Birth Story

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

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.

Fathers who pushed to be included in their children's births beginning in the 1950s have brought real change to the modern birth, according to historian Judith Walzer Leavitt's 2009 book Make Room for Daddy.

Buoyed by changing perceptions of how men should function in society, fathers have created "unprecedented new roles for themselves in a traditionally women's event"  and have "helped to make hospitals more flexible in how they handled birth," Leavitt writes.

Dads' participation in birth has helped to break down the "mystique of modern medicine and further opened the world of obstetrics to lay participation and interpretation," she writes.

Fathers often report that witnessing a child's birth is one of the best experiences of their lives.

"It was better than any game I've played or any big hit I've had," said Ian Desmond, the Washington Nationals' shortstop who recently took advantage of Major League Baseball's new paternity leave to attend the birth of his son, Grayson.

However, the journey has not always been easy for men, who in their public lives often are far more in control than they feel attending the birth of one of their own children.

Leavitt quotes the writer Stephen Harrigan, who wrote in Reader's Digest in March, 1979, about attending the birth of his son. Before the birth, Harrigan worried that he would be no more than a spectator metaphorically holding out Gatorade to his wife, the "athlete who would finish the race."

Harrigan found the experience to be more profound and involving than he expected, but some other fathers feel "at sea, abandoned and out-of-control" at birth, Leavitt writes.

Some fathers cringe at the idea of watching their wives in pain or perhaps fear the experience will damage the desire they feel for their wives. Fathers attending birth are now so ubiquitous that a reluctant dad may well feel pressured to go.

Nevertheless, men's foray into the birth process, which may begin with their attending prenatal classes, has led to their increased participation in their families' lives and experiences, compared with those 1950s dads who began the process, Leavitt writes.

Dads who don't attend their children's birth lose a crucial opportunity, according to researcher Jessica Weiss, who goes so far as to say they risk having "missed the boat of shared parenting."

It isn't that childbirth is more inherently dangerous in countries where many women die in childbirth than in those where relatively few die. The women who survive, statistically speaking, are getting appropriate help from trained attendants.

"...The main complications that lead to death during pregnancy or childbirth are fairly common among all women, regardless of where they live," write the authors of an article titled "Are We Making Progress in Maternal Mortality?" in the May 26 issue of the New England Journal of Medicine.

Hemorrhage, which most often occurs right after birth, is the leading cause of pregnancy-related deaths globally, accounting for 35 percent of all deaths in childbirth, according to the World Health Organization. And in fact, hemorrhage was the second most common complication seen in pregnancies in the United States in 2000.

However, most U.S. women who suffered hemorrhage were treated quickly, and survived, say the article's authors, Anne Paxton and Tessa Wardlaw.

WHO identified the second most common cause of maternal death as hypertensive disorders — pre-eclampsia/eclampsia, for example. Again, these disorders are a common problem all over the world, but women with access to good medical care have a good chance of surviving them.

The countries that are most dangerous for pregnant women are those suffering through wars, or burdened with a large population with HIV/AIDS, the authors write.

In general, poor women die in childbirth more often than affluent ones, rural women more often than urban ones. These populations are more vulnerable because they often deliver their babies without the benefit of skilled birth attendants, and lack access to obstetrical services like surgery by Cesarean section.

Sub-Saharan Africa, with widespread political unrest and HIV/AIDS infection, "has the greatest burden of maternal mortality," even though most countries there are seeing "small but promising" decreases in pregnancy-related deaths.

Worldwide, there is considerable cause for hope, Paxton and Wardlaw write. Maternal mortality has decreased globally by more than one-third since 1990, according to United Nations estimates.

"Dramatic improvements in China and other Asian countries...are associated with economic improvement, decreasing fertility rates and strengthening of health systems...," the authors write.

"The overall rate of decline in global maternal mortality, 2.3 percent, is lower than the 5.5 percent MDG target but is heartening nonetheless," they write.

Image: "Pregnant Graffiti" by Petteri Sulonen

A study released this week on home birth in America shows a substantial increase in the still very small numbers of women who are choosing to have home births.

The study, released online in Birth: Issues in Perinatal Care, shows that of the 4.2 million births in the United States in 2008, 28,357 were home births. That is 2/3 of one percent of the total, but it represents a 20 percent increase, from 0.56 percent in 2004.

Non-Hispanic white women accounted for most of the growth, with an increase of 28 percent between 2004 and 2008. More than 1 percent of those women now have their births at home.

The study was based on United States birth-certificate data.

