GynoFiles

The first thing you get told when your gyno confirms your pregnancy is a due date. And most happy moms are dutifully repeating that date to all they ask! And just how reliable is that "due date" and how likely is that your baby will actually come on time? We've already discussed that obstetricians like to think in pregnancy weeks , and not really days at all. Human pregnancies typically last 280 days or 9 and 1/3 months. But many human pregnancies are delivered after that time, yet we still use the 280 days. For those that bet, ultrasound dates a few days later than the last period due date, so some say if you are a betting woman use 283 days. If we know very precisely when conception was, for instance and IVF pregnancy , then we can add on those 280 days and it's a very reliable prediction. And we then term that due date your EDC or EDD, estimated dates of confinement (old school term) or estimated date of delivery (sounds much better!). But studies done in the e...

How we can safely deliver babies is a complex topic, and one that has to consider mom in the mix. We know that c-section rates over the past 15 years have risen by more than 60% and most experts agree, that rate is alarmingly high as moms have changed a bit, but not enough to warrant such a dramatic increase. It is clear that we can decrease the c-section rate, and there are some proposals as to how from a new study of over 225,000 women that has been producing many interesting publications. In this study from the Consortium on Safe Labor , published by Boyle in OBSTETRICS And  GYNECOLOGY in July 2013 they highlight the risks of Cesarean birth as a reason to try to reduce the American C-section rate which in 2009 was at 32.9 % and appears to still be risking. Although there may be many reasons to have a c-section to increase the safety for mom and the baby(s) in the current pregnancy there are reasons that c-section present risks. It increases the risks in the next pregnan...

In a recent work shop there were two factors emphasized that will help women and their birth attendants avoid Cesarean birth: skills and patience. A third factor has been added: weight management. Since it is one of the most commonly performed surgeries in the US, accounting for a million operative procedures on women in the USA each year, avoiding this surgery is still a goal for obstetrical providers of care. In 2010 the Health People act aimed at 15% rate of Cesarean Birth, but we have over a 30% rate and climbing. So the goal, as reported in a recent workshop report seen in the journal Obstetrics and Gynecology, is to get that rate to 23.9% which would lower our rate down to what it was in the first decade of this century. Staying home also keeps the shortest labor possible, and there is some thought that will even make it less likely to have a c-section. For first timers, if you hit the hospital it is several hours before you birth. Once you actually hit 6 cm dilated, it only tak...

Being obese doesn't always mean you will have a difficult labor. There are many risks of pregnancy for those who are obese. These risks extend to wide reaching consequences including increased pregnancy associated diabetes and hypertension, larger babies, pre-eclampsia and going over due. Obese women and over weight women are 20-40% more likely to have an over due pregnancy. If you are overdue you may need an induction of labor which is more problematic and more likely to have a c-section than if you go into spontaneous labor. Obese women have more problems with the delivery itself. More inductions of labor, labor will progress more slowly in obese patients and if they do have an induction less success with inductions, which is responsible for many of the extra c-section deliveries for those with obesity. Physical obstruction of the birth canal is also a problem that can lead to c-section. But in a study published in the summer o...

Induction of labor is the bringing on of labor prior to the spontaneous onset of natural labor. The reasons for needing an induction may be either based on the health of the mother or the health of the baby, and the optimal time is when both the health of the mother and the health of the baby is considered. Some studies say that being born on time, not very much before or after this "on time" date is the best for babies. But moms may have their own health consideration, and one common medical problem is hypertension in pregnancy. A relatively new study called HYPITAT, which specifically studied hypertension in pregnancy, was quoted as saying that induction of labor "should be advised for women with mild hypertensive disease beyond 37 weeks' gestation." For more information regarding the specifics (warning some is written in Dutch!) you can go to The study of Hypertension and Preeclampsia at Term  . Some of the most interesting information regarding this trial...

