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Pregnancy and maternity

Pregnancy and maternity

Resources

  • HIV Screening in Pregnancy: The bigger picture - from July 2002 seminar
  • WHIS Pamphlet Vitamin K- does my baby need it?
  • WHIS Pamphlet: Ultrasound scans during pregnancy
  • WHIS Information Pack: Caesarean Section

See Also: Breastfeeding

Smile for the camera

In addition to their medical diagnostic purposes, ultrasound scans in pregnancy are increasingly becoming a highly sought after social experience. Jessica Glen, Women's Health Action Intern, considers the changing meanings of ultrasound for women and their families/whanau, and the implications for women's "choice" to be scanned. Full article (pdf)

Study finds pregnant "obese" women are at risk of stigma and discrimination in maternity care

A recent UK study has found that pregnant women labeled as "obese" are at risk of stigmatising and discriminatory treatment by maternity care providers which can negatively impact on the provision of maternity care, and thus on pregnancy outcome, and the childbirth experience. Given the increasing focus on the relationship between women's weight and pregnancy outcome in Aotearoa New Zealand it is important to reflect on these research findings to ensure consideration is given to the impact of practitioner bias and fatphobia on pregnant women labeled as "obese" and how this can be countered. Christy Parker, Women's Health Action Policy Analyst, reviews the research and its recommendations for maternity care providers and service planners... Full article (pdf)

Mothers and mental health webiste:

An excellent new website on 'mothers and mental health' has been launched by the Postnatal Depression Family/Whanau New Zealand Trust. The trust was set up as a Charitable Trust in 2006 to improve awareness and understanding of postnatal depression (PND) and related mental illnesses in pregnancy and after childbirth. Members of the Trust include women who have experienced PND, family members, health professionals, and other interested people. Their hope is that women in the community and their families/whanau will feel less isolated and be more able to access help by using this information.

The website aims to:

  • Provide information for mothers, fathers & families on PND & related conditions, such as anxiety & bipolar disorder.
  • Contain local supports available in NZ.
  • Relates to the cultural diversity in NZ.
  • Has NZ based information and treatments.
  • Has information for medical professionals in NZ to help keep up with new developments.

The Trust has set up this website to provide up to date information for these mothers, fathers and their families/whanau and for those health professionals who are treating them.

This website is unique in that it is New Zealand based and relates to our New Zealand culture with kiwi mums, dads and family/whanau members talking about their personal experiences living with postnatal depression and anxiety.

The site provides relevant information regarding health and support systems in New Zealand. Unfortunately accessibility to perinatal or maternal mental health services is not consistent across the country. For instance, if you live in the North island, there are no designated psychiatric ‘mother and baby' beds therefore it is unlikely that a baby will be able to be admitted when their mother is unwell (some smaller hospitals may allow this).

The only specialised perinatal psychiatric inpatient unit is in Christchurch and the Trust is grateful to that service for the support they have provided in setting up this site. One of the reasons for the greater number of support systems listed for Canterbury is the fact that this is where both the Trust and The Mothers and Babies Service are located. We welcome input from other regions.

This site provides more in depth information on the medications that are available in New Zealand than other sites.

Trust members have used their own professional and personal knowledge and that of other health professionals, contacts, and friends to contribute to this site. The information from this site is not designed to take the place of a personal consultation with a medical professional.

The website can be accessed at:

http://www.mothersmatter.co.nz

 

New Zealand Research on Place of Birth

January 2008 Women's Health Update

Women and midwives have long been aware that the place they give birth can have an enormous impact on the experience. Jesse Solomon looks into some recent research which considers the impact place has on women birthing in New Zealand.

Because the Lead Maternity Carer (LMC) model in New Zealand enables the same practitioners (usually midwives) to care for women in different settings, New Zealand is in a unique position to compare birth experiences and outcomes in different environments. Internationally, midwives often work only in primary birth environments such as in homebirth or primary maternity units such as birthing centres or small hospitals. Secondary and Tertiary hospitals, those that can undertake surgical deliveries and care for tiny and ill babies, are often the domain of obstetricians with midwives not taking the lead for the care of women in these settings....Read More (pdf)

Home Birth Undergoing Renaissance

January 2008 Women's Health Update

It has been an exciting time for home birth recently. The energy from the Home Birth Conference and Hui at the end of September trickled down through Home Birth Week. The Australian Homebirth Conference in Sydney in early November was also exciting, featuring keynote speakers Sheila Kitzinger and Ricki Lake. Jeanette Lazet & Jesse Solomon report....Read More (pdf)

The Maternity Services Consumer Satisfaction Survey 2007. High satisfaction or low expectation?

