Women in Control of Epidural During Labor Use 30% Less Anesthesia

Epidurals have become the “drug of choice” in maternity wards across the United States. As of 1997, “nearly two-thirds of all women who give birth in hospitals with high-volume obstetric units had an epidural during labor. In many hospitals, epidural analgesia is routine and is provided to more than 90 percent of all women who are in labor in that hospital.” Yet epidurals are not without potential risks for both mother and baby, which is part of the reason the findings from a new study on laboring women are so promising.

new study reports laboring women given control over their epidural anesthesia resulted in a 30 percent reduction of the amount of anesthesia used and were “basically as comfortable” as women on a continuous dose. Researchers also report a trend toward fewer deliveries that required instrument assistance, such as forceps, in the patient-controlled group.

Dr. Peter Benstein, a professor of clinical obstetrics and gynecology and women’s health at Montefiore Medical Center and Albert Einstein College of Medicine in New York City, said:

“My personal belief is that epidurals tend to slow labor down. So, if you can get away with less medication with patient-controlled analgesia, I think it’s a wonderful thing.”

“And, it’s not a surprise to me that women used less anesthesia. If you can titrate your own medication, you’re probably not going to give yourself a lot. An anesthesiologist will tend to give you a little bit more because they want to make sure there’s no pain.”

The author of the study is Dr. Michael Haydon, a perinatologist at Long Beach Memorial Medical Center in California.

Generally, epidural anesthesia is given on a continuous basis, according to Haydon. But patient-controlled devices that can control delivery of the anesthesia are widely available, he added. Patients are given a button to push when they feel they need more medication. The devices are programmed to only provide a specific amount of medication for specific time periods to ensure that people don’t give themselves too much.

The study randomly selected first-time mothers for one of three groups: “the standard dose given as a continuous infusion; a continuous infusion with an additional patient-controlled option; and patient-controlled anesthesia only.” The first group used an average of 74.9 mg of anesthesia during labor. The second group used an average of 95.9 mg, while the patient-controlled group used the least anesthesia of all, an average of 52.8 mg, according to the study.

Women in the patient-controlled group did report slightly higher pain scores when they got to the pushing part of the delivery, but also reported being satisfied with their pain relief overall.

Women’s Views On News says:

This is good news because epidurals, despite having made labor more bearable for scores of women, have their pitfalls: they can lead to prolonged labor and an increase in vacuum and forceps deliveries. They can also result in more C-sections, which is far from ideal.

Rebecca on Babble writes:

Less meds with the same level of relief? What’s not to like here? A lower dose of medication with adequate pain management would benefit both moms and babies. I find this study so exciting because it opens up new possibilities for women as active participants, not just passive patients, in hospital births. It’s ideas like these that may help us progress toward a hospital birth model that takes into account the needs of both babies and the mothers who give birth to them.

Laura Nelson at Think Baby writes about the study’s findings and how they might impact maternity care in the United Kingdom.

Patient-controlled epidural analgesia is currently only available in one-fifth of hospitals in the UK due to the expensive costs of the equipment needed. Experts are now looking into whether the positive effects outweigh the costs.??“The technique reduces the need for anaesthetic which in turn reduces the need for forceps delivery – and it gives women a feeling of control. The question is whether the small clinical advantages are enough to justify the cost of new equipment and staff training,” Dr Elizabeth McGrady, a honorary clinical lecturer in anaesthetics at Glasgow University said to the BBC.

Personally I’m all for empowering women to be, as Rebecca said, “active participants” in hospital births. Although I did not have an epidural with either my daughter’s hospital birth or my son’s home birth, there was a point during my induced labor with my daughter that an option like this would have appealed to me (had I not had complications including low platelets that prevented me from getting an epidural anyway). I hope this study leads to hospitals adopting patient-controlled epidurals as standard practice for women who choose to have epidurals.

Related links:

  • Over at Women’s Health and Pregnancy, there’s an informative post with diagrams and pictures about how an epidural is given, as well as the pros and the cons.
  • At Anticipation and Beyond, there’s another informative post about the dangers of epidurals. The author writes, “This blog isn’t to insult those who have made this choice, but to increase your knowledge, so you can make informed choices for the future.”

