FDA warns of harmful nipple cream
WASHINGTON (AP) — The Food and Drug Administration on Friday warned women not to use or purchase Mommy’s Bliss Nipple Cream, marketed by MOM Enterprises Inc. of San Rafael, California.
The cream, promoted to nursing mothers to help soothe dry or cracked nipples, contains ingredients that may cause respiratory distress, vomiting and diarrhea in infants, the agency said.
The potentially harmful ingredients in the cream are chlorphenesin and phenoxyethanol.
“FDA is particularly concerned that nursing infants are being unwittingly exposed by their mothers to this product with dangerous side effects,” said Janet Woodcock, director of the Center for Drug Evaluation and Research. “Additionally, these two ingredients may interact with one another to further compound and increase the risk of respiratory depression in nursing infants.”
The company has stopped selling the cream. The FDA said consumers should stop using the cream and consult a doctor if they experience problems or believe that their infant may have experienced problems due to the product.
Mothers whose children may have suffered adverse effects because of this product should contact the FDA’s MedWatch at 800-332-1088.
Pennsylvania: Midwife for Amish wins appeal
From PennLive.com:
A state court has reversed state-imposed fines and penalties against a Lancaster-area midwife who has delivered thousands of babies for the Amish.
A panel of Commonwealth Court judges ruled the state medical board was wrong to fine and order Diane Goslin to stop delivering babies.
But rather than state that Goslin is free to deliver babies, the written decision concludes Goslin hadn’t been given adequate opportunity to defend herself against charges of practicing midwifery without a license.
Goslin, 50, said today her interpretation of the ruling is that it allows her to resume deliveries. The state board of medicine couldn’t immediately be reached for comment.
The board took action against Goslin in early 2007, eventually fining her $11,000. The situation resulted in several occasions where hundreds of Amish men, women and children came to Harrisburg to rally in support of Goslin.
The Amish argue deliveries performed by so-called “lay midwives” are more natural, safer and in keeping with their culture.
Pennsylvania requires nurse midwives to have a state license. Goslin is certified by the North American Registry of Midwives, which isn’t recognized in Pennsylvania.
From Philly.com:
Pa. court allows unlicensed midwife to resume practice
HARRISBURG, Pa. - A Pennsylvania court has overturned an $11,000 fine against an unlicensed midwife who serves Amish and Mennonite families and says she can resume practicing.
Diane Goslin of Lancaster County says she’s pleased with Friday’s 5-2 Commonwealth Court ruling.
The state Board of Medicine fined Goslin in September for attending an Amish home birth and ordered her to stop practicing immediately. The board argued that Goslin was putting women and their babies at risk by practicing without a license.
The court ruled that the medical board erred partly because it incorrectly concluded that Goslin was practicing medicine and surgery as part of her midwife duties.
An attorney for the medical board won’t say whether the board will appeal to the state Supreme Court.
WebMD: C-Section Tied to Childhood Asthma?
From WebMD: Children Born Via Cesarean Section May Be More Likely to Develop Asthma, Allergies
Cesarean section rather than vaginal deliveries may raise the risk of childhood asthma and allergies by interfering with the child’s immune system development, according to a new study.
Researchers say previous studies have suggested that babies born via C-section are more likely to develop childhood asthma and allergies, but the reasons are unclear.
This study suggests that babies born via C-section have impaired immune cell function because of suppression of regulatory T cells, which regulate the development and function of the immune system.
“This finding is exciting because it suggests that the mode of delivery may be an important factor influencing immune system development,” researcher Ngoc Ly, MD, MPH, assistant professor of pediatrics at the University of California, San Francisco, says in a news release.
C-Section & Asthma Link Explained
In the study, presented at the American Thoracic Society’s 2008 Conference in Toronto, researchers compared T cell suppression in a group of inner city newborns with a family history of asthma that put them at increased risk for childhood asthma.
