Trimming preterm deliveries

Staying in the womb until 39 weeks of gestation can make a big difference in a baby's life.

Thankfully, that discovery is making its way into the everyday practice of medicine,  according to papers presented at the recent meeting in New Orleans of the American College of Obstetricians and Gynecologists.Pregnant Graffiti

Almost two-thirds of the country's hospitals with a registered labor and delivery unit have put policies in place  to discourage births before 39 weeks, according to a new study conducted by researchers at the Perelman School of Medicine at the University of Pennsylvania.

Researchers contacted all 2,641 U.S. hospitals with LD departments, and heard back from 2,367 of them. Two thirds of responding hospitals have such a policy.

Sixty-nine percent of those reported that they strictly enforced the policy, the study's authors reported. More than half (53%) of the hospitals that do not have a policy in place to discourage births before 39 weeks said "not medically indicated births" before term went against their standard of care.

In March, ACOG reminded physicians and hospitals that babies should not be delivered before 39 weeks gestation without a good medical reason. Serious ealth risks, and even higher mortality rates, have been established for babies born even in the 37th and 38th weeks of gestation.

The results of the Penn study "show that most hospitals do recognize the issues with early elective delivery, or non-medically indicated delivery prior to 39 weeks, and are adopting policies to prevent the practice,” said Nathaniel G. DeNicola, MD, Robert Wood Johnson Clinical Scholar at  Perelman, and lead author on the study.

Pregnant Graffiti by Petteri Sulonen

A lucky pair of scissors

One of the luckier babies of 2012 was little Maddalena Douse of Lewes, East Sussex, England, who was born last summer at the Royal Sussex Hospital in Brighton.Baby scissors

Maddalena was born at 23 weeks, and weighed only 382 grams, or about 13 1/2 ounces. According to a story in The Sun, a baby weighing less than a pound would not have been considered viable, and the hospital would not have been likely to use extraordinary measures to keep her alive.

However, at her first weigh-in, Maddalena wound up on the scale with a pair of scissors that went unnoticed. Their weight brought her up to that lucky pound. Only when she was already on a ventilator to help her breathe did the hospital staff discover the difference the scissors had made in her weight.

The little girl went home just before Christmas and "is expected to grow into a healthy child," according to the article.

“We never thought we’d ever bring Maddalena home,” said Kate Douse, Maddalena's mother, according to The Sun. “She now weighs 5½ [pounds] and is getting stronger by the day. She’s our little miracle and we’re so glad to have her home in time for Christmas.”

Maddalena had a twin, Isabella, who did not survive.

On mandatory breastfeeding

Many people mocked supermodel Gisele Bundchen as a "boob" and a "twit" a couple of years ago when she said the law should require mothers to breastfeed for at least six months. It turns out Bundchen may just have been a little ahead of her time.

As of this summer, hospitals in New York City will no longer make formula available to new mothers and babies unless it is medically indicated, or promote its use in any way. "Latch On NYC" is an initiative of the city's mayor, Michael Bloomberg.

"Motherhood" by Mary Cassatt

Studies have been piling up in recent years that show that breast-fed babies  do better in a number of ways than bottle-fed babies. Still, fewer than one-third of babies are consuming only breast milk at 3 months, and nearly four-fifths of babies have stopped breastfeeding altogether before the recommended minimum of one year. 

And as Linda Lowen wrote recently on,

Part of the problem is that we like our swag -- our goodie bags packed with toys and samples and coupons. Hospitals give these out as a matter of course, and as new moms we're eager for it.

The swag started with the formula companies. And they knew exactly what they were doing. They were hooking women at an emotional and vulnerable time, and from there they reeled us in.

Taking the free samples of formula away from new moms in hospitals protects them from the manufacturers who make it so easy to start a baby off on formula, rather than on the breast, Lowen wrote.

But even some breastfeeding proponents are protesting the new methods for giving breast-feeding a leg up in the nursery. Some women say mothers are already feeling the effects of Latch On NYC, which will go into effect Sept. 3.

New NYC mom Jacoba Urist wrote in a Wall Street Journal blog about her experience trying to have her baby fed with formula at the New York University Medical Center, where she had given birth, so she herself could sleep through the night. Nurses twice said they couldn't find any formula, and brought Urist her baby in the middle of the night to breastfeed, she wrote.

After Sept. 3, lack of cooperation, if such it was among those nurses, will turn to rules in NYC. "With each formula bottle a mother requests, she’ll get a lactation lecture about why she should use breast milk instead," Urist writes of Latch On NYC. She supports breastfeeding in general and does it herself, but thinks the new rules themselves will "prey on women in the days (sometimes hours) after they deliver a baby."

Kara Spak, a new mother and my former colleague at the Chicago Sun-Times, made an especially compelling case for leaving formula-feeding moms in peace, in a recent commentary about Latch On NYC in the Sun-Times.

Spak, who is perhaps best known nationally for winning more than $85,000 as a contestant on Jeopardy in 2010, wrote that she intended to breastfeed, but her baby wasn't thriving on breast milk. Ultimately, she had to choose between her baby's health and the breast-feeding ideal. She began feeding her new daughter formula, and continues to do so.

After that traumatic beginning, when Spak talked with her friends with babies, all of whom were committed breast-feeders, it turned out that all of them had had problems nursing, she said.

And that's the travesty here, or one of them, anyway. As Alissa Quart reported in her recent New York Times op-ed piece, "The Milk Wars,"

For most women, there is little institutional support for breast-feeding. According to the Bureau of Labor Statistics, only 11 percent of private-sector workers get paid family leave through their employers. Once mothers go back to work, there are few places where they can pump milk for later use.

Jane Brody's NYT column in response to Quart's piece, "The Ideal and the Real of Breastfeeding," gave readers a look at this longtime health writer's own rocky experience with nursing many years ago, plus a survey of studies and anecdotal evidence that makes it clear that, while breast might be best, it isn't for everyone.

On a more positive note, this year's "Big Latch-On," completed just this weekend, attracted 8,862 nursing babies (and their moms) in 23 countries, a new record.

And check out Birth Story's previous posts on breastfeeding.

Image: Motherhood by Mary Cassatt

Birth in an MRI

Babies are born in all kinds of settings, but a 24-year-old woman in Berlin chose to have her third child in December of 2010 inside a magnetic resonance imaging device at the Charite University Hospital in the German capital.

Researchers at the hospital last month released a brief segment of the seven sequences of real-time images they made of the birth inside a specially constructed open MRI, shown in the photo below. The video accompanied the publication of their article about the event in the American Journal of Obstetrics and Gynecology.

A midwife, an obstetrician, a neonatologist and an anesthetist were in the magnet room while the MRI was on. The hospital's delivery unit was a short distance away on the same floor. Mom and baby left the hospital two days after participating in this historic birth.

The view of the baby's journey into the world from inside the birth canal will provide researchers with valuable insight into the mechanics of this amazing passage, the authors said.

Birth in an MRI

The mother was just shy of 38 weeks gestation, fully dilated and experiencing regular contractions. She received an epidural before entering the MRI, where she remained for less than an hour, according to the article.

One additional "study" was taken of the mother's body after birth, "to evaluate the third stage of labor with regard to placental separation and uterus involution," the authors wrote.

The researchers, all affiliated with Charite, were concerned about subjecting a brand-new baby to the loud noise of the machine without the "maternal soft tissue" padding, so they turned the MRI off just at birth.

Images Christian Bamberg / American Journal of Obstetrics and Gynecology

How the other half births

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 pregnant


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."