DOCSLIB.ORG

Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care Sarah J. Buckley January 2015 Childbirth Connection A Program of the National Partnership for Women & Families About the National Partnership for Women & Families At the National Partnership for Women & Families, we believe that actions speak louder than words, and for four decades we have fought for every major policy advance that has helped women and families. Today, we promote reproductive and maternal-newborn health and rights, access to quality, affordable health care, fairness in the workplace, and policies that help women and men meet the dual demands of work and family. Our goal is to create a society that is free, fair and just, where nobody has to experi- ence discrimination, all workplaces are family friendly and no family is without quality, affordable health care and real economic security. Founded in 1971 as the Women’s Legal Defense Fund, the National Partnership for Women & Families is a nonprofit, nonpartisan 501(c)3 organization located in Washington, D.C. About Childbirth Connection Programs Founded in 1918 as Maternity Center Association, Childbirth Connection became a core program of the National Partnership for Women & Families in 2014. Throughout its history, Childbirth Connection pioneered strategies to promote safe, effective evidence-based maternity care, improve maternity care policy and quality, and help women navigate the complex health care system and make informed deci- sions about their care. Childbirth Connection Programs serve as a voice for the needs and interests of childbearing women and families, and work to improve the quality and value of maternity care through consumer engagement and health system transformation. © 2015 National Partnership for Women & Families. All rights reserved. This publication may be redistributed electronically or digitally for noncommercial purposes only so long as it remains wholly intact, including this copyright notice and disclaimer. Address all other permission re- quests, except for brief quotations with credit to the source, to Childbirth Connection Programs, National Partnership for Women & Families. Disclaimer: The information provided in this report is not intended as a substitute for the professional guidance of qualified maternity care providers. Suggested citation: Buckley, Sarah J. Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care. Washington, D.C.: Childbirth Connection Programs, National Partnership for Women & Families, January 2015. Available with related documents at: www.ChildbirthConnection.org/HormonalPhysiology 1875 Connecticut Avenue NW, Suite 650, Washington, D.C. 20009 phone: 202-986-2600 • fax: 202-986-2539 • e-mail: [email protected] www.NationalPartnership.org Transform.ChildbirthConnection.org www.ChildbirthConnection.org Abstract Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care This report synthesizes evidence about innate hormonally-mediated physiologic processes in women and fetuses/newborns during childbearing, and possible impacts of common maternity care practices and interventions on these processes, focusing on four hormone systems that are consequential for childbearing. Core hormonal physiology principles reveal profound interconnections between mothers and babies, among hormone systems, and from pregnancy through to the postpartum and newborn pe- riods. Overall, consistent and coherent evidence from physiologic understandings and human and animal studies finds that the innate hormonal physiology of childbearing has significant benefits for mothers and babies. Such hormonally-mediated benefits may extend into the future through optimization of breastfeeding and maternal-infant attachment. A growing body of research finds that common maternity care interventions may disturb hormonal processes, reduce their benefits, and create new challenges. Developmental and epigenetic effects are biologically plausible but poorly studied. The perspective of hormonal physiology adds new considerations for benefit-harm assessments in maternity care, and sug- gests new research priorities, including consistently measuring crucial hormonally-mediated outcomes that are frequently overlooked. Current understanding suggests that safely avoiding unneeded maternity care interventions would be wise, as supported by the Precautionary Principle. Promoting, supporting, and protecting physiologic childbearing, as far as safely possible in each situation, is a low-technology health and wellness approach to the care of childbearing women and their fetuses/newborns that is applicable in almost all maternity care settings. CHILDBIRTH CONNECTION | HORMONAL PHYSIOLOGY OF CHILDBEARING | ABSTRACT i Contents Abstract .......................................................................................................................................................... i Figures and Tables ...................................................................................................................................... iii Message from Debra L. Ness ...................................................................................................................... iv Foreword ....................................................................................................................................................... v Preface ........................................................................................................................................................ vii Acknowledgments ...................................................................................................................................... ix Executive Summary ...................................................................................................................................... x 1 Introduction: Overarching Themes and Scope ............................................................................. 