Wine and Pregnancy – Lies That Women Are Told

January 05, 2006
Wine and Pregnancy – Lies That Women Are Told
Editor's note: Please feel free to contribute comments and opinions on this article. Scroll to the bottom of the page to find the comment screen. Only 50 replies are shown per page, starting with the first comment received. Hit the "more comments" link to read our entire public commentary. All comments are read and approved before posting. All opinions are welcome, but comments must contribute to moving the discussion forward and indicate that the reader has in fact read the article and commentaries. Profanity, personal insults and bizarre claims are not allowed. ________________________________________________________ Contributed by Daniel Rogov, wine writer

Since 1990 every bottle of wine, beer and spirits sold in the United States has carried the warning that "according to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects." If that has not been enough to add to the anxiety of women already concerned about their own health and the health of their fetuses, hundreds of newspaper articles and television talk shows have been devoted to convincing women that if they have even a single drink during their pregnancy that there is a chance that their baby will be born deformed, addicted to alcohol or retarded.

It seems, however, as if the American government, medical authorities and media have not been telling American women the entire truth. Although the official message is "don't drink at all during pregnancy", a great deal of recent research and a re-examination of the alcohol-pregnancy issue show that there is no conclusive evidence to demonstrate that moderate drinking during pregnancy can harm the fetus.



According to Doctors David Whitten and Martin Lipp of the University of California at San Francisco, "the campaign against drinking during pregnancy started in 1973 when several studies showed that heavy drinking during pregnancy can cause the condition known as the Fetal Alcohol Syndrome. These studies demonstrated that the children of many alcoholic mothers were born with a cluster of severe birth defects. "What the government conveniently chose to ignore" say Whitten and Lipp, is that this syndrome is extremely rare, occurring only 3 times in 100,000 births, and then only when the mother drinks abusively throughout her pregnancy."

Lipp and Whitten, whose "To Your Health" was published in 1995, are among an increasing number of doctors and researchers who feel that pregnant women have no reason to fear drinking a glass of wine every day. As revealed by contributing editor Thomas Matthews in the August 31, 1994 issue of the "Wine Spectator" magazine which was devoted largely to this controversy, "there is even new research that shows that moderate drinking during pregnancy may actually help the development of the child after birth."

No one questions the fact that the consumption of large amounts of alcohol during pregnancy can harm the fetus. It has been well established, for example, that the children of women who drink more than 3 - 4 glasses of wine daily show significant decreases in birth weight and length than those of women who drink 1 - 2 glasses daily, and it is generally accepted that having five or more drinks per day is especially dangerous to the fetus. Here, however, agreement ends, and Genevieve Knupfer of the Alcohol Research Group in Berkeley, California says that part of the problem comes about because many of the studies that reported adverse effects on the fetus used imprecise methodology. In several studies, for example, researchers arbitrarily defined "heavy drinkers" as those women who consumed more than one glass of wine daily.

Feeling even more strongly, Dr. Michael Samuels of New York City's Doctor's Hospital says that the data has been "turned around for the purpose of frightening women", and indicates that birth defects of any kind occur in 3 - 5% of babies born in the United States and only 1 - 2% of those can be related to the ingestion of alcohol. Based on the data of Samuels and other medical researchers, it becomes clear that less than 0.1% of all birth defects are related to alcohol, and that more than 90% of the affected children are born to women with a history of alcohol abuse.

More than this, not even one study carried out since the mid-1980s has shown a direct correlation between moderate alcohol consumption and birth defects. One study, of 33,300 California women showed that even though 47% drank moderately during their pregnancies that none of their babies met the criteria for Fetal Alcoholic Syndrome. The authors of this study concluded "that alcohol at moderate levels is not a significant cause of malformation in our society and that the position that moderate consumption is dangerous, is completely unjustified."

Some studies go as far as to indicate that light to moderate drinking may actually improve the chance of successful pregnancies. A 1993 study published in the "American Journal of Epidemiology" by Ruth Little and Clarence Weinberg concluded, for example, that there were fewer stillbirths and fewer losses of fetus due to early labor among women who consumed a moderate level of alcohol. That some alcohol can be protective against preterm birth is also supported by Dr. Martha Direnfeld of Haifa University who points out that when used properly, alcohol is known to stop unwanted uterine contractions, and thus has "saved many pregnancies that might otherwise have spontaneously aborted." More than this, Dr. Robert Sokol of the National Institute on Alcohol Abuse in Detroit has shown that it is light drinkers and not abstainers who have the best chance of having a baby of optimal birth weight and in their book "Alcohol and the Fetus" and Doctors Henry Rosset and Lynn Wiener have presented data that shows that children of moderate drinkers tend to score highest on developmental tests at the age of 18 months.


Despite these and many other findings the United States government, the American Medical Association, the British Medical Association and the vast majority of American and English doctors continue to recommend complete abstention from wine, beer and spirits during pregnancy. An examination of why this is true reveals that the issue is as emotional, ideological and political as it is medical. Well respected wine writer Janis Robinson, has declared that "in this our male dominated society, men feel entitled to lecture pregnant women on how they should best discharge their responsibilities to their unborn children." In a similar tone, Katha Pollit, writing in "The Nation" claimed that "all of these warnings allow the government to appear to be concerned about babies without having to spend any money, change any priorities or challenge any vested interests."