The family of David A. Sinclair MD, the late Honolulu obstetrician who delivered Barack Obama on August 4, 1961, were surprised and honored to learn of his role when the President recently released his long-form birth certificate.

Dr. Sinclair was a freshly minted young doctor in 1961. Born in Portland, Ore., Dr. Sinclair had moved to Hawaii with his family as a child. He served as a fighter pilot in World War II, settling back down in Hawaii after the war. There, he attended college at the University of Hawaii, where he met his wife, Ivalee.

Dr. Sinclair received his medical training, including his residency in obstetrics and gynecology, at the University of California at San Francisco. He returned to Hawaii in 1960.

He delivered babies all over Hawaii, but his practice was centered at a hospital now known as Kapi'olani Medical Center for Women & Children in Honolulu, where President Obama was born, according to news accounts.

Dr. Sinclair died in 2003 at the age of 81.

"I'm just honored and proud of my father," said Karl Sinclair, one of Dr. Sinclair's six children.

"I think it's great," said Dr. Brian Sinclair, another son. "Hawaii was a very small place back then so I guess I'm not surprised."

Childbirth is  “a truly murderous business,” the Scottish actress Tilda Swinton told reporters today at the Cannes Film Festival.

“It’s violent. And if one doesn’t embrace that, if one can’t embrace it — and it’s really tough to do that — then you’re up a gum tree because it means you’re going to be cutting off a whole part of yourself,” said Swinton, 50, the mother of teenage twins.

Tilda Swinton

Swinton told reporters that movies and television give people an idealized vision of birth, according to a story by Anita Singh in the Telegraph, a British paper.

“In movies, and particularly in television films, when people have babies, they are sitting in a hospital room and there are flowers everywhere. They are made up, magically, and they have a baby in their arms and it’s all really lovely,” she said.

Swinton made the remarks while discussing her latest film, "We Need to Talk About Kevin," directed by Lynne Ramsay, which is generating major buzz at Cannes. The film is based on a 2003 novel by Lionel Shriver.

Image courtesy of Wikimedia Commons

Where do you stand on this? It probably depends on how seriously you take your sports.

The baseball season was only a few weeks old when a sports blogger lambasted Texas Rangers pitcher Colby Lewis for missing a game in which he was scheduled to pitch, in order to attend the birth of his daughter, Elizabeth Grace.

Colby Lewis

Lewis, 31, was the first player to go on Major League Baseball's new paternity leave list. A player can be on the list, and off the roster, for up to three days for the birth of a child.

"Baseball players are paid millions to play baseball," Richie Whitt wrote in a post for the Dallas Observer sports blog. "If that means 'scheduling' births so they occur in the off-season, then so be it. Of the 365 days in a year, starting pitchers 'work' maybe 40 of them, counting spring training and playoffs.

"If it was a first child, maybe. But a second child causing a player to miss a game? Ludicrous."

Twitter and blogosphere lit up with sputtering rebuttals: Fatherhood trumps baseball any day, buster.

The Rangers' pitching coach, Mike Maddux, said he supports the new list.

But baseball writer Rob Neyer waded in on Whitt's side of the fracas for SB Nation:

"I'm going to be honest here, as I have been since the first time this came up, some years ago (official paternity leave is new, but players taking a game off to attend childbirth is not)," he wrote.

"As a human being, I think this is fantastic. As a baseball fan, though? If my team's in the playoff hunt, I'm sorry, but I don't want one of my starting pitchers taking the night off. We're not talking about some guy who works on the assembly line for the Integrated Widget Corporation. We're talking about one of the most talented pitchers on the planet, not easily replaceable. What if your team finishes one game short of the playoffs? Was it really worth it?

"Or as a sage philosopher once observed, The needs of the many outweigh the needs of the few.

"And last I checked, there were many fans of the Texas Rangers."

Well, it's not just the Texas Rangers anymore. Several other players have already gone on the list, including the Oakland Athletics' catcher Kurt Suzuki, Washington Nationals' shortstop Ian Desmond and New York Mets' left-fielder Jason Bay.

“Teams were basically granting [leave to attend births] anyway, but they ended up playing short, and that really wasn’t the goal,” Peter Woodfork, a senior vice president with Major League Baseball, told the New York Times' Tyler Kepner for a story about the list. “[The paternity leave list] leaves no gray area. Neither side feels like, ‘Well, we really want you to stay.’ There’s no guilt, and it helps both sides.”

Image courtesy of Wikimedia Commons