Labor usually comes on its own when the baby is ready. In most cases its an onset of contractions, in only 8% do we find that the membranes spontaneously rupture on their own. The baby hasn't come yet, although your due date is nearing, or just passed, and you may find your self still wondering: what did your mom do to bring labor on? Or did Grandma try any of these "time-honored ritual of castor oil, enema, hot bath with or without quinine?" And even our grandmother's mother may have tried these things without medical supervision. Not only were these  usually a prolonged and uncomfortable ordeal, but I was often useless and could be harmful to both mother and fetus. Now days it's a matter of what is best for both mom and baby, and done with a variety of medications, typically beginning with a prostaglandin cervical ripening. Still the most commonly used medication for inducing contractions is oxytocin , and the study of the use of  oxytocin is more than a half...

Electricity was used to induce labor and it was tried by man obstetricians of old: Herder in  1802; Schreiber in 1843; Radford in 1844; Hennig in 1856; and Bayer 185. When electricity was used  to induce labor the physicians sent a constant current going through the uterus. The positive electrodes were placed on the fundus , or the top of the uterus, and the negative poll in the cervical canal or vault of the vagina. At first weak currents were used, with the currents turned off and on in the same timing pattern as we see in  normal labor pains. The current was slowly strengthened and the interval shortened. And it worked! Women who had the electrical currents did go into labor, but there were drawbacks! This was quite an efficient method of induction, but very dangerous to the fetus! (Midwives Chronicle & Nursing Notes; A History of Induction; 1978; pages 109-10.) Separation of Membranes by Forefinger (Hamilton 1810) Use of digital stripping or pushing the memb...

Being born with a caul, or the membranes over your head was considered lucky. They were so rare the membranes from a caul were sold. Through history David Copperfield, and led to the myth in Victorian times that one would never drown if you were born with a caul . Roman time myths, according to Wikipedia says that if you were born with a caul you became a vampire, or the Russian 'born with a shirt ', which means born lucky. Other famous real characters like Gypsy Rose Lee, Freud and Napolean were born with cauls. It only occurs about 1/80,000 births, so if labor needs a start, rupturing that caul is not likely to prevent being born with one. Women who need to be induced have to have some treatment to get them into labor, and a straight forward and successful technique has been to break the bag. In fact physicians have clung on to the technique of rupturing a patient's members for at least the past 2000 years! Rupturing the membranes is a technique called Amniotomy , or ...

Anesthesia has improved, and become safer for women in labor or those who have to have a operation for the birth of teir baby.  But women will ask at their prenatal visit exactly how save it is to have a C-section , and one of the topics to cover is the topic of anesthesia safety. In the 1980s women still had to remove their nail polish for operations because we had no means better than monitoring the amount of oxygen in the blood stream other than seeing if the nail beds still had normal color! But today we have instruments which measure the amount of oxygen in the blood stream, and this has been a huge stride forward in safety. How safe is anesthesia in pregnancy with respect to some of the other causes of serious complications in labor?The CDC has been tracking this since 1987 when they established the Pregnancy Mortality Surveillance System, and all the states provide them with copies of actual death certificates for them to glean data to help improve the health of women. Fr...

Block the Pain. Forget the Pain. Recreational drug users have long found that blocking out parts of our memories seem to enhance other parts. It has to do with getting away from the laundry lists of daily tasks and drifting over to those thoughts induced by dopamine and various opioids on our brain. The result: euphoria. Enough euphoria to want the drug again. But a group physicians from Northwestern decided to use those properties to combat depression, postpartum depression, it was an intriguing thought, it didn't work, but it might in future studies. What they did find in a year follow up of 82 women that giving ketamine, in just a single dose after C-section reduced the post op C-section pain. There were two women in the placebo group that reported depression at a year, none in this ketamine group, giving the researchers hope that they could still use this chemical signal to the benefit.

50-50. About one half of all births in the US today go into labor spontaneously, otherwise, planned inductions, planned C-sections make the process less spontaneous than planned. But if you have had that positive pregnancy test and are wondering if you are going to just pop into labor on your own, that question, at that point, can apparently be answered with a coin toss! Interesting!