No one argues that there are no risks whatever in alcohol consumption during pregnancy, even at sensible levels, but as Thomas Matthews stated in the Wine Spectator, "it is important to ask: risky when compared to what?" In her recently published book "The Myths of Motherhood", Shary Turner indicates that alcohol is far from the only risk factor pregnant women are warned against. Other items on the list include caffeine, chocolate, raw oysters, unpasteurized cheese, tropical fruits, drugs that alleviate cold symptoms, nail polish, suntan lotion and hair dye, all of which in some amount may harm the fetus. Turner's conclusion is that "the only risk free pregnancy is one that is meant less to benefit the baby than to imprison the mother in anxiety and self-reproach."


In the absence of 100% certainty about the issue, many continue to insist that abstinence is the best advice to give pregnant women. Others, however, see this attitude as illogical and have concluded that the risks and benefits associated with light to moderate regular wine consumption compare quite favorably with most other activities of daily life. Doctors Whitten and Lipp write that "light, regular wine consumption, or one or two glasses of table wine per day can be part of the healthy lifestyle for most people, including pregnant women." Israeli gynecologist-researchers Howard Carp and Martha Direnfeld also feel that women who were drinking healthfully before pregnancy are not putting their fetuses in danger if they go on drinking in the same way during pregnancy. Dr. Carp states that "an occasional glass of wine or any other drink is fine, no problem at all, and those women who drink a glass of wine once or twice a week with their meals should not feel any guilt or fear at all." Like Dr. Carp, Dr. Direnfeld acknowledges the harm of drinking in excess but feels that "a reasonable amount of alcohol, say a glass of wine per day, will not harm the baby."

It is true that all of the evidence has not yet been gathered, but it is difficult not to see the logic of the conclusion that when it comes to drinking, evidence demands interpretations and decisions require judgment. Women are capable of choosing for themselves.

_________________________________________________

Daniel Rogov is the Wine and Food Critic of HaAretz newspaper in Israel. He is also the author of Rogov's Guide to Israeli Wines and a regular contributor to Tom Stevenson's Wine Report and Hugh Johnson's Pocket Wine Book. His wine and gastronomy internet site and forum can be found at http://www.stratsplace.com/rogov/home.html

Don't Sell Your Sisters Down the River

Editorial: Don't Sell Your Sisters Down the River
Jan Tritten
© 2000 Midwifery Today, Inc. All Rights Reserved.

[Editor's note: This editorial originally appeared in Midwifery Today Issue 55, Autumn 2000.]

The Midwives Alliance of North America (MANA) has always been an inclusive organization, a place for all midwives. MANA's whole foundation has been one of acceptance and unity. I was shocked, therefore, when I heard that the board had proposed that only licensed, certified professional midwives (CPMs) or certified nurse-midwives (CNMs) could be voting members. This proposal reeks of a witch hunt and will cause even worse separation in our already divided movement.

Midwifery was bruised and nearly broken in New York state in the mid-1990s when direct entry and lay midwives were outlawed, then replaced, by only those midwives coming out of an "approved" direct entry program. Is MANA planning this scene for the whole country? Will MANA members simply stand by in complicity? If so, another midwifery uprising will occur, bringing forth a new surge of lay midwives who are willing to serve women in a way that we can't. The flow of the river is carrying us in a direction we will soon be unable to resist. Midwifery will be back where it was several years ago, with a strong, illegal lay midwifery movement acting as a powerful undercurrent. The midwives of MANA will represent the status quo. We will have colluded with the patriarchal medical establishment so that it is against the law to practice anything the whim of medicine decides midwives should or shouldn't do. We will be limited soon by protocols that will hamstring us into practicing watered-down midwifery and will rob women of their birthing rights.

Remember, we are all in this together—mothers, families and all midwives who promote and maintain the midwifery model of care. The movement also includes—needs—the associated helpers, physicians, doulas, childbirth educators and activists. As a movement, we must be careful not to be self-promoting in a factional manner. The further we get away from this concept of a unified movement, the more self-promoting we become.

Midwifery knowledge really belongs to the people. Professions seek to exclude others from the closely guarded knowledge of their members. This sort of exclusive professionalization should not become the pathway of midwifery. Our movement must continue to recognize that birth belongs to families.

Otherwise, we are building our own trap. Even CNMs can't practice unless a physician signs for them. Will we, as non-medically trained professionals, get more privilege than CNMs? Don't bet on it. The current is sweeping us along. What we get by with now will change later. Let's open our eyes and wake up. We have to protect the future as well as the present. Today midwives are still allowed multiple routes of entry, but tomorrow we may be required to enter via an “approved” school, probably steeped in the medical model. The medical culture in this country exists cradle-to-grave and is strong. Midwives are the still, small voices advocating for women and their babies. Scream! Don't let your mouth be gagged by the MANA proposal.

Are you worried about safety at birth? Then focus your worry on what is happening to motherbaby during pregnancy and birth in medically based practices. If you call yourself a midwife, then protecting motherbaby from harmful procedures and substances is your first job.

The idea behind the MANA proposal is not culturally sensitive. Midwives are now engaged in birthing a global movement to honor and preserve traditional midwifery. We have some of the best traditional midwives right here in the United States, yet this proposal undermines them. Gladys Milton was a wonderful granny midwife who fought the state of Florida for her ability to practice—and won. We were all incensed when this happened to her, but it appears that we are willing to turn around and take the ability to practice away from our sisters.