Photo credit: Women Health and Pregnancy

Cross-posted at BlogHer

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Americans STILL Aren’t Eating Their Veggies

Last month, The New York Times reported that despite 20 years of “public health initiatives, stricter government dietary guidelines, record growth of farmers’ markets and the ease of products like salad in a bag, Americans still aren’t eating enough vegetables.”

The Centers for Disease Control and Prevention issued a comprehensive nationwide behavioral study of fruit and vegetable consumption. Only 26 percent of the nation’s adults eat vegetables three or more times a day, it concluded. (And no, that does not include French fries.)

These results fell far short of health objectives set by the federal government a decade ago. The amount of vegetables Americans eat is less than half of what public health officials had hoped. Worse, it has barely budged since 2000.

The government recommends four and a half cups of fruits and vegetables (which equals nine servings) for people who eat 2,000 calories a day.

People know that vegetables are good for them and can improve health, but they are also seen as a lot of work and have a much quicker “expiration date” than processed foods. Even if you buy veggies with the best of intentions, if you don’t consume them fast enough, they are doomed to rot in your refrigerator. I think this is something we’ve all been guilty of at one time or another. A survey of 1,000 Americans conducted by White Wave Foods indicates that almost half of us leave our fruit in the refrigerator until it rots. I can only assume that even more vegetables suffer a similar fate.

At Mother Nature Network, Katherine Butler asks, “what is the price of not eating vegetables?”

Mostly, it means that Americans are lacking in vital nutrients. Antioxidants and fiber fill vegetables, as well as key nutrients such as potassium, beta-carotene, iron, folate, magnesium, calcium and vitamins A, C, E and K. Fiber can reduce cholesterol; potassium, found in foods like spinach, helps blood pressure. Vitamin C helps gums and teeth, while vitamin E fights against premature aging.

Apparently, orange veggies are something we should be focusing on too. According to The Ohio State University Extension blog:

Orange vegetables, like pumpkin, squash, carrots, and sweet potatoes contain nutrients and phytonutrients found in no other group of vegetables. That’s why experts recommend we eat at least 2 cups a week of orange vegetables. How many do you eat? If you’re not eating enough, now is the perfect time of year to start!  All types of winter squash — acorn, butternut, hubbard, etc. are in season and cheap.  Pumpkins and canned pumpkins are stocking the shelves. Carrots and sweet potatoes are found commonly throughout the year.

I’m not sure there’s a solution for getting adult Americans to consume more vegetables. They know they are healthy, but they still don’t eat them. Even with convenient options like prepackaged servings of broccoli and bagged salads available, they aren’t biting (pun intended). Until Americans make eating vegetables a priority, it’s not going to happen. After all, you can’t force feed them. Maybe we could hide vegetables in french fries? Hmm. Probably not. Although that is a technique some people use to get children to eat their veggies (remember Jessica Seinfeld’s book Deceptively Delicious?), though not everyone agrees with it.

Organic Authority points out the important of fruits and vegetables for children. “A diet high in fruits and vegetables is important for optimal child growth, maintaining a healthy weight, and prevention of chronic diseases such as diabetes, heart disease and some cancers—all of which currently contribute to healthcare costs in the United States,” says William H. Dietz, MD, PhD, director of the CDC’s Division of Nutrition, Physical Activity and Obesity.

Lisa Johnson mentions that some high schools have added baby carrot vending machines next to the typical junk food machines and wonders if the packaging (designed to look similar to a potato chip bag) will entice kids to buy them. Lisa says, “I have to say I think it’s a good idea. It might seem a little condescending to some but we are visual creatures and we react positively to colorful items that grab our attention while glossing over the ho-hum stuff. Shouldn’t we just capitalize on human nature to achieve a greater good?”

The Huffington Post reports “The U.S. Department of Agriculture recently announced what it called a major new initiative, giving $2 million to food behavior scientists to find ways to use psychology to improve kids’ use of the federal school lunch program and fight childhood obesity.” Some schools are employing psychology tricks in hopes of getting teens to make healthier lunch choices in the cafeteria. Cornell researches have dubbed these little tricks a success: “Keep ice cream in freezers without glass display tops so the treats are out of sight. Move salad bars next to the checkout registers, where students linger to pay, giving them more time to ponder a salad. And start a quick line for make-your-own subs and wraps, as Corning East High School in upstate New York did.”

