Meconium statistics and implications

I just came across a journal article about meconium, risk factors and what some of its consequences may be.

Here's the conclusions from the article:

"Curtailment of post-term pregnancy reduces the occurrence of meconium-stained amniotic fluid, and meconium aspiration syndrome.

Uterine stimulants, particularly misoprostol, are associated with occurrence of meconium-stained amniotic fluid.

Amniotomy during labour may be a risk factor for meconium aspiration syndrome."

I wasn't able to read through this article, so I'm not sure of what their definition of post-term pregnancy means.  This definition has changed within the culture of childbirth from time to time.  Post-term usually means 42 weeks.  But I have seen some physicians and hospitals that go by after 40 weeks or 41 weeks.  What post-term is could really be a whole other discussion, though.

What I find interesting is the medical establishments fear of post-term pregnancy and it's potential outcomes(like meconium aspiration syndrome) and yet the use of uterine stimulants(like misoprostol or cytotec) and anmiotomy's are perfectly acceptable.  They are deemed needed in many normal births.  Yet both of these medical interventions are also associated with meconium stained fluid or meconium aspiration syndrome.

An interesting delemha....a first time one is 42 weeks pregnant and yet is not ready to go into labor.  Thus there is an apparent risk of meconium in the fluid.  Yet many physicans will then order cytotec or pitocin to induce labor, which is also associated with meconium in the fluid.  They will also then break the water to further encourage labor.  Both of which are also associated with meconium in the fluid.  These routine medical interventions are all done in the hopes of preventing meconium aspiration.  So which factor plays a larger role in meconium aspiration?  I'd be curious to know.  And why to we perform interventions that cause a complication when they are being used to prevent it?  Would it be better just to let the overdue mom go into labor on her own?  I'd be curious to know what those answers are.

References:

http://www.earlyhumandevelopment.com/article/S0378-3782%2809%2900198-4/abstract

OP babies

I've been looking up research on occiput posterior (OP) babies and how to help a mother work through her labor with an OP baby. Basically an OP baby is one whose face is facing to the front of the mother rather than the back. Why is this such a big deal? It creates a larger diameter around the babies head, which makes it a harder fit down the birth canal.

OP babies can lead to longer labors, increased pain, increased use of forceps or vacuums, increased risk of infection(I'm assuming this could be due to the longer labor), and bigger tears. Some studies have shown an increase in c-section rate, but I'm inclined to think that has more to do with the provider you choose.

There are also problems associated with OP babies and the outcome of the baby. An OP baby is more likely to have lower apgar scores, meconium in the amniotic fluid, birth trauma, NICU admissions, and increased NICU stays.

Factors that are associated with OP babies are first time moms , a mom greater that 35 yo, a baby that is greater than 41 weeks gestation, a baby that is greater than 4000 g, artificial rupture of membranes, augmented labors, and epidurals. The association with epidurals could be due to the fact that OP babies tend to create more painful contractions thus leading to more epidural use, but we really don't know. Luckily, 87% of the babies that present with OP in labor, turn on their own.

From what I've read, the best thing to do for the increased back pain, is to be in the hands and knees position. This is a position that has been shown to reduce back pain during labor in general. It also allows room for your labor support to use counter pressure on your hips or back. There has been some research that has shown that this position could also help rotate the baby to a more favorable position. There really hasn't been enough good research done on the rotaion of the baby, though, to come to any conclusions. It is thought to help rotate a baby due to gravitational pull.

Upright positions in general have been shown to be more comfortable for mom, decrease the length of labor, and increase the strength of the contractions. Upright positions as well as side-lying have both been found to increase the intensity and coordination of contractions. It appears that these upright positions also help to facilitate the head coming down into the pelvis. How this effects OP babies is really unknown, but I think it helps to keep these ideas in mind when dealing with an OP baby to help to facilitate labor and birth.

It is also good to note that the sitting, squatting, and hands and knees positions enlarge the pelvic outlet by 0.5-1.5 cm. This could help facilitate an OP birth as it allows more room for the baby to pass through. Being up right and moving also allows the mothers ligaments to stretch and expand more, again, allowing more room in the pelvis.