Right now, empirical midwives in the United States still have the most autonomy of nearly any midwives anywhere. Yet we are slowly sacrificing that autonomy with our licensing requirements. I realize that the current MANA proposal addresses voting privileges only within the organization. However, voluntary licensing is available only in Oregon and Minnesota. The rest of the states that have adopted licensing require it. Although licensing might be an unfortunate necessity in some states, taking the vote away from our unlicensed sisters is simply not acceptable. Licensing is a double-edged sword that limits women's choices. The more rules we have, the less we can use our intuition and knowledge. The less autonomy we have, the less we can really serve women. Instead of serving the motherbaby, we begin to serve the Western medical patriarchy.

As midwives, aren't we capable of something different and more feminine than thinking in a Western, hierarchical, patriarchal manner—the “we are in, you are out” thought style? I believe we are. Our midwifery model is planted in a holistic model. The midwives' role is planted squarely on the shoulders of our sisters Shiphrah and Puah. In the story of Moses, they disobeyed Pharaoh; so must we.

Take a look at Robbie Davis-Floyd's work on open and closed thought systems in her book Authoritative Knowledge. The closed thought system evident in the MANA proposal tromps on my freedom of religion as well as my inherent right to the pursuit of happiness. As Ina May Gaskin said, birth is “a sacrament.” Birth is a holy event of God sending a baby, a new human being, to this life on Earth. I have the most freedom to enact this sacrament my way if I can choose with whom, if anyone, I will birth. More women already are choosing unassisted homebirth, and as midwives lose their freedom to serve the women who want unmedicalized homebirth, there will be a lot more.

The damage this impending rift will cause in our fragile movement is immeasurable but huge, with a ripple effect that will be felt forever in our herstory. If we sell our sisters downriver, will the river change course? A popular song from the ’70s said “freedom's just another word for nothing left to lose.” But that's not true. Freedom is our heritage and goes deep into the American soul (see my editorial in Issue No. 52).

Midwifery Today seeks to have a loving midwife available to all moms. Let's let the families who want midwives to attend them choose whom they want. Let's provide these families a wide variety of choices.

The MANA proposal likely will have the unfortunate side effect of outlawing lay midwifery all over the United States in spite of the organization's once-stated goal to decriminalize midwifery. MANA might consider rejoining the fight to decriminalize rather than going after certain midwives whose practices aren't stamped and approved by the medical patriarchy. Remember, diversity is our strength. Let's find ways to work out our needs without excluding others.

Note: Issue 56 is on building birth communities. I invite you to respond with your ideas for building strong communities with a sense of unity and responsibility that we owe to each other. The concept “Save the Midwife” includes all of us.


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Midwives 'losing' breech birth skills

Most breech labours end in Caesareans

Midwives are losing the skill to carry out breech births because so many women are having Caesareans, health experts have warned.
Jean Robinson, a former General Medical Council (GMC) and Patient Association member, said better midwife training would give pregnant women more choices.

She said: "Women are losing the opportunity to have vaginal births and those that are being carried out are being carried out by obstetricians.



Women are supposed to have a choice. At present only those who can afford a private midwife are likely to get a midwifery breech delivery

Jean Robinson

"In the days when a large proportion of our births were home births, midwives were able to deliver babies, twins, small babies and very large babies as well as breech babies."

A "breech baby" is a baby who is not positioned in the birth canal with his or her head down. Instead, the legs or buttocks appear first.

Ms Robinson said fewer and fewer midwives were being offered the chance to carry out such births and so were losing vital skills.

"They would not have the skills or the confidence to deliver them vaginally. More and more breeches now mean a routine Caesarean."

Ms Robinson, a current honorary officer for the Association for Improvements in Maternity Services (AIMS), raised her concerns in an article in the British Journal of Midwifery.

Complications

She said: "Whether working at home or in the hospital, midwives are going to find themselves coping unexpectedly with a breech arrival.

"Transferring the woman before the birth or getting an experienced doctor quickly is not always an option.

"Some of the births in transit might have been better managed by delivery before transfer, but I suspect the midwives could not, or dare not, do it.

"Women are supposed to have a choice. At present only those who can afford a private midwife are likely to get a midwifery breech delivery."


Midwives need to learn how to do breech births


She said women should be offered vaginal births wherever possible to avoid complications during surgery or in future pregnancies.

Independent midwife Mary Cronk agreed.

She said breech deliveries were not recommended but women should, where possible, be offered the chance to have vaginal breech births.

"I think many of us have lost the skills. And many who trained in the 80's and 90's never learnt the skill," she said.

Midwives who could carry out breech births were being inundated with calls from mothers anxious to avoid surgery, she added.

"In the last 48 hours I have had three calls from women with breech births and all the women told me that they had been told they would need a Caesarean."

'Unnecessary surgery'

She said midwives needed to be given better training and education to cope with breech births.

A spokeswoman for the Royal College of Midwives said they were aware of the need for health professionals to update their skills to avoid unnecessary surgery.

"Obstetricians and midwives need to update their skills to successfully manage vaginal breech birth once more," she said.

"The RCM has run practice based seminars for midwives on the management of breech vaginal births as part of our ongoing continuing professional development programme for midwives."

But she said that a Canadian study comparing the outcome of planned Caesarean section with planned vaginal birth for breech presentation at term suggested that planned Caesarean section was better for the baby than planned vaginal birth."

I am interested in breech births

Breech birth
From Wikipedia, the free encyclopedia

A breech birth is the birth of a baby from a breech presentation. In the breech presentation the baby enters the birth canal with the buttocks or feet first as opposed to the normal head first presentation.

