Wednesday, July 25, 2007

Ricki Lake's birth documentary

Several people have asked about "The Business of Being Born," Ricki Lake's documentary about birth in the hospital and birth at home. The most recent update I have is that the film could have a limited theatrical release in the fall and perhaps an airing on Showtime before the DVD is released by the end of the year. It is an eye-opening film.

Monday, July 09, 2007

Gateway drug

From the LA Times....,0,7239244.story?coll=la-home-nation

Birth drug leaves some moms feeling worse
A drug commonly used for preterm labor has more serious side effects than alternatives and may even harm newborns, researchers say.
By Thomas H. Maugh II
Times Staff Writer

June 30, 2007

The drug most commonly used to delay preterm labor in women has more — and more serious — side effects than alternatives, without being any more effective, Stanford researchers reported Friday. The drug may even harm infants, they concluded.

Although labor generally cannot be stopped completely, physicians try to delay it for at least 48 hours to allow transfer of the mother to a specialized hospital and to maximize the effectiveness of steroids used to help the fetus' lungs mature.

The drug most commonly used is magnesium sulfate, but nifedipine and others are occasionally used.

"There is no free lunch with any of these drugs," collectively called tocolytic agents, said Dr. Deirdre Lyell of Stanford University's Lucille Packard Children's Hospital. "But magnesium sulfate has some particularly unpleasant side effects, including vomiting, lethargy and blurry vision. The alternative, nifedipine, often leaves women feeling better."

Despite obstetric advances, preterm delivery — births before 37 weeks' gestation — remains a major problem. In the U.S., 12.3% of births are preterm, for reasons largely unknown. Prematurity is the cause of 30% of infant deaths and of a variety of developmental problems.

Lyell, Dr. Yasser El-Sayed of Stanford and their colleagues studied 192 women in preterm labor at Packard Children's and Santa Clara Valley Medical Center. Half were randomly assigned to receive infusions of magnesium sulfate, and half oral nifedipine.

In the journal Obstetrics & Gynecology, the team reported that though magnesium sulfate quieted contractions more effectively than nifedipine, there were no differences in how long delivery was delayed, in the gestational age of the newborn or in the birth weight of the infants.

Meanwhile, two-thirds of the women who received magnesium sulfate experienced mild to severe side effects during treatment, including shortness of breath and fluid buildup in the lungs. Only a third of the women receiving nifedipine experienced side effects, such as headaches.

Infants born to the mothers who received magnesium sulfate, moreover, were more likely to be admitted to the neonatal intensive care unit and to stay there longer — a median of 8.8 days, compared with 4.2 days for the babies whose mothers received nifedipine.

Dr. Victoria Camerini, a neonatologist at Childrens Hospital Los Angeles who was not involved in the study, pointed out that magnesium can cause respiratory depression and bowel dysfunction in infants and that the mother's body has a mechanism to transport the drug across the placenta.

"If an obstetrician asked me which drug I would prefer," she said, "I would say nifedipine."

The researchers emphasized that magnesium sulfate was still an appropriate treatment for preterm labor. Many physicians continue to use it at the two hospitals where the study was conducted.

But perhaps it is time for physicians to give more weight to side effects when considering what to try first, Lyell said. "It has been my experience that women who have had magnesium sulfate remember it," she said. "They don't like it."

The findings are "probably a strong call to come up with more effective … agents with fewer side effects," said Dr. Michael C. Lu of UCLA's David Geffen School of Medicine, who was not involved in the research. "We also need to rethink our strategy in terms of preventing preterm births. Giving tocolytic therapy may be too little, too late."


Monday, July 02, 2007

New baby in the family

My brother's wife had a baby last Wednesday. Now, this would be a point of fascination for any aunt, but of course, Morgan's arrival was of particular interest to me. When I was finishing the manuscript for my book, Birth the Surprising History of How We Are Born, the final words I wrote were about my sister-in-law, Annmarie. She had just witnessed her own sister's delivery of a baby girl by cesarean (the baby was breech.) And Annmarie was transfixed by the idea of scheduling a date, waddling in to the OR, and having a newborn pulled from the zipper compartment. I wrote about her story in the context of the cesarean generation. (One out of every three babies in the US is born by c-section today, certainly not all out of necessity.)
Last fall, however, after Annmarie had read my book, she found out she was pregnant. Suddenly she seemed to have had a change of heart. She wanted a vaginal birth -- perhaps even with an element of surprise! So we were all excited when last week, she checked in to the hospital and contracted for several hours on her own. But her doctor thought her progress was slow compared with others on the maternity floor. Then came the Pitocin. Then the pain. Then the epidural. Then nothing...for three hours. No more dilation. So she had a c-section. The baby was in zero distress, by the way.
When the OB started cutting, Annmarie screamed. She could feel the scalpel scraping across her taut belly. They upped the juice and tried again. Again she screamed. They then put her under general anesthesia. When she woke up, she saw her gorgeous baby girl, with dark hair and big eyes, blinking at her.
Annmarie, like most new mothers I know, had little time or energy to question what had just happened. Fumbling with nursing, nursing a scar, she just valiantly got on with things, the many many things, involved with being a mother: loving her perfect baby, and being grateful for it. It's an anesthesia more powerful than the one they pumped into her in the OR.