1 1.1 Human Childbearing: Evolution and Safety .......... 2 1.2 Contemporary Childbirth Practices .......... 2 1.3 Current Understandings of the Hormonal Physiology of Childbearing .......... 4 1.4 Alignment with Other Frameworks .......... 7 1.5 Scope of This Report .......... 10 1.6 Introduction: Summary .......... 11 2 Physiologic Onset of Labor and Scheduled Birth ......................................................................... 14 2.1 Physiologic Onset of Labor at Term .......... 15 2.2 Possible Impacts of Scheduled Birth .......... 20 2.3 Physiologic Onset of Labor and Scheduled Birth: Summary .......... 24 3 Oxytocin ............................................................................................................................................ 26 3.1 Oxytocin: Normal Physiology .......... 27 3.2 Common Maternity Care Practices That May Impact Oxytocin Physiology .......... 54 3.3 Oxytocin Physiology: Summary .......... 90 4 Beta-Endorphins ............................................................................................................................. 93 4.1 Beta-Endorphins: Normal Physiology .......... 94 4.2 Common Maternity Care Practices That May Impact Beta-Endorphins Physiology .......... 102 4.3 Beta-Endorphins: Summary .......... 109 5 Epinephrine-Norepinephrine and Related Stress Hormones .................................................. 111 5.1 Epinephrine-Norepinephrine and Related Stress Hormones: Normal Physiology .......... 112 5.2 Common Maternity Care Practices That May Impact Epinephrine-Norepinephrine and Related Stress Hormones .......... 125 5.3 Epinephrine-Norepinephrine and Related Stress Hormones: Summary .......... 138 6 Prolactin ........................................................................................................................................ 140 6.1 Prolactin: Normal Physiology .......... 141 6.2 Common Maternity Care Practices That May Impact Prolactin Physiology .......... 149 6.3 Prolactin: Summary .......... 154 7 Conclusions and Recommendations ........................................................................................... 156 7.1 Conclusions .......... 157 7.2 Recommendations to Promote, Support, and Protect Physiologic Childbearing .......... 163 7.3 Conclusions and Recommendations: Summary .......... 169 Appendix: Resources for Learning More and Improving Practice ...................................................... 171 References ................................................................................................................................................ 175 Abbreviations ........................................................................................................................................... 224 Photo Credits ............................................................................................................................................ 225 CHILDBIRTH CONNECTION | HORMONAL PHYSIOLOGY OF CHILDBEARING | CONTENTS ii Figures and Tables Figures Figure 1: Women’s oxytocin levels in late pregnancy, in early labor, at birth, and after birth .............. 36 Figure 2: Maternal oxytocin levels, with and without epidural analgesia ......................................... 76 Figure 3: Women’s beta-endorphins levels non-pregnant, in labor, and after birth ........................... 99 Figure 4: Maternal beta-endorphins levels, with and without epidural analgesia ...........................
Load more

Recommended publications
  • Strategies to Increase ß-Cell Mass Expansion
    This electronic thesis or dissertation has been downloaded from the King’s Research Portal at https://kclpure.kcl.ac.uk/portal/ Strategies to increase -cell mass expansion Drynda, Robert Lech Awarding institution: King's College London The copyright of this thesis rests with the author and no quotation from it or information derived from it may be published without proper acknowledgement. END USER LICENCE AGREEMENT Unless another licence is stated on the immediately following page this work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence. https://creativecommons.org/licenses/by-nc-nd/4.0/ You are free to copy, distribute and transmit the work Under the following conditions: Attribution: You must attribute the work in the manner specified by the author (but not in any way that suggests that they endorse you or your use of the work). Non Commercial: You may not use this work for commercial purposes. No Derivative Works - You may not alter, transform, or build upon this work. Any of these conditions can be waived if you receive permission from the author. Your fair dealings and other rights are in no way affected by the above. Take down policy If you believe that this document breaches copyright please contact [email protected] providing details, and we will remove access to the work immediately and investigate your claim. Download date: 02. Oct. 2021 Strategies to increase β-cell mass expansion A thesis submitted by Robert Drynda For the degree of Doctor of Philosophy from King’s College London Diabetes Research Group Division of Diabetes & Nutritional Sciences Faculty of Life Sciences & Medicine King’s College London 2017 Table of contents Table of contents .................................................................................................