Contents [hide]
1 Etiology
2 Epidemiology
3 Categories
4 Process of breech birth
5 Risks
6 Factors influencing the safety
7 Turning the baby to avoid breech birth
8 Breech birth versus Caesarean section
9 See also
10 References
11 External links


Etiology
Certain factors can encourage a breech presentation. Prematurity is likely the chief cause. Twenty five percent of fetuses are in the breech position at 32 weeks gestation; this drops to three percent at term. The increasing size of the fetus near term traps the fetus into the head down position normally. Pregnancies ending in preterm birth simply recruit more breeches before they can turn to head down. Factors predisposing to term breech presentation include:

multiple (or multifetal) pregnancy (twins, triplets or more)
abnormal volume of amniotic fluid: both polyhydramnios and oligohydramnios
fetal anomalies: hydrocephaly, anencephaly and other congenital abnormalities
uterine abnormalities
prior Cesarean section[1]
It is postulated that the baby normally assumes a head down presentation because of the weight of the baby's head. As the mass of the fetal head is the same as that of the pelvis, it is more likely that the enlarging fetus is more and more restricted in its movements, and simply becomes entrapped. The shape of the uterus is a more likely determinant of the final fetal presentation as uterine shape anomalies are strong predictors of breech presentation and other malpresentations.

Epidemiology
Researchers generally cite a breech presentation frequency at term of 3-4%[2][3] at the onset of labour though some claim a frequency as high as 7%[4]. When labour is premature, the incidence of breech presentation is higher. At 28 weeks' gestation 25% of babies are breech, and the percentage decreases approaching term (40 weeks' gestation).


Categories
There are four main categories of breech births:

Frank breech - the baby's bottom comes first, and his or her legs are flexed at the hip and extended at the knees (with feet near the ears). 65-70% of breech babies are in the frank breech position.
Complete breech - the baby's hips and knees are flexed so that the baby is sitting crosslegged, with feet beside the bottom.
Footling breech - one or both feet come first, with the bottom at a higher position. This is rare at term but relatively common with premature fetuses.
Kneeling breech - the baby is in a kneeling position, with one or both legs extended at the hips and flexed at the knees. This is extremely rare.

Process of breech birth
As in labour with a baby in a normal head-down position, uterine contractions typically occur at regular intervals and gradually cause the cervix to become thinner and to open. In the more common breech presentations, the baby’s bottom (rather than feet or knees) is what is first to descend through the maternal pelvis and emerge from the vagina.

At the beginning of labour, the baby is generally in an oblique position, facing either the right or left side of the mother's back. As the baby's bottom is the same size in the term baby as the baby's head. Descent is thus as for the presenting fetal head and delay in descent is a cardinal sign of possible problems with the delivery of the head.

In order to begin the birth, internal rotation needs to occur. This happens when the mother's pelvic floor muscles cause the baby to turn so that it can be born with one hip directly in front of the other. At this point the baby is facing one of the mother's inner thighs. Then, the shoulders follow the same path as the hips did. At this time the baby usually turns to face the mother's back. Next occurs external rotation, which is when the shoulders emerge as the baby’s head enters the maternal pelvis. The combination of maternal muscle tone and uterine contractions cause the baby’s head to flex, chin to chest. Then the back of the baby's head emerges and finally the face .

Due to the increased pressure during labour and birth, it is normal for the baby's leading hip to be bruised and genitalia to be swollen; this usually resolves shortly after birth.

Babies who assumed the frank breech position in utero may continue to hold their legs in this position for some days after birth - this is normal.


Risks
This article does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (March 2007)

Umbilical cord prolapse may occur, particularly in the complete, footling, or kneeling breech. This is caused by the lowermost parts of the baby not completely filling the space of the dilated cervix. When the waters break the amniotic sac, it is possible for the umbilical cord to drop down and become compressed. This complication severely diminishes oxygen flow to the baby and the baby must be delivered immediately (usually by Caesarean section) so that he or she can breathe. If there is a delay in delivery, the brain can be damaged. Among full-term, head down babies, cord prolapse is quite rare, occurring in 0.4 percent. Among frank breech babies the incidence is 0.5 percent, among complete breeches 4-6 percent, and among footling breeches 15-18 percent.

Head entrapment is caused the failure of the fetal head to negotiate the maternal midpelvis. At full term, the fetal bitrochanteric diameter (the distance between the outer points of the hips) is about the same as the biparietal diameter (the transverse diameter of the skull) - simply put the size of the hips are the same as the size of the head. The relatively larger buttocks dilate the cervix as effectively as the head does in the typical head-down presentation. In contrast, the relative head size of a preterm baby is greater than the fetal buttocks. If the baby is preterm, it may be possible for the baby’s body to emerge while the cervix has not dilated enough for the head to emerge.

Because the umbilical cord—the baby’s oxygen supply—is significantly compressed while the head is in the pelvis during a breech birth, it is important that the delivery of the aftercoming fetal head not be delayed. The head only just fits through the pelvis, and if the arm is extended alongside the head, delivery will not occur. If this occurs, the Lovset manoeuvre may be employed, or the arm may be manually brought to a position in front of the chest. The Lovset Manoeuvre works by rotating the fetal body by holding the fetal pelvis. Twisting the body such that an arm trails behind the shoulder, it will tend to cross down over the face to a position where it can be reached by the obstetrician's finger, and brought to a position below the head. A similar rotation in the opposite direction is made to deliver the other arm. In order to present the smallest diameter (9.5 cm) to the pelvis, the baby’s head must be flexed (chin to chest). If the head is in a deflexed position, the risk of entrapment is increased. Uterine contractions and maternal muscle tone encourage the head to flex. If the birth attendant pulls on the baby’s body, this action may deflex the head.