June 2008 Women's Health Update

 

The 2007 Maternity Services Consumer Satisfaction Survey released this month has been celebrated for its overwhelmingly positive results and the gains made since the last survey in 2002. The survey, of 2,936 women who gave birth to a live baby (or babies) in March and April 2007, was commissioned by the Ministry of Health. It included both the rating of satisfaction levels and open ended questions. Satisfaction levels of 90% or higher were recorded for every area of NZ's maternity service. High satisfaction indeed, but is there more to the numbers than meets the eye? Christy Parker looks at the history and research around maternity consumer satisfaction surveys....Read More (pdf)

The national rollout for HIV screening

May 2007 Women's Health Update

The National Antenatal HIV Screening Implementation Advisory Group (NAHSIAG) was established by the National Screening Unit in 2005 to oversee and provide advice on the establishment and roll out of a national HIV screening programme for pregnant women. The advisory group was scheduled to meet in Auckland at quarterly intervals throughout the year but due to the cancellation of the meeting in November met only three times in 2006. Four meetings have been planned for this year. Lynda Williams reports on work to date. Read More (pdf)

Screening for HIV in pregnancy

May 2007 Women's Health Update

Antenatal blood tests are accepted medical practice in New Zealand as in other countries. Wende Jowsey looks at the reasons for adding HIV screening and the issues raised for informed consent. In March of 2006, testing for HIV was added to the current list of five antenatal blood tests by the Waikato District Board of Health. The aim is to prevent the spread of the virus from a mother to her unborn child. According to HIV Specialist Dr Jane Morgan, if a woman is untreated during pregnancy, transmission occurs approximately 25-30% of the time, as opposed to a 1% transmission rate if treated. Read More (pdf)

Third trimester routine ultrasound does not reduce perinatal mortality

December 2006 Women's Health Watch

This large Scandinavian study sought to evaluate the effects of third trimester ultrasound screening on prognosis. Over 200,000 deliveries between 1985 and 1996 were evaluated by observational design using data stored on the Swedish Medical Birth Registry and the National Board of Health and Welfare. In non-screening areas SGA (small for gestational age) suspicions were based on clinical examination rather than the routine ultrasound. The study found no significant difference in outcomes at birth comparing perinatal infant mortality, Apgar score and rate of caesarean or instrumental delivery between routine screening and non-screening areas. The study concludes that routine ultrasound screening in the third trimester to detect SGA infants lacks a significant effect on perinatal/infant mortality and morbidity.

Reference
Sylvan, K et al (2005) Routine ultrasound screening in the third trimester: A population-based study. Acta Obstetricia et Gynecologica Scandinavica 84:1154-58.

Voluntary caesareans more risky

December 2006 Women's Health Watch

A large US study has found that the risk of death to newborns delivered by voluntary Caesarean section is much higher than by vaginal delivery.
The study concludes that the neonatal mortality rate for Caesarean delivery among low-risk women is 1.77 deaths per 1,000 live births; 2.9 times the rate for vaginal delivery (0.62 deaths per 1,000).... Read More

The Latest on Aropax and Pregnancy

December 2006 Women's Health Watch

Women's Health Action reported on the risks associated with Aropax (Paxil, or paroxetine) in January 2006. (Update, Jan 2006) Aropax, an SSRI antidepressant produced by GlaxoSmithKline was found in a large retrospective study to increase the risk of birth defects, mostly heart defects, when taken by pregnant women. A year after that study was released the American College of Obstetrics and Gynaecologists have issued a recommendation that women who are pregnant or trying to become pregnant avoid the medication. There are currently a series of lawsuits occurring in the US against GlaxoSmithKline alleging that GSK was aware of the drug's risk before the FDA urged them to change the labelling to warn of possible birth defects in September 2005. ACOG currently recommends that 'paroxetine use among pregnant women or women planning to become pregnant be avoided, if possible'.
Reference: American College of OBGYN

Pregnancy police close in on women's rights in the U.S.

