As I described in the first part of this post, being on the road in recent weeks has led to my finding a larger-than-usual number of interesting articles that I’d like to share, so I have created these posts as a round-up of the most interesting-looking articles that are awaiting my full attention, in the hope that some might be of interest to others as well…
1. Umbilical blood flow patterns directly after birth before delayed cord clamping
The latest tidbit about physiological cord clamping comes from a paper which used ultrasound technology to measure the blood flow in the umbilical cords of 30 babies straight after birth, in the hope of adding to our knowledge about the duration and patterns of blood flow as the newborn baby adapts to extrauterine life. The results were as follows:
“Venous flow: In 10% no flow was present, in 57% flow stopped at 4:34 (3:03-7:31) (median (IQR) min:sec) after birth, before the cord was clamped. In 33%, flow continued until cord clamping at 5:13 (2:56-9:15) min:sec. Initially, venous flow was intermittent, increasing markedly during large breaths or stopping and reversing during crying, but then became continuous.
Arterial flow: In 17% no flow was present, in 40% flow stopped at 4:22 (2:29-7:17) min:sec, while cord pulsations were still palpable. In 43% flow continued until the cord was clamped at 5:16 (3:32-10:10) min:sec. Arterial flow was pulsatile, unidirectional towards placenta or bidirectional to/from placenta. In 40% flow became continuous towards placenta later on.”
The authors’ conclusions included that, “during delayed umbilical cord clamping, venous and arterial umbilical flow occurs for longer than previously described. Net placental transfusion is probably the result of several factors of which breathing could play a major role. Umbilical flow is unrelated to cessation of pulsations.”
Boere I, Roest AAW, Wallace E et al (2015). Umbilical blood flow patterns directly after birth before delayed cord clamping. Archives of Disease in Childhood: Fetal and Neonatal Edition , vol 100, no 2, March 2015, pp F121-F125.
2. Being a homebirth midwife in the Nordic countries – a phenomenological study
It can be fascinating to read about others’ experiences of midwifery, and also heartening for those who work in more medicalised situations to read about midwifery in lower-tech settings. As a midwife I met recently said, it’s nice to know that it’s still alive and possible. Researchers conducted interviews with 21 homebirth midwives from the five Nordic countries and used a phenomenological approach to analyse the data. The resulting paper includes some lovely descriptions of the kind of midwifery that many of us are working hard to keep alive:
“The midwives find a unique way of working with every family, following the individual rhythm of each woman. They can be close to the woman, comforting and supporting her. On the other hand, they can provide stillness as well, letting the woman and her partner rule the birthing process by themselves, with the midwife acting only if needed. The midwives’ descriptions of their trust in a woman’s ability to give birth have influence on their handling of the situation; they talk more about their “being” than their “doing”. It does not mean that the midwife is passive; she is attentive and ready to act, but not by doing or saying a lot of things.
You would think that doing more gives more, but that’s not how it is… actually, less is more, the simpler, the more the woman is able to do what she wants to do.
The most important thing is keeping things calm, not being unnecessarily active … keeping a balance between being and doing.
They mean that a woman finds it easier to give birth when she is allowed to be herself, and they strive to allow the woman to “be who she is.” When focusing on one woman’s birth process, you can follow the flow and be in contact with intuition since the attention is not being disturbed by other tasks.”
Sjöblom I; Lundgren I; Idvall E; et al, (2015). Being a homebirth midwife in the Nordic countries – a phenomenological study. Sexual and Reproductive Healthcare. Online ahead of print.
3. Intrapartum Synthetic Oxytocin Reduce the Expression of Primitive Reflexes Associated with Breastfeeding
Aim: Several synthetic peptide manipulations during the time surrounding birth can alter the specific neurohormonal status in the newborn brain. This study is aimed at assessing whether intrapartum oxytocin administration has any effect on primitive neonatal reflexes and determining whether such an effect is dose-dependent.
