Trusted Information for Healthy Pregnancies
postpartum
Ultrasound Reveals Breastfeeding Mechanics
May 12th
Although it might look like a baby is chewing on the mother's nipple, ultrasound images show that the infant actually removes milk by creating a vacuum - also known as sucking.
The finding is important, as it could explain why some babies fail to take to the breast. It may also shed new light on why - for a minority of women - breastfeeding really can be a painful experience.
"There have been two theories about how breast milk is expressed," says Donna Geddes of the University of Western Australia in Crawley.
"One is that the baby uses a peristaltic or compression motion to actually push the milk out of the nipple and breast. The other theory is that vacuum is primary in removing the milk."
Until now, most studies examining the mechanics of breastfeeding have focused on bottle-feeding infants, or on old X-rays that were of poor quality.
Instead, Geddes and her colleagues combined ultrasound imaging of infants suckling on the breast with measurements of the strength of the vacuum created by the baby's mouth in 20 infants aged 3 to 24 weeks as they breastfed.
"What we see is that when the tongue is lowered and the vacuum is applied, that's when the milk is coming out of the breast, and that doesn't involve any compression of the nipple," says Geddes. "It's not a milking action at all."
They also found that infants who struggled to breastfeed generated much weaker vacuums than successful breastfeeders. This may explain why babies with a cleft palate often fail to breastfeed, as do premature babies: preterm infants don't have strong enough mouth muscles to suck hard enough.
The next step is to devise a simple and universal test that could be used to assess babies' ability to suck. This could reassure mothers whose infants are struggling to feed that it's not their fault. "Currently there are no measurements to assure the mother or the clinician that things [in the breast] are working," says Geddes.
For such women, keeping the milk flowing using a breast pump and using this to top up breastfeeding until the baby is strong enough to suck effectively may be a better option than giving up on breastfeeding altogether.
The team also looked at women who found breastfeeding painful and discovered that their infants had a particularly vigorous action.
"They're strong suckers," says Geddes. Some were also distorting or crushing the nipple. Further study of these infants may aid the development of better nipple shields to reduce pain during breastfeeding.
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7 Tips to Get Ready for Breastfeeding
May 6th
The world tells us breast is best, but when you're pregnant for the first time, planning to breastfeed can be intimidating.
All the conflicting advice doesn't help -- toughen up your nipples! No, don't touch them!
You're going to be leaking milk like crazy! No, that milk won't come in for days after baby's born!
The Stir got the skinny on what you really need to know to be ready to breastfeed from Laura Keegan, a family nurse practitioner and author of Breastfeeding With Comfort and Joy: A Photographic Guide for Mom and Those Who Help Her, who maintains a holistic family practice in southern Dutchess County, New York.
"Communication with your partner, family, and friends about your plans to breastfeed and what you'll need from them in the early weeks is THE most important component of breastfeeding preparation during pregnancy," says Keegan. "There's a learning curve experience to breastfeeding and everyone in your circle needs to be prepared."
Chat up your family. Limiting visitors postpartum is recommended by the World Health Organization's Baby Friendly Hospital guidelines to get acclimated to breastfeeding. But you'll have to tell grannies and aunties beforehand.
"A good rule for visitors in the first weeks is to limit their stay to 15 minutes per visit and request that they bring a meal," Keegan says. "To provide perspective, in cultures where breastfeeding is the norm, women and their families have a period of 40 days with minimal visitors and activities outside the home combined with full support from their community in terms of meals and child care."
Talk to your partner about what to expect. "Although it's difficult to anticipate the experience of a crying baby having difficulty taking the breast in the middle of the night, it's important to talk about the importance of staying calm and focused during those challenging times and understanding and anticipating that it's a normal part of the learning curve," Keegan says.
Talk to your health-care provider. "Let them know that you want to have your baby placed immediately on your chest at birth and to delay all routine procedures until after you've had time skin to skin with your baby, allowing your baby the opportunity to feed within the first hour of birth," Keegan suggests. "Consider writing a birth plan to communicate your preferences, because how you birth your baby can impact breastfeeding. With a Cesarean birth, the baby can be brought to the chest and feed even as the incision is being closed."
Find a pediatrician with breastfeeding expertise or a lactation consultant. "Ask if someone will be able to observe and evaluate your baby feeding during an office visit, if there's a concern about the baby’s weight," Keegan says. "Have a phone number available for a trusted lactation specialist or consultant in your area to call should you need assistance."
