Midwifery is catching

I’d forgotten to tell all of my loyal followers here that I’ve moved to a new blog… My House Smells Like Vanilla. There are a couple of reasons for this, but go over there to check it all out. It’s much less midwifery-focused and more Me focused, which is how I want to approach my life for the next few years!

The association between cord pH at birth and intellectual function in childhood.
Early Hum Dev. 2008 Jan;84(1):37-41.
Svirko E, Mellanby J, Impey L.
Department of Experimental Psychology, University of Oxford, Oxford, UK.

BACKGROUND: Acidemia at birth is very common but little is known about its long-term consequences.

AIM: To determine if pH at birth is related to established tests of intellectual function.

SUBJECTS: School children aged 6-8, for whom obstetric data were available, who had been delivered after labour at term, and had an umbilical cord arterial pH>7.00 (i.e. that was not extremely acidemic).

STUDY DESIGN/OUTCOMES: Retrospective cohort study correlating birth and arterial pH data with childhood tests for non-verbal intelligence, grammar comprehension and literacy. METHODS: Relationships between pH and cognitive measures were analysed with parametric correlations. Partial correlations were used to examine these relationships, controlling for possible confounding factors.

RESULTS: Arterial pH was significantly negatively correlated with literacy (p=0.001) and with non-verbal intelligence (p=0.033).

CONCLUSIONS: Lower arterial pH is associated with higher scores on literacy and non-verbal intelligence tests at ages 6-8. This is unlikely to be a chance finding and is further evidence that acidemia in isolation should not be considered an adverse outcome. Further research on the relationship between labour and long-term cognitive measures is required.

Cervical Manipulations Linked to Perinatal Sepsis: Consider GBS-specific chemoprophylaxis
OB/GYN News, Oct 15, 2001 by Kathryn DeMott

QUEBEC CITY — Obstetricians may want to hold off on performing cervical manipulation or membrane stripping to hasten labor in women with cervical/vaginal infection or colonization with pathogens, Dr. Carol Stamm reported at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology. In a series of eight case reports, Dr. Stamm of the University of Colorado, Denver, described how cervical manipulation or membrane stripping preceded perinatal sepsis and even one instance of stillbirth caused by invasive group B streptococcus (GBS) as well as other pathogens.

In each case, the salient features were the same: Each woman had a history of term gestation in a previously healthy pregnancy. All had elective or nonurgently indicated promotion of labor, digital cervical manipulation, and rapid labor with placental findings of histologically severe intrauterine infection or funisitis, half the time in the absence of classical clinical criteria of chorioamnionitis. One patient gave birth to a stillborn 15 hours after membrane stripping due to overwhelming fetal GBS sepsis. In four of the eight cases, the women had no risk factors such as known GBS infection or symptoms of chorioamnionitis; in the remaining four cases there were such red flags. It has always been assumed that such events are rare; however, their incidence can only really be established by large, prospective epidemiologic studies, Dr. Stamm noted in her poster presentation. Membrane stripping and cervical manipulation to release prostaglandins can be considerably vigorous. And this series of case reports builds on prior evidence that suggests that it is traumatic enough to cause vaginal microbes to spread into the lower uterus.

On the basis of these case reports, obstetricians may want to reconsider doing elective cervical manipulation, at least on patients who have cervical vaginal infection or colonization with potential perinatal pathogens. They may also want to consider providing GBS-specific chemoprophylaxis before membrane stripping, she said.

Perky’apostrophe is running a fundraiser for Medical Students for Choice and I’d encourage you to consider donating, and maybe win a prize as well as providing education for the doctors of the future in the United States.

When I come back from San Francisco, I’ll be running a week-long fundraiser and I’d like you to be part of it.  No, I’m not raising money for myself to buy a house or a new appliance.  I’ll be raising money to create better physicians.

After Roe v. Wade, hospitals stopped seeing a lot of injuries and deaths from illegal abortions and eventually most hospitals stopped performing them.  As a result of this, as well as political pressure and fear of being targeted by anti-choice whackadoodles, many medical schools quietly removed abortion from their curriculum.  Today your average first or second year medical student is lucky to get even a mention of abortion in a Pharmacology lecture, and it’s really rare for a third or fourth year student to see an abortion or abortion-related complication during the clinical part of their education.  Even OB/GYN residents aren’t guaranteed education around abortion - only 50% of residency programs have an opt-out abortion rotation.  I don’t particularly think it matters how one feels about abortion and whether it should be legal or illegal…I think we should want our doctors to be well-trained enough to deal with something that impacts over one-third of their female patients.  Even if the doctor chooses not to perform abortions, don’t you think doctors should know something about it?

Look, 87% of U.S. counties lack an abortion provider and the pool of trained physicians willing to provide services continues to shrink (the statistics for Canada are no less depressing).  Legalized abortion is under threat in this country, but the shrinking pool of providers threatens to make the legality issue irrelevant.  And maybe you don’t care, maybe you’re thinking, “Good! We shouldn’t make it easy for women to find abortion services!” Well, consider this: most medical schools devote more class time to learning about Viagra than to all forms of contraception combined.  Many medical students aren’t learning much at all about important things like sterilization procedures or pregnancy options counseling.  You wonder why we keep hearing things about gynecologists refusing to prescribe birth control pills and perform vasectomies on unmarried men.  And put into this context, the proposed Dept. of Health and Human Services regulations that would make it a federally-protected act to not just withhold information to patients on abortion and contraception, but provide false information, well…it’s frightening.

And so I’ll be running a fundraising drive to make better doctors.  And there will be prizes!!!  For every each $10 donated, your name will go in a drawing to win one of the following:

    * one pair of handmade socks
    * one half pint of handmade watermelon rind relish
    * one half pint of handmade peach butter
    * one half pint of handmade plum barbecue sauce
    * one half pint of handmade watermelon barbecue sauce
    * one pint of handmade tomato-red wine sauce
    * One handknit stuffed uterus
    * One dozen of the most fantastic cookies you’ll ever eat: chocolate chip with sea salt.
    * Two skeins of handspun yarn
    * Gorgeous agate earrings donated by Designs by Galina