Perhaps the veggie avoidance can be traced back to infancy. I wrote in 2007 about a study that showed breast-fed babies are more likely to like fruits and vegetables (if their mother ate them while breastfeeding) than their formula-fed counterparts.

Senior author of the study Julie A. Mennella, PhD said, “The best predictor of how much fruits and vegetables children eat is whether they like the tastes of these foods. If we can get babies to learn to like these tastes, we can get them off to an early start of healthy eating. … It’s a beautiful system. Flavors from the mother’s diet are transmitted through amniotic fluid and mother’s milk. So, a baby learns to like a food’s taste when the mother eats that food on a regular basis.”

However, regardless of whether your baby is breast-fed or formula fed, the article points out the importance of offering your baby “plenty of opportunities to taste fruits and vegetables as s/he makes the transition to solid foods by giving repeated feeding exposures to these healthy foods.”

What’s the answer to get Americans to eat their veggies? I vote for focusing on the children. Perhaps if Jamie Oliver’s Food Revolution continues, not only will children start eating healthier, but their new habits may rub off on their parents too.

Photo via Masahiro Ihara on Flickr

Cross-posted on BlogHer.

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BPA Exposure ‘Much Higher’ Than Believed & Proposed BPA Ban

Bisphenol-A or BPA — a chemical used primarily to make plastics — has been under scrutiny in the United States since 2008 when its safety was called into question. Most recently, a study published Sept. 20 in the online NIH journal Environmental Health Perspectives “suggests exposure to BPA is actually much greater than previously thought and its authors urge the federal government to act quickly to regulate the chemical that is found in baby bottles, food-storage containers and many household products.”

One of the researchers, Frederick vom Saal, professor of biological sciences at the University of Missouri, said in a news release that the study “provides convincing evidence” that BPA is dangerous and that “further evidence of human harm should not be required for regulatory action to reduce human exposure to BPA.”

According to a New York Times article, the U.S. Environmental Protection Agency says “it is OK for humans to take in up to 50 micrograms of BPA per kilogram of body weight each day. The new study, published in the journal Environmental Health Perspectives, suggests that we are exposed to at least eight times that amount every day.”

In August, Canada placed BPA on a toxic-substance list under the Canadian Environmental Protection Act. The country first banned BPA-containing plastic baby bottles in 2008, “but the new move will see BPA removed from all products on store shelves. As a result, Canada will become the first country in the world to declare BPA as a toxic substance.”

Five states in the USA – Connecticut, Massachusetts, Washington, New York and Oregon – have limits on BPA, particularly in children’s products, but California state legislature recently failed to pass a bill that would have eliminated BPA from baby bottles, sippy cups and infant formula cans.

Senator Dianne Feinstein (D-CA) believes BPA should be legislated on a national level and wants to amend the Food and Drug Administration Food Safety Modernization Act currently under consideration in the Senate to ban BPA from children’s food and beverage containers. However, Republicans and industry representatives are pushing back, saying that research hasn’t conclusively proven that the chemical is harmful. Sen. Feinstein said, “In America today, millions of infants and children are needlessly exposed to BPA. This is unacceptable. If this isn’t a good enough reason to offer an amendment, I don’t know what is.”

What is BPA and Why Should You Care?

Bisphenol-A is “a synthetic estrogen used to harden polycarbonate plastics and epoxy resin.” It is found in many plastic containers as well as in the lining of canned goods. According to the Environmental Working Group:

Over 200 studies have linked BPA to health effects such as reproductive disorders, prostate and breast cancer, birth defects, low sperm count, early puberty and effects on brain development and behavior. BPA leaches from containers like sippy cups, baby bottles, baby food and infant formula canisters into the food and drink inside where it is then ingested by babies and children. The CDC found BPA in 93 percent of all Americans. Just last year EWG research revealed BPA in umbilical cord blood of newborns, which demonstrates that babies are exposed to this toxic chemical before they are born.