Oxygen deprivation may occur from either cord prolapse or prolonged compression of the cord during birth, as in head entrapment. If oxygen deprivation is prolonged, it may cause permanent neurological damage or death.

Injury to the brain and skull may occur due to the rapid passage of the baby's head through the mother's pelvis. This causes rapid decompression of the baby's head. In contrast, a baby going through labor in the head-down position usually experiences gradual molding (temporary reshaping of the skull) over the course of a few hours. This sudden compression and decompression in breech birth may cause no problems at all, but it can injure the brain. This injury is more likely in preterm babies. The fetal head may be controlled by a special two handed grip call the Morisseau-Smellie-Veit manoeuvre or the elective application of forceps. This will be of value in controlling the rate of delivery of the head and reduce decompression. Related to potential head trauma, researchers have identified a relationship between breech birth and autism[5].

Squeezing the baby’s abdomen can damage internal organs. Positioning the baby incorrectly while using forceps to deliver the aftercoming head can damage the spine or spinal cord. It is important for the birth attendant to be knowledgeable, skilled, and experienced with all variations of breech birth. In the United States, because Cesarean section is increasingly being used for breech babies, fewer and fewer birth attendants are developing these skills.

Injury may occur even if a birth attendant uses appropriate interventions during labour. A majority of full-term term frank breech babies would be born without problems even without assistance. However, in a minority of cases, expert assistance is needed for the baby to be born safely. This must be placed in perspective. It is this minority that determines the safety of the choice of vaginal delivery of the breech. A fetal death rate as low as 1% might be acceptable to some societies if a greater benefit could accrue. Take a country like the United States with a population of 300 million, and a 14.14/1000 birth rate, assume a 3% breech rate, and the aforementioned 1% mortality. This would result in an annual attributable death rate from breech delivery of 1,273 babies per year. Attributable death rate implies that the deaths occurred because of the selection of vaginal delivery and not from concurrent problems, such as congenital abnormalities or prematurity.


[edit] Factors influencing the safety
This article does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (March 2009)

Type of breech presentation - the frank breech has the most favorable outcomes in vaginal birth, with many studies suggesting no difference in outcome compared to head down babies. (Some studies, however, find that planned caesarean sections for all breech babies improve outcome. The difference may rest in part on the skill of the doctors who delivered babies in different studies.) Complete breech presentation is the next most favorable position, but these babies sometimes shift and become footling breeches during labour. Footling and kneeling breeches have a higher risk of cord prolapse and head entrapment.
Parity - Parity refers to the number of times a woman has given birth before. If a woman has given birth vaginally, her pelvis has "proven" it is big enough to allow a baby of that baby's size to pass through it. However, a head-down baby's head often molds (shifts its shape to fit the maternal pelvis) and so may present a smaller diameter than the same size baby born breech. Research on the issue has been contradictory as far as whether vaginal breech birth is safer when the mother has given birth before, or not.
Fetal size in relation to maternal pelvic size - If the mother's pelvis is roomy and the baby is not large, this is favorable for vaginal breech delivery. However, prenatal estimates of the size of the baby and the size of the pelvis are unreliable.
Hyperextension of the fetal head - this can be evaluated with ultrasound. Less than 5% of breech babies have their heads in the "star gazing" position, face looking straight upwards and the back of the head resting against the back of the neck. Caesarean delivery is absolutely necessary, because vaginal birth with the baby's head in this position confers a high risk of spinal cord trauma and death.
Maturity of the Baby - Premature babies appear to be at higher risk of complications if delivered vaginally than if delivered by caesarean section.
Progress of Labour - A spontaneous, normally progressing, straightforward labour requiring no intervention is a favourable sign.
Second twins - If a first twin is born head down and the second twin is breech, the chances are good that the second twin can have a safe breech birth.
Birth attendant's skill (and experience with breech birth) - The skill of the doctor or midwife and the number of breech births previously assisted is of crucial importance. Many of the dangers in vaginal birth for breech babies come from mistakes made by birth attendants.

Turning the baby to avoid breech birth
There are many methods which have been attempted with the aim of turning breech babies, with varying degrees of success:

External cephalic version where a midwife or doctor turns the baby by manipulating the baby through the mother's abdomen. ECV has a success rate between 40 - 70% depending on practitioner (Goer, 1995, 111) The fetal heart is monitored after the turn attempt, usually in the context of an institutional protocol. Studies show that turning the baby at term (after 36 weeks) is effective in reducing the number of babies born in the breech position.[6] Complications from external cephalic version are rare. Studies have also shown that attempting to turn the baby prior to this point has no impact on the presentation at term.[7]
Using hypothetical scenarios, a small study in the Netherlands found that few obstetric practitioners would attempt ECV in the presence of oligohydramnios.[8] A case report of treating oligohydramnios with amnioinfusion, followed by ECV, was successful in turning the fetus.[9]

Various manoeuvres are suggested to assist spontaneous version of a breech presenting pregnancy. These include maternal positioning or other exercises. A study has shown that there is insufficient evidence as to the benefit of maternal positioning in reducing the incidence of breech presentation.[7]

Breech birth versus Caesarean section
Caesarean section is the most common way to deliver a breech baby in the USA, Australia, and Great Britain. Like any major surgery, it involves risks. Maternal mortality is increased by a Caesarean section, but still remains a rare complication in the First World. Third World statistics are dramatically different, and mortality is increased significantly. There is remote risk of injury to the mother's internal organs, injury to the baby, and severe hemorrhage requiring hysterectomy with resultant infertility. More commonly seen are problems with noncatastrophic bleeding, postoperative infection and wound healing problems.