    [Show full text]
  • WHO Safe Childbirth Checklist Implementation Guide Improving the Quality of Facility-Based Delivery for Mothers and Newborns
    BACKGROUND AND OVERVIEW WHO Safe Childbirth Checklist Implementation Guide Improving the quality of facility-based delivery for mothers and newborns WHO SAFE CHILDBIRTH CHECKLIST IMPLEMENTATION GUIDE 1 WHO Library Cataloguing-in-Publication Data WHO safe childbirth checklist implementation guide: improving the quality of facility-based delivery for mothers and newborns. 1.Parturition. 2.Birthing Centers. 3.Perinatal Care. 4.Maternal Health Services. 5.Infant, Newborn. 6.Quality of Health Care. 7.Checklist. I.World Health Organization. ISBN 978 92 4 154945 5 (NLM classification: WQ 300) © World Health Organization 2015 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications—whether for sale or for non-commercial distribution—should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organiza- tion concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.
    [Show full text]
  • The Role of a Midwife in Assisted Reproductive Units
    Clinical Obstetrics, Gynecology and Reproductive Medicine Research Article ISSN: 2059-4828 The role of a midwife in assisted reproductive units O Tsonis1, F Gkrozou2*, V Siafaka3 and M Paschopoulos1 1Department of Obstetrics and Gynaecology, University Hospital of Ioannina, Greece 2Department of Obstetrics and Gynaecology, university Hospitals of Birmingham, UK 3Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Greece Abstract Problem: The role of midwifery in Assisted Reproductive Units remains unclear. Background: Midwives are valuable health workers in every field or phase of women’s health. Their true value has been consistently demonstrated and regards mainly their function in labour. Infertility is a quite new territory in which a great deal of innovating approaches has been made through the years. Aim: The aim of this study is to present the role of midwifery in Assisted Reproductive Units based on scientific data Methods: For this review 3 (three) major search engines were included MEDLINE, PubMed and EMBASE focusing on the role of midwives in the assisted reproductive units. Findings: It seems that midwives have three distinct roles, when it comes to emotional management of the infertile couple, being the representative of the infertile couple and also, performing assisted reproductive techniques in some cases. Their psychomedical support is profound and, in this review, we try to research their potential role in the assisted reproductive units. Discussion: In the literature, only few scientific articles have been conducted in search of the role of Midwifery in Infertility. Their importance is once again undeniable and further research needs to be conducted in order to increase their adequate participation into this medical field.
    [Show full text]
  • Childbirth Education Booklet
    Childbirth Education Contents Normal Discomforts of Pregnancy 2 Call Your Doctor 4 Late Pregnancy 5 Labor: Stage 1 6 Labor: Stages 2 & 3 8 Breastfeeding in the Hospital 9 Breathing Techniques 10 Birth Plans 10 Labor Positions 11 How Your Partner and Doula Can Help 13 Packing for the Hospital 15 Normal Discomforts of Pregnancy Fatigue Backache • Listen to your body, take naps, get extra rest • Maintain correct posture • Do pelvic tilt exercises while standing and on hands Stuffy Nose and knees • Warm compresses to nose • While on all fours, crawl forwards and backwards, • Cool mist humidifier in your home or rock, and do pelvic tilts bedroom at night • When picking up something lift with your legs to protect your back Shortness of Breath • Don’t stay that way, slow down and catch your breath • For prolonged standing, elevate 1 foot on a step stool • Sleep propped up with pillows or in recliner • Receive back massages • Maintain correct posture Dribble Urine • Moderate intensity exercising (walking, stationary • Do Kegel exercises – at least 50 a day bike, swim, flexibility moves) (do 10 every time you wash your hands) • How can you tell if you are dribbling urine or your Heartburn/Nausea water broke? Call your OB or midwife, and remember • Don’t eat 3 big meals a day, eat 5-6 smaller meals this acronym: • Drink 8 cups of water a day COAT. C=color, O=odor, A=amount, T=time. • Have dry crackers/cereal to nibble on–keep in purse and at bedside • Don’t let stomach become empty • Eat well balanced diet–vitamin B may help to decrease • Avoid
    [Show full text]
  • At the CENTER DR
    The Reiss-Davis Child Study Center & Institute at Vista Del Mar presents its 2016-2017 monthly series of SATURDAYS SERIES BEGINS NOVEMBER 19th with at the CENTER DR. ROBERT MORADI PRESENTING ON NIGHTMARES CE Credits for Mental Health Professionals Serving Children, Adolescents and Parents A PLACE TO TURN • A PLACE TO LEARN • A PLACE TO EARN Celebrating its 8th Year of offering Cutting Edge presentations on the latest in developmental-psychodynamic neuro-bio-psycho-social/relational mental health theory and technique for those who work with children and adolescents CONVENIENTLY LOCATED | REASONABLY PRICED | PLEASANTLY SITUATED ON THE GROUNDS OF VISTA DEL MAR *Please note that some sessions are presented on Fridays THE REISS-DAVIS CHILD STUDY CENTER & INSTITUTE is a non-profit, non-sectarian mental health training and treatment center that has been serving the needs of children, adolescents, their families, and professionals since 1950. Our Clinical and Psycho-Educational Services offered at the Center include: • Psychotherapy for children, parents, and families* • Parent Work* • Evidence-based cognitive-behavioral therapies for MediCal eligible children, adolescents and parents* • Diagnostic assessments* • Psycho-Educational Diagnostic testing Services (P.E.D.S.) for assessing LD, AD/HD and emotional issues • Keeping Kids First-educational program for divorcing parents • Neurofeedback/brain training program for children and adolescents with attentional and other issues *For these clinical services please call the Vista Counseling Center at 310-836-1223 Ext. 330/500 For all other services please call 310-204-1666: • Psycho-Educational (PEDS) Program at Ext. 307 • Keeping Kids First Program at Ext. 875 • Neurofeedback Program at Ext.