December 2006 Women's Health Watch

In a frighteningly Orwellian world women are being treated as baby machines as governments step in to regulate what a woman can do with her body1. This obsession with controlling women's bodies is reflective of the conservative Christian discourse of family and a focus on the ostensible reason for women's existence- reproduction. In the overwhelming focus on the baby's health, the health of the mother is being subsumed for that of her child. This dangerous precedent allows third parties to decide what is best for both mother and child. Women are being punished for behaviours that are not considered criminal for other members of society.... Read More

National Women's Hospital Annual Report 2005

December 2006 Women's Health Watch

 

National Women's Hospital released its Annual Clinical Report for 2005 in September and held the customary public seminar examining the information contained in the report on 22 September 2006. This is the thirteenth report in the current series. Lynda Williams has written the following summary for us.
The 232-page report contains a wealth of statistical information on the 7178 women who gave birth at NWH in 2005 and the 7368 babies they gave birth to and the 16 women who gave birth before they actually got to the delivery unit. This is a further drop in the numbers from 2004 when 7471 mothers gave birth to 7659 babies. In 2005 there were 184 sets of twins (188 in 2004) and 3 sets of triplets (there were no triplets in 2004).... Read More

Epidurals associated with early breastfeeding cessation

December 2006 Women's Health Watch

Australian researchers studied a group of 1280 women aged 16 years or older who gave birth to a single live infant in the Australian Capital Territory in 1997. The aim of the research was to test the anecdotal reports suggesting fentanyl (an opioid) added to epidurals during childbirth resulted in difficulties with breastfeeding. Women who had epidurals were less likely to be fully breastfeeding their infant in the few days after birth... Read More

DIY Healthcare

June 2006 Women's Health Watch

Recent developments in DIY healthcare are verging on the ridiculous.

WHA has been approached by a group selling a DIY cervical smear kit. Coming in a video type case, the leg crossing kit comes with a fearsome looking brush and some utterly hilarious instructions. It is hard to figure out just how you ensure that the guiding tube is lined up with your cervix and once having accomplished this rather unlikely feat, you then keep it in place - while you insert the brush in to give it a twirl. Even a relatively athletic woman would find this a challenge but try being older with a little bit of middle age spread and an elusive cervix. Truly an exercise in frustration. We say stick to WONS and Family Planning for this one.
Then there's this little gem from the Herald on Sunday. For a mere $6,000, you can plug in to your computer and keep tabs on your baby in utero.

It's not clear whether this is for internal or external application but both are equally ridiculous. What do you think the poor little blighter is trying to get away with in there?

For a balanced approach to untrasound scans in pregnancy, try reading our WHA pamphlet.

Plastics and infant feeding

January 2006 Women's Health Update

We protect our babies to give them the best start in life. We have long known that the healthiest baby food is breast milk, yet at times we may need to use bottles to store expressed milk or use plastic toys and containers.

There is growing concern about the potential health effects of plastics on babies and young children. Plastic products and packaging are everywhere; unfortunately many plastics contain harmful chemicals. Recently the US Public Interest Research Group released a report which found wide spread use of toxic chemicals in nine popular baby products. A 2004 study showed that bispheno-A, a compound found in many types of baby bottles, has the potential to cause structural abnormalities in human cells and inhibits their growth. Early childhood exposure to toxics can cause neurological effects and behavioral disorders....Read More (pdf)

Aropax and pregnancy

January 2006 Women's Health Update

In September 2005 GlascoSmithKlien issued a warning for their popular anti-depressant Aropax. A new study found increased risk of birth defects for pregnant women taking Aropax (also known as paroxetine, or Paxil in the US) in their first trimester.

