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Evening primrose oil: “Don’t use it if you are pregnant?”

EPO

Many moms and midwives use evening primrose oil (EPO) for cervical ripening. So I was absolutely shocked at the complete lack of evidence on the effectiveness and safety of EPO among pregnant women. There is one study that examined the oral use EPO during pregnancy. It concluded EPO didn’t work as we expected it to and further, women who took EPO were more likely to experience a whole host of complications. Shockingly, there are no studies on the vaginal use of EPO during pregnancy. In short, there is insufficient clinical evidence documenting the risks and benefits of EPO and without that information, should pregnant women take it? [...]

The term “trial of labor after cesarean” is actually really important

TOLAC

On the acronym TOLAC (trial of labor after cesarean)….

Some studies break out statistics in four ways.

1. ERCS/D (elective repeat cesarean section/ delivery) 2. VBAC (vaginal birth after cesarean) 3. CBAC (cesarean birth after cesarean aka cesarean after planned VBAC) 4. TOLAC (VBAC + CBAC stats)

Because we are unable to predict who will [...]

Myth: VBACs should never be induced

IVdrip

Spontaneous labor is always preferable to induced or augmented labor but there are medical conditions that can necessitate the immediate birth of a baby. It’s nice for those women for whom vaginal birth is still an option to have a choice: gentle induction/ augmentation or repeat cesarean. Of course, informed consent reviewing the risks and benefits of their options is essential. Some women might be more comfortable scheduling a cesarean whereas others might want to give a gentle Pitocin and/or Foley catheter induction a go. [...]

Chipping away at the “too posh to push” myth

Some new research questions the idea that women who are “too posh to push” are responsible for America’s rising cesarean rate. The work of University of Arizona sociologist Louise Roth has been featured in an University of Arizona UA News article dated April 13, 2012.

Watch for Roth’s research which will be “published in the [...]

The best compilation of VBAC/ERCS research to date

“There is a major misperception that TOLAC [trial of labor after cesarean] is extremely risky” – Mona Lydon-Rochelle MD, March 2010. “In terms of VBAC, “your risk is really, really quite low” – George Macones MD, March 2010. Both Drs. Macones and Lyndon-Rochelle are obstetricians and researchers who made these statements at the 2010 NIH [National Institutes of Health] VBAC Conference. Now you may think, “Wait a sec. Everything I’ve heard from my family, friends, and medical provider is how risky VBAC is and how cesareans are the conservative, prudent, and safest choice.” Why the discrepancy between the statements of these two doctor researchers and the conventional wisdom prevalent in America? [...]

Just kicking the can of risk down the road

If primary and secondary cesarean rates continue to rise as they have in recent years, by 2020 the cesarean delivery rate will be 56.2%, and there will be an additional 6236 placenta previas, 4504 placenta accretas, and 130 maternal deaths annually. The rise in these complications will lag behind the rise in cesareans by approximately 6 years. [...]

Cerebral palsy cases linked with genetic abnormalities

Conventional wisdom has historically linked oxygen deprivation during labor and delivery to cerebral palsy (CP), but a new study suggests that the majority of CP cases are actually due to genetic abnormalities in at least six genes.

A Medical News Today article dated January 30, 2012 discusses the study published in The Lancet Neurology:

Although [...]

Study finds vernix protects newborns from infection

There is a reason why vernix is present. Read below for some very technical language which essentially says vernix protects newborns from fungi, parasites, and makes pathogens susceptible to our immune system.  In other words, vernix protects newborns from infection which is why it is beneficial to not wash your baby and scrub away all [...]

Studies find pregnant women with prior cesarean choose the delivery method preferred by their doctor

definition decision

“When patients perceived that their doctor preferred a repeat cesarean, very few chose to undergo trial of labor, whereas the majority chose trial of labor if that was their doctor’s preference.” Additionally, 73% of the women admitted for a ERCS did not know the chances of a successful VBAC and 64% did not know the risk of uterine rupture. 54% of women choosing a TOLAC did not know the chances of a successful VBAC and 45% did not know the risk of rupture! [...]

Study: Two-Thirds of OB-GYN Clinical Guidelines Have No Basis in Science

PushNews from The Big Push for Midwives Campaign CONTACT: Katherine Prown, (414) 550-8025, katie@pushformidwives.org FOR IMMEDIATE RELEASE: August 15, 2011 Study: Two-Thirds of OB-GYN Clinical Guidelines Have No Basis in Science Majority of ACOG Recommendations for Patient Care Found to Be Based on Opinion and Inconsistent Evidence WASHINGTON, D.C. (August 15, 2011)—A study published [...]

Cesarean Section Consent Form

From Another VBAC Consult Misinforms:

[My OB] did not mention risks to repeat c-sections.  When I brought it up he said there aren’t any except the obvious risks that come with any surgery.

It’s because some OBs continue to mislead their patients about the risks of cesareans that I share this excellent cesarean section consent [...]

The Risks of Cesarean Section

We all know the primary risk of VBAC – uterine rupture.  And when your typical VBACing mom meets with an OB, she must sign a “VBAC consent form” acknowledging that she understands this risk.  However, I find it ironic that women signing up for a repeat cesarean are not required by their OB to sign [...]

Perinatal Death Low with Home Births

perinatal = “occurring during the period around birth (5 months before and 1 month after)” (wordnetweb.princeton.edu/perl/webwn)

Perinatal Death Low with Home Births

By Nancy Walsh, Contributing Writer, MedPage Today Published: August 31, 2009 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, [...]

Risk of serious complications increase with each cesarean surgery

Shows the rates of placenta accreta in up to six cesareans (Silver 2006).

Per Silver (2006), “The risks of placenta accreta, cystotomy [surgical incision of the urinary bladder], bowel injury, ureteral [ureters are muscular ducts that propel urine from the kidneys to the urinary bladder] injury, and ileus [disruption of the normal propulsive gastrointestinal motor activity], the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries.” [...]