Birth Story

The birth Jan. 7 of Blue Ivy Carter, daughter of hip-hop stars Beyonce and Jay-Z  (Shawn Carter), had Lenox Hill Hospital in Manhattan in a tailspin this week.

Beyonce

Other new parents complained of disruptions and even security breaches as the celebrity family reportedly took over part of the hospital's sixth floor for a private, customized labor-delivery area for $1 million-plus. (A hospital spokesman said the Carters occupied an "executive suite" and paid the standard rate for it.)

Neil and Rozz Nash-Coulon were upset at being detained in the neonatal intensive care unit after visiting their newborn twins, while Edgar Ramirez reported he was refused entrance to visit his baby in the the NICU unit. Windows were covered, private security guards issued orders, and security cameras were even disabled, families complained.

"The security of our children is at risk when you cover security cameras," Ms. Nash-Coulon told Nina Bernstein of the New York Times.

And, all the secrecy fed rumors. Beyonce's website states that "Baby Blue" was "delivered naturally," while portions of the blogosphere ran with a report that the birth was a C-section. And there's even a contingent that holds that Beyonce's pregnancy was a fake, that a surrogate mom bore Blue.

Tina Fey and Jane Krakowski, stars of the sitcom 30 Rock on NBC, told The Today Show's Matt Lauer that they both had their babies at Lenox Hill Hospital as well. Said Fey, "My celebrity treatment at Lenox Hill involved taking a group breast-feeding class in a closet."

How great would it be to be able to tell in advance whether a particular birth would go smoothly or need intervention!

A French team of physicians reported this week at the annual meeting of the Radiological Society of North America that it has developed a new computer model that uses magnetic resonance imaging to predict whether a birth will go smoothly or have problems.

Olivier Ami MD told a session of the RSNA meeting in Chicago that his team applied the new software, called Predibirth, to 24 MR images of pregnant women, and created a three-dimensional model of the woman's pelvis and the fetus. Using these images, Predibirth calculated the likelihood that the babies could find their way out of their mothers' bodies without assistance.

Of the 24 women studied, 13 delivered normally. Predibirth had predicted normal births for all of these women. Predibirth had tagged three women who opted for elective Cesarean sections as being at risk for dystocia.

Of five women who had emergency C-sections, Predibirth had predicted three might have problems — all three involved instructed labor. However, Predibirth had given thumbs up to two of the mothers, whose problems involved heart arrhythmia.

Predibirth had declared "mildly favorable" three additional moms who wound up resorting to vacuum extraction during birth.

Not perfect, but not bad.

"With this virtual childbirth software, the majority of C-sections could be planned rather than emergency, and difficult instrumental extractions might disappear in the near future," Dr. Ami told his audience in Chicago.

Dr. Ami M.D. is an obstetrician in the radiology department at Antoine Béclère Hospital, Université Paris Sud, France.

Image by Petteri Sulonen

The birth in Twilight: Breaking Dawn Part I was not as scary as I thought it would be. (If you don't want to read about the film's ending, stop reading here.) Breaking Dawn is a preteen fantasy through and through, so the birth of Bella's half-human, half-vampire baby winds up looking fairly tidy and vaguely menstrual, even if it does involve blades and teeth. (No trial of labor for Bella.)

Kristen Stewart as Bella Swan

Will Breaking Dawn leave a generation of young girls with tocophobia — fear of childbirth? My guess is that it will not. The birth happens fast, for one thing, and it's all pretty implausible. The baby appears to be a normal baby, though about six months old, and functions for the rest of the movie in a doll-like capacity.

But Bella Swan — the teenager who falls in love with the vampire Edward Cullen (Robert Pattinson) and marries him in this, the first half of the screen adaptation of the fourth and final book in Stephenie Meyers' Twilight saga — does die in childbirth in the film. Her death has been prophesied, so it isn't unexpected, but the sight of her still, gray form on the table where her baby was born is upsetting.

However, the second half of Breaking Dawn is scheduled for release one year from now, so let's just say that birth for Bella is a defining moment. We haven't seen the last of her.