Materials and Methods: A cohort prospective study was conducted at a tertiary hospital. Mother–infant dyads who received intrapartum oxytocin (n=53) were compared with mother–infant dyads who did not receive intrapartum oxytocin (n=45). Primitive neonatal reflexes (endogenous, antigravity, motor, and rhythmic reflexes) were quantified by analyzing videotaped breastfeeding sessions in a biological nurturing position. Two observers blind to the group assignment and the oxytocin dose analyzed the videotapes and assessed the newborn’s state of consciousness according to the Brazelton scale.
Results: The release of all rhythmic reflexes (p=0.01), the antigravity reflex (p=0.04), and total primitive neonatal reflexes (p=0.02) in the group exposed to oxytocin was lower than in the group not exposed to oxytocin. No correlations were observed between the dose of oxytocin administered and the percentage of primitive neonatal reflexes released (r=0.03; p=0.82).
Conclusions: Intrapartum oxytocin administration might inhibit the expression of several primitive neonatal reflexes associated with breastfeeding. This correlation does not seem to be dose-dependent.
Marín Gabriel MA, Fernández Ibone O, Malalana Martínez AM et al (2015). Intrapartum Synthetic Oxytocin Reduce the Expression of Primitive Reflexes Associated with Breastfeeding. Breastfeeding Medicine , 18 March 2015.
4. ‘Oh no, no, no, we haven’t got time to be doing that’. Challenges encountered introducing a breastfeeding support intervention on a postnatal ward.
The title sounds depressing, I know. And I’m not going to pretend that this study, which collected data through observing and interviewing postnatal ward midwives and maternity support workers (MSWs) during the process of introducing a new breastfeeding support intervention for young women, has a cheerful message. There was significant non-compliance with the support intervention from ward staff, who experienced a lack of time and control over their work:
“It was evident that the ward staff had no control over who visited the ward and when. Although none of the visitors were necessarily unwelcome, the constant and unpredictable comings and goings resulted in midwives and MSWs having little control over their time, or space to carry out their work. Midwives were often interrupted when carrying out checks or interacting with women in their care, as other staff wanted access to the women they were with, or requested assistance to find equipment or notes needed for care elsewhere. On one occasion a midwife was called from a consultation to help find equipment required by doctors, while they waited in the coffee room. Such behaviour clearly indicates that medical activities were seen as more important than midwifery care.” (Hunter et al 2015)
The paper raises some interesting – and at times controversial – issues and questions. And I’m glad these issues are getting an airing, because we’re not going to change or improve anything unless we face up to the issues that are causing the problem.
Hunter L, Magill-Cuerden J, McCourt C (2015). ‘Oh no, no, no, we haven׳t got time to be doing that’: Challenges encountered introducing a breast-feeding support intervention on a postnatal ward. Midwifery doi:10.1016/j.midw.2015.03.006
5. Cranberry juice capsules and urinary tract infection after surgery: results of a randomized trial
This study isn’t related to pregnancy/birth, but I suspect readers of this blog will still be interested. According to its authors, this paper reports on, “the first randomized, double-blind, placebo-controlled trial of the therapeutic efficacy of cranberry juice capsules in preventing UTI after surgery”. It involved 160 women who were undergoing elective gynaecological surgery (other than fistula repair or vaginal mesh removal) and who were randomised to receive either two cranberry juice capsules twice a day for six weeks, which is equivalent to two 8-ounce servings of cranberry juice per day, or a placebo.
“The occurrence of UTI was significantly lower in the cranberry treatment group compared with the placebo group (15 of 80 [19%] vs 30 of 80 [38%]; odds ratio, 0.38; 95% confidence interval, 0.19–0.79; P = .008). After adjustment for known confounders, including the frequency of intermittent self-catheterization in the postoperative period, the protective effects of cranberry remained (odds ratio, 0.42; 95% confidence interval, 0.18–0.94). There were no treatment differences in the incidence of adverse events, including gastrointestinal upset (56% vs 61% for cranberry vs placebo). Among women undergoing elective benign gynecological surgery involving urinary catheterization, the use of cranberry extract tablets during the postoperative period reduced the rate of UTI by half.”
Foxman B, Cronenwett AEW, Spino C et al (2015). Cranberry juice capsules and urinary tract infection after surgery: results of a randomized trial. AJOG doi:10.1016/j.ajog.2015.04.003
Interesting stuff, I hope you’ll agree?