One large study has confirmed that elective cesarean section has lower risk to the fetus and a slightly increased risk to the mother, than planned vaginal delivery of the breech[10] however elements of the methodology used have undergone some criticism.[11][12]

The same birth injuries that can occur in vaginal breech birth may rarely occur in Caesarean breech delivery. A Caesarean breech delivery is still a breech delivery. However the soft tissues of the uterus and abdominal wall are more forgiving of breech delivery than the hard bony ring of the pelvis. If a Caesarean is scheduled in advance (rather than waiting for the onset of labor) there is a risk of accidentally delivering the baby too early, so that the baby might have complications of prematurity. The mother's subsequent pregnancies will be riskier than they would be after a vaginal birth (uterine rupture). The presence of a uterine scar will be a risk factor for any subsequent pregnancies.


See also
Asynclitic birth, another abnormal birth position
Childbirth
Pregnancy
Uterine Rupture

References
^ Vendittelli F, Rivière O, Crenn-Hébert C, Rozan MA, Maria B, Jacquetin B (May 2008). "Is a breech presentation at term more frequent in women with a history of cesarean delivery?". Am. J. Obstet. Gynecol. 198 (5): 521.e1–6. doi:10.1016/j.ajog.2007.11.009. PMID 18241817.
^ link not accessible: http://www.rwh.org.au/rwhcpg/maternity.cfm?doc_id=7857
^ Breech at term, Early and late consequences of mode of delivery, Lone Krebs, Danish Medical Bulletin - No. 4. November 2005. Vol. 52 Pages 234-52
^ Pregnancy, Breech Delivery, emedicine.com
^ Deborah Bilder, MD, Judith Pinborough-Zimmerman, PhD, Judith Miller, PhD and William McMahon, MD. "Prenatal, Perinatal, and Neonatal Factors Associated With Autism Spectrum Disorders." Pediatrics, 123(5), May 2009, pp. 1293-1300
^ External cephalic version for breech presentation at term Hofmeyr GJ, Kulier R, cochrane.org
^ a b Cephalic version by postural management for breech presentation Hofmeyr GJ, Kulier R, cochrane.org
^ Kok M, Van Der Steeg JW, Mol BW, Opmeer B, Van Der Post JA (2008). "Which factors play a role in clinical decision-making in external cephalic version?". Acta Obstet Gynecol Scand 87 (1): 31–5. doi:10.1080/00016340701728075. PMID 17957499.
^ Buek JD, McVearry I, Lim E, Landy H, Afriyie-Gray A (June 2005). "Successful external cephalic version after amnioinfusion in a patient with preterm premature rupture of membranes". Am. J. Obstet. Gynecol. 192 (6): 2063–4. doi:10.1016/j.ajog.2004.07.057. PMID 15970899.
^ Planned Caesarean section for term breech delivery, Hofmeyr GJ, Hannah ME, cochrane.org
^ When Research is Flawed: Planned Vaginal Birth versus Elective Cesarean for Breech Presentation [1]
^ Inappropriateness of randomised trials for complex phenomena [2]
Banks, Maggie. Breech Birth Woman Wise. Birthspirit Books, 1998.
Fraser, Diane and Cooper, Margaret (Eds). Myles Textbook for Midwives, 14th edition. Churchill Livingstone, 2003.
Frye, Anne. Holistic Midwifery: A Comprehensive Textbook for Midwives in Homebirth Practice, Vol I, Care During Pregnancy. Labrys Press, 1995.
Gabbe, Steven; Niebyl, Jennifer; and Simpson, Joe Leigh (Eds). Obstetrics: Normal and Problem Pregnancies, 4th edition. Churchill Livingstone, 2002.
Goer, Henci, Obstetric Myths versus Research Realities, Bergin and Garvey, London, 1995,
Oxorn, Harry. Human Labor and Birth, 5th edition. Appleton & Lange, 1986.
Vernon, David ed. Having a Great Birth in Australia Australian College of Midwives, Canberra, 2005 ISBN 0-9751674-3-X
Waites, Benna. Breech Birth. Free Association Books, 2003.

Neonatal Death

When a baby dies in the first 28 days of life, it is called neonatal death. In the United States in 2002, about 19,000 babies died in their first month (1).

As parents attempt to cope with a loss, they may have many questions about what happened to their baby. The following may help parents discuss the loss of their baby with their health care providers.

What are the most common causes of neonatal death?
Premature birth (before 37 completed weeks of pregnancy) is the most common cause of neonatal death. Prematurity and its complications cause almost 30 percent of neonatal deaths (2). The earlier a baby is born, the more likely he is to die. About 20 to 35 percent of babies born at 23 weeks of pregnancy survive, while about 50 to 70 percent of babies born at 24 to 25 weeks, and more than 90 percent born at 26 to 27 weeks, survive (1, 3).

About 12 percent of babies are born prematurely (4). The causes of premature delivery are not thoroughly understood. In some cases, a pregnant woman may have health problems (such as high blood pressure) or pregnancy complications (such as placental problems) that increase her risk of delivering prematurely. Women who have had a previous preterm delivery, are pregnant with twins (or other multiples), or have certain abnormalities of the uterus or cervix also are at increased risk. More often, preterm labor develops unexpectedly in a pregnancy that had been problem-free.