Breaking Dawn is rated PG-13.

It is officially the silly season, the last days of summer, when news traditionally slows down to a trickle and publications fill their pages with stories so fluffy they practically float.

Koi

My candidate for this year's silly-season birth story is "Koi-Assisted Birth," a winsome website about a couple, "Jane" and "Shane," who are planning a water birth in the fall. The two have decided to enlist their 15 koi to help them and their midwife usher their new baby into the world.

The website has generated some controversy. My guess is that Jane is pulling our leg.

She says that "koi are excellent birthing partners," their skills honed by giving birth to thousands, or even tens of thousands, of baby fish, with help from koi dads.

"That's exactly the kind of birthing energy I want!" Jane writes.

But Shane will have a net at the ready to catch the baby, just in case.

Image courtesty of Wikimedia Commons

Free birth-control and breast pumps? Government subsidies for domestic-abuse interventions? Some people have no trouble conjuring the moral slide those new policies will precipitate.

Modeled on recommendations by the independent Institute of Medicine and announced by the U. S. Dept. of Health and Human Services this week, the new provisions set off a firestorm of protest in some conservative circles, including this diatribe from Stephen Colbert's conservative  character on Comedy Central.

The Institute of Medicine issued a report this week that added eight preventive services for women to the provisions that will be provided free of charge under the Patient Protection and Affordable Care Act.

One noteworthy recommendation calls for free contraception and counseling on how to prevent unintended pregnancy.

In addition, pregnant women would be screened for gestational diabetes and new mothers would receive counseling and equipment to support them in efforts to breastfeed their babies.

The report "provides a road map for improving the health and well-being of women," said committee chair Linda Rosenstock, dean of the School of Public Health at the University of California at Los Angeles.  Each of the eight services "stands on a foundation of evidence supporting its effectiveness," she said.

The recommendations would fill "gaps" in care that bedevil women in the present system, the report said.

The seven additional recommendations are these:

• contraceptive methods and counseling to prevent unintended pregnancies
• screening for gestational diabetes
• cervical cancer screening, including human papillomavirus testing, for women over 30
• counseling on sexually transmitted infections
• counseling and screening for HIVAIDS
• lactation counseling and equipment to promote breast-feeding
• screening and counseling to detect and prevent interpersonal and domestic violence
• yearly well-woman preventive care visits to obtain recommended preventive services

My daughter Nora lives in Los Angeles, Cal., so I am aware that Angelenos are so dreading the shutdown of 10 miles of the I-405 expressway there for road work this weekend they have dubbed the event "Carmageddon."

Nora is going to walk or take buses as much as she can this weekend, and being from Chicago, she is comfortable with those activities. But many Angelenos are famously more car-bound than she is.

Los Angeles commuter traffic

Crosstown airline flights between the suburbs of Long Beach and Burbank are sold out this weekend and the police department is asking celebrities to urge their Twitter followers to avoid the expressway and, indeed, to drive in the city as little as possible.

But Jenny Benjamin, writing in The Stir today, brings up an interesting and, to her and other expectant moms, urgent point: What happens if your baby decides to be born in L.A. this weekend?

Pregnant with twins, less than two weeks shy of her due date, a 30-minute drive away ("without traffic") from the hospital she carefully chose for its neonatal intensive care unit, Benjamin considers the possibility of an early labor and aks, "For the love of all things good and holy, what am I going to do?!?!"

Will her husband wind up delivering the twins (one of whom is in a transverse position) on the side of the road? Should she call an ambulance? "Ambulances aren't hovercrafts -- they're going to get stuck in the same traffic!" Benjamin notes.

Her doctor lives close to the hospital. "Good to know at least one of us will be able to get there," she writes.

"Aargh, it's times like this that I really wish that Segways had caught on!" Benjamin frets.

The best solution, she notes, is not to have the babies this weekend. "I have about as much control over that as I do the traffic," Benjamin writes. "Maybe I should see how much my husband knows about home birthing."