GlascoSmithKlien (GSK) sponsored a retrospective study of 3,581 pregnant women in the US. The research compared the rate of birth defects among pregnant women who took the antidepressant in their first trimester with the rate of birth defects in the general population. They found a 1% increase in the rate of birth defects (most frequently heart defects) in the children of women taking paroxetine. "Paroxetine is the most popular type of antidepressant in New Zealand taken by more than 54,000n people". Read More (pdf)

HIV screening in Pregnancy

January 2004 Women's Health Update

When pregnant, almost all women have contact with health professionals. Most women are well and deliver healthy babies. However, between one and four per 10,000 pregnant women is HIV positive and some will not know. The National Health Committee is currently considering proposals to offer HIV screening to all pregnant women. We asked Jo Fitzpatrick about the issues for women... Read More

Giving birth between two worlds - Goan women in NZ

April 2003 Women's Health Update

Ruth De Souza recently completed a masters degree on migration, mental health and motherhood. Ruth, born in East Africa of Goan Indian origin, works in NZ as a mental health nurse and nursing educator. Camille Guy asked her about the research and the birthing experiences of recently immigrated Goan women....While working in maternal mental health and in post-natal wards in Auckland, Ruth De Souza became curious about why mental health services are under-utilised by migrant women. White, articulate and affluent women certainly used them. So how were migrant women, deprived of their traditional safety nets, coping?... Read More

Choosing a designer delivery - The rising rate of elective caesareans

December 2002 Women's Health Watch

What was once an emergency procedure, to be undertaken only when mother or baby is in danger, is now promoted as enhancing women's control over childbirth and a choice. But is the story really that simple? Camille Guy looks at some of the issues involved.

In recent months a female obstetrician has spoken on national television and to Little Treasures magazine personally endorsing elective CS (CS) delivery as a choice for women giving birth. She and a handful of older white middle class New Zealand women speak glowingly of what was called their 'social caesarians' it is advertising money could not buy. With role models like these, small wonder that our caesarian section rate (CSR) has virtually doubled over the past 15 years. Do improved procedures mean that women need no longer labour to give birth? Does women centred childbirth mean that we can now elect to deliver by CS, without any clear medical indications? Is this what we mean by choice? And is CS the safe way to deliver your baby?... Read More

Study confirms that the health of sole mothers is poor compared to other New Zealand women

March 2002 Women's Health Watch

Recent research from Auckland University throws light on the health of women on the DPB. Cordelia Lockett reports.

Researcher Karen McMillan was not surprised by the finding of the study that sole mothers have poor physical and emotional health.'Our research mirrors what the international literature is saying. What was surprising, however, was the extent of the disparity. .... Read More

Celebrating Whaea

October 2002 Women's Health Update

A new Maori language CD speaks about the powerful experiences of birth, breastfeeding and motherhood. Camille Guy talked to its creator, Ariana Tikao.

For Christchurch singer and composer, Ariana Tikao, the experiences of childbirth and motherhood were powerful and life-changing. "When I became pregnant I realized that there is a lot of expectation that life doesn't change much," says Ariana. "There is not much appreciation that motherhood is a job."

For Ariana and her partner Ross, motherhood deserved more honouring than that. When Ariana was first hapu (pregnant), they began to read and research Maori approaches to pregnancy and birth. As part of Maori kaupapa about birth, Ross learned an oriori or traditional chant, spoken at the moment of birth. Oriori (lullaby) refers to the genre of waiata for birth... Read More

Obstetric intervention rates and ethnicity

September 2002 Women's Health Watch

Maori and Pacific women who gave birth at National Women's Hospital in Auckland from 1992 to 1999 had much lower rates of induction, prelabour caesarean section and operative vaginal delivery than other women, according to hospital researchers... Read More

Unwanted pregnancies in New Zealand

September 2002 Women's Health Watch

Six out of ten pregnancies in a New Zealand cohort of women under 25 were unwanted, according to interviews from 1998. The cohort was made up of 966 participants in the Dunedin Multi-disciplinary Health and Development Study, born between April 1972 and March 1973. The results of the interviews were analysed by researchers at the Otago School of Medicine.... Read More

No consensus but much discussion on routine HIV testing in pregnancy

September 2002 Women's Health Watch

A recent WHA seminar showed the lack of agreement on routine HIV testing in pregnancy among health practitioners, consumer groups and organisations working with high-prevalence communities, but it was a good opportunity to hear different viewpoints

The July seminar was the first public event to bring together all the interested groups since it became known in 2001 that National Women's Hospital was considering the introduction of routine HIV testing.
Participants raised many concerns about the issue in workshops, including issues around informed consent, the lack of cost/benefit analysis of routine screening, the relevative priority of the issue compared with other health needs, and resource constraints, especially time and training resources for health professionals in maternity care. Speakers did agree that the current policy of offering HIV testing to pregnant women at high or uncertain risk was not being implemented.... Read More

Older fathers put offspring at risk

June 2001 Women's Health Watch

Children fathered by older men may run a much high risk of developing schizophrenia. Researchers say this finding provides evidence that men, like women, have a biological clock when it comes to having children. Researchers at Columbia Uni-versity College of Physicians and Surgeons, New York University School of Medicine and Israel's Ministry of Health say a child's risk of developing schizophrenia increases dramatically and steadily as the age of the father rises. After reviewing the records of more than 87,000 people born in Jerusalem they found men aged 50 years or older ran three times the risk of fathers under 25.

Study leader Dr Dolores Malspina says the findings augment a growing body of evidence of an increased likelihood of health problems for children of older men. The study, published in Archives of General Psychiatry says that as men age, sperm cells can accumulate mutations that can be passed on to offspring.

Other conditions linked to increasing paternal age include prostate cancer, nervous system cancer, the most common type of dwarfism, neurofibromatosis and defects of the eyes, bones, heart and blood vessels.

However the researchers advise men to keep the study in perspective. They say even though children of older fathers have a greater risk of disease, most children are fine.
Ref: Weekend Herald 2001; April 14-15

The future of National Women's Hospital

July 2001 Women's Health Watch, Republished from Dialogue article, New Zealand Herald

Sandra Coney discusses the controversial plan to move NWH into the Auckland Hospital, with some fragments left behind at Greenlane.

Five years ago Auckland women's groups were reassured that a plan to close the existing National Women's Hospital and relocate services into a large new general hospital in Grafton would not result in any loss of identity and reduction in service. They were told that in fact it would better. But as the Health Services Delivery Plan which mandates the shift reaches its final stages, it is clear that an inexorable process of compromise has led to the hospital being carved up, with services located in different parts of the city... Read More

The perils of being a midwife

June 2000 Women's Health Watch

Jenny McDonald reports on Risk versus Choice - an interactive medico-legal workshop for midwives.

On 12 July 2000 at the Oakridge Center at Unitec Women's Health Action hosted a very lively, often funny, sometimes emotionally painful forum on the medico-legal issues foremost in every midwife's mind. It was well attended by 80 midwives - in fact a sellout, which is a statement in itself when most midwifery seminars struggle for minimum numbers. There were also a few consumer groups represented, one of which was the Post-traumatic Birth Support Group. The Health and Disability Commissioner, Ron Paterson, was noticeable present, partly because he was one of two males present in a room of women - hard to go unnoticed really.... Read More

Women, pregnancy and varicose veins

June 2000 Women's Health Watch

The development of varicose veins is clearly associated with pregnancy, according to an article in the Lancet. Although varicose veins do not cause serious or life-threatening disease, they are one of the commonest reasons for referrals to surgical clinics in the United Kingdom. The Lancet reports that varicose veins occur more in women who have had children but it is not clear whether pregnancy merely accelerates the development of varicose veins in susceptible women. The authors say most varicose veins that develop during pregnancy will probably disappear. Wearing graduated compression stockings may help but any other treatments should be deferred.

Ref: Lancet 2000; 355: 1117-18

More rehospitalitalisations with caesarean deliveries and assisted births

June 2000 Women's Health Watch

Women who have caesareans or assisted vaginal deliveries are much more likely to be rehospitalised with infections. The research, just published in JAMA, was carried out because there is very little information about how delivery methods affect women's health. The researchers found women who had a caesarean delivery were twice as likely to be rehospitalised compared to women who had a normal vaginal delivery. A smaller but significant number of women who had assisted vaginal delivery were rehospitalisated with postpartum hemorrhage, obstetrical surgical wound complications and pelvic injury.

