Thursday, April 28, 2011

Fish and Preterm Labor

Speaking of interesting articles by ACOG this month- they published one that showed increased intake of fish decreases risk of preterm birth in patients who have experienced preterm birth before. They found that 2-3 servings per week of fish particularly early in pregnancy had the greatest benefit, and that eating more than that did not show any extra benefit. However eating fish less than once a month for patients with increased preterm birth risk increased their risk of preterm birth again.

It is unknown if taking fish oil capsules has the same effect as eating fish. In this particular study, the patients who were given capsules started them at 16-21 weeks gestation and this did not decrease their risk for preterm delivery. Thus, it is either important to start them earlier in the first trimester or perhaps prior to pregnancy or to stick with fish as there may be some other dietary supplement in fish that decreases the risk of preterm labor/birth.

The study did not look at other socioeconomic factors, but as I tell all of my patients, 2 servings of fish/week is reasonable and may have added benefit of reducing preterm labor.
Happy fishing!

Back to the Home Birth Topic

So, recently in the May 2011 addition of the ACOG journal (American College of Obstetricians and Gynecologists) were two articles discussing the topic of planned home birth. I'd like to share some key points from their articles as things to consider with homebirth. However, it appears they have based their information off of only one study in the Netherlands and the rest of their research has to do with the physicians ethical practice of medicine and what they feel is in the best interest for patients.

They state that "planned home births were associated with a twofold increased risk of neonatal death." They further state that the cause of this may be largely in part due to distance from a hospital in the event of an emergency (many patients studied lived >20 minutes from hospitals). They also state that the majority of home deliveries there are not attended by Certified Midwives, but rather by lay midwives who lack experience and the skill to save a baby or mother if needed. They also stated percentages of complications were higher in first time pregnancies in women laboring at home versus those who had experienced other births.

The College does however, note the right of the patient to make an informed medical decision being fully aware of her risks to herself and to her baby. They also advise physicians not to participate in home birth, but to give care and advice during pregnancy despite where the patient decides to deliver and to be willing to provide emergency care in the hospital when needed if a patient participating in home birth necessitate emergency hospital care.

So here are my thoughts. I respect ACOG's present position and generally I try to follow their guidelines for care of my patients. However, I don't feel that they have enough research on other areas (like Sweden) where they have Certified Midwives providing home births in areas close to the hospital etc. I still believe there are places where home birth is safe and effective for LOW RISK women.

I've decided if any of you out there would like to try home birth, I may be willing to deliver you at home if you see me throughout pregnancy for your care, are extremely low risk and remain that way throughout pregnancy. You would also have to live within 15 minutes from the local hospitals that I have privileges at, be willing to sign arbitration and home birth consent forms and pay out of pocket for this service if your insurance does not cover home birth. Further, I will likely not exceed 2-3 home births/month as this may complicate things with my other patients, hospital deliveries, and office/clinic schedule. This is open as a trial period and I may stop if I feel it is putting you, your baby, or myself at too much risk.

I welcome all comments!