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    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Feb 02
    2007

    Normal Vaginal Births Cause Infant Brain Hemorrhages

    Archived User
    Yeah, look what I found... http://www.medpagetoday.com/OBGYN/Pregnancy/tb/4961

    I especially like the note at the end of the article:
    'The research was support by grants from the National Institute of Mental Health and the University of North Carolina School of Medicine. The researchers said they had no financial conflicts.'

    This made me think about the story 'The Butterfly and the Cesarian':

    The Butterfly and the Caesarean

    A man found a cocoon of a butterfly. A a small opening appeared, and he watched the butterfly struggle to force its body through that little hole.

    It seemed to stop making any progress. It appeared as if it had gotten as far as it could and could go no farther.

    The man helped the butterfly; he took scissors and snipped off the remaining bit of the cocoon. The butterfly then emerged easily. But it had a swollen body and small, shriveled wings.

    The man expected that, at any moment, the wings would enlarge and expand to be able to support the body, which would contract in time.

    It didn't. The butterfly spent the rest of its life crawling around with a swollen body and shriveled wings. It never was able to fly.

    What the man did not understand was that the restricting cocoon and the struggle required for the butterfly to to get through the tiny opening were God's way of forcing fluid from the body of the butterfly into its wings so it would be ready for flight once it achieved freedom from the cocoon.


    So, there is blood. Maybe it is supposed to be there? Maybe there is a a reason we don't understand? I can only roll my eyes at this...

    Any comments, Henci?

    By the way, I am now using a Mac and this forum looks very different on the Mac. Or was there a design change since last time I visited? I wasn't sure where to put this mail. On my former computer I could just start a new topic. I hope it is ok in this folder.

    maria.
    Henci Goer
    Starting with your last comment first, it isn't your switch to a Mac. We are using new Forum software. It went live last week.

    As for the new study, I'm on it. Stay tuned; I've got a copy of the study and will be posting a critique of it in the next day or so.

    -- Henci

    P.S. I loved your story of the man and the butterfly.
    Archived User

    Ahh! Well, it looks nice!

    Except that I can't log on. I don't have my password anymore and when I tried 'reset password' here, it doesn't work. Glitch?

    Feel free to use the story to make a point anywhere you feel fit! It is not mine, but I know it is circling openly without copyright on the web. I love it too.

    Very much looking forward to your comments/analyses/debunking of the research!

    Is the whole HPV scandal in Texas within your range of work? I call it a scandal at least. I am outraged. I could so use a 'Henci' here :-)

    maria.
    Henci Goer
    Hmm. My recommendation is to start again as if you were never previously registered on the site. That is what they did for me. If that doesn't work, there is a link to the webmaster on the opening page with all the info about the Forum. And if that doesn't work, let me know, and I'll see who I can contact.

    Sorry you're having problems.

    As for the Texas HPV brouhaha, a friend just sent me some articles on that. It seems the Texas governor overrode the process and approved administering the vaccine with, of course, the right of parents to refuse. Aside from the absurdity that a teenaged girl will decide to have or not have sex based on her risk of getting the HPV virus, has it not occurred to opponents of vaccination on moral grounds that a perfectly chaste, virgin-until-marriage young woman can marry a man who either has or picks up the virus or that she may be assaulted by someone carrying the virus? And even if it is what some may define as a moral issue, does a sexually active woman or girl deserve cancer as punishment?

    -- Henci
    Archived User
    Just had to add this, copied from the CDC website, under the header 'HPV and men':

    'Should I be worried that I cannot be tested or treated for HPV?

    No. HPV is not like other sexually transmitted infections (STIs), which need to be detected and treated. HPV is a virus that lives in the skin, rather than in your body. There is no clear health benefit to knowing you have this virus—since HPV is unlikely to affect your health and cannot be treated. For most men, there would be no need to treat HPV, even if treatment were available— since it usually goes away on its own.'

    GASP

    So the women will be mandated by law to be immunized, whereas the men are free to fool around... I am sure that what it says is true for men on a deserted island, but HPV is a STD and does not exist without the sexual connection, or at least not in a way that would cause problems to women... 


    In light of this http://www.fwhc.org/health/vaccine.htm and this http://www.ewtn.com/library/ISSUES/STEALTH.TXT  this vaccine is down right scary because it seems like a small step from one thing to the next. This is very much outside the scope of this forum though :-)

    Just being paranoid?
    maria
    Archived User
    Posted By n/a on 02/03/2007 12:12 AM

    Ahh! Well, it looks nice!

