From my inbox
Some stats on very low birth weight infants (500-1500 gms) which is where 22 weekers would fall. These are taken from Minneapolis Children's Hospital and Clinics 2002 VLBW statistics report.
Occurence of complications are as follows:
Periventricular Leukomalacia: 3% (this is what leads to cerebral palsy)
Chronic Lung disease 26%
Necrotizing Entercolitis 5%
Intraventricular Hemmorhage (IVH) 25%
Severe IVH 7-10%
Retinopathy of prematurity (ROP) 31-42%
Severe ROP 10%
Survival WITHOUT morbidity ` 49%
At 4 years of age former 23 weekers have a 36% chance of having normal neurodevelopmental outcomes, 13% have mildly abnormal outcomes and 51% have severely abnormal outcomes (n=53)
I would refer you to an article entititled Survival and Long Term Neurodevelopmental Outcomes of Extrememly Premature infant Born at 23-26 weeks Gestational Age at a Tertiary Center by Ronald Hoekstra, Bruce Ferrrara, Robert Couser, Nathaniel Payne, and John Connett, The article appeared in Pediatrics Vol 113 January 2004
Midwifery: February 2005 Archives
From my inbox
According to a study from Denmark, there are higher rates of sick and dead babies, as well as worse maternal outcomes for Type 2 than Type 1 or non-diabetic women.
I have a few theories on why this is the case.
First off, Type 2 diabetes can be hard to diagnose before it has done significant damage to the person's cardiovascular system. Hence, the placental implantation and development is adversely affected.
Secondly, Type 2 diabetes is seen as a non-disease by many of those who have it. You don't have many symptoms, and untreated, it takes a long time to die from it. Conversely, type 1 diabetes makes its sufferers very sick fairly quickly and it is dramatic in its effects. Coma gets attention.
Thirdly, until quite recently, there was little effort made to encourage those with type 2 diabetes to keep their sugars under tight control. Type diabetics are encouraged to check sugars at least 4 times daily, more often if sick or stressed. Pregnant type 1 diabetics test 7 times daily (at least initially). I am lucky if I can get a (non-pregnant) type 2 diabetic to test twice a week.
Another factor is that type 2 diabetes is usually treated with oral medications, and those are usually only given if lifestyle changes are unsuccessful. There is a psychological difference between taking a pill and injecting medication - injection seems to make things seem more real, more serious somehow.
I also wonder if many of these poor outcomes are among women who thought themselves infertile, and whose fertility recovered before they got their diabetes under control. I also wonder if the docs who diagnosed their diabetes and intitiated treatment gave these women the ugly truth about the impact of diabetes on reproductive outcomes.
It is extremely important for women with diabetes who are at any risk of pregnancy to keep their diabetes under very tight control before conception and during the entire pregnancy. This can drastically reduce the risk of major malformations (heart, kidneys, spinal cord) that occur in as many as 10% of babies concieved to poorly controlled diabetic women. Continuing tight control can also reduce the risk of pre-eclampsia, macrosomia (huge babies), and other complications.
Gestational diabetes is a different topic, but anyone with a history of gestational diabetes should try to eat low-glycemic for the rest of her life and should be tested for type 2 diabetes on a regular basis. Between 40 to 60% of women with gestational diabetes will go on to develop type 2 diabetes later in life.
Presented by one of my midwifery mentors, B.J. Snell CNM
A friend sent me this link, which looks to be a paper from a Christendom student. I haven't had a chance to read through it in detail, but the author cites all the same folks that I would cite for such a paper.
(American Academy of Pediatrics Newest Policy Statement)
Considerable advances have occurred in recent years in the scientific knowledge of the benefits of breastfeeding, the mechanisms underlying these benefits, and in the clinical management of breastfeeding. This policy statement on breastfeeding replaces the 1997 policy statement of the American Academy of Pediatrics and reflects this newer knowledge and the supporting publications. The benefits of breastfeeding for the infant, the mother, and the community are summarized, and recommendations to guide the pediatrician and other health care professionals in assisting mothers in the initiation and maintenance of breastfeeding for healthy term infants and high-risk infants are presented.
New Low- and High-Tech Calendar Methods of Family Planning (Medscape registration required)
Calendar-based methods are not usually considered effective or useful methods of family planning among health professionals. However, new "high-" and "low"-tech calendar methods have been developed, which are easy to teach, to use, and may be useful in helping couples avoid pregnancy. The low-tech models are based on a fixed-day calendar system. The high-tech models are based on monitoring urinary metabolites of female reproductive hormones. Both systems have high levels of satisfaction. This article describes these new models of family planning and the research on their effectiveness. The author proposes a new algorithm for determining the fertile phase of the menstrual cycle for either achieving or avoiding pregnancy.
Preliminary data for 2003 indicated that 27.6% of all births in the United States resulted from cesarean deliveries, an increase of 6% from 2002 and the highest percentage ever reported in the United States. After declines during 1989—1996, the total cesarean rate and the primary cesarean rate (i.e., percentage of cesareans among women with no previous cesarean delivery; 19.1% in 2003) have increased each year. In addition, the rate of VBAC, which had increased during 1989—1996, decreased by 63% to 10.6% in 2003. Among women with previous cesarean deliveries, the likelihood that subsequent deliveries would be cesarean was approximately 90% in 2003.
Source: National Vital Statistics System, annual files, 1989—2003.
I fully recognize that most of these cesareans are totally necessary when they are done, but I am concerned that not enough is done to help women and their babies to be healthy before and during labor. I am also concerned that among the general public, there is a perception that a cesarean is the easy way to have a baby (especially a scheduled cesarean). Ask many of the readers of this blog who have been there (RoseMarie, recovering owl,) or especially those who have done it both ways (Elena?) and you will hear that in many cases, a cesarean is still a case of the mom sacrificing a bit of herself for the sake of her child (the reason that many moms in the 1940s were afraid to go to Catholic hospitals - the false idea that Catholic doctors would sacrifice the mother to save the baby).