Tell Me When to Push

Assumption: Medical personnel help women give birth by telling them when to push and counting for them.

In this study, medical personnel stopped several practices that have become standard in our hospitals. They stopped telling women when and how long to push and allowed women to push in the position of their choice (usually not on their backs since this is less comfortable for most women).  During the study, the incidence of third and fourth degree tears decreased significantly.

My Views:
This isn’t surprising to many women who have given birth. The body’s natural urges tend to guide Mom better than a generic formula. I’d like to see a study of these same women in five or ten years and compare to a control group in assessing lasting perineal trauma. (i.e. peeing on yourself when you sneeze or jump) I suspect there would be a significant difference there too.

Relaxation During Pregnancy

Assumption: Mom’s state of relaxation in pregnancy affects Mom and Baby during and after labor and birth

This review of past studies demonstrates that relaxation during pregnancy does affect several aspects of labor, including:
Mom’s emotional state,
Fewer obstetric and postpartum complications,
Reduction of fetal heartrate and motor activity,
Higher birth weights, and
Regulation of emotional states and physiology

My Views:
This is the crux of the earliest theories put forth by Dr. Lamaze.  The ability to relax during pregnancy and labor does affect both Mom and Baby.  Whether they use breathing patterns, positioning, massage, yoga or other meditation techniques, visualization, hypnosis, or anything else, it is so important for moms to be able to will their bodies to release tension during pregnancy.  And once a woman has mastered the art of total release through relaxation, she can use these same skills for the release of tension during labor itself.

Lower Blood Pressure and Raise Amniotic Fluid Levels

Assumption: If you cannot control your blood pressure with diet and exercise during pregnancy, your only other option is medication.

This study demonstrates that immersion in water can lower blood pressure and raise amniotic fluid levels during pregnancy.

My Views:
This is great news for women who want to avoid medication during pregnancy, but who realize the risks of high blood pressure or are afraid of low amniotic fluid.  Unfortunately, both blood pressure and amniotic fluids started returning to their baseline levels 30 minutes after immersion, so this is not a long-term fix.  I’d like to see further studies about how water can be utilized in pregnancy, though.  This is a great start!

Exercise Bike in Labor?

Assumption: During labor, walking is the most strenuous exercise a woman should do.


In this study, 84% of women perceived labor to be less painful while riding an exercise bike versus being at rest.  Conclusions were that it did not cause harm to the baby, stimulated labor, and alleviated some pain, possibly due to endorphin release.


My Views:
Before I go too far, I will say that this study only included 50 women, so it is not the final word on the subject.  It should, however, encourage more research I think!  I know that riding an exercise bike during labor probably doesn’t appeal to many women, but for those who are interested, it is good to know that it is nor only safe, but could possibly be beneficial!  The more choices women have about how to cope with pain during labor, the more women are going to have positive labor experiences.  Definitely worth looking into!

Breastfeeding and Breast Cancer

Assumption: Breastfeeding is good for the baby and for bonding, but otherwise is insignificant to the mother.


The authors of this study found a direct correlation between breast cancer (or lack thereof) and breastfeeding.  More women with breast cancer had either not breastfed at all or had done so for a shorter duration (less than 10 months) than those without breast cancer (over 15 months).


My Views:Of course, this is all statistics and breastfeeding will not assure that you will not get breast cancer, but it is certainly good information to know!  The more I read, the more convinced I am that our hormones play a big part in both our personalities and our health.  This study does not state that hormones are the reason for the protectiveness breastfeeding provides, but I would not be surprised if future studies do demonstrate the importance of the hormones released while breastfeeding.

Length of Labor With Epidural

Assumption: Getting an epidural does not affect the length of labor in most women.

This new (2014) study confirms that for most women, an epidural adds about 2 hours to the length of a normal labor prior to vaginal birth.  The study reviewed the cases of over 42,000 births and compared the length of the second stage of labor (the pushing stage).  The authors point out that standard practice is to intervene when stage 2 is one hour longer than a “normal” labor.  This study indicates that maybe more time should be given before medical intervention is begun.

