Experience of water birth delivery in Iran.
Arch Iran Med. 2009 Sep;12(5):468-71. PMID: 19722768
Shahla Chaichian, Ali Akhlaghi, Firouzeh Rousta, Mahboobeh Safavi
BACKGROUND: Having considered the physiologic challenges during pregnancy, scientists have searched for different delivery methods with minimal medical intervention. The use of water immersion by women for relaxing during labor is being used worldwide. We aimed to evaluate the controversies surrounding water birth and to find out the interest of Iranian women in this delivery method. METHODS: In a randomized clinical trial, 106 pregnant women were assigned to control and experimental groups. The experimental group underwent the labor and delivery in standardized warm water pools. The control group gave birth by conventional delivery method at the hospital. A questionnaire was completed during the labor for women in both control and experimental groups including the method of delivery; labor length; use of different drugs such as analgesics, opiates, antispasmodic, and oxytocin; use of episiotomy, and newborn's Apgar score and weight. RESULTS: Totally, 53 cases and 53 controls with the mean age of 26.4+/-5.9 and 27.1+/-5.9 years, respectively, completed the study. Women in the control group required oxytocin, antispasmodics, opiates, and analgesics more frequently than those in the experimental group (P<0.001). Meanwhile, the active phase and the third stage of labor were shorter experimental group by 72 and 1.3 minutes, respectively (P<0.004, and P<0.04). All the participants in the experimental group gave birth naturally, whereas only 79.2
Article Published Date : Sep 01, 2009
Effects of water birth on maternal and neonatal outcomes.
Wien Klin Wochenschr. 2002 Jun 14;114(10-11):391-5. PMID: 12708093
Klaus Bodner, Barbara Bodner-Adler, Franz Wierrani, Klaus Mayerhofer, Christian Fousek, Anton Niedermayr, Werner Grünberger
BACKGROUND: Our purpose was to assess benefits and possible disadvantages of water births and to compare maternal and neonatal outcomes with normal vaginal deliveries. METHODS: This case-controlled study was carried out between January 2000 and July 2001. A total of 140 women who wanted water births were enrolled into the study. Our analysis was restricted to a sample of women with a gestational age>37 weeks, a normal sized foetus, a reactive admission cardiotocography, drainage of clear amniotic fluid (if the membranes were already ruptured) and a pregnancy with cephalic presentation. Women with medical or obstetric risk factors were excluded. 140 controls were selected from the delivery database as the next parity-matched normal spontaneous vaginal delivery. RESULTS: A statistically significant lower rate of episiotomies (p = 0.0001) and vaginal trauma (p = 0.03) was detected in the group assigned to water birth, whereas the frequency of perineal tears and labial trauma remained similar in both groups (p>0.05). A statistically significant decrease in the use of medical analgesia (p = 0.0001) and oxytocin (p = 0.002) was observed in women who had water births. A trend towards a reduction of the length of the first stage of labour was only observed in primiparous women bearing in water, but this reduction did not reach statistically significance (p>0.05). Manual placenta removal (p = 0.017), severe postpartum haemorrhage (blood loss>500 ml; p = 0.002) and maternal infection rate (p = 0.03) were statistically significant lower in women who delivered in water. When analysing the postpartum haemoglobin, no statistically significant differences could be observed between the two groups (p>0.05). No statistically significant differences were detected for neonatal parameters (p>0.05) between women who had had water births and those choosing conventional vaginal delivery.
Article Published Date : Jun 14, 2002
A retrospective comparison of water births and conventional vaginal deliveries.
Eur J Obstet Gynecol Reprod Biol. 2000 Jul;91(1):15-20. PMID: 10817872
C M Otigbah, M K Dhanjal, G Harmsworth, T Chard
Department of Obstetrics and Gynaecology, Homerton Hospital, London, UK.
The aim of this study was to document the practice of water births and compare their outcome and safety with normal vaginal deliveries. A retrospective case-control study was conducted over a five year period from 1989 to 1994 at the Maternity Unit, Rochford Hospital, Southend, UK. Three hundred and one women electing for water births were compared with the same number of age and parity matched low risk women having conventional vaginal deliveries. Length of labour; analgesia requirements; apgar scores; maternal complications including perineal trauma, postpartum haemorrhages, infections; fetal and neonatal complications including shoulder dystocias; admissions to the Special Care Baby Unit, and infections were noted. Primigravidae having water births had shorter first and second stages of labour compared with controls (P<0.05 and P<0.005 respectively), reducing the total time spent in labour by 90 min (95% confidence interval 31 to 148). All women having water births had reduced analgesia requirements. No analgesia was required by 38% (95% confidence interval 23.5 to 36.3, P<0.0001) and 1.3% requested opiates compared to 56% of the controls (95% confidence interval 46. 3 to 58.1, P<0.0001). Primigravidae having water births had less perineal trauma (P<0.05). Overall the episiotomy rate was 5 times greater in the control group (95% confidence interval 15 to 26.2, P<0.0001), but more women having water births had perineal tears (95% confidence interval 6.6 to 22.6, P<0.001). There were twice as many third degree tears, post partum haemorrhages and admissions to the Special Care Baby Unit in the controls, although these differences were not significant. Apgar scores were comparable in both groups. There were no neonatal infections or neonatal deaths in the study. This study suffers from many of the methodological problems inherent in investigation of uncommon modes of delivery. However, we conclude that water births in low risk women delivered by experienced professionals are as safe as normal vaginal deliveries. Labouring and delivering in water is associated with a reduction in length of labour and perineal trauma for primigravidae, and a reduction in analgesia requirements for all women.