In the United States about 21 percent of women undergo caesareans and about 14 percent of women have assisted vaginal (forceps or vacuum extraction) deliveries. The research team is calling for strategies to reduce the risks of health problems, including the provision of trained social support in labour, a larger role for midwives, lower dose epidurals and second-opinion requirements on the need for caesarean deliveries. Other proposals involve changes in clinical management such as limiting the number of vaginal examinations during labour and use of assisted spontaneous placenta removal. Ref: JAMA 2000; 283: 2411-16

Parental consent for treatment and staff training in neonatal intensive care units

October 1999

In July 1999 an Inquiry Team appointed by the Minister of Health reported on their investigations into the provision of chest physiotherapy provided to pre-term babies at National Women's Hospital. The investigation looked at the circumstances around the deaths and brain damage of a number of very small premature babies who received chest physiotherapy as a part of their care in the neonatal intensive care unit. The Inquiry Team was headed by Helen Cull QC.

Although the Cull Report has generated ongoing discussion and criticism, it identified a number of issues to be addressed. Two of the issues related specifically to informed consent matters and are described in the report as lesson Four and lesson Five.... Read More

Ukaipo - Maori women and childbirth

October 1999 Women's Health Update

A new resource about Maori experiences of childbirth has been received with great acclaim by Maori and medical communities throughout the country

Ukaipo - Maori Women and Childbirth is a book about Maori spiritual concepts associated with childbirth. In their own words four generations of Maori women tell their stories about conception, pregnancy, antenatal services, birth, complications, postnatal services and the importance of whanau.... Read More

Maternity Care - A decade of change

December 1999 Women's Health Watch

Brenda Hinton reports on the state of New Zealand's maternity services

New Zealand's Maternity Services have undergone numerous changes since the passing of the Nurses Amendment Act in September 1990. Prior to this legislative change, only medical practitioners could take responsibility for the care of women and their babies during the childbearing cycle. Midwives had to work under the 'supervision' of a medical practitioner and, apart from a small number of domiciliary midwives who provided care to women in their own homes, most provided labour, birth and postnatal care in hospitals. Since the passing of the act, an increasing number of midwives have moved out of hospital employment and into community- based midwifery practice.... Read More

Pesticides decrease fertility

September 1999 Women's Health Watch

Exposure to pesticides affects male fertility, according to a Dutch study. Researchers investigated 836 couples seeking in-vitro fertilisation to determine how exposure to pesticides affected the man's ability to conceive. They found fertilisation rates dropped significantly when male partners are occupationally exposed to pesticides.
Ref: Lancet, 1999; 354: 9177

Best spacing for babies

April 1999 Women's Health Watch

The optimal space between babies from the baby's health point of view is 18 to 23 months, say American researchers.

The researchers from the Michigan Department of Community Health looked at the interval between pregnancies and such outcome as low birth weight, preterm birth and small for gestational size. They carried out the research by studying birth certificates for 173,205 babies born to mothers in Utah from 1989 to 1996. They found that all three adverse outcomes were 30 to 40% higher among infants conceived less than six months after a birth than among those conceived 18 to 23 months after a birth. For infants conceived after an interval of 120 months (ten years), the risk of these outcomes was doubled. The researchers found that women with either a short interval of a long interval between pregnancies shared a high-risk demographic profile.

Women who conceived after extreme intervals - either long or short - were more likely than women at the intermediate interval to be at the extreme of reproductive age, to be unmarried, to smoke and to have fewer years of education.
Ref: N Eng J M 1999; 340: 589-94

Maternity services under the spotlight

April 1999 Women's Health Update

Women are the first group to be targeted for their views on New Zealand's troubled maternity service following the announcement of a Maternity Services Review.

The new maternity scheme has been contentious since it was introduced in 1996. Women must now choose a lead maternity carer who is responsible for managing a woman's care and her 'pregnancy budget' throughout pregnancy, labour and postnatal budget. Lead maternity carers can be general practitioners, midwives or specialists.... Read More

Caesarean sections are women doing the choosing?

