Your viewing articles about; Royal College of Obstetricians and Gynaecologists

Fetal kick charts ‘unreliable’ and should be discontinued

Fetal kick charts have been used since the 1970s, but new research finds they ‘are of no benefit to reducing poor outcomes in low-risk pregnant women.’

Research published in the journal The Obstetrician and Gynaecologist suggests that mothers rely on fetal heart rate and routine examinations with a doctor rather than depend on fetal kick charts.

Researchers from the Cork University College Maternity Hospital conducted an anonymous survey of nearly 100 Irish obstetricians and found that only one third of them had any real clinical guidelines on the reduction of fetal movement in pregnant women. In comparison, nearly 70 percent of obstetricians in the U.K. had guidelines in place.

The researchers claimed that inaccuracies in counting from unreliable perceptions by the mother could create situations of unnecessary stress for not only the mother, but also for the doctor. Nearly 15 percent of pregnant women seek consultation in the hospital due to concerns that the baby’s movements are irregular.

“The use of these kick charts has now been superseded by the use of more advanced and reliable medical technology, such as ultrasound scans,” said Cathy Warwick, general secretary of the Royal College of Midwives.

University of Cork’s Dr. Julia Unterscheider agrees.

“Unnecessary investigation in an otherwise healthy pregnancy can lead to increased intervention such as caesarean delivery. In contrast, reduced fetal movements can represent a warning sign that the baby is small for gestation or unwell,” said Unterscheider.

“We suggest that a careful history and examination together with a CTG (cardiotocograph) are used to confirm fetal wellbeing at a given time. Ultrasound evaluation is recommended when babies are at and beyond their due date, or when examination of the mother’s abdomen suggests that the baby is small.”

“Kick-charts, which are in use in many maternity units worldwide, are of no benefit to reducing poor outcomes in low-risk pregnant women. A mother’s subjective perception of diminished movements is a better predictor of problems.”

Pat O’Brien, of the Royal College of Obstetricians and Gynaecologists, suggested that when a mother has uncertainty about diminished movement, it’s important to focus.

“You sometimes can’t feel them because you are too active and I tell mothers if it gets to the middle of the afternoon and you still can’t feel anything, find some place quiet. Sit down and concentrate on the babies’ movements. Push the baby around gently and if you are still worried come up to the hospital.”

         

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Woman Pregnant With 12 Babies Set To Deliver This Month

A Tunisian woman is pregnant with 12 babies after having IVF done.

It is being claimed that teacher from Tunis, is pregnant with 12 babies, 6 girls and 6 boys, and is set to deliver the babies this month. The woman, who has not been named, received IVF after having two miscarriages in two years.

British fertility experts say it is possible for a woman to be pregnant with 12 babies but is very unlikely that all or even one of the babies will survive the birth. One expert claims that there is less than 1 in 100 chance that even one of the babies will survive.

That has not deterred the woman, who is in her 30’s and is supposedly in good health. The woman is says “‘All I want to do is be able to hug my babies and show them all my love.” She added, “This is an absolute miracle, and we all feel blessed after struggling so hard to have children.”

The father of the babies has even said that the medical team is going to allow the woman to give birth naturally to all 12 babies.

British experts are claiming that a natural birth would be impossible and due to the amount of weight of 12 babies and the fact that the uterus can only stretch so far and carry so much weight, it would be likely that the woman would go into labor at 20 weeks - making it hard for a baby to survive being born that early.

It is unknown how far along the woman currently is in her pregnancy, but usually the sex of the baby can’t be seen on ultrasound until at least 16 weeks.

Peter Bowen-Simpkins, a fellow of the Royal College of Obstetricians and Gynaecologists, said: ‘It is certainly possible to carry 12 babies but not for long.”

He added, “The problem is the capacity of the uterus.  This woman is going to be enormous by 20 weeks.  And when the uterus goes into labour there is nothing you can do about it. The youngest that babies have survived is at 22 to 23 weeks.  They need very intensive nursing and the majority have permanent neurological damage. You’d need a very good intensive paediatric unit to cope with this. We couldn’t do it in this country, we don’t have a unit with 12 intensive care cots. I don’t like to dampen her enthusiasm but the chances are she will deliver at 20 weeks. I wouldn’t even give her a one in 100 chance of even one surviving. It’s frightening.”