Article Published Date : Jul 01, 2000
Pre- and postnatal environmental boron exposure and infant growth: Results from a mother-child cohort in northern Argentina.
Environ Res. 2019 Jan 07;171:60-68
Authors: Hjelm C, Harari F, Vahter M
BACKGROUND: Experimental studies show developmental toxicity of boron and we recently found impaired weight and length in newborns of mothers exposed to boron through drinking water during pregnancy.
OBJECTIVES: To evaluate potential impact of pre- and postnatal boron exposure on infant anthropometry.
METHODS: In our mother-child cohort (n = 177) in Argentinean Andes, where drinking water concentrations of boron, lithium and arsenic have been found to vary considerably, we collected maternal blood and urine during and after pregnancy, placenta, breast milk, as well as infant urine and blood during the first 6 months of life. In all samples, boron and other potentially toxic elements were measured by ICP-MS. Infant weight (g), length (cm) and head circumference (cm) were measured at birth, 0-3 (n = 120) and/or 3-6 months (n = 120; 79 overlap) of age.
RESULTS: Boron concentrations in breast milk (range: 46-786 µg/L) correlated strongly with those in maternal serum (range: 47-624 µg/L; rs = 0.94) 0-3 months post-partum. In multivariable-adjusted linear regression, urinary boron (log2-transformed; range 60-9200 µg/L) in the youngest infants, but not maternal serum boron during pregnancy, was inversely associated with body weight at both 0-3 months (B: -141, 95% CI: -240; -42, p = 0.006) and 3-6 months (B: -200, 95% CI: -377; -23, p = 0.027). Infant urinary boron was also inversely associated with head circumference at 0-3 months (B: -0.39, 95% CI: -0.74; -0.04, p = 0.028), as well as length (B: -0.57, 95% CI: -1.1; -0.03, p = 0.040) and head circumference (B: -0.30, 95% CI: -0.64; 0.04, p = 0.083) at 3-6 months.
CONCLUSIONS: The observed first evidence that elevated environmental boron exposure in early infancy may adversely affect growth supports previous findings of boron-related impaired fetal growth. More research is needed to verify the findings at older age and in other populations.
PMID: 30654250 [PubMed - as supplied by publisher]
Mating under the influence: male Siamese fighting fish prefer EE2-exposed females.
Ecotoxicology. 2019 Jan 16;:
Authors: Cram RA, Lawrence JM, Dzieweczynski TL
Countless pharmaceuticals and endocrine disrupting chemicals (EDCs) exist on the market with more added each day. Many of these compounds are not removed during the wastewater treatment process and enter bodies of water in their active form. EDCs are known to have physiological and behavioral effects in exposed organisms. Exposure to the synthetic estrogen 17α-ethinylestradiol (EE2), a common EDC found in birth control pills, has been found to lead to population collapse after only a few generations in some fish species. Mechanisms identified as potential driving forces for collapse include feminization of males and altered fecundity in both sexes. However, an additional way in which EE2 could lead to population collapse is by altering courtship behavior, which could then change mating preferences and decrease mating opportunities. The current study had the following objectives: determine if exposing female Siamese fighting fish, Betta splendens, to EE2 changes mate choice in males; assess if the dose and duration of female exposure matters; and examine if exposing males to EE2 influences their mating preferences. Both unexposed and exposed males were presented with pairs of females that differed in EE2 dose and exposure duration. The results indicate that males were more responsive to EE2-exposed females than unexposed females, with males being most responsive to females exposed to the low versus high dose. Furthermore, exposed males responded less overall than unexposed males. If EE2 concentration increases in the environment, the likelihood of successful mating could decrease and, therefore, potentially lead to adverse population impacts.
PMID: 30652235 [PubMed - as supplied by publisher]
Environmental justice and drinking water quality: are there socioeconomic disparities in nitrate levels in U.S. drinking water?
Environ Health. 2019 Jan 17;18(1):3
Authors: Schaider LA, Swetschinski L, Campbell C, Rudel RA
BACKGROUND: Low-income and minority communities often face disproportionately high pollutant exposures. The lead crisis in Flint, Michigan, has sparked concern about broader socioeconomic disparities in exposures to drinking water contaminants. Nitrate is commonly found in drinking water, especially in agricultural regions, and epidemiological evidence suggests elevated risk of cancer and birth defects at levels below U.S. EPA's drinking water standard (10 mg/L NO3-N). However, there have been no nationwide assessments of socioeconomic disparities in exposures to nitrate or other contaminants in U.S. drinking water. The goals of this study are to identify determinants of nitrate concentrations in U.S. community water systems (CWSs) and to evaluate disparities related to wealth or race/ethnicity.