The Environmental Working Group has some tips to avoid exposure to BPA. Raise Healthy Eaters also has a post about How to Become a BPA-Free Family. Maryann Tomovich Jacobsen, a registered dietician, recommends things such as:

  • Switching from plastic food storage containers to glass
  • Reducing your canned goods use
  • Using stainless steel water bottles and more.

Take Action:

If you’d like to urge your Senators to support the FDA Food Safety Modernization Act and Senator Feinstein’s amendment to ban BPA in baby bottles and other children’s products, you may send them an email.

Related Posts:

Photo via nerissa’s ring on Flickr

Cross-posted on BlogHer

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Preparing for a Wedding vs. Preparing to Give Birth – How Much Time Do You Invest?

I read a Tweet this week by Kristen (@OmahaBabyLady) that made me take pause. She said, “Why will people plan for a year for their wedding but 12 weeks of childbirth classes is too long? WTF?” I’d never thought of it in that way before, but it resonated with me. Many people spend a year or longer planning and preparing for their wedding, but how much time do they spend preparing for the life-changing and life-giving event of giving birth to their child?

Kristen, who is a Bradley childbirth educator and doula, was prompted to Tweet and blog about this after a potential client reacted to the news that the birth classes Kristen offered would be 12 weeks long. “Twelve weeks!,” she exclaimed. “You expect me to spend 12 weeks on something so simple as giving birth?” Kristen was at a loss for words and reflected on this for a few days before she made the analogy between preparing for a wedding and preparing for a birth. She said on her blog Baby’s Best Beginning that she planned for her wedding for more than 15 months, including visiting wedding message boards, interviewing people and spending “countless hours agonizing” over all of the details and says most of the people she knows did/do the same. “Of course at the end of the day all that really matters is that they are able to marry their partner but very few people say ‘well, the minister/priest/rabbi etc. is the expert on marriage I will just do whatever they say in regards to my wedding,’ yet when it comes to birth so many couples simply defer to whatever their doctor tells them is best even when there is no medical evidence supporting those choices.”

So is 12 weeks too long to spend preparing to give birth? Kristen obviously doesn’t believe so. She feels, “When it comes to bringing your child into the world this is truly not a case of less is more.”

Not everyone agrees though. @SybilRyan argues that the two events (wedding and birth) are “not even remotely similar” and shouldn’t be compared. Genevieve is taking Bradley classes now and thinks 12 weeks is too long, but eight weeks would be perfect. “I love my teacher, the other parents, etc., but 12 weeks is a really long commitment when you have so much else to do to prepare for your baby.” @Reecemg who blogs at Metagestation said she took an eight-week class and it was the perfect length. Others, such as Heather who blogs at Christian Stay At Home Moms thinks an intensive four to six hour one-day class would be good, as “its difficult to find time to go to a class 1x per week for 12 weeks.”

Mary, who blogs at One Perfect Mess, said on Twitter, “The length [of the class] probably depends on the quality. For us four meetings was plenty.”

Merry With Children also commented on Twitter and said, “I know there are things to learn but so much of it [birth] is going to go how its going to go. Too much info is just scary.”

Rebecca thinks people put more time preparing for their wedding than childbirth for exactly that reason — fear. She commented on Twitter, a “wedding is fun, childbirth is scary. ‘Experts’ will take care of everything when you show up at hospital.”

Andi who blogs at Confessions of a Judgmental Hippy agrees with Kristen and thinks, “if a woman can commit to 12 prenatal appointments (average) then 12 weeks (sessions) of [childbirth education] should be easy.”

Whitney blogs at The (Un)balancing Act of Motherhood took Bradley classes and thinks the length of time was “perfect,” although admits she gave birth before attending the last two classes. She added, “I can’t imagine learning about what happens in birth, what to expect, what to do, etc. in one class or even four classes. But like I said, that’s just me. Others would be fine with one or four classes.”

What do you think? Can the two events – a wedding and a birth – be compared? What is the “right” amount of time to prepare for giving birth?

I planned for more than a year for my wedding, and although I didn’t attend a 12-week Bradley Method session, I feel like I put a good deal of preparation into childbirth. I took Hypnobirthing classes before my first child was born, which were six two-hour classes if I remember correctly. I also read a lot and practiced the Hypnobirthing techniques.

