Choosing a Hospital or Home Birth

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Home or hospital? The question of where to give birth is a topic of ongoing discussion among expectant moms, doctors, midwives, and home birth advocates. As the number of women who give birth at home increases, the sometimes heated debate about which is safer for women, babies, and families will surely continue. The author of a recent New York Times Magazine article wrote “It is unfortunate that the choices and the rhetoric around birth—like many of the choices and rhetoric around motherhood in general—are so polarized.” It’s a big decision.

A woman’s health and risk factors should be central considerations in deciding on a birth venue. Although studies have shown that absolute risks of planned home birth are low, home births don’t always go as planned. Planned home birth is associated with increased risk of neonatal death when compared with planned hospital birth. Risks also increase in women with certain medical conditions such as hypertension, breech presentation, or prior cesarean deliveries, or in births where there are inadequately trained attendants. It is important for any woman choosing home birth to have a certified nurse-midwife, certified midwife, or physician practicing within an integrated and regulated health system with ready access to consultation and a plan for safe and quick transportation to a hospital in case of an emergency.

While ACOG believes that hospitals and birthing centers are the safest place for labor and delivery, we respect a woman’s right to make a medically informed decision about her birth experience. ACOG also continues to support collaborative practices between physicians and certified nurse-midwives/certified midwives to further improve outcomes for pregnant women and their babies.

Ultimately, women have a choice in where to give birth. As ob-gyns, it’s our job to educate our patients on the risks and benefits of hospital vs. home delivery and help them make the best decision for themselves and their families.

Safe Travels during Pregnancy

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For millions of Americans, Memorial Day means the start of the summer travel season. If you’re pregnant, here are a few tips for a safe trip:

*The middle of your pregnancy—weeks 14 through 28—is the best time to travel, but many women can travel safely until a few weeks before their due date. Talk to your doctor before traveling late in pregnancy.

*Air travel is almost always safe up to 36 weeks of gestation for women with low-risk pregnancies. Try to sit near the front of the plane, where the ride is smoother, and choose an aisle seat for easier access to the restrooms. On long flights, get up and walk around every hour or so to reduce the risk of leg swelling and blood clots.

*If you’re planning a road trip, try to spend no more than five or six hours driving each day, and take regular breaks so you can get out and stretch your legs. Keep airbags turned on and sit at least 10 inches back from the dashboard, if possible.

Use a lap/shoulder belt every time you get into a car. Wear the lap belt low on the hip bones, not across your belly. The shoulder belt should be worn across the center of the chest between your breasts (never under your arm), and the belt should be tightened to a snug fit.

*When traveling by bus or train, be sure to hold on to railings and seat backs when moving through small aisles and in bathrooms, and use caution when entering and exiting.

*Taking a cruise? Ask your doctor about safe medicines for calming seasickness. Make sure there is a staff doctor or nurse on board and that the ship will dock in areas with modern medical facilities.

*Before planning a trip abroad, check with your doctor to ensure that your destination is safe for pregnant women. Allow enough time to get any vaccinations you might need. Also, keep a copy of your medical records on hand.

*Drink extra fluids and eat regularly to maintain your energy. It’s a good idea to bring your own juice or water (avoid carbonated drinks, especially before flying) and healthy, high-fiber snacks. Wear comfortable shoes, support hose, and a few layers of light clothing.

*Finally, remember the reason you’re going away in the first place: rest and relaxation! Get plenty of sleep and don’t overdo it.

Enjoy your trip!

A Victory for Healthy Moms

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According to a recent New York Times article, maternal deaths have plunged from more than half a million per year in the 1990s to roughly 287,000 in 2010. A report released by the United Nations attributes the decline to better access to and use of contraceptives and of antiretroviral therapies among mothers with AIDS, and more births being attended by doctors, nurses, and medically trained midwives. Though this number is still far too high, the drop in maternal mortality is dramatic and serves as a powerful reminder that we’re heading in the right direction.

Contraceptive access is essential for all women because, according to the World Health Organization, if the 215 million women desiring contraception could get it, each year unintended pregnancies would drop by 71% and maternal deaths would decrease by 67%. In a world of limited resources and 7+ billion people, helping women control their fertility is the right thing to do. By providing women with options that help them make better reproductive choices and protect their health, and by making childbirth safer, women, families, and their communities become stronger and more empowered. The decline is confirmation that inroads can be made and that small changes can make a huge difference.

Maternal mortality remains a major threat to women of all backgrounds. ACOG continues to explore methods of lowering maternal deaths at home and abroad. In the meantime, this good news puts wind in the sails of physicians, women’s health advocates, and communities who tackle this problem from the front lines. And during National Women’s Health Week, it’s an especially fitting time to celebrate.

Healthy Women = Healthy Families

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A personal note from ACOG President James T. Breeden, MD: This week, I became the 63rd president of ACOG. I am looking forward to the year ahead and to the opportunity, through this blog, to address key health issues for women and the ob-gyn specialty. 

In the week leading up to Mother’s Day, many people (myself included) are busy buying flowers, gifts, cards, and candy for the special women in our lives. During this time, I also like to remind my patients that the best gift they can give to their families and friends is a healthy self.

“Take care of yourself first” may be advice that you’ve heard before, but it bears repeating. So often, women juggle schedules, home life, and work for everyone in their household. In the midst of keeping others on track, their own needs get sidelined. The family calendar may include soccer games, birthday parties, business dinners, and school projects, but what about a spa treatment, time for regular exercise, and a yearly well-woman doctor’s visit?

