This section of the APPPAH Newsletter is intended to draw attention to items in the news that are pertinent to prenatal and perinatal psychology. APPPAH does not necessarily agree with, or vouch for, the scientific worthiness of any of the news items mentioned here. We mean merely to take note of what is going on, so that you may.
PRE-BIRTH MATERNITY LEAVE AIDS BABIES AND MOMS
UC Berkeley researchers found that maternity leave taken before giving birth is good for both moms and their babies, since women who worked right up until delivery day were more likely to have a cesarean section. In the first study of how the time off work relates to the health of both mothers and babies, researchers looked at 447 Southern California women who worked full time and compared those who took leave after the 35th week of pregnancy and those who worked up to their due date; women who took leave early were nearly four times less likely to have a C-section.
"We don't have a culture in the United States of taking rest before the birth of a child because there is an assumption that the real work comes after the baby is born," says lead researcher Sylvia Guendelman, a professor of maternal and child health. A second study by the same researchers found that the longer a woman delayed returning to work, the more likely she was to breastfeed. Says Guendelman, "These new studies suggest that making it feasible for more working mothers to take maternity leave both before and after birth is a smart investment." [Published in Women's Health Issues (1 st study) and Pediatrics (2 nd bin/article.cgi?f=/c/a/2009/01/08/BAC51540IG.DTL] study), reported in SF Chronicle, http://www.sfgate.com/cgi-
HOME BIRTHS "AS SAFE AS HOSPITAL"
The largest study of its kind has found that for low-risk women, giving birth at home is as safe as doing so in hospital with a midwife, finding no difference in death rates of either mothers or babies in 530,000 births. The research was carried out in the Netherlands after figures showed the country had one of the highest perinatal death rates in Europe, and it was suggested that home births could be a factor, given the Netherlands' 30% home birth rate. But, "We found that for low-risk mothers at the start of their labor it is just as safe to deliver at home with a midwife as it is in hospital with a midwife," said Professor Simone Buitendijk of the TNO Institute for Applied Scientific Research. Low-risk women in the study were those who had no known complications, such as a baby in breech or one with a congenital abnormality, or a previous caesarean section. Nearly a third of women who planned and started their labors at home ended up being transferred as complications arose, e.g., an abnormal fetal heart rate, or if the mother required more effective pain relief in the form of an epidural. But even when she needed to be transferred to the care of a doctor in a hospital, the risk to her or her baby was no higher than if she had started out her labor under the care of a midwife in hospital. The researchers noted the importance of both highly trained midwives who knew when to refer a home birth to hospital, and rapid transportation. [Published in BJOG, reported in BBC News, 4/09; http://news.bbc.co.uk/go/pr/fr/- /2/hi/health/7998417.stm]
ONGOING ATTACHMENT EFFECTS OF POSTPARTUM CONTACT v. SEPARATION
A study that whose objective was to evaluate and compare possible long-term effects on mother-infant interaction of practices used in the delivery and maternity wards, including practices relating to mother-infant closeness versus separation, found that skin-to-skin contact, early suckling, or both during the first 2 hours after birth, when compared with separation of the mothers and their infants, positively affected maternal sensitivity, infant self-regulation, and dyadic mutuality and reciprocity 1 year after birth. The negative effect of a 2-hour separation after birth was not compensated for by the practice of rooming-in. In addition, swaddling of the infant was found to decrease the mother's responsiveness to the infant, her ability for positive affective involvement with the infant, and the mutuality and reciprocity in the dyad. [Published in Birth, Volume 36 Issue 2, Pages 97 – 109; Published Online: 28 May 2009]
MUSIC "NURTURES" PREMATURE BABIES
Hospitals that play music to premature babies help them grow and thrive, mounting evidence suggests. The benefits are said to be calmer infants and parents as well as faster weight gain and shorter hospital stays. A Canadian team reviewed nine studies and found music reduced pain and encouraged better oral feeding. Music also appeared to have beneficial effects on physiological measures like heart and respiratory rate, reports. Increasing numbers of neonatal units are using music on their wards. "Although more research is still needed in this area, the study shows that there may be simple and cost-effective ways to provide health benefits to preterm births," says professor of obstetrics Andrew Shennan. [Published in Archives of Disease in Childhood, reported by BBC News, May 2009; http://news.bbc.co.uk/go/pr/fr/- /2/hi/health/8068749.stm]
DIABETES AND PERINATAL DEPRESSION
A retrospective study using data from 11,024 women who gave birth between July 2004 and September 2006 has found that low-income women with diabetes compared with those without diabetes had nearly double the odds of experiencing depression during the perinatal period, even after adjusting for age, race, year of delivery, and gestational age at birth. [Published in JAMA http://jama.ama-assn.org/cgi/content/short/301/8/842, reported by National Healthy Mothers, Healthy Babies]
BABIES CRY MORE WHEN FATHERS ARE DEPRESSED DURING PREGNANCY
Previous research has associated maternal depression with excessive infant crying, but researchers in the Netherlands studying the less-understood influence of paternal depression on infant distress found that paternal depressive symptoms during pregnancy may be a risk factor for excessive infant crying. The authors suggest, "This finding could be related to genetic transmission, interaction of a father with lasting depressive symptoms with the infant, or related indirectly through contextual stressors such as marital, familial, or economic distress." [Published in Pediatrics, July 2009, http://pediatrics.aappublications.org/cgi/content/abstract/124/1/e96?etoc]