I agree to some degree with Merry With Children in that no matter how much one prepares, birth is “going to go how its going to go.” But I also think the more you know and understand about birth, the better informed you will be to make choices along the way. Knowledge is power.

Photo credits:
Bride – http://www.flickr.com/photos/diannadesign/486944603/
Maternity – http://www.flickr.com/photos/mcgraths/3656184801/in/photostream/

Cross-posted on BlogHer

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FOX News says Infant Co-sleeping Deaths Linked to Formula Feeding

The internet has been abuzz lately about a recent FOX News report that has linked co-sleeping deaths to formula feeding. The report, which I found to be quite balanced (though somewhat sensational), is based on a number of co-sleeping or bed sharing deaths in the city of Milwaukee and the city’s message that there is no such thing as safe bed sharing.

I first read about the report from a Tweet by Allie from No Time for Flash Cards. Annie from PhDinParenting quickly posted the FOX News video for all to view and discuss.

The City of Milwaukee Health Department is currently running this ad – with a headstone in place of a headboard – to discourage ALL parents from co-sleeping with their babies. “For too many babies last year, this was their final resting place.” I guess they figure fear mongering is better than educating. As a mother who made an educated decision to co-sleep with my children, I find it quite offensive.

Then there is a TV ad that the state of Indiana is running (more fear mongering) to convince parents that they only place a baby should sleep is in a crib which is plain disturbing.

The FOX News report does a good job of representing both sides of the co-sleeping debate and even interviewed Dr. James McKenna, who literally wrote the book on safe co-sleeping.

The report revealed (although not until the very end of the video) a surprising finding, that in all of the Milwaukee co-sleeping cases they reviewed for 2009 and so far in 2010, 100% of the babies were formula fed. McKenna predicted the outcome and even goes so far as to state, “I really actually think that breastfeeding is a prerequisite for bed sharing.”

The blogger at The Babydust Diaries qualifies the formula finding:

This isn’t to say that the formula caused the death or that formula fed parents don’t care but there are some specific circumstances that can make these kids more prone to bed-related deaths2. The video mentions positioning and waking of the mother but also the frequent wakings of the child. Formula takes longer to digest and thus those children sleep for longer stretches than breastfed babies and often sleep deeper – causing an increase in SIDS deaths as well.

The Fearless Formula Feeder wrote about her thoughts on the Fox report in Cosleeping and formula feeding: a tale of two scapegoats. She particularly took offense at “the immediate and inaccurate battle cry against formula and formula feeding” on Twitter. She suggests rephrasing Tweets from things like:
“FORMULA FEEDING, not alcohol or soft bedding, at root of bed-sharing baby deaths!”
“Formula feeding was the common factor in these poor babies’ deaths!”
“Breastfeeding could protect against cosleeping deaths”
“Formula feeding parents should be alerted to cosleeping risks”

The Fearless Formula Feeder adds:

If you watch the video, it is clear that bottle feeding was indeed associated with 100% of the cosleeping death cases in Milwaukee. …

However, the sensationalist news report also mentioned, in passing, some other important factors. Like that the majority of the babies lived in low-income, black families. And that 75% lived in households where smoking was a factor, and many had parents who engaged in drug use or drank frequently. Or that a number of the cases, though originally classified as cosleeping deaths, were later ruled as other causes of death, like SIDS.

Although the City of Milwaukee Health Department would like it to be a black and white issue, there are clearly shades of gray. The medical examiner reports in Milwaukee County showed that the vast majority of co-sleeping deaths were African-American babies living in what the Black Health Coalition calls “chaotic homes.” McKenna agrees that there is an “overwhelming predominance of deaths in the lower socioeconomic environment.” Yet the city refuses to acknowledge and address the complexities.

The Baby Dust Diaries blogger commented on this as well:

The other issue brought up in the piece is about socioeconomic status. Statistically, more bed-related deaths occur in poorer and often unstable homes. Once again this is a correlation not a causal relationship. I was flabbergasted at the health department woman’s assertion that she shouldn’t even have to think about different types of people. Seriously? How do you serve a population and remain blind to the demographics? I really liked the woman from the community program [Black Health Coalition]. She, correctly, points out that ignoring the reality of the situations at home only drives these already under-served people further away from the services that can help them.