    Except that I can't log on. I don't have my password anymore and when I tried 'reset password' here, it doesn't work. Glitch?
    Maria and others, in the upgrade to the new software, we lost the ability for users to log in to the forums except for Lamaze Members who have this ability. We are looking into how we might be able to restore that feature in the future. But for now, you will just need to enter a username each time you post or reply to a post. Sorry for the inconvenience. Amy Romano Forum Administrator
    Henci Goer

    So, as I wrote a couple of posts back, I said I would take a look at the study summarized under the Medpage Today headline “Normal Vaginal Births Cause Infant Brain Hemorrhages.” I have pasted in the study’s abstract and the URL for it from PubMed for those of you not familiar with the study’s details.

     

    Radiology. 2007 Feb;242(2):535-41. Epub 2006 Dec 19.

     

    Intracranial hemorrhage in asymptomatic neonates: prevalence on MR images and relationship to obstetric and neonatal risk factors.

    Looney CB, Smith JK, Merck LH, Wolfe HM, Chescheir NC, Hamer RM, Gilmore JH.

    Department of Psychiatry, CB No. 7160, 7025A Neurosciences Hospital, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7160, USA.

    PURPOSE: To retrospectively evaluate the prevalence of neonatal intracranial hemorrhage (ICH) and its relationship to obstetric and neonatal risk factors. MATERIALS AND METHODS: Pregnant women were recruited for a prospective study of neonatal brain development; the study was approved by the institutional review board and complied with HIPAA regulations. After informed consent was obtained from a parent, neonates were imaged with 3.0-T magnetic resonance (MR) imaging without sedation. The images were reviewed by a neuroradiologist with 12 years of experience for the presence of ICH. Medical records were prospectively and retrospectively reviewed for selected risk factors, which included method of delivery, duration of labor, and evidence of maternal or neonatal birth trauma. Risk factors were assessed for relationship to ICH by using Fisher exact test statistics. RESULTS: Ninety-seven neonates (mean age at MR imaging, 20.8 days +/- 6.9 [standard deviation]) underwent MR imaging between the ages of 1 and 5 weeks. Eighty-eight (44 male and 44 female) neonates (65 with vaginal delivery and 23 with cesarean delivery) completed the MR imaging evaluation. Seventeen neonates with ICHs (16 subdural, two subarachnoid, and six parenchymal hemorrhages) were identified. Seven infants had two or more types of hemorrhages. All neonates with ICH were delivered vaginally, with a prevalence of 26% in vaginal births. ICH was significantly associated with vaginal birth (P < .005) but not with prolonged duration of labor or with traumatic or assisted vaginal birth. CONCLUSION: Asymptomatic ICH following vaginal birth in full-term neonates appears to be common, with a prevalence of 26% in this study. (c) RSNA, 2007.

     

    http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=Display&DB=pubmed

     

    Here are the problems and weaknesses that jumped out at me:

     

    • The study reports that instrumental vaginal delivery was not associated with these “small bleeds,” as they are described in the article (don't you love them using the word "hemorrhage" in the title and in the take-home message to be given to parents?), that caused no symptoms; however, studies consistently find an association between instrumental vaginal delivery and larger, symptomatic bleeds. With only 65 vaginal births, of which 13 were instrumental vaginal deliveries, the study lacks the statistical power to detect a difference, so this conclusion is misleading.
    • These births were not “normal” by Lamaze International’s standards. Twenty out of every 100 women having a vaginal birth in this population had an instrumental delivery (13 out of 65). Fourteen out of every 100 babies (9 out of 65, assuming all trauma occurred during vaginal delivery) experienced delivery trauma, defined as “cephalohematoma [a fluid-filled swelling under the scalp], scalp laceration [cuts], or bruising associated with the use of forceps.” Given this rate of vaginal instrumental delivery and delivery trauma (can you imagine these stats in a home birth practice or at a free-standing birth center even including transfers to hospital?), it’s a safe bet that pushing position and technique were also not physiologic. “But,” as they say on the late night commercials, “there’s still more.” Investigators note that most bleeds were at the base of the skull. As a retired doula, I can tell you that conventional obstetricians often don’t just “catch” babies. The head emerges, and then they tug, and maneuver, and twist the baby’s head to “deliver” the shoulders, as if the shoulders wouldn’t come out on their own. It’s also a safe bet that a high proportion of the women were given drugs to start or intensify labor. Overly strong contractions in second stage might have a harmful effect too. In summary, like the accusations that vaginal birth weakens the pelvic floor, we don’t actually know to what degree these bleeds are inherent to vaginal birth and to what degree they are iatrogenic (caused by doctors) injuries. It would be interesting to do a study comparing MRIs of babies whose mothers pushed in positions other than on their backs, who pushed and breathed according to their inner urges, and who birthed their babies truly spontaneously with babies whose mothers had typical obstetric management.
    • Amy Romano, my boss at Lamaze International, and author of Lamaze’s quarterly Research Roundup, points out another confounding factor: Babies with bleeds had the MRI at a mean of a week earlier than babies who didn’t have bleeds. Why is this important? The investigators note that they excluded infants older than 5 wks from the study because other studies had found that “all hemorrhages identified at birth had resolved by that age.” In other words, a week could make a big difference as to whether a bleed was found or not. If women having cesarean surgery tended to have their babies scanned later, this could explain some of the difference between groups.
    • Even if vaginal birth is inherently associated with small bleeds, what the radiologists measured is a surrogate outcome, that is, an outcome believed to be in the causal pathway to a clinical outcome but not one itself. Surrogate outcomes often turn out to be misleading. For example, hormone replacement therapy improves blood lipid profiles in menopausal women but doesn't reduce heart attacks. It is likely that head molding can cause a bit of bleeding at the suture lines even when care during labor is optimal--which it certainly was not here--but it would be faulty logic to assume that this is anything but innocuous. Remember that no adverse effects were seen in these babies. In point of fact, we have no evidence that the liberal use of cesarean surgery improves neurologic outcomes compared with spontaneous labor and spontaneous vaginal birth. On the contrary, we have ample evidence of its potential harms for babies, not to mention women, in both the current and future pregnancies.