Mother’s Day kicks off National Women’s Health Week. This year’s theme, “It’s Your Time,” encourages women to take time every day to do something healthy. Try incorporating good habits, such as being more active each day, making smarter food choices, getting a full night’s sleep, or finding a new way to keep stress under control. If you haven’t had your annual exam, now’s a good time to schedule your appointment.

Starting now and throughout the entire year, remember to make self-health a top priority.

Fighting Preeclampsia in May and Beyond

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This is my last blog post as ACOG president (I continue as immediate past president for another year), so I’d like to finish where it all began, with my Issue of the Year: preeclampsia. It’s a condition that affects up to 7% of pregnant women, and in my opinion, it’s the most important medical complication of pregnancy. It’s potentially life-threatening to mother and baby during pregnancy and can signal health problems for the mother later in life. Unfortunately, this serious and common condition is understudied and largely misunderstood.

As part of my President’s Program on Monday, May 7, at The College’s Annual Clinical Meeting, I invited three of my esteemed colleagues at the forefront of preeclampsia research to share what we know, what’s new, and the advances that may be coming soon in preventing and treating preeclampsia. This session will help educate ob-gyns about the condition. It’s imperative that physicians appreciate a patient’s experience of preeclampsia. It’s also extremely important to raise awareness of the signs and symptoms of preeclampsia among women.

High blood pressure and protein in the urine can both signal preeclampsia. Because these changes are hard—if not impossible—for women to spot, blood pressure and urine tests are routinely checked at each prenatal visit. Other symptoms may arise, especially in the last three months of pregnancy, including sudden weight gain, headaches, swelling of the face or hands, blurred or altered vision, chest pain or shortness of breath, pain in the upper right abdomen area, and nausea and vomiting. These symptoms may seem normal, but because preeclampsia can worsen quickly, it’s important that pregnant women alert their doctor immediately if they occur.

Preeclampsia Awareness Month (PAM) in May is an excellent time to educate women and spread the word about this condition. The Preeclampsia Foundation’s website has a page devoted to the signs and symptoms of preeclampsia and what women can do to monitor themselves for preeclampsia-related changes. The foundation also has great news and information about risk factors, resources, and local PAM events. The more we know, the safer we can make pregnancy for women and their families.

Two Must-Sees in San Diego

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I talked recently about the excitement leading up to ACOG’s upcoming Annual Clinical Meeting (ACM). As in every year, attendees can look forward to a thoughtful and comprehensive scientific program. I wanted to share two of the sessions that have particularly piqued my interest from this year’s line-up.

While I admit to being a stargazer, the special session on maternal and child mortality headlined by Christy Turlington Burns and Tonya Lewis Lee promises to offer much, much more than a celebrity sighting. Both are activists and documentary filmmakers who have used their star power to raise awareness about maternal and child health in the US and around the world. Maternal and infant mortality is an issue that ACOG continuously works to address and improve. With all the advances in medicine and obstetrics available to us, it is a travesty that mothers and babies around the world are still dying every day. In fact, the US has the highest rate of maternal mortality among industrialized nations. Ms. Turlington Burns and Ms. Lewis Lee will share the insights that they have gained from their time spent on the front lines with at-risk women and children.

Switching gears, the second session I won’t miss addresses cosmetic gynecology—a hot topic in ob-gyn. We are a society preoccupied with appearances, and procedures that promise to give our looks a boost generally receive a lot of attention. Some ob-gyns have stepped into the cosmetic surgery arena, performing cosmetic gynecologic procedures such as labioplasty, “revirgination,” and other forms of vaginal “rejuvenation” as well as aesthetic procedures such as injecting Botox. A four-expert panel will discuss the pros, cons, and ethics of ob-gyns performing these surgeries and the controversies that surround some of these procedures.

These are just two highlights in a scientific program studded with clinical pearls. Check back from May 5–9 to hear more about the happenings at the ACM.

Meetings Matter—The Importance of Our Annual Clinical Meeting

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The ob-gyn community is abuzz in anticipation of our 60th Annual Clinical Meeting (ACM), just over two weeks away in San Diego. You read that right. We’re excited over an annual meeting. I’ve been an ob-gyn since the 1970s and I’ve had many reasons for attending the ACM over the years. In my opinion, each meeting gets better and more relevant to my daily practice.

The ACM is the best place to gather with other ob-gyns to learn about and discuss a wide array of new findings in research and in clinical practice. The phenomenal poster sessions—where more than 260 research abstracts will be presented—help physicians get a pulse on emerging areas in ob-gyn research and of the breakthroughs that may be coming soon. The ACM also provides an excellent opportunity to meet up with colleagues, collaborators, and friends from the US and abroad. It has been the birthplace of countless projects and initiatives that support our mission of providing the highest quality women’s health care and eliminating obstacles and health disparities our patients may face.

Of all the times I’ve attended, this particular ACM holds special significance. It marks the sunset of my tenure as president of ACOG. It has been an amazing and transformational year for our organization. One of the highlights of my presidency has been shining a national spotlight on preeclampsia, a leading cause of maternal and infant sickness and death in the US that is both understudied and misunderstood. Unfortunately it is also an area of reproductive research that is woefully underfunded especially with regard to clinical trial undertakings. The 2012 ACM will kick off with my President’s Program on preeclampsia. I’m very excited to have James M. Roberts, MD, giving the historical and current perspective on the condition; John Barton, MD, reporting on the findings of ACOG’s Preeclampsia Task Force and some of the implications for our clinical practice; and Eleni Z. Tsigas of the Preeclampsia Foundation discussing how it affects women and families.

So for the next few weeks, I’ll be looking forward to all that awaits me at the ACM. There’s still time to register for what promises to be an informative, fun, and comprehensive meeting. Hope to see you in San Diego!