    [Show full text]
  • 95667-Acth High Risk Pregnan.Pdf
    Fetal Diagn Ther 2006;21:528–531 Received: July 12, 2005 Accepted after revision: January 19, 2006 DOI: 10.1159/000095667 Published online: September 12, 2006 The Effectiveness of Adrenocorticotropin Repeated Doses in High Risk Pregnancies M. Klimek Department of Gynecology and Infertility Clinic of Jagiellonian University, Krakow , Poland Key Words higher newborn mass and length than patients who re- Adrenocorticotropin Preterm birth Oxytocinase ceived a series of three hormonal injections as well as Hormonal therapy control women who had no clinical or laboratory indica- tion for such therapy. Conclusions: ACTH-depot injection results in the oxytocinase increased serum level, a de- Abstract creased number of abortion and preterm deliveries and Objective: The aim of this study was to assess the effect prolonged duration of pregnancy. Single repeated doses of two kinds of adrenocorticotropin (ACTH)-depot re- of the ACTH-depot therapy had statistically signifi cant peated doses administered to pregnant women who un- better results in the prolongation of pregnancy, newborn derwent infertility treatment. Material and Methods: The mass and length than a serial hormonal dosage. study population included 424 pregnant women with Copyright © 2006 S. Karger AG, Basel singletons. Two hundred and forty-two women received repeated 0.5 mg doses of ACTH, whereas 182 women also were treated for infertility but did not receive any Introduction therapy. The ACTH-treated patients were subdivided into two subgroups: (1) 142 patients received only series The benefi cial effects of the antenatal ad r enocortico- of three 0.5 g ACTH-depot injections every other day in tropin (ACTH)-depot and corticosteroids have been the fi rst and/or second trimester with occasionally single known, respectively for more than 40 [1] and 30 years [2] , ACTH-depot doses in the third trimester, (2) 100 patients but still only a small part, i.e., 25% of potential patients received only single 0.5 mg ACTH-depot doses for the are exposed to the hormonal therapy.
    [Show full text]
  • The Effects of Alcohol in Newborns Efeitos Do Álcool No Recém-Nascido
    REVIEW The effects of alcohol in newborns Efeitos do álcool no recém-nascido Maria dos Anjos Mesquita* ABSTRACT alcoólicas leva a prejuízos individuais, para a sua família e para The purpose of this article was to present a review of the effects toda a sociedade. Apesar disso, a dificuldade do seu diagnóstico e of alcohol consumption by pregnant mothers on their newborn. a inexperiência dos profissionais de saúde faz com que o espectro Definitions, prevalence, pathophysiology, clinical features, diagnostic dessas lesões seja pouco lembrado e até desconhecido. As lesões criteria, follow-up, treatment and prevention were discussed. A causadas pela ação do álcool no concepto são totalmente prevenidas search was performed in Medline, LILACS, and SciELO databases se a gestante não consumir bebidas alcoólicas durante a gestação. using the following terms: “fetus”, “newborn”, “pregnant woman”, Assim, é fundamental a detecção das mulheres consumidoras “alcohol”, “alcoholism”, “fetal alcohol syndrome”, and “alcohol- de álcool durante a gravidez e o desenvolvimento de programas related disorders”. Portuguese and English articles published from específicos de alerta sobre as consequências do álcool durante a 2000 to 2009 were reviewed. The effects of alcohol consumed by gestação e amamentação. pregnant women on newborns are extremely serious and occur frequently; it is a major issue in Public Health worldwide. Fetal alcohol Descritores: Bebidas alcoólicas/efeitos adversos; Feto; Recém-nascido; spectrum disorders cause harm to individuals, their families, and the Síndrome alcoólica fetal; Transtornos relacionados ao uso de álcool entire society. Nevertheless, diagnostic difficulties and inexperience of healthcare professionals result in such damage, being remembered rarely or even remaining uncovered.