METHODS: We compiled nitrate data from 39,466 U.S. CWSs for 2010-2014. We used EPA's Safe Drinking Water Information System (SDWIS) to compile CWS characteristics and linked this information with both city- and county-level demographic data gathered from the U.S. Census Bureau. After applying multiple imputation methods to address censored nitrate concentration data, we conducted mixed-effects multivariable regression analyses at national and regional scales.
RESULTS: 5.6 million Americans are served by a CWS that had an average nitrate concentration ≥ 5 mg/L NO3-N between 2010 and 2014. Extent of agricultural land use and reliance on groundwater sources were significantly associated with nitrate. The percent of Hispanic residents served by each system was significantly associated with nitrate even after accounting for county-level cropland and livestock production, and CWSs in the top quartile of percent Hispanic residents exceeded 5 mg/L nearly three times as often as CWSs serving the lowest quartile. By contrast, the percent of residents living in poverty and percent African American residents were both inversely associated with nitrate.
CONCLUSIONS: Epidemiological evidence for health effects associated with drinking water above 5 mg/L NO3-N raises concerns about increased risk for the 5.6 million Americans served by public water supplies with average nitrate concentrations above this level. The associations we observed between nitrate concentrations and proportions of Hispanic residents support the need for improved efforts to assist vulnerable communities in addressing contamination and protecting source waters. Future studies can extend our methods to evaluate disparities in exposures to other contaminants and links to health effects.
PMID: 30651108 [PubMed - in process]
Caesarean section rate and cost control effectiveness of case payment reform in the new cooperative medical scheme for delivery: evidence from Xi County, China.
BMC Pregnancy Childbirth. 2018 03 09;18(1):66
Authors: Liu S, Wang J, Zhang L, Zhang X
BACKGROUND: In China, increases in both the caesarean section (CS) rates and delivery costs have raised questions regarding the reform of the medical insurance payment system. Case payment is useful for regulating the behaviour of health providers and for controlling the CS rates and excessive increases in medical expenses. New Cooperative Medical Scheme (NCMS) agencies in Xi County in Henan Province piloted a case payment reform (CPR) in delivery for inpatients. We aimed to observe the changes in the CS rates, compare the changes in delivery-related variables, and identify variables related to delivery costs before and after the CPR in Xi County.
METHODS: Overall, 28,314 cases were selected from the Xi County NCMS agency from 2009 to 2010 and from 2014 to 2015. One-way ANOVA and chi-square tests were used to compare the distributions of CS and vaginal delivery (VD) before and after the CPR under different indicators. We applied multivariate linear regressions for the total medical cost of the VD and CS groups and total samples to identify the relationships between medical expenses and variables.
RESULTS: The CS rates in Xi County increased from 26.1% to 32.5% after the CPR. The length of stay (LOS), total medical cost, and proportion of county hospitals increased in the CS and VD groups after the CPR, which had significant differences. The total medical cost in the CS and VD groups as well as the total samples was significantly influenced by inpatient age, LOS, and hospital type, and had a significant correlation with the CPR in the VD group and the total samples.
CONCLUSION: The CPR might fail to control the growth of unreasonable medical expenses and regulate the behaviour of providers, which possibly resulted from the unreasonable compensation standard of case payments, prolonged LOS, and the increasing proportion of county hospitals. The NCMS should modify the case payment standard of delivery to inhibit providers' motivation to render CS services. The LOS should be controlled by implementing clinical guidelines, and a reference system should be established to guide patients in choosing reasonable hospitals.
PMID: 29523121 [PubMed - indexed for MEDLINE]
A sibling study of whether maternal exposure to different types of natural space is related to birthweight.
Int J Epidemiol. 2018 02 01;47(1):146-155
Authors: Richardson EA, Shortt NK, Mitchell R, Pearce J
Background: Birthweight is an important determinant of health across the life course. Maternal exposure to natural space has been linked to higher birthweight, but stronger evidence of a causal link is needed. We use a quasi-experimental sibling study design to investigate if change in the mother's exposure to natural space between births was related to birthweight, in urban Scotland.
Methods: Amount (% area) of total natural space, total accessible (public) natural space, parks, woodlands and open water within 100 m of the mother's postcode was calculated for eligible births (n = 40 194; 1991-2010) in the Scottish Longitudinal Study (a semi-random 5.3% sample of the Scottish population). Associations between natural space and birthweight were estimated, using ordinary least squares and fixed effects models.
Results: Birthweight was associated with the total amount of natural space around the mother's home (+8.2 g for interquartile range increase), but was unrelated to specific types of natural space. This whole-sample relationship disappeared in the sibling analysis, indicating residual confounding. The sibling models showed effects for total natural space with births to women who already had children (+20.1 g), and to those with an intermediate level of education (+14.1 g).
Conclusions: The importance of total natural space for birthweight suggests that benefits can be experienced near to as well as within natural space. Ensuring expectant mothers have good access to high quality neighbourhood natural space has the potential to improve the infant's start in life, and consequently their health trajectory over the life course.
PMID: 29253203 [PubMed - indexed for MEDLINE]