She also points out that there’s a difference between a mom who brings her baby into bed as a last resort and falls asleep and a mom who has done her research and knows how to safely bed share – like she did, as did I. “It isn’t a last resort of the exhausted, but a well-thought out, planned, and safe situation.”

So is it fair, as the city of Milwaukee and the state of Indiana suggest, to say nobody should ever co-sleep? Or how about what James McKenna said, that only breastfeeding moms should be allowed to co-sleep? Or should we instead try to raise awareness about the risks AND benefits of co-sleeping for both breastfed and formula-fed babies and the increased risk for formula-fed babies so that parents can make decisions based on research rather than on fear?

For more information about safe bed sharing, visit:

Cross-posted on BlogHer

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Cesarean Awareness Month: Why is it so hard to get a vaginal birth?

April is Cesarean Awareness Month. You may wonder why an entire month needs to be devoted for raising awareness about c-sections. Here’s why. The c-section rate in the United States is on the rise at an alarming rate. It’s estimated that in 2008 over 1.3 million babies in the US were born by c-section, accounting for 32.3% of all births. It also marks the 12th consecutive year the Cesarean birth rate has risen, despite a number of medical organizations — including The World Health Organization (WHO) and American Congress of Obstetricians and Gynecologists (ACOG) — urging medical care providers to work on lowering the Cesarean birth rates and increase access to Vaginal Birth after Cesarean (VBAC).

Cesarean Awareness Month - April

My Gentle Birthing Blog discusses that while VBAC is often suggested as an option to a woman who has had a c-section, in reality, VBACs are hard to come by due to the fact that many hospitals no longer allow them.

According to the National Center for Health Statistics, the C-section rate in the United States has risen 53% since 1996. Cesarean birth is being overused, and VBAC (Vaginal Birth After Cesarean) is being grossly underused, at about 8%, because many hospitals are outlawing VBACs. Because of bans on VBACs, women have been denied access in over 40% of hospitals in the United States. The National Institutes of Health has found that VBACs are reasonably safe for women who had a previous cesarean birth and are low risk for uterine rupture.

Andrea Owen says, “Fighting for my own VBAC has changed my life. I don’t use that term very often, only when I truly mean it. It opened my eyes up to the world of American obstetrics, and how far we’ve come away from birth as a natural process. In my opinion, we’ve shoved a big, fat middle finger in Mother Nature’s face.”

And in the sometimes the truth is stranger than fiction category, the Keyboard Revolutionary wants to know how it is that “a woman can waltz in off the street, say she’s pregnant and wants a Cesarean, and everyone leaps to her command….yet a woman who IS pregnant has to jump through hoops and fight tooth and nail just to give birth vaginally?” Yep, in 2008 in Fayetteville, NC, a woman who was NOT even pregnant was given a c-section.

So how can a woman avoid a c-section in the first place? Knowledge is power. Here is a list of Five Essential Questions to ask your care provider. My Gentle Birthing Blog also has a list of the risks with cesarean birth as well as a list that might help you avoid having your first c-section.

On Live Your Ideal Life guest blogger Pamela Candelaria who writes over at Natural Birth for Normal Women discusses the risks of a c-section as described on a typical consent form and says, “what isn’t on the form may be surprising.”

Heather of A Mama’s Blog provides a lot of information about The Reality of C-sections.

And Breastfeeding Moms Unite posted What to Expect of Your Body after a C-section.

Bellies and Babies has a great round up of posts in honor of Cesarean Awareness Month.

There is one victory worth celebrating regarding Cesarean birth and women’s health in general. Thanks to the Health Care Reform, c-sections, giving birth and domestic violence can no longer be considered pre-existing conditions and used to deny insurance coverage. It’s a step in the right direction, but so much more needs to be done to lower the c-section rates and allow women access to VBACs, so that they don’t have to travel 350 miles just to have a vaginal birth. And that’s why an entire month is needed to raise awareness about cesarean sections.

Additional resources:

Photo credit: Flickr – Grendellion

Cross-posted on BlogHer

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