While We Were Out

by Melissa Garvey, ACNM Writer and Editor

ACNM staff have been out of the office due to two major snowstorms that hit the DC area last week. Now that power is restored and major roadways are cleared, it’s time to catch up on all the midwifery news I missed.

• ACNM volunteers and telecommuting staff put the finishing touches on our newest Position Statement: Nitrous Oxide for Labor Analgesia. Stay tuned for more information on why this is so exciting and important.
  
  
• A new service named Text4Baby is now available for expectant moms. The free service delivers messages about physical and emotional health to women who may not have Internet access. ACNM’s staff midwives had a chance to review the messages in advance and pushed for more provider neutral language. Amie Newman has posted her take on the service at RH Reality Check.
  
  
• Last Friday, midwife supporters rallied to demand that midwifery services return to St. John’s Pleasant Valley Hospital in Camarillo, CA. Watch the Birth Action Coalition for continuing developments.
  
  
• A new certified midwife (CM) program has been announced at the University of Philadelphia. They are now accepting applications for fall 2010. For Midwife Connection newcomers, the certified midwife credential is a direct-entry route to midwifery designed for applicants with bachelor’s degrees in disciplines other than nursing. CMs are educated to meet the same high standards that every state in the US has recognized as the legal basis for nurse-midwifery practice. Learn more in this QuickInfo document.
  
  
• The California Dental (CDA) Foundation published Oral Health During Pregnancy and Early Childhood: Evidence-Based Guidelines for Health Professionals. (Did you know February is National Children’s Dental Health Month?)
  
  
• Science and Sensibility had its fourth healthy birth blog carnival. This round addresses how to avoid interventions that are not medically necessary.
  

What else did I miss?

Restricting food and drink in labor is not justified

by Amy Romano, CNM (Originally published on Science and Sensibility for Lamaze International)

Listen to this great podcast about the new Cochrane review showing that the policy of restricting food and drink in labor is not justified. It’s a nice summary of how and why the research was conducted. In addition, I particularly liked these tidbits:

1. Rather than asking “is eating and drinking in labor safe?” the reviewers turned the question around to ask “is there any justification for restricting food and drink in labor?” This is not just a nuance. How a researcher asks a question can influence both the findings and the conclusions, as I have discussed previously.

2. Since they identified no benefits (nor harms) of restricting oral intake, the reviewers concluded that women should be able to eat and drink according to their preference.

3. It was her experience teaching antenatal classes that led one of the reviewers to study food and drink in labor. Listening to women’s concerns and anxieties made her question the justification for restricting women’s autonomy in labor.

In perusing the web to try to find an image for this post, I came across this heartbreaking picture of a woman begging for a drink in labor and being told no. (I’d post it here but it is copyrighted.) When the researchers said they found “no harms” of restricting food and drink in labor, they pointed out that no one had actually studied women’s preferences or experiences. I’m heartened to know that some of those who tout evidence based care are beginning to recognize that emotional distress is itself a harm. If there is no counterbalancing benefit, the conclusion is clear.

SOGC Says No More Automatic Cesareans for Breech Babies

Whether you’re aiming for a hospital, birth center, or home delivery, if you get the news that your baby is in the breech position, chances are you’ll be advised to have a cesarean section. But on Wednesday, the Society of Obstetricians and Gynaecologists of Canada (SOGC) released new guidelines for health professionals that turn the breech issue upside down. They state that health professionals should not automatically recommend cesarean sections for women carrying breech babies.

After a comprehensive review of research, SOGC concluded that vaginal breech birth is a safe option in some cases:

“The evidence is clear that attempting a vaginal delivery is a legitimate option in some breech pregnancies,” said Dr. André Lalonde, Executive Vice-President of the Society of Obstetricians and Gynaecologists of Canada. “The onus is now on us as a profession to ensure that Canadian obstetricians have the necessary training to offer women the choice to deliver vaginally when possible.”