Thursday, July 22, 2010

ob/gyn: "Fetal heart monitoring is an appallingly poor test."

This story in The Philadelphia Inquirer asks a good question...
Why do we use fetal heart monitors when they do not lead to improved outcomes?

"A test leading to an unnecessary major abdominal operation in more than 99.5 percent of cases should be regarded by the medical community as absurd at best," wrote Steven Clark and Gary Hankins in the American Journal of Obstetrics and Gynecology. "Electronic fetal heart rate monitoring has probably done more harm than good."
Why do doctors cling to continuous fetal heart monitoring? An obstetrician will most likely point to the fear of being sued, but the complete answer is more complex. Our medical culture prizes technology and tests, even if they don't work and can cause harm.

"It's our bias that anything that can be quantified is an improvement," said H. Gilbert Welch, a professor at Dartmouth Medical School whose research focuses on harm caused by screening and over-diagnosis.
Alex Friedman is a fellow in maternal-fetal medicine at the Hospital of the University of Pennsylvania.

Read the full story by Dr. Friedman in The Philadelphia Inquirer:

Wednesday, July 21, 2010

Breastfeeding Cuts Fever Risk After Vaccines

A new study shows that infants who are exclusively breastfed are less likely to run fevers after their routine immunizations than infants who are partially breastfed or only receive formula.

"Babies want to nurse more frequently, and because they are nursing more frequently, they are getting more food [than formula-fed infants], so whatever need they have to repair their body and bring down the fever is being met," said Barbara Holmes, a lactation specialist at New York University Langone Medical Center in New York City.

Read more:

Thursday, July 1, 2010

Don't Short-Change Your Baby By Inducing Labor

I read this column on MSNBC today, about why women should not choose to induce labor in their final weeks of pregnancy. The author refers to a recent study that details the complications that come with late preterm births, including respiratory distress and difficulty sucking and swallowing.

I agree with the column, but I would add that the dangers of induction do not end at 40 weeks or the "due date" your doctor wrote in your medical file. Just because some babies are born around 40 weeks does not mean every baby is ready to be born at 40 weeks. Why induce at 40 weeks if you would not induce at 38?

Here are some good comments from Judith A. Lothian in the Journal of Perinatal Education:
Thinking of, and clinging to, the “due date” as “the day” makes it difficult for women to trust nature's beautiful plan for the end of pregnancy and the start of labor. What women rarely know, and what people tend to forget, is that some variation exists in how long it takes for an individual baby to mature fully. Acknowledging that babies can safely come 2 weeks before or 2 weeks after the due date does not tell the whole story. Some babies are mature as early as 37 weeks (259 days), and others need 42 completed weeks (294 days) and sometimes a bit more to be fully ready. Size is not an indication of maturity, and the due date is only a guideline.

She notes that "Waiting for labor to start spontaneously is almost always the best way to know that the baby is ready to be born and that a woman's body is ready for labor." Read her article for more details about the risks of induction: