Normal Vaginal Births Cause Infant Brain Hemorrhages
Yeah, look what I found...
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
This made me think about the story 'The Butterfly and the
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
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.
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
required for the butterfly to to get through the tiny
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
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
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
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
P.S. I loved your story of the man and the butterfly.
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
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
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?
Just had to add this, copied from the CDC website, under the header 'HPV and
'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.'
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?
Posted By n/a on 02/03/2007 12:12
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
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.
Feb;242(2):535-41. Epub 2006 Dec 19.
Intracranial hemorrhage in asymptomatic neonates:
prevalence on MR images and relationship to obstetric and neonatal
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.
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
- 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
- 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
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
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
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
Amy V. Haas, BCCE
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.
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
You might give them a plug.
I just posted some
talking points about the “brain bleed” study under
"Resources for Educators"
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...
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.
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.
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.
All Times America/New_York
Please note that this Forum is intended to help women make informed decisions about their care. The content is not a substitute for medical advice.