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

“Call the Midwife”

Birth Story could hardly ignore the debut of a new PBS series called Call the Midwife, an import from England. I watched the first episode last night, and I expect I'll be a regular viewer.

I didn't love the first episode of Call the Midwife, though. I thought it romanticized birth on the low end of the social order in London in 1957, even though it begins with two women fighting on a street in the tough East End.

This episode of "Call the Midwife" features a woman who had 25 children, and that made me wonder what the record is for offspring from one woman.

Well, here it is — 69.

The wife of Feodor Vassilyev (1707–c.1782), a peasant from Shuya, Russia (they didn't even keep track of her name!) had 27 "confinements," in which she gave birth to 16 pairs of twins, seven sets of triplets and four sets of quadruplets.

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

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."

Predicting problems in labor

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.Pregnant Graffiti

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