Premature babies, especially those born at less than 32 weeks of pregnancy and weighing less than 3 1/3 pounds, often develop respiratory distress syndrome (RDS). About 23,000 babies develop RDS each year (4).

Babies with RDS have immature lungs that lack a protein called surfactant that keeps small air sacs in the lungs from collapsing. Treatment with surfactant has greatly reduced the number of babies who die from RDS. However, about 880 babies a year die in the neonatal period due to RDS (2).

About 25 percent of babies born preterm, usually before 32 weeks of pregnancy, develop bleeding in the brain called intraventricular hemorrhage (IVH)(5). While mild brain bleeds usually resolve themselves with no or few lasting problems, severe bleeds often result in brain damage or even death.

Some premature babies may develop an intestinal problem called necrotizing enterocolitis (NEC). Treatment with antibiotics and surgery can save many affected babies. However, some develop severe bowel damage and die.

Premature babies have immature immune systems and sometimes develop serious infections such as pneumonia (lung infection), sepsis (blood infection), and meningitis (infection of membranes surrounding the brain and spinal cord). In spite of treatment with antibiotics and antiviral drugs, some babies die.

While deaths due to prematurity are still too common, the outlook for these babies is improving. Surfactant and other treatments are saving more of these babies after birth. And treatment before birth can sometimes prevent or lessen the complications of prematurity. Women who are likely to deliver between 24 and 34 weeks of pregnancy should be treated at least several days before delivery with drugs called corticosteroids, which speed maturation of fetal lungs (6). Studies show this treatment reduces RDS, brain bleeds and infant deaths (6).

Birth defects cause about 21 percent of neonatal deaths (2). Babies with birth defects may be premature or full-term. Sometimes parents learn about their baby's birth defects before birth from prenatal tests, such as ultrasound, amniocentesis and chorionic villus sampling (CVS).

Ultrasound uses sound waves to take a picture of the fetus. It can help diagnose structural birth defects, such as spina bifida (open spine), anencephaly (brain and skull defect), and heart or kidney defects. In amniocentesis, the doctor inserts a thin needle through the abdomen to obtain a small sample of amniotic fluid for testing. In CVS, the doctor takes a tiny sample of tissue from the developing placenta, either using a thin tube that is inserted through the vagina or a needle that is inserted through the abdomen. Amniocentesis and CVS are used to diagnose chromosomal abnormalities, such as Down syndrome, and many genetic birth defects.

Other causes of neonatal death include problems related to:

Complications of pregnancy
Complications involving the placenta, umbilical cord and membranes (bag of waters)
Infections
Asphyxia (lack of oxygen before or during birth) (2)
Which birth defects most commonly cause neonatal deaths?
Heart defects are the most common birth defect-related cause of infant death in the first year of life (7). Heart defects cause nearly one-third of infant deaths (2).

About 1 in every 125 babies is born with a heart defect (8). Because of improvements in the surgical treatment and medical management of these defects, most affected babies survive and do well. However, some babies with severe heart defects may not survive until surgery, or may not survive the surgery. Many babies who die of heart defects in the first month of life have a specific heart defect called hypoplastic left heart syndrome. In this heart defect, the main pumping chamber of the heart is too small to supply blood to the body. New surgical procedures are saving more babies with this heart defect, but many still die. In most cases, doctors do not know why a baby is born with a heart defect, although both genetic and environmental factors are believed to play a role.

Birth defects of the lungs are another common cause of neonatal death. Sometimes, one or both lungs does not develop at all or is malformed for reasons that are not known. In most cases, lung defects occur because other birth defects or pregnancy complications interfered with lung development. Many babies die due to complications that occur in immature lungs as a result of premature birth.

Chromosomal abnormalities are also a common cause of neonatal death. Humans normally have 46 chromosomes. Chromosomes are tiny thread-like structures in our cells that carry our genes; genes are the basic units of heredity that dictate all traits from eye color to workings of internal organs. However, sometimes a baby is born with too many or too few chromosomes. In most cases, an embryo with a chromosomal abnormality will not survive, and the pregnancy will end in miscarriage. In other cases, the baby survives until birth but dies in the early weeks of life.

For example, babies with an extra copy of chromosome 18 or chromosome 13 (called trisomy 18 or trisomy 13) have multiple birth defects and generally die in the first weeks or months of life. Babies with less severe chromosomal abnormalities, such as Down syndrome (trisomy 21), often survive, although affected children have mental retardation and other serious problems.

Birth defects involving the brain and central nervous system are another cause of neonatal death. One example is anencephaly, in which most of the brain and skull are missing. Affected babies may be stillborn (fetus died before birth) or die in the first days of life. This birth defect often can be detected before birth with a blood test, ultrasound or amniocentesis. Anencephaly may be prevented in subsequent pregnancies when the woman takes the B vitamin folic acid before and in the early months of pregnancy. A woman who has had a baby with anencephaly, or a related birth defect called spina bifida, should consult her health care provider before getting pregnant again to find out how much folic acid to take. Generally, a higher-than-normal dose is recommended (usually 4 milligrams) (9).

