Since I got back from our latest trip, I’ve been catching up with the research, blog posts and thinking that went on while we were away, and I found so many interesting things that I decided to write a summary of four recent birth-related revelations that caught my eye…
More benefits for optimal cord clamping
Firstly, a systematic review published in the American Journal of Obstetrics and Gynecology (Fogarty et al 2018) has shown that delaying the clamping of the umbilical cord for one minute can reduce hospital mortality for preterm infants by around 32%. Delayed clamping also reduced the proportion of infants needing a blood transfusion by 10%. According to the authors, this analysis was conducted since the latest update to the Cochrane review on this topic and includes more babies, which means that the results give more precise estimates in relation to key outcomes. (Note: eagle-eyed followers of my newsletter may realise they have seen this news before. You’re not imagining things! I highlighted this when it came out in its ‘online ahead’ form, and I’m doing so again because the print version has now been published.)
Increasing our knowledge of gestational age and VBAC
Another recent study looked at the effect of gestational age on women who attempted VBAC after one previous caesarean section. Although not a prospective trial, this cohort study included 2849 women. “Of those, 2584 (90.7%) had a successful TOLAC (sic; this refers to trial of labour after caesarean, a term which many find unhelpful) and 16 women (0.56%) had uterine rupture. Those rates did not differ significantly for any gestational age (GA) group. Following adjustment for possible confounders, GA was not found to be independently associated with adverse maternal or neonatal outcomes.” (Ram et al 2018). I had planned to write more about this study, and then came across ‘Cinderella VBACs and Gestational Age’; a brilliant blog post by Pamela Vireday at The Well Rounded Mama, so I’m going to point you to that instead.
The language of humanising birth
A wonderful discussion piece published by the British Medical Journal explains why some of us have spent years campaigning for and writing about the importance of language in and around birth. In a freely-available piece entitled, ‘Humanising birth: Does the language we use matter?’, Natalie Mobbs, Catherine Williams and Andrew D Weeks point out that, “Sadly, some women may not be aware of their human rights during childbirth: rights for respectful care, privacy, and freedom of choice concerning their birth. It is therefore the duty of caregivers to use language that will help empower all women.” The article includes a really helpful table which offers a number of suggestions of alternatives to commonly-used and less appropriate words and phrases.
More evidence that midwives help prevent unnecessary intervention
And lastly, a study from the USA that was published in Birth shows that, “In low-risk nulliparous laboring women, care by obstetricians compared with nurse-midwives was associated with increased risk of labor interventions and operative birth” (Carlson et al 2018). The researchers, like many others before them, identified that caesarean rates vary significantly across hospitals and providers, and that this variation is the greatest in healthy women having their first babies at term. Many of these women end up with caesareans that may not be medically warranted. In the study, “adverse maternal or neonatal outcomes were not different by provider type across all modes of birth, but were more frequent in women with cesarean than vaginal births.” The authors concluded that “changes in labor management or increased use of nurse-midwives could decrease the rate of a first cesarean in low-risk laboring women”. (Carlson et al 2018).
Stay on top of the evidence!
I have long been passionate about helping midwives and birth folk to stay on top of the evidence. During our recent trip, we’ve been recording video presentations for a brand new online course which will help you to catch up with the latest birth-related research and thinking and discuss it with like-minded colleagues. We’ll be releasing more details over the next few weeks and readers of our free, monthly newsletter are always the first to hear about courses, as well as being the recipients of updates just like the one in this blog post. So if you’re not already on the list but would like to be, sign up here – we’re looking forward to connecting with you!