth.
Contrary to what you may have heard, eating two to three servings of seafood a week during pregnancy is healthy and safe for you and your baby. A fish-rich diet not only protects your heart but may prevent pre-term labor and depression during and after pregnancy. A single serving of seafood provides almost one-third of the daily protein moms-to-be need in just 100 calories.
The nutrients in seafood are also important for your little one. Fish is full of the healthy fat omega-3 DHA which helps babies' eyes and brains develop. In fact, seafood, such as salmon and canned tuna, is the only naturally rich source of omega-3 DHA.
Unfortunately, pregnant women do not eat as much seafood as they should. On average, expecting moms in the U.S. only eat 2 ounces of seafood a week, less than a fourth of the amount they need. Most women should not only double or triple but quadruple the amount of fish they eat to meet the recommendation.
The expert advice is clear. During your pregnancy:
So how does a woman get more fish in her diet? One way is to savor the tastes of autumn with delicious and nutritious seafood dishes like the one featured here. Round out your meal with vitamin-rich seasonal vegetables like carrots, cauliflower and zucchini.
“For pregnant women strapped for time, look to your pantry for quick and easy seafood meal solutions," says Dr. Mary Harris, a professor in the Department of Food Science and Human Nutrition at Colorado State University. "Many popular types of fish like salmon, tuna and crab are all available in shelf-stable cans or pouches-and they are high in omega-3 DHA."
Get more expert information and recipes in "A Seafood Lover's Guide to Eating During Pregnancy," which was created with registered dietitians and doctors for expecting and new moms to explain why eating seafood is important, how much to eat and how to eat it. The guide is full of delicious and nutritious recipes and snack ideas, including the dishes mentioned earlier, to help you and your family enjoy seafood two to three times a week. Download a free copy at www.healthytuna.com.
– Source: ARA Content
Hickory Smoked Tuna Quesadilla
This quick and easy recipe combines smoky hickory flavors and crisp peppers and onions for a delicious dinner or family appetizer. Quesadillas are easy to reheat and make for a nutritious lunch, too. Serves two to eight.
1 pouch StarKist Hickory Smoked Tuna
1/2 cup Colby jack cheese blend, shredded
1/8 cup green onions, thinly sliced
1-1/2 ounces cream cheese, softened
1/8 cup roasted red pepper cut into small strips
2 flour tortillas, burrito size
In a small bowl, mix tuna, cream cheese, shredded cheese, pepper strips and sliced onions until blended. Spread tuna mixture on one tortilla shell, to the edges. Top with the other tortilla shell. Spray a large skillet, lightly, with vegetable spray and heat. Brown the shell in the skillet until golden brown on each side, approximately two to three minutes each side. Cut shell into eight wedges and serve.
– Source: ARA Content
Read 0 Comments... >>
JULY 2010 - New Mind-Body Fertility Programs Proving Popular and Effective
CF Staff Report
Studies are increasingly being done that show a direct link between increased stress and infertility – and anything that can be done to reverse that stress is proving to be very helpful.
Now a unique line of audio relaxation and mind-body programs are available for women who are trying to conceive AND women who are currently pregnant.
The patent-pending Circle + Bloom Fertility Mind-Body programs are based on years of extensive research and encompass proven methods to reduce stress and create a mind-body connection to produce real changes in the body.
Visualization techniques are a proven way to open the mind-body connection while reducing stress. Based on the natural 28-day reproductive cycle, the Circle + Bloom regimen combines music and words to allow women to enter into deep relaxation and then tap the mind-body connection that tracks to the specific part of the cycle they are experiencing each day. Fifteen minutes a day is all that is required.
It’s non-invasive, painless, and free of any harmful side effects.
Easy and accessible, the Circle + Bloom programs guide women through the process each day and demystify what they need to visualize for optimum fertility and health awareness. The flagship Circle + Bloom program is a downloadable MP3 set containing 30 individual and unique programs designed to be listened to on any digital audio playback device. With more than six hours of content, the program is structured by days, such that Day One of the program correspond s to the first day of the listener’s menstrual cycle.
The program also contains a Special Ovulation Session.
Although, there are many mind-body fertility seminars and programs on the market, most are expensive and done in facilities outside of the home. The Circle + Bloom programs are the only ones to combine proven relaxation techniques, effective research-based, mind-body intelligence and powerful emotional release exercises that can be used on a woman’s personal schedule in her own home on a daily basis. They are also the only programs that track in detail to the daily reproductive cycle, which heightens the mind-body effectiveness.
The company has also released its program designed for use during pregnancy.
The Pregnancy Program allows women to reduce their levels of stress, which has been shown to cause low birth-weight and premature labor, and could potentially affect the baby's temperament and neurobehavioral development.
The program is an audio MP3, segmented by trimester.
The Pregnancy Program was developed in response to the women who became pregnant while using the stress reduction programs and requested a post-conception program to continue using the powerful relaxation and mind-body routine throughout their pregnancy.
Read 0 Comments... >>