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Showing posts with label Obstetrics/ gynecology. Show all posts
Showing posts with label Obstetrics/ gynecology. Show all posts

Sunday, April 1, 2012

NIH study finds women spend longer in labor now than 50 years ago




Women take longer to give birth today than did women 50 years ago, according to an analysis of nearly 140,000 deliveries conducted by researchers at the National Institutes of Health. The researchers could not identify all of the factors that accounted for the increase, but concluded that the change is likely due to changes in delivery room practice.
The study authors called for further research to determine whether modern delivery practices are contributing to the increase in labor duration.
The researchers compared data on deliveries in the early 1960s to data gathered in the early 2000s. They found that the first stage of labor had increased by 2.6 hours for first-time mothers. For women who had previously given birth, this early stage of labor took two hours longer in recent years than for women in the 1960s. The first stage of labor is the stage during which the cervix dilates, before active pushing begins.
Infants born in the contemporary group also were born five days earlier, on average, than were those born in the 1960s, and tended to weigh more. The women in the contemporary group tended to weigh more than did those who delivered in the 1960s. For the contemporary group, the average body mass index before pregnancy was 24.9, compared with 23 for the earlier generation. Body mass index is a measure of body fat based on height and weight. At the time they gave birth, the mothers in the contemporary group were about four years older, on average, than those in the group who gave birth in the 1960s.
"Older mothers tend to take longer to give birth than do younger mothers," said the study's lead author, S. Katherine Laughon, M.D., of the Epidemiology Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). "But when we take maternal age into account, it doesn't completely explain the difference in labor times."
Among the change in delivery practice the researchers found was an increase in the use of epidural anesthesia, the injection of pain killers into the spinal fluid, to decrease the pain of labor. For the contemporary group, epidural injections were used in more than half of recent deliveries, compared with 4 percent of deliveries in the 1960s. The study authors noted that epidural anesthesia is known to increase delivery time, but said it doesn't account for all of the increase.
Doctors in the early 2000s also administered the hormone oxytocin more frequently (in 31 percent of deliveries, compared with 12 percent in the 1960s), the researchers found. Oxytocin is given to speed up labor, often when contractions seem to have slowed. Its use should be expected to shorten labor times, Dr. Laughon explained.
"Without it, labor might even be longer in current obstetrics than what we found," she said.
Their analysis was published online in the American Journal of Obstetrics and Gynecology.
The study compared data from nearly 40,000 deliveries between 1959 and 1966 with records of almost 100,000 deliveries that took place in 2002 through 2008. Data from the recent deliveries were collected through the NICHD-supported Consortium on Safe Labor.
Dr. Laughon conducted the study with D. Ware Branch, M.D., of Intermountain Healthcare and the University of Utah, in Salt Lake City; Jun Zhang, Ph.D., M.D., with the NICHD at the time of the study and now with the Shanghai Jiaotong University School of Medicine, China; and Julie Beaver, M.S., formerly with the NICHD.
Other differences between the two groups reflect changes in later stage delivery practices. For example, in 1960s-era deliveries the use of episiotomy (surgical incision to enlarge the vaginal opening during delivery), and the use of forceps, surgical instruments used to extract the baby from the birth canal, was notably more common.
In current practice, doctors may intervene when labor fails to progress. This could happen if the dilation of the cervix slows or the active phase of labor stops for several hours, Dr. Laughon explained. In these cases, intervention can include administering oxytocin or performing a cesarean delivery.
In fact, the study found that the rate of cesarean delivery was four times higher today than it was 50 years ago (12 percent vs. 3 percent).
The authors note that while their study does not identify all the factors contributing to longer delivery times, the findings do indicate that current delivery practices may need to be re-evaluated.
The women in the contemporary cohort had an average pre-pregnancy BMI of 24.9. A BMI of 25 is considered overweight. Overweight and obesity raise the risk of pregnancy complications for mother and baby. Women who are overweight or obese and who would like to become pregnant should speak with their health care provider about losing weight before becoming pregnant.
Provided by National Institutes of Health
"NIH study finds women spend longer in labor now than 50 years ago." March 30th, 2012. http://medicalxpress.com/news/2012-03-nih-women-longer-labor-years.html
Posted by
Robert Karl Stonjek

