Archive for the 'medical news' Category

Having sex late in pregnancy does not induce labor, researchers say

http://www.npr.org/templates/story/story.php?storyId=16618423

My loving hubby called me to let me know that there was a story on NPR about new research on labor induction via sex.   (The guy doesn’t really get my fascination with birth, and listens for hours on end when I talk about things like placentas and episiotomies and my thoughts on the management of the second stage of labor, yet calls me when a story like this is on!  Love him!)  Click on the above to listen then come back here.

As a doula, when my clients get uncomfortable in the last few weeks and start talking about how they can’t take another day of being pregnant, I have been listing out natural induction methods.  Sexual stimulation is always one of the things I mention.  (I don’t mention herbal methods of induction or castor oil, as I feel they are out of my scope of practice and should be discussed instead with their care provider as they are more controversial.)  I always assumed sex was the best method of my natural induction bag of tricks – semen has natural prostaglandins in it, nipple stimulation is often involved in sex and can bring on contractions, and orgasm contracts the uterus as well.  Given that the study and the speaker on the NPR story are from the medical (vs. the midwifery) model of care and I heard a couple of red flags, I think it may change how I talk to my clients during the last few weeks of labor.

In the past, here was my “normal” speech:  “I can hear how uncomfortable you are.  Would you like to hear ways to ease your comfort, or ways to encourage labor to begin?  (Client chooses to hear labor encouraging methods)  There are a number of ways to encourage labor to start naturally.  You can try…”

Here I think will be my “New and improved” speech:  “I can hear how uncomfortable you are.   You may have heard about many ways of encouraging labor to start on its own, such as walking and sex.  New research is showing that while these methods should work in theory, they actually do nothing more than increase your contractions for a few hours and get you excited, then peter out leaving you physically exhausted and emotionally frustrated.  Although it may be disappointing to hear that there is no good way to help labor along, it might be helpful to remind yourself that your body does know what it is doing.  The physiology of how labor begins is a very complex process, and even induced labor in the hospital does not mimic naturally occurring labor very closely.  Did you know that there are many chemical reactions that occur in the mother’s body to begin labor starting several days before you feel it, but that the very first reaction actually occurs in your baby’s brain?  So in fact, your baby will choose when s/he will be born.  How cool is that?  In almost every case, a mother will go into labor on her own, given the chance to do so.  And there are real benefits on waiting – a healthier baby and an easier labor being the big ones.  Your body is gearing up for labor, and the discomfort you are experiencing now will actually make labor shorter and easier when it does occur.  I know you are uncomfortable.  There is not a mother this far along in pregnancy that does not feel your pain, and I’ve been there myself.  My theory on it is that we are designed to be this uncomfortable in the last few weeks in pregnancy so that we actually look forward to the pain of labor when it begins.  But the good news is there are things you can do to ease your discomfort.  You can try a warm bath, hands and knees and other positions, hot and cold packs, massage, and distractions such as movies, shopping, dining out, visiting friends, baking, and starting a big project that you may or may not be able to finish before the baby comes.  Or you can practice your breathing and other coping techniques we’ve learned together and hone them so they’ll work better for you during labor.  Keep in mind that your body knows what it is doing and try to forget about due dates and other arbitrary timelines – you will go into labor when you and baby are ready.”

I’m starting to understand just how deeply the thought that we can somehow magically jumpstart our labor effects the mother.  When she tries something then fails over and over, it teaches her that something is wrong with her body and she learns to distrust herself.  She believes that her body is incapable of going into labor, so induction looks better and better.  And coupled with our culture telling moms that “37 weeks is full term” (can we just all stop saying that please?) and “I’m past my due date (at 40 weeks plus one day instead of at 42 weeks)”, unless the mom is steadfast in her resolve opts for induction, thinking that at least it will all be over and at least she can choose her doctor and her due date.  And we all know that an induced labor is not only physically more painful, but also usually comes with many more interventions because induced labor must be monitored more closely.  External fetal monitor, the IV (pitocin), perhaps internal fetal monitor or interuterine pressure catheter all have cords wrapped around mom, so mom is in more pain yet tethered to a bed where she cannot move to cope well.  And with induction, the increased likelihood of foreceps/vacuum assisted birth or cesarean birth all come into play.  And a mother who wanted a natural labor and got anything but (whether it was a few extra cords, or an epidural, or an assisted or cesearean birth) begins to resent her care providers, herself and possibly even her baby.

As a doula, having a mom second-guess her birth experience is absolutely the last thing I hope for my clients.   I want a mom feeling empowered about her decisions, whatever they are.  So while I will never try and stop a mother from doing what comes naturally *for her*, I’m going to stop with the old wives’ tales induction speech.  Sometimes learning to walk the “evidence-based practice” walk is hard, but it is well worth it.

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Confirmed: A link between breast cancer and hormone replacement therapy

Kaiser Permanente in Portland, Oregon has confirmed it: hormone replacement therapy that was so popular only a few years ago then was stopped suddenly did, in fact, have links to breast cancer, and was not, as many suggested, just because of the increase in the use of mammography that caught more cases of breast cancer.

But does hormone therapy-once touted as being heart-healthy and preventing bone-thinning osteoporosis-offer any benefits? “To get rid of hot flashes and to make it through the night, it’s probably a reasonable thing,” Berry says. “But don’t count on it having any long-term beneficial effects.”

Glass stresses that there are other treatments for cardiovascular and bone health that are more effective and less risky. “The only reason to take…[hormones]…now is for menopausal symptoms,” he says, “and it should be the smallest dose for the shortest time.”

It’s just one more example of how no treatment is often the safest and most effective treatment.


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