In January of this year, Nadya Sulemom went above doctor’s expectations and delivered 8 healthy babies. She has since taken all 8 babies home and they are all thriving.

Other women have not been as lucky as Nadya.

Mandy Allwood, a British woman, became pregnant with 8 babies after taking fertility drugs. Doctors advised her to to abort some of the babies but she chose not to and gave birth at only 22 weeks. None of the babies survived.

         

Exercises during pregnancy could help babies

Moderate pregnancy exercise can benefit babies development new research suggests. Though pregnant women should discuss exercise levels with their GP first.

A research team from the Kansas City University of Medicine and Biosciences suggest it is linked to nervous system development and better foetal heart health as well as aiding the mother’s health.

The team set out to research if maternal exercise had direct cardiovascular benefits for the foetus.

They also wanted to see if foetuses whose mothers exercised had increased breathing movements compared to non-exercise exposed foetuses.

Foetal breathing is a “practice” movement where a baby developing in the womb gets ready to breathe after it is born.

It is also a sign of how well the respiratory system and central nervous system are developing.

The scientists used a non-invasive device to measure the magnetic fields produced by the electrical activity of maternal and foetal heart rates.

It was also able to pick up foetal movements including breathing, body movements, hiccups and sucking.

The women studied were aged between 20 and 35 and were checked between the 36th and 38th weeks of pregnancy.

They were classed as exercisers if they did moderate intensity aerobic exercise such as moderate to vigorous walking, stationary bicycling and running for at least 30 minutes, three times per week. Most were doing more.

The researchers then compared them with pregnant women who did not exercise regularly.

Dr Linda May, who led the study, said: “Foetal breathing movement and the nervous system were more mature in babies exposed to exercise.”

She said further research was needed, both to look at more pregnancies and to evaluate the health of babies once they had been born.

But she said understanding more about how to improve the development babies’ nervous system could aid understanding of cot death.

“Some researchers think it has to do with something being wrong in the central nervous system, which affects respiration.

“Babies aren’t able to wake up and breath for themselves if they need to.”

She said this study had shown the babies of women who exercised had a more mature respiratory system, suggesting they would fare better after birth.

Dr May said it was safe for women to exercise while pregnant.

But she said the team did not yet have evidence about what the minimum beneficial level of exercise in pregnancy was.

Patrick O’Brien, a consultant obstetrician and spokesperson for the Royal College of Obstetricians and Gynaecologists said the study was interesting and worth following up, although it was small.

He added: “This is an interesting finding and one which should encourage women to keep healthy when pregnant.

“Pregnant women should consult their midwives and doctors on the types of exercise they could do when pregnant and how much.”

Mr O’Brien said excessive exercise during pregnancy could be dangerous for the unborn baby if a woman becomes too hot or lets their heart rate go over 130 beats per minute.

But he said there was is no increased risk of miscarriage or premature labour linked to exercise.

He advised: “Keep within your comfort zone so that you can still hold a conversation.”

The findings from this pilot study of 26 women are being presented to the American Physiological Society’s conference in New York.

         

Epidural for labour being denied by NHS

Women in labour are being denied epidurals to help them cope with the pain of childbirth.

New guidelines issued by the National Childbirth Trust, (NCT) have categorised the procedure as, “Unnatural” in an attempt to boost the number of women having traditional births. The aim is to reduce the number of women having epidurals or caesareans by up to 40%. Many NHS Trusts have signed up to the guidelines.

The NCT guidelines have the backing of the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists.

The reports summation is that both doctors and mothers are overly keen to resort to medical intervention in what is one of the most natural occurrences on earth. Rushing to administer an epidural or a conduct a caesarean they are creating other potential risks to mother and child.

Kim Hinshaw, a consultant obstetrician at Sunderland Royal Hospital, said: “I have major concerns with this. I don’t think we will ever reach a figure of 60% normal delivery using this definition. For example, in Sunderland we have an epidural rate in first labours of 60%.”

During an epidural procedure a needle goes between the vertebrae of your back, and into the space outside the coverings that surround your spinal cord.

A fine tube is then passed through the needle and then the needle is removed.