Talk to the hospital staff. Ask for the baby to "room in," and let them know there should be no use of artificial nipples (i.e., pacifiers, formula bottles).
Find breastfeeding moms. Talk to them for tips now but also so you'll have someone to reach out to when baby comes. They can work with you on ways to hold the baby that "facilitate ease in breastfeeding rather than the ways you may be accustomed to seeing for bottle-feeding," Keegan says.
"In cultures where breastfeeding is the norm, moms hold their babies more to the center of their bodies than you might expect because with bottle-feeding, we hold our babies more to the side of our bodies for bottle placement," she explains. "This bottle-feeding imprinting causes many unnecessary challenges for breastfeeding, and the desire to correct this imprinting was the inspiration for Breastfeeding With Comfort and Joy."
Talk to your boss. "Seek out comfortable places to nurse in advance for when you're on the go, so you'll feel prepared to nurse outside your home in comfort just as a bottle-feeding mom is comfortable nursing outside her home," Keegan suggests.
Sterilization surgery not linked to sexual problems
Feb 18th
Women who have their "tubes tied" to prevent future pregnancies do not seem to have an increased risk of sexual dysfunction afterward, according to a new study.
In fact, researchers found, women in their study who'd had the procedure showed lower risks of certain sexual problems and tended to be happier with their sex lives than other women.
The surgery, known as tubal ligation, involves blocking the fallopian tubes that connect the ovaries with the uterus. It is done either right after childbirth -- through the vagina or during a cesarean section -- or via laparoscopic surgery, where one or two small incisions are made in the abdomen.
There are no physiological reasons to believe tubal ligation would cause sexual problems, but there has been little research on the subject, said Dr. Anthony Smith of La Trobe University in Melbourne, Australia, the lead researcher on the current study.
What studies there are have generally only asked women about their general sexual satisfaction, Smith told Reuters Health in an email.
For their study, Smith and his colleagues surveyed 2,721 Australian women about various sexual dysfunction symptoms and their overall satisfaction with their sex lives. Of those women, 447 -- or about 16 percent -- had had a tubal ligation, most of whom were between the ages of 40 and 64.
Overall, women who had had the procedure were less likely to report sexual problems and more likely to say they were happy with their sex lives, according to findings published in BJOG, a British medical journal.
Just over 42 percent said they lacked interest in sex, for example, compared with 51 percent of women who had not had a tubal ligation. And while 17 percent of the latter group said they "did not find sex pleasurable," only 14 percent of women in the tubal-ligation group said the same.
When the researchers accounted for other factors -- like age, education and marital status -- women who'd had a tubal ligation were roughly one-third less likely to lack interest in sex, take "too long" to reach orgasm, have vaginal dryness during sex or find sex unpleasant.
In addition, the study found, women in the tubal-ligation group generally gave higher marks to their sex lives. Thirty-six percent reported "extremely high sexual satisfaction," compared with 30 percent of women who had not had the procedure; when the researchers considered the other factors, women in the tubal-ligation group were two-thirds more likely to give such high ratings to their sex lives.
It's possible, Smith's team notes, that the women and their partners were enjoying sex more because they were free of anxiety over a potential unplanned pregnancy.
Of course, tubal ligation is only one method of birth control. In general, experts recommend it only for women who are sure they do not want to become pregnant in the future. And like any surgery, it carries some risks -- including bleeding or infection during the procedure, and incomplete closing of the tubes; about one in 200 women who have a tubal ligation later become pregnant.
Studies have also found that anywhere from 6 percent to 20 percent of women who have the procedure later regret their decision -- with younger women being more likely to express regrets.
Source
Migraine drugs don’t up birth defect risk: study
Feb 16th
A study in nearly 70,000 pregnant women has found no link between migraine drugs called triptans and the risk of birth defects.
However, the researchers did find a "slight increase" in the risk of excessive bleeding during labor, and the failure of the uterus to contract normally after delivery, for women who used the drugs while pregnant.
Triptans are among the most powerful drugs used for migraine; others include aspirin, Excedrin, and ibuprofen.
While as many as three in 10 women may develop migraines during their childbearing years, women often shy away from using such drugs during pregnancy because of safety concerns, according to study co-author Katerina Nezvalova-Henriksen of the University of Oslo in Norway and her colleagues.