What support is available for parents who experience a loss?
Parents of critically ill babies in the neonatal intensive care unit (NICU) need support from family, friends and health care professionals. They should never hesitate to ask their baby's doctors and nurses about their baby's comfort and care. Parents may want to ask how they can share in their baby's care so they can feel that they are helping their baby and creating memories of their baby. Some hospitals have support groups where parents of very sick newborns can share their feelings. Many also have support groups for parents of sick newborns and for parents of babies who have died. Parents who are having trouble coping with their grief, before or after the baby's death, should ask their health care provider for a referral to a counselor who is experienced in dealing with infant death.

Some NICUs have a March of Dimes NICU Family Support® project, which provides information, comfort and services to families with a baby in the NICU. For information and resources from NICU Family Support, click here.

Parents also can visit Share Your Story an online community for families who have or have had a baby in the NICU, including families who have experienced a loss.

What happens after the baby dies?
Grieving parents may be asked if they would like to see or hold their baby after death. Some parents may find this comforting, but others may feel this is too upsetting. Parents should do what feels right to them. Providers may ask if the parents want certain mementos of their baby, such as a lock of hair, footprints or a receiving blanket. Even if looking at these things now is painful, parents may eventually treasure these remembrances. The hospital staff also may provide information on options for burial or memorial services.

The baby's doctors will visit the parents in the hospital and tell them what is known about the cause of the baby's death. They may suggest an autopsy (internal examination after death) to find out more. An autopsy reveals new information about why the baby died in more than one-third of all cases (10). This information can be helpful for parents when they are planning another pregnancy and could possibly improve care in a future pregnancy.

Some parents are not comfortable with an autopsy and can choose not to have one. In these cases, other tests can help determine why the baby died. These tests include X-rays, an examination of the placenta and umbilical cord, and genetic tests. Some of these tests also are done along with an autopsy.

The doctors who cared for the newborn usually meet with the parents about 4 to 6 weeks after the baby's death to discuss the test results. At this time, they can answer the parents' questions in detail. Doctors also can refer the family to counselors or support groups.

Parents whose baby had a birth defect should consider consulting a genetic counselor. These health professionals help families understand what is known about the causes of a birth defect, and the chances that future babies could have the same birth defect. Genetic counselors can provide referrals to medical experts, as well as to appropriate support groups in the community.

For additional support and information on neonatal death, parents can contact:

March of Dimes: Pregnancy and Newborn Loss
March of Dimes: Share Your Story
Learn more about the March of Dimes Campaign to Reduce Preterm Birth.

References

Matthews, T.J., et al. Infant Mortality Statistics from the 2002 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports, volume 53, number 10, November 24, 2005.
National Center for Health Statistics. 2002 Period Linked Birth/Infant Death Data.
Alexander, G.R., et al. U.S. Birth Weight/Gestational Age-Specific Neonatal Mortality: 1995-1997 Rates for Whites, Hispanics, and Blacks. Pediatrics, volume 111, number 1, January 2003, pages e61-66.
Martin, J.A., et al. Births: Final Data for 2003. National Vital Statistics Reports, volume 54, number 2, September 8, 2005.
Horbar, J.D., et al. Trends in Mortality and Morbidity for Very Low Birth Weight Infants, 1991-1999. Pediatrics, volume 110, number 1, July 2002, pages 143-151.
American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG). Guidelines for Perinatal Care, Fifth Edition, Elk Grove Village, IL and Washington, DC, 2002.
Hoyert, D.L., et al. Deaths: Preliminary Data for 2003. National Vital Statistics Reports, volume 53, number 15, February 28, 2005.
American Heart Association. Congenital Heart Defects in Children, accessed 12/20/05.
Centers for Disease Control and Prevention (CDC). Folic Acid: Public Health Service, updated 7/26/05.
Laing, I.A. Clinical Aspects of Neonatal Death and Autopsy. Seminars in Neonatology, volume 9, 2004, pages 247-254.
March 2006

Meth

I found this to be interesting. I had never thought about where meth came from to start with.

One of the earliest uses of methamphetamine was during World War II when the German military dispensed it under the trade name Pervitin.[6] It was widely distributed across rank and division, from elite forces to tank crews and aircraft personnel. Chocolates dosed with methamphetamine were known as Fliegerschokolade ("airmen's chocolate") when given to pilots, or Panzerschokolade ("tank chocolate") when given to tank crews. From 1942 until his death in 1945, Adolf Hitler may have been given intravenous injections of methamphetamine by his personal physician Theodor Morell as a treatment for depression and fatigue. It is possible that it was used to treat Hitler's speculated Parkinson's disease, or that his Parkinson-like symptoms which developed from 1940 onwards resulted from using methamphetamine.[7]


After World War II, a large supply of amphetamine stockpiled by the Japanese military became available in Japan under the street name shabu (also Philopon, pronounced Hiropon, a tradename)[8]. The Japanese Ministry of Health banned it in 1951; since then it has been increasingly produced by the yakuza criminal organization.[9] Today methamphetamine is still associated with the Japanese underworld, and its use is discouraged by strong social taboos.[citation needed]

In the 1950s there was a rise in the legal prescription of methamphetamine to the American public. According to the 1951 edition of Pharmacology and Therapeutics by Arthur Grollman, it was to be prescribed for "narcolepsy, post-encephalitic Parkinsonism, alcoholism, ... in certain depressive states... and in the treatment of obesity."[citation needed]

The 1960s saw the start of significant use of clandestinely manufactured methamphetamine as well as methamphetamine created in users' own homes for personal use. The recreational use of methamphetamine continued into the 1980s. San Diego, California was described as the "methamphetamine capital of North America" in the December 2, 1989 edition of The Economist[citation needed] and again in 2000, also with South Gate, California as the second capital city