BREASTFEEDING MAY REDUCE WOMEN'S LIFELONG CARDIO RISK
Women who breastfeed are at lower risk for heart disease later in life, reports a study of nearly 140,000 postmenopausal women (median age 63 years). Authors found that postmenopausal women with a single live birth who breastfed for 7-12 months were significantly less likely to develop cardiovascular disease than women who never breastfed. Among the women, increased duration of lactation was also associated with lower rates of hypertension, diabetes and hyperlipidemia. The researchers said they don't know the mechanism underlying the reduction in cardiovascular risk, but previous studies have shown that active lactation improves glucose tolerance and lipid metabolism and lowers C-reactive protein levels. In addition, they said, lactating mothers lose more weight after birth than those who do not breastfeed. [Published in Obstetrics and Gynecology, reported by National Healthy Mothers, Healthy Babies Coalition; http://journals.lww.com/greenjournal/Abstract/2009/05000/Duration_of_Lactation_and_Risk_Factors_for.5.aspx]
BREASTFEEDING PROTECTS INFANTS FROM SIDS
A study in Germany of the association between type of infant feeding and sudden infant death syndrome has found that breastfeeding decisively reduces the risk of SIDS in infancy. In a case-control study of 333 infants who died of sudden infant death syndrome and 998 age-matched controls, it was found that exclusive breastfeeding at 1 month of age halved the SIDS risk, and the conclusion was that breastfeeding reduced the risk of sudden infant death syndrome by 50% at all ages throughout infancy. Study authors recommend including the advice to breastfeed through 6 months of age in sudden infant death syndrome risk-reduction messages. [Published in Pediatrics, http://pediatrics.aappublications.org/cgi/content/full/123/3/e406]
BREASTFEEDING NOT IMPAIRED BY PACIFIERS
Researchers reviewed 29 studies from 12 countries that looked at pacifiers and breastfeeding, and found no good evidence of a link between pacifier use and nursing. "Pacifiers have traditionally been thought to interfere with optimal breastfeeding," wrote the University of Virginia School of Medicine authors, and in the 1980s, health officials discouraged their use. But in recent years, researchers have found evidence that babies who use pacifiers when they sleep may be less susceptible to sudden infant death syndrome, and the American Academy of Pediatrics now recommends that pacifiers be used for that reason. For health professionals, this has posed a conundrum regarding pacifier use: to encourage breast-feeding, which is healthiest, but to reduce the risk of SIDS. The researchers did find that women whose babies used a pacifier seemed to stop breast-feeding earlier than other women. But it did not appear that the pacifiers were the reason. [Published in Archives of Pediatric and Adolescent Medicine, reported May 2009 in NY Times, http://www.nytimes.com/2009/05/05/health/05child.html?_r=2&nl=8hlth&emc=hltha3]
EFFECTIVENESS OF NATURAL CHILDBIRTH CLASSES QUESTIONED
A Karolinska Institute study of more than 1,000 pregnant mothers in Sweden found that learning relaxation and breathing techniques did not reduce a woman's need for an epidural in labor. Study subjects attended one of two classes: the first taught natural coping methods, the other emphasized pain relief. No difference was found in the use of epidurals between the women when they went into labor; just over half the women in each group ultimately opted for the spinal analgesia. As well as there being no difference in epidural rates, which researchers saw as a useful measurement of perceptions of pain, the proportion of vaginal births and emergency cesareans was the same between the two groups. In the natural childbirth group, there was a slightly higher rate of instrumental births, involving forceps or vacuum extraction. Royal College of Obstetricians and Gynaecologists spokesman Patrick O'Brien says that it is "only fair that women should be told the results of this study. It's almost accepted that these techniques might help, but the evidence out there is not that strong. This is the first good evidence to compare the two approaches." Belinda Phipps, head of the UK's National Childbirth Trust, said, "This limited study in Sweden compares two slightly different types of antenatal education and does not look at the more common situation in the UK which is no or limited antenatal preparation. Testing to see whether breathing and relaxation techniques alongside antenatal preparation have an effect on birth outcomes is a tall order. They are only one small part of antenatal education." [Published in BJOG, reported in BBC News online, May 2009, http://news.bbc.co.uk/go/pr/fr/- /2/hi/health/8068889.stm]
IVF TWINS "SICKER IN EARLY LIFE"
Researchers in Australia and the UK studying perinatal outcomes and hospital admissions for all twins born in Western Australia between 1994 and 2000 found that IVF twins face more early health problems than naturally conceived dizygotic twins: they had a greater risk of poor perinatal outcome, including preterm birth, low birthweight and death, and were far more likely to be admitted to neonatal intensive care and to be hospitalized in their first three years of life. Until now there has been conflicting evidence about whether assisted reproduction itself is responsible for adding to the number of problems seen in ART twins, apart from such problems inherent in multiple births in general. The reason for the increased risks to ART twins is unclear, but the underlying causes of parental infertility and components of the ART procedure have been mooted. Researcher Michele Hansen, of the Telethon Institute for Child Health Research in Western Australia, said couples undergoing fertility treatment should be made aware of these findings and consider the benefits of opting for single embryo transfer. The Human Fertilisation and Embryology Authority said it is driving forward a national strategy to reduce the number of multiple births following IVF: "This study is another piece of the jigsaw that women and their doctors need to consider before treatment. We know that multiple pregnancy and birth pose the biggest single risk to mothers and babies following fertility treatment." [Published in Human Reproduction, reported in BBC NEWS, May 2009: http://news.bbc.co.uk/go/pr/fr/- /2/hi/health/8057210.stm]