Everybody knows that obstetricians are one of the most-sued medical specialties, but nailing down the details on that truism can be difficult.

CRICO Strategies, an international firm that provides risk-management software to hospitals and insurances companies, last month released a "benchmarking report" on malpractice risks in obstetrics that helps fill out that sketchy picture.

The report looked at 800 obstetrics-related medical-liability suits filed between 2005 and 2009.

Families dealing with the death of a mother or child, a severely damaged infant, or some other effect of a childbirth gone awry most commonly charged "communication failures, judgment lapses, and faulty technique as the reasons behind their injuries and their malpractice cases," the report states.

Sixty-five percent of cases involved "high-severity injuries."

Across the board, about one in 1,000 births involves a "preventable adverse outcome," the report noted.

While those can occur throughout pregnancy and birth, most suits in the study concerned allegations that birth assistants had mismanaged labor and delivery, particularly the second stage of labor — the actual birth.

"Substandard clinical judgment" was the top complaint in the suits, accounting for 77 percent of claims. Most of the suits named an attending physician.

The most common reason for suing was "birth asphyxia," a potentially injurious lack of oxygen, which accounted for 27 percent of the suits, and the most common allegation was that of a "delay in treatment of fetal distress" (25 percent of claims involving small hospitals, 19 percent involving large ones).

We here in the United States will be celebrating the birth of our country on Monday, July 4 — a different kind of birth story from the one we usually consider at Birth Story.

Given the difficult times many Americans (and others) are now experiencing, Paul Simon's wistful "American Tune," performed here during a 1981 reunion concert with Art Garfunkel, seems to me a suitably reflective way to head into the holiday weekend.

The rousing anthems and the fireworks will still be there on the holiday itself. I hope it's a happy one for you.

Why is the Cesarean rate so precipitously on the rise, from 21 percent of all American births in 1996 to 33.2 percent in 2007? The journal Obstetrics and Gynecology has the results of a new study that examines that question.

The Yale University Schools of Medicine and Public Health in New Haven, Conn., reacted to a spike in C-sections during births at Yale-New Haven Hospital between 2000 and 2002 by setting to work gathering comprehensive data on the 32,443 births that occurred there between 2003 and 2009, even while the hospital's C-section rate ballooned from 26 percent to 36.5 percent.

Not surprisingly, the study found that actual birth complications remained steady, while subjective judgments about the births changed.

The new study, presented at the February meeting of the Society for Maternal-Fetal Medicine, looks at the decision-making on the part of individual doctors that drove that increase.

"In this study, we examined physician-documented indications for Cesarean delivery at a major urban academic medical center in Connecticut, a state with one of the largest rate increases in the nation, to determine which specific indications contributed to the increase in our Cesarean delivery rate over a seven-year period," the researchers wrote.

First-time mothers accounted for half of C-sections during the study.

Indications for Cesarean delivery included "nonreassuring fetal heart tracing," an interruption in dilation, more than one fetus, pre-eclampsia, an especially large baby (which begins to be a concern just shy of nine pounds), and the mother's expressed desire for a Cesarean, the study's authors reported.

Complications like breech presentations, an interruption in the baby's progress into the birth canal and cord prolapse  did not increase significantly over time, the study found.

Slow dilation and those unsatisfactory fetal heart rate reports displayed only slight increases over time but contributed to an outsize degree to the increase in C-sections, the study showed. Concern for the baby's well-being, based on fetal-heart monitoring, was the top indicator for a Cesarean section at Yale-New Haven Hospital during the period studied.

Maternal request, suspected macrosomia (a large baby), more than one fetus and pre-eclampsia also showed big annual increases as indications for Cesareans.

Interestingly, the C-section rate among patients of physicians in private practice was 33.2 percent. For "university patients," who received care from the hospital service's residents and faculty midwives, supervised by attending physicians, the rate was 25.6 percent. The rate for "high-risk" patients (whose care was provided by some of the same maternal-fetal specialists who supervised in the "university" cases) was 44.6 percent.