    [Show full text]
  • A Review of the Potential Therapeutic Application of Vagus Nerve Stimulation During Childbirth
    A Review of the Potential Therapeutic Application of Vagus Nerve Stimulation During Childbirth By Tanya Enderli A thesis submitted to the College of Engineering at Florida Institute of Technology in partial fulfillment of the requirements for the degree of Master of Science In Biomedical Engineering Melbourne, Florida March, 2017 We the undersigned committee hereby recommend that the attached document be accepted as fulfilling in part the requirements for the degree of Master of Science of Biomedical Engineering. “A Review of the Potential Therapeutic Application of Vagus Nerve Stimulation During Childbirth,” a thesis by Tanya Enderli ____________________________________ T. A. Conway, Ph.D. Professor and Head, Biomedical Engineering Committee Chair ____________________________________ M. Kaya, Ph.D. Assistant Professor, Biomedical Engineering ____________________________________ K. Nunes Bruhn, Ph.D. Assistant Professor, Biological Sciences Abstract Title: A Review of the Potential Therapeutic Application of Vagus Nerve Stimulation During Childbirth Author: Tanya Enderli Principle Advisor: T. A. Conway, Ph.D. The goal of this research is to show that transcutaneous Vagus nerve stimulation (tVNS) should be investigated as a possible modality for increasing endogenous release of oxytocin during childbirth. There have been many great advances made in the practice of modern obstetrics in the last century. The 1900s saw the discovery, isolation, and subsequent widespread use of the hormone oxytocin as an agent to prevent postpartum hemorrhage and to initiate or quicken labor during childbirth. There are significant risks to the fetus when synthetic oxytocin is used. While the medical administration of oxytocin during labor was being popularized, there was also research being conducted on its physiologic mechanism in labor.
    [Show full text]
  • Out of Institution Birth Packet
    Out of Institution Birth Packet Revised 6/2021 511-1-3-05. Registration of Out of Institution Births 1. In any case where a birth occurs outside a hospital, or other recognized medical facility, without medical attendance and the birth certificate is filed by someone other than a health care provider, additional evidence in support of the facts of birth shall be completed and filed in the presence of the local Vital Records registrar in the county where the birth occurred. A birth certificate for a birth which occurs outside a recognized medical institution shall only be filed upon personal presentation of the following evidence by the individual(s) filing the certificate: (a) Proof of pregnancy: 1. Prenatal records; or 2. Statement from a physician or other licensed health care provider who is qualified to determine pregnancy; or 3. Prenatal blood analysis or positive pregnancy test results from a laboratory. (b) Proof of the mother’s residence on the date of the out of institution birth: 1. A valid driver’s license, or a state-issued identification card, which includes the mother’s current residence on the face of the license or card; or 2. A rent receipt which includes the mother’s name and address, and the name, address, and signature of the mother’s landlord. 3. A utility bill (e.g. electric bill, phone bill, or water bill) showing the address at child’s birth. (c) A copy of a bank statement showing the address at child’s birth. 2. An identifying document, with photograph, for the individual(s) personally presenting the evidence required to file the certificate.