Fifty of the children were born via C-section, and 68 were born vaginally. T cell suppression was measured by analyzing the child’s cord blood.
The results showed that children born by cesarean section had a reduction in T cell suppression function compared with the other children. For example, the average T cell suppression index was 0.78 for children born via C-section and 1.11 for those born vaginally.
Ly suggests that the stress and process of labor itself or exposure to specific microbes through the birth canal in vaginal rather than C-section delivery may influence neonatal immune responses.
“These findings are preliminary and further work is needed to explore potential mechanisms for the association between mode of delivery and neonatal immune responses,” Ly says. But researchers say this study provides a possible biological explanation for previous reports of the association between cesarean section and asthma.
For more health and baby news, follow the link above to WebMD.
American College Of Nurse-Midwives Publishes Clinical Guidelines For Oral Nutrition During Labor
From Medical News Today:
The newest Clinical Bulletin from the American College of Nurse-Midwives reviews evidence relevant to providing oral nutrition to women in labor and concludes that drinking and eating during labor can provide women with the energy they need and should not be routinely restricted.
Currently, most U.S. hospitals have policies that restrict women’s oral intake during labor. The debate over these policies is focused on the concern about possible detrimental effects of fasting on the labor process versus the risk of aspiration if general anesthesia is administered following oral intake. This Clinical Bulletin reviews energy utilization during labor, the effects of fasting during labor, recent randomized controlled trials that have evaluated the effects of food and fluids in labor, the rationale used to deny laboring women food and fluids, and the risks of aspiration if general anesthesia is administered.
“It is important that we don’t unnecessarily restrict a women’s ability to eat or drink during labor,” said Deborah Anderson, CNM, Associate Clinical Professor from the University of California, San Francisco. “In addition to providing hydration, nutrition, and comfort, self-regulating intake decreases a women’s stress level and provides her with a feeling of control.”
Considerations for the determination of appropriate nutrition in labor must take into account the health status of the woman, the risk of surgical intervention, and the system in which the women gives birth. Additional recommendations from the Clinical Bulletin include:
- During antepartum care, discuss with women the very small but potentially serious risk of aspiration if general anesthesia is used.
- Promote self-determination by healthy women experiencing normal labors concerning oral intake.
- Evaluate all women who are at increased risk for operative birth for factors that could result in difficult intubation or aspiration.
- Continue to participate in research to confirm the safety of ad lib nutrition for normal laboring women.
For additional information about ACNM not relevant to this article, follow the link above to the full text.
IDAHO: Meet the Midwife
From the Coeur d’Alene Press Newspaper (follow the link for graphics):
Many moms-to-be turning to alternative childbirth method
Kelly Routte labored with her child for three days before she finally relented and arrived at the hospital, ready for a cesarean.
She sat in the birthing tub, a particularly popular choice at Dayspring Midwifery Services in Hayden. She walked around Costco, pausing every 10 minutes or so when contractions hit.
Then midwife Inga Arts made the executive decision to move to the hospital.
“She knows that she tried,” Arts said, “so there’s no regret.”
Elongated births likely caused death in pre-modern medicine days, Arts said.
“I would have preferred to have the baby here,” Routte said last Wednesday, cradling a blanket-swathed Cody Drake.
But Inga and her midwife-in-training, Becky Orchard, accompanied Routte the entire time.
“You feel more like livestock in the hospital than a person,” Routte said. But, “the outcome was awesome to have a baby that’s healthy and happy. That’s all that counts.”
After two days recovering in the hospital, Routte returned to Dayspring, where she sat in an herbal bath to soothe stretched and sore muscles. Routte said her recovery would have been two hours had she birthed at Dayspring.
Births like Routte’s underscore the conflict between modern medicine and midwives.
Though the two can complement one another, expecting mothers must weigh philosophical differences regarding medicine and modes of delivery.
According to Arts, hospital babies are born more lethargic. Doctors often rush to cesareans, driven by fear of malpractice suits, she said.