My Views:
I realize than many women will choose a longer labor without the pain to a shorter labor with the pain, but I think it is only fair to tell women they may be extending the time of their labor so they can make that choice themselves.  It would also be wise for the medical practitioners to give as much time as possible to the laboring woman if baby and mom are healthy.  Beginning interventions just based on the clock may be causing unnecessary interventions, including cesarean sections.  So, with this study in mind, if the clock does remain important, maybe they could extend the “expectant management” (waiting and watching) time to 2 hours instead of 1 to give women a better chance to birth their babies vaginally and without expensive and intrusive interventions.

IVF and Perinatal Outcomes

Assumption: An IVF pregnancy is just the same as a naturally occurring pregnancy.

FALSEIn this study from 2004, researchers found that low birthweight, early preterm delivery, spontaneous preterm delivery, placenta previa, gestational diabetes, preeclampsia, and neonatal intensive care admission were statistically higher in women who had used IVF to achieve pregnancy.  The conclusions recommended that doctors take this into consideration when recommending elective preterm labor induction or cesarean.


My Views:I am in no way against IVF and in fact some of my very favorite people started life this way! 🙂  However, I recently got a question from a student about whether she should actively petition her doctor to induce because her baby was conceived through IVF and I thought this topic was an interesting one to look into.  My research found that while morbidity was more prevalent in IVF babies, this was usually associated with other factors, including mother’s health and multiple pregnancies.  This study actually indicates that induction, particularly induction before the due date, is contraindicated and should be avoided because of the prevalence of low birthweight babies and NICU admission.

Acetaminophen in Pregnancy

Assumption: Acetaminophen is safe during pregnancy.

This is only one study, but it is the only long-term study of its kind and the results may surprise you.  Children whose mothers had taken acetaminophen for 28 days or more during pregnancy showed delays in motor and communication skills and had more behavioral problems than their siblings who were not exposed to the drug.  The authors of the study hypothesize that taking  acetaminophen for short periods will likely not cause damage.  They also caution that further research is needed before concluding causality.

My Views:While I understand that the authors of the study do not want to cause undue alarm, I think it is important that pregnant women understand that any chemical they put in their bodies reaches the fetus and it is the doctor’s role to help her weigh the risks (proven or not) and the benefits of taking the drug.  When a drug is assumed safe, like acetaminophen, people often are not as cautious with its use and do not fully think about risks vs benefits.  It is important to make studies like this known so women can make decisions based on even *possible* consequences.

GBS+ and Antibiotics

Assumption: If a mother tests positive for Group B Strep, she must have antibiotics or her baby will catch GBS.

In this study, mothers who used chlorhexidine for vaginal flushings were no more likely to pass GBS to their babies than those who were on antibiotics.  In fact, when antibiotics were used, e. coli was more prevalent.

My Views:
As a person who greatly appreciates the value of antibiotics when they are necessary and who greatly respects the need to use antibiotics *only* in these necessary situations, I am pleased that a simple vaginal flush can accomplish the same goals while exposing neither mother nor baby to unnecessary IV antibiotics.  If you are GBS positive and would like to avoid IV antibiotics during labor, ask your doctor or midwife about this alternative.  (Chlorhexidine is sold over-the-counter with brand names such as Hibiclens and Dexidin.)

Infant Gut Microbiota

Assumption: All human guts contain similar microbiota.

This study analyzed the gut microbiota of infants and determined that two factors significantly impacted the types of microbiota found.  The factors were elective cesarean birth and ingestion of infant formula.

My Views:
This study does not define any particular gut microbiota as “good” or “bad.”  It simply states that the make-up is *different* in babies, depending on type of delivery and what they are fed.  From here we can research how each of these microbes works and what we can do to keep our babies as healthy as possible.  So, I don’t see this study as an endpoint, but as a beginning.