However, the authors of the study in Headache note, untreated migraine may itself carry risks for mother and child; some studies have linked it to pre-eclampsia, a potentially deadly pregnancy complication.
"While it is important to exert caution when using any medications during pregnancy, this study indicates" that pregnant women can either start or continue taking triptans without "any major risk" of miscarriage, premature delivery, or other bad outcomes, the authors conclude.
Nezvalova-Henriksen and her team studied nearly 70,000 women. Two percent, or 1,535, had used sumatriptan (Imitrex), rizatriptan (Maxalt), zolmitriptan (Zomig), or eletriptan (Relpax) in pregnancy.
Less than one percent -- 373 women -- had used the drugs before getting pregnant but not during pregnancy.
The overall birth defect rate, which encompasses everything from large birthmarks to serious heart problems, was the same among women who had taken triptans during pregnancy and those who didn't have migraines: 5 percent. Among those who had used triptans in the past but not during pregnancy, it was slightly higher: 6 percent.
The women who used triptans were also more likely than non-triptan users to take other drugs during pregnancy, including acetaminophen (Tylenol) with codeine and non-steroidal anti-inflammatory drugs such as ibuprofen.
However, the rate of major birth defects - such as serious problems of the limbs or internal organs -- was 3 percent for all three groups. That rate - about one in 33 births - is about what would be expected for all birth defects in the general population.
The researchers did find that women who used triptans in their second or third trimester were more likely to develop a condition called atonic uterus, in which the uterus fails to contract back to its normal size after delivery. This is the leading cause of excessive bleeding after delivery. They were also more likely to lose significant amounts of blood during labor and delivery.
And during pregnancy, they were more likely to suffer from vomiting than women who had never used the drug; they were also more likely to develop pre-eclampsia or eclampsia, and more likely to have deficiencies in the B-vitamin folate.
While many women who suffer migraines will experience improvements in their symptoms after their first trimester, Nezvalova-Henriksen and her team note, those whose symptoms don't improve by then aren't likely to get better.
Source
With C-Section, Stitches May Be Best
Feb 4th
Women who've had a cesarean delivery are less likely to suffer complications if their wound is closed using sutures rather than staples, says a U.S. study.
It included more than 400 women who underwent cesarean delivery in labor or scheduled cesarean delivery and were interviewed two to four weeks after the procedure.
The researchers at the Lehigh Valley Health Network in Allentown, Pa., found that: wound separation rates were 16.8 percent for staples and 4.6 percent for sutures; composite wound complication rates were 21.8 percent for staples and 9.1 percent for sutures; and that 36 percent of women who received staples required post-surgery physicians visits, compared with 10.6 percent of women who received sutures.
Median surgery time for women who received staples was 49 minutes, compared with 57 minutes for those who received sutures.
The researchers concluded that the use of staples for cesarean delivery wound closure is associated with increased risk of wound complications and post-operative physician visits. They said their findings suggest that sutures may be the preferred method.
The study was to be presented Thursday at the annual meeting of the Society for Maternal-Fetal Medicine in Chicago.
Source
Massage Reduces Depression in Pregnant Women
Jan 26th
New research shows massage therapy reduced depression in pregnant women, and also reduced the incidence of massaged women's babies being born prematurely.
The study was conducted by researchers at the Touch Research Institutes, where pioneering research about massage has been conducted since 1992.
Pregnant women diagnosed with major depression were given 12 weeks of massage, twice per week, by their significant other. A control group did not receive massage, according to an abstract published on www.pubmed.gov.
The massage-therapy group versus the control group not only had reduced depression by the end of the massage-therapy period, they also had reduced depression and cortisol levels during the postpartum period.
The massaged women's newborns were also less likely to be born prematurely and low birthweight, pubmed noted, and they had lower cortisol levels and performed better on the Brazelton Neonatal Behavioral Assessment habituation, orientation and motor scales.
Source
Prompt treatment beneficial for pregnant and postpartum women with H1N1
Dec 31st
Delayed treatment of suspected influenza A (H1N1) illness among pregnant women may result in a four-fold risk of intensive care admission or death, according to results of a recent study.
Regardless of rapid antigen test results, prompt evaluation and antiviral treatment should be considered for pregnant or postpartum women displaying influenza A (H1N1)-like symptoms, according to researchers from the California Department of Public Health.
The study was a review of records for women of reproductive age who had been hospitalized or died from influenza A (H1N1) between April 23 and August 11, 2009.
