Sandra Parisi

Source: Birth 2008; 35: 92-7 Examining the perinatal effects of doula support for nulliparous middle-income women accompanied by a male partner during labor and delivery. MedWire News: The continued presence of a doula during labor significantly reduces cesarean delivery rates and the need for epidural analgesia in middle- and upper-class US women accompanied by their male partner or another family member, researchers report. They suggest that maybe fathers should not be expected to fulfill the role of primary labor companion. Susan McGrath and John Kennell from Case Western Reserve University, Cleveland, Ohio, USA, investigated the potential benefit during labor of an experienced doula to provide both emotional and instrumental support. A total of 420 women were randomly assigned to either have a doula present throughout labor in addition to their male partner or no such additional support. Women who had the support of a doula had a significantly lower cesarean delivery rate than the control group, at 13.4 percent versus 25.0 percent. They were also less likely to need epidural analgesia, at 64.7 percent versus 76.0 percent, respectively. Among women with induced labor, just 12.5 percent of women with a doula had a cesarean delivery, compared with 58.8 percent of those without a doula. All women and their male partners who received the support of a doula rated their experience as positive. "Continuous labor support by a doula is a risk-free obstetric technique that could benefit all laboring women and should be made available in all maternity units," the researchers conclude. Posted: 03 June 2008

Cesareans tied to strokes Source: American Journal of Obstetrics & Gynecology 2008; 198: 391.e1-391.e7 Investigating whether cesarean section delivery is a risk factor for strokes. MedWire News: Cesarean section (CS) delivery is an independent risk factor for stroke, a study of almost a million births has revealed. Current strategies for preventing stroke rely mainly on controlling inherent risk factors in daily life, such as hypertension, smoking, and obesity, say the Taiwanese researchers. They examined whether stroke risk could also increase after CS among 987,010 women who had singleton deliveries in their country between 1998 and 2002. The team from the University of Taipei found that women who delivered by CS had significantly higher stroke rates within 3 months postpartum than those who delivered vaginally, at 0.03 percent versus 0.02 percent, respectively. The same was true within 6 months after delivery, at 0.05 percent versus 0.03 percent, and at 12 months, at 0.08 versus 0.05 percent, respectively. Hazard ratios for stroke with CS compared with vaginal delivery were 1.67 within 3 months of delivery, dropping to 1.61 within 6 months, and 1.49 within 12 months. Shiyng-Yu Lin and co-workers suggest CS delivery could alter hemodynamic and coagulation status, thereby predisposing to stroke. "Based on the results of this study, a reduction in the CS delivery rate should prove to be beneficial for stroke prevention," they conclude. Posted 29 April 2008 (c) 2008 Current Medicine Group Ltd, a part of Springer Science+Business Media

Delaying elective cesarean delivery reduces neonatal morbidity Source: Obstetrics & Gynecology 2008; 111: 823-8 Investigators evaluate the relationship between gestational age at elective cesarean delivery and neonatal intensive care unit admission and respiratory distress. MedWire News: Researchers recommend delaying elective cesarean delivery beyond 37 weeks' gestation, if possible, to reduce the risk for admission to neonatal intensive care units (NICU) and respiratory distress. "In our population if elective cesarean delivery were planned for beyond 270 days (38 weeks) of gestation, the risk of respiratory distress could be reduced by 50 percent and NICU admission by approximately 40 percent in these neonates," report Wendy Yee and colleagues from the University of Calgary in Alberta, Canada. The researchers reviewed the medical charts of 1,193 mother-infant pairs. Infants born at 36 weeks or more and weighing 2,500 g or more were included. Overall, 13.1 percent of infants delivered by elective cesarean were admitted to NICU, compared with 7.3 percent of all infants delivered vaginally in the preceding year. About 10 percent of infants admitted to the NICU had respiratory distress. The team's analysis indicated that a 1-day advancement in gestational age could reduce the risk for respiratory distress by 7 percent. Yee et al note that waiting for delivery symptomatic contractions or ruptured membranes before carrying out cesarean delivery did not offer any additional protection against NICU admission or respiratory distress. Posted: 28 April 2008 (c) 2008 Current Medicine Group Ltd, a part of Springer Science+Business Media