“It’s a life event, not a medical emergency,” Arts said. “It’s painful but it’s pain that has a good outcome. A lot of pain is wrapped in fear.”
According to Dr. David Compton, an obstetrician with Coeur d’Alene OB/GYN, cesareans were more prevalent five years ago than they are today.
But, the “pendulum” of obstetric thought now errs more on the side of moderation, Compton said, though he acknowledged that fear of litigation can impel the surgery.
“We could have a lower c-section rate at the cost of higher litigation and potentially an injured baby or two,” Compton said. “One factor is society’s expectation of perfection … We want perfection in babies, but we also want to not have c-sections.”
The number of women choosing midwives over modern medicine is growing.
Arts said her clientele doubled from 2004 to 2005, from 43 to 80. This year, she’ll likely bring 100 babies into the world.
Dayspring occupies a sprawling two-story Victorian style home.
A big, velvety red couch offers seating in the sage green walled living room. One birthing tub sits downstairs in a white bathroom.
The second, larger one sits upstairs in the birthing suite, where there is also a big bed and a closet with emergency equipment.
At Dayspring, Arts likes to say, there are no shift changes. She builds an emotional connection with her clients, guiding them through delivery, and often beyond. One client made Arts her child’s godmother.
James and Clarissa Wilson welcomed Wesley Archer into this world almost seven weeks ago. The couple initially hesitated when contemplating Arts’ services.
What if something went wrong, they wondered.
“It’s non-traditional, but at the same time, it’s traditional because it’s happened for so many thousands of years,” James said. “It’s more natural.”
Arts said she never hesitates to send mom and baby to the hospital if things go wrong.
James said, “we’ve never had any fear about anything.”
About 6 percent of the babies Arts delivers need transportation to the hospital, she said.
The United States counts more infant deaths than Italy, Canada, New Zealand, Israel and Cuba. According to the Central Intelligence Agency’s Factbook, America ranks 180 out of 222 nations for infant mortality.
Midwife proponents say the medicine used during childbirth affects those rates.
Compton said poverty and inadequate medical care play a large part in determining which babies live and which babies die.
In countries with socialized medical care, lower-income women receive care similar to their economically advantaged counterparts. Obesity also contributes to infant mortality, an epidemic which has become more prevalent in the last two decades, Compton said.
There are two kinds of midwives, certified nurse midwives and certified midwives.
“Certified nurse midwives are a wonderful asset,” Compton said. “In many ways they are better at delivering babies than obstetricians.”
The nurse midwives complete master’s degree studies, and in the words of Compton, “are very experienced, very educated people.”
“The certified midwives are dangerous to say the least. I don’t believe that the majority of patients who are seeing the certified midwives understand what they are getting into.”
Idaho doesn’t license midwives, and passing legislation to end that becomes another battleground between doctors and midwives.
Last legislative season, a bill was introduced proposing voluntary licensure. For Compton, “it makes absolutely no sense to have voluntary licensure. Either you have licensure or you don’t.”
If a midwife were to lose her license under a voluntary system, Compton said it would make no difference because she could still practice.
Arts said those expecting should carefully inquire where a midwife received her education and certification. She apprenticed in Alaska and took an eight-hour test to become certified.
Near the Mexican border, Arts said some ladies watch 100 births, then call themselves midwives. “That’s what I call a microwave midwife and that’s scary,” Arts said.
Experience is the best teacher. “It never goes textbook,” Arts said.
“I know that on a daily basis I stick my neck out for people,” she said. Arts doesn’t carry insurance, and said that’s something her clients need to consider.
“I can’t live in that fear. If I lived in the fear of being sued, I couldn’t do this.”
Podcasts
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Podcast 1: Midwives
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Podcast 3: Thinking About Home Birth
Podcast 4: The Birth Kit
Podcast 5: Interview with Ricki Lake