Some studies offered some interesting ideas on how to get a baby to turn, but again, they really needed to have larger sample sizes and more research needs to be done. Some of positions that showed some promise was turning the mom to the same side as the fetal spine. This appeared to shorten labors and turn the baby also. Positioning in general has not been shown to be helpful when it is done before labor. The positions mentioned above, though, did appear to help once the woman was already in labor.

Besides positioning, manually rotating the baby has shown to help decrease c-section rates at least.

Things you can do to help make sure your baby is positioned well....change positions throughout labor. For those who get an epidural (which is associated with increased risk of OP baby) request a light epidural that makes it easier to move and change position. I have had women with epidurals on hands and knees, squatting, and sitting up. Wait until you go into labor on your own, and allowing the your bag of water to break on it's own may also be useful as both of these are associated with OP babies.

References:

Cheng ,Yvonne W.; Shaffer, Brian L.; Caughey, Aaron; Associated factors and outcomes of persistent occiput posterior position: A retrospective cohort study from 1976 to 2001. The Journal of Maternal-Fetal and Neonatal Medicine, September 2006; 19(9): 563–568

McKay, Susan; Maternal Position During Labor and Birth A Reassessment. JOGN Nursing , September/October 1980; 288-291.

Ridley, Renee. Diagnosis and Intervention for Occiput Posterior Malposition. JOGN Nursing, March/April 2007; 36(2): 135-143.

Baker, Karen. Midwives should support women to mobilize during labor. British Journal of Midwifery ,August 2010; 18(8):492-498.

H1N1 and hospital safety

I am doing my own independent research. The CDC is now recommending that infants be removed from their mothers who after birth whose mothers are showing symptoms of H1N1. See link here:http://www.cdc.gov/h1n1flu/guidance/obstetric.htm"Place the ill mother in isolation after delivery (http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm). The mother who has influenza-like-illness (http://www.cdc.gov/h1n1flu/casedef.htm) at delivery should consider avoiding close contact with her infant until the following conditions have been met: she has received antiviral medications for 48 hours, her fever has fully resolved, and she can control coughs and secretions. Meeting these conditions may reduce, but not eliminate, the risk of transmitting influenza to the baby. Before these conditions are met, the newborn should be cared for in a separate room by another person who is well, and the mother should be encouraged and assisted to express her milk. Breast milk is not thought to be a potential source of influenza virus infections. As soon as all conditions are met, the mother should be encouraged to wear a facemask, change to a clean gown or clothing, adhere to strict hand hygiene and cough etiquette when in contact with her infant, and begin breastfeeding (or if not able to breastfeed, bottle feeding). She should continue these protective measures, both in the hospital setting and at home, for at least 7 days after the onset of influenza symptoms (http://www.cdc.gov/h1n1flu/guidance_homecare.htm#c). If symptoms last more than 7 days, she should discuss the symptoms with her doctor. Protective measures might need to be continued until she is symptom-free for 24 hours. People who are once again well 7 days after getting sick are thought to be at low risk for transmitting the virus to others."
I am wanting to know if this is really necessary. I would like to look at three groups of women 1)those who have symptoms and have been isolated from their baby but cont. to feed breast milk 2) those who have had no symptoms, were given baby within 2 hours after birth and breastfed 3) those who have no symptoms, but were not with baby within 2 hours after birth and breastfed or expressed milk for infants. All of these should be full terms infants (37-42 weeks) . They can be born at the hospital, or alternative birthing area.
I am hoping to follow these babies for six months to see if who is getting sick. In order for this to be a valid study, I need as many moms as possible to participate, so please e-mail this to friends and family. I will be reposting this every month, just to see if their are new people who are interested. I will also be doing this until the flu season is over. Thanks, Rachelwww.thebeginningofmotherhood.blogspot.comrachel.leavitt@gmail.com

The motherhood project

Here's a link I came across for those who are wanting to add a little bit to our research knowledge out there about women, motherhood, and birth.

http://www.headandbelly.org/