Medicine
Two of the most important questions that pregnant women have are: 1) How can I improve my chances of having a normal (vaginal) delivery? and 2) Does where I plan to have my baby make a difference in birth outcomes? In the August 1st issue of American Family Physician, Drs. Lee Dresang and Nicole Yonke reviewed the management of spontaneous vaginal delivery by family physicians. The authors noted that the following practices are associated with positive maternal and neonatal birth outcomes:
1) Encouraging patients to walk and stay in upright positions
2) Waiting until at least 6 cm cervical dilation to diagnose active stage arrest
3) Providing continuous labor support (e.g., doulas)
4) Using intermittent auscultation in low-risk deliveries
5) Group B streptococcus prophylaxis
6) Active management of the third stage of labor
Guidelines from the American Academy of Family Physicians and American College of Obstetricians and Gynecologists encourage women with a previous low transverse uterine incision to consider a trial of labor after cesarean delivery, as most will be able to deliver vaginally.
Although obstetricians and family physicians remain the most common birth attendants in the U.S., pregnant women at low risk of complications have been increasingly turning to midwives practicing in birth centers or other out-of-hospital settings. A United Kingdom prospective cohort study that examined perinatal and maternal outcomes by planned place of birth in 64,000 healthy women with low-risk pregnancies found no differences in the odds of a composite outcome of perinatal mortality and intrapartum neonatal morbidities in freestanding midwifery centers compared to obstetric hospital units. Planned home births were associated with worse neonatal outcomes for women delivering for the first time, but not for women in subsequent pregnancies. As one might expect, labor interventions occurred most frequently in hospital settings.
**
This post first appeared on the AFP Community Blog. I've also written other posts about the decline of vaginal birth after Cesarean and studies comparing the risks of planned home to planned hospital births.
- Once A Cesarean ... Now, A Vaginal Delivery
A recent essay in the "Narrative Matters" section of Health Affairs by physician and health policy researcher Carla Keirns highlighted the challenges that even a highly educated, well-informed patient faces in achieving the desired outcome of a vaginal...
- What Pregnancy Care Costs, And Related Writings
Elisabeth Rosenthal's New York Times story on the staggering costs of maternity care in the U.S. featured a short interview with my wife, a family physician who last year gave birth to our third child with a nurse-midwife 12 minutes after arriving...
- Vbac Redux
Several months ago, I wrote in this blog about the precipitous decline of vaginal births after Cesarean (VBAC) in the U.S., which I attributed in part to the the internalization by obstetric specialists of the medical maxim "hearing hoofbeats, thinking...
- The Decline Of Vbac: Hearing Hoofbeats, Thinking Zebras
My daughter, who turns two years old in June, is becoming something of a medical rarity. This isn't because she is showing signs of a late-developing handicap or extraordinary ability for her age - it's because she came into the world as a vaginal...
- Does The Type Of Birth Affect Postpartum Health?
My first child was born surgically via cesarean section, while my second arrived naturally by what maternity care providers call a “normal spontaneous vaginal delivery.” Surgical deliveries are rapidly becoming the norm rather than the exception in...
Medicine
Improving one's chances for a successful vaginal delivery
Two of the most important questions that pregnant women have are: 1) How can I improve my chances of having a normal (vaginal) delivery? and 2) Does where I plan to have my baby make a difference in birth outcomes? In the August 1st issue of American Family Physician, Drs. Lee Dresang and Nicole Yonke reviewed the management of spontaneous vaginal delivery by family physicians. The authors noted that the following practices are associated with positive maternal and neonatal birth outcomes:
1) Encouraging patients to walk and stay in upright positions
2) Waiting until at least 6 cm cervical dilation to diagnose active stage arrest
3) Providing continuous labor support (e.g., doulas)
4) Using intermittent auscultation in low-risk deliveries
5) Group B streptococcus prophylaxis
6) Active management of the third stage of labor
Guidelines from the American Academy of Family Physicians and American College of Obstetricians and Gynecologists encourage women with a previous low transverse uterine incision to consider a trial of labor after cesarean delivery, as most will be able to deliver vaginally.
Although obstetricians and family physicians remain the most common birth attendants in the U.S., pregnant women at low risk of complications have been increasingly turning to midwives practicing in birth centers or other out-of-hospital settings. A United Kingdom prospective cohort study that examined perinatal and maternal outcomes by planned place of birth in 64,000 healthy women with low-risk pregnancies found no differences in the odds of a composite outcome of perinatal mortality and intrapartum neonatal morbidities in freestanding midwifery centers compared to obstetric hospital units. Planned home births were associated with worse neonatal outcomes for women delivering for the first time, but not for women in subsequent pregnancies. As one might expect, labor interventions occurred most frequently in hospital settings.
**
This post first appeared on the AFP Community Blog. I've also written other posts about the decline of vaginal birth after Cesarean and studies comparing the risks of planned home to planned hospital births.
- Once A Cesarean ... Now, A Vaginal Delivery
A recent essay in the "Narrative Matters" section of Health Affairs by physician and health policy researcher Carla Keirns highlighted the challenges that even a highly educated, well-informed patient faces in achieving the desired outcome of a vaginal...
- What Pregnancy Care Costs, And Related Writings
Elisabeth Rosenthal's New York Times story on the staggering costs of maternity care in the U.S. featured a short interview with my wife, a family physician who last year gave birth to our third child with a nurse-midwife 12 minutes after arriving...
- Vbac Redux
Several months ago, I wrote in this blog about the precipitous decline of vaginal births after Cesarean (VBAC) in the U.S., which I attributed in part to the the internalization by obstetric specialists of the medical maxim "hearing hoofbeats, thinking...
- The Decline Of Vbac: Hearing Hoofbeats, Thinking Zebras
My daughter, who turns two years old in June, is becoming something of a medical rarity. This isn't because she is showing signs of a late-developing handicap or extraordinary ability for her age - it's because she came into the world as a vaginal...
- Does The Type Of Birth Affect Postpartum Health?
My first child was born surgically via cesarean section, while my second arrived naturally by what maternity care providers call a “normal spontaneous vaginal delivery.” Surgical deliveries are rapidly becoming the norm rather than the exception in...