The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA
This brief but well-referenced post analyzes cesarean rates relative to differences in maternal diagnoses or pregnancy complexity. On average, the likelihood of cesarean delivery for an individual woman varied between 19 and 48 percent across hospitals.”
Birth attendants often claim that their high cesarean rate is due to their clientele - that they provide care for a lot of high-risk clients. This analysis shows that:
Among lower risk women, likelihood of cesarean delivery varied between 8 and 32 percent across hospitals.
Among higher risk women, likelihood of cesarean delivery varied between 56 and 92 percent across hospitals.
Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics.
This shows that practice variation in cesarean rates is real, substantive, and not just a reflection of the mother’s risk level.
Tips for Choosing a Care Provider - great overview! from Henci Goer
From: Cfirstname.lastname@example.org (Reuters) Subject: Maternal infection raises cerebral palsy risk-study Organization: Copyright 1997 by Reuters Date: Tue, 15 Jul 1997 13:03:24 PDTCHICAGO (Reuter) - The risk of developing cerebral palsy rose nine-fold in babies of normal birth weight who were exposed to infection in their mothers' wombs, a study said Tuesday.
Judith Grether of the California Birth Defects Monitoring Program and Karin Nelson of the National Institute of Neurological Disorders and Stroke studied 424 babies born in Northern California from 1983 to 1985, 46 of whom suffered from disabling spastic cerebral palsy.
``Maternal fever exceeding 38 degrees Celsius (100.4 Fahrenheit) in labor was associated with a 9.3-fold increase in the risk of unexplained spastic cerebral palsy, as was a clinical diagnosis of chorioamnionitis,'' they wrote in the Journal of the American Medical Association.
Chorioamnionitis is an infection involving the membrane surrounding the fetus, the amniotic sac and amniotic fluid.
``One or more indicators of maternal infection, placental or other, during the admission for delivery were noted in 22 percent of children with unexplained cerebral palsy,'' the researchers wrote.
Previous research had associated maternal or placental infection with an increased risk of cerebral palsy in low birth weight infants, but not among normal birth weight babies who represent about half of all cases.
The current study also found maternal infection was linked to delivery room depression and neonatal seizures, symptoms commonly attributed to birth asphyxia.
Two to six babies per 1,000 born in the United States develop cerebral palsy, which stems from brain damage suffered in the later months of pregnancy, during the birthing process, or early in life, according to the American Medical Association's Encyclopedia of Medicine. Many sufferers are also mentally retarded, although a proportion are of normal or high intelligence.
In an accompanying editorial, David Eschenbach of the University of Washington in Seattle said the new study clarified some issues but raised new questions, including treatment options for pregnant women with evidence of infection and for their newborns.
But he said any progress was welcome for the affliction that incurs
annual medical costs of $2.4 billion, ``representing one-third of the cost
of the 18 most common birth defects.''
From: Cemail@example.com (UPI) Subject: Mom's infections bring risk of palsy Organization: Copyright 1997 by United Press International Date: Tue, 15 Jul 1997 13:21:28 PDTUPI Science News
CHICAGO, July 15 (UPI) -- A study of California babies shows that infections in their mothers may explain previously mysterious cases of full-term infants born with cerebral palsy.
Doctors have known that infections increase the risks of the movement disability for premature infants. However, the study released today in the Journal of the American Medical Association links maternal infections to cerebral palsy in full-term babies.
The researchers focused on bacterial infections of the placenta, kidneys, urinary tract and blood at the time of delivery.
Judith Grether, from the California Birth Defects Monitoring Program, and colleagues drew their conclusions from birth records for the 155,000 plus babies born in the San Francisco Bay area in the early 1980s. Grether, in Emeryville, worked with Dr. Karin Nelson from the National Institutes of Health, to identify 46 normal-weight babies whose cerebral palsy had none of the previously known causes. Doctors had already checked for obvious explanations like brain malformations, injuries during the pregnancy or herpes exposure. Studying these babies led to the warning about maternal infections.
Grether now estimates that infections in mothers may account for as much 19 percent of cerebral palsy in normal-weight babies.
She warns that doctors need more research before they can control the
risky infections. Grether points out that timing can be tricky in giving
antibiotics effectively to pregnant women. However, other ways of controlling
inflammation are under development.
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