    It is, to put it mildly, disingenuous to recommend telling parents that vaginal birth causes “brain hemorrhage” while cesareans do not, and then add “but we think it’s probably nothing to worry about.” There is, however, a real take-home message that was noted by the investigators but didn’t make it into the news or the study abstract: Should a baby in the first weeks of life undergo neurologic imaging, finding a bit of blood under the skull does not necessarily mean the baby has been physically abused—at least, considering the number of instrumental deliveries and the amount of delivery trauma reported in this study, not by the baby’s family.

    -- Henci

                                                                                                                     

    Archived User
    Thank you, Henci!
    maria.
    Archived User
        Thank you Henci.
    I suspected they hadn't controlled for interventive births.
    Now to debunk this we would need to test a population of totally natural birth babies.  However, how many people would consent to this type of testing for their newborn infant?   Why would you want to subject a newborn to an MRI unless it was truly medically necessary? Do we know that the testing it's self does not effect the brain?  There is so much we don't know. I would be curious to know what prompted them to do this study in the first place.
    I'm getting rather tired of studies that continually try to prove that the normal way to birth is dangerous, and that c-sections are safer.  Argh!

    Amy

    Amy V. Haas, BCCE
    www.healthybirth.net
    Archived User
    I am so glad you pointed out this great information. I saw this article front and center on a weekly update provided by BabyCenter.com. Frightening, as most women on the site are less inclined to challenge official research findings, taking it at face value. You should post an abbreviated version on their site.

    Leah
    Henci Goer

    I'm pleased to know that you find my post helpful. Deconstructing these studies is my idea of a good time. To be honest, I don't spend time surfing other sites. You could certainly link to my post, though, or copy and paste into a post on the BabyCenter.com site. And while you were at it, I can't say enough good things about the Lamaze Giving Birth with Confidence blog at http://birthwithconfidence.blogs.lamaze.org/. You might give them a plug. 

    -- Henci

    Archived User

    I just posted some talking points about the “brain bleed” study under "Resources for Educators" here.

    Archived User

    Hi,

    my baby was born 4 weeks ago, by a normal birth (vaginal) and yes, the doctor adviced us he has two cephalohematomes. They are two swollen areas filled with blood and liquid, they measure 3/4" each, but then again the same doctor (he's the pediatric doctor of the birth center in wich my baby was born) specified us that this hemorrhages are "normal" (at least in this center) and they should be disappeared by 6 months or so...

    Henci Goer

    A cephalohematoma is a fancy word for a type of bruise, that is, bleeding under the scalp and outside the skull. It will take a while for the bruise to go away, as it does for any bruise, but they are not a problem. The study discussed in this thread is about bleeding inside the skull, which in the wrong place and in sufficient quantity--although not in the study under discussion--can be serious.

    -- Henci

    Archived User

    I had posted a question in another section about this same thing but I think you may be able to answer it from this blog. My son was born with what the doctors called two "epidural hematomas". They were very large and stayed on his head until his was about 4 months old. It has always scared me thinking that the blood could have gone under the skull instead of on top. I am now pregnant and due in Jan and am afraid of this happening again and maybe worse. I was wondering if there are some type of positions or something else I could do to try and prevent this from happening again? It was a very long and drawn out labor with my first and it seemed as though he was just stuck for a really long time.

    Thank you.

    Henci Goer

    Unfortunately, I have been in a car accident and am recovering from knee surgery. I will not be able to respond to your question at this time. Apologies.

    ~ Henci


    All Times America/New_York

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