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.

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.

Sugar and Preeclampsia

Assumption: It is wise to keep processed sugar to a minimum during pregnancy

This Norwegian study concludes that processed sugar (sugar-enhanced beverages were mentioned specifically) can contribute to the condition known as preeclampsia.  Sugars found naturally in fruit did not cause the same problems and, in fact, were associated with a decreased risk of preeclampsia.

My Views:
I am not one to turn down sugary treats when they are offered from time to time, but I can see the wisdom in not keeping them around and indulging daily. 🙂  This study does not mention high fructose corn syrup, but since that is one of the main sugars used in beverages, I can’t help but think this one to particularly stay away from.  Several years ago I remember reading some advice (sorry no citation here; will look for a study!) that increased protein consumption could decrease ones chance of preeclampsia. That advice would seem to go along with this in that a high protein/ low sugar diet would be a healthy one.  I am pleased to see, however, that fruit was not implicated with processed sugar.  The body does handle different kinds of sugars differently and natural sugars like those found in fresh fruit are good for you!  (Be sure not to mistake fruit for fruit juice, however.  Even 100% fruit juice is the juice of MANY pieces of fruit, which can be too much of a good thing.)

Gestational Diabetes Screening

Assumption: Screening for gestational diabetes helps prevent problems during pregnancy.

In this study including nearly 4,000 women, screening for gestational diabetes was inconclusive about whether there were any improved outcomes for mothers and babies.

My Views:
I find this very interesting because I have seen first-hand and through my clients that GB is taken very seriously by the medical community.  Blood sugar is monitored 7-14 times a day, even if insulin is not used.  Tests, including nonstress tests and sonograms, are ordered often, regardless on blood sugar readings.  This is a lot of time and energy spent by both doctors and patients.  If all these resources are being used, I’d like to see a correlation to a better outcome for mom, baby, or both.

Corticosteroids for Preterm Babies

Assumption: A dose of corticosteroids given to women at high risk of preterm labor helps babies’ lungs develop and prevents problems.

No negative side effects have been documented, but fewer babies are dying of breathing problems when moms are given an injection of corticosteroids prior to birth.  The corticosteroids help the lungs develop more quickly, preventing respiratory distress.

My Views:
Since the lungs appear to be the last organs to fully develop, I am so glad women have options that will help their babies breathe if the babies are born early (prior to 37 weeks).  These studies indicated no adverse effects to mom or baby, which is comforting as well.  However, the studies examined in this report examined the effects of ONE does of the steriods.  Multiple doses *may* have effects and should be used sparingly.

Prescribed Bed Rest

Assumption: Bed Rest will prevent premature birth.

Although more studies are needed, current findings show no evidence that bed rest prevents premature birth.

My Views:  My suspicion is that bed rest per se is not going to prevent premature birth.  However, I wonder if stress might contribute to the problem.  Some women may be working too hard and therefore bed rest would be helpful for getting them to slow down.  Other women might be *more* stressed if they are limited to the bed.  Finding a situation that is right for the woman involved should be the main goal of the physician when deciding to prescribe bed rest or not.

Hands and Knees Position

Assumption: The hands and knees position prior to labor helps baby move into optimal birthing position.

Studies have shown no evidence that babies move into a better position when moms assume the hands and knees position for 10 minutes twice daily in late pregnancy.  This does not mean that there is harm in the position, just that it is not proven to help with positioning.  It can and does, however, alleviate backache during labor.

My views: Hands and knees can be a very comfortable position for women during the third trimester because gravity allows the baby to move away from the parts s/he is usually pressing on. 🙂  So, if it feels good to mom, there is no reason not to relax in this position.  During labor, this position is particularly comfortable if baby is posterior (facing up).  I have not found any studies that demonstrate whether this position can help a baby turn *during* labor.  I suspect that giving the baby extra room to move doesn’t hurt as baby is aligning him/herself for birth.

Late Pregnancy Ultrasound

Assumption: Ultrasound tests always provide important and beneficial information for pregnant women and their babies.

Studies demonstrate that late pregnancy (24 weeks+) ultrasounds for low-risk pregnant women do not provide benefit for Mom or baby.  Having late pregnancy scans did not change the number of women who had preterm labor, labor induction, or instrumental deliveries.  Those with scans did have a slightly higher cesarean birth rate.  For baby, late scans did not  affect birthweight, condition at birth, necessary interventions, or admission for special care.  Infant survival was no different between the groups with and without late pregnancy ultrasound.

My Views:
I’m a little concerned about over-use of ultrasounds in pregnancy in general and am glad to have these studies to show women that more is not always better.  Of course, nothing here shows that late ultrasounds *cause* problems (other than the higher rate of c-sections) either, so that should be noted.  I just wonder if bombarding our tiny babes with sound waves is as safe as assumed… maybe it is.  But, deciding against late pregnancy ultrasounds certainly should not be frowned upon, in light of this research!

Midwifery Care

Assumption: Women need to be under the care of a medical doctor to receive the best are during pregnancy.

Unless there are “substantial medical or obstetric complications,” women should be offered the choice of being cared for by a midwife.  In randomize trials, women under the care of midwives experienced no adverse affects and felt more in control of their birthing situations.

My Views:
I love the midwife-led model of care, personally.  Midwives tend to be able to give their patients more individualized time at each appointment and in my experience this translates to women feeling more educated and more empowered about making choices regarding birth.  Many people do not realize that a midwifery model is available in some hospitals, so those who do not want to have their babies at home can still receive midwifery care.

Some recommendations for midwifery care in the San Antonio area:

Hospital birth:
Lone Star Midwives

Birth Center or Home Birth:
San Antonio Birth Center (Alisa Voss)

Family Birth Center (New Braunfels)

Home Birth:
Jennifer Kelleher

Robin Rabenschlag

Salli Gonzalez

Beta-Blockers for Hypertension

Assumption: Precaution is needed when taking any medication during pregnancy.  Beta-blockers for high blood pressure are included.

Although beta-blockers taken during pregnancy can help lower blood pressure, babies whose mothers took beta-blockers grew more slowly than average babies.

My Views:
Of course, your care provider must help you weigh the benefits and risks of any medication you take while pregnant.  If you have mild to moderate hypertension, I think it would be best to look for alternate ways to lower blood pressure so as not to risk the baby’s health.  And what would those alternate ways be?  Hmmm.  Let me see what I can find!

Ooohhh… how about this one?! 🙂