The study involved 94 pregnant women, 137 non-pregnant women and 8 postpartum women who had delivered <2 weeks prior. False negative results for rapid antigen tests were observed in 38% of patients.
Among 94 pregnant women, 95% were in the second or third trimester. Risk factors for complications from influenza other than pregnancy were observed in 32 of 93 (34%) of those pregnant women.
Early antiviral treatment was defined as treatment <2 days after the onset of symptoms. Pregnant women treated later than this had an RR of 4.3 for admission to an ICU or death.
Intensive care was required for 18 pregnant women and four postpartum women (total, 22 of 102 [22%]). There were eight deaths (8%).
Of six deliveries which took place in the ICU, four were emergency cesarean deliveries.
The specific mortality ratio associated with influenza A (H1N1), which the researchers defined as the number of maternal deaths per 100,000, was 4.3.
Source
Kerri Walsh Is Pregnant Again!
Dec 15th
Seven months after giving birth to her first child, two-time Olympic gold medalist Kerri Walsh is pregnant again. She says she will skip the 2010 season and longtime partner Misty May-Treanor will play with a new teammate for the first time since 2001.
Kerri Walsh amazed mothers everywhere in August when she stepped back into a bikini and competed on the AVP Tour just more than two months after giving birth to her first child. She'll impress many more if she can do it again.
She'll have a chance again this summer because she's almost four months pregnant with her second child, Walsh told UniversalSports.com on Friday.
"I'm pregnant again so I'm taking the year off and Misty is going to be playing with a different partner," the 31-year-old said, adding, "My due date is May 30, so end of May I'll be taking care of my family and starting to creep back into shape and I'll be ready for the 2011 season. My hope and my plan is for Misty and I to get back together and be better than ever."
"The goal is to play together and win in 2012, to win an Olympic gold medal," Walsh said.
Though Walsh, who is married to fellow AVP star Casey Jennings, says she's aiming to be back for the 2011 season, few would be surprised to see her sooner. She gave birth to a son, Joseph Michael, on May 22 and was back on the court in early August. Walsh says she's itching to play again right now.
"Part of the challenge of coming back this year was to make sure that I could do it and I did physically. And once I can wrap my head around it mentally then I know I'll be a better player than ever before," Walsh said.
Source
Glucose Intolerance in Pregnancy Associated With Postpartum Cardiovascular Risk
Dec 6th
Women who have gestational glucose intolerance (a condition less severe than gestational diabetes) exhibit multiple cardiovascular risk factors as early as three months after birth, according to a new study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM).
Placenta Teddy Bear?
Nov 11th
After giving birth, many women choose to have the placenta tossed out by hospitals. Some women are choosing less conventional ideas...
British designer Alex Green is taking people's placentas and turning them into teddy bears.
"I was very interested in how it was discarded unceremoniously as medical waste, why it's discarded and how we could bring it back…" said Green, who thought placentas deserved a symbolic treatment whether they're saved or not. "It was really about provoking a debate about placentas and how we treat them."
Green said that the placenta must first be cured with salt to kill the bacteria and remove water. He then softens it with eggs and tannins. Once the placenta is prepared, he sews it into the shape of the bear and fills it with brown rice.
"It's more heavy than you'd imagine -- they're more the sort of thing that you'd stick on a mantel pieces," Green told ABC. "It feels soft, somewhere between leather and suede but it's much more flexible than leather -- it's bendy."
Green knows that his idea isn't for everyone. "Of course a lot of people feel it's grotesque," said Green. "But, quite a few women have expressed interest in making them."
Many readers expressed disgust at the the concept. "This is just weird, and a gimmick, and yet one more thing to sit on a shelf, take up space, and collect dust. And, of course, lots of bucks for the 'artist' who thought it up," said LS on the blog ParentDish.
Added reader Ann, "Why turn the placenta into a teddy bear. That's disgusting...I think it's better to save the placenta and spinal cord in case the baby needs it to cure a disease in the future. It's called cord blood banking and so much more valuable than what has to be the most awkward teddy bear in the world."
But many treat the placenta with respect. Some cultures bury placentas and plant fruit trees on top of them as a living monument for the birth of their children. Discovery Green offers a how-to guide. Others believe that eating the placenta can be healthy for women who have just given birth. In Chinese medicine , eating placentas are said to replenish lost blood and nutrients. Some even believe it can help with postpartum depression.
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