An anesthetist injects a cocktail of drugs into the tube to numb the lower part of the abdomen. Legs and feet go numb as well as the feelings of contractions.

         

“Milkscreen” could prove dangerous

Milkscreen, tests alcohol in breast milk, though experts say there is no clarity on, “Safe” levels of alcohol whilst breastfeeding and that this new product could do more harm to mothers and babies than good.

Containing test pads, Milkscreen colour changes on contact with breast milk that contains alcohol, creating a visual alert by a concentration of alcohol in the breast milk greater than 0.02 percent.

There is no clarity to how much a new mother can drink before the alcohol gets into her milk, say experts. Nor how long she should wait after drinking the alcohol to ensure it is not passed on to her baby. Further that many other factors are missing from the test including body weight, the type of alcohol consumed, and food intake.

The Royal College of Obstetricians and Gynaecologists says one or two units a couple of times a week is “probably” safe. The British Medical Association advises breastfeeding women remain abstinent.

According to Milkscreen, babies can safely consume breast milk with an alcohol concentration of approximately 0.03 percent.

Kimberly Schram of UpSpring, the company that produces Milkscreen said: “There is other research showing that any alcohol at all in breast milk can impair the motor development skills of babies, but the majority of research focuses on the impact on sleeping and eating, and cites this 0.03 percentage, so that is what we have concentrated on.”

Some studies claim that about 2% of the alcohol a mother consumes will enter her bloodstream and then her breast milk, with levels rising in milk for between 30 and 90 minutes after the last drink of alcohol. Other conflicting research says that a babies immature liver makes it almost impossible to process even small amounts of alcohol.

There is very little research on the impact of alcohol on breastfeeding, but Schram is adamant that Milkscreen is both safe and accurate. “We are in the process of finalising approval with the US Food and Drug Administration, so we are not able to share accuracy rates at this time,” she said. “However, from the clinical studies that have been performed to date, we are confident in the accuracy of our product and the peace of mind that it provides to breastfeeding women.”

Susan Fleisher, founder of the National Organisation for Foetal Alcohol Syndrome-UK said: “There are lots of reasons why this test could be dangerous: alcohol might only stay in a woman’s system for 12 hours, but it can stay in a baby’s system for up to 72. This means there is a real danger of babies accumulating alcohol in their body.”

Editors Note: The following was sent to us via email from Kimberly Schram of UpSpring . In the interests of providing a balanced and impartial view, we’ve included this communication.

Date: Tuesday, February 17, 2009, 12:34 PM

Dear BabyChums,

I saw your article entitled “Milkscreen could be dangerous” and was very concerned about this claim about our product.

The American Academy of Pediatricians (AAP) considers alcohol compatible with breastfeeding. The AAP as well as the British National Health Service’s say an occasional alcoholic drink probably will not hurt baby, but a mother who chooses to have a drink should wait at least two hours before breastfeeding.

Because everyone metabolizes alcohol differently, women may want more precise information about how their own bodies are processing alcohol, and how much is getting into their breast milk. Milkscreen is the only test that lets a woman know if there is alcohol in her breast milk. The Milkscreen test shows a color change at 0.02%. This is a level of alcohol that according to the leading U.S. medical experts may impact baby’s sleeping and eating behaviors. If consumers obtain a positive test result with Milkscreen they should find an alternative food source (preferably stored breast milk) for baby until they can retest and obtain a negative test result.

Breastfeeding gives babies the best possible start in life, and all experts recommend doing everything possible to maximize the period of time that mom and baby participate in this health-giving activity.

Milkscreen was invented by a mom to help extend the life of breastfeeding and ease some of the restrictions that can discourage women from continuing to breastfeed, while keeping their babies healthy. Dr. Jack Newman of the Newman Breastfeeding Clinic & Institute and La Leche League International Health Advisory Council says that, “prohibiting alcohol is another way we make life unnecessarily restrictive for nursing mothers and that reasonable alcohol intake should not be discouraged at all.”

Milkscreen does not condone alcohol abuse or excessive drinking. If you would like to set up a time to speak with Milkscreen inventor Julie Jumonville please let me know and I am happy to arrange a call.

Thank you for your attention to this matter.

Kimberly Schram

UpSpring Baby