Friday, March 9, 2012

Perceptions of conception




For many women, the decision to get pregnant can take on a life of its own. In fact, according to a survey conducted for SpermCheck Fertility, 42% of those who conceived say they became obsessed with getting pregnant once they started trying. Yet just 10% say their partner shared this obsession.
This year, approximately 7 million couples will experience conception issues and about 50% of these infertility problems will be directly attributed to the male, according to John C. Herr, Ph.D., director of the University of Virginia's Center for Research in Contraceptive and Reproductive Health; most male infertility problems are mainly due to low sperm count, he adds.
Yet women are typically the ones to take action when conception is slow to happen, often undergoing a battery of sometimes invasive and typically costly testing. While -- analyzing the male's sperm count is considered a key first step by infertility specialists -- -- less than one-fifth of men (17%) ever get tested for their sperm count, according to the SpermCheck survey. And just 23% of the women surveyed in the SpermCheck survey who are currently pregnant or who have conceived a child said their partner did everything he could to get himself as healthy as possible before they started trying to conceive.
According to Pamela Madsen, a nationally recognized fertility educator, advocate and founder of the American Fertility Association, "While there is absolutely nothing to be self-conscious about, many men are often reluctant or embarrassed to go to their healthcare provider to take a sperm count test, even if it means that their partner might take it upon herself to start having herself tested and in some cases begin taking fertility treatments. Now, with SpermCheck® Fertility, a new and easy, 10-minute, over-the-counter, FDA-approved, at-home sperm count screening test that men can take in the privacy of their home, they can find out if their sperm count is normal or low – and have an accurate answer, right then."
The SpermCheck survey found that 8 out of 10 women (83%) trying to or planning to conceive say their partner assumes he is fertile, and 43% say their partner would like to know for sure that his sperm count is normal. A much higher number, more than two thirds of women surveyed (67%) say they would like to know their partner's sperm count is normal when they start trying to get pregnant.
The following are highlights of this survey:
Fertility worries: 
  • A little less than half (44%) of those trying/planning to conceive are worried that when they actually want to conceive, they won't be able to because they tried hard for years to avoid pregnancy.
  • More than half (59%) of those trying/planning to conceive say they won't tell people they are trying to get pregnant in case it doesn't happen.
  • Almost half (49%) of women who took longer than expected to conceive indicated their significant other was not eager to have his sperm count tested.
  • 23% of women who have conceived/trying to conceive would not seek advice or testing for their significant other if it was taking longer than expected to get pregnant.
  • More than a quarter (27%) of those trying/planning to conceive are embarrassed to discuss fertility with friends and family, and a similar number, 23%, say their partner is uncomfortable discussing male fertility issues.
Conception perceptions: How fertility and conceiving a child affect relationships: Perceptions before (trying/planning to get pregnant) and after having a child were quite different on this topic:
• Spouse will be/is supportive 
--(Before) 90% (After)76% 
• Relationship will be/is stronger 
--(Before) 80% (After)64% 
• Partner knows how to support me 
--(Before) 74% (After)61% 
• Partner is excited to be pregnant 
--(Before) 92% (After)80% 
• Partner will leave if don't get pregnant 
--(Before) 11% (After) 4%
Provided by Robin Leedy & Associates, Inc.
"Perceptions of conception." March 8th, 2012. http://medicalxpress.com/news/2012-03-perceptions-conception.html
Comment:
Thinking that you could get pregnant anytime if you want to is very different to discovering that you can't get pregnant ~ the previous comforting thought disappears and one may be left feeling barren, a feeling that the female will naturally want to fight and the same feeling that the male seeks to avoid by clinging to imagined (untested) potentency.
Posted by
Robert Karl Stonjek