September 1998 Women's Health Watch

The number of women giving birth by caesarian section at National Women's Hospital continues to rise with suggestions some of the increase is due to women seeking elective caesareans. The caesarean rate now stands at just over 22%, a rise of about five percent since 1992.... Read More

Deaths following sex soon after childbirth

December 1998 Women's Health Watch

The deaths of two young British women have drawn attention to the risks of fatal complications as a result of having sex too soon after childbirth. In a recent issue of The Postgraduate Medical Journal, doctors describe two young women who died of air embolisms (air bubbles in the major arteries to the heart and brain) while having sex within eight days of giving birth.

Lead author and pathologist at Bradford Hospital's National Health Service Trust in Bradford, Dr Philip Batman says women are more vulnerable to air embolisms soon after childbirth than at other times. Air forced into the uterus during sex can enter the bloodstream through blood vessels torn during delivery.

Doctors used to recommend women avoid sex for six weeks after childbirth but the rules have been relaxed in recent years, says the chief of the high-risk obstetrics group at the Yale School of Medicine Dr Joshua Copel. 'Six weeks is an arbitrary time frame and many women probably disregard our advice anyway.'The American College of Obstetricians and Gynaecologists recommends women can usually have sex in about three or four weeks or when they feel comfortable, a sign the uterus has healed. Obstetricians say it also takes this long for incisions outside the vagina or from a Caesarean section to heal.

Earlier research found pregnant women are also at increased risk because air can become trapped between the sac containing the foetus and the uterus wall, then escape through blood vessels on the surface of the uterus. However most doctors sanction intercourse during pregnancy because the risk is so slim, according to the American College.
Ref: New York Times on the Web, 6 October 1998

Abortion and ectopic pregnancy

April 1998 Women's Health Watch

French researchers recently published research which suggests that women who have had induced abortions have a greater rate of subsequent ectopic pregnancies. The case control studied compared 570 women with ectopic pregnancies with 1385 controls who delivered babies at the same hospital.... Read More

Infertility treatment and small infants

November 1997 Women's Health Watch

Fertility therapies raise a mother's risk of having a very low birth weight baby - weighing under 1500 grams or 3.3 pounds - say researchers from Boston. The risk is only partly explained by the fact that multiple pregnancies are more common in women who have had fertility treatment.

The researchers sought to determine if fertility treatments increased the risk of very low birth weight babies, as this is linked to half of all neonatal deaths occurring in the USA each year. They mailed catenaries to mothers of nearly IO,OOO of such babies born during 1988 asking about any history of subfertility and whether they had treatment. The respondents were divided into two groups: women who had had treatment, and those who had been 'concerned' with subfertility, but who had never had treatment.

It was found that the rate of very low birth weight babies was 6.8% in the 'concerned' group, but 11.4% in the treatment group. The national rate of very low birth weight babies is only 1.2%. These results suggest that it is something about being subfertile that leads to the low birth weight baby, rather than the infertility treatment, although black women faced especially high risks of very low birth weight babies after infertility treatment. Black mothers who had infertility treatment had a much greater rate of prematurity.

Once a caesarean, always a caesarean, no longer valid

April 1997 Women's Health Watch

Trial of labour is acceptable after an initial caesarean section, according to a recent study in the New England Journal of Medicine. The study compared two groups: the first had a trial of labour, the second elective caesarean section. Complications were uncommon in both groups, but major complications (rupture of the uterus, hysterectomy) occurred in 1.3% and were twice as common in the trial of labour group. The incidence of hysterectomy was 0.2% in both groups, suggesting that other factors beside the trial of labour influenced the decision to remove the uterus. Eight women in the trial of labour group who had uterine ruptures did not have hysterectomies.

Perinatal deaths were similar but slightly higher in the trial of labour group (9 vs 5 per 1000 live births). Complications were highest in women undergoing elective caesareans who had gone through at least three prior deliveries.

The paper makes the obvious point that avoiding caesareans sections in the first place would be the greatest help in avoiding complications in subsequent pregnancies. Despite the concern caesarean sections rates continue to be high in many hospitals, including New Zealand maternity facilities.
Ref: NEJM 1996; 335: 735-6

Resources

 

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