    [Show full text]
  • Experiences of Transition to Motherhood Among Pregnant Women Following Assisted Reproductive Technology: a Systematic Review Protocol of Qualitative Evidence
    SYSTEMATIC REVIEW PROTOCOL Experiences of transition to motherhood among pregnant women following assisted reproductive technology: a systematic review protocol of qualitative evidence 1,2 1,2 1,2 1,2 1,2 Kunie Maehara Hiroko Iwata Mai Kosaka Kayoko Kimura Emi Mori 1Graduate School of Nursing, Chiba University, Chiba, Japan, 2The Chiba University Centre for Evidence Based Practice: a Joanna Briggs Institute Affiliated Group ABSTRACT Objective: This systematic review aims to identify and synthesize available qualitative evidence related to the experiences of transition to motherhood during pregnancy in women who conceived through assisted reproductive technology (ART). Introduction: Women who conceived through ART experience pregnancy-specific anxiety and paradoxical feelings, and face unique challenges in their identity transition to motherhood. It is important for healthcare professionals working with these women to understand the context and complexity of this special path to parenthood, including the emotional adaptation to pregnancy following ART. A qualitative systematic review can provide the best available evidence to inform development of nursing interventions to meet the needs of pregnant women after ART. Inclusion criteria: This review will consider any qualitative research data from empirical studies published from 1992–2019 in English or Japanese that described experiences of transition to motherhood during pregnancy in women who conceived with ART. Methods: This review will follow the JBI approach for qualitative systematic reviews. Databases that will be searched for published and unpublished studies include MEDLINE, CINAHL, PsycINFO, ProQuest Health & Medical Collection, Google Scholar and Open Access Theses and Dissertations (in English), and Ichushi-Web, CiNii and the Institutional Repositories Database (in Japanese).
    [Show full text]
  • The Parent-Child Dyad in the Context of Child Development and Child Health Who Assumes a Consistent Role of Daily Care Over an Extended Period with a Developing Child
    The Parent-Child Dyad in the Context of Child Development and Child Health Introduction arrangements of orphanages, which evolved into formal child welfare systems, foster care, and From the commitment to ensure all children have adoptions. In some cases, there literally was no the support they need to grow up healthy, family, and the church or the state stepped in to researchers, public health, and public policy provide care for the child. In many cases however, advocates have deepened our search for the factors including today, the parent or family exists but does that affect child health. This search has revealed not have the means, the mental health, or the skills that old definitions of adversity from child welfare to provide for the child. systems were too narrow, previously focusing mostly on overt child abuse and trauma. As we have Another unhappy fact about the child welfare story is learned about the huge negative impact on children that just removing a child from a neglectful home from factors such as poverty, food and housing and placing them in a safe, loving foster family does insecurity, and community violence, we have not necessarily result in a good outcome. By the realized that the scope of childhood adversity is time that a child is relocated, they may have endured much deeper and more challenging to address than significant developmental trauma, and the foster or previously thought. adoptive parents may be unprepared for the tumult that may come with placement. As child health experts turn more toward child development, and away from specific incidents of Additionally, researchers have found that the parent trauma, the focus turns toward the family.2 who is cast in the role of neglectful or abusive parent Increasingly we recognize the impact of the critical most likely has had a traumatic and disrupted early relationship between the child and their childhood themselves.
    [Show full text]
  • Elective Induction of Labor at 39 Weeks in Low-Risk Nulliparous Patients Does Not Increase the Risk of Adverse Perinatal Outcome
    Elective induction of labor at 39 weeks in low-risk nulliparous patients does not increase the risk of adverse perinatal outcomes, according to ARRIVE trial investigators. ILLUSTRATION: KIMBERLY MARTENS FOR OBG MANAGEMENT MARTENS KIMBERLY ILLUSTRATION: 36 OBG Management | January 2019 | Vol. 31 No. 1 mdedge.com/obgyn Obstetrics UPDATE Jaimey M. Pauli, MD Dr. Pauli is Associate Professor and Attending Perinatologist, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania. The author reports no financial relationships relevant to this article. What are the clinical implications of trial results on these 2 delivery-related issues: timing of elective induction of labor and timing of pushing in the second stage? Plus, ACOG’s new recommendations for optimizing postpartum care. he past year was an exciting one in Finally, the American College of Obstetri- obstetrics. The landmark ARRIVE trial cians and Gynecologists (ACOG) placed new T presented at the Society for Mater- emphasis on the oft overlooked but increas- nal-Fetal Medicine’s (SMFM) annual meet- ingly more complicated postpartum period, ing and subsequently published in the New offering guidance to support improving care IN THIS England Journal of Medicine contradicted a for women in this transitional period. ARTICLE long-held belief about the safety of elective Ultimately, this was the year of the labor induction. In a large randomized trial, patient, as research, clinical guidelines, and Labor induction Cahill and colleagues took a controversial education focused on how to achieve the best at 39 weeks but practical clinical question about second- in safety and quality of care for delivery plan- This page stage labor management and answered it for ning, the delivery itself, and the so-called the practicing obstetrician in the trenches.
    [Show full text]